Inspection on 06/06/08 for Greenhill

This inspection was carried out on 6th June 2008.

CSCI found this care home to be providing an Adequate service.

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 12/06/07

Greenhill 16/06/06

Greenhill 12/12/05

Greenhill 27/06/05

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Greenhill Wagon Road Potters Bar Hertfordshire EN4 0PH Lead Inspector Mrs Alison Butler Unannounced Inspection 6th June 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Greenhill DS0000019415.V366023.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Greenhill DS0000019415.V366023.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenhill Address Wagon Road Potters Bar Hertfordshire EN4 0PH Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0208 449 8849 0208 449 6343 greenhill@bmcarehomes.co.uk B & M Investments Limited (Trading as B & M Care) Caroline Ann Inch Care Home 67 Category(ies) of Dementia - over 65 years of age (26), Learning registration, with number disability over 65 years of age (1), Old age, not of places falling within any other category (67), Physical disability over 65 years of age (3) Greenhill DS0000019415.V366023.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th June 2007 Brief Description of the Service: Greenhill is a care home providing personal care and accommodation for 67 people aged over 65 years and who may have a physical disability and/or dementia. No other categories apply and, therefore, the home cannot provide nursing care or a service to people who have mental health problems other than dementia. Set in extensive, and well-kept grounds, Greenhill is a very attractive old detached manor-house style property, which has had various extensions and an annexe has been added. The property has been sensitively adapted, whilst maintaining its numerous and attractive features, including a bar and large hall with seating for several people. There is a passenger lift. The majority of the homes rooms provide single occupancy, two offer shared accommodation. Most of the rooms have an en-suite facility. There are four communal bathrooms in use. The upper rooms and gardens provide wonderful views as far a-field as Canary 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. Information regarding the home can be obtained from the statement of purpose and service user guide. Both documents and a copy of the most recent CSCI inspection report can be obtained from the manager. Up to date fees for the services can be obtained from the manager. Additional charges are made for newspapers, toiletries etc. Greenhill DS0000019415.V366023.R01.S.doc Version 5.2 Page 5 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. We (The Commission for Social Care Inspection) carried out this key unannounced inspection between 09:30 – 16:30 over a 7-hour period. We looked at relevant documentation, observed what was going on in the home, spoke with residents, visitors and staff and made a tour of the building. Our records show that we sent out an Annual Quality Assurance Assessment (AQAA) form, and this was completed and returned within the given timescale. This has been used in the report where appropriate. What the service does well: The atmosphere in the home is calm and welcoming. The home is well maintained and a continual programme for redecoration is in place. There is good management in place and they now cover 7 days a week, which provides them with the opportunity to know what is happening in the home all week and enables visitors to speak with them on their visits at weekends. Activities are well organised and residents are able to choose to join in or not, additional activities are looked into at the request of the residents to give them further choices. A rolling training programme is in place to ensure that staff are kept up to date with their skills and any changes in care practise. We are kept informed of complaints and concerns and anything that affects the well being of a resident so that we can monitor the quality of the service provided. Where the needs of the people who live at Greenhill have changed the manager has arranged further assessments. This is to see if they are able to continue to meet their needs appropriately in Greenhill. Where they are no longer able to meet these needs the relevant people are informed with a view to moving the person into a more suitable service that is better placed to meet their needs e.g. a home that provides nursing care. Greenhill DS0000019415.V366023.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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 DS0000019415.V366023.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenhill DS0000019415.V366023.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 is not applicable to Greenhill) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that a comprehensive assessment is carried out to identify any needs, which then ensures that the service is able to appropriately meet resident’s needs. EVIDENCE: Pre-admission assessments are carried out which form the basis of the initial care plan to ensure that individual needs have been met. There is a four week trail period after which a decision can be taken on both sides as to whether they would like to stay if the home are able to meet their needs. To help in the admission process they have created a quality assurance questionnaire to be completed after admission to get residents views and review the process and make changes as necessary. Greenhill DS0000019415.V366023.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that care is provided to residents by staff that will treat them with respect and are aware of peoples needs, although not all the information in care plans was fully up to date, which could mean they do not actually receive the appropriate care. Medication procedures are in place which, if followed would ensure people are kept safe. EVIDENCE: New care plan formats have been introduced since the last inspection. Some care plans provided more detail than others on how resident’s needs are to be met. Care plans are a working tool and where changes are made to the care of the residents this should be recorded, signed and dated by the person who has identified the change. Monthly reviews should include how the needs of the residents are being met and note any changes in care in detail; as those we saw stated “continue with care plan”. It would also provide a clear audit trail of care and demonstrate that the home are still able to meet the needs of the Greenhill