Inspection on 16/05/06 for Greenhill

This inspection was carried out on 16th May 2006.

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 13/12/05

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 Rosemary Blenkinsopp Unannounced Inspection 16th May 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 DS0000042521.V290376.R01.S.doc Version 5.1 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.V290376.R01.S.doc Version 5.1 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.V290376.R01.S.doc Version 5.1 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 RGNs 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. 13/12/05 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 Dementia Unit occupies a floor with its own staff team. The home is a modern, purpose-built facility having opened in 2003, located close to Bromley town centre with its wide selection of amenities. The categories of registration include Dementia, Old Age and Physical Disability. 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. Fees Range between £511 - £790 weekly. Additional cost are charged for chiropody £22, Hairdressing £8 - £26, newspapers and holidays variable. The report is made available in the hallway of the home and on request. Where needed, residents would be assisted with reading and understanding its content. Greenhill DS0000042521.V290376.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted by two inspectors, one spending two days in the home. The inspection was conducted unannounced. The emphasis of the inspection was on the ground floor unit and the top floor Dementia Unit. The findings from each unit are set out individually as these differ in some standards. The inspector case tracked two residents each and, where possible, met with their key workers. Comment cards were left for residents, several relatives met with the inspector on the second visit Saturday 20 May 2006, and feedback forms were sent to care managers and the home’s GP. At the point of writing the report six comment cards had been received. The comments related various issues of which some were more positive that others. Issues relating to the lack of availability of fresh fruit and vegetables also the presentation of food, and the lack of staff at weekends were noted. What the service does well: What has improved since the last inspection? What they could do better: Care planning and risk assessment documentation needs improvement. Care plans and supporting documentation were inadequate to accurately reflect the residents’ needs, including physical, psychological and social aspects. The documentation in general was lacking in detail both in respect of care plans Greenhill DS0000042521.V290376.R01.S.doc Version 5.1 Page 6 and supporting records. Reviews in some cases were absent, as was, on the first floor, the date the care plan was generated. The staff personnel files were incomplete and did not include evidence that staff had been subject to robust recruitment procedures. This was particularly true of POVA, CRB and the receipt of two written references. Immediate requirements were left in respect of the recruitment practices. A response has been received from Mission Care that this will be addressed as a matter of urgency. 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.V290376.R01.S.doc Version 5.1 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.V290376.R01.S.doc Version 5.1 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. The quality rating in this area is poor. This was based on evidence gathered including the site visit. Assessments are insufficient in detail to provide staff with enough information to develop a care plan in the initial stages, or from which staff could confidently address residents’ needs. EVIDENCE: Intermediate care is not provided in this home. Dementia Unit Staff assess prospective residents prior to admission. Opportunities to visit the home are available, although in reality residents themselves rarely undertake these, although relatives do on occasions. The assessment form is a tick box format which provided limited information on which to base a care plan. In addition there was little information received from members of the multidisciplinary team or the assessment conducted under Community Care procedures by care management. Specific areas of need, and those which would require more input, were not expanded upon. This would provide limited information for staff. Please see requirement 1. Greenhill DS0000042521.V290376.R01.S.doc Version 5.1 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 rating in this area is adequate. This was based on evidence gathered including the site visit., Care plan information is insufficiently completed and supporting documentation limited in content. In the event that problems had been identified the interventions were limited. This was also true of the risk assessments. In some areas reviews were absent or overdue. Medications need to have comprehensive documentation in place particularly for those items prescribed, “as required”. EVIDENCE: Dementia Unit Care Plans Two care plans were case-tracked - one of a new resident the other randomly selected. The Mission Care assessment, addressed after admission, was reasonably well completed. The care plan related mainly to physical health problems with little on mental health, even though this resident was diagnosed as Lewy Body Dementia. There was no evidence of risk assessments in respect of identified issues, even though the referral information indicated aggression was present. Greenhill DS0000042521.V290376.R01.S.doc Version 5.1 Page 10 There was a separate night care plan which, in some cases, duplicated the issues and therefore the information was confusing. Daily events statements reflected mainly physical care. The second care plan was similarly completed and the resident had the same diagnosis. This gentleman was now nursed in bed and cot side were used. There was no risk assessment or care plan in relation to this issue of cot sides. This must be addressed. On the weight chart, it indicated that the resident had lost five kilos between the months of April 2006 and May 2006. There was no intervention stating what action should be taken in respect of the weight loss. The nurse in charge felt