CARE HOMES FOR OLDER PEOPLE
Greenhill Wagon Road Potters Bar Hertfordshire EN4 OPH Lead Inspector
Mrs Alison Butler Key Unannounced Inspection 19th June 2006 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 DS0000019415.V294314.R01.S.doc Version 5.2 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 DS0000019415.V294314.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Greenhill Address Wagon Road Potters Bar Hertfordshire EN4 OPH 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) 0208 449 8849 0208 449 6343 B & M Investments Limited (Trading as B & M Care) Caroline Ann Inch Care Home 67 Category(ies) of Dementia - over 65 years of age (16), Learning registration, with number disability over 65 years of age (1), Old age, not of places falling within any other category (67), Physical disability over 65 years of age (3) Greenhill DS0000019415.V294314.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th December 2005 Brief Description of the Service: Greenhill is a care home providing personal care and accommodation for 67 people aged over 65 years and who may have a physical disability and/or dementia. No other categories apply and, therefore, the home cannot provide nursing care or a service to people who have mental health problems other than dementia. Fees for the services are £550-£695 per week. Additional charges are made for newspapers, toiletries etc. (this was correct as at 19/06/06). Set in extensive, and well-kept grounds, Greenhill is a very attractive old detached manor style house, which has had various extensions and an annexe has been added. The property has been sensitively adapted, whilst maintaining its numerous and attractive features, which include a bar and large hall with seating for several people. There is a passenger lift. The majority of the homes rooms provide single occupancy, two offer shared accommodation. Most of the rooms have an en suite. There are four communal bathrooms in use. The upper rooms and gardens provide wonderful views as far a-field as London Wharf, and are easily accessible. There is ample parking space within the grounds and Potters Bar Town Centre is a short car journey of approximately two miles. Greenhill DS0000019415.V294314.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two inspectors carried out this inspection. The aim of this inspection was to assess all the key standards. The majority of the inspection was spent talking to residents, relatives and staff. Care and administration records were checked. Where information remains the same this has been brought forward from previous reports. On arrival no one was around and the inspector pulled the call bell in a toilet near the managers office. A member of the senior team came past and ignored the bell. This was discussed with the manager who addressed the issue with the member of staff concerned. What the service does well: What has improved since the last inspection?
A manager has now been registered with the Commission For Social Care Inspection. Morale throughout the staff team has improved since the last inspection. Medication was being dated on opening and the temperature of the room was being recorded and monitored and appropriate taken when necessary. Staff have received additional training to meet the needs of the residents especially in regard to hearing aid maintenance. The manager has put a rolling programme in place. The senior team have received training in supervision.
Greenhill DS0000019415.V294314.R01.S.doc Version 5.2 Page 6 The manager has ensured that views of staff and visitors have been listened to, this led to the manager dealing with issues of poor practice and resulted in a member of staff being dismissed. Whilst some work has been carried out on improving the care plans this work needs to continue. A review of staff had been carried out and additional staff have been allocated appropriately to meet the higher needs of the residents. 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. Greenhill DS0000019415.V294314.R01.S.doc Version 5.2 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 DS0000019415.V294314.R01.S.doc Version 5.2 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): 3 Standard 6 is not applicable to Greenhill The quality outcome in this area is good. This judgement has been made using the available evidence, including a visit to the home. Residents are issued with contracts and are made aware of the terms and conditions. Information is received and an assessment carried out prior to admission to ensure the home can meet their needs fully. EVIDENCE: A newly admitted residents records were checked and found to contain the required information. A contract had been issued with details of the homes terms and conditions. Following admission a care plan is put in place and the information discussed with the resident and their representative. Greenhill DS0000019415.V294314.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9, & 10 The quality outcome in this area is adequate. This judgement has been made using the available evidence, including a visit to the home. Individual care plans are in place although more detailed action required by staff is needed to ensure that their care needs are met. Some improvement is needed in the administration and management of medication. Residents are treated with dignity and respect and their privacy is upheld. EVIDENCE: The care plans examined during the inspection showed that whilst some improvements had taken place more needed to happen giving more details of the action required by staff. One resident file showed they self medicate especially in regard to application of creams. Clear guidance is needed on how this is managed including a more detailed risk assessment. Where bed rails are used again there needs to be a more detailed risk assessment in place to ensure they have eliminated the risk as far as is practicably possible.
