Inspection on 24/04/07 for Greenhill House

This inspection was carried out on 24th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 House 27/01/06

Greenhill House 14/07/05

Greenhill House 12/01/05

Greenhill House 06/07/04

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

CARE HOMES FOR OLDER PEOPLE Greenhill House Tweentown Cheddar Somerset BS27 3HY Lead Inspector Alison Philpott Unannounced Inspection 24th April 2007 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 House DS0000015979.V334723.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 House DS0000015979.V334723.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenhill House Address Tweentown Cheddar Somerset BS27 3HY 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) 01934 742280 01934 743476 Somerset Care Limited Mrs Bernice Lesley Parfitt Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Greenhill House DS0000015979.V334723.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27/01/06 Brief Description of the Service: Greenhill House is located on the outskirts of the village of Cheddar, where there are a range of shops, banks, post office, churches and public houses. The home is registered with the Commission for Social Care Inspection (CSCI) to provide personal care for 26 people over the age of 65. The acting manager is Avril Wright; the registered providers are Somerset Care Ltd. There are lawns at the front of the building and a patio area accessed through the homes conservatory. There are parking facilities at the side of the house. Greenhill House is a purpose built residential home providing accommodation on one floor. There are two lounges, a number of open plan sitting areas, a conservatory and a dining room. There are 22 single rooms and 2 double rooms. One single room has an ensuite facility. There are 7 communal toilets and 2 bathrooms fitted with bath hoists. All rooms are fitted with an emergency call system and all service user rooms are fitted with locks. A pay phone is available for service user use and service users are able to have a private telephone in their room if they wish. The current fee range is £373 to £420 per week. Greenhill House DS0000015979.V334723.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The previous inspection took place on 27 January 2006. This unannounced key inspection took place over 6.5 hours. Mrs Avril Wright, Acting Manager was available throughout the inspection. There were twenty three residents living in the home. During the inspection, eleven residents, one relative and four members of staff were spoken with. The Inspector viewed the home. Staff were friendly and were observed being kind and caring toward residents. Records viewed included care plans; risk assessments; medication; health and safety records; staff recruitment & training. The Inspector would like to thank the residents and staff for their involvement and participation in the inspection process. As a result of this inspection the home has four requirements and four recommendations. What the service does well: The home provides a well-maintained and comfortable environment. Residents spoken with confirmed that they are happy living at the home. Residents are very happy with the care and support that they receive. All residents spoken with commented on the kindness of the staff. One resident said ‘it’s great, we have a good laugh’. Staff are friendly and caring. Staff spoken with demonstrated a good knowledge of individual residents. Staff respect resident’s privacy and were observed offering support and choices to residents. Visitors to the home are made to feel welcome. One relative confirmed that they were very happy with the care provided, and commented that the “staff are superb”. The home has its own activities co-ordinator and provides a range of activities for residents. The home has a robust recruitment procedure to ensure that residents are protected. Greenhill House DS0000015979.V334723.R01.S.doc Version 5.2 Page 6 Residents are offered a choice of menu. Residents spoken with confirmed that the food is very good. What has improved since the last inspection? What they could do better: The care plans viewed did not contain detailed guidance for staff to follow in order to meet the resident’s needs. However, the home is currently in the process of implementing a new care planning format that will be person centred and contain more detailed information. There were a number of shortfalls relating to the recording of administration of medication. The home must review its procedures to safeguard residents. The home must undertake a detailed risk assessment for the un-guarded radiators in the corridor and take any necessary action in relation to this, to protect residents. The home must ensure all staff undertake fire training. The home should ensure that staff who handle food complete food hygiene training, and consider providing training in dementia awareness. This is so that staff are up to date with current best practice and equipped to meet the needs of residents. When carrying out financial transactions for residents, the home should obtain two signatures to protect residents. The home should review its practice of residents bedroom doors being left open to ensure that residents are not placed at risk of harm in the event of a fire. Latex gloves must be stored securely to protect residents from the risk of harm. Please contact the provider for advice of actions taken in response to this Greenhill House DS0000015979.V334723.R01.S.doc Version 5.2 Page 7 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 House DS0000015979.V334723.R01.S.doc Version 5.2 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 House DS0000015979.V334723.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home undertakes pre-admission assessments for prospective residents to ensure that their needs can be met appropriately. EVIDENCE: The inspector viewed two pre-admission assessments. These were comprehensive. Where one resident had been admitted from hospital, the home had also obtained discharge information. The information leaflet ‘Welcome to Somerset Care’ has been produced in Braille since the previous inspection. The home has not introduced intermediate care since the previous inspection. Greenhill House DS0000015979.V334723.R01.S.doc Version 5.2 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. 