Inspection on 17/03/06 for Greengates

This inspection was carried out on 17th March 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Greengates 26/09/06

Greengates 16/08/05

Greengates 30/03/05

Greengates 12/07/04

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 Greengates 26 Fore Street North Petherton Bridgwater Somerset TA6 6PY Lead Inspector Judith Roper Announced Inspection 17th March 2006 10:00 Greengates DS0000033922.V274347.R01.S.doc Version 5.1 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 DS0000033922.V274347.R01.S.doc Version 5.1 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 DS0000033922.V274347.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Greengates Address 26 Fore Street North Petherton Bridgwater Somerset TA6 6PY 01823 423126 01278 663871 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) Somerset County Council (LD Services) Mrs Josephine Gillett Care Home 7 Category(ies) of Learning disability (6), Physical disability (1) registration, with number of places Greengates DS0000033922.V274347.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th August 2005 Brief Description of the Service: Greengates is a care home providing personal care and accommodation for seven people with learning disabilities including one person with physical disabilities. Greengates is a home run by Somerset Social Services (now Community Directorate). The responsible individual is Mr. David Dick. The registered manager is Mrs Josephine James (nee Gillett). The home is situated on the main road in the village of North Petherton. The home is within walking distance of all the amenities in the large village. The house is set back from the road and has ample parking for staff and visitors. Greengates is a large detached house. All of the bedrooms are single. Bedrooms are located on the ground and first floor. Greengates DS0000033922.V274347.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was carried out by one inspector and took place over one day between the hours of 10.15 am – 13.15pm. 7 residents were at the home on the day of the inspection. There are currently no vacancies at the home. The inspector was able to see and spend time interacting with most residents and saw all 7 residents during the inspection visit. There were no relative visitors at the home during the inspection visit. Staff on duty were able to give time to speak with the inspectors. The registered manager was not on duty but her deputy Mr. Welland was available to assist the inspector during the announced visit. The inspector would like to thank the staff for their time and hospitality shown to the inspector during her visit. The atmosphere at the home was relaxed and informal. Staff carried out their duties in a friendly and professional manner. The inspector’s aim on this inspection visit was to follow up on good practice recommendations made to the home at the August unannounced inspection and to assess Standards not inspected on that visit. Some key Standards have also been inspected during this announced follow up visit to the home. Records examined during the inspection were two resident care and support plans, two resident contracts, staffing rosters and staff training records. The home submitted a pre-inspection questionnaire as requested by the CSCI. This included samples of current menus and staffing rosters. Prior to the inspection the CSCI also sent out feedback cards for service users, relatives and associated health care professionals who visit the home. No feedback cards were returned to the CSCI prior to the inspection. What the service does well: What has improved since the last inspection? No requirements were made at the last inspection. Three recommendations were made at the last inspection. These related to upgrading the environment by redecorating communal areas. This has been arranged and work commences in the recommended areas at the end of March 2006. Two other Greengates DS0000033922.V274347.R01.S.doc Version 5.1 Page 6 recommendations were made that have not been implemented. These relate to staff update training in the protection of vulnerable adults and the relocating of a boiler, currently in a cupboard in one resident’s room. These recommendations remain. The provider has moved the thermostatic control panel for this boiler, however, to a more suitable place, as recommended in the last report. 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 DS0000033922.V274347.R01.S.doc Version 5.1 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 DS0000033922.V274347.R01.S.doc Version 5.1 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, 3, 4, 5. There has been one admission since the last inspection. The admission process was staggered with the home staff and other residents given opportunities to meet the new resident to see if the placement would be appropriate. Staff understand the health and social needs of the current residents well. Information in the home for residents uses the Somerset Total Communication language aids. EVIDENCE: It was reported by the home staff that the mix of residents is good and staff are aware of trigger factors that may instigate challenging behaviour in individual residents. Current needs are assessed in the care plans inspected very well. Behaviour modification programmes for staff to follow were documented well. Contracts were inspected for the two residents that the inspector case tracked. These contracts between the provider and resident were in order. There has been one new admission to the home since the last inspection. Introductory visits were planned and the admission followed a process that fully involved the service user, their family and care manager. Greengates DS0000033922.V274347.R01.S.doc Version 5.1 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 the following standard(s): 6, 7, 8. Care and support plans for residents are holistic, person centred and reflect current assessed needs. Resident’s are supported to make choices about their daily routines in a format of communication that staff working at the home understand. Resident’s can find a common language in which to communicate their needs to staff. EVIDENCE: Two care and support plans were examined. The documents were maintained very well. Changing needs had been regularly reviewed and plans amended to reflect a change of circumstances. Residents are not able to demonstrate that they are consulted in the writing of care and support plans but staff were able to verbalise to the inspector examples of meaningful choices made by residents in the way they wish to be treated by staff, communicate, choose what to eat and drink, rise and retire and engage in