Inspection on 09/03/09 for Greenhill Grange Residential Home

This inspection was carried out on 9th March 2009.

CSCI found this care home to be providing an Good 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 Grange Residential Home 09/03/07

Greenhill Grange Residential Home 22/02/06

Greenhill Grange Residential Home 28/09/05

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Greenhill Grange Residential Home Catherston Close Frome Somerset BA11 4HR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Shelagh Laver     Date: 0 9 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Greenhill Grange Residential Home Catherston Close Frome Somerset BA11 4HR 01373471688 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Greenhill Grange Residential Home Ltd care home 25 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 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. Mrs Twohigs daughter, a registered nurse and manager of a nearby nursing home, also assists Mrs Twohig with staff training and management areas of the 0 Over 65 25 Care Homes for Older People Page 4 of 25 Brief description of the care home home.The fees were confirmed as five hundred pounds a week in March 2009. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last Key inspection of the home was 09/03/07. An Annual Service Review was undertaken on 01/04/08 when 18 people in the home, 21 relatives and 7 staff returned comment cards that were positive about the care and management of the service. The home continues to provide a good standard of care and support to people who live there. On the 09/03/08 March we (CSCI) made a visit to the home and met with people who live in the home and staff. We made a tour of the home and reviewed care and staff records. The manager Mrs Twohig was available for most of the day and provided all assistance. Prior visiting the home we had received an Annual Quality Assurance Assessment which gives information about the service. The AQAA contained a review of what had been achieved in the previous twelve months and sets out plans for the coming year. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? The recommendations made at the last Key Inspection have been addressed. The medication system has been reviewed and all senior staff who give medication have received external training. There are plans to provide training up-dates annually. People are able to self-medicate if they wish to and are assessed as safe. The achievement of National vocational Qualifications has improved. Care Homes for Older People Page 8 of 25 The bathroom floors have been recovered. A hoist has been purchased to raise people from the floor in the event of a fall. All people have a comprehensive care plan that includes nutritional assessments. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is information available to assist people to make a choice before they come to the home. People have a comprehensive assessment before they come to the home to ensure the home can meet their needs. Evidence: Information is available for people to help them make choices about coming to the home. Some people spoken to during the visit to the home had not had an opportunity to visit the home prior to coming to live there because they had been unwell. Two people talked about the role of their relatives in selecting a home. The manager always conducts an assessment visit prior to someone coming to live in the home. Completed comprehensive assessments were seen in peoples files. On the day of the inspection the manager went to complete an assessment after being sent a care plan from Social Services. The manager discussed the importance of always completing an assessment even Care Homes for Older People Page 11 of 25 Evidence: when there was a sense of urgency because a hospital discharge was needed. Records were also seen that showed that people were reassessed by health professionals as their needs changed and in some cases more appropriate care settings were found. Care Homes for Older People Page 12 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 in the home receive a good standard of personal and health care. There are sound systems in place for the administration of medication. People are traeted with kindness and respect by staff. Evidence: All people spoken to during the inspection said that they were well cared for. There was further evidence in the Residents Questionnaires sent out by the home that people found the care to be good or excellent. Each person has a care plan that is completed and up to date. There is evidence that people and their families are involved in setting up the plan. Three plans were seen and reviewed in detail. The plans included a background profile of the person in some cases written by family in others by the person themselves. The home has systems in place to assess nutritional status and risk of pressure damage. The inspector discussed with the manager the need to put a plan in place to prevent pressure damage if a person is assessed as being at risk. The manager said that the home has had no-one with pressure damage as the staff knew what to report and were very observant. Care Homes for Older People Page 13 of 25 Evidence: Weights are recorded regularly and kept in a book. It is important that the weight records kept in the care plan are also clear and up-to-date. We discussed the importance of keeping more detailed nutritional records when a person has a short term illness or there is concern about their weight. Regular reviews are held in the home. One persons first review after admission was being held during the inspection. Relatives or representatives are invited into the home and the care plan is discussed. There is an opportunity to to discuss any concerns