Inspection on 24/09/05 for Greenacres

This inspection was carried out on 24th September 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 no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greenacres 27/11/07

Greenacres 25/04/06

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Greenacres Mill Lane South Chailey Lewes East Sussex BN8 4DY Lead Inspector Jon Wheeler Unannounced Inspection 24th September 2005 8:55 Greenacres DS0000063869.V257464.R01.S.doc Version 5.0 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 DS0000063869.V257464.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 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 DS0000063869.V257464.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Greenacres Address Mill Lane South Chailey Lewes East Sussex BN8 4DY 01273 481238 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) East Sussex County Council Vacant Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Greenacres DS0000063869.V257464.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is seven (7). Service users must be aged between eighteen (18) and sixty-five (65) years on admission. Service users with a learning disability only to be accommodated. Date of last inspection 14 April 2005 Brief Description of the Service: Greenacres is an established service that is registered to provide care for up to seven people who have learning disabilities and challenging behaviours. The home is a large bungalow in South Chailey, a village to the north of Lewes. It is in a quiet location, and has large gardens around the bungalow. The home includes seven single bedrooms, a lounge, a dining room, a kitchenette/dining area, a large kitchen, two bathrooms and a sensory room. There are two vehicles to enable people to access services and community facilities. Staff are employed by East Sussex County Council Social Services department, and are responsible for providing the care and day-to-day running of the home. Greenacres DS0000063869.V257464.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on Saturday 24 September 2005, starting at 8.55 am and lasted for just over three hours. The aim of the inspection was to assess standards in the home and check on progress following the inspection on 11 April 2005. During the inspection, three staff and three service users were spoken with. Because of the nature of their learning disabilities, two other service users were not able to clearly express their views about the home. The method of inspection included observing staff working with service users; a brief tour of the home; reading of three care plans, a range of policies and records and looking at the storage, administration and recording of medication. Following the inspection, there was a telephone conversation with the current manager to get further details, as he was not on duty at the time. The staff in the home work hard to try to meet the needs of the service users, who have a range of complex needs and challenging behaviour. Staff provide caring support in difficult circumstances. What the service does well: What has improved since the last inspection? What they could do better: The service should ensure that there are clear, up to date support guidelines for all service users in the care plans and that staff are aware of, and able to put in to practice the specified support at all times. Risk assessments and care plans should be reviewed and updated as necessary. The service should Greenacres DS0000063869.V257464.R01.S.doc Version 5.0 Page 6 ensure that all staff have received training in moving and handling and food hygiene. The service should ensure that the toilet and bathroom facilities are renovated to ensure they meet the needs of the service users, and that fire equipment is regularly checked. The service should report all incidents to the Commission, which affect the health or well-being of service users. 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. Greenacres DS0000063869.V257464.R01.S.doc Version 5.0 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 DS0000063869.V257464.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4. The home has policies and procedures to identify the needs of prospective service users, who have the opportunity to visit the home prior to moving in. EVIDENCE: Whilst no new service users have moved in to the home recently, there was documentary evidence of a robust admissions procedure, where information is sought about prospective service users and they are able to visit the home to meet service users are staff. Due to the nature of the learning disabilities and challenging behaviours of the service users, staff reported that it is difficult to ensure the needs of current and prospective new service users are consistently met. It was reported by staff that it can be difficult to meet all the needs of the service users, if they are trying to manage challenging behaviours. There was a range of evidence that staff have a knowledge and understanding about the needs and support required of each service user. However, it was reported by staff that there are often agency staff used, who do not have sufficient experience or knowledge of the service users to fully meet their needs. Greenacres DS0000063869.V257464.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 9. Care plans and risk assessments were not sufficiently up to date or accurate to ensure the health and safety of service users nor that they would consistently have their needs met. EVIDENCE: Care plans had a variety of information, including background information, service users’ likes and dislikes, daily routines and support guidelines. However, some of the information in the care plans viewed had not been updated, so they did not contain accurate and up to date information. Whilst staff were able to describe some support guidelines, they were not clearly documented in the care plan. In one care plan, there were guidelines to help staff manage the challenging behaviour of one service user. During the inspection, the service user became distressed and whilst one staff member demonstrated a clear knowledge and understanding of the behaviour management guidelines, two staff did not work in line with the guidelines and Therefore did not provide a sufficiently consistent response to ensure the protection of the service users and other staff. It is recognised that the service Greenacres DS0000063869.V257464.R01.S.doc Version 5.0 Page 10 users have a range of complex needs, but staff should be able to work in line with clear guidelines to meet the needs of the service users. There was documentary evidence of a range of risk assessments for service users to undertake activities in the home and in the community. However, risk assessments for one service user had not been recently updated, nor was there evidence of them having been signed and dated. There was documentary evidence of restrictive physical interventions forms being in place where service users’ rights or freedoms are limited, to ensure their health or well-being. Greenacres DS0000063869.V257464.