activities. Care plans are stored in resident’s individual bedrooms. Residents are allocated a key worker. This person will coordinate activities and spend quality days out with the individual resident on a 1:1 basis. Key workers support residents with their financial affairs and this is audited at least monthly by Social Services representative. Greengates DS0000033922.V274347.R01.S.doc Version 5.1 Page 10 Photographs of staff on duty for each day are displayed in an individual resident’s room in a format that they find useful. The photograph of their key worker is also displayed. Residents are involved in weekly menu planning and shopping at local stores. Greengates DS0000033922.V274347.R01.S.doc Version 5.1 Page 11 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): 13, 14, 16, 17. Opportunities for leisure and socialising and educational activities are plentiful and managed well at the home in order to appropriately stimulate residents. Family and friend contacts are supported and encouraged for residents. No feedback cards from relatives were received at the CSCI prior to the inspection for their judgement on the service. Residents are actively involved in the daily routines at the home and participate to the degree that they are able. Meals are relaxed and residents assist with meal planning and food shopping. EVIDENCE: Somerset Total Communication is used at the home. Residents are encouraged and supported to engage in daily living activities such as maintaining their own rooms, laundry, preparing meals etc. Care records demonstrate that residents enjoy planned activities both on weekdays and weekends and evenings. Residents mix with people from outside the Social Services network of home via colleges, pubs and clubs as well as leisure opportunities. Residents are offered an annual holiday and day trips with key Greengates DS0000033922.V274347.R01.S.doc Version 5.1 Page 12 workers. There is sufficient 1:1 time for residents and key workers planned as part of the staff duty rota. Family contact is supported and placement reviews documented feedback from family members about the service provided for their relative at the home. Bedroom doors are locked when unoccupied by staff in order to prevent residents going into another person’s room. Residents can have free access to their own room at all times. Staff were observed unlocking bedrooms for residents to access when they indicated that they wanted to go to their room. The home’s boiler is sited in a locked cupboard in a service user’s bedroom. Please see Standard 24 of this report for comments about the premises and the appropriateness of the boiler being sited in a resident’s room. Meals are taken in the kitchen or dining room. Most residents need support or supervision at meal times and staffing levels facilitate this. The dining room would benefit from redecoration, as it is looking tired in décor. It was reported that this has been scheduled into the planned upgrade of communal areas from April 2006. In the kitchen the inspector saw records of daily fridge and freezer temperatures and food in fridges date labelled to protect against food poisoning. The kitchen is equipped sufficiently. Greengates DS0000033922.V274347.R01.S.doc Version 5.1 Page 13 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): 19, 20, 21. Residents are supported to attend community health care appointments and care and support plans inspected demonstrated that resident health care needs are anticipated and actioned appropriately. Individualised care is given via the key worker system. Key workers on duty during the inspection seemed to know the needs of their designated residents well. Medication is safely managed at the home. Ageing and illness is part of the care planning process in order to ascertain the wishes of service users and their close families regarding this topic. EVIDENCE: Nursing care is not provided at the home, although some staff members are trained nurses. Each resident has a key worker and a co-key worker. Many residents have complex behavioural and psychological care needs. Care and support plans demonstrated regular support from community learning disability and mental health specialists as well as GP or community nursing support. Care reviews for residents were carried out annually by the care manager for social services. The routines in the home are flexible but reflect the need of some residents to have structure in their days. Sensory equipment is provided in many resident’s bedrooms in order to positively effect moods. Greengates DS0000033922.V274347.R01.S.doc Version 5.1 Page 14 A record is maintained in care and support plans of healthcare appointments and outcomes. No current residents are able to self-medicate. The community pharmacist inspected the home’s medication management in March 2006. This report has been forwarded to the CSCI. Only two minor recommendations were made to the home in order to further improve medication management. The home has a homely medicines policy. The CSCI recommend that written authorisation for homely medicines from the resident’s GP be reviewed on an annual basis. There have been no deaths at the home for several years. Ageing and illness is part of the holistic care planning process for the service. Greengates DS0000033922.V274347.R01.S.doc Version 5.1 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. There have been no complaints made since the last inspection. Most of the current residents would have difficulty in understanding how to raise an official complaint but families are supplied details of the home’s complaint’s policy. Policies and procedures are in place for the protection of vulnerable adults from abuse. Many staff have not received an update in abuse training for some years and an update training session remains recommended from the last inspection report. EVIDENCE: The home has not received any complaints since the last inspection. The home has a complaints policy, which includes the name and address of the Commission for Social Care Inspection. The complaints policy is included in the Service User Guide. There are polices and procedures available for staff in the protection of vulnerable adults. The Community Directorate Whistle Blowing policy is displayed in a staff area. For staff that have been employed for several years, the majority have not had a formal update training session in abuse awareness and the protection of vulnerable adults for some years. It is therefore recommended that staff at the home receive a training update in the protection of vulnerable adults. Greengates DS0000033922.V274347.R01.S.doc Version 5.1 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, 