Inspection on 16/10/06 for Greene House

This inspection was carried out on 16th October 2006.

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 found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greene House 09/10/08

Greene House 31/01/06

Greene House 28/09/05

Greene House 02/03/05

Greene House 24/09/04

Greene House 25/02/04

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Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Greene House The National Society For Epilepsy Chesham Lane Chalfont St Peter Gerrards Cross Bucks SL9 ORJ Lead Inspector Chris Schwarz Unannounced Inspection 16th October 2006 09:30 Greene House DS0000022973.V308289.R01.S.doc Version 5.2 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 Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greene House Address 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) The National Society For Epilepsy Chesham Lane Chalfont St Peter Gerrards Cross Bucks SL9 ORJ 01494 601426 01494 871927 www.epilepsynse.org.uk The National Society for Epilepsy Andrew Anderson Care Home 18 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That as of the 1st of April 2006, in relation to the variation submitted to CSCI, the home’s registration is varied to allow for the admission of one service user with dementia. That this condition relates to a single service user, and should they leave the home, for whatever reason, the home must notify CSCI and this condition will cease to apply. Date of last inspection 31st January 2006 Brief Description of the Service: Greene House is a care home registered to provide care, support and accommodation for up to 17 people with learning and physical disabilities. The home is part of the National Society for Epilepsy’s campus in Chalfont St Peter and constitutes a detached building offering single room accommodation to all service users. There is ample communal space as the home is divided into five groups. Externally there are communal grounds of the campus. Service users are able to access the nearby towns of Amersham, Slough and High Wycombe although public transport links are restricted. The village of Chalfont St Peter has some amenities and there is a shop and a restaurant on campus. Current placement fees ranged from £859.89 to £1579.10 per week, subject to assessment. Personal items such as toiletries, hairdressing, newspapers and magazines and trips/outings are at additional cost to the service user. Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over the course of a day, with a feedback meeting the following day, and covered all of the key standards for younger adults. Prior to the visit, a questionnaire was sent to the manager alongside comment cards for distribution to service users, relatives and visiting professionals. Any replies received from the comment cards have helped form judgements about the quality of care at the home. The inspection consisted of discussion with the manager and deputy manager, observation of care practice, attending staff handover and meeting with a group of service users to gain their views. A tour of the premises and examination of some of the required records was also undertaken. At the end of the inspection, feedback was given to the manager and deputy manager. The inspection revealed good standards of care in all but one area, the environment, although efforts have been made to make the best of an old building in making it look homely for service users. Staff and service users are thanked for their co-operation and hospitality throughout the inspection. What the service does well: Needs arising from diversity and equality are well met. Thorough assessment is undertaken of prospective service users, to ensure that care needs are ascertained prior to providing a service. Care plans have been produced for all service users, ensuring that needs have been identified and can be met. Service users are enabled to make decisions and be as independent as possible, providing them with choice and involvement. Service users are enabled to take responsible risks, ensuring that their independence is promoted. Service users take part in appropriate activities and make use of the local facilities, providing stimulation and variety, although there are some restrictions which limit choice and availability. Service users are enabled to keep in contact with friends and family, maintaining important social links. Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 6 The rights of the individual are respected, promoting fulfilment and affording service users respect. Measures are in place to provide an improved diet which better meets nutritional needs. Personal support needs are recorded in care plans to ensure that service users receive the assistance they require. Physical and emotional health care needs are managed on site to ensure that service users keep well. Medication practice is safe and ensures that service users receive the medicines they require. Effort has been made to create a safe, homely and comfortable place for service users to live within the constraints of an old and listed property. Competent and qualified staff work at the home, ensuring that they have the skills and knowledge necessary to meet service users’ needs. Thorough recruitment practices are undertaken, to ensure that service users are protected from unscrupulous persons working with them. Training is undertaken by staff to ensure that they are equipped to meet the needs of service users. The home is managed by a competent and qualified person, ensuring continuity of care and that needs are met. There is effective monitoring by the provider to ensure that standards of care meet the needs of service users. Health and safety is well managed overall with some areas needing attention to ensure that staff, service users and visitors are not placed at risk of harm. What has improved since the last inspection? There was evidence of care plans and daily record sheets being monitored and reviewed. Care plans reflect the care provided to service users. Dates and signatures were in place where risk assessments had been amended or reviewed. The complaints folder had been developed to include information on outcomes. Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 7 Information was forwarded to the Commission for Social Care Inspection regarding improving the environment. Maintenance and cleaning issues highlighted at the last inspection had been attended to. Swing top bins had been replaced with foot pedal operated ones to reduce risk of cross-infection. The fire based risk assessment had been updated. Hot water and shower temperatures are being checked and recorded as such. Servicing records for central heating, the boiler and hoists were largely available in the house. What they could do better: There are six recommended actions following this inspection to improve quality of care: Individual guidance for service users on managing their behaviour needs to be reviewed at least every six months with a record kept of these reviews, to ensure that guidance is still appropriate. The safe minimum core temperature for cooked foods is to be added to the record sheets to remind staff. A record of routine health screening appointments is to be maintained within care plan files in order that information is available on service users’ well being. The glass covering the skylight in the office is to be kept clean to improve natural lighting. Central heating needs to be controllable from within the house and ideally with individual room thermostats, in order that the house can respond to changing outside temperatures and service users’ own preferences. Fire drill records are to be supplemented with further information to demonstrate thorough safeguards. Requirements have been made in five areas to improve quality of care: Service users’ money is to be managed safely and accurately to ensure that their finances are appropriately handled and can be tracked. Cooked food core temperatures are to reach at least 70°Celsius to reduce the risk of food poisoning. Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 8 Carpet needs to be replaced outside one of the shower rooms if the staining cannot be removed by cleaning, to improve the appearance of the corridor. Lime scale needs to be removed from a shower tray to prevent bacteria growing. An updated generic risk assessment of the premises is needed to ensure that risks to service users, visitors and staff from hazards is minimised. 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 office. Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Thorough assessment is undertaken of prospective service users’ needs, to ensure that care needs are ascertained prior to providing a service. EVIDENCE: Pre-admission information was looked at relating to a new service user. A detailed assessment had been carried out by the manager and deputy manager, outlining care needs in broad areas and including history of epilepsy. A visit had been made to the service user’s place of residence and assessment took into account views of relevant parties. A four-week assessment period at the National Society for Epilepsy (NSE) was offered to the service user which involved further assessment on site. The service user is now permanently resident at Greene House and there is a care plan in place to ensure that needs are met. Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Care plans have been produced for all service users, ensuring that needs have been identified and can be met. Service users are enabled to make decisions and be as independent as possible, providing them with choice and involvement. Service users are enabled to take responsible risks, ensuring that their independence is promoted. EVIDENCE: A sample of care plans was read and found to be in good order. Documentation provided a guide to the type of assistance service users required, where this was necessary, as well as areas that they manage independently. Description of seizure types was present as well as useful basic information and a photograph of the person. A quick reference file had also been established to provide new or bank staff with summarised information of service users’ needs. Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 12 Guidelines were in place on managing challenging behaviour with accompanying risk assessments and supporting documentation from the consultant neurologist where applicable. One piece of guidance on behavioural management had been prepared in 2004 with evidence of review most recently in January 2005. Advice was given to the manager to ensure that the guidance is reviewed and recorded as such at least every six months, to ensure that the measures in place are still relevant to supporting the service user. A recommendation is made to address this. A range of dated and signed risk assessments was in place on each file to reduce the risk of harm and promote service users’ independence. There was evidence from minutes of service users’ meetings and from speaking with service users to show that they are involved in decision making and are encouraged to be as independent as possible. Most prepare their medication wallets and take their medicines themselves, the majority hold their day-to-day money, keys to the front door and bedrooms have been issued, several possess and use mobile telephones and some have computers and make use of email communication. Care plan files also provided evidence of service users being given copies of key information such as the complaints procedure, fire procedure and service users’ guide. One person had written a significant part of his care plan himself, setting goals and how these could be achieved. The staff team manage the day-to-day money of a couple of service users and risk assessments are in place to explain why this is the case. Wider banking facilities are available on site and managed separately to the residential provision. Examination of financial record sheets in the house showed that a member of staff had used their own loyalty card against a service user’s purchases, contrary to acceptable practice. The recorded balance of a second service user’s finances did not tally with the actual balance as the expenditure records had not been completed to date. A requirement is made to ensure that service users’ money is managed safely and accurately and in line with the NSEs financial procedures. Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 – 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users take part in appropriate activities and make use of the local facilities, providing stimulation and variety, although there are some restrictions which limit choice and availability. Service users are enabled to keep in contact with friends and family, maintaining important social links. The rights of the individual are respected, promoting fulfilment and affording service users respect. Measures are in place to provide an improved diet which better meets nutritional needs. Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 14 EVIDENCE: Service users talked about various activities, work and therapies that take place during the week such as gardening/grounds maintenance, light assembly work, college courses and access to art, sensory and computer sessions on site. Some added that there was little by way of on-site activity or entertainment at weekends, which was an issue as the house has to hire transport to take service users off-site, rather than being able to respond in a spontaneous manner. The manager has put together a proposal for the house to have its own transport, which hopefully will be supported by senior management. A number of successful theatre trips and outings had taken place and there had been holidays both abroad and in this country for those service users who wanted a break. Consultation meetings have been taking place with relatives to keep them informed of events and provide a forum if they have any matters they wish to raise. There was evidence from comment cards that service users are able to receive visitors without restriction and records within the house showed that some service users stay with family at weekends. Contact with families is facilitated through several people owning mobile telephones and there is also a payphone provided within the house. Routines within the home promote service users taking part in providing meals for the house, several service users were observed making their own drinks and one person had been cleaning her lounge and dining area. Since the last inspection the house has become self catering and service users commented that the quality of meals had improved significantly. Menus reflected a balanced and nutritious diet and it was positive to see so much fresh fruit and vegetables in the house; a wide range of fruit was available in the main kitchen as well as the individual lounges. Core food temperatures of cooked foods are tested and recorded. Records showed there had been some occasions where food had been served at below 70°Celsius which could present a food poisoning risk. A requirement is made to ensure that core temperature has reached at least 70°Celsius and a recommendation is made to add the minimum safe core temperature to the record sheet as a reminder to the staff team. Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Personal support needs are recorded in care plans to ensure that service users receive the assistance they require. Physical and emotional health care needs are managed on site to ensure that service users keep well. Medication practice is safe and ensures that service users receive the medicines they require. EVIDENCE: The sample of care plans examined provided a good account of service users’ personal support needs and what they are able to manage for themselves. There was evidence in files of the involvement of multi-disciplinary health professionals, based on site, and regular appointments with the consultant neurologist. Psychiatric and psychology input was also being provided for service users where necessary. Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 16 Feedback from health care professionals included, “Greene House staff are very good in caring and observing their residents. They are quick to notice any problems and they inform us straight away”. A consultant described staff as a “highly motivated staff team” and comments from relatives included, “The care and treatment she has received has always been of the very best”, and, “I think Greene House is a wonderful friendly home for my sister and I know she is happy and contented there”, with praise also for helping the service user deal with a family bereavement. Records within care plans did not indicate attendance at routine health screening appointments such as dental and eye checks. Assurance was given that these checks do take place and are organised by staff working within the medical facilities unit and carried out on site. Some service users are independent in attending such appointments and would receive their appointment in post addressed to them. In discussion with the manager, advice was given that it would be good practice to be able to demonstrate that screening takes place regularly with a record sheet maintained within care plan folders detailing date of appointment and a brief description of the outcome. A recommendation is made to address this. Medication was being well managed at Greene