Inspection on 26/04/05 for Green Bank EMI Care Home

This inspection was carried out on 26th April 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 19/10/05

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 Kev Whatley Unannounced 26 April 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 H59-H10 S21120 Greenbank V218594 260405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Greenbank Address 11 Hastings Road Bexhill on Sea East Sussex TN40 2HJ 01424 211704 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Judy Pillow Miss Sophie Williams Care home only (PC) 16 Category(ies) of Dementia (DE) registration, with number of places Greenbank H59-H10 S21120 Greenbank V218594 260405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users to be accommodated will be sixteen (16). Date of last inspection 7 December 2004 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 H59-H10 S21120 Greenbank V218594 260405 Stage 4.doc Version 1.20 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 April 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 registered manager, two members of care staff, and a visiting District Nurse; whilst several care staff were also 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. Records and documentation inspected included: residents files, residents care plans, fire safety log, the homes accident book, and various policies and procedures I including those relating to adult protection, health and safety, and personal care. Information was also viewed in relation to an adult protection investigation, carried out by the Commission for Social Care Inspection (CSCI), concerning the home in October 2004; some elements of the investigation were upheld. The Inspector would like to thank residents and staff for the enthusiastic and helpful manner in which they participated in the inspection process. What the service does well: What has improved since the last inspection? Greenbank H59-H10 S21120 Greenbank V218594 260405 Stage 4.doc Version 1.20 Page 6 The home have developed a suitable quality assurance format for gaining the views of residents families, carers, and friends as to the level of care being provided. Comments received since the last inspection have all been very positive. The homes statement of purpose has been amended to include the contact details of relevant care agencies, such as Social Services. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Greenbank H59-H10 S21120 Greenbank V218594 260405 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Greenbank H59-H10 S21120 Greenbank V218594 260405 Stage 4.doc Version 1.20 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 standard(s) 3, 4, 5, and 6. The home have a robust and comprehensive approach to assessing the needs of each resident prior to admission, and place residents at the centre of their planning. EVIDENCE: Care plans viewed contained comprehensive pre admission information, such as hospital reports, notably in respect of any assessment made regarding dementia. Care plans also contained social services assessments, and background histories, The care plan relating to the most recently admitted resident contained clear and relevant information regarding previous and current health issues, physical and mobility assessments, plus a considerable amount of social history gained from a social worker, doctor, and relative. Pre admission questionnaires confirmed that full needs assessments had been carried out by the manager prior to residents arriving at the home; these highlighted the medical, physical, and social care needs of each resident with a clear objective of how care staff are to meet such needs. Greenbank H59-H10 S21120 Greenbank V218594 260405 Stage 4.doc Version 1.20 Page 9 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. The home do not offer intermediate care. Greenbank H59-H10 S21120 Greenbank V218594 260405 Stage 4.doc Version 1.20 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 standard(s) 7, 8, and 9. Clear, relevant, and accurate planning and recording, enables the home to meet the assessed needs of residents. The home must be vigilant to ensure the medical needs of residents are protected. EVIDENCE: Care plans were seen to contain comprehensive and clear information regarding just how care staff are to meet 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. There was recorded evidence of risk assessments having been undertaken in relation to residents including their levels of mobility and risk of falls. 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 Altzheimers and Parkinsons. There was evidence that care staff receive appropriate awareness training in relation to such illnesses and how they may impact on residents. The home also utilise specialist help, and there were records of one resident having regular contact with an Greenbank H59-H10 S21120 Greenbank V218594 260405 Stage 4.doc Version 1.20 Page 11 alzheimers nurse. Records confirmed that residents were registered with local doctors and that they 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. Records of medicine administration indicated that clear, accurate, and up to date, information is maintained with regards to the type of medication, the amount given, and the date and time of when administered. They also include evidence of when medicines have been refused by residents. However one residents record had not been kept up to date. Greenbank H59-H10 S21120 Greenbank V218594 260405 Stage 4.doc Version 1.20 