Inspection on 27/04/05 for Greenfields

This inspection was carried out on 27th April 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greenfields 31/05/07

Greenfields 03/08/06

Greenfields 22/12/05

Greenfields 12/01/05

Greenfields 27/07/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Greenfields Derby Road Barnstaple North Devon EX32 7EZ Lead Inspector Patricia Hellier Unannounced 27th April 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Greenfields CS0000039188.V217518.R01.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Greenfields Address Derby Road, Barnstaple, Devon EX32 7EZ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01271 343709 01271 329121 Mr Ian Rice, Devon County Council Paul William Jellicoe Care Home 11 Category(ies) of LD Learning Disability [11] registration, with number PD Physical Disability [11] of places SI Sensory Impairment [11] Greenfields CS0000039188.V217518.R01.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Yes 1. Caters for young people and adults between the ages of 16 and 25 years 2. Current service users over the age of 25 or under the age of 16 will be allowed to continue to use the service 3. To admit one named person aged under 16 as detailed in the notice dated 5th August 2004 and one named person aged over 25 as detailed in the notice dated 10th September 2004 4. The maximum number of persons accommodated at the home, including the named young persons, will remain at 11. 5. On the termination of the placement of either of the named young persons, the registered person will notify the Commission in writing and the particulars and conditions of this registration will revert to those held on the 26th July 2004 or as appropriate Date of last inspection 12/01/2004 Brief Description of the Service: Greenfields provides planned respite care and accommodation for up to 11 young adults and some children with severe learning disabilities and physical or sensory impairment, aged 10 to 25 years (male and female), whose families live within North Devon and Torridge District Councils’ boundaries. Services are sometimes provided to young people and adults from outside these catchment areas. Some service users who reach the age of 25 years continue to use the service for a further 10 years. Usually the maximum number of children, young people and adults staying at the home at any one time is nine. However, in certain circumstances, up to 11 children, young people and adults are accommodated. Emergency admission for unplanned respite is provided, for those service users already using the facility for planned respite care. The home has nine bedrooms. Only children aged less than 16 years share bedrooms. The home also provides day care for young adults, Mondays to Fridays, 9 am to 4 pm with various activities on offer. Greenfields is owned and managed by Devon County Council Greenfields CS0000039188.V217518.R01.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the first statutory inspection of the current year and took place over one day. Before the inspection took place the last report was reviewed and the focus of this inspection decided from the requirements and recommendations of that report. Also reviewed were documents submitted to the office following the last report. These included a revised Statement of Purpose and a letter regarding the arrangements for the registered manager to fully manage the home. The inspector looked around the home, had discussions with four residents, five members of staff and the manager. Care records and employment records were inspected as also were health and safety related documents. What the service does well: What has improved since the last inspection? The majority of recommendations and three of the requirements from the last inspection have been met. This includes the Statement of Purpose in which there are now references to younger adults. It also shows awareness of the transition process from child to adult, which impacts on the individual, their family, and the care services they receive. A contract document has been put in place for the residents and their families. This document sets out the details of the arrangements made between the local authority and the home for the provision of care for the young people, and includes the terms and conditions of that provision. Medication systems have been reviewed and clear records are now kept of all medication entering and leaving the home Greenfields CS0000039188.V217518.R01.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Greenfields CS0000039188.V217518.R01.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Greenfields CS0000039188.V217518.R01.doc Version 1.20 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 standard(s) 1,3,5 Information for prospective residents about the home and the purchase of service is clear and accessible. Little progress has been made to improve the admission procedure to ensure that there is a proper documented assessment of needs prior to people moving into the service. Without this there is not assurance that care needs will be met. EVIDENCE: The Statement of Purpose includes references to younger adults as well as children. In the Statement of Purpose clear awareness is shown of the transition period for children from child to adult, both personally and with in the care systems and detailing how this can be managed. Contracts inspected showed clear information regarding the agreement of purchase with the local authority and the terms and conditions of residency. Individual records are kept for each of the residents and inspection of the records for the two most recent admissions did not have full assessment information. In one file there were a number of letters, faxes and e-mails, of information from other