Inspection on 04/07/06 for Greenacres

This inspection was carried out on 4th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Greenacres 20/06/07

Greenacres 17/11/05

Greenacres 04/05/05

Greenacres 06/01/05

Greenacres 19/07/04

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

CARE HOMES FOR OLDER PEOPLE Greenacres Wellfield Close Hatfield Hertfordshire AL10 OBU Lead Inspector Mrs Alison Butler Key Unannounced Inspection 4th July 2006 10:00 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 Greenacres DS0000019413.V301942.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 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. Greenacres DS0000019413.V301942.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenacres Address Wellfield Close Hatfield Hertfordshire AL10 OBU 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) 01707 280 500 01707 280 561 www.quantumcare.co.uk Quantum Care Limited Toni Patricia Greenhill Care Home 60 Category(ies) of Dementia - over 65 years of age (60), Old age, registration, with number not falling within any other category (60), of places Physical disability over 65 years of age (60) Greenacres DS0000019413.V301942.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th November 2005 Brief Description of the Service: The home was first registered on 1st July 1992 by Hertfordshire County Council. Greenacres is a modern purpose built two- storey building, and is situated close to the centre of Hatfield with all its community facilities, health centres and clinics. Fees for the services are £400-£535 per week. Additional charges are made for newspapers, toiletries etc. (this was correct as at 04/07/06). The accommodation is offered in four units. It provides a home to elderly people requiring long stay residential care. Each bedroom has en-suite toilet and wash hand basin. Each wing as two lounge/dining areas, a kitchenette and night /medication storage station. Each wing has an assisted bathroom and assisted shower. Other facilities available include a reception area and an activities/day area. A fully equipped kitchen is located on the ground floor, as is the administrators office and reception desk. On the first floor are the hairdressers’ salon and fully equipped laundry. Facilities for staff include a smoking room, staff room and changing room with shower on the first floor. The home has an enclosed garden in the centre of the building with patio areas. There is a day centre for the elderly in close proximity. Greenacres is able to offer respite care to enable families to take a break and offers day care to those who live in the community. Greenacres DS0000019413.V301942.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by one inspector between the hours of 09:00 and 17:00. The aim of this inspection was to assess all the key standards. Attendance at the home’s forum on 5th July 06 and relative questionnaires were analysed and were used to gather evidence for this inspection. The majority of the inspection was spent talking to residents, relatives and staff. Care and administrative records were checked. Where information remains the same this has been brought forward from previous reports. What the service does well: What has improved since the last inspection? Whilst a lot of work has been carried out on the medication, there is still some to be carried out especially on one unit. Photographs are now in place soon after admission of all residents. All fire testing had been carried out and recorded appropriately. Greenacres DS0000019413.V301942.R01.S.doc Version 5.2 Page 6 A daily activity co-ordinator has been employed and this has increased the activities on offer but the home would benefit from additional activity hours. 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. Greenacres DS0000019413.V301942.R01.S.doc Version 5.2 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 Greenacres DS0000019413.V301942.R01.S.doc Version 5.2 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): 1, 2, 3, 4 & 5 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Standard 6 is not applicable to Greenacres. Up to date information is available to prospective residents to ensure that they are able to make an informed choice. The needs of the residents are assessed prior to admission to ensure the home is able to meet their needs. Residents and/or their families are able to visit the home to assess the quality, facilities and suitability prior to making a decision on whether the home is where they would like to live. EVIDENCE: A comprehensive Statement of Purpose and Service User Guide is available and prospective residents are provided with a copy. Two residents files were case tracked and these confirmed that assessments had been completed prior to admission and families had had the opportunity to Greenacres DS0000019413.V301942.R01.S.doc Version 5.2 Page 9 visit the home prior to admission. A copy letter was included within the care notes confirming their placement at Greenacres, which is good practice, and in line with regulation 14. Admission procedures are in place to assist staff to ensure all the relevant information has been obtained prior to admission. From the eight questionnaires returned a couple of relatives stated they had not received a contract but had been involved in the care planning process; the files examined showed that contracts had been signed and a copy of the Statement of Purpose and Service User Guide received. Greenacres DS0000019413.V301942.R01.S.doc Version 5.2 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, 9 & 10 The quality outcome in this area is adequate. This judgement has been made using the available evidence including a visit to the service. The quality of the information is generally good, but there are still areas for improvement to be made. Medication administration recording still needs some improvement especially around the reconciliation. Staff are knowledgeable and provide appropriate support to meet the needs of the residents EVIDENCE: Examination of four care plans showed that whilst on the whole the care plans on some units were very detailed and contained useful information on meeting the needs of the residents. One resident had been placed on a food and fluid chart but there was no information on the care plan as to why it was necessary and when it was reviewed it was no longer required. Monthly reviews should be expanded to reflect the care plans and meeting the individual needs. Other care plans demonstrated that health needs are recorded and dealt with appropriately. Greenacres DS0000019413.V301942.R01.S.doc Version 5.2 Page 11 Analysis of the relative questionnaires showed that half of them felt that the residents usually receive the care and support they need, just under half felt it is always received and one who felt it is sometimes received. One relative had some concerns that