it was due to incorrect weighing of the resident, however this was not checked. No further actions were taken to address the weight loss. In general it was noted that when high risk was identified, limited interventions were recorded and the frequency of review not increased as would be expected. Some issues were not reviewed or overdue for review. The multi-disciplinary sheets had entries relating to visits by the chiropodist dentist and GP. Dementia Unit Medication The medication storage area is limited and cramped. The medication charts were inspected. The file itself was untidy and information may become detached. Within the file there was information on covert administration of medication. The home must develop its own policy and procedure regarding this, as it cannot rely on the guidance to protect the individual residents and staff. Covert administration of medication must only be used when such policies and procedures are in place. The policies and procedures must specify the medication, how it is to be administered, with the decision making process documented and it must be kept under review by the multi-disciplinary team. The medication charts were completed with the allergies recorded and photographs in place. The administration records were generally completed without gaps in recordings. The disposal of medications was recorded, however, only one signature was in place, two are needed. Those medications, which are required to be given as necessary, needed to have full instructions recorded. The medication charts of the residents who were case-tracked, were inspected. One resident was written up for Lorezepam tablets, however there were no specific instructions as to when this medication should be given. This was also the case for other medications to be administered as required. Full instructions need to be recorded as to when to give the medication, maximum dose and where appropriate, the duration. Greenhill DS0000042521.V290376.R01.S.doc Version 5.1 Page 11 First Floor Care Plans The care plans of two residents were inspected. The relatives of the two residents met with the inspector on the second visit. In general, the care plans were also poorly completed. The date the care plan was generated was not stated, the review dates were also absent. The weight chart of one resident indicated she had lost six kilos in one month, again as on the other units, no action had been taken even though it had been identified that this lady had a poor appetite. This resident also had a very high waterlow score indicating pressure sore risk, again this was reviewed monthly. More monitoring of the resident is required when risks are identified. Supporting risk assessments were in similar vein with limited interventions and details on how to reduce the identified risks. In the event that cot sides are used then a full risk assessment and care plan must be in place to address this. The fluid balance charts, for those residents with identified needs, were poorly completed. More specifically they were without 24 totals or any indication that monitoring of sufficient input/output was been addressed. Some records indicated that residents’ input was far less than that required for a healthy adult. The food chart was similarly completed. One resident’s care plan clearly stated that she had a poor appetite which was also confirmed by her daughter, however, the food chart gave limited information in respect of her nutritional intake. The care plans and supporting documentation for this resident were insufficiently completed to address her needs satisfactorily. First Floor Medications On the first floor the medications were generally well managed. The administration records were well completed and dates of opening included on all items that required this. The “as required” medications need to have full instructions as stated previously. There was an oxygen cylinder beside the nurses’ station. This was free standing and inadequately safely stored. Oxygen must be stored using the appropriate guidelines and administered only for use of a named individual. Ground Floor Care Plans The first individual care plan showed an assessment with some good information relating to the physical, mental, social and emotional needs of the resident. However, the file contained no care plan interventions or risk assessments despite staff, and daily records, confirming verbal and physical aggression, mood swings and non-compliance with medication. The falls risk Greenhill DS0000042521.V290376.R01.S.doc Version 5.1 Page 12 assessment had only partly been completed and the Waterlow risk assessment did not show the score had been achieved. There was no psychological care plan despite the evidence of depression. There was a lack of risk assessment regarding behaviour, emotional needs and medication. There were regular updates relating to moving and handling. Some of the records lacked signature and dates. There was good evidence of the way in which health care was accessed including dentist and chiropody appointments and visits to clinics. The records also showed regular health checks in the home including regular weighing and other observations. The second care plan contained a lot of information regarding the individual’s needs including moving and handling, safety, Waterlow, falls and his risk of depression. However, where risks had been identified, interventions were limited, for example, the Waterlow score was 21, very high risk, but no care plan was in place; similarly that for the risk of depression. There was little information regarding the mobility equipment currently being used. There were no nutrition and personal care plans, despite the resident needing full assistance, including a soft diet, the use of special crockery and food supplements. The resident had also recently returned from hospital with a stroke and whilst there were good records relating to this there is a need to ensure the care plan accurately reflects his current health needs. The daily records in general were informative and reflective of the current care needs and action taken by the home. There were also some good records regarding medical and healthcare checks. Records relating to the treatment of wounds were in place, however, these lacked clarity. Ground Floor