Inspection on 09/08/07 for Greenfield Care Home

This inspection was carried out on 9th August 2007.

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 no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greenfield Care Home 09/08/06

Greenfield Care Home 24/10/05

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 Home 385/387 London Road Mitcham Surrey CR4 4BF Lead Inspector Jean Stuart Unannounced Inspection 9th August 2007 12:00 Greenfield Care Home DS0000061460.V347312.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 Greenfield Care Home DS0000061460.V347312.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. Greenfield Care Home DS0000061460.V347312.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenfield Care Home 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 Home DS0000061460.V347312.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9 August 2006 Brief Description of the Service: Greenfields also referred to, as London Road Lodge, is a registered care home for nine residents with a learning disability. The home is on two 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 tramline are within a short distance. The home currently has eight residents. The fee range is from £1200 to £1250. Greenfield Care Home DS0000061460.V347312.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on the afternoon and early evening of the 9 August 07, covering almost seven hours. The inspection included discussions with people living there, and staff. Records were examined and the premise inspected. Three survey forms were returned from residents, and two from relatives. Five relatives were spoken with on the telephone as a part of this inspection. All people spoke positively about the service. A resident reported, “ it is good living here”, a relative reported that residents “have settled in, staff are very helpful”. What the service does well: What has improved since the last inspection? The home has a new manager who is introducing new working practices to the home. Staff all have a designated resident for whom they have particular responsibility i.e. key working. The staffing rota is clearly set out and can only be changed with the prior agreement of the manager. On the last key inspection four requirements were set concerning the quality of information and the need for supervision. These have been achieved. Greenfield Care Home DS0000061460.V347312.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Greenfield Care Home DS0000061460.V347312.R01.S.doc Version 5.2 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 Home DS0000061460.V347312.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Adequate information is available to residents before they move in. Skilled staff complete a needs assessments, seeking information from the resident and their family if appropriate, to confirm that this is a suitable placement. EVIDENCE: The Statement of Purpose and service user guide should be in format which can be understood by residents. The provider reported he has recently purchased such a document that he finds to be unsatisfactory. Further efforts will be made by the provider to achieve a user friendly document. Assessments take place prior to a person moving in. Prospective residents must have a full assessment from the Local Authority Care Management Team. The homes own assessment includes physical and psychological assessments and the person, family, and advocates are involved in drawing up a comprehensive document. This was confirmed by the documentation seen. Greenfield Care Home DS0000061460.V347312.R01.S.doc Version 5.2 Page 9 The assessment focuses on achieving positive outcomes for people, ensuring that the facilities can meet the ethnicity and diversity needs of the individual by being responsive to individual’s requirements. A relative reported that they visited Greenfields prior to their family member moving in. Two surveys forms showed that relatives receive enough information about the service provided. Greenfield Care Home DS0000061460.V347312.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ needs are recognised and residents have a care plan setting out their needs and reviews are carried out. Care plans would be improved by having more detail and risk assessments must be reviewed in line with the care plan. . EVIDENCE: Care plans address all areas of a person’s life. More must be done to make sure information is person centred and specific to each resident, including a detailed life plan. Information on social interests is limited and there was no information on sexuality. Greenfield Care Home DS0000061460.V347312.R01.S.doc Version 5.2 Page 11 Daily reports reflect these limitations and would be improved by a general statement about what the person has achieved on any one day. The contribution from residents could not be seen in the care plan. Staff must encourage people to be involved in the ongoing development of their care plan. Residents reported that they decide on what they want to do. One person walks to the day care and is supported by staff to achieve this. Another resident said they enjoy going to the Gateway club. Residents are free to spend their time as they wish when at home. Residents were seen using a drawing book, another resident had a game. Later in the day residents initiated a knowledge game through the use of Makaton letters. Risk assessments are available but these need to be regularly revised. One resident’s confidence has grown in recent months and they are now more independent. This was clearly shown in the review of the care plan but not in the risk assessment. Both should be reviewed and updated at the same time. Greenfield Care Home DS0000061460.V347312.