Random inspection report
Care homes for older people
Name: Address: Greengates Redland Lane Westbury Wilshire BA13 3QA two star good service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. 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: Alison Duffy Date: 0 6 0 8 2 0 0 9 Information about the care home
Name of care home: Address: Greengates Redland Lane Westbury Wilshire BA13 3QA 01373822727 01373826320 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) : Greengates Care Home Limited care home 54 Number of places (if applicable): Under 65 Over 65 0 0 51 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: Date of last inspection Brief description of the care home 51 3 0 2 9 1 0 2 0 0 8 Greengates is situated in a residential area of Westbury. The original property has been extended on several occasions. The home is built around a central patio area, which may be accessed directly from the communal lounges. The majority of peoples rooms are on the ground floor. Many look onto the central courtyard. Seven bedrooms are located on the first floor. The home is registered to provide care for up to 54 people. Around half of these places are in shared rooms. The home has some on site and street car parking. The town centre and its railway station are about fifteen Care Homes for Older People Page 2 of 11 Brief description of the care home minutes walk from the home. There is a bus stop at the end of the road. Care Homes for Older People Page 3 of 11 What we found:
We made an unannounced visit to Greengates on the 6th August 2009 at 1.25pm. The visit was arranged as part of an investigation, which took place under the Wiltshire and Swindon, Safeguarding procedures. Mr Yeoh was not on duty during our visit. A senior carer, Mrs Macaraig assisted us with the information we needed. We spoke with one other member of staff. We looked at staff training records with particular attention to manual handling and first aid training. We looked at one persons care plan and care records. We did not look at the statutory requirements, which we made at the last key inspection. These will be addressed at the next key inspection. Mrs Macaraig told us that Mr Yeoh facilitated the majority of staff training within the home. She said that external trainers would be used for specialist subjects such as first aid. Mrs Macaraig said that Mr Yeoh was a manual handling trainer, so kept staff up to date with manual handling training on a day to day basis. She said that formal manual handling training had been arranged for November 2009. Records showed that staff had recently had training in how to use the bath and standing hoist safely. They had also been shown how to use the green belt to assist people with limited mobility, to transfer from their chair to a wheelchair, for example. We saw that staff had signed to say that they could use the manual hoist safely and that they had read the Using a Hoist policy. We advised that the policy be reviewed to include more information about the complexity of peoples needs. Records showed that there had been no formal manual handling training since 2007. Mrs Macaraig and another member of staff told us that they had not received formal training in manual handling for a long while. They said they could ask Mr Yeoh at any time, if they were unsure of moving people safely. We said that formal manual handling training must be undertaken on a yearly basis. We said that the training should also take into account the complexity of peoples needs. Documentation showed that all staff had completed training in first aid in June 2008. Some certificates showed that the areas covered were the unconscious patient, resuscitation, choking, severe bleeding and shock, fractures and illness recognition. Mrs Macaraig told us that staff practiced on the resuscitation dummy as part of the training. We saw that staff had undertaken a three hour dementia care training session in February 2009. Records did not demonstrate that further dementia care training had been completed. At the last key inspection, we made a requirement that staff must complete training in communication with and care provision to people with dementia. We also recommended that opportunities should be sought for staff to extend their knowledge and competency in working with people with dementia. We advised that the requirement and recommendation were further addressed. We looked at the care plan and care records of the person at the centre of the safeguarding investigation. We saw that the daily care records did not give a detailed account of the identified areas, which were initially raised within the safeguarding referral. We said that staff must ensure that they record detailed, specific, factual
Care Homes for Older People Page 4 of 11 information. In the event of a wound or bruising, staff must record the actual size, location and colour of the area affected. We said that a format showing a body map could be used to identify this. We said that documentation must also identify the exact details of any emergency procedure, such as resuscitation, which is undertaken in the home. We saw that instructions given by a health care professional regarding the persons health care needs had not been transferred to their care plan. This must be done so that all staff have the correct information to support people appropriately. The persons care plan stated make sure staff are aware as a form of intervention. We said that clarity was required as any intervention should explain the support the person needed. This would ensure that staff were working in the same way and the person would receive their care in a consistent manner. There was no evidence as to how the staff were to manage the persons health care condition, which initially prompted the safeguarding referral. We said that this needed to be within the persons care plan. What the care home does well: What they could do better: 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 Older People Page 5 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 13 The registered person must ensure that where food, drinks or medicine are administered to a service user by special means, e.g. by use of a syringe, their care plan includes precise guidance on how the task is to be carried out safely and with consent. The service must be able to demonstrate that the person or a representative has been consulted on delivery of care that might otherwise be seen as intrusive. 18/03/2009 2 8 12 The registered person must 18/03/2009 ensure that pressure area risk assessments, and associated care plans, reflect any changes noted in a persons wellbeing, as they occur. Many of the people being cared for have frail skin, so their pressure areas can be quickly vulnerable to changes. 3 8 12 Whenever charts are used to 18/03/2009 monitor aspects of care, such as fluid intake or regular turning, the registered
Page 6 of 11 Care Homes for Older People 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 person must record when and why this has been decided, and must ensure the care plan explains to staff why and how the chart is to be used. The usefulness of monitoring is diminished unless it is aimed at specific outcomes. 4 9 13 The labels of prescribed medicines must not be removed or altered. This will ensure that medicines are only used for the person they are prescribed for. 5 9 15 The registered person must 18/03/2009 ensure that where a service user is prescribed as needed medicine, their care plan includes guidance on how such medicine is to be used and recorded. This requirement was made at the previous key inspections, 10/05/06 and 05/03/08. Residents and staff are vulnerable in the absence of clear protocols about how to determine that a medicine should be used, and who takes responsibility for that. 6 30 18 The registered person must 18/03/2009 arrange externally provided training for staff at all levels in communication with and care provision to people with dementia.
Page 7 of 11 09/01/2009 Care Homes for Older People 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 The home is registered as a specialist home and needs to demonstrate that staff are kept up to date with knowledge and trends in dementia care, so people receive person-centred care that takes full account of their individuality and abilities. Care Homes for Older People Page 8 of 11 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 7 12 Care plans must fully reflect 30/11/2009 peoples care needs and the support they are to be given. This must include the management of peoples health care conditions. So that staff have sufficient information to meet peoples needs effectively. 2 30 13 All staff must have regular, yearly manual handling training, which takes into account peoples complex health care conditions. So that staff have the right knowledge and skills to move people safely. 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 30/11/2009 1 7 Staff should record specific details of any emergency procedure, such as resuscitation, which is performed within
Page 9 of 11 Care Homes for Older People 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 the home. 2 7 Staff should ensure that specific details of any wound or bruising are clearly identified within the persons care records. Staff should ensure that they only record clear, specific and factual information within peoples care records. 3 7 Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission 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 Older People 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: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 11 of 11 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
