Inspection on 08/02/06 for Greenbanks

This inspection was carried out on 8th February 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 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 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 Claire Farrier Unannounced Inspection 8th February 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 Greenbanks DS0000019414.V282928.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.V282928.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.V282928.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th August 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 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. Greenbanks DS0000019414.V282928.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this unannounced inspection, and including preparation time it took a total of 11 hours. During their time in the home the inspectors spoke with five residents, three visitors and five members of staff, and feedback was given to the manager. The interaction between residents and staff was observed. The records were checked of residents’ care and residents’ money, staff rotas and health and safety records. This was a positive inspection, and the majority of the standards inspected on this occasion were met or partially met. All the residents spoken to were happy in the home and several visitors were complimentary of the staff and the care provided. New requirements were made concerning care plans, cleaning, water temperatures and fire precautions. This was the second inspection of the year. Core standards that were not inspected on this occasion were assessed to have been met in the previous inspection report, to which reference can be made. What the service does well: What has improved since the last inspection? Greenbanks DS0000019414.V282928.R01.S.doc Version 5.1 Page 6 The requirements made in the last inspection report have been acted on. Medication procedures have improved, and equipment has been repaired. 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.V282928.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.V282928.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): These standards were not inspected on this occasion. EVIDENCE: Greenbanks DS0000019414.V282928.R01.S.doc Version 5.1 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 the following standard(s): 7, 8 and 9 The care plans are arranged in a format that provides up to date and easily accessible information on each resident, so that the care staff are able to meet the resident’s needs. But some care plans do not contain clear and accurate information. The home monitors and addresses all the residents’ personal care and health needs. Greenbanks DS0000019414.V282928.R01.S.doc Version 5.1 Page 10 EVIDENCE: Detailed case tracking was carried out through the files of eight 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, mobilising, socialising and a night care plan. One resident has a care plan for a cataract, which states that staff should approach her from the right, and the use of natural tears ointment. There is good daily recording that generally relates to care plans, of the personal care given, activities and any health concerns. There was detailed recording of all the concerns and care provided for one resident who had several falls during a short period, and two admissions to hospital. 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. Individual risk assessments are in place for each resident, for example being unable to use the call bell, for the use of Warfarin and for the prevention of falls. One resident has a reclining chair in her room, but there is no risk assessment in place for its use. This must be addressed to ensure their safety, the risk assessment should identify the rationale for use and clear instructions for staff. 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. The files of two residents with diabetes were inspected. Both have diabetes that is controlled by diet and medication. One contains good details of the dietary needs, the possible risks, including pressure sores and reduced circulation, and the signs to watch for, including abdominal pain, headaches or clamminess. The other file states that staff should offer the resident plenty of fluids and be aware of indicators of high blood sugar, but with no specific information on these indicators. For diet the care plan states “X is aware of what foods she can eat,” but there are no details of her dietary needs. The resident confirmed that she knows what she can and cannot eat, and she is confident that appropriate food is provided for her. However last July she was admitted to hospital with suspected kidney failure related to the diabetes. The procedures for managing diabetes have recently changed. All residents with diabetes now have a blood test every other day, and a file on the condition is kept in their room. However the information on the needs of each individual in their care plans is not consistent and in some cases is not clear. Greenbanks DS0000019414.V282928.R01.S.doc Version 5.1 Page 11 The care plans for residents with dementia contain good details of their needs, and the specialised training in dementia is provided for the staff. The manager and sixteen care workers are doing a certificated Alzheimers Society course. The care plan for one resident states, “Carers should tell as often as is needed the date, day and time in a calm and pleasant manner. Carers should never raise their voice and remember X is not being awkward when she is asking questions. Carers should engage X in simple conversations to keep her stimulated.” However for another resident a review states “Continues to exhibit challenging behaviour.” But there is no strategy in the care plan for managing her behaviour. All the care plans have a record of each resident’s weight, and nutritional assessments are carried out and food and fluid intake is monitored when there is any concern. However the scales have been out of order since October 2005, and no one has a recorded weight since then. One care plan for a resident with a history of falls and health concerns stated that her weight should be monitored and any change should be reported. Daily observations are recorded that she is eating and drinking well, but an accurate record of weight is an essential tool for providing good health care. The procedures for administering and recording generally sound. The home uses a monitored dosage system with MAR (medication administration record) sheets to record all aspects of administration. Controlled drugs are recorded appropriately and stored in a separate cupboard. The staff spoken to confirmed that they are trained and supervised in their practice. Greenbanks DS0000019414.V282928.