Inspection on 28/09/05 for Greenhill Grange Residential Home

This inspection was carried out on 28th September 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Greenhill Grange Residential Home 09/03/09

Greenhill Grange Residential Home 09/03/07

Greenhill Grange Residential Home 22/02/06

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 Unannounced Inspection 28th September 2005 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.V254447.R01.S.doc Version 5.0 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.V254447.R01.S.doc Version 5.0 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.V254447.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th March 2005 Brief Description of the Service: Greenhill Grange is a purpose built home situated in a residential area of Frome. The home is set in its own very pleasant gardens with extensive countryside views. 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.V254447.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken by B Ludlow for CSCI. The homes Manager came to the home and kindly stayed throughout the inspection day to assist with the inspection process. The Senior Carer in charge was available throughout her shift and assisted the inspector with information as requested. The home was found to be well presented, homely and comfortable. Twentythree service users were in residence. Service users spoken with were happy at the home and confirmed that they felt well cared for. A tour of the premises was made and all service users were seen both in their rooms and in the communal areas of the home. Sixteen service users were spoken with during the inspection day. Lunch was observed being served. Records for inspection included care plans, activities and medication administration records, staff recruitment and duty rotas, maintenance and equipment servicing records. What the service does well: What has improved since the last inspection? Greenhill Grange Residential Home DS0000064201.V254447.R01.S.doc Version 5.0 Page 6 This was the first inspection by B Ludlow and it was not possible to judge improvements in the service. However, attention had been given to all except two of the requirements made at 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. Greenhill Grange Residential Home DS0000064201.V254447.R01.S.doc Version 5.0 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 Grange Residential Home DS0000064201.V254447.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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 service user guide had been reviewed in April 2005. Contracts were sampled and were satisfactory. The Manager undertakes pre-admission assessment before a service user is admitted to the home. EVIDENCE: The most recent Statement of Purpose was confirmed as April 2004. The latest version of the Service user Guide (April 2005) was given to the inspector. This document provides a good level of information about the services offered at the home. Greenhill Grange Residential Home DS0000064201.V254447.R01.S.doc Version 5.0 Page 9 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. One service user spoken with was on week three of her trial period and was about to decide whether or not to stay permanently. Another review is made after about six to nine months with a care supervisor, Mrs Twohig and the service users representative if they wish, these meetings would be documented and held one file. Files were sampled for recent admissions; the examples of the resident’s agreement seen were satisfactory. 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 fees are currently up to a maximum of £450.00 per week unless where a double room is occupied as a single room by choice, when £525.00 per week is charged. Charges are made for extras such as hairdressing, chiropody newspapers, personal toiletries and transport. Greenhill Grange Residential Home DS0000064201.V254447.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Service users were well attired and all looked to be well cared for. Service users all spoke positively about the care at the home and the care was documented in the care plans sampled. One service user commented that ‘the staff are all lovely and the Manager Gill is very nice’. EVIDENCE: All service users had care plans. Photographic identification is used and appropriate personal information was recorded. Care plans sampled had falls risk assessments and manual handling assessments recorded. Review meetings are documented and evidence of social worker visits and input in a Care Manager capacity was seen recorded. The district nurse was seen visiting the home during the inspection. One partially sighted service user was seen to have a large buttoned telephone for ease of use. Greenhill Grange Residential Home DS0000064201.V254447.R01.S.doc Version 5.0 Page 11 Medication Administration Records were seen and were satisfactory. The lunchtime medication round was seen in progress and was observed. Care was taken when tablets were dispensed straight from nomad boxes, however, an alternative method should be considered to ensure that tablets are not directly handled. Tablets were seen in one bedroom that were not locked safely away, lockable storage should be provided and care of medications agreed and monitored for safety. It was noted that creams for use in service users bedrooms had not been labelled with opened on nor discard by dates, this is required. The home had recently had a very thorough pharmacy inspection; recommendations had been to the GP and the home. The home was advised to update the homely remedies policy, the fridge policy and it’s management, these items will be followed up in detail at the next inspection. It was reported that no service users had pressure sores and that there had been no admissions to hospital via the accident and emergency department. Service users spoke highly of the staff and management; observed interactions between staff and service users were patient, kindly and appropriate. Greenhill Grange Residential Home DS0000064201.V254447.