CARE HOMES FOR OLDER PEOPLE
Green View House 34 Greenhead Road Huddersfield West Yorkshire HD1 4EZ Lead Inspector
Tracey South Unannounced Inspection 24th November 2005 09:20 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 Green View House DS0000064138.V254480.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. Green View House DS0000064138.V254480.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Green View House Address 34 Greenhead Road Huddersfield West Yorkshire HD1 4EZ 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) 01484 306633 01484 300066 Green View House Limited Care Home 33 Category(ies) of Dementia - over 65 years of age (33), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (33) Green View House DS0000064138.V254480.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Can accommodate one service user under 65 years of age - category DE 9th August 2005 Date of last inspection Brief Description of the Service: Green View House is a care home with nursing. The home has the provision to accommodate 33 older people with mental health care needs. It is a large Victorian building, which stands within its own grounds, with a driveway and car park to the front. There is a frequent bus route to Huddersfield town centre. There are two lounges and a very spacious dining room on the ground floor. The home has 6 bedrooms on the ground floor all of which have ensuite facilities. There are 10 bedrooms on the first floor, three of which are double rooms all have ensuite facilities. Twelve bedrooms are located on the second floor, 4 of which have ensuite facilities. There is a passenger lift, which serves the ground, first and second floor. Green View House DS0000064138.V254480.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 4.5 hours. There were 31 residents living at the home on the day of the inspection. Case files, care plans, complaints log, training data and health and safety documentation were examined. One service user, two relatives and three members of staff were spoken to. Their comments have been included as part of this report. There is currently no registered manager at the home. One of the registered owners, Claire Detraux is to submit an application to the CSCI to become the registered manager for Green View House. The last inspection took place on 9th August 2005 when the majority of the core standards were assessed. The home received an additional visit on 23rd September 2005. The purpose of the additional visit was to investigate concerns raised by the Huddersfield Primary Care Trust. The concerns raised were in respect of one resident who had developed pressure sores and required hospital admission for specialist treatment. Questions were asked as to whether or not the home provided the appropriate level of care to the resident whilst living at the home. As a result of the investigation, six requirements were made and the registered owners were required to provide an action plan of how and when they would address those requirements. An action plan has since been provided and the CSCI have met with the registered owners to discuss the measures they have put into place to prevent such an incident being repeated. What the service does well:
Residents looked well cared for and the atmosphere at the home was warm and relaxed. One resident said she felt safe and that the staff who looked after her were kind. Residents and staff were seen interacting well with each other, throughout the day of the inspection. Those staff spoken to said the atmosphere at the home was relaxed and that staff morale was good. Care staff felt that the registered owners were both approachable and supportive. One of the care staff who has worked at the home for a number of years said the atmosphere at the home is much better than it was and the new owners have made a big difference to the fabric of the building and most importantly staff now feel valued. Green View House DS0000064138.V254480.R01.S.doc Version 5.0 Page 6 Residents are encouraged to make their own decisions about how they spend their day. Residents were seen getting up at different times throughout the morning. The residents have safe access to the majority of the downstairs accommodation and are able to walk around the home without feeling restricted. Visitors said they were made to feel welcome whilst in the home and that they were always offered refreshments. One relative explained how he has been invited to have Christmas dinner with his wife who lives at the home. Relatives indicated that staff are good at their job and that residents are well looked after. Relatives knew who to approach should they have any concerns about the home. Care plans contained detailed information about the needs of the resident and the level of support they require to ensure those needs are met. What has improved since the last inspection? What they could do better:
