CARE HOMES FOR OLDER PEOPLE
Greenacre Brewers Hill Road Dunstable Bedfordshire LU6 1UU Lead Inspector
Dragan Cvejic Unannounced Inspection 13th December 2005 09:00 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 Greenacre DS0000014904.V273104.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. Greenacre DS0000014904.V273104.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Greenacre Address Brewers Hill Road Dunstable Bedfordshire LU6 1UU 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) 01582 603029 BUPA Care Homes (Bedfordshire) Ltd Mr Ian Dunthorne Care Home 42 Category(ies) of Dementia - over 65 years of age (42), Learning registration, with number disability (1), Learning disability over 65 years of places of age (42), Old age, not falling within any other category (42), Physical disability over 65 years of age (42) Greenacre DS0000014904.V273104.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Addition of category LD The home can provide care for one service user who is under 65 years and has a learning disability. This condition applies only to the one service user who has been identified to the National Care Standards Commission. At such time as that identified service user ceases to live at the home, the NCSC must be informed immediately and the category LD and this condition of registration will be removed. 19th July 2005 Date of last inspection Brief Description of the Service: Greenacre is a large purpose-built home for older people, situated in a residential area on the outskirts of Dunstable. It is close to local amenities such as schools, local shops and places of worship, but too far from the town centre for service users to be able to walk there. The home is on a bus route and the bus stop is in front of the home. Attached to the building is a day centre for people with dementia, which offers a service to people living in the community and at Greenacre where appropriate. The home is organised into five separate living units and offers services to people over 65 years, including one unit for people with dementia and one for people with learning disabilities. Built into a square shape, it has an enclosed garden area that was arranged attractively and contained a bird avery and a fishpond. Greenacre DS0000014904.V273104.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. It was carried out during one working morning within 5 hours. The manager was not present, but the deputy manager helped and facilitated the inspection. Eleven service users, four staff members and three visitors provided comments about the home that are quoted in this report. The home did not meet the requirements from the last inspection, but an action plan was drawn up and they tried to address issues that did not meet the standards and that service users identified as areas where the home should be doing better. A number of users commented on the poor quality of food What the service does well: What has improved since the last inspection?
The home had carried out a quality assurance review that allowed them to audit and identify areas that could be improved. The results pointed to the
Greenacre DS0000014904.V273104.R01.S.doc Version 5.0 Page 6 catering aspect of provisions. Service users expressed dissatisfaction with food. A complaint received in the home also addressed the poor quality of food served. The management team analysed the problem in depth and created an action plan to improve and resolve identified problem areas. Risk assessments were now reviewed and up-dated, and ensured better protection of service users. 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. Greenacre DS0000014904.V273104.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 Greenacre DS0000014904.V273104.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): 3,4,6 The admission assessment was thorough and ensured the place was appropriate for service users and they could be sure that their needs would be met upon admission. EVIDENCE: The service users’ files contained the admission assessment documents. They demonstrated that all relevant aspects of users’ lives were assessed. The home used the assessment to ensure that users’ needs were met once they were admitted. History of falls was further assessed during the initial trial period. Risk assessments were drawn up at that time and covered identified hazards and provided proposed action to eliminate or reduce risk. Service users and visitors spoken to confirmed that the home met users’ needs. Care plans differed in content for those with physical disabilities, for those with learning disabilities and for the general group of frail elderly. The home did not provide intermediate care. Greenacre DS0000014904.V273104.R01.S.doc Version 5.0 Page 9 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): 7,8,9,10 The service users’ files were detailed documents and were effectively used to offer good care to each individual. Seeing users as individuals meant concentrating on the individually assessed need and ensured appropriate actions were taken to meet these needs. Medication procedure was appropriate and protected service users, and the home was expanding this protection through further improvements to medication procedures. EVIDENCE: Care plans were drawn up from the initial assessment and explained in detail the tasks and goals for service users. “Transfer needs to be slow paced”, stated one instruction in a care plan, showing the detail recorded. The newer records of reviewed risk assessments showed that they were reviewed monthly, with care plans from April this year. Visits of external health professionals were particularly well recorded. Apart from the records of visits with signatures and comments, the home created a chart to monitor the frequency of these visits through the year. Report sheets used to record daily progress were also well recorded and demonstrated that entries were made according to changes and needs for each individual. One sheet had 6 entries in one day, while another had 18 recorded entries.
