Inspection on 16/08/05 for Greenbanks

This inspection was carried out on 16th August 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

Greenbanks 08/05/07

Greenbanks 15/05/06

Greenbanks 08/02/06

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 Claire Farrier Unannounced 16 August 2005 at 8:50 th 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. Greenbanks I52 s19414 greenbanks v243280 160805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Greenbanks Address Greenbanks Road Watford Hertfordshire WD17 4JP 01923 255160 01923 255170 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) Runwood Homes plc Ms Christine Larner Care Home 66 Category(ies) of DE Dementia - 66 registration, with number OP Old Age - 66 of places PD(E) Physical Disability over 65 - 66 Greenbanks I52 s19414 greenbanks v243280 160805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home may accommodate one (named) resident currently 62 years old. 2. The manager must inform CSCI when the above (named) resident leaves the home or reaches the age of 65, whichever comes first. 3. This variation applies only to this (named) man and ceases to be in force when the man leaves the home or reaches 65, whichever comes first. Date of last inspection 1st February 2005 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 home’s 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. Greenbanks I52 s19414 greenbanks v243280 160805 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced inspection of the inspection year and took place over one day, starting at 8.50am. Two inspectors visited the home, and the majority of time was spent observing and talking to residents and staff. Some time was also spent looking at records and care plans, and the results of the inspection were discussed with the manager. Nine residents and five members of staff were spoken to during the inspection. This was generally a positive inspection, and the majority of the standards were met or partially met. A new requirement was made concerning equipment that is out of order, and a requirement has been repeated on the recording and audit of medication, and the temperature of medication storage cupboards. What the service does well: What has improved since the last inspection? Most of the requirements made in the last inspection report have been acted on. Evidence was seen that all the residents now have a copy of the Service Users Guide. No health and safety issues were found during this inspection, and the advice of the fire service has been acted on concerning the use of door wedges. Greenbanks I52 s19414 greenbanks v243280 160805 stage 4.doc Version 1.40 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 I52 s19414 greenbanks v243280 160805 stage 4.doc Version 1.40 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 Greenbanks I52 s19414 greenbanks v243280 160805 stage 4.doc Version 1.40 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) 3 and 4 A comprehensive assessment of the needs of the residents was seen to be in place, and appropriate risk assessments are carried out to ensure that the residents live in a safe environment. The home has sufficient information on residents’ needs and access to appropriate services to enable the needs to be met. EVIDENCE: Care records of residents were inspected and there was evidence of preadmission assessment of needs being carried out in each case. The home receives a copy of the pre admission assessment of needs of prospective residents for those who are funded by the Social Services and discharge letters from hospital, where applicable Greenbanks I52 s19414 greenbanks v243280 160805 stage 4.doc Version 1.40 Page 9 The staff members were observed to have a good relationship with the residents and to treat them with respect. The home has sufficient levels of staff and appropriate training to ensure that they can meet the needs of the residents. All the staff spoken to, including domestic staff, said they have the skills and knowledge to meet the specific care needs of the residents. The residents spoken to said that the staff are very good and very kind, and understand their individual needs. The dementia unit has environmental aids to orientation, including sensory wall decorations and pictures on the doors. Staff on the dementia unit have training in dementia care. One man aged 62 was admitted to the home, and a variation to the conditions of registration was agreed. The ongoing assessment since he moved into the home has shown that he has behavioural problems that the home has not been able to provide for, and since this inspection he has moved out of the home. The variation conditions will now be removed. Greenbanks I52 s19414 greenbanks v243280 160805 stage 4.doc Version 1.40 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 standard(s) 7, 8, 9 and 10 The individual needs of residents are clearly set out in care plans to ensure that all their needs are identified and can be met. Several errors were seen in the administartion and recording of medication, which could cause a risk to the health of the residents. Residents said that staff treat them with respect, and the policies and practice in the home also promote service user privacy and dignity. EVIDENCE: Detailed case tracking was carried out through the files of seven residents. They contain clear and easily accessible information on the resident’s health and personal care needs, with comprehensive procedures for meeting the needs. Appropriate goals are identified for each person, related to personal care, health care and activities. Examples seen include personal care needs, activities and a night care plan. Risk assessments are in place for each resident, including for the risk of falls for all residents, and for individual needs such as being unable to use the call bell. Greenbanks I52 s19414 greenbanks v243280 160805 stage 4.doc Version 1.40 Page 11 The care plans contain good information on the residents’ health care needs, with appropriate monitoring of specific health concerns and recording of all contacts with medical practitioners. All residents have assessments for the risks of falls, care needs, nutrition and pressure areas, and for dementia where this is appropriate. The assessments are updated regularly, at the most every three months, and appropriate changes made to the care plans. All the residents said that the staff treat them with respect and provide a good quality of care. One said that the staff are very good, and always there to help if needed. Staff were observed administering eye drops to a resident in the dining room. Although this is not an intrusive treatment, consideration should be given to administering personal treatments, such as eye drops, in the residents room, to ensure their privacy and dignity. The medication round was observed on Clarendon unit, and the procedures and recording were inspected on the other three units. The procedures generally were seen to be satisfactory, but some discrepancies were observed. 