Inspection on 13/12/05 for Greenhill

This inspection was carried out on 13th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Greenhill 05/06/08

Greenhill 17/05/07

Greenhill 16/05/06

Greenhill 05/07/05

Greenhill 28/02/05

Greenhill 28/07/04

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

CARE HOMES FOR OLDER PEOPLE Greenhill 5 Oaklands Road Bromley Kent BR1 3SJ Lead Inspector Miss Rosemary Blenkinsopp Unannounced Inspection 13th December 2005 10:00 X10015.doc Version 1.40 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 Greenhill DS0000042521.V264961.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 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. Greenhill DS0000042521.V264961.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Greenhill Address 5 Oaklands Road Bromley Kent BR1 3SJ 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) 020 8289 7925 Mission Care Vacant Care Home 60 Category(ies) of Dementia (21), Old age, not falling within any registration, with number other category (39), Physical disability (9) of places Greenhill DS0000042521.V264961.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. After initial registration all new admissions must be in the category of old age, not falling within any other category There are no changes made to the current staffing compliment, with the exception that the top floor designated as providing dementia care has a RMN as a team leader and that the use of RGN`s on this floor is done so on the basis that they have substantial experience or relevant training specific to dementia; and that a RGN working on this floor will always hand over to a RMN. Mission Care must conduct a review of staffing levels at the end of the first 6 months of this variation being agreed. That review must take account of incidents/accidents within the home, complaints received, the activity of service users at night and the ability of the staffing compliment to respond to such activity. A report of this review must be submitted to the Commission. 5 July 2005 3. Date of last inspection Brief Description of the Service: The home is a registered nursing home providing care for up to 60 residents. The categories of registration include Dementia, Old Age and Physical Disability. The Dementia Unit occupies a floor with its own staff team. The home is a purpose-built facility having opened in 2003. The home comprises four floors, with services such as kitchen and laundry located in the basement. Bedrooms are well appointed with ensuite facilities; disabled toilets, baths and showers are located throughout the home. In the reception area there are two lifts, which access all floors. The reception area is large and spacious; residents enjoy sitting in this area. There is a garden area to the rear of the building and parking is provided. The home is located close to Bromley town centre with its wide selection of amenities. Greenhill DS0000042521.V264961.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted unannounced; it took place between 10.00 and 14.00, and was carried out by inspectors R. Blenkinsopp and S. Hall. The acting manager, Sheila Mears, was present throughout the inspection. She stated that she received support from the company. The inspectors explained how the inspection was to be carried out. One inspector went to inspect the second floor – the Dementia Unit. The second inspector examined staff files, staff training, and supervision records. Feedback was given at the end of the inspection with four immediate requirements left in respect of assessment of residents, care plan documentation, staff recruitment documentation and medication records. Progress on these will be followed up with a separate unannounced inspection. What the service does well: What has improved since the last inspection? What they could do better: The record keeping and documentation in respect of residents’ assessments and care plan interventions was limited and not reflective of needs. Without full and comprehensive information staff would be unable to fully address the residents’ needs in a consistent manner. Greenhill DS0000042521.V264961.R01.S.doc Version 5.0 Page 6 Medication records were in some areas poorly completed and introduced an element of risk to residents because of the lack of clarity and detail of the information recorded. The Dementia Unit did not feel homely or welcoming and an institutional atmosphere prevailed. Many areas were cold as windows had been left open to air the rooms. The area was untidy due to the lack of domestic support. 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. Greenhill DS0000042521.V264961.