Inspection on 10/07/06 for Greengates

This inspection was carried out on 10th July 2006.

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

The inspector 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greengates 17/03/09

Greengates 03/10/07

Greengates 12/10/05

Greengates 09/06/05

Greengates 01/02/05

Greengates 19/05/04

Similar services:

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 Greengates 96 Monkton Street Ryde Isle Of Wight PO33 2DD Lead Inspector Annie Kentfield Unannounced Inspection 10th July 2006 17:45 Greengates DS0000012494.V295017.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 Greengates DS0000012494.V295017.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. Greengates DS0000012494.V295017.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greengates Address 96 Monkton Street Ryde Isle Of Wight PO33 2DD 01983 564418 01983 564418 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) Islecare `97 Limited Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Greengates DS0000012494.V295017.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th October 2005 Brief Description of the Service: Greengates is a residential home providing care and accommodation for up to five adults with a learning disability. The home is a detached two-storey property situated in a residential area of Ryde, a short walk from local shops, beach and leisure facilities. Also close are Ryde town centre, bus station and the railway station. There is a good-sized garden that is laid mainly to lawn with patio and seating for use by the service users. Off road parking is limited but spaces can usually be found in the neighbouring streets. The home is owned by Islecare 97. The current scale of charges starts at the Local Authority care band 2 and there are additional charges for transport, hairdressing, toiletries, chiropody and papers/magazines. Greengates DS0000012494.V295017.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. In order to provide a quality rating for this service evidence was gathered from a number of sources including two visits to the home – one unannounced in the evening and a second visit arranged two weeks later when the manager was available. Comment cards were sent to care managers, GP surgeries and left for service users and their relatives. Three comment cards were returned from health and social care professionals and all were satisfied overall with the service. One comment card was completed by a service user (with assistance from a member of staff) and all comments were positive. There has been a change in the management of the home and the acting manager is responsible for two small care homes in the Ryde area and plans to apply to become the registered manager. What the service does well: What has improved since the last inspection? Since the last inspection of October 2005 some of the bedrooms and the sitting room have been re-decorated, some areas have been re-carpeted and the bathroom has new flooring. From the previous inspection there were 7 requirements and action has been taken to address some of these although some are still outstanding: Islecare has recently updated the adult protection policy. Work has been completed on the bathroom. A service user contract is in draft form but hasn’t been finalised. Greengates DS0000012494.V295017.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. Greengates DS0000012494.V295017.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 Greengates DS0000012494.V295017.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Prospective service users have their care needs assessed before moving into the home. The previous requirement for all service users to have a contract or terms and conditions of living in the home has been partly met. EVIDENCE: A draft contract has been put together but there is no evidence that this has been discussed with service users. In discussion with the manager, it was agreed that all information for service users must be in a language or format that is suitable for the service users. At present all information is in a written format. The service needs to demonstrate that reasonable efforts have been made to explain the contract/terms and conditions to service users, where this is more appropriate. From the home’s records it is evident that prospective service users have an assessment of their care needs based on the care management assessment, with the registered manager deciding whether the service can meet the care needs of new people moving into the home. New service users are encouraged to visit the home and meet the other residents before deciding to move in. Greengates DS0000012494.V295017.R01.S.doc Version 5.2 Page 9 Greengates DS0000012494.V295017.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 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 the available evidence including a visit to this service. All of the service users have an individual plan of care and some of the service users said they were aware of their care plan. It was evident that service users are supported to make informed decisions about their daily activities as much as possible. EVIDENCE: Generally the individual care plans contain sufficient information to provide clear guidance for staff on the care to be provided and are regularly reviewed. However, a person centred approach to care has been initiated with one service user and needs to be developed with all of the service users. The manager is very keen to do this and is clear that care plans do not currently meet service users’ needs to be actively participating in planning and recording all goals and aspirations. It is recommended that person centred care planning be introduced as soon as possible. Greengates DS0000012494.V295017.R01.S.doc Version 5.2 Page 11 Service users are encouraged and supported to participate in the daily routines of the home as much as possible and one service user said they had planned days at home and liked to be involved in keeping their room clean and tidy. Service users have been involved in choosing the decoration and furnishing for their rooms and for the sitting room and share responsibility for watering the plants in the garden with the staff. A separate flat has been set up within the home to support greater independence for one service user and this appears to be very successful from the feedback from service users, staff and care managers. Greengates DS0000012494.V295017.