Greenacre DS0000014904.V273104.R01.S.doc Version 5.0 Page 10 A senior staff member was observed administering medication. She prepared the medication trolley in the surgery room before taking it to the service users. The home was in the process of changing medication practice and changing from NOMAD system to blister packs. Some medication was still delivered in boxes, rather than pre-packed in blister packaging system. Records of medication, including controlled drugs, were correct and accurate. Privacy and dignity were respected and promoted both in the home’s documents and in practice. One care plan stated: “post to be given to user, or to wait for his relative’s visit to be opened”. Another user confirmed that clothing care and personal choice were highly respected. Greenacre DS0000014904.V273104.R01.S.doc Version 5.0 Page 11 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): 12,13,14,15 The home offered structured and set activities that met the needs of service users. The daily routine was flexible and was subject to decisions made by service users during their meetings. Despite the home’s plan and action regarding the food, the service users still were not satisfied with the quality of food provided and further action was needed to improve this provision. EVIDENCE: Service users held their monthly meetings regularly. They decided on a daily routine in the home and discussed activities. A service user and a visitor commented that activities were appropriate and matched service users expectations and preferences. Friends and relatives were welcome in the home and one of the activities, coffee mornings three times a week, attracted relatives and visitors to visit the home more often. Service users interacted with each other. A service user admitted due to isolation in her own home, who was sinking into depression, regained social stability soon after her admission. Her relative commented: “She is a different person since she came here. She is sociable again and she sees sense in life. This is very good place for her.” The service user confirmed this statement. Greenacre DS0000014904.V273104.R01.S.doc Version 5.0 Page 12 Some service users retained control of their money, while some needed help and used BUPA’s financial system that ensured financial protection. Balances and statements checked were accurate. The home did not have a standard procedure for recording service users’ personal belongings. Records were kept for newly admitted users, but those who had been in the home longer did not have these records. It was agreed for an audit to be organised, lists formed and then kept up to date. The home had reacted to the requirement from the last inspection to improve the standards of food. However, the plan did not give expected improvements within a reasonable time scale and it was obvious that it needed revising. The home still did not have a stable, permanent cook and the deputy manager was allocated one day/week to oversee the kitchen, but the time allocated did not seem to be sufficient. While the home waits for the new cook, the deputy manager must be given more time to focus on the kitchen and food standard issues, as an interim measure. Greenacre DS0000014904.V273104.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 had an effective complaints procedure that allowed all people with potential concerns and complaints to raise them. The home looked at each complaint seriously and ensured good protection of service users by investigating issues raised and by implementing protection policy. EVIDENCE: The home had received a complaint that was investigated and an outcome was reached. This investigation was carried out by an external investigator and demonstrated that BUPA was considering complaints seriously and used them to improve services and provisions. However, slow progress with food related improvements, which were initially raised as a complaint, showed that the organisation should support the home more with overcoming problems and negative complaint outcomes. Protection of service users was in place through the policies, procedures and practice of safe working in the home. Greenacre DS0000014904.V273104.R01.S.doc Version 5.0 Page 14 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): 19,24,25,26 The purpose built building was well maintained, equipped and arranged in a pleasant, domestic style and offered a comfortable living environment to service users. EVIDENCE: The home was located in a quiet street in Dunstable and being purpose built, environmentally met the needs of service users. The home was accessible throughout to all service users. The home was regularly inspected by fire service and environmental health and there were no requirements following their inspections. Communal areas were comfortable and arranged in a homely manner. Operational division of the home to units was facilitated by the existence of small dining areas and separate lounges in each unit. The lighting was appropriate and two service users confirmed that they loved to and could read in communal areas. As a part of case tracking, four service users’ bedrooms were inspected, and met the standards, apart from discrepancies in hot water temperatures taken in two bedrooms. This issue was addressed during the inspection and a maintenance man undertook immediate action to rectify the problem.