1. The staff knew that medication should be signed for after it is administered, but some are recording it beforehand. Staff were also observed handling tablets by hand, instead of putting it directly from the blister pack into the pot in which it was handed to the resident. 2. Some medication is administered from the original packaging, and there is no evidence of a regular audit to ensure that the medication is administered correctly. A spot check of the medication for two residents showed discrepancies between the amount recorded as administered and the number of tablets in the packet, with more tablets in stock than there should be if the medication was recorded accurately. PRN (when required) medication is administered for each resident from blister packs, but the current amount held in the home is not recorded on the MAR (medicines administration record) chart, which means that it is difficult to carry out an accurate audit. This was also observed during the previous inspection. 3. One resident has a variable prescription of warfarin, and the staff put the appropriate doses in a dossett box to avoid the risk of error. However all medication must be dispensed from the package in which it is supplied by the pharmacist. The pharmacist should advise the home on the best way to manage variable doses, and provide the medication in an appropriate format. 4. The temperature of the controlled drugs cupboard is now monitored, but there are no thermometers in the medication cupboards on the units, which were felt to be warm. The temperature of all rooms used to store medication must be regulated to below 25°C. This was also a requirement in the previous inspection report. Greenbanks I52 s19414 greenbanks v243280 160805 stage 4.doc Version 1.40 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 standard(s) 12, 13, 14 and 15 The residents are happy with the activities and daily life in the home and maintaining contact with families and friends is promoted by staff in accordance with the residents’ wishes. Wholesome and varied meals are provided within the home presenting a well-balanced nutritious diet for the residents. Residents maintain their independence by making choices about the food and how they spend their days. Greenbanks I52 s19414 greenbanks v243280 160805 stage 4.doc Version 1.40 Page 13 EVIDENCE: The provision of activities was again assessed as commendable. The residents and staff all praised the activities organiser. Each resident has an individual activity care plan and an entry is made every time that an activity is undertaken. All the residents are encouraged to join in, although there is no pressure put on individuals. Those who don’t wish to join in the group activities have individual activities such as going shopping. There are specially tailored activities for the dementia care unit. The activities organiser was not in the home on the day of the inspection, but residents spoke of bingo, discussion groups and art activities. One person said that she was encouraged to take part in some art activities which she had never done before, and which she now thoroughly enjoys. A man said that he enjoyed gardening, and he had created a small garden outside his bedroom window. He was no longer able to take part in this activity, but he enjoyed the company of the other residents, and especially the discussion groups. A group of residents were seen in the activities lounge after lunch, having manicures and enjoying music and conversation. Families and friends are welcomed into the home, and family members are consulted about the resident’s care. Residents’ autonomy is promoted and all the bedrooms seen contained evidence of the resident’s own furniture and decorations. There are regular residents meetings, and their views and wishes are seen in the choice of activities and of the meals provided. The residents were enjoying a leisurely breakfast when the inspection began. There is a good choice of meals, and all the residents spoken to said that the food is good and that they enjoy their meals. Greenbanks I52 s19414 greenbanks v243280 160805 stage 4.doc Version 1.40 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 standard(s) 16 and 18 The home has a comprehensive complaints procedure in place, and residents and their relatives are confident that any complaints will be properly investigated. All staff have appropriate training on prevention of abuse, and robust polices and procedures are in place to ensure that the residents are protected. EVIDENCE: The home has a satisfactory complaints procedure in place. Residents and their relatives are encouraged to make their concerns and complaints known. All complaints made to the home are recorded, and it was reported that all were responded to appropriately. One complaint was received by CSCI, concerning staffing in the home during the night. The manager investigate the complaint and found no evidence to support it. (See Standard 27) Training in the prevention of abuse is included in the induction programme. Most of the staff spoken to were aware of the home’s procedures and of the whistle blowing policy, and training is currently taking place for all the staff, including domestic staff. Greenbanks I52 s19414 greenbanks v243280 160805 stage 4.doc Version 1.40 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 standard(s) 19 and 26 The home and gardens are well maintained and provide a comfortable and attractive environment for the residents. Individual and communal facilities are appropriate for the residents’ needs. This ensures that the residents are able to maximise their independence and live in a safe and comfortable environment. Greenbanks I52 s19414 greenbanks v243280 160805 stage 4.doc Version 1.40 Page 16 EVIDENCE: No changes have been made to the fabric of the home since the last inspection. It was purpose-built in a residential area of Watford. The decorations and furnishings are domestic in style, and provide a homely and comfortable environment. The home has a garden that is accessible for all