Greenhill DS0000019415.V294314.R01.S.doc Version 5.2 Page 10 Residents spoken stated they felt their privacy and dignity were respected. “It is a good place to be”, “I am encouraged to be as independent as I am able”. Staff were seen to interact well with the residents and were kneeling down to their level to communicate and gain eye contact. Medication procedures, storage and administration were checked and a number of issues were raised. Pre-printed labels should not be placed on the medication, administration record (MAR) sheet as this may cover up information. Handwritten details had been placed on a new MAR sheet and then a pre-printed sheet had been obtained both sheets had recorded that medication having been given making it look as though the medication had been administered twice. Where medication is prescribed as one or two it is recommended that the usual dosage is underlined and any other dosage is written on the reverse of the MAR sheet this would allow correct reconciliation at any point in time. There is a need for a resident’s medication to be reviewed as they were refusing to take pain relief and it may be better for them to have it prescribed as given as required. Medication had been signed on opening. The room temperature was being taken and recorded appropriately. The controlled drugs were well documented and a spot check showed them to be correct. Greenhill DS0000019415.V294314.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 14, & 15 The quality outcome in this area is adequate. This judgement has been made using the available evidence, including a visit to the home. More activities need to be offered in consultation with the residents. Family and friends are able to visit the home at any time and are made to feel welcome. Residents receive a wholesome, appealing and balanced diet in pleasant surroundings. EVIDENCE: There is a daily activities co-ordinator who works 21 hours a week. The residents stated they enjoy activities when they are on and would like to see more. The manager is currently recruiting for a further activity co-ordinator, which should increase the range of activities on offer. A discussion was held at looking at ways to develop the programme and display in a user-friendlier format. Visitors felt they were made to feel extremely welcome when they come to the home and they can visit at any time. The menu looked to provide a wholesome, well balanced and varied meals. The residents were complimentary about the meals provided. Staff need to be
Greenhill DS0000019415.V294314.R01.S.doc Version 5.2 Page 12 reminded that they should be seated when assisting residents to eat as this would provide a more relaxed and unhurried approach. There are a number of areas where residents can choose to sit and have their meals; mealtimes can be flexible on request or if a resident has a planned appointment etc. Greenhill DS0000019415.V294314.R01.S.doc Version 5.2 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 the following standard(s): 16 & 18 The quality outcome in this area is good. This judgement has been made using the available evidence, including a visit to the home. Residents and relatives are confident that their views are listened to and acted upon. Residents are protected from abuse EVIDENCE: There is a complaints procedure in place. Relatives spoken to during the inspection felt that their views are listened to and acted upon. It is recommended that a complaints file is introduced; this would provide the number of complaints received the action and the outcome and allow them to be monitored to make any improvements to the home. Residents are protected from abuse and the manager has recently dealt with issues that have been raised by residents and visitors around a member of staff and their care practice. The manager conducted several interviews with the relevant people, which resulted in the individual being dismissed. Training is carried out on a rolling programme and covers adult protection and abuse. Greenhill DS0000019415.V294314.R01.S.doc Version 5.2 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 the following standard(s): 19, 23 & 26 The quality outcome in this area is adequate. This judgement has been made using the available evidence, including a visit to the home. Greenhill is reasonably well maintained and clean. Some hygienic practices need improving and some areas of the home where the odour was detected need to be monitored and improved. Residents are provided with a good laundry service. EVIDENCE: A tour of the home found that most areas with the exception of a bedroom, an upper corridor and a corridor on Cedar unit (which had strong odours present) were fresh and clean. These areas of concern were raised with the manager at the time of the inspection and she would look into dealing with the situation and continue to monitor. Greenhill DS0000019415.V294314.R01.S.doc Version 5.2 Page 15 A couple of the bathrooms were found to have bars of soap present and soft paper towels must be provided in all bathrooms and toilets, to prevent the risk of the spread of infection. A number of toilets were noted not to have locks; locks must be added (of a type that can be overridden in an emergency) to promote privacy and dignity to all who use them. There are good systems in place to maintain repairs and redecoration is carried out as required The residents were dressed appropriately in freshly laundered clothing and stated they were satisfied with the laundry service provided. Resident’s rooms have been personalised with photographs, pictures and small ornaments. These residents spoken to were happy with their rooms, and stated they were kept clean and tidy. Greenhill DS0000019415.V294314.R01.S.doc Version 5.2 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 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): 27, 28, 29 & 30 The quality outcome in this area is adequate. This judgement has been made using the available evidence, including a visit to the home. Recruitment of staff is not as robust as it could be, due to the standard of references accepted. Staff receive an induction in line with the Sector Skills induction programme, although this had yet to commence with the recently recruited members of staff. A rolling programme is in place. EVIDENCE: Staff numbers appeared to be adequate to meet the needs of the residents at the time of this inspection. Examination of the rotas showed that a minimum of 7 carers plus a manager were on duty at anyone time. Examination of the newly recruited member of staff showed that whilst all the required information had been received. It is recommended that when references are received and only contain the dates to which the individual is employed, additional references should be sought about the persons character. This would enable a better judgment to be made about the person suitability to carry out the role.