27, 28, 30. The environment at the home is domestic in character, adapted to meet the sensory needs of residents and is clean. There is a range of communal space and large garden space. Residents’ rooms are personalised reflecting individual tastes. The home is due to benefit from some routine redecoration in communal areas to enhance the quality of living space and bathrooms from the end of March 2006. The boiler currently sited in a locked cupboard in one resident’s room is not ideally located as it can mean that the resident’s privacy can be compromised. EVIDENCE: Single room accommodation is provided at the home. Staff run baths for service users to prevent flooding. Bedroom sizes are adequate for the needs of the currently independently mobile residents. Bedrooms are personalised and reflect individual’s tastes. Many bedrooms have sensory equipment to promote positive moods and tactile stimulation. The home’s boiler is housed in a locked cupboard in one resident’s bedroom. Staff continue to report that from time to time they have to disturb the resident sometimes at night in order to adjust boiler settings. This invades the resident’s privacy. It remains a recommendation that an alternative site for the boiler be found at the home so that the resident’s privacy is not invaded. Greengates DS0000033922.V274347.R01.S.doc Version 5.1 Page 17 There are communal bathrooms on both floors of the property. Both would benefit from upgrading and redecoration and it was reported that this has been scheduled from the end of March 2006. Communal space at the home offers a choice of areas for residents to relax, socialise or be alone. The gardens are spacious with a raised patio area and a lawned garden. The home is aware that residents require supervision in the garden, as there is a risk of some residents eating garden plans and shrubs. Poisonous plants therefore need to be identified and removed. Staff sleeping-in provision with en-suite facility is provided at the home. This room doubles as the home’s office. At night there is one waking and one sleeping-in staff on duty. The home is adapted to meet the physical and sensory needs of residents. Infection control measures are sufficient and adequate and chemicals are locked away to make them inaccessible to residents. Laundry facilities are sufficient. Staff carry out the cleaning of the home as part of their duties. Residents are encouraged to assist in order to take personal pride in the upkeep of the home. The home was clean to a good domestic standard on the day of the inspection. Greengates DS0000033922.V274347.R01.S.doc Version 5.1 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, 33, 35. The staff team is settled; there are some periods of time through staff long term sickness that has resulted in staffing running at minimum levels. Nevertheless, 1:1 key worker time is still allocated for residents. There had been a staff training needs audit in recent weeks. This has identified shortfalls in training requirements for staff. EVIDENCE: In the hall is a notice board displaying the staff on duty for the day. Current staffing rosters were supplied with the pre-inspection questionnaire. The home is staffed daily with a minimum of three staff during the day and one waking and one sleeping-in staff at night. It was reported that no new staff have joined the service since the last inspection. Managers now have access to a home computer to assist record keeping and keeping in contact with other managers in the Community Directorate. A staff training need audit has taken place recently to identify shortfalls in staff training requirements. Staff have been booked on courses to rectify this throughout 2006. NVQ training for staff is provided. Greengates DS0000033922.V274347.R01.S.doc Version 5.1 Page 19 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): 39, 40, 42, 43. Quality assurance measures are both formal and informal with the views of service users actively sought on their view of their daily routines. Records examined at the inspection were maintained in sufficiently good order. Health and safety records were sufficiently detailed. The home manages the needs of residents who may display challenging behaviour very well. The service is run by the Community Directorate, which is currently seeking a bid to be recognised for a beacon award for good practice in learning disability services. EVIDENCE: Records examined were maintained appropriately. There were risk assessments regarding clinical need and risks associated for individuals with swallowing difficulties or epilepsy. It is therefore recommended in light of the risk assessment outcomes that there be an appointed first aid trained staff member on shift at al times, to manage this risk. The home accommodates residents who may display challenging behaviour. Appropriate training is provided for support staff. Greengates DS0000033922.V274347.R01.S.doc Version 5.1 Page 20 As the registered manager was on rostered on duty during the unannounced inspection, access to many of the home’s records was not possible. These will be examined at subsequent visits. The service has formal quality assurance policies and procedures. Views of service users are sought about their day to day choices. The Community Directorate is part of Somerset Social Services, which was awarded 3 stars in the CSCI inspection in 2005. Greengates DS0000033922.V274347.R01.S.doc Version 5.1 Page 21 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 3 4 3 5 3 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 3 25 X 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 N/A 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 3 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 3 3 X X 3 3 X 3 3 Greengates DS0000033922.V274347.R01.S.doc Version 5.1 Page 22 N/A 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard YA16 YA20 YA23 YA42 Good Practice Recommendations It is recommended that an alternative site be found for the boiler sited in a locked cupboard in one residents room. It is recommended that G.P signed authorisation for homely remedies be reviewed on an annual basis. It is recommended that staff receive a training update in the protection of vulnerable adults. It is recommended in order to safeguard the health and safety of service users that there is at least one staff member holding a current first aid certificate (minimum of appointed person) on each shift. Greengates DS0000033922.V274347.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Greengates DS0000033922.V274347.R01.S.doc Version 5.1 Page 24 - 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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