Inspection on 05/07/05 for Greenhill

This inspection was carried out on 5th July 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Greenhill 05/06/08

Greenhill 17/05/07

Greenhill 16/05/06

Greenhill 13/12/05

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 Announced 5 July 2005 09.00 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 G51-G01 s42521 Greenhill AI v228065 050705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Greenhill Address 5 Oaklands Road, Bromley, Kent, BR1 3SJ 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) 020 8290 9130 Mission Care Ann Vezey 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 G51-G01 s42521 Greenhill AI v228065 050705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. After initial registration all new admissions must be in the category of old age, not falling within any other category. 2. There are no changes to the current staffing compliment, with the exception that the top floor designated as providing dementia care has an 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 an RGN working on this floor will always handover to an RMN. 3. Mission Care must conduct a review of staffing levels at the end of the first six 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. Date of last inspection 28/02/05 Brief Description of the Service: The home is a registered nursing home providing care for up to 60 residents. The catogories of registration include Dementia, Old Age and Physical Disability. The Dementia unit occupies a floor with its own staff team. The home is a purpose built facility having opened 2003 . The home comprises four floors, with services such as kitchen and laundry located in the basement. Bedrooms are well appointed with ensuite facilities, disabled toilets, baths and showers are located throughout the home. In the reception area there are two lifts which access all floors. The reception area is large and spacious and residents enjoy sitting in this area. There is a garden area to the rear of the building and parking is provided. The home is located close to Bromley town centre with its wide selection of amenities. Greenhill G51-G01 s42521 Greenhill AI v228065 050705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted as an announced inspection of which the home was notified in advance. In preparation for the inspection the manager had completed the pre-inspection questionnaire. The inspector received eight comment cards from relatives and ten from residents. Positive comments related to the activities programme and the helpful staff. Other comments were concerned that the quality of food had deteriorated whilst another relative was concerned about the lack of communication and scant information between staff and relatives, particularly when incidents/accidents occur. The inspector met with five relatives during the course of the inspection. The inspector spoke to staff and residents. Records and documentation were viewed including care plans, medication charts, service records, Statement of Purpose and Service Users Guide. The inspector focused her time on the Dementia Unit as this had not been fully opened at the last annual inspection. One complaint, which had been investigated earlier this year, had related to care practices on the Dementia Unit and the manager is currently off long term sick. What the service does well: What has improved since the last inspection? What they could do better: Avenues for communication should be improved to offer relatives/visitors opportunities to raise concerns, make comments and general involvement in the home. Introducing systems such as relatives meeting on a regular basis, where allocated key workers are present, may act as a communication opportunity. A newsletter for the home advising of events, changes and staffing may also be of benefit. Please contact the provider for advice of actions taken in response to this Greenhill G51-G01 s42521 Greenhill AI v228065 050705 Stage 4.doc Version 1.30 Page 6 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Greenhill G51-G01 s42521 Greenhill AI v228065 050705 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Greenhill G51-G01 s42521 Greenhill AI v228065 050705 Stage 4.doc Version 1.30 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 standard(s) 1,2,4,5,6. Residents are provided with information on which to make an informed choice about the home. Those residents who lack capacity are reliant on appropriate assessments being undertaken and relatives being provided with sufficient information on which they can base their decision. EVIDENCE: The Statement of Purpose and Service Users Guide contained relevant information regarding the home including the management structure, services provided and the complaints policy. The manager or a team leader assesses all prospective residents. Information is received from the placing authority and care manager where possible. Introductory visits are offered although in reality the relatives of the resident usually take these up. Each resident has a trial period of three months with a four-week notice period included. Contracts, terms and conditions are in place for each resident. The home does not admit those residents who require intermediate care. Greenhill G51-G01 s42521 Greenhill AI v228065 050705 Stage 4.doc Version 1.30 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 standard(s) 7,8,9,10. Health care needs are well provided for by the staff in the home and the additional support from the multi disciplinary team. The supporting documentation, care plans and risk assessments are not reflective of the care given or the identified needs of the resident . EVIDENCE: Three