Inspection on 04/05/05 for Greenacres

This inspection was carried out on 4th May 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Greenacres 20/06/07

Greenacres 04/07/06

Greenacres 17/11/05

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 Herts AL10 0BU Lead Inspector Alison Butler Unannounced 4 May 2005 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 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 I52 s19413 Greenacres v225649 040505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Greenacres Address Wellfield Close, Hatfield, Herts, AL10 0BU Telephone number Fax number Email 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 Quantum Care Limited Vacant CRH Care Home 60 Category(ies) of Dementia over 65 years (60), old age, not registration, with number falling within any other catergory (60), physical of places disability over 65 years of age (60) Greenacres I52 s19413 Greenacres v225649 040505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 6 January 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. The accomodation 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 kitchinette and night /medication storage station. Each wing has an assissted bathroom and assisted shower. Other faciltlies 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. Facilties 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. Greenacres is situated close to the centre of Hatfield with all its community facilities, health centres and clinics. 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 I52 s19413 Greenacres v225649 040505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted with the newly appointed manager, who has transferred from another home within Quantum Care, residents and staff in the home at the time. The inspectors were in the home from 9.30am until 4pm. The inspectors spent a majority of their time talking to residents, staff and visitors. The interaction seen between residents and staff was seen to be warm and caring and support offered as appropriate. Discussions and contact was made with 15 residents and 6 staff as well as the manager and the deputy manager. Care and administration records were checked. What the service does well: What has improved since the last inspection? What they could do better: The manager should ensure more staff are trained in the use of the camera to ensure photos are placed on the residents file and/or medication sheets as soon as possible after admission to reduce any errors especially in dispensing medication. Some medication processes need to be reviewed and staff Greenacres I52 s19413 Greenacres v225649 040505 Stage 4.doc Version 1.30 Page 6 reminded on the correct procedures for administering medication. The manager should monitor and eliminate the odour detected on Bluebell Unit. The introduction of a day care co-ordinator should be explored in consultation with the residents to try to increase the activities on offer within the home. Where the care plan details care needs information should be recorded to ensure the needs are being met and they are being reviewed. Where changes have been made staff should sign and date them. 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 I52 s19413 Greenacres v225649 040505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Greenacres I52 s19413 Greenacres v225649 040505 Stage 4.doc Version 1.30 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 standard(s) 1, 3 & 5. 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 their 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 for Purpose and service User Guide is available and prospective residents are provided with a copy. Both these documents will require amending with the newly appointed managers details. A copy must be forwarded to the Commission For Social Care Inspection when they have been amended. Greenacres I52 s19413 Greenacres v225649 040505 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 & 10 The quality of information recorded is generally good, but progress is not always monitored and recorded. Residents receive a good quality of care and are supported by knowledgeable and experienced staff. EVIDENCE: Examination of four care plans showed that some information although recorded was not then monitored for progress (for example, a resident who is under weight). Where a resident has been given encouragement to mobilise, evidence should be recorded on the daily record to ensure the care plans are kept updated. On care plans that have been updated, staff should remember to sign and date any amendments. Good interaction was seen during the inspection between the residents and staff and appropriate support was offered. Residents felt they are treated with respect and feel well looked after. Residents stated that staff use the knock and wait policy before entering their rooms. There is very little information recorded on the social lives of the residents, see section on daily life and social activities There has been a high turnover of residents into the home and it is noted that photographs were not on either the care plans or the medication sheets resulting in staff not being able to recognise individuals if they have been off on holiday etc. Photographs should Greenacres I52 s19413 Greenacres v225649 040505 Stage 4.doc Version 1.30 Page 10 be put in place as soon after admission as possible, to prevent errors. The home has a digital camera, and it is recommended that additional staff are trained in its use (for example all care team managers). There were a number of issues with the medication observed during this inspection; where a respite residents had been admitted, it appeared that the staff had not checked the medication brought in and/or was incorrectly counted. It appeared they took the number as that stated on the packet. Some medication was found on the trolley belonging to a resident that has since returned home. Staff should ensure that all medication that belongs to an individual is returned to them on leaving and signed for. A care worker was seen handling some medication from the blister pack before transferring to a dispensing vessel. Date and time on opening of medication should be placed on all non blistered packs which will ease in the reconciliation. Where medication is brought forward the date and time should be noted on all medication. Internal & external medication should be stored separately. No missed signatures were noted on the Medication, Administration, and Record sheet. Greenacres I52 s19413 Greenacres v225649 040505 Stage 4.doc Version 1.30 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 standard(s) 12, 13, 14 & 15. Autonomy and choice is promoted within the home. Visitors are welcomed and contact is maintained with the local community. EVIDENCE: Information on social care was not noted in the care plans examined. Activities take place with the care staff only once all personal care has been attended to. It is recommended that the employment of a daily activities co-ordinator be explored to give a more structured approach in organising activities in consultation with the residents. On one of the units two care staff were holding a quiz session for those residents wishing to take part. Residents spoken to stated, “staff don’t always have time to do activities, although they do acknowledge us”. Visitors spoken to felt they are made to feel very welcome whenever they visit the home, but at weekends they have to wait to gain entry to the home as the reception desk is usually not manned. It is recommended that wipe or chalk boards are placed within each unit to display the daily menu as, when asked, staff stated that according to the information it was a steak pie and when lunch arrived it was sausage. On one unit lunch was nicely presented and the residents confirmed they usually find the