Inspection on 13/06/06 for Greathouse Home - Leonard Cheshire Disability

This inspection was carried out on 13th June 2006.

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 1 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... 04/01/06

Greathouse Home - Leonard... 12/07/05

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 Key Unannounced Inspection 13th & 21st June 2006 09:45 Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 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 Greathouse Cheshire Home DS0000015913.V298740.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 Adults 18-65. 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. Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greathouse Cheshire Home Address Kington Langley Chippenham Wiltshire SN15 5NA 01249 750235 01249 758826 greathouse@ic-uk.org www.leonard-cheshire.org.uk Leonard Cheshire 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) Mrs Frances Judith Ashby Care Home 25 Category(ies) of Physical disability (25), Physical disability over registration, with number 65 years of age (25) of places Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users who may be accommodated in the home at any one time is 25. The maximum number of service users in receipt of nursing care who may be accommodated in the home at any one time is 21. The maximum number of service users in receipt of personal care who may be accommodated in the home at any one time is 6. 4th January 2006 Date of last inspection 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 Leonard Cheshire Foundation, which is a voluntary 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 four 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. There is no firm information yet about when or how this will happen. Fees charged vary depending on the assessed needs of the individual service users. At the time of this inspection, they ranged between £687 and £1317 per week, with the average cost being around £900. Information about the service is available on request. It is also displayed in a number of locations around the home. A copy of the most recent CSCI inspection report is kept in the entrance hallway. Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key inspection took place in June 2006. The evidence gathered included pre-inspection information supplied by the service; and eight survey forms completed by service users. An unannounced visit was then carried out. This fieldwork section of the inspection included the following: observation of care practices; sampling of records, with case tracking; discussions with service users, staff and management; sampling a meal; and a tour of the premises. What the service does well: What has improved since the last inspection? Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 6 Seven of the eight requirements from the previous inspection have now been addressed satisfactorily. Service users’ contracts have been updated. This ensures that individuals have all the information they are entitled to, and on which they can base their decision about purchasing a service. Service users can be confident that their abilities, needs and goals are reflected in the service’s documentation. Care planning and risk assessments for service users have been thoroughly reviewed. A new format is now being implemented, which makes it much easier to find key current information about each individual. There is a clear link between initial assessments, and how these then lead to planning, monitoring and reviewing care. The input of service users or their representatives is also shown. Progress has been made by care staff obtaining National Vocational Qualifications (NVQs) in care, towards the 50 target required in care homes standards. This will benefit service users by increasing the number of hours of support which are delivered by staff qualified to a recognised minimum level. Improvements in record keeping have benefited service users by enhancing the effectiveness of the care given to them, and by ensuring that all necessary measures are shown to be carried out. Where bed sides are in use with any individual, suitable measures are in place to ensure their welfare and protection. The home’s risk assessments are supported by suitable evidence of consent from the service users concerned, or by someone representing them. Changes in practice are helping to give service users more opportunities for independence, which helps with individuals’ goals to live in less supported settings. Staff deployment has changed to give more hours to care support rather than cleaning, with the aim being for carers to support service users in doing such tasks. New laundry facilities are also being provided which service users can use. An information technology room has been completely refurbished to make it a more accessible and attractive environment. What they could do better: One requirement remains unmet from the previous inspection. Guidelines need to be developed for any use of medication which is prescribed to be given ‘as required’. Objective definition of the circumstances in which such drugs may be administered will help to ensure that they are given in line with the prescribers’ intentions, upholding the welfare and safety of service users. There also needs to be clarity in records about any review of medication. If suggestions have been made about changes that might benefit individual Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 7 service users, there should be a follow up to show whether or not actions have been taken, and the reasons why. Service users would benefit from the continuing development of the activities programme offered by the home. In particular, people would like more opportunities for outings, and for evening activities. The home is working towards these goals by researching ideas from other projects, reviewing the staff rotas, and considering ways of using the input of volunteers. A review is already underway of the home’s dining room furniture. Ensuring that tables and chairs meet the needs of service users and staff will help to ensure that all mealtime support can be given appropriately. At the moment, staff sometimes need to stand to assist service users, which is not desirable. The home would benefit from staff training on how to support service users with learning disabilities, and those with behavioural needs. At the moment, staff lack knowledge and confidence in these areas. This places both service users and staff at some risk that needs may not be supported safely and effectively. This training need has already been identified by the home, and efforts are being made to identify suitable courses. Fire safety measures should be fully upheld, to ensure the safety of service users and others. Practice is generally good, but weekly checks of the alarm system have not always been noted. All required checks need to be carried out and recorded at the prescribed intervals. 