Inspection on 04/01/06 for Greathouse Home - Leonard Cheshire Disability

This inspection was carried out on 4th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 no outstanding requirements from the previous inspection report, but made 10 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... 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 Unannounced Inspection 4th January 2006 10:30 – 17:10 Greathouse Cheshire Home DS0000015913.V270103.R01.S.doc Version 5.0 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.V270103.R01.S.doc Version 5.0 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.V270103.R01.S.doc Version 5.0 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 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) Leonard Cheshire 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.V270103.R01.S.doc Version 5.0 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. 12th July 2005 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. Greathouse Cheshire Home DS0000015913.V270103.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place in January 2006. A total of 6.75 hours were spent in the home. The following inspection methods have been used in the production of this report: indirect observation; pre-inspection questionnaire, completed by the provider; sampling of records, with case tracking; discussions with service users, staff and management; survey of service users and relatives. What the service does well: What has improved since the last inspection? Measures for the administration and recording of medicines prescribed for service users have improved, benefitting their welfare and safety. Greathouse Cheshire Home DS0000015913.V270103.R01.S.doc Version 5.0 Page 6 Recording systems have been thoroughly reviewed, predominantly as a result of an investigation by Leonard Cheshire Homes after an error occurred. The findings and recommendations of this investigation have reinforced the necessary principles of good practice. In particular, staff have been reminded that all medication administered to service users must be promptly recorded on the appropriate chart, to reduce any risk of the same dose being given twice. The findings have been seen by the local pharmacist inspector for the CSCI, who has judged them to be appropriate. The home has also ensured that any information about known allergies of individual service users is prominently displayed with their medication administration records. This minimises the risk of any person mistakenly being given something that may be harmful to them. A new call system has been installed throughout the home, which functions much more effectively than the one in use previously. This means that service users receive a quicker response when they use a call point to summon staff assistance. Monthly visits and reports on the conduct of the home by managers of the Leonard Cheshire organisation are being used to address progress on issues that have been identified. This includes the findings of CSCI inspections, and of any investigations that the provider itself has carried out. The regular focus on areas for development helps to ensure that the quality of service to the home’s users continues to improve. Attention has been given to the décor and cleanliness of the home, enhancing the quality of the living environment for service users. For instance, the main dining room has been redecorated. There has also been thorough cleaning up to high ceiling levels, removing a number of cobwebs which previously had accumulated there. Progress has been made on the implementation of a quality assurance system, and the production of a service development plan. A set of measurable objectives are now to be drawn up. This will help to ensure that the home is conducted and developed in line with service users’ needs and preferences. What they could do better: Service users need to be provided with updated information on their contracts with the home, particularly in relation to annual changes in fee levels. This will ensure that individuals have all the information to which they are entitled, and on which they can base their decisions about purchasing a service. Care plans and risk assessments for service users need attention, to ensure that no individual is placed at risk by a failure to plan for all needs effectively. Currently there are deficits such as incomplete assessments on key topics; a Greathouse Cheshire Home DS0000015913.V270103.R01.S.doc Version 5.0 Page 7 lack of full information on some issues that have been noted; and a failure to develop clear care guidance for needs identified through assessment. Guidelines also 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. More progress is needed in care staff obtaining National Vocational Qualifications (NVQs) in care, to reach the 50 target required in care homes standards. This will benefit service users by increasing the number of hours of support which are delivered to them by staff qualified to a recognised minimum level. Various improvements in record keeping would benefit 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. Good practice principles also need to be observed, such as signing and dating all records, and clearly crossreferencing between linked material. Where bed sides are in use with any individual, suitable measures must be taken to ensure their welfare and protection. The home documents risk assessments, as required, but there is not yet suitable evidence of consent by the person concerned, or by someone representing them. Fire safety measures need to be improved to ensure the safety of service users and others. All required checks need to be carried out and recorded at the prescribed intervals. A clear record must also be maintained to demonstrate that staff receive instruction in the topic at least once in every three months. Induction training should be reviewed to ensure that it remains in line with the expectations of national standards for the social care workforce, which have recently been amended. This will ensure that new employees make speedy progress along the appropriate learning pathway, enabling them to deliver more effective support to service users more quickly. Each employee has individual supervision sessions with a manager, but these need to happen at least six times per year to meet the standard. This will provide an effective means of monitoring and developing the performance of each staff member, to the overall benefit of the service and its users. 