care plans were viewed of those residents who are on the Dementia Unit. Care plans contained a photograph, initial information and contact details. The identified needs were related to the activities of daily living and limited in respect of psychological and mental health issues. In general the content was limited, first names had been used in records, the daily events repetitive and not reflective of the identified care needs. This has been identified and new care plan formats are planned. The care plan of a newly admitted resident was incomplete. Some of the terminology in the care plan was inappropriate i.e. Senile Dementia was recorded as the diagnosis. Limited information was recorded on the assessment records. The assessment process does take a period of time to complete, however when assessments have identified areas of high risk, action should be implemented immediately. It was noted that this resident had a Waterlow score of 31 – very high risk, although no further action was recorded. Please see requirement 1. Greenhill G51-G01 s42521 Greenhill AI v228065 050705 Stage 4.doc Version 1.30 Page 10 The accident book was viewed and information was well completed. The home has a Visiting Medical Officer, GP service, for the home on contract. All specialist services are through GP referral. The inspector sat in for part of the staff handover on the Dementia Unit; again the focus was on physical health problems with occasional reference to mental health issues. The manager confirmed that the Dementia training received by staff had included aspects of care planning and information sharing. The medication on the third floor was inspected. Medication charts had photographs in place. Gaps were evident on the medication administration charts. One medication for pain relief had not been administered for nine days although the GP had ordered this to be given four times daily. This was not an “as required” medication. However it was still not administered. Another chart indicated that the resident had refused the medication for ten nights. If residents are refusing medication, staff should advise the GP regarding the situation and this should prompt a review of the medication. Two tablets were seen in the clinical room sink; medications must be disposed of correctly. In the event that “as required” medication is ordered, full instructions must be in place to identify when to use it, duration etc. Please see requirement 2. Please see recommendation 1. There was a long discussion regarding covert administration of medication. The manager and staff were referred to the NMC guidelines and those produced through the Royal Pharmaceutical Society, from which a robust policy must be developed. Currently there is no policy for covert administration. If this is required, a policy must be developed. Greenhill G51-G01 s42521 Greenhill AI v228065 050705 Stage 4.doc Version 1.30 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 standard(s) 12,13,14,15. Social activities are incorporated into the daily lives of residents and participation is encouraged. EVIDENCE: Residents were seen to spend time in their own bedrooms or communal areas. Bedrooms had TVs and radios for individuals. Relatives were in visiting throughout the day. Two visitors said that the home has held a strawberry tea afternoon, which they had enjoyed and would like more of these kind of activities. The manager advised the inspector that relatives’ meetings are poorly attended. Other events offered to residents include monthly concerts, a video afternoon, birthday events and other annual celebrations. External activities are offered through the “Scope Sunshine Club”, the Multiple Sclerosis Centre and holidays organised through the “Holidays for the Disabled” foundation. Hairdressing is provided in the home on a weekly basis. The home has a Christian ethos, church services are held in the home and other Christian events celebrated. Greenhill G51-G01 s42521 Greenhill AI v228065 050705 Stage 4.doc Version 1.30 Page 12 The lunch was observed. Tables were nicely presented with condiments, cutlery and napkins in place. Morning tea was offered with sweet biscuits or savoury biscuits and cheese. The lunch was nicely presented and with good portion size. The catering company are about to change as the home has appointed a new company to provide this service. Greenhill G51-G01 s42521 Greenhill AI v228065 050705 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. Information on how to make complaints is available although efforts should be made to publise this information to all interested parties. EVIDENCE: The complaints procedure was on display in large print in the hall, although two relatives were unaware of its existence or whom, externally, they could contact regarding complaints. The CSCI have investigated two complaints regarding this service one of which was received through the Adult Protection procedures. Both of these complaints were partially substantiated. One complaint was recorded in the complaints book received 29/8/2004. This had been investigated internally. The complaint was regarding the use of wheelchair lap straps. The supporting correspondence and a note of the outcome was recorded. Information was forwarded to the home regarding restraint, including the use of lap straps. The home has referred one staff for inclusion on the POVA register. Complaints referred to the home are investigated either by the manager or senior personnel from Mission Care. The manager operates an open door policy for staff, relatives and residents. Greenhill G51-G01 s42521 Greenhill AI v228065 050705 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) 