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Greenhill DS0000042521.V264961.R01.S.doc Version 5.0 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 the following standard(s): 1,3. There was little evidence that residents are assessed prior to admission to ensure that the home can meet their needs. There were limited records to demonstrate that residents were provided with sufficient information on which to base their decision regarding placement. EVIDENCE: The Statement of Purpose, complaints information and registration certificate were all incorrect as they detailed Ann Vezey as the manager. Ann Vezey left earlier this year. A new certificate will be issued once a new manager has been appointed. The Statement of Purpose will need to be amended to ensure that it accurately reflects the management and staffing in the home. On the Dementia Unit the staff were unable to locate the assessment information and supporting documentation of the two most recently admitted residents. The home’s assessment information was not available. One of these residents had not been assessed by any staff from Greenhill; this was confirmed by the acting manager, Sheila Mears. One resident who had been admitted the evening before had very little information, none of which detailed her mental health condition. The staff on admission had completed her Greenhill DS0000042521.V264961.R01.S.doc Version 5.0 Page 9 property list, nil else. The care plan documentation is further referred to under standard 7. Two other residents’ documentation did contain application forms and admission information. The admission information form was a tick box format and little has been added to the information hence limited in its detail. Please see Requirements 1 and 2. Greenhill DS0000042521.V264961.R01.S.doc Version 5.0 Page 10 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 the following standard(s): 7,9,11. Care plans are not sufficiently completed, robust or comprehensive in content to adequately and consistently address residents’ needs. Medication records, particularly on the Dementia Unit, are not sufficiently completed to safeguard residents. EVIDENCE: The care plans for three residents on the Dementia Unit were viewed. A newly admitted resident, who had arrived the evening before, had very little information available regarding her needs. It was evident however that the night staff had applied a bed rail to her bed overnight, this could have compromised her safety, particularly as the resident was described as agitated. There was no risk assessment for this procedure and limited other information on which the decision had been based. Care plan information and assessments were blank with the exception of the property list. The transfer letter from the discharging hospital detailed little about her mental heath needs or current condition. Greenhill DS0000042521.V264961.R01.S.doc Version 5.0 Page 11 Within another care plan the nursing assessment was fairly well completed although when risks had been identified e.g. high waterlow scores, additional actions and increased review were not in place. In another care plan the resident’s waterlow score was 39, which is very high risk. It was still reviewed monthly and limited actions documented to prevent tissue damage occurring. Wound care was also poorly completed and difficult to audit. The medication systems were inspected on two units. Medication - Dementia Unit Within the medication file was information on covert administration and refusal of medication, NMC guidelines and Nomad guidelines. On the medication administration records (MAR), there were photographs of the residents and some allergies were recorded, not all. The hand transcriptions of medications did not have staff signatures in place nor was the quantity of medication received recorded. When medication had been omitted a code was used as “other “, although there was no explanation recorded on the charts to further explain this omission. One medication in use was not dated on opening although it only had a life of fourteen days once opened. The sharps disposal bin was not dated on opening it contained inappropriate items in it and was over filled. Medication - First Floor The clinical room is extremely small and not suitable for it’s purpose. There is a very small hand-washing facility. The medicine trolley had to be removed from this room before cupboards could be accessed. Medication is stored in locked cupboards. External medication was separated from internal. Two items were found which had been prescribed in 2003 and 2004. If these items are not needed they should be sent for disposal. MAR charts had been well completed on this floor. A photograph of the resident accompanied each one. A list of staff signatures, including agency staff, was retained in the manager’s office. The drugs fridge was not locked. Eye drops were dated on opening except for one item. The inspector noted that there was a bottle of paracetamol labelled as “homely remedy for staff.” This is unsatisfactory. No medication should be kept or stored for staff. If staff require medication they must bring in their own, and store it safely in lockers. Please see requirement 3 and 4. Greenhill DS0000042521.V264961.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 12,15. Within the Dementia Unit, orientation, activities and personal contact were limited. Staff are task orientated and individual residents’ needs are addressed within the routines of the unit. EVIDENCE: One of the inspectors met the activities co-ordinator, who works three hours per day, Monday to Friday. There is an activities room on the first floor. The co-ordinator brings residents from other floors to join in with activities held in this room, which is quite small. It is suitable for smaller numbers of residents at any one time. Activities range from reminiscence, bingo, clay modelling, making jewellery, quizzes and seated exercises. An adult education teacher comes in to help teach clay modelling. The residents had made Christmas cards together. Within the Dementia Unit, prior to lunch, residents who were in the lounge area, had the TV playing, many seemed sleepy. This was in sharp contrast to the ground floor where