Inspection on 19/10/05 for Green Bank EMI Care Home

This inspection was carried out on 19th October 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Green Bank EMI Care Home 15/06/09

Green Bank EMI Care Home 27/06/07

Green Bank EMI Care Home 25/04/06

Green Bank EMI Care Home 26/04/05

Green Bank EMI Care Home 07/12/04

Green Bank EMI Care Home 09/07/04

Green Bank EMI Care Home 29/07/02

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

CARE HOMES FOR OLDER PEOPLE Greenbank 11 Hastings Road Bexhill-on-sea East Sussex TN40 2HJ Lead Inspector Kevin Whatley Unannounced Inspection 19th October 2005 10:00 X10015.doc Version 1.40 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 Greenbank DS0000021120.V250510.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 Older People. 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. Greenbank DS0000021120.V250510.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Greenbank Address 11 Hastings Road Bexhill-on-sea East Sussex TN40 2HJ 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) 01424 211704 Mrs Judy Pillow Miss Sophie Williams Care Home 16 Category(ies) of Dementia (16) registration, with number of places Greenbank DS0000021120.V250510.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of residents to be accommodated will be sixteen (16) 26th April 2005 Date of last inspection Brief Description of the Service: Greenbank is located close to Bexhill-on-Sea old town and about one mile from the seafront. There is access to local shops, public transport, churhces and other community services. Greenbank is a long established family owned home registered to accommodate up to 16 older people with a Dementia type illness. The property was originally a two storey victorian house which has since been extended to accommodate residents on the ground floor of the building. There is a large well maintained garden to the rear of the property with has easy access for residents. Greenbank DS0000021120.V250510.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Greenbank will be referred to as ‘residents’. The unannounced inspection took place on a weekday in October and lasted for approximately five hours. The inspection included a tour of the premises and it’s facilities, including viewing residents bedrooms. Those spoken to included the homes proprietor, the deputy manager, two members of care staff, and a visiting Community Psychiatric Nurse; whilst care staff were observed carrying out their duties. Several residents were also spoken with, however due to the level of their comprehension it was not possible to gain substantial feedback. At the time of the inspection Greenbank was accommodating 15 residents. Records and documentation relating to residents and staff were seen along with a number of the homes policies and procedures. What the service does well: Greenbank provides sufficient information for prospective residents their relatives/carers and other care professionals regarding the home and the services it offers. No resident is admitted to the home without first having their needs fully assessed, such needs are then included in a clear plan of care and risk assessments and are delivered by care staff who are committed, caring and respectful. The home attempt to engage residents in interactive activities, whilst supporting them and their relatives/carers and friends to maintain contact. Residents are protected from the risk of abuse by a robust adult protection policy and staff are fully aware of the procedures that must take in the event of any concerns or suspicions. The home environment is homely and residents rooms are personalised and comfortable. The home is managed with the well being of residents as paramount importance. Greenbank DS0000021120.V250510.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: 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. Greenbank DS0000021120.V250510.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenbank DS0000021120.V250510.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5. The home provides prospective residents and their relatives/carers with sufficient information regarding the services offered at Greenbank. No resident is admitted to the home without first having their care needs assessed and subsequently incorporated into a plan of care. EVIDENCE: The homes statement of purpose was viewed, this confirmed that all relevant information regarding the physical layout of the premises and the care services being offered at Greenbank are clearly explained. The document also details the homes philosophy of care and includes comments received from relatives and carers regarding the standard of care being provided. A number of care plans were seen, most notably those relating to the most recently admitted residents. All care plans contained comprehensive pre admission information such as social and health care histories, physical and emotional needs and medical issues. The deputy manager confirmed that he had visited the most recently admitted resident to carry out the needs assessment process. The subsequent care plan Greenbank DS0000021120.V250510.R01.S.doc Version 5.0 Page 9 had been completed with the identified care needs being addressed appropriately, including the manner in which such needs would be met by care staff. Residents initially move in on a trial basis. Care plans contained evidence of the involvement of relatives and carers from the point of referral onwards, with note made of any concerns, advice, or wishes they may have. The visitors book also confirmed that relatives and carers had visited the home prior to a resident being admitted. Greenbank DS0000021120.V250510.