or request changes to care. The manager said that relatives might come with a prepared list of issues to discuss which was good because it means that all items are addressed thoroughly. Senior staff will attend the reviews and take responsibility for making changes to care plans. There are regular visits from health professionals, doctors and nurses to the home. There is support available from community Psychiatric Nurses when needed and input to one persons care plan was discussed. A Nurse Practitioner visits the home regularly and this has given continuity of care and was seen as a beneficial development providing the opportunity for regular health checks and referring to the doctor when needed. There is evidence that people can access specialist care when needed. In care plans there are clear records of visits from doctors, nurses, chiropodists and opticians. People can make their own arrangements and continue to visit their own choice of professional services with family or home support. There is one senior member of staff responsible for ordering medications. records of medication were clear and there were no gaps. Three controlled drug records were checked and were found to be accurate. There are systems in place for the disposal of unused medications. Creams for topical application are dated on opening and there are systems in place to monitor applications. The staff administering medication receive regular training up-dates. Throughout the inspection people were seen to be treated with kindness and respect. There are links to the local hospice when palliative care is required. Care Homes for Older People Page 14 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 are able to make choices about how they spend their days at the home. There is a varied range of activities and social events available in the home. The people in the home are offered a nutritious and wholesome diet. Evidence: People spoken to during the inspection were pleased with the meals provided. One person said The cook brings breakfast in our rooms if we want it. Some people like to go to the dining room. The days lunch menu is displayed in the dining room. People are offered alternatives if they do not want the main dish. Omelets and salads are always available. It is recommended that the choices of meals available are written on the menu board or elsewhere so that people can see on a daily basis what their choices are for meals. The kitchen has been awarded five stars (the highest rating) after a visit from the Environmental health agency. People can choose how they spend their days at the home including what time they get up and go to bed. One person was sleeping very late and another person likes to sit up late watching sports on television. Some people spoken to liked to spend much Care Homes for Older People Page 15 of 25 Evidence: of the day in their rooms. People were seen reading their papers or books. Others like to go to the sitting room for much of the day. At coffee time during the visit to the home there were five people reading papers, knitting and sitting talking to each other. A Pat dog had come to visit. One person seen sleeping in her chair during the morning clearly enjoyed this visit very much. Staff took time to ensure that the meeting was a success. The activities available are written on the board is each day. The activities cocoordinators offer exercise classes, bingo, read the local papers and craft classes. There is on-going interest in the chickens that were hatched. There are trips and outings planned. Photographs and newsletters show that the home marks the passing of the seasons with events. There were photographs of Christmas celebrations, Harvest festival, Easter Bingo and the Burns Lunch. The dates when communion can be taken in the home are displayed. People are encouraged to go outside and enjoy the gardens when the weather is suitable. some people were seen walking around the outside of the home. People can be involved in the gardens if they chose. There is a green house and allotment where some of the produce for the home is grown. In the central courtyard there are pots where people can grow their own plants. There was discussion of a sunflower competition for this summer by some people in the sitting room. Visitors are welcome at any time and were seen in the home. The home has good links with the local community. They take part in the Frome in bloom competition. The Carnival Queen comes to visit. The hairdresser attends the home twice a week and people were seen in their rooms having their hair dried. Care Homes for Older People Page 16 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 home has a complaints procedure in place. People are confident that their concerns will be addressed. The home has policies and procedures in place to protect people. Evidence: People spoken to during the day said that they would feel quite happy speaking to staff about any concerns that they had. Some people would raise matters with care staff, others would ask to speak to the manager. One person said that things were always sorted out and never got to the complaint stage. Staff receive training in safeguarding adults. This training should be linked to the local authority guide lines so that senior staff know what action to be taken should the need ever arise. . Care Homes for Older People Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 live in a home that is comfortable and adapted to meet their needs. There is a system of planned maintenance in place. Evidence: Overall the home was comfortable and clean on the day of the inspection. All en-suites and bathrooms were clean and warm. Questionnaires sent to people in the home as part of the services quality assurance system