Inspection on 11/05/07 for Greenacres

This inspection was carried out on 11th May 2007.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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Newton Court (1-2)

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Pemdale

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

CARE HOME ADULTS 18-65 Greenacres The Street Felthorpe Norwich Norfolk NR10 4DQ Lead Inspector Andy Green Unannounced Inspection 11th May 2007 2.45pm Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 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 Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenacres Address The Street Felthorpe Norwich Norfolk NR10 4DQ 01603 754451 01603 400418 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) New Boundaries Community Services Limited Robert James Rolland Jenner Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16/5/06 Brief Description of the Service: Greenacres is a three bed roomed home which was registered as a care home in August 2004. The home is situated in the village of Felthorpe, which is a few miles from the city of Norwich The home provides care and support for 3 residents with learning disabilities. Bedrooms are located on the ground and first floors. There are communal lounge, dining and kitchen areas. There is a bathroom with integral shower. Residents living in the home access a combination of day services, including those operated by the proprietor. The home does not have its own transport, however, transport is made available from another of the homes operated by the proprietor nearby. The charges range from £1153.61 to £1605.32 per week. Copies of inspection reports are available to residents and their representatives from the home’s office. Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Andy Green, Regulation Inspector, undertook this key unannounced inspection on 11th May 2007. The inspector met with the manager and inspected a number of documents including care plans, staff files, training records, medication records, fire records and the provider’s management visits. A tour of the premises was also undertaken and the inspector spoke to residents and a member of care staff on duty. What the service does well: What has improved since the last inspection? What they could do better: The current format of The Statement of Purpose needs to be reviewed as the document reflects the organisations aims rather than specific information regarding the home. There still continues to be problems regarding lack of choice for residents when accessing the community due to the staffing levels, access to transport and the secluded situation of the home. This was raised at the previous inspection and needs to be addressed. A record of meals that are consumed during each day needs to be implemented. The manager has not received any formal supervision from his line-manager and this must be actioned by the provider. This was a requirement made at the last inspection and will be restated. Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 6 Annual quality assurances reports need to be submitted to CSCI on an annual basis. This was a requirement from the last inspection and will be restated. 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. The summary of this inspection report can be made available in other formats on request. Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides information to residents and their relatives before they move in so that they are aware of all the services provide. However the Statement of Purpose needs to be reviewed to be more specific about the home. EVIDENCE: The Home has a Statement of Purpose and a brochure, which provides information to prospective residents and their relatives regarding the services provided in the home. There have been no changes to the Statement of Purpose since the last inspection. The manager stated that this document will be reviewed to ensure that the information regarding the home remains up to date and accurate. It was also noted that the current format of The Statement of Purpose needs to be reviewed as the document reflects the organisations aims rather than specific information regarding the home. The manager stated that the document would be altered to ensure that the home’s services were better represented. Since the last inspection two residents have moved to other homes in the organisation due to their changing needs and two new residents have moved in. Records show that detailed assessments were carried out by the Manager, Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 9 which involved the resident, previous carers and other professionals involved in their lives. The assessment forms the basis of the care plan, which is made available prior to the new resident’s admission to the home. The care plan is updated following a review for the resident. Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are treated with dignity and respect and receive personal care to meet their assessed needs. EVIDENCE: Two care plans were inspected and they contained detailed information to give staff clear guidelines in how to meet the resident’s health, social care needs and activities. The persons likes and dislikes are recorded along with a detailed personal profile. The care plans also contain risk assessments, which provide guidance to staff about how to manage situations assessed as being of medium to high risk. There was evidence that the care plans had been reviewed with detailed notes in place following the first formal review for the resident. Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 11 The residents are aware of the existence of their care plans and participate in the process as much as possible. A member of staff confirmed that she was aware of the care planning processes and that she used them as a working document. Daily records are kept for each of the residents, detailing information about a range of issues on a daily basis. Residents take part in the day-to-day running of the home and join in with domestic chores with staff assistance. The majority of residents are out during the day but participate in chores during the evening and weekend. Staff were observed to offer choices to the residents and to ask them their views about a range of issues during the Inspection. Staff were observed to be supportive and friendly and spoke to residents in an appropriate manner. Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff provide appropriate support to ensure that residents can engage in activities appropriate to their needs. EVIDENCE: All of the residents attend formal day services for the majority of the week with transport provided by the local authority. The residents continue to participate in shopping trips and attend a social club on one / two evenings per week. The home is situated in a rural village and there are very few facilities within walking distance. The home continues to share the use of a vehicle with one of the other homes owned by the organisation. There is usually only one member of staff on duty when there are residents at home. It was noted that there has been an increase in staffing by 13 hours, which are used mainly at weekends so that additional choice can be given to residents. However there still continues to be problems regarding lack of choice for residents when accessing the community. The three residents living Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 13 in the home have diverse interests and it is quite likely that they will not all enjoy the same social interests. The home also has a limited number of staff who can drive which also reduces choice for residents. Occasionally residents go on daytrips with residents and staff from the other nearby homes when transport is available. These concerns regarding the lack of choice were highlighted in the last inspection report and need to be addressed. A requirement will be made regarding the lack of choice regarding activities and accessing the community. The care plans contain information about the residents friends and relatives and the arrangements in place to enable the resident to maintain contact with the people who are important to them. All residents are supported to visit family and friends or for them to visit them at the Home. The rights of the residents are respected and understood by the staff. Staff were seen to knock on bedroom doors prior to entering to preserve the privacy and dignity of residents. The staff provide support to the residents in understanding their responsibilities, particularly with regard to the fact that they share the house with two other people. The care plans reflect this with appropriate risk assessments in place regarding behavioural issues. A menu is completed in consultation with residents at the house meetings and directly with individual residents in more informal chats for the forthcoming weeks. A record of the residents weight is kept in their care plans. It was noted that although there were set menus in place there were no records of meals that were consumed during each day. The manager stated that a record book would be implemented as soon as possible. A requirement regarding records of meals will be made. Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are clear guidelines regarding personal care and the safe administration of medication. A risk assessment procedure is in place to protect residents. EVIDENCE: Care staff continue to assist residents with their personal care needs as required. The care plans contain details about how the physical and emotional health needs of the residents are to be met and the staff have a good understanding of this. The care plans contain evidence that residents receive appropriate input from healthcare specialists including visits from a chiropodist. Appointments with GP’s, dentists and opticians are arranged as required. Residents are also assisted by care staff to attend out hospital out- patient appointments when necessary. The medication system was inspected and the recording procedure has been amended to ensure that all medication is clearly recorded on one sheet to avoid any discrepancies as highlighted in the last inspection report. Medication administration records were accurately recorded. Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 15 All staff receive training which is assessed by the Manager prior to administering medication alone. The Team Leader continues to be responsible for the ordering and checking of medication stored in the home. Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints process to make sure that residents and their representatives are able to raise concerns and have them dealt with appropriately. EVIDENCE: One complaint had been received from a resident concerning the behaviour of another resident in the home. This has been satisfactorily resolved to the resident and her relatives satisfaction. There have been no further complaints made to the Manager or to the Commission. The Home has a complaints procedure and residents are made aware of who to speak to if they wish to raise any concerns. The training records show that staff receive training with regard to the protection of vulnerable adults both in their induction and in ongoing training. A member of staff confirmed that she had received POVA training and was clear about her responsibilities if there were any allegations of abuse. The manager also stated that agency staff receive appropriate training to ensure that residents are protected from abuse. Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment of the home provides residents with a safe, comfortable, clean place to live. EVIDENCE: One of the residents showed the Inspector around the Home, including their bedroom. The home is attractively presented and provides a homely, comfortable home for the residents. The communal lounge provides adequate seating for the residents and the kitchen is hygienic and well maintained. Residents are encouraged to bring their own furniture if they wish to and have been supported to personalise their bedrooms with photographs, music systems, televisions, pictures and ornaments. One of the residents bedrooms has been recently redecorated with a colour of her choosing. Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 18 The garden is well maintained and the manager stated there are plans to add more planted areas. Residents will also be encouraged to take more part in creating areas of the garden for themselves. It is recommended that a maintenance plan is put in place so that the home is aware of which areas will be decorated on an ongoing basis throughout the year. Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s recruitment policy and processes ensure that residents are protected from harm. Training is provided to make sure that care staff are competent to deliver personal care to the residents they support. EVIDENCE: Since the last inspection a new manager has been appointed who also provides management to of the organisations two nearby homes. There is also a team leader and two care staff employed in the home. Agency staff are not used on a regular basis except for emergencies or sickness. The Manager stated that another permanent member of staff is due to start at the Home shortly and that this will mean that very few agency staff will be needed. The manager tries to ensure that the agency staff on duty are those who know the residents and the home well. At the time of the inspection there were was one member of care staff on duty who confirmed that she had received a thorough 6-week induction and ongoing training including; moving & handling, fire safety, first aid, care planning, POVA, autism and challenging behaviour strategies. She also confirmed that she receives regular recorded supervision from the team leader. Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 20 Training with regard to mental health issues is being organised to ensure that staff have appropriate knowledge to assist one of the residents who has mental health issues. The Manager carries out formal supervision for the Team Leader and records are kept of this as well as any informal support/supervision provided. The member of care staff said that she felt well supported by the manager and team leader. The manager stated that he has not received any formal supervision from his line-manager. This has been previously raised and a requirement was made at the last inspection. This must be actioned by the provider. A further requirement will be made regarding this issue. Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well managed and the manager provides supportive leadership and guidance to staff. However, improvements are needed regarding records that are required EVIDENCE: The new manager was registered in January 2007 and he also manages two of the organisations nearby homes. The manager is currently undertaking NVQ Level 4 and also undertakes other training as appropriate. The manager receives informal support from the other managers within the organisation and meets more formally with them and the Proprietor on a monthly basis. The managers in other homes take part in an on call system, which provides support to the staff on a 24-hour basis The organisation is in the process of implementing a more formal quality assurance process with monthly audits. The views of the residents continue to Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 22 be sought in a variety of ways, including house meetings, care plan reviews and general day-to-day situations. The manager is aware of the need to bring together all of the individual quality assurances processes into a formal report on an annual basis. This was a requirement from the last inspection and will be restated. A requirement will be restated. The health and safety needs of the residents and staff are taken seriously with regular checks on equipment being carried out. A recent fire officers visit has recommended that fire doors and smoke detectors are installed. Risk assessments are carried out for individual residents and for situations within the Home. It was also noted that the administration processes in the home would benefit from an upgrade including an office phone instead of the use of a payphone. The manager stated that this did not give a professional presentation of the home especially when the money was running out during a call. The home would also benefit from the aid of a computer/printer system so that documents can be dealt with in-house rather than having to be handwritten and then typed up at the organisations office. Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 3 3 X X 2 X Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 24 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 YA14 Regulation 16 (m) Requirement Residents must be supported to take part in activities of their choosing. This was a requirement from the last inspection, failure to comply may result in legal action being taken against the home. The manager must receive formal supervision on a regular basis. This was a requirement from the last inspection, failure to comply may result in legal action being taken against the home. An annual quality assurance report must be provided to the Commission. This was a requirement from the last inspection, failure to comply may result in legal action being taken against the home. A record of all meals consumed during the day must be kept. Timescale for action 31/07/07 2 YA36 18 30/06/07 3 YA39 24 31/07/07 4 YA17 17(2) Schedule 4. 30/06/07 Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 25 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 YA37 Good Practice Recommendations It is recommended that the administration processes in the home are reviewed to provide a more professional approach. Greenacres DS0000068107.V340276.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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