Inspection on 02/11/05 for Greengates

This inspection was carried out on 2nd November 2005.

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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greengates 29/11/06

Greengates 21/04/05

Greengates 22/11/04

Greengates 19/05/04

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

CARE HOME ADULTS 18-65 Greengates 697-699 Southmead Road Filton South Glos BS34 7QY Lead Inspector Melanie Edwards Announced Inspection 2nd November 2005 09:45 Greengates DS0000020333.V249947.R01.S.doc Version 5.0 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 DS0000020333.V249947.R01.S.doc Version 5.0 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 DS0000020333.V249947.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Greengates Address 697-699 Southmead Road Filton South Glos BS34 7QY 0117 9236067 NONE 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) admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Mrs Jennifer Alcock Care Home 11 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (11) of places Greengates DS0000020333.V249947.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May accommodate up to 11 persons aged 18 years and over who have mental disorder and are receiving nursing care. Staffing Notice dated 20/05/1999 applies Manager must be a RN on parts 3 or 13 of the NMC register Date of last inspection 21st April 2005 Brief Description of the Service: Aspects and Milestones Trust operates Greengates Care Home, which is registered to provide nursing care to 11 adults with a mental disorder between 18 and 65 years old. The property is located in a busy residential area, close to some local shops and amenities. There are 11 single bedrooms of various sizes, all of which have sinks. There are parking spaces and grounds to the side and rear of the house. Greengates DS0000020333.V249947.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Eight of the ten residents currently living at the Home were consulted to find out their views of the service. The registered manager, the deputy manager, a care assistant, and the cook, were also consulted about their roles and responsibilities, their training needs, and how they assist and support residents and carry out their duties. Staff were also observed assisting residents with their needs. A range of records relating to the day-to-day running and management of the Home were inspected. A selection of resident’s care records and care plans were also inspected. A number of completed Commission for Social Care Inspection questionnaire comments cards were returned to the area office of the Commission for Social Care Inspection before the inspection. These had been completed by residents and relatives, and have been used as additional inspection information and are an additional way for residents and their representatives to make their views known about the Home. The majority of the environment was seen; the only areas not viewed were a small number of resident’s bedrooms. What the service does well: What has improved since the last inspection? What they could do better: The health and safety of residents and staff would be better protected if the kitchen fridge that has rust around the bottom seal were replaced, as this is a potential health and safety hazard. Overall communication and management systems would be even further improved if there were a `fax’ machine in use at the Home. Greengates DS0000020333.V249947.R01.S.doc Version 5.0 Page 6 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 DS0000020333.V249947.R01.S.doc Version 5.0 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 DS0000020333.V249947.R01.S.doc Version 5.0 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): 1,2,3 Prospective residents and their representatives are provided with the necessary information to make an informed choice about the Home and residents’ individual needs are met. EVIDENCE: A copy of the statement of purpose and service users guide to the Home was inspected to see what information is provided to residents and their representatives. Both documents contained a range of detailed, helpful information about life in the Home, the staffing structures and levels, and the service that is provided, including information about daily life, as well as how they will be supported to meet spiritual needs while living at the Home. Both documents include a range of colour photographs of the Home and surrounding community, to show what type of service is provided, as well as the community facilities that are nearby. To find out how the Home assesses residents’ needs including mental health needs, two residents assessment records were inspected. The Home carries out assessments based on the idea of ‘person centred planning’ meaning the views and wishes of residents are at the centre of all care provided. There was detailed information recorded about residents care needs. The assessments had been regularly reviewed and updated helping to demonstrate staff monitor residents changing needs. Residents are actively involved in the assessment process, and sign care documentation in agreement with care that is provided. Greengates DS0000020333.V249947.R01.S.doc Version 5.0 Page 9 All of the residents who were asked expressed positive views of the care they receive. Examples of comments made by residents included, `we are lucky to live here,’ `we have a meeting every week you can’t beat it’, and `we get lovely porridge when we get up.’ Greengates DS0000020333.V249947.R01.S.doc Version 5.0 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): 6,7,8,9 Residents changing needs are met, monitored and reviewed, and residents are consulted about daily life in the Home. EVIDENCE: To find out about the care provided, two residents care plans were inspected. Care plans had been written from the perspective of `person centred planning’ meaning residents help to identify what they feel their needs are, and how best they think staff can help them. This helps to ensure that care is individualised and based on the involvement and participation of residents. The care plans contained a range of information, and demonstrated how to support the residents to meet their health care needs. Care plans also addressed the psychological needs of residents, and detailed how to respond to the person if distressed or agitated. There was information written by residents which demonstrated they had been actively involved in deciding what they felt their care needs were. Residents had invited the inspector to attend a` residents house meeting’ during the inspection. The inspector observed that residents are being supported and encouraged to run these meetings themselves, and to set their own agenda and discuss what they feel matters. This is good practice and staff Greengates DS0000020333.V249947.R01.S.doc Version 5.0 Page 11 were supporting residents sensitively to express their views during the meeting. Greengates DS0000020333.V249947.R01.S.doc Version 5.0 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): 14,16,17. Residents are provided with a healthy, well balanced diet and are supported to be a part of the local community, and to take part in their preferred social and therapeutic activities. EVIDENCE: During the inspection, staff were seen spending time talking with residents either chatting, or going out into the local community with them. Several residents also said how much they had enjoyed their very recent holiday at a coastal resort. Residents have had the opportunity this year to go on a holiday of their choice, and small groups of residents went to several different places, supported by staff. One resident was going on holiday on the morning of the inspection, accompanied by staff, to Cornwall. The residents menu was reviewed, to see what range of meal choices the Home offers. The choices seen were nutritionally well balanced and varied. The lunchtime meal was a `ploughman’s’ lunch with cheese, cold meats, and pâté. The meal looked tasty and well presented, and the cook had been assisted to prepare the meal by one of the residents. The cook serves food in the dining room, and it was noticeable how relaxed and calm the lunchtime meal experience was for residents. Greengates DS0000020333.V249947.R01.S.doc Version 5.0 Page 13 All of the residents who were asked said they thought the meals served in the Home were very good. One resident said they enjoy making cakes on a regular basis with the cook’s support. This is an activity that several residents regularly take part in. Greengates DS0000020333.V249947.R01.S.doc Version 5.0 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): 18,19,20 Residents are supported to meet their mental health needs in the way they prefer, and there is a safe system in place for handling, administrating, storage and disposal of resident’s medication. EVIDENCE: The procedures for the administration, storage, and disposal of medication were inspected with the assistance of the deputy manager, to monitor systems in place for handling medication. The medication administration charts of three residents were inspected in detail. There was a photograph of the resident maintained with each record to ensure medication is dispensed to the correct person as well as a medication administration profile, which details the preferred way that residents like to have their medication administered. The medication administration charts were legible, up to date, and contained the signature of the dispensing registered nurse, demonstrating resident’s medication is administered safely, the reasons for any omissions had also been written on the charts. Up to date records were also being kept of all medication being received into the Home, and medication being returned to the issuing pharmacy, showing there are safe systems in place to monitor how much medication is held in the Home. Greengates DS0000020333.V249947.R01.S.doc Version 5.0 Page 15 Staff assisted residents with their needs in a good humoured and sensitive manner. As has been previously referred to in the report, residents care plans include a range of detailed helpful information, stating how best to support residents to meet their physical, mental, social and spiritual needs. Greengates DS0000020333.V249947.R01.S.doc Version 5.0 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, 23 There are procedures in place to ensure complaints are investigated promptly and thoroughly, and to protect residents from harm or abuse. EVIDENCE: A copy of the complaints procedure is on display on a wall in a well-frequented part of the Home. The procedure includes the contact details for the Trust who run the Home, as well as the area office of the Commission for Social Care Inspection, if someone is not happy with the outcome of a complaint investigated by the Home. The complaints record book was viewed to see how complaints are responded to. There had been no new complaints received since before the last inspection, the record did include the details of how complaints were to be dealt with. A residents meeting took place recently, (as a result of views expressed by residents during the recent residents consultation exercise,) to make sure residents are all aware of how to make a complaint. This demonstrates a commitment by the Home to ensuring residents are enabled to make complaints about the service if they so wish. There are policies and procedures in place relating to the issue of protection of vulnerable adults from abuse. All staff attend training sessions run by South Gloucestershire Council to ensure they are up to date in their understanding of the principle of the protection of vulnerable adults from abuse. Greengates DS0000020333.V249947.R01.S.doc Version 5.0 Page 17 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): 24-30 The Home is adequately suitable for meeting the needs of residents. EVIDENCE: The Home is two houses converted into one property, built over two floors, which can be accessed by stairs only. The building is over one hundred years old and is a converted residential property. The majority of bedrooms and all the communal areas were viewed. Bedrooms are all for single occupancy, and were generally adequately decorated and maintained. Bedrooms do not have en suite facilities, however there are bathrooms and toilets located within close proximity, and a washbasin in each bedroom. There is a dining room situated on the ground floor, as well as a television lounge and a designated ‘smoking’ lounge, this is a popular room as a number of residents are smokers. Residents were observed sitting in communal areas looking very relaxed and comfortable in the environment. Facilities were adequately clean and tidy when viewed. Greengates DS0000020333.V249947.R01.S.doc Version 5.0 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): 32,33,34,35,36 Residents are supported to meet their needs by skilled well-supervised staff. EVIDENCE: The staff duty record for shifts in October 2005 was inspected to review the number of staff on duty to support residents to meet their needs. There is a minimum of three staff on duty for a day shift, consisting of two care staff and one registered nurse and two staff at night consisting of one registered nurse and two care staff. The number of staff on duty for each shift met the minimum staffing numbers required by the Health Authority staffing notice issued under previous care homes legislation. Mrs Alcock also works regular supernumerary management hours, as well as some shifts. There are also ancillary workers employed who work on a daily basis in the Home, specifically a domestic assistant and a cook. A selection of three staff recruitment records were inspected to find out if the required ‘safety checks’ have been carried out when staff are recruited. The required Criminal Records Bureau offences checks are being carried out for all new staff. These checks help to ensure staff are suitable and are considered `fit’ to work with vulnerable people helping to protect them from potential risk of harm. There were also two detailed references obtained for all newly recruited staff, demonstrating that the Home ensures the suitably of all new employees to work in the Home. Greengates DS0000020333.V249947.R01.S.doc Version 5.0 Page 19 All staff are receiving regular support and supervision of their work and practice. Mrs Alcock has put in place a model of supervision to best meet the needs of staff and the service as a whole. The training records demonstrated staff had attended training relevant to the needs of residents over the last twelve months. Staff also demonstrated that they communicate and support residents in a sensitive manner, and are working well as a team. Greengates DS0000020333.V249947.R01.S.doc Version 5.0 Page 20 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): 37,38,39,42 The Home is well run, with resident’s views actively taken into account by management in the day-to-day running of the service, and generally the health and safety of residents, staff and visitors is protected. EVIDENCE: Records are kept in the office and this room is kept locked when not in use ensuring residents confidential information is held securely. All the records inspected were well maintained, up to date and in order. Other records have been referred to elsewhere in this report, and demonstrate wellorganised management in the Home. The environment looked satisfactorily maintained throughout, however one of the kitchen fridge’s requires replacing as there is rust around the bottom seal, and this is a potential health and safety hazard, and may mean the fridge will not be working effectively. There are health and safety procedures in place for staff and residents to follow to promote health and safety in the Home. Greengates DS0000020333.V249947.R01.S.doc Version 5.0 Page 21 The fire logbook record showed that the range of required fire safety checks were being carried out and were up to date helping to ensure the safety of people inside the building is maintained. Since the last inspection Mrs Alcock and the team have worked hard to carry out a quality-monitoring audit of the care and service that is provided to residents. Residents and their relatives have been consulted about their views of the care and service .An action plan has been put in place to address any issues raised by residents or their relatives. From reading a sample of the responses that were received, it is evident that residents and relatives generally feel very satisfied by the quality of the service in the Home. The evidence from this inspection demonstrates a commitment by the management in the Home to continued resident consultation and inclusion in the day-to-day running of the Home. Currently the Home does not have a fax machine on the premises, the use of a fax machine is very beneficial in Care Homes to assist in general communication, and is a benefit to the overall running and delivery of the service. Greengates DS0000020333.V249947.R01.S.doc Version 5.0 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 3 3 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 3 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Greengates Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 4 4 X X 3 2 DS0000020333.V249947.R01.S.doc Version 5.0 Page 23 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA42 YA42 Regulation 2. (ii) 16(2) g Requirement There must be a `fax’ machine in operation in the Home. The kitchen fridge must be replaced. Timescale for action 02/01/06 02/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Greengates DS0000020333.V249947.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 DS0000020333.V249947.R01.S.doc Version 5.0 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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