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14. Service users are offered a range of activities in the home and in the community to meet their needs and preferences. EVIDENCE: There was documentary and photographic evidence of service users being supported to access a range of activities in the home and in the community. Activities include accessing day services, college courses, drives in the community, going to cafes and listening to music. Since the last inspection, the home has had a team of day service staff, who ensure all service users have access to a activities to suit their needs and preferences. There was evidence of service users accessing a mixture of vocational and leisure activities, including visiting garden centres and parks, arts and craft work, cooking, swimming and using the home’s sensory room. The staff had recorded where service users had been offered an activity but had refused. There was also folders for each service user, where the service had started to put photographs of activities and trips out. Two of the service Greenacres DS0000063869.V257464.R01.S.doc Version 5.0 Page 12 users spoken with said that they were able to choose what activities they did. One service user said he had been to see hot air balloons. Because of the rural location of the home, service users are supported to access activities and facilities in local towns in the area. Greenacres DS0000063869.V257464.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Service users receive dignified and sensitive support to meet their personal, emotional and health needs. There are robust systems for the storage, administration and recording of medication, to protect the service users. EVIDENCE: Staff were generally knowledge about the needs of the service users and the support required and were observed working hard to try to meet those needs in a dignified and sensitive way. It was reported by some of the staff that they and some of their colleagues felt under pressure from the challenging behaviours and needs of some of the service users. Some staff were observed responding in an inappropriate way to the challenging behaviours of one service user, as their responses were not in line with the guidance in the care plans. However, staff were sensitive to the individual needs of each service users and were able to describe the tensions between the rights of the service users and duty of care for all the people living in the home. One service user said that staff “are kind and treat me very well”. Another said that staff work hard and are “good”. There was documentary evidence that service users are supported to access a range of services to meet their emotional and health needs. All service users Greenacres DS0000063869.V257464.R01.S.doc Version 5.0 Page 14 are registered with a local G.P. and use a range of other services to meet their individual needs. There was evidence of on-going support from the local community learning disability team. Providing community nursing, psychiatric and psychologist support as required. Staff were observed dispensing and recording medication in line with the service’s robust policy and procedure. One staff dispensed, administered and signed for medication, whilst another staff member witnessed the signing and dispensing procedures. It was confirmed that all staff who dispense medication have received appropriate training. All medication is kept securely within the home and all records were up to date and accurate. Greenacres DS0000063869.V257464.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Service users are not consistently protected, with some significant events not being reported. A complaints policy and procedure enables service users to raise complaints and concerns. EVIDENCE: The home has a complaints procedure, available to service users and visitors. There had been no record of any complaints since the last inspection. Staff reported that where service users were unable to raise concerns or complaints, staff would be vigilant to record and address signs of distress or unhappiness. This would then be discussed by the staff team to try to identify any problems and work out any possible solutions. There is an adult protection policy, which staff were aware of. Two of the staff described the adult protection training they had recently completed as part of their induction training course. There was recording of a number of incidents that had occurred in the home, although some of the incidents had not been reported to the Commission as significant events which affected the welfare of service users. Greenacres DS0000063869.V257464.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30. The bedrooms and communal areas provided a suitable, clean environment. The bathrooms are too small and in too poor a condition to adequately meet the needs of the service users and staff. EVIDENCE: There are seven single bedrooms rooms in the home. There is a range of communal spaces, including a large lounge, a small dining room, a kitchenette/dining area and a sensory room. There is a large kitchen, which is kept locked to ensure the protection and safety of the service users. Service users are supported to make drinks, snacks and their breakfasts in the kitchenette area. There are two bathrooms and two toilets in the home, but these are in poor condition and because of their small size do not offer sufficient space to safely meet the needs of the service users. It was a requirement from the last report that the bathrooms be renovated to ensure they meet the needs of the service users. Whilst there was evidence that plans had been made to renovate the bathrooms and toilets, this work had not started. Service users rooms were individualised and met their current needs. Two of the service users said they liked their bedrooms and were able to put up their own pictures and photographs. Greenacres DS0000063869.V257464.R01.S.doc Version 5.0 Page 17 There is a large well-kept garden around the home, which two service users said they liked to spend time in. At the time of the unannounced inspection, the home was clean and tidy. There are limited adaptations required in the home, although locked doors are risk assessed to ensure any limits in the home are to ensure the health and safety of service users and staff. Greenacres DS0000063869.V257464.