The manual handling assessments need to clearly identify the level of support required by staff. This must also include any equipment being used. Visitors felt that more care could be taken when washing personal items of clothing. They explained how clothes had been ruined and there were occasions when certain items of clothing had not been ironed properly. Green View House DS0000064138.V254480.R01.S.doc Version 5.0 Page 7 Care staff need to refrain from writing opinionated and judgemental comments when completing daily reports. Whilst it is acknowledged that the registered owners have focused their efforts on the care planning in the home, it is important that they pay particular attention to the health and safety standards. Every effort must be made to ensure that effective health and systems are put into place as a matter of urgency. 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. Green View House DS0000064138.V254480.R01.S.doc Version 5.0 Page 8 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 Green View House DS0000064138.V254480.R01.S.doc Version 5.0 Page 9 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): None of these standards were assessed on this occasion. EVIDENCE: Green View House DS0000064138.V254480.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): 7,8,11. Care plans are detailed. Good progress has been made in ensuring the health care needs are being met. EVIDENCE: Since the last inspection a further review of the care planning process has taken place. All care plans are currently being reviewed and amended as required. Three care plans were examined each contained detailed information about the needs of the resident. The plans clearly outlined the level of support required by staff. Monthly reviews have been taken place since October 2005. The resident’s relative had signed one care plan. Daily reports are maintained in respect of each resident. Both nursing and care staff are responsible for recording daily events. Whilst looking through the daily reports there were a number of judgemental and opinionated comments recorded. This was pointed out to the registered owner during the inspection. The owner explained that a new approach to daily reporting is to be adopted as from December 2005. The care staff are to be given prompts on the areas they should be reporting on. Whilst staff take onboard this new
Green View House DS0000064138.V254480.R01.S.doc Version 5.0 Page 11 way of reporting they must ensure they remain non-judgemental and write factual statements. Good progress has been made in ensuring the health care needs of residents are monitored and any concerns are reported and recorded appropriately. Wound charts have been implemented and are used to monitor progress when treating residents suffering from pressure sores. As part of the investigation in September 2005, the home was criticised for not knowing which residents were funded for nursing and those who were residential funded. This has now been addressed and each case file contains written information about the status of that resident. All staff have been informed that non-nursing residents must only receive nursing care from community district nurses and not the nursing staff employed at the home. New sit-on weighing scales have recently been purchased and since the beginning of November 2005 residents are weighed each month, unless it is required more frequently. It is important that when staff are reviewing the nutritional assessment they look at the weight chart; this is not currently happening. New movement and handling assessments have been introduced and whilst the proforma being used is satisfactory there are a couple of issues that need to be addressed. The assessment must be dated upon completion. Some of the forms did not have a space for the date, which may result in staff forgetting to insert it, but most importantly, the assessment must include clear instructions to staff on the level of support they are required to provide. It is also important that staff detail any equipment being used as an aid in transferring the resident, for example, a hoist and the type of sling being used. It was pleasing to note that information about arrangements following death and when residents are ill, is now being sought from those people who know the resident well. The information gathered is recorded in writing. Green View House DS0000064138.V254480.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): None of these standards were assessed on this occasion. EVIDENCE: Green View House DS0000064138.V254480.R01.S.doc Version 5.0 Page 13 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, 18 The home has an appropriate complaints procedure in place. Residents are protected from abuse. EVIDENCE: There have been no complaints received at the home since the last inspection in August 2005. The home has its own complaints procedure, which is displayed in the front entrance of the home. Relatives said they would speak to the person in charge should they wish to make a complaint. Relatives also said that they felt quite confident that any concerns they may have, would be dealt with appropriately. They said they found the registered owner to be an approachable person. All potential staff are checked against the Protection of Vulnerable Adults register prior to them starting work at the home. Six staff attended adult protection training in November 2004. A further 13 people are due to attend adult protection training on 13th December 2005, provided by Kirklees Metropolitan Council. The training is more of a briefing session, which takes place over approximately 3 hours. The home as its own adult protection policy in place. Due to the nature of this service, in that staff are caring for people with very diverse needs, it is inevitable that altercations between residents take place. It is important that staff are clear about when they should refer such incidents to the relevant agencies. As a matter of caution the adult protection unit
