Inspection on 27/06/05 for Greenhill

This inspection was carried out on 27th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Greenhill 06/06/08

Greenhill 12/06/07

Greenhill 16/06/06

Greenhill 12/12/05

Greenhill 08/03/05

Greenhill 10/12/04

Greenhill 26/01/04

Greenhill 16/09/02

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOMES FOR OLDER PEOPLE Greenhill Wagon Road Potters Bar Hertfordshire EN4 OPH Lead Inspector Hazel Wynn Unannounced 27.06.05 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Greenhill I52_s19415 Greenhill v233349 270605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Greenhill Address Wagon Road Potter Bar Hertfordshire EN4 OPH 0208 449 8849 0208 449 6343 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) B & M Investments Limited (Trading as B&M Care) Anna Golightly Care Home 67 Category(ies) of DE(E) Dementia - over 65 - 16 registration, with number of places LD(E) Learning Disability - over 65 - 1 OP Old age - 67 PD(E) Physical Disability - over 65 Greenhill I52_s19415 Greenhill v233349 270605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: There are none. Date of last inspection 8 March 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 nor a service to people who have mental health problems other than dementia. 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 home’s 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 I52_s19415 Greenhill v233349 270605 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out on the 27th June 2005. Two inspectors carried out the inspection and met with Service Users and some visiting relatives. We looked at records, including: Care Plans, Staff Records, Accident and Incident Records, Finance Records, Evidence of Staff and Service User Meetings, Fire Safety and Health and Safety Records and also made a tour of the building. We found that most of National Minimum Standards were met and that the Registered Manager had brought in many positive changes. Morale amongst the staff team was apparently good and we found them to be professional, friendly and accommodating. We made one immediate requirement for the removal of fire wedges from some of the doors that we found propped open and there were some other requirements and recommendations. Communication difficulties, that some of the staff had, were being positively attended to with training courses planned or being attended. What the service does well: The home carries out an in-depth assessment which aims to ensure that the needs of service users being offered a placement can be met. The new care plans provide a clear view of needs and how these are to be met including the minimising of risk. The registered manager actively seeks service user’s views with an aim to respond positively to these. There are few complaints, which are followed through according to the home’s policy and procedure. Numerous compliments are received from relatives and friends. There is a good activity programme and a very satisfactory menu; Service users are consulted and asked for feedback in relation to the food served in the home. The home provides training for all staff on a rolling training programme and a through induction programme is operated for new staff. Greenhill I52_s19415 Greenhill v233349 270605 stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: The home should consider the fitting of automatic door closures as doors must not be maintained in an open position by a method not approved by the fire safety officer. Service users must be given the option of being able to lock their room when they leave it as currently they can only secure their door once they are in their room (with access for staff in the event of emergency). The home may wish to review their security arrangement to the entrance; currently the front entrance is easily accessible; diligent staff recently turned away some people who called in without reason. Risk assessments must be carried out on two privately owned electric recliner chairs so to ensure safety of serviceusers at all times. To enhance infection control procedures hand basin or alcohol jel hand wash is required in the laundry room. The temperature of the storage room for medication must be maintained at a maximum of 25 degrees centigrade. All medication must be dated on opening. Staffing levels should be reviewed as changes in service users needs are identified so that the home can continue to meet all residents needs. Please contact the provider for advice of actions taken in response to this Greenhill I52_s19415 Greenhill v233349 270605 stage 4.doc Version 1.30 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Greenhill I52_s19415 Greenhill v233349 270605 stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Greenhill I52_s19415 Greenhill v233349 270605 stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 ,3, 4, 5 and 6. Service Users and their representatives are supported in making a choice of home that will meet their assessed needs. Intermediate care is not provided. EVIDENCE: Each service user and/or their representative are given a copy of the Service User Guide. A further copy of the guide and the Statement of Purpose is also available in the home’s hallway. A full assessment is carried out in conjunction with the Service User and all significant others. A visit to the home prior to accepting the offer of a trial placement is encouraged. Both parties sign the agreement and a copy is given to the service user. A Quality Assurance questionnaire is also given to service users on admission in order that they can make their views known (with help from a relative/visitor if they wish). Greenhill I52_s19415 Greenhill v233349 270605 stage 4.doc Version 1.30 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 standard(s) 7, 8, 9, 10 and 11. Health, Personal and Social Care