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. The home is developing its care planning systems. The home’s medication procedures do not fully protect residents. Staff respect resident’s privacy and dignity. EVIDENCE: Three care plans were viewed. These contained some good detail, highlighting individual resident’s preferences. All of the care plans viewed identified the need for some assistance with bathing, washing and dressing. However, there was no detailed guidance for staff to follow in order to meet the resident’s needs or information relating to their preferences. There was evidence that the care plans were reviewed monthly. The acting manager advised that the Greenhill House DS0000015979.V334723.R01.S.doc Version 5.2 Page 11 home is currently in the process of implementing a new care planning format that will be person centred and contain more detailed information for staff to follow. Risk assessments were viewed in relation to moving & handling and falls. Residents have access to a range of professionals including GP, District Nurse, Dentist, Social Worker, Optician and Chiropodist. A record of the visits is recorded in the care plan. The home stores medicines securely in a locked cabinet. The home was not storing any controlled drugs. The home uses a Monitored Dosage System. The inspector viewed the Medication Administration Record Sheets (MAR) for each service user. Some of the hand transcribed MAR sheets were not signed and dated. The home should ensure that hand transcribed MAR Sheets are dated and signed by two members of staff to safeguard residents. There were two gaps in the MAR sheets. It was of concern that a note on one of the sheets appeared to be asking a member of staff to sign for a medicine that should have been administered two days prior to the inspection. The home must ensure that the administration of medication is recorded on the Medication Administration Record Sheets at the time of administration, at all times to safeguard residents. The home does not currently record the application of creams to service users. The acting manager advised that a new system was being implemented. On several occasions, the home had changed a prescription on the medication administration record sheet. The home advised that this instruction had been received verbally by the GP. There was no documentation to confirm this. The home should request written confirmation of the change by fax to protect residents. All staff who administer medication have completed training. One service user self medicates. The home has undertaken a risk assessment and a lockable space is provided in the service user’s bedroom. Residents spoken with confirmed that staff respect their privacy and dignity. Staff were observed knocking on bedroom doors. Greenhill House DS0000015979.V334723.R01.S.doc Version 5.2 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. 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. The home has its own activities co-ordinator. Visitors to the home are made to feel welcome. Residents are very happy with the food at the home and the choices available to them. EVIDENCE: The home employs an activities co-ordinator who works four days a week. The activities programme included pet therapy visits, board games, whist, and gentle exercise. Residents spoken with confirmed that they enjoy the activities. Residents said that they had enjoyed the Easter bonnet making and the recent St George’s Day celebrations and musical entertainment. Greenhill House DS0000015979.V334723.R01.S.doc Version 5.2 Page 13 During the inspection, residents were observed reading, listening to music, watching television and chatting. The Inspector observed warm and friendly interaction between staff and residents. All residents spoken with commented on the kindness of the staff. One resident said ‘it’s great, we have a good laugh’. All residents spoken to confirmed that their visitors are made to feel welcome at the home. The inspector spoke with one relative who confirmed that they were very happy with the care provided, and commented that the “staff are superb”. The Inspector observed staff offering resident choices throughout the day. Residents confirmed that they can spend their time as they want to and that they are given choices. Resident’s rooms are personalised with their own possessions. The home has a six week menu. The tables in the dining room were laid attractively for lunch. All residents spoken with confirmed that the food is good and there is always a choice of dishes. Greenhill House DS0000015979.V334723.R01.S.doc Version 5.2 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. 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 home has a complaints procedure that is available to residents and staff. Residents are protected from the risk of harm. EVIDENCE: The home has a complaints procedure. Since the previous inspection, the procedure has been made available in Braille. The home had not received any complaints since the last inspection. Residents confirmed that they knew who to speak to if they had any concerns. Three staff files were viewed. These all contained evidence of POVA first checks and completed Criminal Record Bureau checks. The members of staff did not commence work until the home had received the POVA first check. The home has policies relating to whistleblowing and abuse. Staff spoken with demonstrated a good awareness of the steps to take if they witnessed or discovered abuse. Greenhill House DS0000015979.V334723.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, 25, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a well maintained environment with comfortable furnishings. The home was clean. The home has systems in place to control the spread of infection. EVIDENCE: The inspector viewed the home’s communal areas and a number of bedrooms. The home has two lounges, sitting areas, a dining area, conservatory and gardens. Since the previous inspection, the home has purchased some new chairs for the lounge. Residents spoken with were pleased with these. Greenhill House DS0000015979.V334723.R01.S.doc Version 5.2 Page 16 Several bedrooms have been re-carpeted since the previous inspection. The acting manager advised that there are plans for further improvements to the home. Three radiators in the corridors are not guarded. The home must undertake a detailed risk assessment and take any necessary action in relation to this, with particular regard to the vulnerability of some of the residents. The home was clean and smelt fresh throughout. The inspector observed that the laundry was clean and tidy. Aprons and gloves were available for staff. Liquid soap, hygienic hand rub and hand towels were provided. Greenhill House DS0000015979.V334723.