Greenacre DS0000014904.V273104.R01.S.doc Version 5.0 Page 15 Private bedrooms had lockable facilities in addition to lockable doors. One of the inspected bedrooms had a hand-rail fitted, demonstrating that rooms were individually assessed to meet the needs of service users. One unit had repeated, continuous problems with the supply of hot water despite a number of interventions by the maintenance section and the replacement of boilers. Both the manager and the maintenance department were aware of the problem and were trying to identify the cause and eliminate the problem. The home was clean and infection control measures were in place. The laundry service operated efficiently and laundry and cleaning staff commented that they were not particularly affected by the problems with the hot water supply. Greenacre DS0000014904.V273104.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): 27,28,29,30 The care staff were able to meet users’ needs in areas of their responsibility. The kitchen was not staffed to the level to ensure that users needs were met. EVIDENCE: The home employed sufficient and skilled care staff. However, the home had serious problems with kitchen staff. At the time of the inspection the deputy manager was overseeing catering arrangements, but the outcome: the quality of food, still had not improved to a level which satisfied service users. The action plan created and implemented by the home did not give satisfactory results and there was a need to review and adjust the plan. The maintenance man had started work in this home only 6 weeks prior to this inspection and stated that he had identified and acted upon all reported faults, but was still learning about the major issues affecting the home. Fourteen staff had completed their NVQ training, 3 more were at the end and three more were on this programme at the time of the inspection. The home followed company policy for recruitment, ensuring all new staff were properly checked prior to the job offer and provided with a structured induction based on the Skills for Care programme. Staff from abroad employed by the home were also properly vetted. The home emphasised training and training records showed recent updates of Fire training, Manual Handling, and Food and Hygiene with 8 staff currently doing the course and twelve more who were going to start. This last training was also part of the action plan for improving catering arrangements. Greenacre DS0000014904.V273104.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): 31,32,33,35,36,37,38 The home was managed by the experienced, qualified and skilled manager. His management style ensured an open atmosphere where service users’ welfare and safety was promoted and protected. EVIDENCE: The manager was experienced and had run this home for a number of years. A quality assurance survey was carried out by an external facilitator and the action plan focused on the catering arrangements. This action plan coincided with the action plan set and implemented by the home as a response to the requirements from the last inspection. Service users were encouraged to keep their money as long as they were capable of doing so. For those users that could not manage their money, the company, BUPA, had a system in place to protect their financial interests. A few service users held small amounts of money with them, while the majority used the benefits of the BUPA system. Balances inspected were correct. Greenacre DS0000014904.V273104.R01.S.doc Version 5.0 Page 18 Staff confirmed that the frequency and content of their supervision sessions was appropriate. Supervision plan for deputy manager was inspected and was appropriate. The staff received all mandatory training and extra sessions on users’ condition related subjects. Greenacre DS0000014904.V273104.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 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 1 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Greenacre DS0000014904.V273104.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 OP27OP15 Regulation 16,18 Requirement The home must ensure that a competent and skilled cook is employed who will be able to cook the meals according to chosen menus, to the expected quality, and that food provided does not vary in quality on particular days in the week. Timescale for action 31/10/05 2 OP15 16 3
Greenacre OP14 16 This is a requirement from the last inspection that was not met. Although an action plan was drawn up, the outcome for service users was not met. The new requirement is set out below to focus on the outcome. 15/01/06 The home must ensure that the quality of food meets service users’ needs, expectations and respects food hygiene principles. In order to ensure improvements, as a temporary, interim measure the home must allocate sufficient time, two days per week to start with, to a delegated person who would oversee and monitor catering provisions. The home must arrange and 30/01/06 record private possessions
DS0000014904.V273104.R01.S.doc Version 5.0 Page 21 brought into the home by service users and keep these records up to date for all service users, not only for those recently admitted. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP25 Good Practice Recommendations The home should aim to rectify problems with the hot water supply on a permanent basis by engaging specialists who would be able to identify and eliminate the cause of the disturbed supply. Greenacre DS0000014904.V273104.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Greenacre DS0000014904.V273104.R01.S.doc Version 5.0 Page 23 - 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!