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36. The staff team work hard in the home, but do not consistently work in line with support guidelines and therefore do not ensure they meet the needs of the service users. Gaps in training and knowledge about their roles from some staff, as well as insufficient staff on some shifts, means there is not a consistently effective staff team. EVIDENCE: Staff spoken to were generally clear about their roles and responsibilities, although all the staff spoken with said that the team was under pressure because of the nature of the work, with people who have challenging behaviour. However, following an incident involving a service user displaying some challenging behaviours, not all staff responded to the incident in line with support guidelines. One staff member was observed providing a dignified, sensitive and skilled intervention, which was consistent with the home’s policies and procedures. However, two other staff were not clear or consistent in their approach. There was documentary evidence to support staff reports that many shifts do not have four staff on duty, which affects the access of service users to activities outside the home. It was reported by staff that there are vacancies in the home, which generally are covered by the use of regular relief staff and agency staffing. It is acknowledged that the organisation continues to work Greenacres DS0000063869.V257464.R01.S.doc Version 5.0 Page 19 hard to try to recruit and retain sufficiently skilled and experienced staff to ensure the service is able to meet the needs of the service users. The organisation has worked hard to ensure that all employment records are up to date and accurate, and ensure references and criminal records bureau checks are taken prior to the worker commencing employment. It was not possible during the inspection to evidence that range of training undertaken by the staff team. However, two of the staff on duty said they had not done any training in moving and handling or in food hygiene. Two permanent staff reported that they receive regular supervision, which they said was supportive and helpful. One relief member staff reported that in ther past there had been regular supervision, but this had not been the case for the past few months. Whilst the relief staff member spoken with was knowledgeable about his role and the needs of the service users, it is recommended that given the complex needs of the service users, all relief staff also receive regular supervision, to ensure they are able to work with existing staff to provide consistent care. Greenacres DS0000063869.V257464.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42. There is a supportive and skilled manager providing direction and a clear ethos in the home. Service users views are taken in to account in the running of the home. Some gaps in health and safety checks do not ensure the health and well-being of service users and staff. EVIDENCE: Following a change in management of the home, the current manager is in the process of applying for registration with the Commission. He is an experienced practitioner, who has been registered at other homes in the past. Following the inspection, in a telephone call, the manager was able to clearly describe the ethos and values of the home and the direction he thought the home should go to ensure it could identify and meet the needs of the service users. He was also able to describe how he thought staff should be supported to enable them to provide consistent and good quality care. Staff described the manager as approachable and supportive. One service user said that the manager was “nice and I can talk to him if I am unhappy”. Two Greenacres DS0000063869.V257464.R01.S.doc Version 5.0 Page 21 of the service users said that they thought their views were listened to by the service. There was documentary evidence of regular residents meetings, where they are able to raise any issues or concerns and where they are asked for their views in relation to the running of the home. There was evidence of a range of regular health and safety checks including checks of the temperature of the water, fire systems and of the environment. However, the servicing of the fire extinguishers was over-due. Greenacres DS0000063869.V257464.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 3 3 X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 1 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 2 2 2 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Greenacres Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 3 3 X X 2 x DS0000063869.V257464.R01.S.doc Version 5.0 Page 23 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 2 3 4 Standard YA6 YA9 YA23 YA27 Regulation 15 (1) Requirement Timescale for action 01/11/05 01/11/05 24/09/05 01/01/06 5 6 YA35 YA31 7 YA42 Review and update care plans as necessary, to include clear support guidelines. 13(14)(b) Review and update risk (c) assessments as necessary. 37(1)(e) Any incident affecting the health or well-being of a service user is reported to the Commission. 23 (2) (a, Provide bathrooms which are b, d) suitable for the needs of the service users and are in good decorative order. 18(1)(c)(i) Ensure all staff have received up 16(2)(j) to date training in moving and handling and food hygiene. 18 (1) (a) Ensure all staff are clear about their roles and responsibilities and approaches in the home to meet the needs of the service users. 23 (4) (c) Fire extinguishers are checked (iv) and serviced. 01/11/05 01/10/05 01/10/05 Greenacres DS0000063869.V257464.R01.S.doc Version 5.0 Page 24 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 YA36 Good Practice Recommendations Regular relief staff receive regular formal supervision. Greenacres DS0000063869.V257464.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greenacres DS0000063869.V257464.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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