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.V270103.R01.S.doc Version 5.0 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.V270103.R01.S.doc Version 5.0 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, 3 & 5 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 their needs and aspirations met by the home. Not all service users have updated contracts with the home, so they do not have all the current information to which they are entitled, and on which to base their decision about purchasing a service. Greathouse Cheshire Home DS0000015913.V270103.R01.S.doc Version 5.0 Page 10 EVIDENCE: Records for a person recently admitted to the home show that a thorough assessment process is carried out. The needs of this particular individual are clearly defined, and the reasons for placement at Greathouse are set out. A review meeting took place six weeks after the person first moved in. There are detailed notes from this, which explain how the decision for the placement to continue has been reached. The choice is shown to be in keeping with the individual’s own expressed wishes, as well as those of their family; and is supported by the judgement of all the relevant professionals involved with the person’s care. Greathouse has a range of specialist services 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. 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. These amendments have not been attached to individual contracts. The manager now intends to remedy this in April 2006, in line with the start of the new financial year. Greathouse Cheshire Home DS0000015913.V270103.R01.S.doc Version 5.0 Page 11 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 Some service users have no suitable care plans or risk assessments, placing them at risk that their needs will not be met safely. Service users can make choices and decisions in their daily lives, and about the conduct of the home. EVIDENCE: Records relating to three service users were sampled during this inspection. These indicate that a range of assessments are used in the home, from which care plans are formed on any identified areas of need. There are systems for review of care, and a note is made in records whenever this has been done. There were various deficits in the records for a person recently admitted to the home. A moving and handling assessment had been started, but not completed. The document was not signed or dated. Greathouse Cheshire Home DS0000015913.V270103.R01.S.doc Version 5.0 Page 12 An entry in daily notes referred to an episode of challenging behaviour, and was cross referenced to another incident sheet, which could not be located. No risk assessments or care plans had been completed for responding to such issues. The person’s care plan had brief references to their needs in areas such as communication and nutrition, but these had not been developed into appropriate guidance for staff. The service user also presented a particular area of need, outside that which Greathouse usually provides for. Records were clear in showing that placement at the home was appropriate for the individual. But it had also been identified as important that this other need area was recognised and planned for. As yet, there was insufficient evidence that this had happened. 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. 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. 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. Where staff of the home have any involvement in supporting service users with managing their money, clear records are kept. All transactions are logged, with two signatories for each. Receipts are retained. Independence is promoted wherever possible. For instance, some people manage sums of money for their personal use. Greathouse Cheshire Home DS0000015913.V270103.R01.S.doc Version 5.0 Page 13 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): These standards were not inspected on this occasion. They were met at the previous inspection. EVIDENCE: Greathouse Cheshire Home DS0000015913.V270103.R01.S.doc Version 5.0 Page 14 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): 19 & 20 Some service users do not have appropriate written guidance to ensure effective health care support. This places them at risk of harm. 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: Service user records show that 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. Sampled care plans generally have a lot of detail on physical health needs, reflecting the nursing specialisms in the home. A range of health assessments are usually completed, and support is then based on the needs identified from these. Good practice was noted in some files. Clear plans were in place for Greathouse Cheshire Home DS0000015913.V270103.R01.S.doc Version 5.0 Page 15 each relevant need area, and the record also specifically stated when there were no care needs for an individual under a particular heading. Some deficits were also identified at this inspection. For instance, one service user was identified as having needs for wound care, and the prevention of pressure damage. But no care plans were in place for either of these issues. A ‘turn chart’ had been placed in the relevant file. This is used for recording regular changes of position, which is an intervention designed to reduce the risk of pressure damage occurring. But the chart was blank, and there was no documentation to show whether or not such a regime was in place. 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 non-administration, such as refusal or absence. Where the prescription instructions allow for varying doses, the record shows which one has been given. Recording systems have been thoroughly reviewed, predominantly as a result of an investigation by Leonard Cheshire Homes after an error occurred. The findings and recommendations of this investigation have reinforced the necessary principles of good practice, particularly in ensuring that all medication administered to service users is promptly recorded on the appropriate chart. The findings have been seen by the local pharmacist inspector for the CSCI, who has judged them to be appropriate. The home has also ensured that any information about known allergies of individual service users is prominently displayed with their medication administration records. This addresses a recommendation of the previous inspection report. Medicines available without prescription may also be given to service users. The home has obtained signed agreements from service users’ GPs about which of these ‘homely remedies’ they may take. Some service users are prescribed medication to be given ‘as required’. At Greathouse, the majority of such prescriptions are for pain control. Specific health needs, such as epilepsy, may also lead to people being written up for certain drugs, for use in particular circumstances. Greathouse Cheshire Home DS0000015913.V270103.R01.S.doc Version 5.0 Page 16 There are no specific individual plans to promote safe and accurate administration of such medicines. 