a male carer had been carrying out personal care. A discussion took place with the manager and if a resident requested that they did not wish to have there personal care dealt with by a male carer information would be recorded on the care plans and where possible this would be actioned. With regard to the medical support the residents need it was split between always, usually and sometimes with only one stating that health issues are not being picked up and they have to ask several times for the GP to attend. Staff should be reminded that Tippex should not be used on care notes but a single line should be placed through the error. Whilst a lot of work has been carried out to ensure that the medication errors don’t occur, on checking one unit a number of errors were discovered. Reconciliation had occurred, but there still appeared to have been a discrepancy as the inspector and the member of staff were unable to reconcile two resident’s medication. One of them appeared that although staff had signed, they could not have given them as there would not have been enough tablets in the packet. The manager will investigate this. Medication had been dated on opening. Although two missed signatures were discovered, these had been addressed by the care team manager and recorded. One residents medication had been hand written on the medication administration record (MAR) sheet it had not been copied exactly from the dispensing label by omitting the required dose which could have serious consequences for the individual resident. Controlled drugs were well stored and a spot check showed they reconciled. Following the recommendation made at the last inspection photographs were in place for those care plans examined during this inspection. Good interaction was observed during the inspection between residents and staff and appropriate support given. Residents felt they were treated with respect and staff were sensitive when personal care was being provided. Greenacres DS0000019413.V301942.R01.S.doc Version 5.2 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): 12, 13, 14 & 15 The quality outcome in this area is adequate. This judgement has been made using the available evidence including a visit to the service. There is a limited range of activities on offer. Recording of activities is limited but the manager is aware and there is a good understanding that this area of the service can be improved. Autonomy and choice is provided as much as possible. Visitors are welcomed and contact with the community is maintained. EVIDENCE: A daily activities co-ordinator has been employed since the last inspection although she only does 16 hours a week, a further one is being sought to be able to offer more hours and increase the activities on offer. Residents spoken to stated that they “enjoy the activities but would like to see more, staff try to do there best but they are very busy and haven’t always got time to sit and chat”. A discussion and examination of her records took place with the activities co-ordinator, it was suggested that she records the information in more detail on individuals this would give a better picture of the residents and also help in planning activities. She initially discussed with the residents what activities they would like to do and used this as a staring point, she intends to ensure that she talks with individuals on a regular basis on what they would Greenacres DS0000019413.V301942.R01.S.doc Version 5.2 Page 13 like to do or try and plan accordingly. Relatives on the whole felt that there were usually activities for residents to take part in, although they would like to see more outings arranged. It is thought that not all residents are aware of what is happening and residents who have mobility problems can have difficulties accessing activities held downstairs if staff are unable to assist. The homes forum also raised the issue of residents getting out on a more regular basis. The manager stated this was being considered but transport difficult for residents with mobility problems. Although in the past when outings are being arranged, residents have looked forward to it, but once the transport has arrived they have then chosen not to go. This will not stop them trying to arrange further outings. The area manager conducting the forum stated that she would contact other home managers who have managed to arrange transport for outings in the past and get further details from them. The manager had carried out a trial on offering the main meal of the day at teatime instead of the usual lunchtime with the exception of Sunday where the main meal is offered at lunchtime. This appeared to have gone down extremely well and majority of the residents appeared to be more alert during the afternoon. The intention is to carry this out on a permanent basis following further discussions. Residents were complimentary about the meals on offer and that they are offered alternatives if they don’t wish to have those on offer. Comments from residents include “they are hot and tasty” “ there is always plenty of choice” “ I love my food and I can’t complain”. Observation at lunchtime showed that residents were being appropriately supported, in an unrushed approach and residents were chatting to each other. From the relatives’ questionnaires, one relative stated that her mother had complained on a number of occasions to them, that they had not enjoyed their meals although it does not state if the staff at the home have been made aware of this. Another relative was concerned that the meals are not balanced and that not enough vegetables are served and that the meals are sometimes not very hot. The meals were served from hot trolleys that were plugged in on the day of the inspection. Greenacres DS0000019413.V301942.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The quality outcome in this area is good. This judgement has been made using the available evidence including a visit to the service. Robust procedures are in place to ensure the protection of the residents. Residents feel safe and that there concerns are listened to. EVIDENCE: A copy of the complaints procedure is available in the entrance to the home. Residents are clear to whom they can speak to if they were unhappy with any aspects of their care or the staff. One complaint had been received since the last inspection and had been dealt with appropriately and the action and outcome recorded appropriately. A number of compliments have been received and these are held for staff to see. The visitors at the homes forum were complimentary about the care provided at Greenacres and did not appear afraid to raise issues and say what they had concerns about. One relative from the questionnaires felt that although issues are raised they feel no action is taken, they did not give any further information so the manager was unable to check out any issues but