19,20.21,22,23,24,25,26. The home provides a comfortable environment in which to live with additional equipment to manage disabilities. EVIDENCE: The home is a new-build and benefits from spacious modern accommodation. There was an abundance of equipment. Many items are needed for those residents suffering with physical disabilities. In addition pressure relieving equipment was available to those residents identified “at risk” of tissue damage. There are several multi-purpose communal areas including a quiet room and training room. It as noted that portable fans were in use. These need to be risk assessed as they could pose a hazard to residents. The hot water dispensers in the dining rooms need to be risk assessed to prevent injury. The hot water dispensers have restrictors in place to prevent access by residents although on two occasions the inspector noted that restrictors has not been applied. Please see requirement 3. The home was clean, tidy and well maintained. A new maintenance team has been appointed to address an ongoing programme of maintenance. Greenhill G51-G01 s42521 Greenhill AI v228065 050705 Stage 4.doc Version 1.30 Page 15 Bedrooms were in the main personalised with photographs, ornaments, plants etc. Wall pictures are not usually provided in individual bedrooms as most residents wish to bring their own. A few bedrooms seemed bare, staff should ensure that the bedrooms are personalised for the comfort of residents. Please see recommendation 2. Greenhill G51-G01 s42521 Greenhill AI v228065 050705 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) 27,30. Staff are provided in sufficient numbers to address care needs. Training is ongoing and relevant to residents’ needs although the training is not always incorporated into the daily routines and practices. EVIDENCE: Staffing levels were agreed at the point of registration. Staffing levels are maintained above those agreed, one qualified per floor, with nine care staff during the morning, seven during the afternoon and four during the night. The head of care on the Dementia Unit is currently off sick. There is a Registered General Nurse in an acting up position, with Registered Mental Nurses in support during this period. A selection of training records were inspected. Dementia training had been provided over two days for all staff with an additional session in house on the same topic. Other topics include first aid training, and dealing with abuse Staff induction is a period of one week under supervision in a supernumerary capacity. Health and safety issues COSHH, manual handling and fire are some of the topics covered during induction. Staff meetings are held monthly and additional unit and management meetings are conducted. Greenhill G51-G01 s42521 Greenhill AI v228065 050705 Stage 4.doc Version 1.30 Page 17 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) 31,32,38. The home is managed by a competent experienced manager who places great emphasis on the health and safety aspects in the home EVIDENCE: The manager, Ms Vezey, has been in post with Mission Care for nineteen years. Ms Vezey is a Registered General Nurse with a Diploma in Management and NVQ 5 in Operational Management. The staff and some of the residents, with whom the inspector met felt that they could approach Ms Vezey. They felt that she was helpful and acted upon issues raised. A selection of service records were inspected and found to be to a satisfactory standard. Hoists had stickers confirming servicing under the LOLER regulations. Greenhill G51-G01 s42521 Greenhill AI v228065 050705 Stage 4.doc Version 1.30 Page 18 The fire records detailed weekly fire alarm testing and servicing of all equipment including fire alarms and extinguishers. The staff in the home must receive fire training at appropriate intervals, four times a year for night staff and twice a year for day staff. Greenhill G51-G01 s42521 Greenhill AI v228065 050705 Stage 4.doc Version 1.30 Page 19 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 x 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 x x x x x 3 Greenhill G51-G01 s42521 Greenhill AI v228065 050705 Stage 4.doc Version 1.30 Page 20 yes 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 7 Regulation 15 Requirement Timescale for action 30/10/05 2. 9 13 3. 19 13 The Registered Manager must ensure that care plans are comprehensive in content, reflective of needs of residents and information is crossreferenced to risk asssessments and acted upon. Risk assessments and reviews must be in place for cot sides and any other forms deemed as restraint. The Registered Manager must 30/8/05 ensure that medications have full instuctions recorded, administered as prescribed by the GP, and reviewed as needs dictate. The Registered Manager must 30/8/05 ensure that all items in the home are deemed safe by undertaking thorough risk assessments. 4. 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 Standard Good Practice Recommendations G51-G01 s42521 Greenhill AI v228065 050705 Stage 4.doc Version 1.30 Page 21 1. 2. 3. 9 19 22 The Registered Manager should ensure that two staff sign for all hand transcriptions of medications to reduce the margin for error. The Registered Manager should promote orientation in the home particularly in the Dementia Unit. The Registered Manager should investigate ways of disseminating information to all interested parties. Greenhill G51-G01 s42521 Greenhill AI v228065 050705 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 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 G51-G01 s42521 Greenhill AI v228065 050705 Stage 4.doc Version 1.30 Page 23 - 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!