House. Several people manage their medicines independently, filling weekly dossette packs themselves, subject to risk assessment. Records were in place to verify that staff check that the packs are being filled accurately and safely. Where staff administer medicines to other service users, records were being accurately maintained alongside prescribed dose times. The medication cabinet was secure and locked when not in use. Recommendations made at the previous inspection had been addressed, such as ensuring that drips from liquid medicines were wiped up, guidelines produced for a medicine and clearly legible instructions were in place for all pharmacy dispensed medicines. The drugs register was read and found to be up-to-date. The house has also produced a quick guide file in case service users need to go to hospital, with information such as basic details, medication regime and a photograph of each person. Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Effective complaints procedures are in place to listen to the views of service users and their representatives. Adult protection is well managed with appropriate policies, procedures and staff training in place. This needs to be supplemented with input for service users in order that their awareness is raised. EVIDENCE: A complaints procedure was in place and a log of compliments and complaints was being maintained within the home. An advocacy service was involved with a complaint raised by a service user. No information regarding complaints made to the service by service users or their representatives has been received by the Commission. Adult protection and whistle blowing procedures were in place and Protection of Vulnerable Adults training is undertaken by staff. It is also important that service users understand their rights and what is acceptable and some adult protection awareness raising needs to be organised for them, to supplement the procedures and training available to the staff team. A requirement is made to address this. The Commission is not aware of any adult protection issues regarding this service. Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Effort has been made to create a safe, homely and comfortable place for service users to live within the constraints of an old and listed property. EVIDENCE: Greene House is a detached property divided into small living groups with a communal lounge and kitchen supplementing those in each group. Most of the accommodation is on ground floor level with a three-person flat on the first floor. All areas of the home were bright, light and clean and effort had been made to add homely touches such as pictures, fresh flowers and fruit. The addition of a service user’s cat was well met by those people spoken with and service users were taking responsibility for making sure she was fed and well cared for. Redecoration had taken place within the home and it looked fresh and clean throughout. It was noticed that central heating within the building cannot be controlled in any of the rooms and this resulted in some overheated areas of the home during the morning, measured at 25°Celsius, requiring windows to be opened to cool down. It needs to be possible for the house to be able to Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 19 regulate central heating itself, ideally with each room having its own control. A recommendation is made to address this. All bedrooms in the house are single occupancy and those viewed were personalised and close to bathrooms/toilets. One service user mentioned that he was enabled to go to Ikea with staff to select furniture for his room which he subsequently put together himself. It was noticed that a service user who uses a wheelchair had very little space within his room to manoeuvre and it was not possible to arrange his bed in order that staff could assist from either side if need be, as well as providing sufficient space to get into the room. The manager has made some proposals to senior management regarding improving the facilities within the house which included this room. Staff have tried to make bathrooms/showers look homely but expanses of white tiles appear cold and clinical and the main bathroom is the most unappealing in this respect. The shower tray in the upstairs flat had a patch of limescale which needs to be removed. The carpet outside the shower in the eight-bedded unit was stained and this will need to be replaced if shampooing does not remove it. It is recommended that natural lighting be improved in the office through cleaning of the vaulted skylight glass. There were no unpleasant odours in the building and laundry was under control. Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Competent and qualified staff work at the home, ensuring that service users are cared for by people with the skills and knowledge necessary to meet their needs. Thorough recruitment practices are undertaken, to ensure that service users are protected from unscrupulous persons working with them. Training is undertaken by staff to ensure that they are equipped to meet the needs of service users. EVIDENCE: Sufficient numbers of staff are rostered to work at the home to meet current care needs. Shifts appeared to be well organised with a handover between morning and afternoon staff and the use of shift leader planning records. These had been reformatted to ensure confidentiality if any of the service users wanted to see what staff had recorded about them. Minutes of staff meetings showed that four meetings had taken place so far this calendar year with a range of topics and issues discussed between the team. Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 21 Cover of vacant posts was well managed with the deputy manager arranging for a member of bank staff to work the afternoon shift on the day of the inspection and the person who was supplied had been inducted by the NSE. Examination of the recruitment records for the two staff taken on since the last inspection showed that thorough recruitment processes had been followed with all necessary checks undertaken and original documentation available at the human resources office on site. Probationary reports were also available on the files to demonstrate that their performance had been evaluated. It was positive to hear that the manager had been interviewed by a panel which included three service users and this involvement is to be encouraged. Training records showed that mandatory training is well managed with staff largely either up-to-date with learning or booked to attend first time or refresher training. Equality and diversity training was also being rolled out to staff. Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is managed by a competent and qualified person, ensuring continuity of care and that needs are met. There is effective monitoring by the provider to ensure that standards of care meet the needs of service users. Health and safety is well managed overall with some areas needing attention to ensure that staff, service users and visitors are not placed at risk of harm. EVIDENCE: The manager is registered with the Commission and has completed the Registered Manager’s Award and was completing the National Vocational Qualification Level 4 in Care. Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 23 Some of the people who completed comment cards stated that he has been a positive addition to the staff team and to improving quality of care at the home. The deputy manager is experienced and has National Vocational Qualification Level 3 and is undertaking the Registered Manager’s Award. A 20-hours a week administrator’s post has been created which will be a positive addition to the staffing establishment. Regular monitoring visits are undertaken on behalf of the provider with reports prepared of the findings. A range of health and safety checks is undertaken. Fire safety precautions were being carried out with regular testing, drills, servicing and checking the means of escape from the building. A fire based risk assessment was in place and a gas safety certificate was in place. Staff additionally check the tumble dryer filter on a regular basis to ensure that this is kept clear. The only observation made regarding fire safety practice was that records of fire drills do not consistently contain all of the following information: date and time of drill, who was present (both service users and staff), how long it took to evacuate the premises and any issues such as service users not responding or people taking an unnecessarily long route out of the building. It is recommended that the drill records be supplemented to contain such information. Checks are undertaken of hot water temperatures to ensure that service users are not placed at risk of scalding. Shower heads are regularly descaled and a test for Legionella species was carried out in August 2005. There were records to show that the call-bell system is checked regularly to ensure that it works. There was a certificate to verify that the electrical installation of the premises was checked and found to be satisfactory in 2004 and portable electrical appliances had very recently been checked and the test report awaited. Records were in place in relation to the control of substances hazardous to health. Accident records had been completed by staff as had records of incidents. An updated generic risk assessment is needed for the premises to ensure that potential hazards are reduced and a requirement is made to address this. Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 2 Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 25 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 YA7 Regulation 13(6) Timescale for action Service users’ money is to be 20/11/06 managed safely and accurately and in line with the NSEs financial procedures. The core temperature of cooked food provided at the house is to be at least 70° Celsius. Awareness raising on adult protection is to be offered to service users. The environment is to be improved through: a) replacing the carpet outside the shower in the 8-bedded unit if it cannot be removed through shampooing and b) removing the lime scale on the shower tray in the upstairs bathroom. An updated generic risk assessment is to be prepared for the premises. 20/11/06 20/03/07 20/12/06 Requirement 2 3 4 YA17 YA23 YA24 13(4) 13(6) 23(2)b,d 5 YA42 13(4) 20/01/07 Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 Refer to Standard YA9 Good Practice Recommendations Individual guidance on managing behaviour is to be reviewed at least every six months and recorded as reviewed. The safe minimum core food temperature is to be added to the record sheets as a reminder to staff. A record of routine health screening appointments, such as dental and eye checks, is to be maintained within care plan folders. The glass covering the vaulted skylight in the office is to be kept clean. Central heating needs to be controllable from within the house, ideally with each room having its own thermostat. Fire drill records are to be supplemented to contain details of date and time of drill, who was present (both service users and staff), how long it took to evacuate the premises and any issues such as service users not responding or people taking an unnecessarily long route out of the building. YA17 YA19 YA24 YA24 YA42 Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate Cascade Way Oxford Business Park South Cowley Oxford, OX4 2SU 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 Greene House DS0000022973.V308289.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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