Inspection on 22/02/06 for Greenhill Grange Residential Home

This inspection was carried out on 22nd February 2006.

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

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

Other inspections for this house

Greenhill Grange Residential Home 09/03/09

Greenhill Grange Residential Home 09/03/07

Greenhill Grange Residential Home 28/09/05

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

CARE HOMES FOR OLDER PEOPLE Greenhill Grange Residential Home Catherston Close Frome Somerset BA11 4HR Lead Inspector Barbara Ludlow Announced Inspection 22nd February 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Greenhill Grange Residential Home Address Catherston Close Frome Somerset BA11 4HR 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) 01373 471688 Greenhill Grange Residential Home Ltd MRS GILLIAN PATRICIA TWOHIG Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th September 2005 Brief Description of the Service: Greenhill Grange is a purposefully adapted and extended home situated in a residential area of Frome. The home is set in its own very pleasant gardens, with car parking. The home has extensive countryside views from its communal rooms. Greenhill Grange is registered with the Commission for Social Care Inspection to provide care for up to 25 older people requiring assistance with personal care. This is a family run business with Mr Twohig and his son responsible for maintenance, gardening and driving duties. Mrs Twohig is the Registered Manager, and responsible for day-to-day management of the home. Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was carried out by B Ludlow for CSCI. Mrs Twohig Proprietor/Registered Manager was present throughout the inspection day. Time was taken to explain the anticipated changes to the inspection programme for the forthcoming inspection year, 2006/2007. Senior members of the care staff team were involved in the inspection process, sharing their particular areas of work at the home with the inspector. A tour of the premises was made. Service users were seen in the communal areas of the home and in private, in their rooms. Twenty service users were seen and spoken with during the inspection day. Staff on duty were observed and were spoken with during the day. Lunch was observed being served in the main dining room. Records were sampled; these included care plans and the daily diary, maintenance and servicing records and staff recruitment and training files. The home was clean and tidy; service users looked well cared for and were satisfied with the care and service they receive at Greenhill Grange. The meal at lunchtime was nicely served and looked appetising. Staff were pleasant and helpful, service users were observed to be treated in a dignified and appropriate caring manner. Feedback was given to Mrs Twohig at the conclusion of the inspection and a written response to the feedback was received at CSCI. Service user and relative/carer comment cards were distributed by the home and were returned to CSCI. There was a good level of response with 20 cards returned from service users and 18 from relatives and friends. Very positive feedback was heard. The analysis is included in the body of the report. What the service does well: Greenhill Grange is a well established, nicely maintained, purposefully adapted home. It has level access and is comfortably furnished. There is a homely atmosphere and service users are well catered for. Service users have a range of activities open to them, which includes exercises, crafts and potted gardening. Mealtimes are well managed and are social occasions. Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 6 There is a stable and appropriately trained staff group to deliver care at the home. The home has good relationships with relatives of service users and encourages feedback on the service offered at the home. An excellent written response was made to CSCI from relatives/carers and service users. This information is most helpful and the inspector would like to extend thanks to all the respondents. What has improved since the last inspection? What they could do better: The home felt cool on the day of the inspection, which was very cold. It was noted that radiators in the hallway and close to the homes main entrance were cold to touch. Care should be taken to maintain a warmer ambient temperature around the home on very cold days. Service user weights were recorded in a book, at the point of inspection day feedback this was discussed. A letter received post inspection confirmed that weights are now recorded in the individuals care plan. Also addressed post inspection, one Yale style lock with a dead lock facility seen during the tour of the premises, has been removed from a bedroom door. The bathrooms have carpeted floor covering, this is not recommended for good infection control. A waterproof washable floor covering should be considered when the floor covering is next renewed. Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5, NMS 6 does not apply. The home has produced information for prospective service users to enable them to make an informed choice when coming into the home. Visits to the home are welcomed. The statement of purpose and service user guide were reviewed in April 2005, copies were supplied to CSCI. EVIDENCE: The pre-inspection questionnaire indicated that there have been no changes to the statement of purpose since the last inspection. At the last inspection it was noted that, ‘the contract has been revised to reflect the business change to a limited company. Contracts were sampled and these were satisfactory.’ The review process for those who are privately funded was discussed with Mrs Twohig. The inspector was informed that the process offered is for Service users to have a review meeting after admission when the contract is issued.’ Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 10 The home has a dedicated link social worker for those who are funded and care managed, visits are made three times per year to conduct service user reviews and monitor progress. The current fees rates range from £400.00 to £525.00 per week, the fees are assessed annually and fee changes are due to be applied in April. Charges are made for extras such as hairdressing, chiropody, newspapers, personal toiletries and transport. There is a charge for the disposal of incontinence pads; this ranges from £7.50 to £10.00 per month, at the time of this inspection. Twenty service user comment cards were returned to CSCI. Eighteen responded that the service user likes living at the home. Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Service users are treated well and with respect; care needs are met at this home. EVIDENCE: All service users had care plans, four care plans were sampled. These demonstrated that pre admission information is gathered from appropriate sources. This information includes relevant contact, a personal history and family and work history. Care is planned to meet the needs of the service user. Monthly reviews are made and are recorded. A significant event such as the District Nurse visiting is logged in the care plan. Contact with professional allied to healthcare was documented such as the chiropodist. Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 12 Risk assessments were in place for manual handling. Nutritional assessment was less well recorded. Weights are recorded in a separate book; Mrs Twohig confirmed after the inspection that she addressed the weights and that they are now recorded on each individual care plan. Medication management was seen and was satisfactory. The homes NOMAD system is to be replaced with a weekly delivery system. Records were examined; there were two signatures on all staff hand transcribed entries on the Medication Administration Records (MAR’s). One MAR had a small number of gaps otherwise all were complete. Entries signed by service users were seen in the care plans confirming selfadministration of creams. Twenty service user comment cards were returned to CSCI. All twenty confirmed that they felt well cared for, staff treat them well and that there privacy is respected. Two comment cards from visiting healthcare professionals indicated that they are satisfied with the care of the patients they see and have received no complaints about the home. Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service users are treated respectfully at the home and are able to choose how they spend their time. The home offers a range of activities. Meals are nicely presented and the food looked appetising. EVIDENCE: The home has two dedicated activities staff and there are a variety of events on offer for service users who can choose whether or not they wish to join in. There is an activities book and activities are included in the care planning records for service users. An exercise class was held in the lounge in the morning on the inspection day and service users all willingly joined in. A knitting class was held during the afternoon and again there were many participants. The inspector was informed that one carer is usually assigned to activities to assist individuals requiring help to participate fully. Service users can watch large screen television in the large communal lounge or may spend time more quietly in the smaller lounge, which has a table. Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 14 Board games are played and jigsaws are available. The home has library books in large print. Examples of the many of the craft items made are displayed in the hall. The cup for the best potted garden plants and tomato plants etc is also displayed. The home has a well-stocked shop for service users to purchase small necessities such as toiletries. Day care is offered and one day care service user was seen at this inspection. They were warmly and very pleasantly greeted on arrival and made welcome during the day. The menu for lunch is displayed each day on the chalkboard in the hall. Service users are able to request an alternative. Specialist diets are catered for. Service users are able to eat in the very nicely presented dining room, or their own bedroom as they choose. Lunch was seen at this inspection and the menu looked appetising, dessert was apple pie and custard and was served by the cook. Service users confirmed that they had enjoyed their lunch. After eating, tea in mugs or cups and saucers and milky coffee in coffee cups and saucers was served to each individual from a small tea trolley which was taken from table to table around the dining room. This was very nicely done. Mealtimes are appropriately spaced and supper is available, those who wish can request something to eat in the evening. Twenty service user comment cards were returned to CSCI. Eighteen responded that the home provides suitable activities, two said sometimes. Nineteen said they liked the food, one said sometimes. Asked ‘do you wish to be more involved in decision making at the home’, fifteen said no and two said yes. Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The home has a complaints policy. There have been no complaints made to CSCI or the home since the last inspection. Staff recruitment procedures are satisfactory and are used to offer protection to service users. EVIDENCE: The complaints procedure is given to all service users and is within the Service User Guide for the home. Staff files were examined, one new recruit had a POVA First completed before commencing work and a CRB check had been received. Two satisfactory references were on file and induction had been given. A contract of employment had been issued. This was satisfactory. Twenty service user comment cards were returned to CSCI. All twenty confirmed that they feel safe at the home. Asked ‘if you feel unhappy with your care do you know who to speak to?’ seventeen said yes, one commented that they ‘had never been unhappy’. Seventeen service users indicated that they did not wish to speak to the inspector. Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 16 Relatives gave a mixed response to knowing about the homes complaints procedure, however, only two indicated that they had ever needed to complain. Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 The home has level access and was found to be clean, comfortable and well maintained. There are two assisted bathing facilities and there are sufficient toilet facilities. EVIDENCE: The home sits in pleasant grounds that have sufficient parking, level access to the main door. The home has comfortable communal areas, bedrooms are well appointed and twenty-one of the twenty-three bedrooms have en-suite toilet facilities. There is no lockable storage, this is recommended especially where service users self medicate. The home has one designated double room for service users who wish to share. Bedrooms can be personalised and can be locked. The two bathing facilities are assisted. Since the last inspection they have been fitted with hot water fail-safe devices to regulate the hot bath water Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 18 delivery temperature to a maximum of 43/44 degrees Celsius. This is a Health and Safety requirement made to prevent service users from suffering accidental scalding when bathing. The home was clean and is well maintained. The home is centrally heated and well ventilated. Radiators have not been guarded in all parts of the home. The home maintains risk assessments in relation to unguarded radiators. The radiators in the entrance hall and corridor were felt to be cool during the afternoon of the inspection, which was a particularly cold day. The lounges were kept warm. Care must be taken to ensure that the ambient temperature of the home is kept warm in such cold weather. The in house fire alarm check was made on 22/02/06 the zones are varied each week for testing. The home has a contractor checking the fire alarm and detection systems on a quarterly basis and in house checks are carried out weekly/monthly in between as required. The annual fire extinguishers checks were due. Fire training has been held Mrs Twohig confirmed that all staff have attended. There is a call bell system throughout the home. There are hand washing facilities for staff and staff have access to protective clothing, gloves and aprons. The home has waste control contract arrangements. The inspector noted that bathroom floors are carpeted; this is not the optimum floor covering for communal bathrooms and toilets. Washable flooring should be considered when the bathroom floor coverings are next replaced. Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The home has a skill mix of appropriately trained staff. Recruitment practice was satisfactory. EVIDENCE: There was sufficient staff on duty at the time of the inspection. There is a senior carer role at the home and a senior is usually in charge of the home. Three carers work with a senior in the morning and two during the afternoon. At night there is a senior plus a carer. The seniors have specific delegated management tasks for example one takes responsibility for allocation of the duty rotas. The home works with establishment hours of 479 care hours per week. The home recruited overseas staff through a recruitment agency last year, work permits and recruitment checks made at this inspection were satisfactory. The home has separate catering and cleaning staff. No issues were raised about staffing at this inspection. Training was evidenced with each staff member having a personal record. Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 20 Training has included food hygiene training, medication training, and first aid. Relatives responding in writing indicated that in their opinion there is always sufficient staff on duty. Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36,37,38 The home is well managed and service users benefit from Mrs Twohig’s leadership style. EVIDENCE: The Registered Manager, Mrs Gillian Twohig has many years of experience managing a care home for older people. Mrs Twohig is responsible for the dayto-day management of the home and is supernumerary to the care staffing number. Mrs Twohig has an open and enabling management style that is beneficial to staff and service users. Staff are given responsibilities and were seen to rise to the challenges and opportunities this offers them. Greenhill Grange is homely and service users were observed to be treated with care and respect by all staff. The last service Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 22 users/relatives meeting was well supported with twenty-two attending; ideas for improving aspects of the service delivery were openly discussed. Records were sampled for equipment servicing and maintenance: The fire log was up to date. Fire extinguishers were last serviced in 15.02.05 and were due. Evidence of fire training was seen. The home displayed the current CSCI registration certificate and their current employers liability insurance certificate. One liquid scented ‘plug in’ atomiser was seen that was on its side and leaking whilst being plugged into an extension lead. This was disconnected and removed at the time of the inspection. Care must be taken to use such items in line with the manufacturers instructions for safe use. Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 23 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 ENVIRONMENT CHOICE OF HOME Standard No Score 1 2 3 4 5 6 Standard No 19 20 21 22 23 24 25 26 Score 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 3 2 Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 24 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 OP38 Regulation 13(4)(a) Requirement Electrical ‘plug in’ air fresheners must be used safely. Timescale for action 12/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP26 Good Practice Recommendations Communal bathroom and toilet floor coverings should preferably be washable and waterproof for optimum infection control. This should be considered when carpeted floor covering is replaced in bathrooms/toilets. Greenhill Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Grange Residential Home DS0000064201.V277967.R01.S.doc Version 5.1 Page 26 - 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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