Medications The inspectors noted on arrival that medicines were being administered by the RGN on duty on the ground floor. The inspectors observed that the RGN left the medication keys in the medication trolley whilst she went to a resident’s room to administer medication. The trolley was left unattended during this time. All medications were stored in the trolley in blister packs. Those medication records viewed were in the main completed fully with photograph and allergies recorded. In general the medication administration charts showed good recording with no gaps. Where creams had been prescribed there should be more information regarding the administration, including when and where these are to be applied. Greenhill DS0000042521.V290376.R01.S.doc Version 5.1 Page 13 One medication record showed that a resident had been regularly refusing their medication. This was also evident from the resident’s file. Refusals for some medication had lasted eighteen days. There was no evidence of any review or referral to the GP, nor included in the care plan. The “as required” medication was in a similar vein as that previously stated. The unit also has a fridge to store medicines at the required temperature. The temperatures had been recorded daily. The inspector found two limited shelf life medications opened, but no date of opening recorded. Please see requirements 2, 3 and 4. Greenhill DS0000042521.V290376.R01.S.doc Version 5.1 Page 14 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 rating in this area is adequate. This was based on evidence gathered including the site visit. The choices in activities of daily living are variable, and in part dependant on the ability of the residents. Residents with Dementia are reliant on staff to advocate for them and ensure that flexibility, privacy dignity and choice are incorporated into their day. EVIDENCE: Dementia Unit On arrival in the unit the reality orientation board stated Monday – the day was actually Tuesday. This was corrected once the inspector prompted staff. It was noticeable that there were limited domestic type reality orientation aids within the unit except a few clocks and calendars in individual bedrooms. In a unit where disorientation is present amongst the majority of residents, it is essential to maximise orientation aids and maintain these correctly. The majority of the residents were in the lounge area. In this area the TV was on, and old-time music was playing. This is very noisy and confusing, it would be difficult to hold a conversation over this. Again, once prompted, staff rectified this. Many residents were sleepy or drowsy, there was little evidence of well being . The inspector observed the mid morning tea and lunch being served. There was little evidence of choice in both of these activities. Meals were simply placed in front of the residents without reference to the amount of Greenhill DS0000042521.V290376.R01.S.doc Version 5.1 Page 15 additional gravy or sauces preferred. There was a menu on display. This was correct and indicated a choice. Juice, one flavour, was served with the meal, again, no other fluids were offered. Comments regarding the general lack of fruit and fresh vegetables were received by the inspector. Some staff interacted with the residents well; others did not initiate contact unless this was task-orientated. There was discussion about activities. Staff do try activities with the residents although more input is needed to address this. There is a proposal to appoint an activities person for the unit. This would be beneficial. In the main, those residents in their own bedrooms were without fluids this was also true of the lounge area. Two residents had stimulation, one a TV the other the radio, the others had nothing. The doors to the bedrooms were closed. This would mean that those residents in the bedrooms would have little contact or stimulation. Positive feedback from visitors from the church who were visiting a number of residents on the ground floor unit. They said staff are kind, caring and sensitive to residents’ needs. They feel the home is welcoming and staff try hard to ensure residents are well cared for. However, they also feel that at times there are communication difficulties between staff and residents. Ground Floor There was discussion with one visitor who visits the home daily. She believes that the resident is well cared for and chooses her own routine. She felt staff were understanding and tolerant of her needs. There are regular activities and these are generally well supported with a schedule in place for each day. There are also church services on Sunday and she believes that staff do support the co-ordinator to escort residents to the activities. She often sees families visiting and taking residents out. One relevant issue at the moment was lack of minibus drivers to take residents out. More importantly one resident could not go to her regular day centre as they had no driver in the day. The resident enjoys bird watching and has a bird table outside of her window. The visitor felt able to raise any issues to the home Manager and feels she is listened to with any necessary action taken. Please see recommendation 1. Greenhill DS0000042521.V290376.R01.S.doc Version 5.1 Page 16 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 rating in this area is adequate. This was based on evidence gathered including the site visit. Avenues by which to make complaint are available and investigated appropriately. Staff are insufficiently trained or knowledgeable in respect of adult protection procedures. EVIDENCE: Complaints information was available in the main entrance hall. The CSCI have received no complaints regarding this service since the last inspection. On previous occasions when complaints or concerns have been raised Mission Care have responded openly and professionally conducting appropriate investigations. Generally within the comments received, relatives and residents were aware of how to raise a concern, usually stating the home manager. In relation to adult protection, there was no training indicated on the list provided with the pre-inspection information. Staff had a limited knowledge of the topic and this is something which must be addressed. Please see requirement 5. Greenhill