professionals but none of this information had been collated into the homes assessment form to demonstrate the needs of this resident matched against the provision offered. With no clear needs assessment the formulation of a care plan had been limited and thus care provision compromised. Greenfields CS0000039188.V217518.R01.doc Version 1.20 Page 9 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 standard(s) 6,7,9 Limited progress has been made on improving arrangements to ensure that the health care needs of residents are identified and met. These shortfalls have a potential to place residents at risk. The home consults families and relevant professionals appropriately, over decisions and dilemmas in resident’s lives. This is particularly important given that service users have limited capacity to contribute to plans and decisions. EVIDENCE: Three care plans inspected all had pre-printed forms providing prompts for relevant information to assist in the meeting of care needs. These forms were incomplete and not all needs identified or individual goals stated. Personal and environmental risk assessments were present and seen to be reviewed regularly. Four care staff interviewed had an understanding of residents care needs from a list of tasks; however there was no plan of care identifying needs, stating aim and action to achieve this aim. Reviews and consultation with other professionals had been recorded intermittently. Correspondence from relatives was seen in care files demonstrating consultation regarding resident’s care. Three files contained letters of praise for the care given to their relatives. Residents appeared to be happy and were seen laughing with staff. Greenfields CS0000039188.V217518.R01.doc Version 1.20 Page 10 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 standard(s) 12,13,14,16 Links with the community are good and support resident’s social and educational opportunities during the day. Kind and caring staff respect resident’s rights and responsibilities. . EVIDENCE: The home has a wide and varied range of facilities for life skills activities and stimulation. These facilities are used for residents on a daily basis. Choice is limited due to the resident’s limited communication but staff talked of varying the activities daily. Records in care plans did not reflect variety of activity or if the activity had been resident’s choice. Residents are daily enabled to attend the local school or college or to participate in peer activities. On the day of inspection a group of residents went to the library to choose books. There was evidence of good relationships between residents, relatives and the staff. Communication between staff and relatives is good and facilitated by a shared notebook. Staff were observed communicating with residents in their preferred way and giving choice and responsibility where able. Greenfields CS0000039188.V217518.R01.doc Version 1.20 Page 11 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 standard(s) 19,20 The health needs of residents are not fully met due to lack of care planning, staff awareness and skills. Good multi-disciplinary working takes place on a regular basis. Medicines, administration and medical needs are managed well. EVIDENCE: Care plans inspected confirm that the home has good links with local GP practices and district nurses, however they did not reflect all care needs and the ways they were to be met. Staff were unaware of how to manage one resident’s psychological needs which were very integral to the care needed. The home uses specialist professionals to assess residents with complex needs who challenge the service, and to provide guidance and training to the staff in supporting residents through difficult times. The CSCI pharmacy inspector made recommendations during an inspection in December 2004. Policies, procedures and care plans have been updated to comply with the recommendations. Greenfields CS0000039188.V217518.R01.doc Version 1.20 Page 12 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 standard(s) 23 The home has good systems in place to protect service users from abuse, neglect and self-harm. EVIDENCE: Staff received Child Protection training in February this year. While staff have not received specific adult protection training the home has a copy of the Alerter’s guide and the No Secrets video. Five members of staff interviewed demonstrated a good understanding of what constitutes abuse and the way to deal with it. The home has a comprehensive policy and all staff interviewed were aware of the contents and where to find it. Review of the accident and incident book showed several incidents where staff have sustained injuries following challenging behaviour from residents. In discussion with staff they said they had not received training in handling challenging behaviour. Staff said that there were a number of residents with this type of behaviour and that training would be useful. Greenfields CS0000039188.V217518.R01.doc Version 1.20 Page 13 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 standard(s) 24,30 The standard of décor within the home is adequate with evidence of improvement through maintenance or future planning. The cleanliness and standard of hygiene is good and provides a safe environment EVIDENCE: The home is well maintained with an ongoing programme of redecoration and refurbishment. Sine the last inspection the garden room and flat roof patio area have been improved. The gardens are well maintained, safe and wheelchair accessible. Environmental risk assessments were inspected and staff interviewed spoke of how they maintain a safe environment through observation and removal of hazards. The home has an Infection Control policy and five staff interviewed demonstrated awareness of its