menu to their liking. Although occasionally they did not eat it what was on offer, an alternative is always offered. Greenacres I52 s19413 Greenacres v225649 040505 Stage 4.doc Version 1.30 Page 12 On one unit lunch was not served as nicely as the gravy was splashed around the plate. The pureed meal was served separately. Staff need to be reminded that when assisting residents to eat they should be seated and not standing. Greenacres I52 s19413 Greenacres v225649 040505 Stage 4.doc Version 1.30 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 standard(s) 16, 17 & 18. Robust procedures are in place to ensure the protection of the residents EVIDENCE: A copy of the complaints procedure is available. Those residents spoken to said they are aware of the complaints procedure or who to speak to if they were unhappy about any aspect of their care. One complaint had been received by the home since the last inspection and a full investigation had been carried out and a satisfactory outcome was achieved. Commission for Social Care Inspection had been provided with a copy of the investigation and the findings contained within the comprehensive report. The commission was satisfied that the issues raised had been dealt with appropriately. 22 staff have attended the protection of vulnerable adults training. Those staff spoken to were aware of the whistleblowing policy and what to do if an incident of abuse were reported to them. Greenacres I52 s19413 Greenacres v225649 040505 Stage 4.doc Version 1.30 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 standard(s) 19 & 26. The home is clean, well maintained and regular maintenance checks are carried out on services and equipment. EVIDENCE: An unpleasant odour was detected on Bluebell unit and this needs to be monitored by the manager and efforts made to eliminate it. The rest of the home was clean to a high standard and carpets are cleaned regularly. There is adequate housekeeping staff. It was noted during a tour of the building that a chair at a unit desk was unstable and should be removed to prevent an accident. The laundry facilities are adequate to meet the needs of the residents. Residents were happy with the laundry service and were well dressed on the day of the inspection. Policies and procedures are in place for the prevention of infection. Greenacres I52 s19413 Greenacres v225649 040505 Stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, & 30 The procedures for the recruitment of staff are robust and offer protection to the people living in the home. The numbers of staff and their deployment are sufficient to meet the personal care needs of the residents. EVIDENCE: From the two staff files examined all the relevant checks had been carried out prior to staff commencing employment which ensures the protection of the residents. From examination of the rotas, adequate numbers of staff were deployed to meet the personal care needs of the residents at the time of this inspection. Although it is still recommended that a member of staff is allocated to ensuring a programme of activities is available see section on Daily life and social activities. Residents spoken to said that the staff were “polite and gentle” “all are very good”, “they are too busy to do activities but do acknowledge us”. Good interaction was observed between residents and staff. Residents were appropriately encouraged to maintain independence where possible. A discussion with a visitor was held and they raised a concern regarding handovers where no staff were available on the unit for approximately fifteen minutes. The manager must address this and ensure a member of staff is available on each unit at all times. Greenacres I52 s19413 Greenacres v225649 040505 Stage 4.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36, 37, & 38. There are good systems in place for the monitoring of care, health and safety requirements. Care staff are supervised in their day to day work and also through formal supervision and appraisal systems. The manager ensures the smooth running of the home and keeps updated with the paperwork and that standards are being maintained. EVIDENCE: The manager has recently transferred to Greenacres from another home within Quantum Care. She ensures she attends relevant training to update her skills and knowledge. This is confirmed in the training records and certificates held. The home prepares an annual questionnaire, which is sent to residents, families and professionals that have dealings witn the residents of the home. The responses are collated and form the basis for a report that includes and action plan for the following year. This ensures that standards are reviewed and/or maintained. Greenacres I52 s19413 Greenacres v225649 040505 Stage 4.doc Version 1.30 Page 17 The fire safety records demonstrated that this area is regularly reviewed. Regular checks are made on the hot water, moving and handling equipment and lift servicing is carried out. The hot water temperature carried out o the day was within the required health & safety limits. Training records showed that there is on-going health & safety training which is provided for all staff. Accident and incidents records showed that they are regularly audited and any action required is carried out, for example reviewing of the risk assessments. The Commission For Social Care Inspection has been notified appropriately of anything that has affected the well being of the residents. Staff confirmed they receive regular supervision and records showed this to be the case. Greenacres I52 s19413 Greenacres v225649 040505 Stage 4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x 3 N/A 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 2 COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 3 3 3 3 3 x x 3 3 3 Greenacres I52 s19413 Greenacres v225649 040505 Stage 4.doc Version 1.30 Page 19 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. Standard 9 Regulation 13 (2) Requirement Staff must be trained in the correct handling of medicines Timescale for action immediate as of 4th May 2005 and henceforth immediate as of 4th May 2005 and henceforth immediate as of 4th May 2005 and henceforth 2. 9 13(2) Internal and external medication must be stored seperately. 3. 27 18(1) The manager must ensure that at least one member of staff is available on each unit at all times 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 7 Good Practice Recommendations Care plans should include followup information to ensure there is a monitoring of the issues raised. Where information is added to the care plan, staff should sign and date the entry. Photographs should be placed on each residents file as soon as possible after admission. (more staff shuld be I52 s19413 Greenacres v225649 040505 Stage 4.doc Version 1.30 Page 20 2. 7 Greenacres 3. 4. 5. 6. 7. 8. 9. 9 9 12 & 27 15 15 26 trained in the use of the camera) The bring forward system should record the date and the time this was carried out to ease reconcillaiton. Staff should ensure all medication is returned to the residents on leaving Greenacres. The manager should investigate the employing of a daily activites co-ordinator to provide a full and varied programme of activties in consultation with the rsidents. White and/or chalk boards should be purchased for all units to display the menu of the day. Where staff are required to assiting residents in eating they should be reminded to be seated at all times. The manager needs to monitor the odour on Bluebell unit and efforts made to elimate it. Greenacres I52 s19413 Greenacres v225649 040505 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City, Herts 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 I52 s19413 Greenacres v225649 040505 Stage 4.doc Version 1.30 Page 22 - 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!