residents, with pathways suitable for wheelchairs and several seating areas. The home is well decorated and the fabric of the building appears to be well maintained. On Clarendon unit the dishwasher had not been working for approximately three weeks, and the leakage had damaged the floor. It was reported that the floor was due to be repaired, but the lack of a dishwasher means that the staff have to wash up by hand, which means that they have less time to spend with the residents. The tumble drier on Cassiobury unit had been out of order since February, and the dishwasher in the kitchen was also out of order. The home appeared to be clean throughout, and there were no offensive odours. Appropriate procedures are in place for the control of hygiene. Greenbanks I52 s19414 greenbanks v243280 160805 stage 4.doc Version 1.40 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 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, 28, 29 and 30 Staff numbers in the home are sufficient to ensure that all the residents’ needs are met, and staff receive appropriate training. Good recruitment procedures and staff training make sure that, as far as possible, the residents are supported and protected in the home. EVIDENCE: The home has a good level of staffing, with at least two care workers on each unit. Sufficient staff were on duty during the inspection, and the residents spoken to said that the staff are very good, and always available when needed. The home is fully staffed with permanent care staff, and there has been no need to use agency staff for the past three months. The CSCI received an anonymous complaint about night staff, which claimed that some staff sleep when they are working at night. The manager carried out a thorough investigation, and found no evidence to support this, but she intends to carry out more stringent supervision of the night staff to ensure that they are working according to their rota. A thorough recruitment procedure, is practiced including obtaining CRB (Criminal Record Bureau) and POVA (protection of vulnerable adults) disclosures before new staff start to work in the home. Greenbanks I52 s19414 greenbanks v243280 160805 stage 4.doc Version 1.40 Page 18 The staff spoken to feel well supported in their work, with a good training programme and regular supervision. Four members of staff already have NVQ at level 2 or 3, and the manager has completed the Registered Managers Award. Two people are working towards their qualification, and fourteen are registered to start the course. The home has not yet achieved the target of 50 of staff trained to NVQ level 2, but all the staff are encouraged and supported to undertake NVQ qualifications. Greenbanks I52 s19414 greenbanks v243280 160805 stage 4.doc Version 1.40 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 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) 33, 35, 36 and 38 The views of the residents and other involved people are actively sought in order to ensure that a good quality of care is provided. The residents of the home are safeguarded by the practice of appropriate health and safety procedures. EVIDENCE: A sound quality assurance system in place that meets the needs of the service. Annual questionnaires are sent to all the residents and their families, and feedback is given to them on the outcomes. There are regular residents meetings in the home. Runwood Homes carries out an annual audit of all aspects of the service provided by the home, and the report from this includes an action plan and the views of the residents. The proprietor makes monthly visits to the home to monitor the quality of care provided. Greenbanks I52 s19414 greenbanks v243280 160805 stage 4.doc Version 1.40 Page 20 The arrangements for management of residents’ money were checked inspected and appeared to be accurate. Money is stored safely and adequate records are maintained in order to protect service users from financial abuse. Appropriate records are maintained for the health and safety of the residents and staff in the home, and staff follow the home’s policies and procedures. All the staff have training in moving and handling, fire safety, food hygiene and infection control as part of their induction. Since the last inspection the manager has sought the advice of the fire service on the use of wedges to hold open bedroom doors. One resident wants to have her door held open, and there is a risk assessment in place and a the fire procedure covers this situation. It was reported that the fire service is satisfied with these precautions. The water temperature in one bathroom measured 46°C on the home’s thermometer, which is above the safe limit of 43°C. However the plumber was fitting new blender valves to control water temperature on the day of the inspection. Greenbanks I52 s19414 greenbanks v243280 160805 stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 3 x 3 Greenbanks I52 s19414 greenbanks v243280 160805 stage 4.doc Version 1.40 Page 22 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 Some poor practice was observed in the administration of medication. Effective measures must be put into place to ensure that all medication is stored, administered and recorded according to the guidelines of Royal Pharmaceutical Society and the relevant legislation.In particular: 1. Medication must be recorded accurately to enable an effective audit to be carried out. Previous timescale of 31.3.05 not met 2. The temperature of all rooms used to store medication must be regulated to below 25°C. Previous timescale of 31.3.05 not met 3. All medication must be dispensed from the package in which it is supplied by the pharmacist. A dishwasher and a tumble drier had been out of order for some time, causing inconvenience to the residents and staff. All equipment must be maintained in working order. Timescale for action 31.10.05 2. 19 23(2) (c) 31.10.05 Greenbanks I52 s19414 greenbanks v243280 160805 stage 4.doc Version 1.40 Page 23 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 10 Good Practice Recommendations Consideration should be given to administering personal treatments, such as eye drops, in the residents room, to ensure their privacy and dignity. Greenbanks I52 s19414 greenbanks v243280 160805 stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City 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 I52 s19414 greenbanks v243280 160805 stage 4.doc Version 1.40 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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