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 standard(s) 12, 13, and 15. The home endeavours to meet the lifestyle needs of residents and encourages and supports contact with family, carers, and friends. The dietary requirements of residents are met by the home. EVIDENCE: The times of meals are advertised around the home and are set at reasonable and realistic times of the day. A plan of activities was evident which included creative and interactive events such as music therapy, movement and singing, and plays put on by professional groups specialising in performances for older people. Due to the level of comprehension amongst residents it was not possible to gain any clear feedback as to the quality of such activities. The manager stated that many residents enjoyed the activities notably the more interactive events such as music and movement and singalongs and expressed a desire to pursue creative activities further. 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. The menu indicated that the home provides residents with a varied, wholesome and nutritious diet. The dining room area is pleasantly situated overlooking the garden and is furnished appropriately. The home have a ‘likes Greenbank H59-H10 S21120 Greenbank V218594 260405 Stage 4.doc Version 1.20 Page 13 and dislikes’ book in which residents tastes regarding the type of foods they like/dislike are recorded, this being kept with the menu in the kitchen. One resident had been noted as being a vegetarian, however it was unclear as to whether this resident received such a diet. Greenbank H59-H10 S21120 Greenbank V218594 260405 Stage 4.doc Version 1.20 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 standard(s) 17 and 18. The home ensures that the rights and choices of residents are supported and maintained, whilst protecting them from harm, neglect, or abuse. EVIDENCE: Records confirmed that since being admitted to Greenbank that all residents have been included on the local electoral roll and are often assisted by their family and friends to vote via the posting system. 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, including ‘what to do’ in the event of discovering, or having concerns, that residents have been mistreated or harmed. Staff spoken to had a clear understanding of such procedures and a good understanding of adult protection issues in general. The homes accident book was viewed and this confirmed that all entries were relevant and legible. One entry regarding a residents fall did not have a date, however by viewing the relevant residents daily log the date was found and added to the accident book records. Greenbank H59-H10 S21120 Greenbank V218594 260405 Stage 4.doc Version 1.20 Page 15 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 standard(s) 19, 20, 24, 25, and 26. The home’s environment is generally suitable to meet the needs of all residents. However, the home must review it’s health and safety polices and procedures to ensure that residents are kept safe. EVIDENCE: Greenbank has generally been maintained to a good structural order both inside and out and has been decorated in a homely style. A number of residents bedrooms were viewed and these were seen to be in good order having been personalised with photo’s, pictures and ornaments. Many bedrooms also had pressure mats fitted underneath bedside rugs, these mats were linked to a central call point which subsequently alert night staff of a resident leaving, or indeed falling during the night. The home has a reasonable amount of communal living space that have a TV and stereo; there is also a garden to the rear of the property with easy access for all residents. The home was found to be clean, tidy, hygienic and free from any odours or smells. However there were a few areas of the home that appeared in need of repair and up keep, such as a loose fitting mirror in an enGreenbank H59-H10 S21120 Greenbank V218594 260405 Stage 4.doc Version 1.20 Page 16 suite bedroom, a wire hanging low above a fire door, and the door to the dinning room, having been removed, being stored behind a sideboard. On the day of the inspection it was found that some fire doors had been propped open by wooden door stops, unused wheelchairs had been stored in the lounge, whilst a chair was left blocking the entrance to the dining room. 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. Fridge temperatures were recorded as being checked daily. Greenbank H59-H10 S21120 Greenbank V218594 260405 Stage 4.doc Version 1.20 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, and 30. The assessed needs of residents are met by the numbers and skills of care staff deployed at the home. The home ensure care staff are aware of their duties and responsibilities. The home must review it’s polices and procedures to ensure the protection of vulnerable adults. EVIDENCE: On the day of the inspection the manager was working as a member of care staff, she stated this was due to staff shortages on the day. The rota indicated that three or four members of care staff are on duty during the day, whilst two members of ‘waking night’ care staff are on duty during the night; either the manager, who lives on site, or her deputy, are also ‘on call’ for support and assistance when necessary. The home employs a cook who also undertakes domestic cleaning duties. Staff files confirmed that many care staff had previous experience within the care profession prior to being employed at Greenbank, whilst five members of care staff