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17.Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home promotes the individual’s rights to live ordinary and meaningful life, both in the home and the community. Residents are supported to achieve their goals. EVIDENCE: Residents attend work(day care) with their friends, one resident spoke about they are now living with two people known from school. Residents reported that they enjoyed a recent holiday when they went horse riding and did archery with residents and staff. In the office there is a weekly activity board drawn up for residents. This shows when residents are at day care or spending time in the community. On the day of the inspection one resident was waiting for their family. A regular swimming trip was planned, other people go out for a drink with their relative. A relative spoke of their resident going shopping with carers and going to Greenfield Care Home DS0000061460.V347312.R01.S.doc Version 5.2 Page 13 church. Residents attending church was on the weekly activity sheet and in care plans. One relative said that the family member “is happy there” and since being at the home has become “more self sufficient”. Another relative said that “generally people are happy, staff respect residents wishes”. From talking with residents and observing resident’s reactions to staff it could be seen that residents are aware of the routines of the home and of what was happening that evening. Some residents could be involved in independent living arrangements and this could be developed. Residents reported most positively on the food. When asked what they enjoyed the most a long list was given of the food they enjoyed, including the food served at a recent BBQ. The menu is available in the office and also special diets that some residents require. Staff spoke of different residents dietary needs. Greenfield Care Home DS0000061460.V347312.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive effective personal and health care support based on individual needs and preferences. Knowledgeable staff deliver good care, which will be enhanced by person centred planning. Care is based on staff knowledge. The home’s medication policies and procedures protect from harm. EVIDENCE: Resident’s health care needs are documented in their care plan but not in detail. Personal support is responsive to the preferences of the individual. All residents are registered with a local G.P. Residents emotional well being is also attended to and a record was seen of input by a psychiatrist. As seen during this visit, staff are alert to changes in behaviour and general well being, and understand the action to be taken. Greenfield Care Home DS0000061460.V347312.R01.S.doc Version 5.2 Page 15 To meet residents’ needs the home works closely with external professionals, and families to support the individual. The home has an effective medication policy and procedure. Care staff have the required accredited training. Greenfield Care Home DS0000061460.V347312.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home welcomes complaints and suggestions about the service. People feel safe and secure in the service provided by Greenfield’s. Staff had a very caring manner to residents. EVIDENCE: Individuals feel safe and well supported and are able to state their concerns to staff. As seen during this visit all staff know the importance of taking peoples view seriously and responding to the issues raised. Appropriate posters are available detailing the complaint procedure. However these are not well positioned, nor are they of the right size. They should be clearer for the process to be easily seen. The poster needs to reflect the Local Authority in which the home is based. One resident expressed no concerns and reported, “There are no problems here”. Another resident said If there is an issue they will “speak with the key worker”. Relatives have a small box in which to post their issues. The provider rather than the manager will open the box. Greenfield Care Home DS0000061460.V347312.R01.S.doc Version 5.2 Page 17 Five relatives were spoken with by phone, they reported they would be happy to take any issue to the manager. They reported that a residents committee was to be set up, but none of the five people spoken to had been asked to take on a role. Two survey forms were returned and these indicated that they were aware of the complaint procedure but had never had to use it. No complaints have been received since the last inspection. A prescribed timescale is set for any complaints received. Concerns about the care provided are recorded and the manager responds on the same day to resolve the matter. Greenfield Care Home DS0000061460.V347312.