DS0000042521.V290376.R01.S.doc Version 5.1 Page 17 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): 19,24,26. The quality rating in this area is good. This was based on evidence gathered including the site visit. The building is purpose built and provides a good standard of accommodation. Ongoing maintenance is required to keep it at this standard. Specific adaptations such as reality orientation aids should be maximised to benefit those residents who require them. Additional storage other than that of the ensuite facilities needs to be investigated. EVIDENCE: The home is a purpose-built facility providing a good standard of accommodation generally throughout. All floors are accessible by way of the two lifts. Safety features are in operation throughout the home with additional security measures to exits and lifts on the Dementia Unit. All bedrooms are ensuite. Communal areas are located on each floor with separate dining facilities. Greenhill DS0000042521.V290376.R01.S.doc Version 5.1 Page 18 Dementia Unit There had been some improvement in personalisation of individual bedrooms although some were still bare. Several of the ensuite facilities were congested with wheelchairs and other pieces of equipment. Appropriate storage of these items should be investigated. In bedroom 53, the drawers were all broken; it was stated that the residents had done this. It is the responsibility of the home to ensure that furniture and fittings are an appropriate standard and maintained in such a way. It was noted that the pressure relieving mattresses had the alarms muted. In the event that these should malfunction, the resident would not be provided with the appropriate equipment to prevent tissue damage. Again the alarms were said to have been switched off by a resident; this is unlikely. The lounge and dining rooms are quite domesticated. The hot water boiler in the dining room had been made safe with a safety catch applied. The inspector tested this and she could not remove it. At lunchtime tables were laid with cloths and serviettes. Juice was served. The cupboard housing the sluice machine remained unlocked and the door partially open throughout the morning of the inspection. This was pointed out to the Team Leader who rectified it once alerted to it. There was evidence of marked walls and skirting boards particularly in the corridors and dining room. First Floor There was a limited inspection undertaken on this floor. However all parts inspected were clean and odour free. Some of the bathrooms were congested with items of equipment such as wheelchairs etc. It has been proposed that an additional three bedrooms maybe provided on this floor. The bedrooms will be provided, in part, from the quiet room on this floor. This would give residents limited opportunity to sit in alternative areas other than the main lounge. Ground Floor A number of rooms were viewed and found, in the main, to be satisfactory with appropriate furniture and furnishings in place and standard decoration of rooms. The amount of personal possessions and mementoes varied. Previous reports have highlighted the bareness of the walls in many bedrooms. This has been addressed in some but not all bedrooms. Greenhill DS0000042521.V290376.R01.S.doc Version 5.1 Page 19 Rooms contained nursing beds, alarm call bells, which were within reach and, where required, hoists. The home was generally clean and appropriate infection control procedures were in place, including those required for individual rooms. Greenhill DS0000042521.V290376.R01.S.doc Version 5.1 Page 20 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 rating in this area is poor. This was based on evidence gathered including the site visit. Staff are not subject to robust recruitment procedures, which leaves residents at risk. Staff training is insufficient to address some of the residents’ individual needs. In addition the mandatory topics require regular updating. EVIDENCE: Three personnel files were requested of those staff with whom the inspectors had had contact. Two were available only, one of the RMN on the Dementia Unit the other of a domestic on the ground floor. The third staff file was still not available on the second day of visiting. Both of these were limited in content. One had no previous employment stated on the application form; the second one only went back to 1999, even though her date of birth was 1960. There was evidence of only one reference in each of these. There was no evidence of CRB or POVA clearance. Confirmation of induction and ongoing supervision was also absent. The file of the RMN did not contain her PIN number nor was this included on the application form. In addition the confirmation of the PIN number was not on the file. Immediate requirements were left in respect of staff recruitment. The senior person on the Dementia Unit had a good knowledge of her key resident and mental health issues generally. She had been in post since October 2005. She confirmed that she had received some training although limited. She stated that she had not undertaken training in manual handling, Greenhill DS0000042521.V290376.R01.S.doc Version 5.1 Page 21 first aid, or basic food hygiene This needs to be addressed. She also was unable to relate when her last formal supervision had taken place. A second key worker met with the inspector. She had a limited knowledge of the resident and was unaware of what Lewy Body Dementia was or its presentation. This was referred to the Manager to ensure that information and guidance were provided on this subject and any other conditions, which may be present on the unit. The staff member confirmed that she had received training in Dementia, fire, manual handling and some elements of health and safety. She had not received training in first aid, or other mental health issues. She stated that supervision was ongoing although was unable to state the date of the last one she had received. The Manager confirmed that fifteen staff have completed the level two NVQ training . It was noted from the pre-inspection information that a large amount of agency staff had been used previously. The Manager confirmed this was the case, however, numbers had reduced recently. The numbers of staff provided must be sufficient to address residents’ needs at all times. Information