Christmas carols, decorations and Christmas sweets were readily available. The Dementia Unit felt institutional and contact with residents negligible with the exception of one member of staff who was dressed in a Christmas hat and made more effort. Greenhill DS0000042521.V264961.R01.S.doc Version 5.0 Page 13 On the Dementia Unit the lunch was observed. It was noted that there were no tablecloths or linen serviettes available. Juice was served with the meal. Many residents were provided with a spoon only. One plate-guard was in use. Seventeen residents were in the dining room with two staff assisting. The menu on display was incorrect as it referred to the previous week. Within a Dementia Unit it is important that all forms or orientation, visual and verbal are maximised. The orientation/notice board was blank. Please see Recommendation 1. Greenhill DS0000042521.V264961.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 16. Information is available for staff, residents and visitors to access in the event that they should want to raise a concern or complaint. EVIDENCE: The complaints log was viewed by one inspector. No complaints had been entered since 29.08.04. The complaints information was on display in large print in the foyer area. This will need to be amended to reflect the correct name of the home manager when appointed. Greenhill DS0000042521.V264961.R01.S.doc Version 5.0 Page 15 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 the following standard(s): 19,22,26. The environment is purpose built and fully equipped with the equipment to assist residents with disabilities. More effort needs to be made to make the Dementia Unit feel homely and bedrooms personalised. Orientation signs, which are domestic in manner, need to be maximised particularly in a unit where it all looks very similar. EVIDENCE: One of the two lifts was out of service, which causes some inconvienence in this large home. Within the Dementia Unit there was little evidence of the approaching festive season. A small Christmas tree was positioned beside the lift, which kept falling down; there were no other decorations in the unit. Staff informed the inspector that the unit was without domestic cover. This was evident with bins overflowing and debris on bedroom floors. The qualified staff stated that she had emptied some of the bins. Greenhill DS0000042521.V264961.R01.S.doc Version 5.0 Page 16 There was a limited amount of sheets and bedding ; there were no tablecloths or serviettes available. The inspectors were informed that all the laundry is sent to another home, and the turn around is too slow for sheets, tablecloths etc. to be received prior to lunch. The lack of bedding, sheets etc. was noted at the last night visit. This home has a fully fitted laundry room in the basement, which is not used. The laundry system needs to be reviewed. Please see Recommendation 2. Greenhill DS0000042521.V264961.R01.S.doc Version 5.0 Page 17 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29,30 Staff recruitment procedures are not robust enough to safeguard residents in this home EVIDENCE: The inspector viewed a selection of four staff files. The new administrator assisted the inspector with accessing staff files. A random selection was requested to include new staff as well as some who had been employed long term, including care assistants, and a qualified nurse’s file. In one file there were no records of the previous employment prior to 1996, although she had a date of birth of 1962, nor had references been received. There were no records of verbal references being taken. There were notes of a Criminal Record Bureau (CRB) application form having been completed in a previous employment at “Savacare”. This is not appropriate, as CRBs are not portable between employers. There was no record of a CRB being sent for, or of a POVA first check since employment. The interview records were detailed, and there were good interview forms and appropriate questions for prospective employees. The employee was from another country (non- EU). There was no confirmation of indefinite leave to remain in this country, no passport copy, work permit, proof of ID, photograph, or medical history. She was offered employment on 14.10.05, with none of this documentation evident. The duty rota confirmed she had been working in the home as a “Bank” employee. Greenhill DS0000042521.V264961.R01.S.doc Version 5.0 Page 18 The second personnel file included the completed application form dated 26.11.02. The employment history was only completed from 2001 onwards. The CRB confirmation had been received 29.06.04. The occupational health interview was conducted 6.2.03. Other information on file included copies of a birth certificate, passport and confirmation of the home address as well as a photograph. Training records included certificates for NVQ 2, Dementia study and understanding difficult behaviour. There were no references on file. The file of a long-term employee was inspected and found to be divided into neat sections with satisfactory recruitment records except there was no photograph. A qualified staff’s file was inspected and found to contain all relevant matters including checks on her NMC PIN number, CRB, and good up-to-date training records for 2004 and 2005, including team leading, venepuncture, palliative care, basic food hygiene and understanding older people. The inspector noted that she had raised concerns about