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides accommodation that meets the specialist needs of residents living there. A good level of maintenance has not been achieved. The décor shows a disregard for the residents living there. EVIDENCE: The home is comfortable but is not well maintained. Residents have personalised their rooms, the majority of bedrooms have ensuite facilities or a bathroom adjacent to their room. The environment now looks tired with walls that are marked, and stained carpets. A section of banister is becoming loose. A toilet bowel in one of the bedroom is stained black and the manager reported no matter how often it is Greenfield Care Home DS0000061460.V347312.R01.S.doc Version 5.2 Page 19 cleaned still looks dirty. Maintenance work is not planned but is reactive. All of these areas require cleaning or replacing. The home must ensure that a pleasant environment is created and the necessary work is carried out. A resident who has just joined the home has stickers in text on the chest of drawers and wardrobe indicating what is in each of these spaces. The resident can not read of these stickers. The stickers are not homely and are an institutional practice. The manager was asked to explain to the key worker why this is not good practice and have these stickers and any others removed. The with the exception of the poor maintenance identified above the home and carpets are clean and smells fresh. Greenfield Care Home DS0000061460.V347312.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34,35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Qualified and trained staff support residents. Staff files were available. Staff are supervised and training needs identified as a part of the process. The failure to have fresh CRB means a satisfactory recruitment process is not completed. EVIDENCE: Residents who use the service report highly of staff and the work they do “they help me”. Residents know the team well and are able to communicate with them freely, and easily. Staff have the skills to communicate effectively with residents. Rotas show that the home is adequately staffed. Two staff and the manager were on duty throughout the day for eight residents. At 6.30pm, just prior to the manger leaving staff cover was increased when the night member of staff turned up for work. On the day of this inspection there were enough staff to Greenfield Care Home DS0000061460.V347312.R01.S.doc Version 5.2 Page 21 meet the needs of residents. The residents were all calm and spending their time as they wished, with staff help as required. Staff are informed of training opportunities. On the day of the inspection the whole staff group were attending training on challenging behaviour and how it can be managed. The manager reported that all staff in the current group are trained to National Vocational Qualifications (NVQ) level two. A member of staff who is about to finish level two reported that they would be going straight on to level three. There is wide diversity in the staff team and its composition reflects the gender of residents using the service. The manager spoke of the procedure followed when recruiting staff. References are collected. Fresh Criminal Record Bureau (CRB) checks are required to protect residents from harm however not all staff have these. The manager recognises this and has applied for new CRBs for staff who require them. Staff spoke of receiving regular supervision and regular staff meetings. Records of supervision and meetings were seen Greenfield Care Home DS0000061460.V347312.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is developing a clear vision for the home and what is to be achieved. The premises must be maintained to a higher standard and have consistent record keeping to develop the service. A quality audit was not available. The home’s health and safety policies promote peoples safety. EVIDENCE: Greenfield Care Home DS0000061460.V347312.R01.S.doc Version 5.2 Page 23 The manager has been at the home since April was able to demonstrate a clear vision and a sense of direction. This vision is yet to be implemented, the property is not well maintained and parts lack basic cleanliness. Record keeping is not to a consistently high standard. Equality and diversity issues are given priority and all individuals are encouraged to achieve their goals with staff support if required. The service has an understanding of equal opportunity issues. Records required for the protection of residents are with the exception of risk assessments up to date. However the quality particularly of care planning could be improved. Staff have regular team meetings. Records of meetings were seen. The manager was not aware of a yearly audit. In the past this service has carried out an audit but the CSCI has not received a copy of the most recent. The home proactively monitors its health and safety performance and consults specialist agencies as required. Recent discussions with the fire officer about the routines for the home were seen on file. Relatives all reported that they are happy with the care delivered. Greenfield Care Home DS0000061460.V347312.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 2 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 3 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 x 2 X 2 X X 3 x Greenfield Care Home DS0000061460.V347312.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard YA6 YA18 YA9 Regulation 15 13(5) Requirement The manager must ensure specific details each resident’s care is recorded. The manager must ensure that risk assessments are periodically reviewed and reflect changing needs. The manager must that all parts of the home are kept clean and are reasonably decorated. The manger must ensure that all staff are CRB checked. The manager must make proper provision for the care, health and welfare of residents. Timescale for action 30/11/07 30/09/07 3. 4 5 YA24 YA30 YA34 YA37 23(20(d) 19(7) 12 30/11/07 30/09/07 30/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The registered person should ensure the Statement of Purpose and service users’ guide is produced in a format suitable for people who live at the home. Greenfield Care Home DS0000061460.V347312.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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