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and10. The assessed care needs of residents are addressed via a comprehensive system of care planning. The home meet the health care needs of residents, however they must ensure that they adhere to their policies and procedures in regard the administration of medication. Residents are treated with respect, dignity and care. EVIDENCE: Care plans viewed were seen to contain comprehensive and clear information regarding the health, physical, and social care needs of residents. These included reference to the manner in which care staff should carryout care tasks with each resident, such as bathing and other personal care needs. Care plans also contained information as to how residents prefer to be addressed and the level of emotional support they need. The care plan relating to the most recently admitted resident contained clear and relevant information regarding previous and current health issues and included physical and mobility risk assessments. The care plan included a thorough risk assessment relating to falls linking this with the pre admission information and subsequently offered care staff clear guidance on how this aspect of risk would be reduced. Greenbank DS0000021120.V250510.R01.S.doc Version 5.0 Page 11 Care plans viewed contained information relating to the assessed health care needs of residents including the particulars of prescribed medication, physical difficulties or concerns, and health care assessments in relation to dementia type illnesses such as Alzheimer’s and Parkinson’s. When necessary the home utilise specialist help from other care professionals such as the Alzheimer Nurse. During the inspection a visit was made to one resident by a Community Psychiatric Nurse (CPN). Records confirmed that this visit had been requested by the home in response to an increase in the resident’s emotional stability. Residents are registered with local doctors and are taken by care staff to health care appointments such as outpatient hospital visits, dentists, and opticians. Due to the high care needs of residents, care staff are responsible for administering all medication. The home have suitable storage and medicine administration systems in place and are visited regularly by the Pharmacist who provides the homes medicines. The Pharmacist checks medicine stocks, appropriate storage of items and advises the home in any areas regarding prescribed medication. On viewing the homes medicine administration records it was found that several entries had not been completed during the morning of the inspection. Throughout the inspection staff were observed to be caring, patient and respectful toward residents. Staff spoken with displayed a clear understanding of how they care for residents with dignity and thought for their individual needs. Greenbank DS0000021120.V250510.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above 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, 14 and 15. The home provides residents with a suitable routine and allows them opportunities to engage in interactive activities. The home encourages relatives and friends to visit residents. The dietary requirements of residents are met. EVIDENCE: Mealtimes at the home are set at appropriate periods of the day and residents can choose to have these in their room or the main dinning area. Several residents prefer to have their meals in the smaller lounge. The menu confirmed that residents benefit from a varied and nutritious diet whilst special dietary needs such as two residents who are vegetarian are catered for. The lunchtime meal was well presented, nutritious and tasty. Since the last inspection Greenbank have employed the services of a professional activities facilitator who visits the home once a week. It so happened that this activity took place during the inspection and was seen to be very interactive utilising music, song, movement and motivation to engage residents. The co-ordinator explained that the weekly sessions involve the use of motivation to encourage residents to use co-ordination, movement and word association in connection with visual games. The co-ordinator noted that the format she uses has been developed by a physiotherapist and includes a high level of interaction from residents. This activity was seen to be very well Greenbank DS0000021120.V250510.R01.S.doc Version 5.0 Page 13 enjoyed by the residents, whose energy levels appeared to increase as a result of their involvement. A member of the local clergy visits the home once a month and facilitates a general service for those wishing to attend. The homes visitors policy encourages families, carers, and friends to visit residents as frequently as possible. The visitors book confirmed that residents are visited on a regular basis, daily logs also indicated when residents had had contact with family and friends, this included a number of residents who had been taken out by relatives and friends at weekends. Most recently the home had accompanied a resident to attend a funeral. Residents also receive telephone calls and one that occurred during the inspection was facilitated to allow the resident to have a private conversation in the office. Greenbank DS0000021120.V250510.