unpaid meal breaks at night. This was included in the feedback to the manager. This needs to be reviewed, as staff are unable to leave the home at night, therefore should be able to do what they want to in their meal breaks. Staff files confirmed there is ongoing staff training, and the manager keeps a record of the staff who attend each training session. However, there is no staff training matrix in place, and therefore it is impossible to check that each staff member has completed all mandatory training without going through individual files. One care assistant working in the Dementia Unit, who had done so for a number of weeks, stated that she had not received any training/instruction in Dementia or related topics. Please see Requirements 5 and 6. Please see Recommendation 3. Greenhill DS0000042521.V264961.R01.S.doc Version 5.0 Page 19 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 36 Supervision systems are in place although not implemented as frequently as stated within the standards. EVIDENCE: The supervision records were inspected. The manager advised the inspector that the supervision records for the staff who work on the ground floor with the physically disabled residents, had “gone missing”, but supervision records for the first floor were available. The supervision system is that of delegated responsibility in a cascading approach. The clinical leader on each floor addresses supervision for the qualified staff on their unit, who will then give supervision to the care staff in their own team. Greenhill DS0000042521.V264961.R01.S.doc Version 5.0 Page 20 The administrators are responsible for the domestic team and should give them supervision. There are two administrators, one of whom was off sick, the second administrator had only been in post for two weeks. There is a set system for supervision with pre-printed formats. Each staff member has key objectives discussed and set out at the beginning of each year. These had been implemented in June 2005 for staff on the first floor, and where completed, were excellently done. One care assistant had objectives completed, and these included her wish to study for NVQ 2. She had worked in the home for five months and had had one supervision session since the objectives were completed. This was reasonable, bearing in mind the induction and probationary period. Another care assistant had had supervision four times during 2005, 11.1.05, 26.03.05, 26.05.05 and August 05. The supervision notes were well completed, but she had had no supervision since August. Two other care assistants had little in respect of supervision records after June 2005. The acting manager was made aware of this. The home has been using agency nursing staff recently – mostly the same two nurses from May Day Healthcare. The lack of permanent nursing staff and the retirement of the manager, may have contributed to the reduction in the amount of supervision given in the last few months. Clinical leaders are paid to have one day off the floor per week to complete records, supervisions, duty rotas etc., therefore these records should be maintained in an up-to-date manner with appropriate levels of supervision. Please see Recommendation 4. Greenhill DS0000042521.V264961.R01.S.doc Version 5.0 Page 21 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X X 2 2 STAFFING Standard No Score 27 X 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 2 X X Greenhill DS0000042521.V264961.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes. 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. Standard OP1 Regulation 4 Requirement The Registered Person must ensure that the Statement of Purpose and all relevant documentation are maintained with up to date information. 14 The Registered Person must ensure all residents are fully assessed by suitably qualified staff prior to admission. The Registered Person must ensure that care plans are reflective of needs, kept under review and have all supporting risk assessments in place. Previous time frame for action 31/10/05. This is now outstanding The Registered Person must ensure that all medication records are fully completed; medication is administered as prescribed and stored correctly. Previous time frame for action 30/8/05. This is now outstanding. Timescale for action 30/03/06 2 OP3 13/12/05 3 OP7 15 13/12/05 4. OP9 13 13/12/05 Greenhill DS0000042521.V264961.R01.S.doc Version 5.0 Page 23 5. OP29 19 6 OP30 18 The Registered Person must 13/12/05 ensure that all recruitment items as stated in Schedule 2, are in place prior to employment. The Registered Person must 30/12/05 ensure that all staff are suitably skilled and trained for the type of resident with whom they work. 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 OP12 OP26 OP29 OP36 Good Practice Recommendations The Registered Person should ensure that orientation is maximised within the Dementia Unit. The Registered Person should ensure that the system for laundry of all items is reviewed to ensure an appropriate level of service. The Registered Person should ensure that the payment for night staff break period is is reviewed. The Registered Person should ensure that all staff receive formal supervision six times a year. Greenhill DS0000042521.V264961.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Greenhill DS0000042521.V264961.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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