indicated that people rated cleanliness of the home as excellent or good. People are able to make choices about their own rooms. One person had brought her own bed and all rooms reflected peoples tastes and contained personal belongings. The gardens are a feature of the home. There is a lawned area with wonderful views of the surrounding countryside. There is also a sheltered internal courtyard. This can be accessed from peoples rooms via patio doors. People are encouraged to take an interest in the pots in the courtyard and to choose plants if they wish. People were discussing their choice for this year with people favouring sun flowers with an element of competition. There are procedures in place to prevent the spread of infection however it is good practise to have staff hand washing facilities including liquid soap, paper towels and flip top bins in all bedrooms. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a sound system of recruitment in place which could be improved with attention to good practise. People in the home benefit from being cared for by staff that are well trained and supervised. All staff in the home are qualified to National Vocational Qualification level 2 or above which is a real achievement. Evidence: Rotas indicated a balanced staff team on duty in sufficient numbers. People said that there were usually enough staff on duty. Staff are well trained and people in the home benefit from a stable workforce. Four staff files were reviewed. Two staff had been recruited recently. Each file contained an application form and two references. It is good practise to ensure that one reference is from the last employer. If this is not available a note should be made on the file to say why this could not be obtained. It is good practise to ask for ten years of employment history. If this is not available on the application form this area should be explored at interview. Staff had had Criminal Record Bureau checks and there was a record of formal induction. The home is currently considering using the Skills for Care Induction standards and this is recommended. Care Homes for Older People Page 19 of 25 Evidence: There was evidence that established staff had received training and appraisals. The file of one senior member of staff had maintained her mandatory training and had attended Medication up-dates and become a Moving and Handling Instructor. There is a system of appraisals in place. Staff training is co-ordinated by one senior member of staff. 100 of care staff are trained to National Vocational Qualification level two. This is a real achievement as the target is 50 . Senior staff have gone on to take NVQs at Level 3 and 4. Other staff are encouraged to obtain level 3 nad are actively working to wards this. Senior staff have a medication review and up-date annually. The mandatory training for staff for example fire and first aid is tracked and recorded. Manual handling up-dates should be included formally on this grid. The home has three manual handling trainers in-house that monitor practise and up-date staff as and when needed. Recent this has included training with the new hoist and when a new person comes to the home. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 benefit from a home that is well managed in their best interests. There are systems in place to maintain the health and safety of people who live in the home. Evidence: The home benefits from a stable and well qualified management team. The registered managed has allocated key responsibilities to three care co-coordinators and this system works well. One person is responsible for the medication orders, another training and another recruitment and staffing. There are systems in place to co-ordinate the functions of the home through regular meetings. There are regular supervisors meetings. The registered manager keeps a management grid to track key activities. Staff in the home work well in a team. Records were seen of the homes response to Care Homes for Older People Page 21 of 25 Evidence: an infection risk in the home. Additional staff training was organised, appropriate action taken and the infection was contained without risk to other staff or other people who live in the home. The home responds well to challenges and always tries to secure the best outcome for people who live there. The home holds regular Residents Meetings. Minutes of these were seen. There were opportunities to discus forthcoming activities, menus and issues of concern. Questionnaires are distributed to people. One was administered independently. newsletters are complied by the activities co-coordinators and include information about activities in the home and news of staff and people who live in the home who also contribute news items. Thereare sytems in place to ensure the health and sfaety of people who live in the home and staff who work there. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 When a person is assessed as being at risk of pressure damage or poor nutrition it is good practice to record the action that is taken to miniomise further damage. It is good practice to offer the choice of meals available in written form so that people are clear what is available on a daily basis. l The homes safeguarding adults training should be linked to the local guidance so that staff are claer what action is to be taken. It is good practice to have staff hand washing equipment (liquid soap, paper towels and flip top disposal bin) in all rooms but particularly where regular personal care is being provided. Changes to the recruitment practise should be implemented as discussed during the inspection. 2 15 3 18 4 26 5 29 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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