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. Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 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 the following standard(s): 2&5 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Prospective service users have their needs assessed, so that a decision can be agreed about whether or not the home will be able to support them. Service users have updated contracts with the home, so they have all the current information to which they are entitled, and on which to base their decision about purchasing a service. EVIDENCE: Two sets of records for recently admitted service users were sampled. These showed clear evidence of a full pre-admission assessment process. Assessments are carried out by nursing staff. They visit a prospective service user if possible. Information is also obtained from other professionals who have been working with the individual. Service users have contracts with the home. In many cases, care is funded in part by local authorities or health services, and contracting arrangements reflect this. For people who have lived at Greathouse for some time, there have been annual updates to contract information, chiefly reflecting amended fee levels. Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 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 the following standard(s): 6, 7 & 9 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users have their abilities, needs and goals reflected in their individual plans. Service users can make choices and decisions in their daily lives, and about the conduct of the home. Service users are supported to take positive risks and access new opportunities, as part of an independent lifestyle. EVIDENCE: Since the previous inspection, the home has been implementing a new approach to care planning. Four files were sampled at this inspection. They showed that the new system has improved the presentation of key information about service users. The transfer of care plans and other documents into the new format has also given an opportunity for review of each service user’s care. This will need to be kept updated from now on. Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 11 All relevant areas are covered across the process. This includes assessment, planning care, delivering and monitoring it, and review and evaluation. Care plans address physical healthcare needs, and other areas such as communication and activities. There is a range of topics covered at initial assessment. From this, it can be highlighted which parts are relevant to each individual service user. The input of the individual service user or their representative is also shown. Staff find out service users’ wishes by talking with them. Each service user has a named nurse and a keyworker from the care team. Signed consents are in place to show that service users or their representatives have been consulted on major decisions about care, such as what to do when people are seriously ill. Service users 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. Meetings are held with service users every four to six weeks about the day to day running of the home. This enables them to put forward ideas or suggestions about all aspects of the service. The time of day when meetings are held is varied, to try and promote wider attendance and different participants. Normally, between eight and twelve service users are present for these meetings. One service user confirmed that they act as the team leader for these sessions, and as part of this role, they go round finding out what others would like raised. Surveys are also carried out, to get the views of service users and their representatives on various topics. 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 their behalf. Some users are also involved in meetings about the proposed reprovision of Greathouse. Some service users commented about limitations on their choice and decision making, but this was a reflection that it would not be their ideal choice to live in a care home such as Greathouse. The service is working towards promoting living skills for its users, which should help some to achieve their goals of moving to more independent settings. For instance, service users are able to participate in their own cooking and cleaning, and will also soon have access to new laundry facilities. Around the time of this inspection, one service user had recently moved out to a home of their own, and another was about to do so. Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. 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. Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 13 EVIDENCE: Activities are offered for all service users. This includes up to six 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. 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. Larger social gatherings also take place occasionally. A barbeque in the week before this inspection visit, to celebrate Leonard Cheshire week, had been enjoyed by all the service users who mentioned it. 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. Some therapy sessions, such as special massage techniques, are also provided by people coming into the home. One service user had just had their regular appointment with such a therapist, and confirmed how much they enjoy this. There is an IT room which has been completely redecorated and equipped, to make it a welcoming and accessible facility for all service users. One staff member works 21 hours a week to lead on this. The aim is to work with as many service users as possible, offering them a range of computing options, based on needs and preferences. 