contents. Staff were observed using gloves and aprons appropriately. The broken macerator for the disposable bedpans and urinals had not been replaced. The manager showed the inspector an e-mail from DCC stating it had been ordered and was due for delivery in early June. Meanwhile used disposable urinals and bedpans are put into the clinical waste bins in the sluice area where they remain until the weekly collection. This practice is unhealthy and an infection risk. An industrial air freshener on the sluice wall did not mask the malodour in this area. Greenfields CS0000039188.V217518.R01.doc Version 1.20 Page 14 Clinical waste disposal was discussed with the manager who said he is still in the process of setting up a more suitable arrangement for the collection of this. The laundry facilities are adequate to meet the needs and a sink area for hand washing has been made available. Greenfields CS0000039188.V217518.R01.doc Version 1.20 Page 15 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,35 An effective, competent and experienced staff team supports residents. The procedures for the recruitment of staff are inconsistent and do not always provide the safeguards for the protection of people living in the home. EVIDENCE: During the inspection staff were observed interacting and providing care in a kind and gentle manner. Although communication with residents is limited those spoken with indicated that the staff were nice and they liked them. There is a low turn over of staff but some new staff have recently been employed. The staff files of four staff members employed at varying times showed inconsistency of Criminal Records Bureau (CRB) checks and 2 files contained no proof of identification. Two staff members were spoken to; one said she had completed an application form and neither knew if they had completed a CRB form. All staff have received first aid and fire safety training recently. Staff spoken to said that there was lots of training and records seen showed attendance at a variety of relevant training sessions. Staff spoke of regular supervision and assistance in gaining NVQ qualifications and 2 members of staff and working towards the Learning Disability Award Framework qualification. Greenfields CS0000039188.V217518.R01.doc Version 1.20 Page 16 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,41,42 The manager provides leadership and guidance to staff to ensure residents receive consistent care in a safe environment EVIDENCE: The manager has completed the Registered Managers Award. He has a senior manger to which he refers for advice and direction in developing his management skills. Records inspected did not always have timely, clear and accurate entries for safeguarding the residents’ best interests, as referred to in Individual Needs and Choices section All fire records inspected were up to date and showed regular safety checks. Environmental risk assessments had been completed and regularly reviewed. Since the last inspection a notice by the changing tables stating that 2 members of staff should be present during use have been displayed. The manager told the inspector that changing tables with protective sides have been ordered to assist staff in maintaining the safety of residents during use. Greenfields CS0000039188.V217518.R01.doc Version 1.20 Page 17 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 x x 3 Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 2 Standard No 11 12 x 3 Standard No 31 32 33 34 Score x 3 x x Version 1.20 Page 18 Greenfields CS0000039188.V217518.R01.doc 13 14 15 16 17 3 3 x 3 x 35 36 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 2 3 x Standard No 37 38 39 40 41 42 43 Score 3 x x x 2 3 x Greenfields CS0000039188.V217518.R01.doc Version 1.20 Page 19 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15.1 Requirement Timescale for action 30/06/05 2. YA30 13.3 3. YA30 13.3 unless it is impracticable to carry out such consultation, the registered person shall, after consultation with the resident, or a representative of his, prepare a written plan as to how the residnets needs in respect of his health and welfare are to be met. This relates to the lack of care palns clearly identifying needs, aim and actions to meet the identified needs The registered person shall 30/06/05 having regard to the size of the care home and the number and needs of service seers: (k) keep the care home free from offensive odours and make suitable arrangements for the disposal of general and clinical waste. This relates to the storage of clinical waste in the sluice area for a week at a time. (Previous timescale 01/03/05 not met) The registered person shall make 30/06/05 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the CS0000039188.V217518.R01.doc Version 1.20 Greenfields Page 20 care home. This relates to the broken macerator and the disposal of papier mache urinals and bedpans (Previous timescale 01/03/05 not met) 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. Refer to Standard YA2 YA19 YA41 Good Practice Recommendations The maintaining of full clear records of assessment of needs from which the care plan can be formulated on admission. The provision of training to enable staff to recognise and meet the psychological and emotional needs of residents To keep full, clear and timely records of all incidents and the way in which they have been handled Greenfields CS0000039188.V217518.R01.doc Version 1.20 Page 21 Commission for Social Care Inspection Exeter Office, Suites 1 and 7 Renslade House Bonhay Road EXETER, EX4 3AY 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 Greenfields CS0000039188.V217518.R01.doc Version 1.20 Page 22 - 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. 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