DS0000019415.V366023.R01.S.doc Version 5.2 Page 10 residents who live at Greenhill. From those we saw it is difficult to understand if the care needs are being met and that the needs are being met effectively. Where Greenhill has difficulty in continuing to meet a persons needs, for example it is felt they now require nursing care, the manager has arranged for the person to be re-assessed by the appropriate professionals. This has unfortunately led to people moving out of Greenhill, but on to a service more able to safely meet their care needs. Medication policies and procedures are in place. However, whilst examining the records the coding used on the medication, administration record (MAR) chart was not consistent and made it difficult to reconcile the medication. To make it clear staff should ensure that the coding is consistent. Two prescriptions had been received by the home for the same medication for an individual resident, one was for a prescribed dose at set times, the second was for ‘given as required’, these had been recorded in the same section on the MAR chart, this medication could not be reconciled as the ‘given as required’ medication instructed that 1 or 2 tablets to be given and staff had not recorded the actual number that had been given, this could potentially put the resident at risk by exceeding the number of tablets in any 24 hours. All prescription must be kept separate on the MAR chart to ensure the clarity of what has been administered, received or medication disposal to provide a clear audit trial and ensure the resident is given the prescribed medication at all times. Some residents are self-administering their medication but need prompting, the home need to ensure that there is a risk assessment and guidance in place and give clear instructions to staff on the action to take when prompting to ensure consistency. The controlled drugs were well kept and the records seen were accurate. All medication to be disposed of is recorded and stored appropriately this ensures the safety of all who enter the medication room. Time was spent talking and observing staff and residents, those we spoke to were very happy with the care provided and that their needs were met appropriately. Greenhill DS0000019415.V366023.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that they will be supported to have contact with their families and to be offered a choice of activities to ensure their recreational interests and needs are met. EVIDENCE: There are two activity co-ordinators who work over 7 days. A session was being held in the Cedars unit, which supports people with dementia. A ball was being thrown and caught by a number of the residents, who appeared that they were enjoying this, especially to see how far they were able to throw and occasionally they would laugh as they threw it with some force to see if the activity co-ordinator was awake. We saw a member of staff with a resident who was building using a set of tools; this person had been a carpenter when they were younger. The staff showed patience and understanding and gave them time to carry out the task before moving on to fix the next piece in place. There are a number of events planned over the summer months with a summer fete and a cream tea afternoon where the manager and her staff support the home and ensure that visitors to the home are aware and are able Greenhill DS0000019415.V366023.R01.S.doc Version 5.2 Page 12 to come and take part. Raffles are a regular feature in the home to raise funds for the benefit of the residents. Various pictures are on the walls round the home, which have been created by the residents, they also hold a number of art and craft sessions, which seemed to be enjoyed by a number of the residents. The AQAA states they are hoping to introduce a bridge club as a few residents have expressed an interest in this. Residents have also expressed an interest in being out in the garden more and the home managed to receive a grant had which has enabled them to purchase a log cabin that has now been installed in the garden. This is to be used by the gardening club that has recently been set up as part of the activity coordinators role. There are a variety of tools available and they have started to plant some vegetables, which they hope will be used at mealtimes. One resident who had only been admitted to the home in the last few weeks, was very happy to escort the inspector round the garden and explain all the recent changes. They then sat in the log cabin to have coffee and where they spoke about their life prior to coming to Greenhill, which they now call home. Together we looked at their care plan and there was additional information that was to be included and this was discussed with the manager at the time. They told us that they were very happy with the staff and their care, and said “the staff are wonderful”. The resident requested a copy of their plan and this was arranged and given to them during the inspection. Visitors to the home were complimentary about the care that the staff provided and felt they were kept informed. Those who lived some distance away have regular contact via e-mail, which has helped in the efficiency of any action that needs to be carried out. The cook provides a varied and nutritional diet; she takes part in the serving of the food and meets new residents on admission to get a clear picture of their dietary needs and special requests. She is responsible for ensuring that a nutritional plan is put in place and it is completed, although when they go home the information is recorded in the daily notes and not on the nutritional intake form, this would make it difficult to provide a full audit on food intake, especially if there are concerns of their weight. We were told that they are looking to examine ways of ensuring that all food intake is recorded in one place. Greenhill DS0000019415.V366023.