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home appeared to have sufficient staff on duty to meet resident’s needs. Staff recruitment procedures are robust and protect residents. The home has a comprehensive staff training programme. However, a number of staff have not completed a fire training update. EVIDENCE: The inspector viewed the rotas. There appeared to be sufficient staff on duty during the inspection to ensure that resident’s needs were met. The home employs a care supervisor and three care staff during the day; one waking senior and one waking care staff at night. Residents spoken with confirmed that staff are available when assistance is required. Staff spoken with demonstrated a good knowledge of individual resident’s history, needs, and preferences. New staff had been recruited since the last inspection. Three staff files were viewed. All files contained the required documentation listed in Schedule 2 of the Care Homes Regulations 2001. Greenhill House DS0000015979.V334723.R01.S.doc Version 5.2 Page 18 The inspector spoke with a member of staff who had commenced work at the home since the previous inspection. They were able to describe the recruitment and induction process. The home has set up a mentoring system so that staff have additional support. The home has a training matrix. The training areas completed include moving and handling; first aid; food hygiene; medication. However, only the cook has attended a food hygiene update. The home should ensure that all staff who handle food complete food hygiene training so that they are up to date with current best practice. Twenty two members of staff have not completed fire training since April 2006. The home must ensure that all staff undertake fire training at least once or twice a year. Some staff have undertaken training in oral health and diabetes. The acting manager is currently providing some training on parkinsons. There are a number of residents with dementia care needs. The home should consider providing training in dementia awareness to ensure that staff are equipped to meet the needs of residents. 70 of the care staff have obtained an NVQ in care at level 2 or above. Three members of staff are currently undertaking an NVQ at level 2. Four members of staff are currently undertaking level 3. Greenhill House DS0000015979.V334723.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s has quality assurance systems in place. Residents’ monies are safeguarded. The health, safety and welfare of residents is not fully protected. Greenhill House DS0000015979.V334723.R01.S.doc Version 5.2 Page 20 EVIDENCE: The registered manager has left the home since the previous inspection. Avril Wright has recently joined the home as the acting manager. She has 4 ½ years experience of working at a senior level within Somerset Care. Avril has completed NVQ 3 in Management, the A1 Assessors Award and the IOSH certificate. She is currently working towards NVQ 4 in care. The home’s quality assurance systems include a self audit against the National Minimum Standards. This is undertaken at intervals at the request of Somerset Care head office. This standard was not fully assessed at this inspection. The home holds small amounts of cash for some residents. The monies are stored securely. Three financial transaction records were viewed. Some of the records are double signed by two people. Some records only contain one signature. If the resident is unable to sign the record with the member of staff, the home should obtain two staff signatures to protect residents. The home’s health and safety records were viewed. The fire log book was viewed. The fire alarm systems were serviced on 14.03.07. Extinguishers were serviced on 17.08.06. The home tests its fire alarms weekly. The home had organised a fire drill on the day of the inspection. The fire officer visited the home on 02.10.06. The report states the home has a satisfactory standard of fire safety. A number of residents bedroom doors were open at the time of the inspection. The doors are not self closing in the event of a fire. The home should review its practice to ensure that residents are not placed at risk of harm in the event of a fire. Latex gloves for staff use were easily accessible to residents in toilets and bathrooms. Some of the home’s residents have dementia care needs. The gloves must be removed to protect residents from the risk of harm. Portable appliance testing was undertaken between March and May 2006. The home advised that this year’s test is planned. The kitchen was clean. Fridge and freezer temperatures had been recorded. Food in the fridge was covered, labelled and dated. The Environmental Health Officer visited the home on 11.12.06. The home had taken action on the one issue identified. The home should ensure that staff receive training in all safe working practices (see Standard 30) in order to protect the health, safety and welfare of residents and staff. Greenhill House DS0000015979.V334723.R01.S.doc Version 5.2 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 X X 3 X X X 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 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 2 X X 2 Greenhill House DS0000015979.V334723.R01.S.doc Version 5.2 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 Timescale for action 13(2) The registered person shall make 31/05/07 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. (All staff must follow the homes medication policies at all times). (This time scale has been extended) 31/05/07 13(4)(a)(c The registered person shall ) ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. (The home must undertake a detailed risk assessment for the un-guarded radiators and take any necessary action in relation to this). 23(4)(d) The registered person shall after 24/07/07 consultation with the fire authority make arrangements for persons working at the care home to receive suitable training in fire prevention. DS0000015979.V334723.R01.S.doc Version 5.2 Page 23 Regulation Requirement 2. OP25 3. OP30 Greenhill House 4. OP30 (The home must ensure that all staff undertake fire training at least once or twice a year). 13(4)(a)(c The registered person shall 02/05/07 ) ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. (Latex gloves stored in bathrooms and toilets must be removed to protect residents from the risk of harm). 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 OP9 Good Practice Recommendations • • 2. OP30 • The home should ensure that hand transcribed MAR Sheets are dated and signed by two members of staff to safeguard residents. The home should request written confirmation by fax of changes to prescriptions to protect residents. The home should ensure that all staff who handle food complete food hygiene training so that they are up to date with current best practice. • The home should consider providing training in dementia awareness to ensure that staff are equipped to meet the needs of residents. When carrying out financial transactions for residents, the home should obtain two signatures to protect residents. The home should review its practice of residents bedroom doors being left open to ensure that residents are not placed at risk of harm in the event of a fire. 3. 4. OP35 OP38 Greenhill House DS0000015979.V334723.R01.S.doc Version 5.2 Page 24 Greenhill House DS0000015979.V334723.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South West Registration Team Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 House DS0000015979.V334723.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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