Inspection on 05/06/08 for Greenhill

This inspection was carried out on 5th June 2008.

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 17/05/07

Greenhill 16/05/06

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Greenhill 5 Oaklands Road Bromley Kent BR1 3SJ Lead Inspector Alison Ford Key Unannounced Inspection 5th June 2008 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.V366271.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 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 8290 9130 020 8290 9131 info@missioncare.org.uk www.missioncare.org.uk Mission Care Post Vacant Care Home 64 Category(ies) of Dementia (22), Old age, not falling within any registration, with number other category (42), Physical disability (9) of places Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE (maximum number of places: 22) Old Age, not falling within any other category - Code OP (Maximum number of places: 42) 2. Physical Disability - Code PD (maximum number of places: 9) The maximum number of service users who can be accommodated is: 64 8th December 2007 Date of last inspection Brief Description of the Service: Greenhill is a nursing home, registered with The Commission for Social Care Inspection to provide care for up to 64 residents. The home is a modern, purpose-built facility, which opened in 2003. It is located in a residential road close to Bromley town centre with its wide selection of amenities. Public transport links are good and there is a limited amount of off street parking to the rear of the home. Accommodation for residents is provided over three floors and there are two large passenger lifts so that all parts of the home are easily accessible. All of the bedrooms are well furnished and have en-suite facilities. The ground floor has been designated to care for people who may have a physical disability and the first floor for elderly frail people. The second floor is for elderly people with dementia and adaptations have been made here to make sure that residents are safe. The kitchen is located in the basement and laundry services are undertaken at another, nearby, Mission Care home. Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 Page 5 Fees at the time of this inspection range from £558 - £980 weekly. There are additional charge for services such as chiropody and hairdressing, and these would be discussed prior to admission. Different pricing arrangements are in place for people who fund their placements privately as opposed to those whose funding is arranged by the local authority. Copies of the homes Statement of Purpose and their guide to the home can be requested from them. A copy of their latest inspection report can also be seen at the home or alternatively can be downloaded from the Commission for Social Care Inspection website. Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate, quality outcomes. This was the homes first key inspection for the year 2008/2009. It was an unannounced visit, undertaken by two inspectors, lasting around six hours. We would like to thank the manager and all of the staff for their help throughout the day. During this time, we undertook a tour of the premises and spoke with many of the residents, their relatives and members of staff on duty. We also looked at various records and documentation that the home is required to maintain as evidence of their commitment to the health and safety of the people who use the service. We assessed a sample of care plans and spent time observing residents in the home to try and reflect on what it is like for them living there. We spoke with the cook, looked at menus and kitchen records and the lunchtime meal was served during our visit. When writing this report we have also taken into consideration other information that we have received throughout the year such as the notification of incidents and complaints. The home has recently undertaken a satisfaction survey of their own and we were also able to see the results of that. In addition, the homes previous manager sent us an Annual Quality Assurance Assessment. This is a document that they complete every year to tell us how their service meets the needs of the people they support, what they think that they do particularly well and about their plans for the future. What the service does well: Greenhill is an extremely well presented property. Several of the relatives that we spoke to liked the fact that it didn’t look, to them, like a nursing home and also that it was always very clean and fresh. The manager’s office and administrators are located on the ground floor and during the day, there is a receptionist sitting at the desk so that people know Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 Page 7 where to go when they first come in to the home. Staff were very welcoming when we arrived. The Mission Care Group has developed comprehensive information packs so that anyone considering moving into the home would be able to see what services they offer. If they then decided to come and live there, when a room became available, a senior staff member would undertake a health needs assessment to make sure that they could provide the care that was required. This then forms the basis of a care plan, which sets out, in detail, the way that individualised care is to be delivered in the way that the resident prefer. Most people who were spoken with considered that life in the home suited them. They told us “they feel safe here” that“ staff are very kind. They agreed that they were able to make choices and decisions about how they wanted to spend their days including choosing the clothes that they wanted to wear and when they wanted to get up or go to bed. They said that the food served in the home was “usually very nice”” and “quite good.” They seemed to enjoy the activities that are arranged, for them and photographs are on the walls, which show them enjoying themselves at various events. Records that are maintained by the home as evidence of their commitment to the health and safety and protection of the people who use the service were generally in order. What has improved since the last inspection? The majority of the concerns that were raised at the last inspection have been addressed. On each floor a trained nurse has been designated as a “clinical leader”. This role provides leadership for staff, residents and their relatives and helps to ensure that there are lines of accountability. Medication procedures have improved and a policy has been developed for the “covert administration” of medication. This would be used where it was difficult to persuade residents to take essential medication any other way and would be particularly useful on the dementia unit. It is however rarely used. Complaints monitoring has improved and there is now evidence that any concerns are being addressed in an appropriate and timely way. There have not been any complaints referred to the Commission since the last inspection. As part of the quality assurance process the management team are now undertaking visits to the home to assure themselves that it is being run according to the ethos of the home and in accordance wit the preferences of the people who live there. Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 Page 9 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.V366271.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,3,6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service are able to get comprehensive information that will help them decide if they will like living in the home. Before they move in, an assessment of their healthcare needs will be carried out to make sure that the home will be able to offer them the care and support that they need. This home does not provide intermediate care therefore this standard does not apply. EVIDENCE: Greenhill has produced a comprehensive guide for residents and their relatives which outlines the services that will be provided by the home and gives lots of useful information to help people decide if life in the home will suit them. Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 Page 11 Copies of these documents are in resident’s bedrooms for them to read and refer to. If they were able, a potential resident would be encouraged to visit the home to see if they liked it. In reality, most people are quite frail when the time of admission comes however, their relatives would be encouraged to participate in the process. The relatives that we spoke with confirmed that they had received a contract and also all of the information they needed at the point of admission. One lady commented upon how friendly and helpful everyone had been when she was deciding if the home would be suitable for her mother. For residents whose placement is funded by the local authority a care manager’s assessment would be obtained prior to admission. This would explain, in detail, the care and support that they would need. For people who fund the placement themselves and, in practice, also many of those with local authority funding, a senior member of staff would undertake a needs assessment to make sure that the home would be suitable. These assessments were seen in some of the care plans that we looked at. From these assessments an individual care plan would be developed although as discussed under standards 7-11 the quality of these is variable. Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards7, 8,9,10,11 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service say that their needs are being met in a way, which suits them although documentary evidence of this is sometimes poor. Medication policies and procedures are in place to ensure their safety. EVIDENCE: All of the residents that we met on the day of the inspection looked clean and well cared for. They were nicely dressed and ladies were obviously able to have their hair done regularly. People that were unwell and being nursed in bed looked comfortable and appropriate aids and adaptations were in place to help prevent them from developing pressure sores. Those people that we spoke with told us that they felt safe and that staff were very kind. Our observation was that people are being very well cared for in this home however, supporting documentation, in the form of care plans, was very variable and in some cases quite poor. Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 Page 13 There is a front sheet, which has been developed according to a recognised nursing model relating to the activities of daily living. This is written in a way, which recognises the remaining capabilities of the resident, as in “I can wash my face myself”. The intention is that the intervention and support that is needed will then be added. Although we considered that this showed ownership of the care plan and reflected a person centred approach there was a real lack of detail. Some people with very complex care needs had very little written to show how care was going to be delivered and evaluated. Any member of staff who was unfamiliar with a resident would not always be able to tell from a care plan how to care for them according either to best practice guidelines or their preferences. Some care plans had not been regularly reviewed so that factors, which might indicate deterioration in their health, would not have been identified. Risk assessments such as those relating to the prevention of falls were not always in place. Nutritional screening was not always up to date. There was limited evidence to show that residents or their relatives had been able to contribute to the care planning process and influence the way that care was provided. There was also limited information about residents past lives and achievements, to help staff understand more about the people that they are caring for. Care plans that were viewed on the dementia unit were generally better than those on the other two floors. Here it was evident that some thought had been given to resident’s particular problems and how they were going to be managed. There was also some evidence to show that relatives had been consulted about the way in which residents would be cared for. However, there were still several instances where we found a lack of the detail, which would ensure that all staff would be able to care for people as they preferred. It is acknowledged that the shortfalls have been recognised and steps are being taken to address the issues. We are confident that an improvement will be seen in the care plans at the next inspection. However, this outcome group is considered, by The Commission, to be key to the inspection process and therefore affects the overall rating for the home. Residents have access to services from a chiropodist, optician and dentist and a doctor visits twice a week. Advice would be sought from a tissue viability nurse, dietician and continence advisor if required. Practices in the home with regard to medication were assessed on each floor and found to be satisfactory. Medication is stored appropriately in locked trolleys and administered by trained nurses. There are lists of the signatures of those who are authorised to give medication, photographs of residents on their Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 Page 14 record sheets and both the homes medication policy and the guidelines from the Nursing and Midwifery Council. There is also a policy in place to show the procedures to be used in the administration of covert medication. Unwanted and unused medication is disposed of according to current regulations. Some work is being undertaken within the home in conjunction with the local hospice, to improve care for people who are nearing the end of their lives. In some care plans there was evidence of advance care planning showing that discussions had taken place with residents and their families. This information is also being shared with the “out of hours” doctors’ service in order to prevent unwanted hospital admissions. There has also been some very positive work going on in the home, which is being championed, by one of the trained nurses. This is in response to the governments “Dignity in Care” campaign. Staff are benefiting from training which she has organised, a handout has been produced and there are plans to make a DVD in conjunction with The Royal College of Nursing regarding respecting peoples dignity who are using care services. Residents we spoke with confirmed that staff were always respectful, shutting doors when personal care was being given and always knocking before entering their rooms. One visitor did raise a concern that when her relative needed a hospital visit she was not always told of the outcome and this was relayed to the nurse in charge at the time. Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards12, 13,14,15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service say that it suits their needs and preferences. They enjoy the activities that are arranged for them and the meals that are served. Their families and friends are always made welcome. EVIDENCE: People that we spoke to during the inspection told us that they were happy living in the home. They said that they were able to make choices and decisions about how they wished to spend their days, including the clothes that they wanted to wear, the time that they got up in the morning and went to bed at night and when they had a bath or shower. There is a range of activities organised for residents to join in with if they want to and we met the activities organiser who works in the home three times a week. She displayed a great deal of enthusiasm for her role and residents were obviously very fond of her. She tries to provide both group activities and one to one sessions for people who do not want to mix with others. In addition there is musical entertainment and organised trips out of the home. Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 Page 16 There is a timetable however, it is flexible according to the preferences of the residents. The home also has an enthusiastic volunteer group “The Friends of Greenhill” who organise fundraising events to provide extra money for entertainers who visit on a monthly basis. Pictures around the home showed residents taking part in various events that have been held. In the dementia unit in the home there was also evidence of a considerable amount of engagement between residents and the care staff who were singing, dancing and chatting with them. Local churches provide pastoral support and residents are helped to practice any faith that they choose. Some residents are able to attend church and services, including communion, are also held in the home for those who wish to attend. Relatives and other visitors that we spoke with said that they always felt comfortable coming in to the home and that staff always welcomed them. One lady told us that she liked the fact that she could bring her dog in to visit as well. The lunchtime meal was served during the inspection and was observed on the ground and second floor. Generally it seemed to be a pleasant experience for residents. One gentleman who always comes in to help feed his relative confirmed that the meals always seemed to be good. There was a choice of food; it was hot and nicely presented, everyone had a drink as well. Those people who needed help were offered it and plate guards were in use for others. It was noted, on the dementia unit, that pureed food that had been plated up by the kitchen assistant in separate servings was then all mixed up together by care staff and this process should be discouraged. There was also a lack of salt and pepper on the tables. Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16,18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have access to complaints procedure, which ensures that any concerns that they raise will be managed and resolved appropriately. EVIDENCE: There is a complaints procedure, which is displayed in the home. Details about how to raise any concerns are also in the resident’s guide, which is in their bedrooms. The complaints record was seen and showed that any issues had been addressed according to the procedure. The Commission has not received any complaints about the service since the last inspection. Staff records show that appropriate clearance is received from The Criminal Records Bureau prior to them starting work in the home. This ensures that people who have been judged as not being suitable to work with vulnerable people have been prevented from doing so. Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 Page 18 Staff receive regular training about adult abuse and displayed an understanding of what it was and how they would report any concerns that they had. However, they were not so sure about what was meant by “whistle blowing”. The management team will need to ensure that future training encompasses all of the relevant issues. Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service live in a well-maintained purpose built home which suits their needs in a comfortable way. EVIDENCE: The home is a modern purpose built facility, which opened less than six years ago. It was designed with help from occupational therapists so that it would meet the needs of the people who live there. There are communal areas on each floor, which are used for sitting, activities, and dining. These have been fitted with loop systems to aid those whose hearing is impaired. Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 Page 20 There are also bathrooms with aids and adaptations and some have ceiling hoists. There are handrails and ramps throughout the home to allow easier access. Individual bedrooms are large, well appointed and all of them have en-suite facilities, which would be able to be used by people who need wheelchairs. Beds are height adjustable and fitted with pressure relieving mattresses. All areas have call bells. Residents have been encouraged to personalise their bedrooms with pictures, ornaments and small pieces of furniture although some of them showed more evidence of this than others. On the ground floor it was noted that cot bumpers had been labelled with residents names and this was visible from the open door. This does not reflect people’s dignity and they should be turned around so that it cannot be seen. On the dementia unit bedrooms are locked during the day to prevent residents entering the rooms of others. Staff all have keys, as do relatives and those spoken with understood the need for this. Although this unit is very pleasantly decorated and residents have their photographs on their rooms it was considered that pictures on the walls were not always relevant for elderly confused people and more could be done to help orientate them. It is recommended that this should be considered, it might be necessary to obtain specialist advice. The home was very clean and fresh on the day of the inspection and those spoken with said that it was always so. Alcohol hand cleansers, aprons and gloves were available throughout the home in order to help with infection control. One relative raised an issue about laundry. The water temperature used to wash residents clothes would seem to be too hot for some modern fabrics and clothes become spoilt. This issue will need to be addressed. Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29,30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service say that they are well cared for however, there are not always sufficient staff on duty to meet their healthcare needs. Staff training must be improved to ensure the safety of both themselves and those that they care for. EVIDENCE: The people that we spoke with commented very positively about the staff that care for them and told us that they were very kind and respectful. One lady said, “ the staff are the nursing home”. Staff members we observed were interacting well with resident are especially those on the dementia unit. Here we saw them laughing and singing with residents many of whom were very demanding with quite advanced stages of dementia. Each floor is staffed by both trained nurses and care staff. One nurse on each floor has been designated as a “clinical leader” and has accountability for that area. Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 Page 22 Off duty rotas were seen and these highlighted the fact that shifts are not always fully staffed and run “one short”. The home is currently trying to recruit more staff to address this shortfall. Meanwhile these vacancies will need to be filled with bank or temporary staff to ensure that resident’s needs are always met. Over 50 of staff have gained an NVQ qualification to at least level 2 however, an assessment of staff training schedules showed that core training was not always being provided appropriately. Several staff had nor received any updates in moving and handling techniques for some years. This could put both them and residents at risk of injury. One staff member had been working in the home for four months and had still not undertaken an induction programme. This situation must be addressed. During the inspection we noted a member of the administrative staff speaking very loudly to a resident in a way, which was not really appropriate. It is recommended that non-clinical staff should be able to access training regarding ways to communicate with people who use the service. Staff files that we saw showed evidence of robust recruitment procedures and appropriate clearance from the Criminal Records Bureau although one staff member had been employed on the strength of two personal references and without at least one from their previous employer. Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35,38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service know that it is being managed in their best interests and that they are able to influence the provision of the care that they receive. EVIDENCE: The home is without a registered manager. A manager from one of Mission Care’s other home is currently overseeing this role on a part time basis. She is very experienced and this is helping to provide leadership and continuity. We understand that interviews are to be held in the near future to find a more permanent solution and appoint someone to this post. Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 Page 24 The quality assurance programme in the home is being developed. As a part of the process a resident’s questionnaire was developed and used in all of Mission Cares Homes. Responses were in the main positive with most people saying that they were reasonably happy with the situation within the home. There are also regular meetings held for residents and their relatives to enable them to voice their opinions about the care and services that they receive in the home. Reports written following inspections by The Commission would be available for residents and their relatives to read. The home returned its Annual Quality Assurance Assessment when it was requested and this outlines the plans that they have for improving the service during the forthcoming year. Equipment and services are all regularly maintained to ensure the health and safety of residents and staff members. A brief tour of the kitchen was undertaken. An inspection had recently been made by the Environmental Health Officer who had rated the kitchen as 5 star. Most residents either manage their own finances or more usually have a relative or representative to do this for them. Records were seen and are well organised. There were some concerns raised about the money kept on behalf of residents by Mission Care and kept in a central account although we have been assured that this is a non-interest bearing account to ensure that the organisation is not able to benefit from it. The Regulations do state that accounts must be in the name of the person using the service therefore, there must be evidence available to show that this facility has been offered to them. Should they, or their representatives, decide that they are happy with the present arrangements we would need to see that they have been made aware of how their money is being managed. Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 Page 25 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Care plans must set out the action, which needs to be taken to ensure that all aspects of the healthneeds of residents have been identified and will be addressed. Care plans must include risk assessments to help prevent any accidents or injuries to people who use the service. Previous timescale 01/02/08 not met Care plans must include nutritional assessments, which are updated regularly to highlight any problems. There must be evidence that residents and their relatives have been given the opportunity to contribute to their care plans and influence the way that care is being delivered. Care plans must include more information regarding residents past lives and achievements in order for staff to understand mire about the people that they are caring for. DS0000042521.V366271.R01.S.doc Timescale for action 30/09/08 2 OP7 15 30/09/08 3 OP7 15 30/09/08 4 OP7 12 (2) 30/09/08 5 OP7 15 30/09/08 Greenhill Version 5.2 Page 27 6 OP27 18 (1)(a) There must be adequate staffing 30/09/08 levels throughout the home at all times of the day to ensure individual health and welfare needs are met. Previous timescale 01/02/08 not met Training for staff must be improved to ensure that core training is updated more regularly. Opportunities for staff training must be extended to include administrative staff. Any money that is held on behalf of residents must be kept in accounts in the name of that person. 7 OP30 18(1)(c) 30/09/08 8 9 OP30 OP38 18(1)(c) 20(1)(a) 30/09/08 30/09/08 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 Refer to Standard OP19 OP26 Good Practice Recommendations It is recommended that work should be done in the dementia unit to provide equipment that will help orientate people who are confused. It is recommended that laundry procedures should be assessed to see if washing temperatures could be reduced. Greenhill DS0000042521.V366271.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V366271.R01.S.doc Version 5.2 Page 29 - 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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