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Residents and their relatives and carers have the opportunity to voice their concerns and complaints. The home have robust policies and procedures in place to ensure that residents are protected from the risk of harm, neglect and abuse. EVIDENCE: The homes complaints procedure offers sufficient information regarding the homes responsibility to investigate any issues of concerns or complaint and includes the contact details of social services and the Commission for Social Care Inspection (CSCI). A copy of the policy is displayed in the home. The homes complaints book was viewed, this confirmed that no complaints had been made since the last inspection; no complaints have been made to CSCI since the last inspection. The homes polices and procedures in relation to adult protection were seen to be satisfactory in addressing the risks posed to vulnerable adults living in residential care settings. Staff files indicated that all staff undertake a compulsory induction programme that addresses the protection of vulnerable adults. Staff spoken to had a clear understanding of such procedures and a good understanding of adult protection issues in general. Since the last inspection the home have further developed their staff handbook that includes all relevant details including what staff should do in the event of suspecting any concerns regarding adult protection within the home. The deputy manager also confirmed that he has recently undertaken Adult Greenbank DS0000021120.V250510.R01.S.doc Version 5.0 Page 15 Protection Trainer training and therefore is now in a position to provide on sight training to all staff at the home. The homes accident book was viewed and this confirmed that all entries were relevant and legible. Greenbank DS0000021120.V250510.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 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, 23, 24, 25 and 26. Residents benefit from a homely environment and personalised rooms, though the home must ensure that all areas of the building must remain as hazard free as possible. The home is kept clean and hygienic. EVIDENCE: A tour of the premises confirmed that Greenbank is generally in a reasonable structural order both inside and out with no obvious decorative defects. Communal living space comprises of two lounges, a dining room and a patio and garden area to the side and rear of the house. All these areas were furnished with domestic style fittings. A majority of the residents bedrooms were viewed and were found to be in good order with personal items such as pictures, photographs and ornaments in evidence. Several areas of the home appeared in need of some modernisation and up grading, whilst a cupboard door that stored a hot water boiler was found not to have a lockable lock fitted. Several of the bedrooms also had pressure mats fitted underneath bedside rugs, these mats were linked to a central call point which subsequently alert Greenbank DS0000021120.V250510.R01.S.doc Version 5.0 Page 17 night staff of a resident leaving or indeed falling during the night and had been placed in certain bedrooms as a result of relevant risk assessments. The home was found to be clean, hygienic and free from any odours or smells, though several areas were found to have items, such as incontinence pads, needing to be stored away into cupboards. Records confirmed that regular fire alarm checks are carried out, whilst the homes fire equipment had recently been serviced. Records of staff training in relation to fire safety was also noted. Documentation also confirmed that the home carryout a risk assessment of the physical layout of the building on a 6 monthly basis. In the past four months routine inspections have been carried out by the Environmental Health Service and Fire Service. Neither inspection highlighted any significant concerns in the home and recommendations made at the time have now been implemented. Greenbank DS0000021120.V250510.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 29. The assessed needs of residents are met by the numbers and skills of care staff deployed at the home. The homes recruitment and induction procedures ensure that residents are protected from the risk of harm. EVIDENCE: The rota was viewed and indicated that currently there are three members of care staff deployed during the morning, whilst two are on duty in the afternoon; during the night the home deploy two members of ‘waking night’ care staff. Aside from care staff the home employ a full time cook and full time domestic cleaner. During day shifts care staff are supported by either the registered manager or her deputy. Staff files indicated that many of the care staff have previous experience of working within the care industry. Since the last inspection the home have further developed their induction programme and all new staff have to undergo a probation period that includes being ‘shadowed’ in the first few days of employment and having to complete work sheets on relevant areas of care such as