Inspection on 20/05/05 for Greengates

This inspection was carried out on 20th May 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 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 06/08/09

Greengates 10/12/08

Greengates 29/10/08

Greengates 05/03/08

Greengates 10/05/06

Greengates 12/10/05

Greengates 21/03/05

Greengates 02/08/04

Greengates 29/01/04

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

CARE HOMES FOR OLDER PEOPLE Greengates Redland Lane Westbury Wiltshire BA13 3QA Lead Inspector Roy Gregory Unannounced 20th May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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 D51_D01_S48635_GREENGATES_V189954_200505_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Greengates Address Redland Lane Westbury Wiltshire BA13 3QA 01373 822727 01373 826320 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Greengates Care Home Limited Mr Chong Siam Yeoh Care Home 54 Category(ies) of DE Dementia (51) registration, with number MD Mental Disorder (3) of places OP Old Age (51) Greengates D51_D01_S48635_GREENGATES_V189954_200505_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 21st March 2005 Brief Description of the Service: Greengates is situated in a residential area of Westbury. The original property has been extended on several occasions. The home is built round a central patio area, which may be accessed directly from the lounges. The majority of service users’ rooms are on the ground floor, many looking onto the central courtyard. Seven bedrooms are on three separate first floors. The home is registered to provide care for up to fifty-four people. Three of these may be aged under 65. Around half of these places are in shared rooms. There were 35 service users in residence at the time of this inspection visit, and so the majority of double rooms were in fact singly occupied. Westbury has a main line station, which is about 15 minutes walk from the home, as are the town centre shops. Some parking is available on site and street parking is also available. There is a bus stop at the end of the road. Greengates D51_D01_S48635_GREENGATES_V189954_200505_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Friday 20th May 2005, between 9:00 a.m. and 3:45 p.m. The inspectors, Roy Gregory and Karen Mandle, were assisted at times during the day by Mr Yeoh, manager, and Mrs Naish, deputy manager. They also had conversations with a number of staff, singly and in groups. Several residents were spoken with and many care interactions were observed, including service of and assistance with the midday meal. Records consulted included a sample of care plans, medication administration records and the fire precautions log. All areas of the home were toured (with the exception of the kitchen), including seeing most of the individual bedrooms and all bathrooms and toilets. There were conversations with a visiting community nursing auxiliary; with the relative of a service user who was to be admitted later in the day; and with two visitors to service users. This inspection included review of compliance with all requirements from the previous inspection. What the service does well: What has improved since the last inspection? The previous inspection, in March 2005, resulted in twenty requirements being set. These had all been met. Care plans now include night care plans, manual handling assessments and nutrition assessments. Medication procedures have been made safer. A number of measures have been put in place to minimise the risks of cross infection, for example, by provision of hand washing facilities for staff in residents’ rooms and ensuring laundry practice is safe. Training has been arranged for staff, in dementia care and infection control. Greengates D51_D01_S48635_GREENGATES_V189954_200505_Stage4.doc Version 1.30 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 D51_D01_S48635_GREENGATES_V189954_200505_Stage4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Greengates D51_D01_S48635_GREENGATES_V189954_200505_Stage4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 4 & 5 (n.b. key Standard 6 is not relevant to Greengates as Intermediate Care is not provided) Good information is made available to prospective residents and their families. Visits to the home by prospective residents or their supporters are facilitated. The home provides a written contract, and written confirmation of its ability to meet assessed needs. EVIDENCE: A person was due to be admitted from another residential home at the end of the day of inspection. Their relative described having researched a number of potential care homes. They considered Greengates to have supplied them with the best information, including a copy of the contract, on which they had obtained advice. They had visited the home, at which time they felt they were given as much time as they needed, and a full opportunity to exchange information. In tandem with the assessment of need, they felt confident in the home’s ability to meet their relative’s needs. They were able to help staff prepare the resident’s room in advance of actual arrival. Admission to the home is always on a one-month’s trial basis. Greengates D51_D01_S48635_GREENGATES_V189954_200505_Stage4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 Provision of care is directed by comprehensive care plans, but these have not all been routinely reviewed and thus cannot be relied upon as an indication of current levels of risk to service users. Health matters receive prompt attention, with excellent liaison with health professionals. Organisation and administration of medications are safe. Staff interactions with service users are sensitive and respectful. EVIDENCE: Care plans showed continued improvement from the previous inspection. Manual handling and nutritional assessments had been added in all cases. There was clear documentation about liaison with external health professionals such as in the current case of a resident with a catheter, to whom it was evident the district nurses were giving a full service. Care records, and notifications to the Commission, showed staff to be prompt in recognising and acting upon ill health indicators. Daily records gave a good picture of how residents were spending their time, for example with records of visits received as well as of purely physical care tasks accomplished by staff. Pressure area care risk assessments had been initiated and informed care plans as appropriate, but there remained shortfalls