Inspection on 15/05/06 for Greenbanks

This inspection was carried out on 15th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Greenbanks 08/05/07

Greenbanks 08/02/06

Greenbanks 16/08/05

Greenbanks 01/02/05

Greenbanks 05/08/04

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

CARE HOMES FOR OLDER PEOPLE Greenbanks Greenbanks Road Watford Hertfordshire WD17 4JP Lead Inspector Julia Bradshaw Key Unannounced Inspection 15th May 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 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. Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Greenbanks Address Greenbanks Road Watford Hertfordshire WD17 4JP 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) 01923 255 160 01923 255 170 Runwood Homes Plc Ms Christine Larner Care Home 66 Category(ies) of Dementia (66), Old age, not falling within any registration, with number other category (66), Physical disability over 65 of places years of age (66) Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th February 2006 Brief Description of the Service: Greenbanks is a care home providing personal care and accommodation for 66 older people, who may also have a physical disability or dementia. It is owned by Runwood Homes plc, which is a private organisation. The home was previously owned by Hertfordshire County Council. It was taken over by Runwood Homes and completely rebuilt in 1999. The home consists of a purpose built two-storey building that is divided into four units, each with its own name and identity. It is situated in a residential area on the outskirts of Watford. There is a parade of shops relatively close by, the town centre with shops, library and access to public transport, is about a mile away. It is next to a day centre that is also owned by Runwood Homes. All the homes bedrooms are single and have en-suite facilities. There is a passenger lift. The home has attractive grounds that are fully accessible for the service users and provide pleasant outlooks from the home and a stimulating and safe outside environment. The fee range for the home is between £400-559 per week. Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection and was carried out by two inspectors over one day. The manager was present at the inspection as well as care staff, administration and domestic support staff . The inspectors would like to thank all the staff and service users for their time and co-operation during this inspection. Time was spent talking to service users, staff and visitors to the home. Overall this was a generally positive inspection with the majority of key standards being met. There were some issues relating to the current service provided within the dementia unit, which is described in the main body of this report. What the service does well: What has improved since the last inspection? Medication procedures have improved since the last inspection was carried out. All service users are now weighed on a regular basis and this is detailed within the care plan. Fire procedures are now carried out more effectively. Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 Page 6 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. Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 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 Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Generally there is a good system of pre-admission assessment in place to ensure that the care needs of people who may want to move into the home are fully understood and can be fully met. However, the current assessment of one service user within the dementia unit is inaccurate. Staff are provided with the necessary training and support to give them the knowledge and skills that they need to be able to meet the varied care needs of residents. EVIDENCE: Care records of service users were inspected and there was evidence of pre admission assessment of needs being carried out in each case. The home receives a copy of the pre admission assessment of needs of prospective service users for those who are funded by Social Services and discharge letters from hospital, where applicable. The manager or a senior member of staff would carry out the home’s own pre admission assessment of needs of any Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 Page 9 referred service user. The home has a comprehensive and holistic pre admission assessment of needs which is used to formulate an initial care plan on admission. Staff members were observed to be interacting well with service users; demonstrating good skills and knowledge to meet the specific care needs of the respective clients’ group. Prospective service users are invited to look around the home. Relatives are encouraged to visit the home prior to admission of their next of kin to the home, where possible. However one service user who is currently living within the dementia unit is unsuitably placed as the staff are unable to manage the level of their personal needs, which is creating a generic problem within the unit for the other service users. Care plans were examined and a detailed assessment process was seen to be in place to ensure that only those people whose care needs could be appropriately met were admitted. However there is one service user who currently lives within the dementia unit where the home should complete a review of their current needs as there are specific problems relating to their care identified at this inspection, in which the home appear unable to meet. Also the current care plans could be further developed and improved by ensuring that individual risk assessments are updated regularly and behavioural guidelines are maintained within the care plan, where applicable. Staff spoken to were positive about the standard of training they receive, which includes Adult protection, moving and handling (Feb 06) fire safety (Feb 06) POVA training (Jan 06) first aid (April 06) Food Hygiene (Feb 06) Dementia training is on a rolling programme. The manager stated that there are currently 60 of all staff trained in Dementia. Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 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 - 10. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. There is a robust system for the administration of medicine in place and staff are provided with the necessary training to enable them to administer medication safely. The standard of care planning is adequate and residents have access to appropriate community healthcare services. Risk assessments require updating The home currently identifies service users who are MRSA Positive which fails to promote confidentiality or dignity. EVIDENCE: The home should not need to identify service users who are MRSA positive if infection control procedures are carried out effectively and efficiently. This practice could “stigmatise” individual service users unnecessarily. This practice should be reviewed with other health care professionals visiting the home i.e. Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 Page 11 District nurses and an alternative procedure implemented. It is suggested that the infection control nurses are also contacted. Service users looked well cared for, and were treated sensitively. One service user said ‘the girls are wonderful but are always rushing around and there never seems to be enough staff.” Some good care practice was observed throughout the day. There was a discussion with the manager regarding the staffing within the dementia unit. On the day of the inspection the home was short staffed due to sickness and therefore the service users within the dementia unit were receiving a limited service. There are several service users who require help with eating their meals in this unit and this appeared to be difficult to implement with only two staff, at any one time, to assist with mealtimes. Generally medication procedures have improved within the home. The home uses the monitored dosage system with MAR sheets to record all aspects of administration Staff spoken to stated that they had received the necessary training to carry out medication procedures. However the manager should ensure that any service user who is self medicating has an accurate and detailed risk assessment in place. This was incomplete in one case on the day of the inspection. Care plans must be reviewed and signed by the key worker. Some care plans inspected were incomplete and contained out of date risk assessments. Also the manager must ensure that individual risks are identified and the necessary risk assessment carried out. There was no evidence found on one file that one service user had been fully assessed for bed rails and there was no consent documentation available. Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 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 - 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Greenbanks is in the process of implementing a person centred approach to providing care to its residents and this is evident in the way that personal preferences and choice are recorded and taken into account in the day-to-day operation of the home. EVIDENCE: Several visiting relatives and friends were spoken to during this inspection visit and all confirmed that their visits are encouraged and facilitated and they all spoke very positively about the home. Although they stated, on occasions, that it was difficult to find a member of staff at key times of the day. The activities co-ordinator should be congratulated on her tireless commitment and enthusiasm for her work within the home. There was a wealth of evidence to confirm that service users are consulted and offered a range of activities within the home and also an outside entertainer visits the home regulalrly. There are some service users who are able to go out to Watford, independently. Activities within the dementia unit are specialised and appropriate to peoples needs. Service users confirmed that they enjoy bingo, art and discussion groups. There are weekly service user meetings held and Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 Page 13 also a “friends of Greenbanks” who meet monthly and this operated independently of the manager of the home. There is also a “comments” box in the reception area of the home, which is monitored and issues responded to, by the manager. The manager is in the process of reviewing the current menu’s and raised this issue during a recent service user meeting as well as with relatives and carers. The review was carried out because the home wanted to improve the choice of main meals from just one to two per day There was a discussion with the manager and activities co-ordinator regarding service users with dementia who are unable to make an informed choice the day before and a suggestion to use pictorial aids was going to be explored as a possible option. Holidays are also offered to specific service users who are still relatively independent. Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints policy and procedure together with staff training in the recognition of adult abuse and the correct response if it is suspected should provide confidence in this service for residents, their relatives and those who care for them. EVIDENCE: Adult protection training was last carried out in January and March 2006.This is part of the annual rolling training programme for both new and existing staff. Staff had a good understanding of adult abuse issues and the appropriate action to take if it were suspected. The home has a robust complaints procedure and those residents and relatives spoken to during this inspection visit confirmed that they felt confident that any complaint or concern raised would be dealt with. “ I can always speak to the manager if I need to.” was the comment of one relative. Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 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, 23 & 26. Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. The health and safety of the service users is currently compromised. Residents’ rooms are well furnished and can be personalised with familiar items of furniture, pictures and ornaments to reflect the personality and taste of individual residents. EVIDENCE: The mal odour within the dementia unit is unacceptable and requires urgent attention. The manager must review the condition of the current flooring within the general area of this unit and provide a more appropriate flooring that can be cleaned on a daily basis to reduce the mal odour that currently exists. The manager stated that there is one particular service user who they are unable to meet their personal toileting needs and staff are unable to combat this problem, which is leading to this unacceptable level of odour. If this is the case Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 Page 16 the manager must co-ordinate a review meeting with the placing authority to ensure a more appropriate placement is found for this person. Residents’ rooms had a variety of items in them which they had either brought with them or had obtained after admission and this means that each room is slightly different and has a sense of being personal to the particular resident. Documentation received as part of the inspection process confirms that the manager is carrying the correct fire safety checks. The fire equipment was last checked in the May 200606.The manager stated that the annual fire safety check was carried out in May 2006 but the annual fire certificate was unavailable on the day of the inspection. The last fire drill was carried out on the 14/12/05. Fire training was last carried out on the 10/2/06. Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 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 - 30. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Current staff numbers require reviewing to ensure service users needs are appropriately met. Records pertaining to recruitment appeared to be satisfactory, assisting in protecting service users from abuse. EVIDENCE: On the day of the inspection there was some concern regarding the staffing levels within the home. This was further confirmed when speaking to several service users and visiting relatives who stated “ there never seems to be enough staff on the floor when you need assistance or to ask a question”. One service user stated, “ staff are very caring but often appear rushed and unable to spend adequate time with me”. The manager confirmed the staffing levels were adequate but on the day of the inspection were understaffed due to a member of the care staff calling in sick. There were times during the inspection where service users within the dementia unit were wandering and in a state of anxiety with no member of staff available to assist them. During the mid-day meal there were inadequate levels of staffing within the dementia unit to assist all service users with eating their meals. Four staff records were checked as part of this inspection and all were found to contain the relevant and necessary information. Staff from overseas had a Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 Page 18 “certificate of good conduct translated into English to confirm they had no convictions. Training records, including an induction programme in line with the requirements of “Skills for Care”, and discussions with some of the staff on duty provided evidence of a good training and support process in operation. However there was a limited amount of documentation to support this. It was suggested to the manager that a “training Matrix” is devised to enable staff training to be monitored more easily. Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 Page 19 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 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The manager and her team provide a clear sense of leadership and purpose and have put in place, together with the proprietor, a robust and effective system of quality assurance to monitor how the home operates. The health and safety of users is currently compromised due to health and safety/infection control issues within the home. EVIDENCE: Staff and residents were very positive about the manager and her team, how open and accessible they were and the atmosphere within the home supported this throughout the inspection visit. Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 Page 20 The manager carries out a monthly audit sheet regarding health and safety within the home. All health and safety records were up to date. The flooring within the dementia unit requires urgent attention and should be replaced with a more suitable covering that can be cleaned on a daily basis. The general standard of record keeping is good Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x 3 x x 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x x x x 2 Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 Page 22 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 OP3 Regulation 14 (1) (d) Requirement Timescale for action 30/05/06 2. OP8 12 (1) (a) 3. OP9 13 (2) 4. 16 (2) (k) The manager must complete a review of the current assessment on the needs of one service user living in the dementia unit. The care plans contain clear and 30/06/06 easily accessible information on the resident’s health and personal care needs, with comprehensive procedures for meeting the needs and up to date risk assessments. The registered person must ensure that all care plans have accurate and up to date information on meeting each resident’s overall care needs. (See also Regulation 15 (2) (b)) The manager must ensure that 22/05/06 all service users who self medicate have an up to date risk assessment in place. There was a noticeable odour on 30/05/06 the ground floor in the dementia unit. Measures must be put in place to keep the home free from offensive odours. Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 Page 23 5. OP27 18 (1) (a) The manager must ensure staff numbers are adequate at all times to ensure the service users receive the care detailed within their individual care plans. The manager must ensure that the health and safety of all service users is maintained at all times (Infection control measures in relation to MRSA and mal odours are reduced within the dementia unit.) 16/05/06 6. OP38 13(4)(c) 30/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 Page 24 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 Greenbanks DS0000019414.V293045.R01.S.doc Version 5.1 Page 25 - 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. 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