Inspection on 24/10/05 for Greenfield Care Home

This inspection was carried out on 24th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greenfield Care Home 09/08/07

Greenfield Care Home 09/08/06

Greenfield Care Home 18/07/05

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Greenfield Care Homes 385/387 London Road Mitcham Surrey CR4 4BF Lead Inspector Jean Stuart Unannounced Inspection 24th October 2005 13:00 Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 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 Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 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. Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Greenfield Care Homes Address 385/387 London Road Mitcham Surrey CR4 4BF 020 8687 3131 020 7431 8618 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) Greenfield Care Homes Ms Madrine Rugano-Wilson Care Home 9 Category(ies) of Learning disability (9), Physical disability (9) registration, with number of places Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18 July 2005 Brief Description of the Service: London Road Lodge is a registered care home for nine service users with learning disability and an associated physical disability. The home currently has three service users, and is staffed 24 hours a day. The home is on three floors of a detached property and is situated within a residential area of Mitcham. Parking is to the front of the home. Public transport bus services and the tram line are within a short distance of the home. Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place during late afternoon and early evening, of 24 October 05. On the 25 October 05 time was spent discussing the running of the home with a director on site. A pharmacist inspection was carried out on 26 October 05. A brief tour of the premises took place and care documentation for the three service users was inspected. Two service users and two members of staff were spoken to individually. The inspection took nine hours. What the service does well: What has improved since the last inspection? On the previous inspection in July 05 seventeen requirements were made. Thirteen requirements have been achieved. Four requirements remain outstanding but are being progressed by the home. The variation of registration to include people with a physical disability has been agreed with the CSCI. The Statement of Purpose has been reviewed as required. Training in mandatory areas such as manual handling, food hygiene, protection of vulnerable adults, has been given to staff. This inspection highlighted improvements in the home, that have enhanced services for the people currently residing at the home. Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 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. Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 Page 7 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 Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 Page 8 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): 1,2,3,4 The Statement of Purpose reflects the service provided, and sets out for service users the aims of the home. Service users and their families have the information they need to make a full assessment of the home. EVIDENCE: Prospective service users and their family have the information they need to make an informed choice on the facilities provided. The Statement of Purpose sets out the aims of the home. The service users guide, reflects the provision of care for people with a learning disability and a physical disability. These documents ensure that service users can make the best possible choice with regard to the facilities provided. New service users are admitted on the basis of a full assessment undertaken by staff from the social services department. A copy of the assessment is supplied to the home and placed on the individuals file. This information is used by the home to develop a care plan, setting out the service users needs. Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 Page 9 The means of communication used by the individual is explained in the passport (care plan). This indicates how service users who use very little, or no speech, express emotions and indicate choice. By understanding the individual, staff have more opportunities to provide quality care. A service user reported that they had been to see the home before moving in, and that they are “very happy” with the home. Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 Page 10 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): 6,7,8,9 The home maintains care documentation. Regular daily recording takes place, however more detail is required. Care plans must be kept up to date, and updated especially prior to a review. Adequate risk assessments are maintained. EVIDENCE: Service users needs are reflected in their care plans, this reflects individual personal planning for each person. A passport to care is drawn up with the involvement of professionals, the service user and their family. It is a visual, document providing graphic illustrations to help the service user to understand what is being discussed. Care plans are generated from the social service assessment. Care plans must cover all aspects of health care and emotional needs. More details must be given of individuals support network and the help they receive from family and friends. If spiritual needs are important to the individual spiritual needs must be clearly documented. The placing of boundaries within the household and intrusion of personal space must be explored and Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 Page 11 understood by all concerned, service users and staff. Thus promoting a positive and safe environment for all people in the home. Staff believe in the right of service users to make decisions, this is reflected in the information collected on their behalf. Differences were noted in activities followed by service users. One service user helped to lay the table at mealtime, and set out the place mats and cutlery. For two individual, the management of risks while they are sleeping is to carry out checks every fifteen minutes. The reason why the checks are happening must be explored further once service users are settled in the home, to ensure that this intrusive action by staff is necessary. Staff have manual handling training to ensure they can meet service users needs. For the home to provide care that meets all the needs of service users, current issues must be recorded. By recording the information, service users wishes will not be overlooked by staff. Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 Page 12 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): 12,13,14,15,16,17 Service users use the local community and have contact with their family and engage in appropriate leisure activities. EVIDENCE: One service user reported that they was going to “keep fit” the evening of the inspection, and that they went to a party with the “scouts” at the weekend and “stayed out until midnight”. Transport is arranged for the service user through the group they are attending. Activities are recorded and care documentation kept. Service users attend day care four days a week, and have one day at home Thursday with carers. Service users go to church and maintain relationships outside the home. Emotional and spiritual needs must be recorded on the care plan. It is important that each care plan fully addresses individual needs and clearly states how these are to be met. Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 Page 13 Service users receive a varied diet. The record shows that the GP has been consulted about the nature of the diet to be followed for one individual and stated that there are no special needs. The ability of service users to make meal choices is noted in the passport. The passport demonstrates to staff how service users indicate choice, thus ensuring service users have a meal they enjoy. Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 Page 14 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): 18,19,20 Appropriate records are maintained about the health care given to service users. Policies and procedures in the handling of medication must be followed at all times. Staff must have accredited training in the handling of medication to ensure service users are protected from harm EVIDENCE: Service users on the day of the inspection were dressed in different styles of clothing, thus ensuring that they maintain their individuality. Service users health care needs are noted in the care plan, the care plan demonstrates when they have received medical treatment. Service users receive medication from the manager of the home. When the manager is not available staff administer medication. The CSCI pharmacist inspected Greenfield on 26 October. The pharmacist noted “minor omissions in the use of the procedures and recording, and one instance of inappropriate practice were found, although these had no dire effect on the health and welfare of residents.” The manager reported that medication training for staff is to happen in the next three months. Accredited medication training for staff will ensure that medication is given safely and that the well being of service users is protected. Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 Page 15 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): 22,23 A satisfactory complaint procedure is in place and is included in the Statement of Purpose and the service users guide. EVIDENCE: Some service users do not find it easy to state their views. Staff reported that one service user clearly reports when they do not want to do something. A facial gesture by a service user observed during this visit indicated unhappiness with an event. A service user had no complaints about the home, indeed is “very happy” living there. The manager reported that the home has not received any complaints, indeed the family of one service user has written to praise the home for the good services given. This is a measure of the level of satisfaction felt by the service users, their families and the professional involved with service users care. The complaint procedure has been amended to reflect the availability of the CSCI, reassuring people that a complaint can be taken to a body outside of the home. Staff have staff attended other training in the prevention and signs and symptoms of abuse. Training provides staff with a heightened awareness of abuse and safeguards service users from harm. A member of staff confirmed that they had received training. Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 Page 16 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): 24,25,26,27,28,29,30 The service users live in a homely, comfortable environment. The registration has been amended to reflect the adequacy of this environment for two people with a learning disability and a physical disability. The home has been assessed by an occupational therapist and necessary requirements carried out. EVIDENCE: Two service users at the home are wheelchair users. The ground floor is accessible. The home does not have a lift and any other service users whose bedroom is not on the ground floor will need to be able to use the stairs. A list of equipment currently used by service users has been provided to the CSCI indicating how service users needs are currently being addressed. The director has presented to the CSCI a report, from an occupational therapist, demonstrating the home is suitable to meet the needs of people with a learning disability and a physical disability. Furnishing and fittings are of a good quality and of a domestic nature. The lounge has a dining area for ten service users, and sitting for six service users. One service user was observed sitting in their wheelchair. The home offers access to local amenities, local transport and support services to suit service users personal and lifestyle needs. The home is clean and hygienic. The facilities provide service users with a comfortable home. Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 Page 17 The home has three service users in total. All service users have single bedrooms. Where required bedrooms are to a suitable size for wheelchair users, i.e. with at least 12 square metres of usable floor space. This excludes the ensuite, which provides a walk in shower and a toilet facility. One service user reported that they enjoy the shower because “I can do more for myself” Bedrooms are personalised by the service users with the help of staff, making the rooms individual to the service user. Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 Page 18 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): 32,34,35,36. Service users are relaxed and comfortable with staff. Staff are accessible to service users. Information on the competency and skills of the staff group is available, staff are supervised. The recruitment procedure must be fully used to ensure that clients are protected from harm. EVIDENCE: Service user responded most positively when a member of staff spoke with them. Staff demonstrated that they are accessible to, and comfortable with service users. A list of staff employed, their skills and qualifications has been submitted to the CSCI indicating that staff have, or are prepared to develop the necessary skills to provide the service. The home has failed to ensure that references and criminal record bureau (CRB) checks are received prior to commencing work at the home. Service users are protected not from harm by these checks not being completed. The manager reported that formal, recorded supervision is given, and is carried out at least six times a year. Records of supervision were seen. Supervision provides the opportunity to explore the work that is being completed with service users, to monitor this work, and to identify training needs. Staff have received training in mandatory areas e.g .manual handling, protection of vulnerable adults, food hygiene. Training ensures that service users receive good quality care. Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 Page 19 Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 Page 20 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): 37,40,41,42 The health, safety and well being of service users is protected and promoted by the policies and procedures of the home but as shown by the failure to collect references and a CRB , these must be policies and procedures must be used in full. The management of the home has improved but is not yet to a standard that safeguards service users. EVIDENCE: Service users are protected through the use of the home’s record keeping policies and procedures which build up a framework for good care to be delivered. Overall the standard of management of the home has improved but records required by regulation are still not maintained. Care plans are not in all circumstances kept up to date, daily recording is completed but is not in detail to present a picture of the care given. The recruitment procedure is not fully used. Such failures do not protect service users best interests. The manager must undertake training to develop the skills to manage the home, and provide a good service to users. Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 Page 21 The registered provider must give support, to ensure that the necessary skills are developed and that national minimum standards are consistently achieved. Continuous self monitoring is one way of achieving this. The manager is receiving regular supervision from a director. The provider has commenced with the required monthly visit to the home to measure the provision of care. Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 X 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Greenfield Care Homes Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score 2 X X 2 2 2 X DS0000061460.V260820.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6YA18Y YA19 Regulation 15(1)(2) Requirement The registered person must ensure that the care plan is maintained as a current record, ensuring that daily recording documents how care is given. Previous timescale of 31.8.05 was not fully met. The registered person must make arrangements for the recording and handling of medicines received into the home. The registered person must ensure that the policies on storage and administration of medication describe their practice in the home. The registered person must ensure that staff receive accredited training in the handling of medication. Timescale for action 30/11/05 2 YA20 13(2) 28/11/05 3 YA20 13(2) 01/12/05 4 YA20 13(2) 30/05/06 5 YA34 19(4)(5) Previous time scale of 31.10.05 was not fully met. The registered person must 31/12/05 ensure that the recruitment policy and procedure including all checks is followed in full. Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 Page 24 Previous time scale of 31.6.05 was not fully met. 6 A37 YA40 YA41YA42Y 17 The registered person must ensure records required by regulation are maintained. Previous time scale of 31.10.05 was not fully met. 30/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Greenfield Care Homes DS0000061460.V260820.R01.S.doc Version 5.0 Page 26 - 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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