Needs are met in accordance with the comprehensive care plans and the homes Policies and Procedures. Storage arrangements for medication need some attention. EVIDENCE: The Care Plan is reviewed in accordance with guidelines and any change in need is responded to appropriately with input from GPs, Community Nurses, Occupational Therapists, Community Psychiatric Nurse, Chiropodist, Dentist and Optician amongst other professionals who provide a service to meet needs/changing needs. So that medication does not deteriate the storage room for medication needs to be kept cooler and a requirement was made for the room to be maintained at a temperature not exceeding 25 degrees centigrade. A requirement was also made for all medication to be dated on opening. This aids reconcilation to ensure an accurate audit can be kept. Service users spoken to said they felt they were treated with dignity and respect and that their privacy was maintained; information about service users was seen to be securely stored. There were numerous compliments referring Greenhill I52_s19415 Greenhill v233349 270605 stage 4.doc Version 1.30 Page 11 to relatives/friends care and support during their lives at the home and at the time leading up to and after death. Greenhill I52_s19415 Greenhill v233349 270605 stage 4.doc Version 1.30 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 standard(s) 12, 13, 14 and 15 Service users experience quality lifestyles in the home according to their preferences and exercise choice and control over their lives. Contact with family and friends is encouraged and supported. EVIDENCE: Service users spoken to told the inspectors that they enjoy visits out to local pubs and garden centres and sometimes further a field; they said that there are also various in house activities that they enjoy. Visitors are welcomed and are made to feel comfortable and may visit at any time convenient to the service user they are visiting. Contact with people in the local community is supported and church services are conducted in the home for those who are unable to get to church. Silver Service Menus are provided for all special occasions and service users stated that they are consulted about the menu and that there is always an alternative meal available; they said the quality of the food was very good. A discussion took place regarding a care worker not seated while supporting a service user to eat and the registered manager agreed that this inappropriate form of support would be dealt with formally. Greenhill I52_s19415 Greenhill v233349 270605 stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17 and 18 The home maintains a high standard in the manner in which it deals with complaints and the protection of vulnerable adults. EVIDENCE: The home had dealt very thoroughly according to its policies and procedures and the Hertfordshire County Council Guidelines for the Protection of Vulnerable Adults with a serious complaint that had arisen during the past year. Various members of the staff team are still improving their English language skills and were unable to recall the meaning of the term “whistle blowing” however all members of the team have been on courses for the protection of vulnerable adults and this training is included in the induction process. Most of the Services Users are supported to exercise their legal rights with the support of their families or friends but the registered manager stated that wherever she assessed the need of an independent advocate being required she would support the service user to access such either through Age Concern or another relevant organisation. Risk assessments are in place to minimise risk of harm to service users. The use of door wedges does pose a risk and has been dealt with later in this report. Greenhill I52_s19415 Greenhill v233349 270605 stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21, 22,23,24,25 and 26. Generally, the home is very well maintained although there are some environmental issues that require attention. EVIDENCE: In touring the home the inspectors found it to be generally very well maintained and accessible. The picturesque gardens are extremely well maintained and service users were enjoying the comfortable seating arrangements with good shading in the garden. To enhance privacy service users should be able to lock their doors from the outside should they wish to do so and a requirement has been made; if a service user chooses not to have a room that is lockable, by themselves, from the outside this information must be added to their signed care plan. Service users rooms are comfortably furnished and encouragement is given for these to be personalised. The communal areas are comfortable and attractive. Some doors, seen by the inspectors, were being held open by the use of door wedges and an immediate requirement for the removal of these wedges was made; doors must not be maintained in an open position by a method not authorised by the fire safety Greenhill I52_s19415 Greenhill v233349 270605 stage 4.doc Version 1.30 Page 15 officer. Specialist equipment is provided to maximise independence and records showed that this is regularly serviced. Two electric recliner chairs (the individual property of two of the service users) had not had a risk assessment carried out and a requirment was made for a risk assessment to be conducted both in the interest of personal safety and of public safety. This should also include the rationale behind use of the chair. (as discussed earlier in this report). A Requirement was made for a hand basin to be installed in the laundry room in the interests of the control of infection/Health and Safety. If it is not possible to install a wash basin then alcohol jel hand wash must be put in place. It is recommended that security to the front door be reviewed after diligent