I am confident that if she was aware of issues they would be dealt with appropriately as they have been in the past. Adult protection is offered on a rolling programme to ensure that all staff attend and are aware of the types of abuse and how to respond to any allegations that may be made or observed. Discussion with staff confirmed their understanding of adult protection and whistle blowing. Greenacres DS0000019413.V301942.R01.S.doc Version 5.2 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): 19 & 26 The quality outcome in this area is good. This judgement has been made using the available evidence including a visit to the service. Generally the home was cleaned and well maintained, although the kitchenettes require some attention. EVIDENCE: Following a tour of the home no odours were detected. Generally the home was cleaned to a high standard with the exception of the microwaves and fridges in kitchenettes on the units, which were in need of cleaning. The fridge on Bluebell unit needs replacing. Analysis of the relative questionnaires showed that two relatives were unhappy with the cleaning of their relative’s room and state that they have had to carry out the cleaning themselves. Whilst other stated they were “bright, clean and well looked after” “ it makes a good impression on visitors.” The water temperature in a shower room exceeded 45ºC, the manager had this attended to during the inspection and the valve was replaced. Greenacres DS0000019413.V301942.R01.S.doc Version 5.2 Page 16 The flooring in all corridors, lounges and dining rooms is to be replaced by the end of September 06. Residents were well groomed and were satisfied with the laundry service provided. Policies and procedures were in place for the prevention of infection. A number of bins around the home were in need of lids. Food placed in fridges should be dated either on opening or being placed in the fridge to prevent possible food poisoning and ensure it is disposed of correctly. Certificates are available showing that the equipment is serviced to ensure it is kept in good working order. Greenacres DS0000019413.V301942.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 quality outcome in this area is good. This judgement has been made using the available evidence including a visit to the service. Procedures for the recruitment of staff are robust to offer protection to the residents. Sufficient numbers of care staff are deployed throughout the home to meet the residents’ personal care needs. EVIDENCE: Examination of the five most recently recruited staff showed that all the relevant checks had been carried out prior to commencement, which offers protection to the residents. It is recommended that a section is included in the interview paperwork that gaps in employment have been explored. Examination of the rotas showed that adequate numbers of staff are deployed throughout the home to meet the personal care needs of the residents. Comments received from the residents include “they try really hard and are always busy” “they are kind and caring” “ it’s a very nice place to be and the staff are very helpful”. Analysis of the relative questionnaires showed that the majority felt that there were usually enough staff on duty whilst only 2 felt that sometimes not enough staff were available. There is still a need for a further activity co-ordinator to offer a wider choice of activities and forlonger periods. Greenacres DS0000019413.V301942.R01.S.doc Version 5.2 Page 18 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, 33, 35 & 38 The quality outcome in this area is good. This judgement has been made using the available evidence including a visit to the service. The managers ensure the smooth running of the service. Staff try to ensure the paperwork is kept up to date and standards are being maintained, although this is not always the case EVIDENCE: There are a number of checks in place to ensure that standards are being maintained, service certificates are available to show that equipment has been checked appropriately. The staff confirmed that the manager works in an open and transparent manner and that the management team supports them as needed and they receive regular supervision. The relatives who attended the homes forum relative were very happy with the home and felt they are able to approach any Greenacres DS0000019413.V301942.R01.S.doc Version 5.2 Page 19 member of staff if they needed to raise any issues of concern. A visitor stated the “manager is approachable at any time”. Fire records showed that appropriate testing and drills had been carried out, where staff had not responded during a drill, a record had been made and it was suggested that notes are entered on their supervision record to ensure they this has been addressed. A monthly audit is carried out on all accidents and incidents to look at any patterns and address any issues for individuals including risk assessments. The Commission For Social Care Inspection are notified appropriately under regulation 37 and have received regular 26 visit reports since April 2006 providing information on the conduct of the home. Greenacres DS0000019413.V301942.R01.S.doc Version 5.2 Page 20 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 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Greenacres DS0000019413.V301942.R01.S.doc Version 5.2 Page 21 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 OP9 Regulation 13(2) Requirement The manager must ensure that Medication can be reconciled at any time Written information should be copied exactly as per dispensing label. The manager must ensure that: A thorough clean is carried out on all fridges and microwaves within the kitchenettes. The fridge must be replaced on Bluebell unit All bins must have lids fitted Timescale for action 31/08/06 2 OP26 13 (3) 31/08/06 Greenacres DS0000019413.V301942.R01.S.doc Version 5.2 Page 22 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 3. Refer to Standard OP7 OP7 OP12 Good Practice Recommendations Care plan reviews should be expanded to include how residents’ needs are being met. Staff need to be reminded that Tippex should not be used on care documentation. The manager should continue to look at employing a further Daily Activity Co-ordinator to increase the hours to provide a full and varied programme of activities in consultation with the residents. The Daily activities co-ordinator should provide more detailed information to provide a full picture of each resident on their likes and dislikes. The manager should think about adding to the interview paperwork that gaps in employment have been explored. 4. 5 OP12 OP29 Greenacres DS0000019413.V301942.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 DS0000019413.V301942.R01.S.doc Version 5.2 Page 24 - 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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