Greenhill DS0000019415.V294314.R01.S.doc Version 5.2 Page 17 Staff who had recently completed the induction programme are waiting certificates to be received. A review is taking place for the induction programme in line with the new common induction standards by the Sector Skills programme. The manager has put a training programme in place. Some residents had been having problems with their hearing aids; the manager arranged a course to give staff the skills to assist the residents in maintaining residents hearing aids adequately. Greenhill DS0000019415.V294314.R01.S.doc Version 5.2 Page 18 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): 31, 33, 35, 36 & 38 The quality outcome in this area is adequate. This judgement has been made using the available evidence, including a visit to the home. Greenhill was found to be well managed with formal and informal systems in place to respond to the views of the residents and relatives. The homes policies safeguard the financial interest of the residents. Staff receive formal supervision. There are well-organised systems in place for protecting and promoting the safety of residents, relatives and staff, although risk assessments require more detailed information. Greenhill DS0000019415.V294314.R01.S.doc Version 5.2 Page 19 EVIDENCE: Since the last inspection the manager has completed the registration process and is now the registered manager of Greenhill. Staff spoken to during the inspection felt there was an open door policy and they felt able to approach the manager with any issues they had. Staff morale had improved and that training and supervision was now in place. Minutes of the staff meeting held in April 06 were seen. Fire records were well documented and up to date. Information was given to the manager on completing a detailed fire risk assessment. The Commission For Social Care Inspection had not received regulation 26 reports since March 2006; the proprietor must ensure that a report is sent to the Commission For Social Care Inspection on a monthly basis giving details on the conduct of the home. Risk assessments are in place it was discussed with the manager that these should be expanded and more detailed, especially for those who use bedrails and self medicate. (Guidance document given to the home). One of the staff files showed that no recorded supervision had been conducted although the manager and staff confirmed this had been conducted. It is recommended that a matrix be produced to enable the manager to monitor at a glance which staff have received supervision. The administrator was away from the home and although not inspected on this occasion, previous inspections showed that robust policies and procedures are in place to protect residents from financial abuse. Greenhill DS0000019415.V294314.R01.S.doc Version 5.2 Page 20 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 3 X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Greenhill DS0000019415.V294314.R01.S.doc Version 5.2 Page 21 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 OP7 OP38 Regulation 13(4)(b) & (c) Requirement The manager should ensure that risk assessments guidance is more detailed giving staff the action to carry out to eliminate as far as reasonably practicable. The manager must ensure that correct medication procedures are followed: Pre-printed labels must not be attached to the recording sheet. Correct recording must take place to show what medication has or has not been given. Residents who regularly refuse prescribed medication a review must take place. The manager must ensure that all toilets have locks in place. (These must be accessible in an emergency) The home must be kept free of offensive odours The manager must ensure that bars of soap are removed from communal areas. References must be sufficently
DS0000019415.V294314.R01.S.doc Timescale for action 31/07/06 2. OP9 13(2) 31/07/06 3 OP10 12(4)(a) 31/08/06 4 5 6
Greenhill OP26 OP26 OP29 16(2)(K) 13(3) & 16(2)(j) 19(5) 31/07/06 31/07/06 31/07/06
Page 22 Version 5.2 7 OP33 26 detailed to enable an appropriate decision to be made on the suitability of an applicant. The proprietor must ensure that a report is written on the conduct of the home and a copy is sent to the Commission For Social Care Inspection on a monthly basis. 31/07/06 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. Refer to Standard OP7 OP8 OP12 OP14 Good Practice Recommendations The staff need to continue to work on the information provided on the care plans to give more detailed action required by staff to meet the needs of the individual residents. On the recruitment of a further activities co-ordinator the programme of activities on offer should be increased in consultation with the residents. A programme should be produced in a user-friendly format. Staff need to be reminded to sit when assisting residents to eat their food choice. Soft hand towels should be provided for staff to aid in the prevention of the spread of infection. The manager should complete a matrix for the supervision of staff to monitor they are happening at least six times a year. 2 3 4 5 OP15 OP26 OP36 Greenhill DS0000019415.V294314.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 DS0000019415.V294314.R01.S.doc Version 5.2 Page 24 - 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!