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Service users spoken with commented that they were satisfied with the care and service offered at the home. There are a good variety of activities on offer and service users can choose how they spend their time. One service user commented that ‘everything is good about living here’. 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. The service users were reported to be having a quiet day following the previous evenings residents meeting and day’s events, which had been the morning, visit by the PAT dog and afternoon Bingo. The home has good community links. Service users were seen ready to go out and one day care service users was seen arriving. Service users are encouraged to grow patio plants such as tomatoes, one service user had achieved a certificate awarded by Frome in Bloom and had Greenhill Grange Residential Home DS0000064201.V254447.R01.S.doc Version 5.0 Page 13 also taken the in house garden competition prize. The home has well kept gardens and a pleasant outlook from the communal areas, with views out across the fields from the big windows. Service users asked enjoyed this aspect of the homes environment. One service user commented about enjoying being taken out to the shops and joining in with the activities and events at the home. The home has a well-stocked shop for service users to purchase small necessities such as toiletries. The menu is displayed each day on the chalkboard. 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, service users confirmed that the food was enjoyable. One service user recalled that: Lunch today was fruit juice, sausages and onions, cauliflower cheese, mashed potatoes, followed by jam tart and custard and coffee. Tea was a ‘birthday tea’ for another service user and would be mixed sandwiches, sausage rolls, cake and trifle. The inspector was also informed that ‘the soups are varied’ and that ‘the alternate day roast is always good’. Another service user said ‘the food was marvellous, always a three course lunch, with sherry on Sundays’, ‘breakfasts of fruit, prunes, cereals, and toast’. ‘Cups of tea or coffee’. Greenhill Grange Residential Home DS0000064201.V254447.R01.S.doc Version 5.0 Page 14 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 The home has a clear complaints policy and procedure. EVIDENCE: There have been no complaints made to the home or CSCI since the last inspection. The complaints procedure is given to all service users and is within the Service User Guide for the home. Greenhill Grange Residential Home DS0000064201.V254447.R01.S.doc Version 5.0 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 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 and comfortable. There are two assisted bathing facilities and sufficient toilet facilities. The hot water is required to be controlled at the bath hot tap outlets to a safe temperature, by fail-safe device. 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. Greenhill Grange Residential Home DS0000064201.V254447.R01.S.doc Version 5.0 Page 16 The two bathing facilities are assisted. They require hot water fail-safe devices to be fitted to regulate the hot bath water 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. Bathing is supervised but the risk remains with an ambulant and able service user group. The homes Proprietor/Manager Mrs G Twohig, agreed to deal with this at the time of the inspection, as soon as possible. The home was clean and well presented and 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 home has an emergency lighting system that is tested on a regular basis evidence supported testing 20.07.05 and 20.08.05 and therefore due for September. The fire alarm was serviced on 20.07.05 and the emergency lighting was fully checked at this point. But is required to be inspected on a monthly basis. There is a call bell system throughout the home. Greenhill Grange Residential Home DS0000064201.V254447.R01.S.doc Version 5.0 Page 17 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 an adequate level of staffing demonstrated on the rotas to deliver a good service to the service users. Training is encouraged for staff to meet the needs of the client group in residence. The homes recruitment practice was not as well managed as it could be and a requirement is made. EVIDENCE: At this inspection there was one senior carer in charge plus two experienced carers on duty. There are three staff on duty throughout the waking day and there are two waking night staff on duty each night. This was evidenced on the duty rotas seen. Staff received praise from service users who found them kind and helpful and one service user informed the inspector that they ‘have very good staff here’. The staff group totals twenty and eighteen are care staff. Care staff are delegated