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. Greathouse Cheshire Home DS0000015913.V270103.R01.S.doc Version 5.0 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 the following standard(s): These standards were not inspected on this occasion. They were met at the previous inspection. EVIDENCE: Greathouse Cheshire Home DS0000015913.V270103.R01.S.doc Version 5.0 Page 18 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, 29 & 30 Service users live in a comfortable, clean and safe environment, suitable to their needs. Service users have suitable adaptations and equipment to promote their independence and quality of life. Greathouse Cheshire Home DS0000015913.V270103.R01.S.doc Version 5.0 Page 19 EVIDENCE: 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 since the previous inspection, enhancing the appearance of the home. For instance, the main dining room has been decorated. A new counter has also been installed, which enables service users to serve themselves to items such as cereals and toast at breakfast time. It is also planned to replace the dining tables during 2006. Other decoration work was ongoing on the day of the inspection. On the first floor repairs were being carried out to an area of corridor which had received water damage due to a leak. A room used for computer activities with service users was also midway through being decorated. Further plans include redecoration of more bedrooms; new floor covering for the ground floor corridor; and the possible conversion of one bathroom to a laundry room which service users could access, as part of practice for more independent living. 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. The usual postholder is on a secondment elsewhere within Leonard Cheshire, so a fixed term replacement has been appointed. 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. 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. Greathouse Cheshire Home DS0000015913.V270103.R01.S.doc Version 5.0 Page 20 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 home’s call bell system has been replaced since the previous inspection. The new one is now in use throughout the home, and is reported to be working effectively. This system will also provide the option for automatic readouts of response times, enabling practice to be audited. The home was clean and hygienic in all areas seen during this unannounced inspection. Greathouse employs its own housekeeping staff. They undertake NVQ training in relevant topics. An environmental health inspection took place during 2005, and is 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, where the cooker was refitted. Greathouse Cheshire Home DS0000015913.V270103.R01.S.doc Version 5.0 Page 21 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 & 36 Service users are supported by suitable numbers of staff. Staff receive relevant training to assist them in meeting service users’ needs effectively. More progress is needed in care staff obtaining relevant nationally recognised qualifications. Service users are protected by effective recruitment practices. Staff are supported and supervised effectively, but the frequency stipulated within standards should be reinstated. 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. Greathouse Cheshire Home DS0000015913.V270103.R01.S.doc Version 5.0 Page 22 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 taken to promote communication between the various departments. The heads of each meet together regularly. Deployment of staff is being reviewed continually. There has been a shift of hours from housekeeping to care staff – 25 hours so far, with another 28 due to happen shortly. Part of this change has meant that care staff must now take on more cleaning tasks themselves. The hope is to promote service user involvement as well, wherever possible. The home is also to advertise for more senior carers, so that there is more direct supervision of care staff during their normal daily duties. It will also help with mentoring of new employees. Each new member of staff has a period of induction. They are issued with an induction folder and must work through this. There are targets for completion at six weeks, and again at three months. During the inspection, it was recommended that the home ensure the approach to induction remains in line with the relevant national standards for the social care workforce, which have recently been amended. Greathouse has not yet achieved the target of 50 of care staff to have a National Vocational Qualification (NVQ) in care, at Level 2 or above. Progress towards this is hampered by staff turnover. The home also has a large number of part time employees. During the inspection, it was discussed that the primary focus should be on those care staff who are full time, or near to it. This will ensure that the amount of care hours provided to service users by qualified workers will increase more quickly. 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 included topics such as medication, challenging behaviour, and relationships and boundaries. All staff have individual supervision meetings with an allocated manager. These sessions are governed by a procedure, and supervision contracts, which set out the purpose, content and boundaries of the meetings. Records are kept of each session. The frequency should be at least six supervisions per year for each employee, but this has not been maintained in all cases over recent months. Whilst there have been pressures in doing so, the home has ensured that new employees have received regular supervision, as has anyone whose performance has caused any concern. Greathouse Cheshire Home DS0000015913.V270103.R01.S.doc Version 5.0 Page 23 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. Greathouse Cheshire Home DS0000015913.V270103.R01.S.doc Version 5.0 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 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 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 need further progress, to ensure the home is conducted and developed in line with service users’ needs and preferences. Service users’ best interests are not safeguarded by the home’s record keeping systems. Fire safety measures need attention, to ensure that the welfare of service users is promoted and protected. Use of bed sides without appropriate evidence of proper decision processes places the safety and welfare of service users at risk. Greathouse Cheshire Home DS0000015913.V270103.R01.S.doc Version 5.0 Page 25 EVIDENCE: The registered manager for Greathouse is Mrs Fran Ashby, who successfully completed the process of registration during 2005. Fran has the relevant nursing qualifications appropriate to her role. She is currently undertaking additional management qualifications, which she is due to complete in the early part of 2006. 