Inspection on 17/03/09 for Greengates

This inspection was carried out on 17th March 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greengates 03/10/07

Greengates 10/07/06

Greengates 12/10/05

Greengates 09/06/05

Greengates 01/02/05

Greengates 19/05/04

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Dalewood Respite Care

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Fairways

Treloar College

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Random inspection report Care homes for adults (18-65 years) Name: Address: Greengates 96 Monkton Street Ryde Isle Of Wight PO33 2DD Inspecting for better lives The quality rating for this care home is: The rating was made on: Two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Janet Ktomi Date: 1 7 0 3 2 0 0 9 Information about the care home Name of care home: Address: Greengates 96 Monkton Street Ryde Isle Of Wight PO33 2DD 01983564418 01983564418 mandy.minshull@islecare.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Islecare Ltd care home 5 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 5 The maximum number of service users to be accommodated is 5. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home 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 goodsized 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, Care Homes for Adults (18-65 years) Page 2 of 12 0 3 1 0 2 0 0 7 Brief description of the care home hairdressing, toiletries, chiropody and papers/magazines. The home is fully accessible on the ground floor with stair access to the first floor. Care Homes for Adults (18-65 years) Page 3 of 12 What we found: One inspector undertook an unannounced visit to the home on the 17th March 2009 and spent approximately three hours at the home arriving at 3pm and leaving at 6pm. A random inspection was completed looking at issues relating to care and the management of the home. The inspector met the newly appointed person in charge, staff on duty and all the people who live at the home. Care plans and related documents were viewed and the inspector observed how people who live at the home spent their time. Also considered are notifications received at the commission since the home had an annual service review in July 2008 and a safeguarding investigation that is ongoing by Isle of Wight Social Services. The home does not have a registered manager with the previous registered manager having been promoted within the provider company approximately fifteen months before this inspection visit. The provider has now appointed a new manager and this person commenced working at the home at the start of March 2009. The person will also be managing a similar home located close to Greengates. The new manager stated that she is aware of the need to register with the commission and the procedures to achieve this. The new manager stated she will be visiting the commissions office in the near future to complete a CRB with the commission as the first part of the registration process. The new manager informed the inspector that she has an NVQ level 4 in care, Registered Managers Award and further training in Autism and that she has previously managed homes for people with learning disabilities. The inspector viewed two care plans. The plans were selected from people at the home at the time of the inspection who the inspector had met on arriving at the home. The home is fully occupied with five people living there. The new manager stated to the inspector, before the inspector viewed the care plans, that she had identified deficits in the homes care plans. The first care plan viewed provided some good specific information about how some aspects of the persons care should be met however it did not have any information about behaviours or risk assessments related to behaviours that may present a risk to the person or to other people living at the home, staff or visitors. The commission had received a notification from the home in February 2009 to inform that there had been an incident in which the person whose care plan had been viewed had made an unprovoked assault on another person living at the home which had resulted in injury to the other person requiring attention at St Marys Hospital Accident and Emergency department. The notification of the incident stated that a staff member was right behind the person assaulted but that X is strong and was too quick to divert his action. The incident occurred in the homes kitchen. The review completed in the persons care plan for February 2009 stated increase in behaviours so more support given to X. There was no care plan for the management of the persons behaviour or identification of what behaviours the person may present. The only risk assessments present were in connection with walking on uneven surfaces and slipping whilst in the bath. Although the home had completed monthly reviews detailing significant events that had Care Homes for Adults (18-65 years) Page 4 of 12 occurred there was no evidence that the care plan had been amended in response to the incident described above and no reference to the incident on the February 2009 review. The second care plan viewed also had no risk assessments in relation to risks that the person may be at due to the behaviour of other people living at the home. Parts of the persons care plan had been reviewed in January 2009 in relation to assistance with personal care. The previous care plan for personal care was in the persons care plan and this showed that previously the way that the person had been supported with one aspect of personal care was inappropriate and indicated institutional care practices had been in operation. The persons care plan had monthly targets however there was no clear evidence what has occurred as a result of these. One monthly target was to wash the house car and increase their skills with washing their own hair. It was not clear from the records viewed if these targets had been met and if the person was still provided with opportunities to wash the house car. The monthly targets for January and February 2009 indicated that within one month the person had become independent in two areas of personal care. It is likely that they would have been able to achieve these goals sooner had they been given the opportunity to do so; the previous care plan stating that staff did these personal care tasks for the person. The home is required to ensure that all care plans are reviewed, any examples of institutional care practices are discontinued and people are actively encouraged to develop independence skills. The home is also required to ensure that risk assessments are in place and management plans in place to address behaviour issues and ensure the safety of the person, other people who live at the home, staff and visitors. There was evidence that people had been supported to access health facilities including GPs where an annual health assessment and review of medications had occurred. The inspector noted on the record held in the care plan of the persons visit to the GP it was noted that the person had refused to be weighed at the GPs. Both care plans showed that people had been weighed in July 2008 and then not again until January 2009. There was no evidence that when the person had visited the GP and refused to be weighed that the GP had been informed of the persons weight in July 2008 and January 2009. One person had gained just under a stone in the six months and the other had lost one stone and two pounds. The person who had lost weight has not been weighed again since January 2009 to determine if there is further weight loss. The person is awaiting the results of some tests but accurate information about ongoing weight should be maintained considering the unplanned loss recorded in the previous six months. There was some information in the care plans viewed about how people liked to spend their time but little evidence to show that they were doing leisure activities. The care plans contained recordings both in daily logs and on community