to key work for individual service users. Staff receive training and are encouraged to undertake NVQ training. Two staff have achieved NVQ Level 3 and three staff have achieved NVQ Level 2, five staff are working towards NVQ Level 2. Greenhill Grange Residential Home DS0000064201.V254447.R01.S.doc Version 5.0 Page 18 Recent staff training included medications training for staff that dispense medication at the home. Fire training is held twice per year, 18 staff are recorded as attending 03/03/05. Seven staff received fire training on 27.09.05 and 13 staff are due to complete the fire training sessions for September. Two staff recruitment files were examined: All staff had a CRB, however, POVA First checks which to enable staff to be checked against the POVA list before commencing work had not been utilised by the umbrella body. CRB checks had been applied for in one case after the employees first two days of working. This is poor and should be addressed for all future employees of the home. This is therefore a requirement at this inspection. Overseas staff were confirmed as having CRB checks. Two references had been obtained but did not have the date written or the date received on them, adding the date received is recommended. Good practice included: Contract of employment was seen for one member of staff and had been highlighted on record as an omission for another. Supervision and appraisal were seen on file. Induction training that included fire training and manual handling training was recorded. Young employee discussion and workplace risk assessments were evident where a member of staff was less than 18 years of age and was on an approved training course. Greenhill Grange Residential Home DS0000064201.V254447.R01.S.doc Version 5.0 Page 19 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): 31,32,35,37,38 The home is very inclusive and the inspector was impressed with the homes philosophy and management style. Financial records were satisfactory. All records were seen to be appropriately and safely stored. 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 level. Records were sampled for servicing, maintenance, personnel and recruitment and care planning and medication administration. Greenhill Grange Residential Home DS0000064201.V254447.R01.S.doc Version 5.0 Page 20 The servicing records were satisfactory; the emergency lighting does require a regular monthly inspection. The weekly fire alarm tests had been carried out, last dated 21.09.05. The mobile hoist had been checked on 30.08.05. Gas safety Certificate was dated 12.10.04. COSHH practice seen was satisfactory. Accident records were the new style for staff. Service users had the details recorded on an individual sheet plus a sketch of the event and falls risk assessment would be undertaken if appropriate from the events recorded. The hot water at bath tap outlets was recorded to be 47 degrees C and 50 degrees C, these are excessive and when reported to Mrs Twohig assurances were given about all bathing being supervised and that urgent attention to the fitting of failsafe devices to remove the danger from accidental scalding would be given. This must be confirmed with the inspection response. The home has a range of policies and procedures in place. These include staff whistle blowing. Service users pocket money records were seen for 15 service users. These were for small amounts only, the accounts are checked each time any money is taken out or added. Receipts are kept and two signatures are recorded. Access to the money which is securely held, is restricted. No passbooks or bank accounts are held by the home. Greenhill Grange Residential Home DS0000064201.V254447.R01.S.doc Version 5.0 Page 21 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 X 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 X 3 1 Greenhill Grange Residential Home DS0000064201.V254447.R01.S.doc Version 5.0 Page 22 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 OP9 Regulation 13(2) Requirement Timescale for action 2 OP38 13(4) Prescribed skin creams must be labelled with an opened on and 17/11/05 /or discard by date. This was required at the last inspection by 11/04/05. Hot water must be restricted to a 17/11/05 safe temperature limit of 43 degrees C at the hot bath tap outlets by fail-safe device to reduce the risk to service users of scalding. This was required at the last inspection by 02/05/05. Action taken must be confirmed with the inspection response. 17/11/05 Where a member of staff is required to commence work before a full CRB check can be obtained a POVA First check must be requested and undertaken, as a minimum before the staff member commences working at the home. 3 OP29 19(1)(b) (i) Sch 2 Greenhill Grange Residential Home DS0000064201.V254447.R01.S.doc Version 5.0 Page 23 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 3 Refer to Standard OP9 OP38OP25 OP29 Good Practice Recommendations Medication and processes for administration should be reviewed to ensure medications are not handled. Emergency lighting should be checked on a regular monthly basis. Staff references should be dated when received at the home. Greenhill Grange Residential Home DS0000064201.V254447.R01.S.doc Version 5.0 Page 24 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.V254447.R01.S.doc Version 5.0 Page 25 - 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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