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. Three service users had gone on an outing on the day of this inspection visit. Service users also have the opportunity to go on holiday, if they wish to do so. Specialist facilities, able to care for the 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. Comments from service users included some concern about limitations on their opportunities due to the location of the home. There was also frustration about the lack of evening activities. The home acknowledges that these issues can be problems. Times when rota cover is lower, such as the evenings, are particularly difficult. The recent Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 14 move to having three night staff should prove beneficial. Service users said that this has been a positive step. More use of volunteers is also planned. The intention is to identify specific activities and outings that individual service users would like to undertake, and find volunteers who can support these. Overall, Greathouse is working hard to promote a range of activities and opportunities, within the constraints created by its location, available resources, and the impairments of service users. 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. 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. Service users also have the opportunity to develop and maintain personal relationships. 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. 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. Menus are drawn up and issued a week in advance, enabling users to choose their preferences. There is always a choice of two items for the midday and evening meals. Other alternatives can also be provided if wished. Breakfast can be selected from various options. The home has a large dining room area on the ground floor. Most service users 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 Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 15 service users. 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 DS0000015913.V298740.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 18, 19 & 20 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are supported to address their personal and health care needs effectively. Service users are protected by most aspects of the home’s policies and procedures for dealing with medicines. People who are prescribed ‘as required’ medication would benefit from more precise guidance on how this is used. EVIDENCE: The health and personal care needs of service users are clearly set out in their individual records. There is regular input from relevant health professionals. The service user group have complex and varied needs, and the range of support accessed reflects this. People’s nursing care needs are assessed both in house, to define the support to be provided at Greathouse; and by external assessors, for the purpose of calculating the free nursing care element of their fees. Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 17 Sampled care plans have a lot of detail on physical health needs, reflecting the nursing specialisms in the home. A range of health assessments are completed, and support is then based on the needs identified from these. Clear plans are in place for each relevant need area, covering topics such as continence, epileptic activity, nutrition and pressure area care. The needs of some service users at Greathouse include learning disability. These issues are picked up appropriately within individual care plans, and relevant professionals give support to the home to help meet these particular areas of need. Service users’ preferences about personal care, such as the gender of staff they would like to support them, are shown in their individual plans. Comments from service users indicate that they are generally satisfied with the support they receive with personal and health care. None of the home’s current service users are assessed as capable of retaining responsibility for their own medication. Therefore, qualified nursing staff are responsible for this task. Systems for medication were checked. Storage and recording arrangements are appropriate. All drugs in the home are kept securely. There is a suitable contract for the disposal of waste medication, which reflects the additional measures required for nursing homes. Records clearly identify each service user, with a photo attached to their own administration charts. Sampled records had been maintained to the required standard. The chart is signed by the relevant nurse if the drug has been taken by the person. Codes are used to denote various reasons for nonadministration, such as refusal or absence. Where the prescription instructions allow for varying doses, the record shows which one has been given. If medication administration or recording errors do occur, these are notified to the CSCI without delay, as required. The home also ensures that any incidents are followed up appropriately, and corrective actions are taken if necessary. Some service users are prescribed medication to be given ‘as required’. At Greathouse, the majority of such prescriptions are for pain control. Service users may ask for them, and staff may have to make a judgement on whether or not to agree to such requests. Or the decision might have to be initiated by a staff member. In either case, it is important to define the criteria for use as objectively as possible, so that the drug is given when it is indicated, and not more or less often. In an example seen in records at this inspection, a service user was prescribed a painkiller ‘as required’. The dose could be one or two capsules at a time, up Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 18 to four times a day “if absolutely necessary”. Records showed that this drug was routinely being given four times a day, in varying doses. There was no information in the service user’s individual plan to explain how this prescription was being used. Furthermore, a review by a pharmacist in March 2006 had noted that a review of the actual painkiller in use may be beneficial to the service user. There was nothing in the record to show whether or not this recommendation had been followed up, or the reasons why. Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 19 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 the following standard(s): 22 & 23 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. 