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 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 the available evidence including a visit to this service. Service users enjoy a range of leisure and social activities. Visitors are always welcome and service users are supported to maintain regular contact with family and friends. Service users said they liked the food in the home. EVIDENCE: Service users are able to choose to attend a number of local recreational resources and there are regular trips to local facilities such as bowling, shopping etc. As a small home, decisions about going out can be made informally on a day-to-day basis depending on the weather, and what residents would like to do. One service user said they liked being at home and going shopping and another service user likes to spend regular and planned time with family and friends. Staff in the home support the residents to do activities of their choice. Greengates DS0000012494.V295017.R01.S.doc Version 5.2 Page 13 The manager explained that a member of staff was planning to develop a way of supporting a service user to better communicate their wishes and likes using photographs and pictures of activities, places, food etc. This will be a positive development and will link in with the plan for developing and recording individual wishes and choices as part of a person centred plan. The manager would like care plans and personal development to be in a format that is suitable to each service user and that is recorded in the first person. There is a weekly menu and meals are eaten in the kitchen/diner. Service users said the food is good and they have lots of choices with the menu being a guide for shopping – there are always alternatives available. Service users have free access to the kitchen and can help themselves to fruit and snacks whenever they want to. The staff explained that some shopping is done weekly and there is always fresh fruit and vegetables. Some of the service users like to help with the weekly shopping. Service users said that they can lock their bedroom doors if they want to and that staff and other residents respect the right to privacy and private space. There are occasional resident or house meetings – this could be developed as part of the quality assurance system offering service users the opportunity to feed back their views of the service and encouraging service user participation in the daily running of the home. Greengates DS0000012494.V295017.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 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 the available evidence including a visit to this service. Care staff are aware of individual care needs and support is offered in the way that service users choose. Medication is safely stored and dispensed and staff have received training in the safe handling of medication. EVIDENCE: It was evident that service users are supported to be as independent as possible and care staff provide discreet encouragement and prompting with all aspects of personal care. One service user said that staff help him with shaving but he liked to spend some time in the bath on his own. The bathrooms and bedrooms have call alarm systems so that service users can ask for help if they need it. Care plans record any healthcare checks or GP visits and staff accompany service users to any appointments. A visiting chiropodist provides regular care for feet and fingernails. Greengates DS0000012494.V295017.R01.S.doc Version 5.2 Page 15 It is evident that care staff are very aware of the service users’ care needs and have developed informal ways of good communication. Greengates DS0000012494.V295017.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 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 adequate. This judgement has been made using the available evidence including a visit to this service. There have been no complaints recorded. Information about how to complain has been updated since the last inspection; however, the information is not in an accessible format for the service users. The overall policy on protecting vulnerable adults has been updated and this needs to be developed with updates in staff training on adult protection awareness. EVIDENCE: It was evident from talking to care staff that they are very aware of the need to protect vulnerable adults and staff discussed a recent incident affecting a service user whilst outside of the home and what action was taken. Only one comment card was completed by a service user, however, this did indicate that they would speak to the manager if they had any worries or concerns. None of the service users are able to complete a written comment card without assistance from care staff. The overall written policy and procedures about adult protection has only just been updated by Islecare and although the manager confirmed that staff are due to update their adult protection training, this needs to be positively addressed and staff need to be aware of the new policy document. Greengates DS0000012494.V295017.R01.S.doc Version 5.2 Page 17 As previously discussed, none of the information for service users is provided in any other format except written and this must be developed so that service users have accessible information about their rights, or the home must demonstrate that all practicable steps have been taken to discuss rights and responsibilities with the service users – using an advocate where this is appropriate. Greengates DS0000012494.V295017.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 the available evidence including a visit to this service. Generally, the home environment is comfortable and safe for the service users. There are some areas that need improvement and the laundry wall is in need of internal repair and this has been highlighted over several inspections and not addressed within previous timescales. The garden fence is a big improvement and makes the garden private and safe, however, the garden needs to be landscaped around the fence. On both visits the home was found to be clean, tidy and free from any unpleasant odour. EVIDENCE: There is a sitting room and kitchen/diner that is shared by four service users and the independent flat has its own kitchen/living room. The sitting room has recently been decorated and is awaiting some soft furnishings. To be fully independent, the flat must be fitted with cooking facilities – there is a sink, but meals have to be prepared in the main house and taken through to Greengates DS0000012494.V295017.R01.S.doc Version 5.2 Page 19 the flat. The flat is also awaiting some