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service can be confident that they will be listened to and action is taken and recorded. Staff have received appropriate training to ensure that residents are safeguarded from abuse. EVIDENCE: We examined the complaints records, which showed us that complaints that had been received had been actioned with good details of the action taken and outcome recorded. We received a letter from a concerned relative in which they state they have not received a response from the home or head office. During the inspection both parties state they have not received these and have therefore been unable to respond. Action was taken during the inspection for this to be looked into. Previous inspections have shown that complaints are acted upon appropriately and are well recorded. We have received a further letter from another relative highlighting some areas of concerns, the information has been passed to the provider to investigate under their own complaints procedure and we will continue to monitor the service within our regulatory duties. Greenhill DS0000019415.V366023.R01.S.doc Version 5.2 Page 14 Staff receive training in safeguarding to ensure that residents are protected from abuse as far as is reasonably practicable. Staff spoken to during confirmed that they are aware of the procedure to follow in the event of abuse being reported to them or if they witnessed anything that would concern them. Greenhill DS0000019415.V366023.R01.S.doc Version 5.2 Page 15 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): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that Greenhill is clean, well maintained, and provides an environment that meets people’s needs. EVIDENCE: We took a tour of the home with a resident; this showed us that the home was clean and well maintained. Systems are in place for the redecoration of the home. In the last 12 months they have redecorated the main lounge, the sun lounge and the communal toilets. A handyperson is available to deal with small maintenance issues fairly quickly or arrange a firm in to rectify large maintenance issues. The Cedars unit has also been redecorated and changes have been made to create a dining room with washable flooring, a small lounge which can be used for visitors to see people in private and a quiet room and the main lounge which is used for activities and watching TV. Greenhill DS0000019415.V366023.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service can be confident that residents will be supported by appropriate numbers of staff who have gone through a robust recruitment process to ensure that people are kept safe and their care needs are met appropriately. EVIDENCE: Newly recruited staff files were looked at which showed us that all the required information had been obtained prior to these staff commencing their employment at Greenhill. Three staff work in the unit that supports people with dementia to ensure their needs are met. The manager needs to ensure that communication for those residents is at the best possible level available. There are a number of staff whose first language is not English. This may make communication difficult for the residents as we had some difficulty making ourselves understood by these staff. A rolling training programme is in place and additional training is provided depending on the needs of the staff. All staff now complete basic dementia training before working on the dementia unit. Greenhill DS0000019415.V366023.R01.S.doc Version 5.2 Page 17 We saw that the rota showed that staff are deployed appropriately throughout the home to ensure that care needs for all are met as required. The manager keeps staffing levels under regular review. The AQAA states that they ensure that staff receive a minimum of six supervisions per year. Staff we spoke to confirmed they receive regular supervision to ensure they are able to meet the needs of those living at the home. Greenhill DS0000019415.V366023.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that the home is run for the benefit of those that live there. There is a management structure in place to support this, and health and safety procedures are in place to protect all those who live, work and visit Greenhill. EVIDENCE: The management structure in place appears to be working well and this has been further improved with the employment of an assistant manager who has a background in working with people with a dementia. This allows them to now provide management cover in the home from 8am till 8pm Monday to Friday and 8am till 4pm at the weekends. Management meetings are held and this ensures that everyone is clear about what is happening within the home. Greenhill DS0000019415.V366023.R01.S.doc Version 5.2 Page 19 Greenhill operates an open door policy and staff and visitors to the home told us that they felt that they were able to go to the office and they would be listened to. Policies and procedures are in place to safeguard residents financial interests but the home does not take responsibility for managing resident’s monies as family or an appointed person does this. Meetings are in place for residents and relatives and minutes are held and a quality questionnaire has been carried out, although the report is not yet available to look at where improvements can be made to improve the residents lives. The manager carries out regular walks around the home and talks with staff, residents and visitors, this is usually happens first thing in the morning. Now they have increased the management team these ‘walk a rounds’ will take place a different times of the day, this will enable them to get better picture of what is happening within the home. A small report will be made to provide an audit of any findings and any action that needs to be taken. Residents and staff confirmed to us that they see the manager regularly. The health, safety and welfare of residents, staff and visitors to the home are protected and promoted through a number of checks which are recorded and action taken where necessary. All issues raised by the fire service have been addressed and confirmed by the fire service to ensure compliance and residents safety. Greenhill DS0000019415.V366023.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 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 Standard No Score 16 3 17 X 18 3 3 X X X X X X 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 3 X 3 X 3 3 X 3 Greenhill DS0000019415.V366023.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13(2) Requirement To ensure the safety of residents’ full and accurate records for the receipt and administration of all medicines on behalf of all people living at the home must be kept at all times. Timescale for action 28/07/08 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 Refer to Standard OP7 Good Practice Recommendations To ensure a full audit trial and ensure the residents care needs are met, monthly reviews should ensure they refer to the care provided and include any changes in the residents needs. Greenhill DS0000019415.V366023.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 DS0000019415.V366023.R01.S.doc Version 5.2 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!