Inspection on 12/07/05 for Greathouse Home - Leonard Cheshire Disability

This inspection was carried out on 12th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greathouse Home - Leonard... 03/09/07

Greathouse Home - Leonard... 13/06/06

Greathouse Home - Leonard... 04/01/06

Greathouse Home - Leonard... 24/02/05

Greathouse Home - Leonard... 22/09/04

Greathouse Home - Leonard... 12/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Greathouse Cheshire Home Kington Langley Chippenham Wiltshire SN15 5NA Lead Inspector Tim Goadby Unannounced 12th July 2005 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Greathouse Cheshire Home Address Kington Langley Chippenham Wiltshire SN15 5NA 01249 750235 01249 758826 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Leonard Cheshire Mrs Frances Judith Ashby Care Home with Nursing 25 Category(ies) of PD Physical Disability (25) registration, with number PD(E) Physical Disability - over 65 of places Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users who may be accommodated in the home at any one time is 25. 2. The maximum number of service users in receipt of nusing care who may be accommodated in the home at any one time is 21. 3. The maximum number of service users in receipt of personal care who may be accommodated in the home at any one time is 6. Date of last inspection 22nd September 2004 Brief Description of the Service: Greathouse provides accommodation, and care with nursing, for up to 25 adults with physical impairments. The homes care planning and review systems show whether an individual is in receipt of nursing or personal care. One room is used for short-term care. Some people also attend for day care. The service is operated by the voluntary Leonard Cheshire organisation. Greathouse is in Kington Langley, on the outskirts of Chippenham, which offers a range of amenities. The village is also close to major road and rail links. The building has been used as a care home for around 50 years. A significant ground floor extension was added in the 1970s. There is a large garden, and views over neighbouring countryside. Parking is available for visitors. Service users can access the ground and first floors. There is a lift between these. All residents have single bedrooms. The room used for short-term care has an en-suite facility. There are 4 bathrooms for general use, and a number of additional toilets. The home has been equipped with a range of equipment and adaptations, designed to suit the needs of its physically impaired users. Due to the age of the property, and its location, there are future plans for reprovision of this service. But there is no firm information yet about when or how this will happen. Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place in July 2005. Since the previous inspection, in February/March 2005, the CSCI had been contacted by 2 complainants raising concerns about Greathouse. These had been investigated by Leonard Cheshire Homes, and the findings and investigation documents were supplied to the Commission at its request. Relevant information arising from those investigations is incorporated into this report. On the day of the inspection visit, a total of 6 hours were spent in the home. The following inspection methods have been used in the production of this report: direct and indirect observation; sampling of records; sampling activities; discussions with service users, staff and management; tour of the premises. What the service does well: What has improved since the last inspection? Findings of 2 detailed complaints investigations conducted by Leonard Cheshire Homes had generated action plans to address the recommendations arising. It Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 6 was clear that the organisation had taken a thorough approach to addressing the concerns raised. A number of elements had been upheld, at least in part. The service was demonstrating openness and a willingness to change by sharing the findings where appropriate, and taking on the challenges of the issues identified. The staff situation was becoming more stable, with reduced turnover. Some care vacancies remained, but the use of agency staff was becoming less frequent. A new chef had also been appointed, and this already appeared to be bringing improvements to the provision of a consistent standard of meals. A change in night cover, from 2 waking and 1 sleeping, to all 3 being awake, took effect in June 2005. This was bringing benefits in a greater flexibility of support for service users during the evening period. Social outings at this time of day were now more possible. Safety concerns about the care needs of people at what can also be a busy time had been allayed. What they could do better: 1 requirement was outstanding from the previous inspection, for the development of a quality assurance system. The home has all the various elements in place, but has not yet combined these into an effective whole. The key piece of evidence needed to demonstrate compliance is the production of a service development plan. A number of action plans are in place, in response to identified deficits. But there should be an overall summary of key themes, with some targets that are also about building on existing strengths. Medication practices were found to be deficient in various aspects of administration and recording at this unannounced visit. Records should usually only be signed to denote that medicines have actually been taken. Judgements about whether to give ‘as required’ medicines, and at what dose, need to be based on the expressed wish of the service user, or other clear criteria. Information about known drug allergies should be shown prominently on administration records. The home’s alarm call system is outdated, and does not provide a safe means of summoning assistance in emergency situations. The organisation’s own recent complaints investigations have highlighted the need to address this issue. Quotes are being obtained. The change needs to be implemented as soon as possible, to ensure the safety and welfare of service users. Please contact the provider for advice of actions taken in response to this Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Service users have their needs met by the home. EVIDENCE: Greathouse has a range of specialist services in place to meet the needs of its user group. In particular, there are many adaptations and equipment designed for people with physical impairments. These enable easier access around the building, assist with moving and transferring people, and offer means of communication, or control of the environment. Nursing and care staff are supported by other colleagues who can offer relevant input. This includes the home’s own physiotherapist. When the home is not able to support someone’s needs or wishes, systems are in place to work with the individual on looking for suitable alternatives. However, the lack of available provision can make this a lengthy process. This may cause frustration for the individuals concerned. Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 & 8 Service users can make choices and decisions in their daily lives, and participate in discussions about wider issues. EVIDENCE: Service users’ wishes are identified through conversation with them. Surveys are also carried out, to get their views on various topics. People participate in their own care reviews. These meetings provide an opportunity to consider all aspects of the service provided at Greathouse, and also any other goals people may have in their lives. Monthly meetings are held with service users about the day to day running of the home. This enables them to put forward ideas or suggestions about all aspects of the service. Minutes of the June 2005 meeting were on display in the dining room. They showed that a wide range of topics had been discussed. Leonard Cheshire has a Disabled People’s Forum. This gives service users the chance to speak out for themselves, or to access advocacy support to do so on Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 11 their behalf. Some users are also involved in meetings about the proposed reprovision of Greathouse. Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14. 15, 16 & 17 Service users have the opportunity to maintain and develop skills. Service users are provided with a range of activities and opportunities. Service users are able to maintain appropriate relationships with family and friends. Service users are offered a healthy diet, in line with individual needs and preferences. EVIDENCE: Various opportunities are present in the home to promote people’s independence. A first floor kitchen is specially adapted to be suitable for wheelchair users. People with very restricted movement have suitable equipment that assists them to communicate, and operate environmental controls in their own rooms. Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 13 There is a new IT room that has just been opened. An employee has been appointed, working 21 hours a week, to lead on promoting access to these facilities. The aim is to work with as many service users as possible, offering them a range of computing options, based on needs and preferences. Based on general and individual assessments, further developments are planned, to improve the environment and accessibility options. Activities are offered for all service users. This includes up to 6 people who may attend for day care. One member of staff leads on co-ordination of these areas. There are designated activities staff, including volunteers. They are present in the home 6 days a week. There are various activities areas in the home. These are mostly on the first floor. Some activities are also carried out in the ground floor dining room. This encourages other people to take part. Sessions offered are based on people’s hobbies and interests, and include cooking, quizzes and games, film shows, and coffee mornings. Sometimes, outside entertainers are booked to come in. Service users have agreed to contribute a small sum to help subsidise the cost of such events. As well as activities at home, Greathouse can support people to access opportunities elsewhere. The service has a number of vehicles suitable for transporting physically impaired people. Unfortunately, outings can be limited due to availability of staff. Shortages reduce the possibility of staff being able to go out with service users. Times when rota cover is lower in any case, such as the evenings, are particularly difficult. More use of volunteers is hoped to be able to help with this. The recent move to having 3 night staff should also prove beneficial. One of the principles behind the intended reprovision of the service is for its replacement to be in a town location, enabling easier access to community facilities. Progress was being made on providing more opportunities for service users. A group had recently been to the last day of the Glastonbury festival. Some were out on trips to the coast on the day of this inspection. And arrangements were being made for one to attend a late night party and disco at their former home. Service users also have the opportunity to go on holiday, if they wish to do so. Specialist facilities, able to care for the significant physical needs of the group living at Greathouse, may have to be accessed. For those less able to go away, day trips can be arranged. Visitors are welcome at any time. Overnight accommodation can be provided, if required. Service users can receive guests in their own rooms. Or various other quiet areas are available. The home is also seeking to build contacts with families generally, via meetings. Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 14 Issues have arisen previously for the home around supporting service users with relationship issues. Some senior staff have now attended relevant training, and it is planned for more of the team to do so. There is a chapel area in Greathouse itself. There are also regular contacts with the local church. Any rules relating to residence in the home are made clear in the information available. In general the principle is to respect users’ personal choice. There is flexibility in daily routines. Arrangements for food were stabilising after a period of change. A new chef had been appointed, and was covering the majority of days. Recruitment was ongoing for the remaining shifts. In the meantime, these continued to be covered by agency cooks. Menus are drawn up. They are issued a week in advance, enabling users to choose their preferences. There is always a choice of 2 items for the midday and evening meals. Other alternatives can also be provided if wished. Breakfast can be selected from various options. The menus were due to be reviewed again. The topic had been discussed in residents’ meetings, and a comments/suggestions book was also being placed in the dining room, so that more feedback could be given to the chef. The home has a large dining room area on the ground floor. Most people tend to eat here. But they can take meals in their own rooms if they prefer. The kitchen is staffed throughout the majority of the day, and into the early evening. At other times, care staff can access it to make drinks or snacks for people. An adapted kitchen on the first floor also gives the option of some service users preparing their own meals. This area is also used when anyone wishes to have a cooked breakfast. Some service users have special dietary or nutritional requirements. These are provided for appropriately. Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 & 20 Service users receive the personal support they require, and steps are being taken to tailor this more closely to their preferences. Service users are placed at risk by deficits in the home’s practices for the administration and recording of medicines. EVIDENCE: All service users at Greathouse require support with personal care. This generally involves use of equipment such as hoists. Staff receive appropriate training in moving and handling. Carers are usually allocated to work in pairs, and will be assigned to a group of service users on each shift. They will then take the lead on assisting those people with their care needs. Some day care users also receive personal care whilst attending the home. Recent complaint investigations had identified the need to improve documentation about the personal care provided. A new daily sheet was now in use for this. Overall, the home is also working on providing more flexibility in this area, and removing any unnecessary elements of routine. Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 16 Systems for medication were checked. Storage arrangements were seen to be appropriate. But deficits were identified in both administration and recording. The record chart was signed before the person concerned had been observed to actually take the medication, which is what it should denote. Some drugs prescribed to be given ‘as required’ for pain were also administered, with no apparent check as to whether the person wished to take them. When questioned, the nurse involved acknowledged that an assumption had been made in one of these cases. Similarly, where the prescription allowed for 2 possible doses, the assumption had been made to give the higher one. The record did not make clear which dose had been given. A recent complaint investigation by Leonard Cheshire Homes resulted in the recommendation that information about any known drug allergies should be prominently shown on medication administration records. This was not in place at this inspection, including for the person who had been the subject of the complaint. Administration records are generally well set out, and include a clear front sheet, with a photo of the service user. Key information such as known allergies could usefully be appended here. Qualified nursing staff are responsible for administering medication. Training is also to be provided for care staff, with the aim that they will then be able to escort and assist during this task. Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 Service users are protected by robust procedures for the investigation of complaints. Systems are in place for the protection of service users from abuse, including the appropriate involvement of other agencies. EVIDENCE: Suitable complaints procedures are in place. Information about these is readily available. The organisation has its own processes for investigating complaints. Other agencies may also be involved, where appropriate. The home has notified the CSCI about issues arising, where these have met the relevant criteria. Leonard Cheshire Homes conducted 2 lengthy complaint investigations over the first half of 2005. The CSCI had also been contacted directly by the complainants in each case. The Commission asked to be kept informed of the findings and conclusions of the organisation’s own investigations. Both processes were completed shortly before this inspection. The Commission considered that the complaints had been fully and appropriately investigated by the provider. Detailed investigations had been performed, including interviews of all relevant persons. The conclusions reached in respect of each complaint element appeared reasonable, based on the evidence gathered. The investigator also gave proper consideration to other issues of concern that arose during the process. A number of complaints were upheld, at least in part. Appropriate actions have been proposed to Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 18 address the issues arising. Some of these have already been implemented. Action plans are in place to address the remainder. The Commission has recommended that the monthly visits and reports that the organisation is required to carry out for Greathouse should specifically consider progress on the recommendations arising from the complaint investigations. This will help to demonstrate that all necessary actions are being taken. These reports are also required to be copied to the Commission, which will therefore be able to monitor progress on the action plans. Any failure to take the identified actions within suitable timescales will be addressed with Leonard Cheshire Homes at the appropriate time. There are also appropriate policies and procedures in place relating to abuse and protection. The service is aware of local multi-agency adult protection processes, and has accessed these when required. The majority of staff have attended training on relevant topics. Abuse and protection form one of the key areas covered with all new employees during their induction. Over a long period, the home has continued to experience occasional problems with money or personal belongings being reported missing. To date, investigations have always proved inconclusive. However, all relevant agencies have been notified on each occasion, including the CSCI, and the Police. In addition, all service users and staff have been reminded of the need to exercise caution in this area. Money retained by service users themselves is held at their own risk. Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 29 & 30 Service users’ environment is generally suitable overall, but would benefit from further attention to some areas of décor and cleanliness. The home needs a more effective call alarm system to uphold the safety and welfare of service users. EVIDENCE: Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 20 Greathouse has parts dating from various periods. The original section is quite old. There are some attractive features. The property is listed. Although not an ideal building in some ways, it has been well adapted and maintained to meet the needs of service users. Some areas of décor would benefit from renewal. Some carpets are also looking worn. Generally, smartening up of some areas would improve the overall feel of the home. The building offers accommodation for service users on the ground and first floors. The second floor is used to accommodate overseas volunteers. The home is set in its own substantial grounds. There is a garden that service users can access. Many rooms also offer attractive views of the surrounding countryside. The home has a hotel services team leader, with overall responsibility for premises issues. However, the postholder has been on a secondment elsewhere for most of 2005. Greathouse has had 2 days per week input from another such postholder from a nearby home. There are 2 part-time maintenance staff, who cover 5 days per week between them. In the longer term, the aim is to reprovide the service for users. It is likely that new purpose built accommodation may be provided. This is in keeping with other projects undertaken by Cheshire Homes elsewhere. The requirement to accommodate people in groups of no more than 10, by 1st April 2007, will also be addressed via reprovision. In the meanwhile, it is important to strike the right balance for Greathouse. Significant investment may not be prudent. But it is important to maintain a good standard of accommodation for service users. The home has large grounds. The garden area provides an attractive additional resource. But it can mean a lot of work to try and keep it in order. It is hoped to be able to identify more volunteers who will be willing to assist with this. Specialist adaptations and equipment have been provided throughout the home. These are based on the assessed needs of service users. There are 4 vehicles used by Greathouse. All are suitable for wheelchair users. Staff receive training in the use of the various equipment, such as hoists. This is usually given by the home’s physiotherapist. Recent complaint investigations by Leonard Cheshire Homes had highlighted the need to review the home’s call bell system. The issue was also considered during this inspection. The current arrangement has a number of deficits. There are separate systems for the ground and first floors. When more than 1 call point is lighted, there is no means of knowing which was activated first. And there are only a limited number of boards which display calls. These can take some time for staff to reach, and therefore be able to respond, due to Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 21 Greathouse’s size and layout. Records showed that, in the week before this inspection, there had been a ‘near miss’ due to a very slow response to an emergency call. The home was generally clean and hygienic in all areas seen during this unannounced inspection. The home employs its own housekeeping staff. They undertake NVQ training in relevant topics. A recent environmental health inspection had also taken place, and was reported to have identified no significant concerns. Investment has been put into a number of necessary improvements over the past year, particularly in the kitchen area. There are a number of very high ceilings in some parts of the building, notably the dining room. Some large cobwebs have accumulated in corners of these. Whilst they are at such a height that they pose no real hygiene risk, they are unsightly, and detract from the overall quality of the environment. Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 & 35 Service users are supported by suitable numbers of appropriately trained staff. EVIDENCE: Because the home is registered to provide care with nursing, there is always at least 1 registered nurse on duty. They are supported by 7 carers in the morning, 5 in the afternoon, and 3 at night. Since June 2005, 3 staff work waking shifts at nights. Previously, 1 person had slept in. The change is already felt to have been beneficial in promoting service users’ choice and safety. Residents were positive about it at their most recent meeting. The home also employs a physiotherapist, and people for day care, activities, catering, housekeeping, administration, and maintenance. Some volunteers also assist with certain tasks. Steps are being taken to try and improve communication between the various departments. The heads of each meet together regularly. Other measures proposed include activities staff attending nursing and care team handovers once a week. Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 23 There have been some staffing pressures for a time. But, after a period of high staff turnover, things were becoming more stable. There has been a drive to recruit to vacant posts. This was continuing. Some carers had been recruited from Hungary. This was done at national level by Leonard Cheshire Homes, making use of an agency. Cover has been maintained at the required levels, with some use of agency staff, mainly in respect of care shifts. The qualified nursing team was at full establishment. A new training co-ordinator has recently been appointed, who gives 14 hours per week to this role. The aim is to network with other Leonard Cheshire homes in the region, to promote efficiency in the timing of courses and ensure good attendance levels. Staff were attending a range of training around the time of this inspection. In addition to NVQ studies, this included topics such as medication, challenging behaviour, and relationships and boundaries. A nurse who was a recent appointment confirmed that they had already attended some courses relevant to their new role, and were due to do more shortly. Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39 & 42 Management systems benefit service users by providing effective oversight of the various areas of service delivery. Development plans would benefit service users more if they focused on building on existing strengths, alongside tackling identified deficits. Service users’ health and safety are protected by the systems in place. EVIDENCE: The registered manager for Greathouse is Mrs Fran Ashby, who successfully completed the process of registration earlier in 2005. Fran is currently undertaking additional management qualifications, which she is due to complete in the early part of 2006. Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 25 Another of the home’s nursing staff, Mrs Ann Scully, is designated as the senior team leader. She has overall responsibility for care, and deputises for the manager in her absence. Ann is also undertaking management training. Various other heads of department lead on specific areas. These include day care and activities; hotel services; and volunteer co-ordination. There are weekly care meetings for senior staff to discuss any issues and identify steps to address them. There is no formal quality assurance system in place yet. The necessary separate elements exist, but have not been co-ordinated into a coherent whole. A range of quality audits are carried out. Consultation also takes place with a range of people, by various methods. For instance, residents’ meetings take place every month. Surveys have also been carried out with service users, and with staff. Meetings have been held with families. Action plans have been drawn up in response to some findings from these sources. In particular, a number of recommendations were generated by 2 recent detailed complaints investigations that Leonard Cheshire Homes conducted. Working parties have also been set up to develop ideas for improvements on certain topics, such as menus, and fire safety. From each of these strands, the home needs to generate a development plan, that can focus on strengths as well as deficits, and encompass all aspects of service delivery. Staff receive health and safety training in various topics. There are a range of risk assessments in place. Specific meetings are held to consider health and safety issues, with certain staff designated to lead on key areas. The home has been engaged in work on developing fire safety measures for some time. This is continuing. Service users and staff are becoming more familiar with the new policies and procedures. Notices on display in the home reflect the advice that is now to be followed. Records demonstrated that the necessary tests, practices and instruction were being carried out at the relevant intervals. The only exception was monthly tests of the emergency lighting system, which had been omitted 4 times so far during 2005. The home’s most up to date fire risk assessment, dated 20th May 2005, could not be produced on the day of the inspection. But a copy was faxed to the Commission the following day. Actions identified related to drills and training, and steps were being taken to address these. Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x 3 x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x 3 3 x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x 2 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Greathouse Cheshire Home Score 3 x 2 x Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x 3 x D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 27 Yes Are there any outstanding requirements from the last inspection? 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 YA20 Regulation 13(2); 17(1)(a), Schedule 3(3)(i) 12(1); 13(4)(c); 23(2)(n) Requirement The persons registered must ensure that there is appropriate administration and recording for all medicines administered to service users. The persons registered must provide a call alarm system suitable to the needs of service users, and the layout of the home. COMMENT: The home was already engaged in obtaining quotes for this work. The persons registered must devise and implement an effective quality assurance system. (Timescale of 30/06/05 not met) COMMENT: The various elements required appear to be separately in place. Work is needed to combine these effectively. Timescale for action From 12/07/05. 2. YA29 3. YA39 24 Action plan, with suitable timescales, to be provided not later than 31/08/05. Annual development plan to be completed not later than 30/09/05. A copy to be supplied to the CSCI. Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 28 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. 3. 4. 5. Refer to Standard YA20 YA22 YA24 YA30 YA42 Good Practice Recommendations Service users medication administration records should include prominent information about any known allergies. Monthly reports on the conduct of the home should include consideration of progress on the recommendations from recent complaint investigations. Attention should be paid to areas of decor in need of renewal. Cleaning of high ceiling areas should take place, to enhance the overall appearance of the home. Care should be taken to ensure that all prescribed fire safety checks are carried out and clearly recorded at the set intervals. Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 29 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB National Enquiry Line: 0845 015 0120 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 Greathouse Cheshire Home D51_D01_S15913_Greathouse_V197216_120705_Stage4.doc Version 1.40 Page 30 - 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. 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