sitting room furniture. The flat has to use the main laundry facilities. The bathroom has been upgraded since the last inspection. The repairs to the laundry wall have not been done – although not major work, this must be done as the wall and part of the ceiling is crumbly and there are holes. Although service users do not use the laundry without assistance the laundry room needs to be in a good state of repair. The garden is a good size and service users with staff support like to use the garden and care for the plants and flowers. The area around the new fence looks desolate and unattractive and needs to be landscaped to fit in with the rest of the garden. Staff are aware of good hygiene and infection control procedures and there are hand-washing facilities with liquid soap and paper towels available in the home. There is a shortage of storage space and staff facilities in the home but there is an office. Care staff demonstrated a good awareness of the importance of the home environment for the service users’ general wellbeing and discussed the need for service users to have private space that was comfortable and relaxing and quiet. Greengates DS0000012494.V295017.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 the available evidence including a visit to this service. Staff working in the home are competent and experienced and some have worked in care for a number of years and enjoy the work very much. The previous requirement has been met and formal supervision is arranged for staff on a regular basis. There is an ongoing staff training programme that covers NVQ in care and the mandatory areas of health and safety and safe working practice. Recruitment is managed centrally, although the manager confirmed that a record of the dates and numbers of the Criminal Record Bureau checks are kept in the home. The manager said that she is advised by the company administrator that all the required checks are satisfactorily confirmed before new staff are appointed. EVIDENCE: The home works a key worker system and in addition staff have different areas of responsibility such as medication, transport etc. Greengates DS0000012494.V295017.R01.S.doc Version 5.2 Page 21 Care staff felt that everyone worked well as a team and they felt well supported. There are currently more than 50 of the staff who have achieved at least the NVQ level 2 in care, some of the staff have done some of the units in the Learning Disability Framework and some of the staff have a knowledge of Makaton. There are usually 2 members of staff on duty during the day and one person at night with the manager in addition and additional staff to work with those service users who need extra support. Some of the care staff are appointed drivers for the home’s transport and there is usually one person on each shift who can drive. The manager confirmed that formal staff supervision is now arranged six times per year and is recorded. There are quarterly staff meetings. There is a photo board in the home so that service users know which members of staff are on duty each day. Greengates DS0000012494.V295017.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 the available evidence including a visit to this service. The manager is qualified and experienced and is in the process of applying to become the registered manager. Issues of health and safety are important in the home and care is taken to ensure that service users’ financial interests are protected. EVIDENCE: The manager divides her time between two small care homes in Ryde but it is evident that Greengates is well managed in the best interests of the service users. Comments from service users and staff demonstrated that the manager has an open and positive approach to managing the home. Greengates DS0000012494.V295017.R01.S.doc Version 5.2 Page 23 There are systems in place to ensure that service users’ financial affairs are protected and each service user contributes to the cost of transport each month. The fire alarm was being tested during the inspection and service users are encouraged to assist with this and there are at least two fire drills every year. The manager said that health and safety issues are regularly reviewed in the company managers’ forum. Islecare has a system of quality assurance that includes a regular internal audit of the service and regular inspection visits by the registered person. In discussion with the manager is was agreed that the quality assurance process needs to be developed to include feedback from the service users and others who provide care, as well as family and visitors and care professionals who have contact with the home. The outcome of this feedback should inform how the service reviews policies, procedures and good practice in the home. Greengates DS0000012494.V295017.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 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 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 3 X 3 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 3 3 3 X 3 X 2 X X 3 X Greengates DS0000012494.V295017.R01.S.doc Version 5.2 Page 25 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 YA24 Regulation 13 (3) Requirement Timescale for action 30/12/06 2. YA24 13 (3) 3. YA24 13 (3) 4. YA39 24 The flat must be fitted with cooking facilities and any other equipment necessary to supporting the service users’ independence. The hole in the laundry wall 30/12/06 must be repaired. Damaged plaster to laundry walls to be replaced. (previous timescales of 30/09/05 and 31/01/06 not met) The area around the new 30/12/06 boundary fence must be landscaped and made good to fit in with the rest of the garden. Quality assurance must be 30/12/06 developed to include feedback sought from service users, carers and family and friends at regular intervals. Greengates DS0000012494.V295017.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 Refer to Standard YA5 Good Practice Recommendations Information for service users should be in a suitable language/format or the manager should demonstrate that reasonable efforts have been made to explain information to service users. The manager should continue to develop person centred care planning for all of the service users so that individual needs and choices are reflected in the care plan. The manager should ensure that service users are aware of the complaints procedure. The staff training plan should include specific awareness training in protecting vulnerable adults. 2. 3. 4. 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