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. Progress has been made since the previous inspection on formalising 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. Information from the most recent service user survey has been collated, and is now due to be presented to them. Issues raised as concerns include the allocation of staff as keyworkers for individual service users; and awareness of the complaints procedure. On the positive side, people are satisfied with the arrangements for confidentiality; and the upholding of service users’ dignity. Action plans have been drawn up in response to some findings from these sources. In particular, a number of recommendations have been generated from recent detailed complaints investigations that Leonard Cheshire Homes has conducted. Monthly visits and reports on the conduct of the home by managers of the Leonard Cheshire organisation are being used to address progress on issues that have been identified. This includes the findings of CSCI inspections as well. 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. Greathouse Cheshire Home DS0000015913.V270103.R01.S.doc Version 5.0 Page 26 At a national level, the Leonard Cheshire organisation has devised a self-audit tool. This will be applied to each service annually, with different areas being focused on over the course of the year. The audit will be conducted by people from within Leonard Cheshire, but independent of Greathouse. Similarly, Mrs Ashby is now becoming involved in visiting other services to participate in auditing them, which also provides a useful source of comparisons and ideas. 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. A format has been devised, and the home’s own programme indicates that goals are due to be set in March 2006. 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. All nurses working in the home attend fire marshal training, and are due to do so again in January 2006. Records demonstrate that most of the necessary tests and practices are being carried out at the relevant intervals. The only exception is monthly tests of the emergency lighting system, which have been omitted in three of the five months since the last inspection. The home has also failed to maintain records of fire safety training for staff at the required frequency. Evidence is needed to show that each person receives this at least once in every three month period. The most recent training recorded in the fire log book is for July 2005. The manager states that more training has taken place since then, but this must be supported by satisfactory records. Record keeping is also deficient in a number of areas relating to service users, as set out elsewhere within this report. Some service users have bed sides fitted. Where this is the case, documented risk assessments are in place, as required. There is also a note to say that the individual concerned has given their consent. But there is no direct evidence of this, such as the person’s own signature, or that of someone representing them. Greathouse Cheshire Home DS0000015913.V270103.R01.S.doc Version 5.0 Page 27 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 3 3 X 2 Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X 3 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 2 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Greathouse Cheshire Home Score X 2 2 X Standard No 37 38 39 40 41 42 43 Score 3 X 3 X 2 2 X DS0000015913.V270103.R01.S.doc Version 5.0 Page 28 No 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 2 2 3 Standard YA5 YA6 YA6 YA9 Regulation 51b,c;2;3 6 12-1,2,3 15 17-1a Sch3-1b 12-1 13-4 15 Requirement All service users must have upto-date contracts relating to their residence in the home. All service users must have individual plans for all assessed and identified needs. This part of Regulations also applies to the above Requirement. The persons registered must carry out risk assessments for all topics relevant to each service user; and demonstrate that suitable management strategies are in place. This part of Regulations also applies to the above Requirement. The persons registered must ensure that there is evidence of appropriate assessment, planning, monitoring and review for all health care needs of each service user. There must be clear guidance on the criteria for administration of medication prescribed on an ‘as required’ basis. The persons registered must take suitable steps to provide a DS0000015913.V270103.R01.S.doc Timescale for action 30/04/06 24/02/06 24/02/06 24/02/06 3 4 YA9 YA19 17-1a Sch3-3q 12-1 13-1 15 24/02/06 24/02/06 5 YA20 13-2 17-1a Sch3-3m 18-1a,c 24/02/06 6 YA32 30/09/06 Greathouse Cheshire Home Version 5.0 Page 29 minimum 50 of care staff with NVQ Level 2 or higher. COMMENT: The timescale reflects the next point by which this will be reviewed by the CSCI. The persons registered must maintain, to an appropriate standard, all those records required by Schedules 3 and 4 of the Care Homes Regulations 2001. The persons registered must ensure that written evidence of consent is in place for any use of bed sides. 7 YA41 17 Sch3&4 24/02/06 8 YA42 12-1,2,3 13-7,8 24/02/06 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 2 3 4 5 6 Refer to Standard YA35 YA36 YA39 YA41 YA41 YA42 Good Practice Recommendations The approach to induction of new care staff should be reviewed and updated, to reflect changes in national standards for the social care workforce. All staff should have regular, recorded supervision meetings at least six times a year. Progress should continue on implementation of the service’s quality assurance system. All records should be clearly signed and dated when they are compiled. There should be more effective cross-referencing of linked information, to aid ease of use. 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 DS0000015913.V270103.R01.S.doc Version 5.0 Page 30 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.V270103.R01.S.doc Version 5.0 Page 31 - 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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