are currently undertaking National Vocational Qualifications (NVQ) in care. The home have developed a commendable staff handbook which contains comprehensive information about the home in general and care staff duties and expectations in particular. The handbook highlights relevant policies and procedures and is given to staff once they are employed at the home. Records indicated that care staff have completed relevant training such as: First Aid, Safe Handling and Lifting, Medicine Administration, Health and Greenbank H59-H10 S21120 Greenbank V218594 260405 Stage 4.doc Version 1.20 Page 18 Safety, and Dementia Awareness. However the previous inspection highlighted a need for the home to implement a training programme that is accredited by the Training Organisation for Personal Social Services (TOPSS), this has yet to be put in place. The manager stated that she and the proprietor are in the process of identifying a suitable training programme that will be implemented in the near future. Staff files confirmed that the home do not employ staff without first following the necessary procedures as required by legislation. This includes gaining suitable references, employment histories, and Criminal Records Bureau (CRB) checks. However one staff file did not contain confirmation of a CRB disclosure check having been completed. Greenbank H59-H10 S21120 Greenbank V218594 260405 Stage 4.doc Version 1.20 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 36, 37, and 38. The management approach of the home ensures that the best interests of residents are of paramount importance, whilst encouraging an open, relaxed and caring environment. The management of the home must ensure that appropriate measures are implemented to supervise care staff, whilst policies and procedures to protect vulnerable adults must be adhered to. EVIDENCE: The manager of Greenbank has worked, and indeed lived, at the home for a considerable number of years. She has an approach toward caring for older people with dementia type illnesses which is knowledgeable, caring, and committed. Care staff confirmed that they felt supported by the manager and stated that she would carry out ‘spot checks’ during the day and night when she was not due to be working to ensure there were no problems in the home. 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. Greenbank H59-H10 S21120 Greenbank V218594 260405 Stage 4.doc Version 1.20 Page 20 Records of the home’s quality assurance questionnaires that had been developed by the management team were viewed. These contained appropriate questions for relatives and carers to complete in regard to the level and quality of care they felt residents received at the home. The questionnaires have been developed for ease of completion and could be completed anonymously. Comments included ‘very high standard of care’ and ‘it’s just like a home’. The previous inspection report made a recommendation that the management team should develop a suitable system of formal staff supervision. Staff records indicated that such supervision has yet to be implemented. The manager stated that her deputy has been given the delegated task of implementing formal staff supervision, though this process has not yet started. 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, up to date, 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. Greenbank H59-H10 S21120 Greenbank V218594 260405 Stage 4.doc Version 1.20 Page 21 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 x x x 3 2 3 STAFFING Standard No Score 27 3 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x 3 2 x 3 3 x x 1 3 3 Greenbank H59-H10 S21120 Greenbank V218594 260405 Stage 4.doc Version 1.20 Page 22 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 OP9 Regulation 17(1) (a) Requirement That the home must ensure accurate records of medicine administration are maintained at all times (outstanding from previous inspection). That the homes environment must remain free from hazards and obstructions at all times. That fire doors must not be propped open unless by approved fire service equipement. That the home must ensure they comply with legislation in relation to the recruitment of staff. That a system of formal staff training be implemented. The home must ensure that when recording in the accident book that the date and time must be entered. Timescale for action Immediate 2. 3. OP19 OP25 13(4)(a) 13(4)(c) Immediate Immediate 4. OP29 17(2) Immediate 5. 6. OP36 OP18 18(2) 17(1)(a) 26th October 2005 Immediate RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Greenbank H59-H10 S21120 Greenbank V218594 260405 Stage 4.doc Version 1.20 Page 23 No. 1. Refer to Standard OP15 Good Practice Recommendations That where a resident or their relatives/carers or advocates have indicated a dietary need, such as being a vegeterian, that the home records this and implements a varied menu accordingly. That the home develops a pictorial menu, ie pictures of meals etc to display in the dining area on each particular day. That the home includes comments gained via its quality assurance questionaires in its statement or purpose. That mangement staff undertake formal supervision training. 2. 3. 4. OP15 OP33 OP36 Greenbank H59-H10 S21120 Greenbank V218594 260405 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection 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 H59-H10 S21120 Greenbank V218594 260405 Stage 4.doc Version 1.20 Page 25 - 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!