Green View House DS0000064138.V254480.R01.S.doc Version 5.0 Page 14 should be informed when residents are physically aggressive towards each other. Green View House DS0000064138.V254480.R01.S.doc Version 5.0 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 the following standard(s): None of these standards were assessed on this occasion. EVIDENCE: Green View House DS0000064138.V254480.R01.S.doc Version 5.0 Page 16 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): 29 Thorough employment checks are carried out prior to new staff starting work at the home. EVIDENCE: The last inspection in August 2005 raised concerns about the recruitment procedures at the home. Since then both the registered owners have instructed senior staff on the correct procedures to follow when recruiting new staff. There has been only one new person employed at the home since the last inspection. The personnel file for that person was examined and it was noted that the person’s most previous employer had not initially been requested to provide the home with a reference. The registered owner explained that this was an oversight on behalf of the previous manager and was confident that this would not happen again. A reference from the employer was eventually requested and received. Green View House DS0000064138.V254480.R01.S.doc Version 5.0 Page 17 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): 38 The home is failing to protect the health, safety and welfare of residents and staff by not having effective systems in place. EVIDENCE: The home has minimal health and safety measures in place. Fire training took place at the home on 19th May 2005 and 22nd November 2005 and 10 staff attended each session. The fire alarm system is checked on a weekly basis. There was no written record of any fire drill taking place at the home. There was no evidence in place to suggest that the following checks are being completed; emergency lighting, means of escape and visual checks. There was no fire risk assessment in place. And there was no record of the fire alarm system being serviced. The only certificate in place related to the servicing of the extinguishers, which had expired in 2003, the more recent certificate could not be located.
Green View House DS0000064138.V254480.R01.S.doc Version 5.0 Page 18 The registered owner explained that lifting equipment was serviced every 12 months and was informed that in accordance with the Manual Handling Operations Regulations 1992 it must be every 6 months. The passenger lift was last serviced on 11th January 2005. There was no certification in place for any other lifting equipment such as, hoists, bath hoists and there was no evidence that the slings used when hoisting residents had been checked. The electrical wiring was last checked on 8th January 2005 and all portable appliances had been tested on 12th December 2004. The registered owner was not aware that the water should be tested for Legionella. Water temperatures are not being checked. Thermostatic valves are fitted to the bathroom outlets and in some of the bedrooms. There was no gas safety certificate in place although the registered owner explained that the boilers have recently been serviced but they had not been sent the certificate. Although the registered owner indicated that there was a health and safety policy in place it could not be located. COSHH (Control of Substances Hazardous to Health Regulations) assessments relating to cleaning substances could not be located. Accidents and incidents are reported and recorded. Staff need to take more care when completing accident forms as some descriptions as to how the accident/incident had occurred were vague. There were no risk assessments in place relating to safe working practices, although there where were individual risk assessments relating to residents. Green View House DS0000064138.V254480.R01.S.doc Version 5.0 Page 19 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 1 Green View House DS0000064138.V254480.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? No 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 OP38 Regulation 13 Requirement The outstanding work in accordance with the fire safety officer’s report must be completed. Fire safety checks must be carried out. Fire drills must be recorded in writing. A fire risk assessment must be implemented. Timescale 30/12/05 Maintenance of fire equipment must take place. Timescale 30/12/05 Lifting equipment must be serviced every 6 months. Timescale 24/11/05 Water temperatures must be checked periodically and recorded in writing. Timescale 30/11/05 The water must be periodically tested against Legionella. Timescale 30/01/06 Gas safety certificates must be
Green View House DS0000064138.V254480.R01.S.doc Version 5.0 Page 21 Timescale for action 30/03/06 2 OP38 13, 23 30/12/05 available for the purpose of inspection. Timescale 24/11/05 The health and safety policy must be located and made available to staff. Timescale 24/11/05 COSHH assessments must be located and should be prominently sited. Timescale 24/11/05 Risk assessments must be in place referring to safe working practices. Timescale 30/03/06 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 Refer to Standard OP7 OP8 Good Practice Recommendations Staff should refrain from recording judgemental statements when writing daily reports about residents. The movement and handling plan should be dated upon completion. The assessment needs to include detailed information about the level of support required including any equipment, which is needed to assist with transfers. Green View House DS0000064138.V254480.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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