in reviewing them. There were in fact a number of care plans that had fallen behind in being reviewed. In response to previous recommendation, nighttime care plans were in place for Greengates D51_D01_S48635_GREENGATES_V189954_200505_Stage4.doc Version 1.30 Page 10 all residents. Mrs Naish confirmed that night staff had been fully involved in devising these. All service users presented as comfortable and highly supported in terms of their personal care needs and presentation. Staff, both established and more recently recruited, demonstrated consistently sensitive caring interactions and a good knowledge of individual preferences and communication abilities. A visiting auxiliary community nurse said she had been greatly helped by the home staff knowledge of the nature of individuals’ dementias and of how to approach and work with residents. All requirements made in respect of medications at previous inspection had been implemented. This included provision of a fridge that had not yet been brought into use, but Mr Yeoh agreed to install it immediately on agreeing a location with the inspectors. Procedure and practice in respect of the medicines administration sheets were excellent, although it was recommended that a more accurate time (in terms of the reality of the medication round) be shown for those drugs given out in the morning. A drugs error policy was required, but at the time of writing a satisfactory document has been produced and appended to the existing medication policy. Greengates D51_D01_S48635_GREENGATES_V189954_200505_Stage4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 - 14 In keeping with the service user group served by the home, a balance has been struck between routines, and opportunities for choice and activity. Staff can respond to residents’ needs for stimulation. Contacts with the wider community including families are promoted. High quality meals are served, with due regard to individual nutritional needs. EVIDENCE: The inspector was able to speak with two visitors to residents. Each said they found access to the home to be simple and readily facilitated, and that they had freedom of choice about seeing their relatives in their own rooms or in the communal rooms. Care plans indicate the degree of community or family contact that individuals have, and how the home can promote these. There was evidence of key workers adding to assessment information about individuals’ backgrounds and interests; staff members seemed familiar with such information and used their knowledge in talking with residents. Residents present with varying degrees of memory loss, disorientation or disjointed experience. Therefore there is some degree of routine in the home, around mealtimes and prompts to use the toilet, to encourage recognition of time and place, thereby increasing opportunities for free expression and choice at other times. There was evidence for example that residents choose when to rise and retire, when to stay in their own rooms, and how much they use the communal spaces. Greengates D51_D01_S48635_GREENGATES_V189954_200505_Stage4.doc Version 1.30 Page 12 One of the staff has an overseas qualification in occupational therapy and has been encouraged to develop an activities co-ordinator role. As recommended, she had made a link with an established co-ordinator at another service in order to develop her practice further. She said she was furthering her knowledge specifically of dementia, with a view to setting up a monthly activities programme. There was already evidence of some craft work having been done in one of the lounges, and staff spoke of a variety of games, reminiscence exercises etc. that have been tried. There was a recognition of the importance of social and mental stimulation, with key workers saying they sought opportunities to engage residents individually in activity such as puzzles and looking at newspapers. Care plans could more clearly identify social and physical stimulation needs, with related activity possibilities. A number of staff and residents spoke of recent accompanied walks in the immediate neighbourhood, including for service users in wheelchairs. Residents were consistently pleased with the food. Plentiful staff provided unhurried service and appropriate assistance to the midday (main) meal, which was of good quality. The cook showed a range of breakfast options are offered, and the teatime meal always includes a light cooked option. All residents have had nutritional assessments. Greengates D51_D01_S48635_GREENGATES_V189954_200505_Stage4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 17 & 18 Civic rights are recognised and protected. The home has been pro-active in using local inter-agency adult protection procedures. EVIDENCE: There was evidence of a number of residents having been assisted to exercise their votes in the recent general election. For each resident there is a record of an external contact for their rights and advocacy needs. The complaints record and procedures were assessed at the previous inspection in March 2005, since when no new complaints had been received. The home has a policy and procedure relating to adult abuse, and each staff member is given a copy of the “No Secrets” guidance to local procedures. Mr Yeoh had made referrals into the procedures, which had been referred back for in-home resolution. The home has a policy of not taking responsibility for safekeeping of money or valuables, putting emphasis on family members or other advocates and representatives assuming all responsibility for residents’ finances. Greengates D51_D01_S48635_GREENGATES_V189954_200505_Stage4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20, 21, 23, 24 &26 The environment is welcoming and safe, with plentiful communal space and unrestricted passage around the home for service users. Residents have been helped to make themselves at home in their own rooms. There is good access to suitable bathrooms and toilets. Housekeeping staff maintain a clean, attractive home. Provision for hygiene is sound, subject to replacement of an item of furniture. EVIDENCE: A number of personal rooms were seen and were functional but homely, reflecting the personalities of their occupants, with a number of own possessions in evidence. Following previous requirement, improved arrangements have been made to provide for staff hand washing in all the bedrooms, thus promoting safety to individual residents as well as better hygiene for the home as a whole. Also in response to