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): These standards were not inspected on this occasion. EVIDENCE: Greenbanks DS0000019414.V282928.R01.S.doc Version 5.1 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 the following standard(s): These standards were not inspected on this occasion. EVIDENCE: Greenbanks DS0000019414.V282928.R01.S.doc Version 5.1 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 the following 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. The cleaning of some parts of the building need more attention to detail. 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. The equipment that was not working at the time of the last inspection has been repaired. On one unit the washing machine was not working. However Greenbanks DS0000019414.V282928.R01.S.doc Version 5.1 Page 15 the procedure for dealing with laundry has been changed, and the domestic style laundry equipment on each unit will not be replaced. All laundry is now washed in the home’s central laundry, and extra staffing has been provided for this. On Cassiobury unit the cooker and the fridge were not working, but this had not been reported prior to this inspection. The home appeared to be generally clean, and cleaning was in progress on the units during the morning. Some attention to detail is needed, such as ensuring that the inside of cutlery drawers is clean. The main kitchen needs a thorough clean, especially around the extractor fan and the lights. There is a strong and lingering odour around the entrance of Hazelmere unit. It was reported that this was due to one resident, and several measures had been tried to address his behaviours, but so far without success. Greenbanks DS0000019414.V282928.R01.S.doc Version 5.1 Page 16 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 and 30 Staff numbers in the home are sufficient to ensure that all the residents’ needs are met. 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. The staff spoken to feel well supported in their work, with a good training programme and regular supervision. Greenbanks DS0000019414.V282928.R01.S.doc Version 5.1 Page 17 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, 35 and 38 The home is well managed. Adequate records are maintained for the effective management of the home and monitoring of health and safety procedures, and appropriate procedures are in place to ensure that the personal money of the residents is looked after and recorded appropriately. EVIDENCE: The manager has been in post at Greenbanks since 1993. She has completed the Registered Managers Award, and she is currently undertaking a certificate in dementia care. The arrangements for management of residents’ money were inspected and appeared to be accurate. Money is stored safely and adequate records are maintained in order to protect service users from financial abuse. Greenbanks DS0000019414.V282928.R01.S.doc Version 5.1 Page 18 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. Two health and safety concerns were observed during the inspection. In the main kitchen fire doors were held open with bricks, and the bath water temperature in one bathroom on Hazelmere unit measured 53°C, which could cause a risk of scalding. Greenbanks DS0000019414.V282928.R01.S.doc Version 5.1 Page 19 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 2 Greenbanks DS0000019414.V282928.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? NO 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 OP7 Regulation 13(4)(c) Requirement One resident has a reclining chair in her room, but there is no risk assessment in place for its use. Appropriate and adequate risk assessments must be put in place for all residents. The care plans contain clear and easily accessible information on the resident’s health and personal care needs, with comprehensive procedures for meeting the needs. However the information on the needs of each individual with diabetes is not consistent and in some cases is not clear. There is no strategy for managing the behaviour of one resident with dementia. The registered person must ensure that all care plans have accurate and up to date information on meeting each resident’s health care needs. Timescale for action 30/04/06 2 OP8 12(1)(a) 15(2)(b) 30/06/06 Greenbanks DS0000019414.V282928.R01.S.doc Version 5.1 Page 21 3 OP8 12(1)(a) Residents have not been weighed since October 2005 as the scales have been out of order. The registered person must ensure that appropriate equipment for weighing every resident is made available in order to maintain effective monitoring of healthcare. 30/04/06 4 OP26 16(2)(k) There was a noticeable odour on the ground floor in Hazelmere unit. Measures must be put in place to keep the home free from offensive odours. 30/04/06 5 OP26 23(2)(d) The cleaning of some parts of the building need more attention to detail, in particular the main kitchen. All parts of the home must be kept clean and hygienic. 30/04/06 6 OP38 13(4)(c) The bath water temperature in one bathroom on Hazelmere unit measured 53°C. Measures must be taken to ensure that hot water temperatures at or close to the required level of 43°C in order to safeguard residents from the risk of scalding. In the main kitchen fire doors were held open with bricks. All fire doors must be kept closed. In situations where there is a need for a fire door to be kept open, an automatic closing device must be fitted. 08/02/06 7 OP38 23(4)(a) 08/02/06 Greenbanks DS0000019414.V282928.R01.S.doc Version 5.1 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. Refer to Standard Good Practice Recommendations Greenbanks DS0000019414.V282928.R01.S.doc Version 5.1 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 Greenbanks DS0000019414.V282928.R01.S.doc Version 5.1 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. 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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