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. One recent complaint from a service user who stayed at Greathouse for short term care had been fully investigated through Leonard Cheshire’s procedures. The complaint was partially upheld, and some action points were identified as a result. For instance, the need for greater clarity with short-term care service users about exactly what the home can offer. Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 20 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 DS0000015913.V298740.R01.S.doc Version 5.2 Page 21 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 the following standard(s): 24 & 30 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users live in a comfortable, clean and safe environment, suitable to their needs. EVIDENCE: Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 22 Different parts of the Greathouse building date from various periods. The original section is quite old. There are some attractive features, and 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. Various redecoration has taken place recently, enhancing the appearance 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. External security has been reviewed over recent months after some incidents at the home. The home has a hotel services team leader, with overall responsibility for premises issues. There are two part-time maintenance staff, who cover five 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 ten, by 1st April 2007, will also be addressed via reprovision. Specialist adaptations and equipment have been provided throughout the home. These are based on the assessed needs of service users. There are four 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. The furniture used in the dining room is under review, with some different tables being tried out. Provision of more suitable tables and chairs in this area should help with the delivery of mealtime support to service users. Although most staff giving assistance sat with someone to do so, one staff member was forced to stand to support a service user, because of the difficult height and angle there would have been if they remained seated. The home was clean and hygienic in all areas seen during this unannounced inspection. Greathouse employs its own housekeeping staff. They undertake National Vocational Qualifications in relevant topics. Some service users commented that there have been problems with the standard of cleanliness in the home. The manager acknowledged that a change in practices, which has meant more cleaning is now undertaken by care staff, had created difficulties for a time. But she is hopeful that this has now Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 23 been resolved. Cleaning schedules are in place, so that the area can be audited. Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 24 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are supported by suitable numbers of appropriately trained staff. Service users are protected by effective recruitment practices. EVIDENCE: Because the home is registered to provide care with nursing, there is always at least one registered nurse on duty. They are supported by seven carers in the morning, five in the afternoon, and three at night. An extra carer may be provided on some mornings. If there are any shortages from within the home’s own staff team, cover is maintained by relief or agency workers. Since June 2005, three staff work waking shifts at nights. Previously, one person had slept in. The change is felt to have been beneficial in promoting service users’ choice and safety. The home also employs a physiotherapist, and staff for day care, activities, catering, housekeeping, administration, and maintenance. Some volunteers also assist with certain tasks. Steps are taken to promote communication between the various departments. The heads of each meet together regularly. Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 25 Deployment of staff is being reviewed continually. There has been a shift of hours from housekeeping to care staff over the past year. Part of this change has meant that care staff must now take on more cleaning tasks themselves. The aim is to promote service user involvement as well, wherever possible. Changes are being carried out with due care and consultation. Some service users commented that they feel staff are not always available to meet all of their needs. In part, this is linked to service users saying they experience slow response times to their call bells. This issue has been raised in the home, and the call bell system can now be checked to see how long it took for a call to be answered. This will enable any specific complaints to be checked. Greathouse had most of the staff it needed at the time of this inspection, following some recent recruitment. There was only a small amount of use of agency staff to cover any shifts. The records of three recently appointed staff were sampled. These show that recruitment practices are in line with all statutory requirements. The necessary checks are carried out and completed before someone takes up post. Service users also participate in the selection process, with some of them sitting on interview panels. Each new member of staff has a period of induction. This includes a three day training course covering various key topics, which takes place before people start working with service users. Staff are issued with an induction folder and must work through this. There are targets for completion at six weeks, and again at three months. These are linked to the national training standards for the social care workforce, and provide a pathway into National Vocational Qualifications (NVQs) in care. Greathouse has not yet achieved the target of 50 of care staff to have an NVQ, at Level 2 or above. But good progress has been made on this since the previous inspection. There is now a clear plan in place to do so. A number of staff have completed NVQs at Level 2 or 3. Other staff are working towards the award, and more are due to register for it shortly. The home has two staff who can act as assessors for NVQ candidates, with one more in training for this role. Nursing staff have a personal responsibility to update their knowledge and skills, to enable them to maintain their nursing registration, which gives them the right to practise. Leonard Cheshire has developed packs which nurses can use for self-directed learning which will assist with this. Topics include nutrition and multiple sclerosis. Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 26 A training co-ordinator within the staff team 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 attend a range of training. In addition to NVQ studies, this includes topics such as medication, challenging behaviour, and relationships and boundaries. In-house sessions are held every fortnight with talks on relevant topics. Training opportunities are publicised on noticeboards in the home, and staff are welcome to put themselves forward for any relevant courses. Records show the training that all staff have undertaken, and when refresher sessions are due. The individual training records for all staff can be crossreferenced with the list of required topics, to help with overall planning of training needed for the home. This is usually done for three months at a time, depending on issues like staff turnover. Comments from staff showed that they are generally satisfied with the range of training opportunities provided. They did identify the need to have more knowledge and skills to support service users with learning disabilities, and those who may display challenging behaviours. These issues have already been acknowledged by the home, and plans are in place to provide suitable training. Service users can also attend training on certain topics, such as health and safety, relationships, and information technology. Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 27 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. The registered manager is suitably qualified, competent and experienced, so that service users benefit from a well run home. Management systems benefit service users by providing effective oversight of the various areas of service delivery. Quality assurance measures ensure that the home is conducted and developed in line with service users’ needs and preferences. Service users’ best interests are safeguarded by the home’s record keeping systems. Service users’ health and safety are protected by the systems in place. This would be enhanced by upholding the proper frequency of fire safety checks. EVIDENCE: Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 28 The registered manager for Greathouse is Mrs Fran Ashby. Mrs Ashby has relevant nursing and management qualifications appropriate to her role. 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. Mrs Scully 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. Lots of work has been put into developing a quality assurance system, from the various sources of evidence available. Several 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. Working parties have also been set up to develop ideas for improvements on certain topics, such as menus, and fire safety. Meetings are held every two months. The groups involve a mixture of service users, and staff from various roles and levels of seniority. At a national level, the Leonard Cheshire organisation has devised a self-audit tool. This is applied to each service annually, with different areas being focused on over the course of the year. The audit is conducted by people from within Leonard Cheshire, but independent of Greathouse. Similarly, Mrs Ashby is involved in visiting other services to participate in auditing them, which also provides a useful source of comparisons and ideas. A range of systems are in place for checking that health and safety is maintained throughout the service. This area is overseen by the hotel services team leader. The home employs its own maintenance staff, who can attend to a range of general tasks around the house and grounds. External contractors are used for other works as necessary. Risk assessments are in place for a range of safe working practice issues. Staff also receive regular training in relevant topics. This includes practical demonstrations in the use of any new products or equipment. Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 29 Most of the records relating to fire safety checks, practices and instruction were noted as being carried out and up to date. However, a test of the fire alarm system should be carried out each week. Records for January to June 2006 showed this as having been missed five times. Decisions about any use of bed sides with service users are supported by documented risk assessments, and evidence of consent. Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 30 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 Standard No Score 1 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X 3 3 X Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 31 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 17-1a Sch3-3m Requirement There must be clear guidance on the criteria for administration of medication prescribed on an ‘as required’ basis. (Timescale of 24/02/06 not met) Timescale for action 28/07/06 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 YA12 Good Practice Recommendations The service should continue with the planned development of activities and outings for service users, especially in the evenings. There should be a review of furniture and equipment used in the dining room, to enable service users to benefit from the most effective staff support. Records should show clearly the actions taken in response to the recommendations of any review of medication. Progress should continue towards the target of at least 50 of care staff to have NVQ Level 2 or higher. DS0000015913.V298740.R01.S.doc Version 5.2 Page 32 2 YA17 3 4 YA20 YA32 Greathouse Cheshire Home 5 YA35 Training should be provided for staff on topics relevant to their work with service users who have learning disabilities. Care should be taken to ensure that all prescribed fire safety checks are carried out and clearly recorded at the set intervals. 6 YA42 Greathouse Cheshire Home DS0000015913.V298740.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham 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 DS0000015913.V298740.R01.S.doc Version 5.2 Page 34 - 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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