participation and activity logs how people had spent their time. The daily logs for both people indicated that throughout March 2009 they had had limited community participation and in house activities. One persons care plan stated that, other than day services attended, they had been for a walk on the 3rd March, to a GP appointment on the 4th March, for a drive on the 15th March and had helped staff with the shopping at tescos on the morning of the day of the inspection, the 17th March. The other care plan viewed Care Homes for Adults (18-65 years) Page 5 of 12 evidenced that the person, who does not attend day services, had four activities in their community participation log up to the 17th for the month of March. Daily logs for both people evidenced that they had not undertaken any evening activities other than watching television and listening to music in their bedrooms. The inspector and the new manager looked in the cabinets in the lounge and found no activities equipment other than videos and on a table a pencil case and two colouring books. Throughout the inspection visit the people who live at the home did not appear to be involved in any meaningfully activity. People were walking up and down the stairs and wondering around the home and garden. The day of the inspection visit was a pleasant warm spring day. There had been three staff on duty and the new manager throughout the day with the day staff finishing at 10pm. One person had spent the day at day services. One person has a one to one support worker and had been out in the afternoon and went out for a walk at 6pm as the inspector was leaving the home. One person had helped staff with the food shopping in the morning and the other two people had spent the day at home. The evening meal was prepared by the afternoon care staff and seen by the inspector being dished up and given to the people who live at the home at four fifty-five pm. One person had only just returned home from day services and immediately had his meal. People ate their meal in the kitchen with care staff standing to eat at the worktop as there was insufficient room at the table. One persons meal was taken through (platted) for them to eat in their separate part of the home. By five thirty people had finished their evening meal, care staff were completing the washing up and the dishwasher had been started. One carer made a cup of tea for one service user and staff and organised the service user to sit in the lounge with a video and stated thats you set up for the evening. One person had been proud to show the inspector and new manager that they had received an award for doing well in a slimming group at their day services. The person was provided with the same evening meal as other service users, roast beef, roast potatoes vegetables and gravy and jam rolly polly and custard for afters. One person got themselves into their nightwear at 5.30pm and another was also in their nightwear when the inspector left at 6pm. Care staff stated that it was the persons choice to get into nightwear if that was what they wanted. There appeared to be little if any effort made by care staff to encourage people not to get into their night wear or to suggest an evening activity such as a walk to the nearby sea front or pub for a drink. The home is required to ensure that people have the opportunity of a fulfilling lifestyle that provides social, leisure and opportunities to learn new skills and increase their Independence. One person living at the home has their own flat with bedroom, bathroom and lounge dining room. They have cooking facilities but staff stated that it has been decided that it is too dangerous for the person to be involved in cooking their own meals. The person has their own front door and part of the garden has been partitioned for their use. The person is known to be unsteady on their feet however their garden area is Care Homes for Adults (18-65 years) Page 6 of 12 unsuitable for their use having uneven surfaces (gravel) to a raised lawn area accessed via uneven steps that have not been clearly identified (painted white etc). The inspector observed how when this person was taken out for an evening walk in their wheelchair they had to use the exit from the home via the main building and then through the main garden. It was difficult for the carer to get the wheelchair out of the home as the back door has a raised base and then had to negotiate two steps to the rear gate. This placed both the service user and staff at risk. The home must ensure that the home and garden are safe for people and that as one person must now use a wheelchair that access is suitable and does not place the person or staff at risk. Care staff have received training in safeguarding adults and had information about safeguarding available within the home. Staff have received supervision approximately every two months. However staff have not identified that some of the practices in the home are inappropriate, such as adults having their evening meal before five pm, and limited social and leisure activities. This has resulted in people not having as fulfilling lives as would be desirable. Care staff have continued to undertake tasks such as manovering the person in a wheelchair through the back door and out via the back gate and steps that places themselves and the person at risk. One care plan viewed had been updated and the new plan did not include the previous inappropriate institutional care practice. What the care home does well: What they could do better: The following requirements are made following this random inspection. The Responsible Person is required to ensure that all care plans are reviewed, any examples of institutional care practices are discontinued and people are actively encouraged to develop independence skills. The Responsible Person is required to ensure that risk assessments are in place and management plans in place to address behaviour issues and ensure the safety of the person, other people who live at the home, staff and visitors. The Responsible Individual is required to ensure that people have the opportunity of a fulfilling lifestyle that provides social, leisure and opportunities to learn new skills and increase their Independence. The responsible person must ensure that the home and garden are safe for people and that as one person must now use a wheelchair that access is suitable and does not place the person or staff at risk. Care Homes for Adults (18-65 years) Page 7 of 12 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 8 of 12 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 9 of 12 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 01/05/2009 The Responsible Person is required to ensure that all care plans are reviewed, any examples of institutional care practices are discontinued and people are actively encouraged to develop independence skills. So that people are safe and have their needs met in an approriate way. 2 9 13 The Responsible Person is 01/05/2009 required to ensure that risk assessments are in place and management plans in place to address behaviour issues and ensure the safety of the person, other people who live at the home, staff and visitors. So that risks are identified and managed to ensure the safety of people. 3 11 16 The Responsible Individual is 01/05/2009 required to ensure that people have the opportunity of a fulfilling lifestyle that provides social, leisure and Page 10 of 12 Care Homes for Adults (18-65 years) Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action opportunities to learn new skills and increase their Independence. So that people can fullfill their potential and enjoy thier lives. 4 24 13 The responsible person must 01/05/2009 ensure that the home and garden are safe for people and that as one person must now use a wheelchair that access is suitable and does not place the person or staff at risk. So that people are safe. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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