requirement, there were new dining chairs on order, with evidence of occupational therapist consultation about them. Service users enjoy a variety of sitting areas in rooms of varying sizes, and most of these in turn open onto a central courtyard with outdoor furniture. There are other secure outdoor areas, which Greengates D51_D01_S48635_GREENGATES_V189954_200505_Stage4.doc Version 1.30 Page 15 could perhaps be developed further for resident access. There is a designated smoking area for residents. Toilets and bathrooms are distributed evenly around the home and they presented well. Both inspectors remarked on high standards of cleanliness throughout the home, with no unpleasant odours present. The laundry, crowded as it is with a variety of domestic machines, was organised and had recent good practice guidance clearly displayed. Unfortunately space limitations mean laundry has to be sorted in the corridor, which is not ideal from the point of view of infection control or fire precaution. The laundry room was also very dusty in places. The laundry person understood infection control issues and use of the red bag system, and confirmed use of the sluice washer for those items needing its higher temperatures. Practices to minimise cross infection risks throughout the home were good. Shavers were now being recharged in their owners rooms rather than communally; blue aprons were worn for service of food; protective gloves were generally available and in use. One compromise noted was a stained and odorous bed base in a shared room, identified at the previous inspection, which must be replaced forthwith. Greengates D51_D01_S48635_GREENGATES_V189954_200505_Stage4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 & 30 Staffing is sufficient to meet both the care needs of residents and the domestic needs of the home. Service users benefit from a mix of carers within a cohesive and appropriately trained team. EVIDENCE: The home was fully staffed. There were six care staff on duty, plus a cook, housekeeper and laundress. There was clear delegation of duties to care staff, such that they knew what tasks had priority and which service users they had individually to care for. The inspectors found staff to be knowledgeable about the residents and responsive to immediate and longer-term needs. Three of the care staff have achieved NVQ level 3 in care and others are working towards level 2 or 3. Mr Yeoh has recruited a number of staff from overseas, who between them have a significant background in education and training in relevant fields. The whole staff group presented as cohesive, and positive about working in the home. At night there are two waking night care staff and a sleep-in member of staff. Training records showed night staff are involved in the home’s training programme. In response to previous requirement there was training arranged for the whole staff group in the near future, in dementia care and in infection control practice, to be delivered by experts in those fields. Greengates D51_D01_S48635_GREENGATES_V189954_200505_Stage4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 36, 37 & 38 (Please note that in respect of key standard 35, the home’s policy of non-involvement in service users’ personal finances, and of not holding valuables in safekeeping, means the outcome sought by this Standard is provided for outside of the working practices of the home) Management and staff project a culture of common purpose leading to a well run home, in which service users present as calm and secure. The manager has systems and practices in place that give him a good knowledge of and working relationships with the staff and resident groups. Record keeping has been developed to safeguard residents’ rights and recognition of their needs. Health & safety of residents and staff is well provided for. EVIDENCE: The manager, deputy manager and staff between them have demonstrated an impressive response to a total of twenty requirements set at the previous inspection; all had been met. There is a good understanding amongst staff of the hierarchy of responsibility within the home, such that events and changes Greengates D51_D01_S48635_GREENGATES_V189954_200505_Stage4.doc Version 1.30 Page 18 in residents’ needs get prompt responses from competent people and, equally important, get recorded appropriately. In staff handover there was a full interchange of information and opinion. There was also now a programme for regular individual supervision sessions for all staff with the manager. Members of staff said they experienced these as valuable reflection time, and as a complement to their regular staff meetings. Residents appeared at ease with all staff and Mr Yeoh was clearly a familiar figure to them. With regard to health and safety of service users, accidents were well recorded, with excellent cross-referencing to risk assessment reviews, care plans and notifications to the Commission. The low number of falls relative to the service user group catered for suggests good levels of supervision and awareness on the part of staff. Fire precautions, electrical and water safety records were all in order. Greengates D51_D01_S48635_GREENGATES_V189954_200505_Stage4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 x 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION x 3 3 x 3 3 x 2 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x 3 3 3 4 x x N/A 3 3 3 Greengates D51_D01_S48635_GREENGATES_V189954_200505_Stage4.doc Version 1.30 Page 20 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 7 26 Regulation 15 (2)(b,c) 13 (3) Requirement Care plans must show evidence of monthly review. The identified bed must be replaced to remove associated hygiene risks. Timescale for action 30th June 2005 30th June 2005 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. Refer to Standard 9 20 Good Practice Recommendations The MAR charts should show morning administered drugs as being administered at 9:00 a.m. in place of 8:00a.m., to reflect actual practice. Consider whether secure external spaces, additional to the central patio area, could be developed for residents access and amenity. Greengates D51_D01_S48635_GREENGATES_V189954_200505_Stage4.doc Version 1.30 Page 21 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB 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 D51_D01_S48635_GREENGATES_V189954_200505_Stage4.doc Version 1.30 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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