received stated that this was not always the case, with weekends particularly short staffed. The Manager must ensure staffing levels are maintained. The Manager stated there are and two full-time care staff vacancies. There were appropriate numbers of staff on duty on the ground floor with one RGN and five care staff with one other member of staff on induction. The unit has twenty residents at present. Ground Floor Three staff met with the inspector to discuss their work, training and ongoing supervision. They all demonstrated a good knowledge of the residents to whom they were key workers. In respect of training they received, the responses were variable and this included mandatory topics. Please see requirements 6 and 7. Please see recommendation 4. Greenhill DS0000042521.V290376.R01.S.doc Version 5.1 Page 22 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): 31,32,33,36,38 The quality rating in this area is adequate. This was based on evidence gathered including the site visit. The home is currently without a permanent Manager and although a senior staff member is acting into the position this is an unsettled period in the home. In addition the lack of a Nursing Director provides little clinical input and guidance to the acting Manager. Health and safety issues in respect of ongoing servicing and maintenance are addressed. EVIDENCE: The Manager is in the acting position and has been since October 2005. At the moment there is no Director of Nursing, hence there is little opportunity for clinical supervision for the Acting Manager. This is the first time the Acting Manger has managed a facility of this size, having previously acted up twice in a smaller facility, and therefore needs sufficient support in her role. This needs to be addressed. Greenhill DS0000042521.V290376.R01.S.doc Version 5.1 Page 23 Regulation 26 visits have not been conducted since September 2005. It is a requirement that these are conducted and reports made. These must be recommenced. There were limited records available relating to residents and relatives meetings. Those records, which were available, were filed with fire drills and other staff training. These should be filed separately. There was no evidence of an annual review of the service or staff survey having been conducted. A selection of health and safety service certificates were inspected and found to be satisfactory. Some certificates were requested to be forwarded as these were not available on site. The hoist’s label on the equipment indicated that servicing was due April 2006. This needs to be addressed. Staff training, in respect of health and safety was limited. It was evident that not all staff had undertaken fire training recently. The last fire drill was 18/1/06 when 27 staff attended, prior to this June 05. This must be addressed. Other training in respect of health and safety including manual handling, COSHH and basic food hygiene were limited in relation to staff attendance. The training list provided indicated limited training and little undertaken 2006. The home does have one person who has completed the manual handling instructors course this year. All staff must be trained in this subject and have an annual update. Other areas, which need to be addressed, include the appointment of a health and safety officer for the home and fire officer. In addition the home must ensure that it has a first aider on duty throughout the 24-hour period. Please see requirements 8 and 9. Greenhill DS0000042521.V290376.R01.S.doc Version 5.1 Page 24 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 2 X X X 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 2 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X X 2 X 2 Greenhill DS0000042521.V290376.R01.S.doc Version 5.1 Page 25 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 OP3 Regulation 14 Requirement The Manager must ensure all residents are fully assessed including information from the multi disciplinary team available on all prospective residents. The Manager must ensure that care plans are reflective of needs, kept under review and have all supporting risk assessments in place. Previous timeframe for action 31/10/05. This is now outstanding. The Manager must ensure that risk assessments are in place for all identified areas of risk and kept under review. Cot sides must be risk assessed. The Manager must ensure that full instructions are included for all medications, oxygen is stored appropriately and all policies are in place including that for covert administration. The Manager must ensure all staff are updated in adult protection procedures. Timescale for action 30/06/06 2. OP7 15 30/09/06 3 OP8 13 30/06/06 4 OP9 13 30/06/06 5 OP18 13 30/06/06 Greenhill DS0000042521.V290376.R01.S.doc Version 5.1 Page 26 6. OP29 19 7. OP30 18 8 OP33 26 9 OP38 23 The Registered Person must ensure that all recruitment items as stated in Schedule 2, are in place prior to employment. Previous timeframe for action 13/12/05. This is now outstanding. The Registered Person must ensure that all staff are suitably skilled and trained for the type of resident with whom they work. Previous timeframe for action 30/12/05. This is now outstanding. The Registered Person must ensure that Regulation 26 visits are undertaken monthly unannounced and a report provided. The Manager must ensure that all staff are suitably trained in respect of health and safety. 30/06/06 30/06/06 30/06/06 30/06/06 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. 2. 3. 4. Refer to Standard OP12 OP26 OP29 OP36 Good Practice Recommendations The Manager should ensure that orientation is maximised within the Dementia Unit. The Manager should ensure that the system for laundry of all items is reviewed to ensure an appropriate level of service. ( Not checked at this inspection ) The Registered Person should ensure that the payment for night staff break period is reviewed. (Not checked at this inspection) The Registered Person should ensure that all staff receive formal supervision six times a year. Greenhill DS0000042521.V290376.R01.S.doc Version 5.1 Page 27 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.V290376.R01.S.doc Version 5.1 Page 28 - 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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