staff caught some people entering the home without any reason to be calling and had to see them off the premises. Greenhill I52_s19415 Greenhill v233349 270605 stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 Staffing was adequate for the numbers and category of service users accommodated but needs to be kept reviewed. Recruitment procedures appears robust and training is provided. EVIDENCE: The numbers of staff on duty and on the rota appeared to be adequate for the numbers of service users currently accommodated; it is recommended that staffing numbers be kept reviewed as the needs of the service users increase. New staff are inducted via a recognised induction programme and there is a satisfactory rolling training programme in place, which includes mandatory training and medication training for those assisting with medication administration. All new staff receive abuse awareness training as part of their induction. Staff records seen by the inspectors contained evidence of the training provided. Staff records seen by the inspectors also evidenced that recruitment is robust and in line with equal opportunities. Criminal Records Bureau checks and the Protection of Vulnerable Adult checks had been carried out as evidenced on file; all other necessary documentation including references, work permits (where appropriate) were on the individual staff member’s file. A large proportion of the staff speak English as a second language and are currently improving their command of this; all new staff recruited have a greater command of English. Some staff have enrolled in English classes to commence in September of this year. One member of staff was observed by the inspection team to be standing whilst supporting a service user to eat; this inappropriate method of support was discussed and the Greenhill I52_s19415 Greenhill v233349 270605 stage 4.doc Version 1.30 Page 17 registered manager stated that she would be meeting formally with the member of staff involved. Greenhill I52_s19415 Greenhill v233349 270605 stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36, 37 and 38 A very competent registered manager, whose own ethos compliments the homes ethos, manages the home. Good administration procedures are in place and the home is operated in the best interest of the service users. EVIDENCE: The registered manager has continued to work hard (with noted success) to build a good rapport with the staff team and service users and has the necessary skills and experience to manage the home in accordance with its stated purpose, aims and objectives. Staff and service users stated that the registered manager is very approachable and supportive and is keen to gain their views and listen to ideas regarding how to improve and create positive change. A quality assurance system is in place to obtain the views of service users and to measure the home’s success in meetings its aims, objectives and Statement of Purpose. Wherever possible service users are encouraged to handle their own financial affairs or their relatives do so on their behalf. Small Greenhill I52_s19415 Greenhill v233349 270605 stage 4.doc Version 1.30 Page 19 sums of money are held for safekeeping and clear separate accounts for individual amounts are maintained. A random check of the accounts was made and found to be clear and accurate. Employment policies are put into practice; evidence for this was gained by a sample check of five staff files. Induction programmes are completed and training records signed by the staff member are kept. There is an ongoing training programme and formal supervision is provided at regular acceptable intervals. A sample of records of the newest members of staff recruited, were found to be complete in the interests of Adult protection. Other records checked and found to be satisfactory, included finance, medication, fire safety and care plans/assessments and risk assessments (a requirement was made earlier in this report regarding carrying out a risk assessment for two privately owned electrically operated recliner chairs). The last Environmental Health Inspection Report was also satisfactory. Greenhill I52_s19415 Greenhill v233349 270605 stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 2 2 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 3 3 3 3 1 Greenhill I52_s19415 Greenhill v233349 270605 stage 4.doc Version 1.30 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 13(4)c & 23(4) (c) (iii) 13 Timescale for action Remove door wedges and ensure Immediate all doors are only kept open by from 27th a method approved by the fire June 2005 safety officer. and henceforth Medication must be dated on Immediate opening from 27th June 2005 and henceforth A hand basin or alchol jel hand 18th August wash must be provided in the 2005 laundry room. Service users must be able to 30th lock their door on leaving their October room should they wish to do so 2005 unless a risk assessment deems this to not be feasible. Risk assessments must be 18 August completed for service users with 2005 electric recliner chairs, including the rationale hehind use. Requirement 2. OP9 3. 4. OP38 OP23 23(J) 12(3) 5. OP22 13 (4) (c) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Greenhill Refer to Good Practice Recommendations I52_s19415 Greenhill v233349 270605 stage 4.doc Version 1.30 Page 22 1. 2. Standard OP27 OP19 Maintain a review on staffing levels to ensure changing needs continue to be met. To review the secuirty to the front entrance regarding the ease with which unwanted callers were able to enter recently. Greenhill I52_s19415 Greenhill v233349 270605 stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 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 I52_s19415 Greenhill v233349 270605 stage 4.doc Version 1.30 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!