Adult Protection, Handling and Lifting and Health and Safety for which they receive a certificate. There was also evidence of the home arranging for care staff to undertake compulsory training such as Working with Dementia and Medicine Administration. As previously mentioned the deputy manager is now a certified Adult Protection trainer and is therefore able to offer new and existing staff considerable training as and when required. Greenbank DS0000021120.V250510.R01.S.doc Version 5.0 Page 19 A number of members of care staff were spoken to and all stated that they felt supported by the management of the home in their tasks. One member of care staff stated that working at the home was ‘just like being part of a family’. A considerable number of care staff have worked at the home for two years or more. Staff files confirmed that the home follows necessary and required procedures when recruiting staff including ensuring that Criminal Records Bureau (CRB) and character reference checks are confirmed prior to staff being able to work at the home. Greenbank DS0000021120.V250510.R01.S.doc Version 5.0 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 36 and 38. Greenbank is managed for the benefit of residents in a manner that is open, caring and committed. The management of the home must continue to develop a suitable system for the formal supervision of care staff. EVIDENCE: The manager of Greenbank has worked, and indeed lived, at the home for a considerable number of years. She has a comprehensive understanding of caring for older people with dementia type illnesses and of supporting care staff in their tasks. The manager is currently studying the National Vocational Qualification (NVQ) level 4 in Care and Management Award. On the day of the unannounced inspection the manager was on her day off, however care staff confirmed that they felt supported by the manager. It was clear from observing the interactions between staff and residents and the role taken on by the deputy manager that the home is managed with the needs of Greenbank DS0000021120.V250510.R01.S.doc Version 5.0 Page 21 residents at it’s core. Care staff said they felt able to speak to the manager in the event of any issues or concerns they may have within the home. Following the last inspection a ‘Greenbank newsletter’ has been developed, this comprises of relevant information, issues and events regarding the home and is issued to all staff; whilst staff meetings have recently been implemented. The newsletter from May this year commented on the findings of the previous inspection report and gave staff clear guidance and encouragement to address the requirements made at that time. It appears that that there has been a period since May when this has not been published, the deputy manager stated that the newsletter will be published regularly from now on. The staff meetings only came into being this month, though are expected to be a regular occurrence. The previous inspection report made a requirement that the management team should develop a suitable system of formal staff supervision. Staff records indicated that such supervision has yet to be fully implemented, although care staff appraisals have now been implemented. The deputy manager stated that he is in the process of finalising the format for formal supervision. All records relating to residents and staff are kept securely in the office, whilst the homes policies and procedures are suitably stored in the same area. All records viewed were legible and accurate. Documentation seen in regard health and safety within the home, including the fire log and accident book contained necessary and up to date information. Since the last inspection the format for reporting incidents has been developed into a more concise system. The home now have two accident/incident forms one for ‘non-injury caused’ and one for ‘injury caused’ this appears to offer staff a clearer guide as to the nature of the incident they are reporting/detailing. Greenbank DS0000021120.V250510.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X 2 X 3 Greenbank DS0000021120.V250510.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? YES 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 OP9 Regulation 13(2) Requirement All records of medicine administration must be maintained accurately and up to date. That the cupboard containing the hot water boiler be fitted with a secure lock. That care staff must receive formal supervision (Outstanding from previous inspections). Timescale for action 19/10/05 2 3 OP19 OP36 13(4) (a) & c) 18(2) 19/10/05 19/04/06 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 Refer to Standard OP7 OP19 OP36 OP36 Good Practice Recommendations That where ever possible residents care plans should be signed by their representative. That the home implements a maintenance development plan to identify environmental improvements/up grading along with realistic timescales. That the ‘Greenbank newsletter’ for staff be published regularly. That minutes of staff meetings be recorded and kept in a DS0000021120.V250510.R01.S.doc Version 5.0 Page 24 Greenbank separate file. Greenbank DS0000021120.V250510.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Greenbank DS0000021120.V250510.R01.S.doc Version 5.0 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!