Inspection on 27/01/06 for Greenhill House

This inspection was carried out on 27th January 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 House 24/04/07

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 Caroline Baker Unannounced Inspection 10:00 27 January 2006 th 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.V265847.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 House DS0000015979.V265847.R01.S.doc Version 5.0 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.V265847.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th July 2005 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 registered manager is Bernice Parfitt; 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. Greenhill House DS0000015979.V265847.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last inspection was announced and took place on 14th July 2005. This inspection was unannounced and took place over one day from 10:00hrs (4.5 hours) and was conducted by Caroline Baker. Not all of the National Minimum Standards (NMS) were assessed at this inspection and this report should be read in conjunction with the report from the last inspection. Twenty-two service users were residing at the home. Staffing levels exceeded minimum levels. An assessment of the premises took place where a selection of bedrooms and communal areas were seen. At least nineteen service users were spoken with. Sylvia Stowe the area manager was at the home conducting her Regulation 26 visit and Bernice Parfitt, the registered manager, was available throughout the inspection. Throughout the day the inspector was able to observe interactions between staff and service users and was able to join service users for lunch. Records relating to the care of the service users, staff and health and safety were examined. The inspector would like to thank service users and staff for their time and help during the inspection. What the service does well: Greenhill House provides a well-maintained, secure and environment, which meets the needs of the current client group. comfortable Service users were observed using all communal areas and appeared comfortable and relaxed in their environment. Service users spoken to stated that they liked their bedrooms and were happy and felt safe at the home. Service users were well attired and looked well cared for on the day of inspection. Service users praised the food. A good choice of wholesome food was given. Greenhill House DS0000015979.V265847.R01.S.doc Version 5.0 Page 6 Fresh flowers were placed on every dining table, which were laid with tablecloths, cutlery, glasses and serviettes, and staff served residents in an unhurried and dignified manner allowing choice at all times. Service users praised the staff. Some comments received included: “they are all kind and caring”, “you couldn’t better it” and “the food is excellent”. Relatives spoken to indicated their satisfaction at the provision of care at the home. Two GP’s visiting spoke highly of the care provision at the home. Staffing numbers and the skill mix of staff were sufficient to meet the dependency needs of current service users on the day of inspection. Staff spoken with stated that they felt well supported and happy working at the home. Staff training was well documented and the provision of training for staff was very good. Staff looked and acted in a professional manner. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Greenhill House DS0000015979.V265847.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 House DS0000015979.V265847.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): 3. NMS 6 is not applicable to the home. The home was able to demonstrate that service users are fully assessed prior to admission to ensure their needs can be met. EVIDENCE: Evidence was seen in the most recently admitted service users care plans sampled that pre-admission assessments had been gained to ensure the home could meet their needs. Service users are able to visit the home at any time prior to admission. A day service can be provided to give them a flavour of the home. One service user spoken to confirmed this. Greenhill House DS0000015979.V265847.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7; 8; 9; and 10. Each service user had an individual plan of care. The home’s care planning system was overall very good however two seen had not been reviewed on a monthly basis. Service users agreed with their written care plan. Service users have access to health care professionals expertise to meet their individual needs. Service users were protected by the homes procedures in regard to the receipt, administration, recording and disposal of medications, however an improvement was needed in hand transcribing and recording of nonadministration for the safety of the service users. Service users were treated with kindness and respect. EVIDENCE: The inspector reviewed and assessed three care plans and met with the individual service users. One care plan reflected the service users current care needs and had been reviewed this month. Two care plans were in need of Greenhill House DS0000015979.V265847.R01.S.doc Version 5.0 Page 10 review and updating to reflect the current care needs of the service users. One service user had not been weighed since July 2005 according to the records. Social histories had not been completed for a number of months. Generic, falls, pressure sore, nutritional and manual handling risk assessments were in place. Evidence was seen recorded in the care plans of regular chiropody visits, GP’s and health care professional visits. During the inspection it was noted that district nurses were visiting at least two service users and the inspector was able to consult with two GP’s who were visiting the home. The GP’s spoke highly of the care provision at the home and commended it for its staff’s attitudes and kindness. Pressure relieving equipment was being used appropriately. Skin care was documented. None of the service users had pressure ulcers at the time of this inspection. All of the care plans seen had evidence of service user input. Medication systems were examined to include records of receipt, administration, and recording. Some service users had responsibility for their own medication, maintaining and encouraging independent living. Each bedroom sampled had provision of a lockable space to store medication in. Some minor shortfalls were noted during examination of the Medication Administration Records as follows: • • • on 3 occasions hand transcribed medication did not carry two signatures on 3 occasions the route or type of medication was not reflected and on 2 occasions there were gaps in signatures with no definitions as to why the medication had not been administered. As discussed with the manager it is recommended that a member of staff is made responsible to audit the medication records on a regular basis and ensure records of audits are maintained. The manager agreed that a visit from CSCI’s pharmacist inspector would benefit the home and assist in improving medication systems. Service users were treated and addressed appropriately by staff. Care plans reflected preferred names. Service users can lock their bedroom doors from the inside if they wish for extra privacy, and staff would be able to access the rooms from outside in an emergency. Staff were seen and heard to knock on doors before entering service users rooms. Service users spoken to indicated that the staff always treated them with respect. All of those service users consulted with and able indicated that they felt well cared for, liked living at the home, that the staff treated them well and that their privacy was respected. Greenhill House DS0000015979.V265847.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12; 13; 14 and 15. Service users benefit from a range of activities provided by the home to suit their individual choices and needs. The home is open to visitors at any time and encourages service users to access the local community. Service users individual choices and needs dictate the routine of the home. Service users are offered a choice of nutritious well-balanced menus promoting their health and well being. EVIDENCE: Activities such as, reminiscence, flexercise, music, films, quizzes, bingo, and crafts, are offered to all service users on a weekly basis. The home has access to a mini bus with a dedicated driver. Trips are organised on a regular basis. Service users spoken to at inspection were happy with the activities provided. On the day of inspection service users were seen enjoying a ‘ball throw’ and answering questions such as name days of the week or how many children they had had. Some were reading newspapers, others were knitting and some were watching TV. Greenhill House DS0000015979.V265847.R01.S.doc Version 5.0 Page 12 Each service user had an individual record of social activities they had joined in with evidencing that all service users have a chance to join in. The home has a visitor’s book, which indicated many visitors to the home at varying times. Service users told the inspector that their families and friends were made welcome at the home. Relatives spoken to during the inspection commended the home for its care provision, and indicated that they were always made welcome. It was evident through comments received from service users that they had a choice of daily living. The service users spoken to and able stated that the food was always good. The daily menu was displayed on a notice board and menus looked well balanced and nutritious. Everyone in the dining room at lunchtime appeared to enjoy their meals. The atmosphere was happy, unhurried and dignified. Hot and cold drinks were available throughout the day. Greenhill House DS0000015979.V265847.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 A complaints procedure is made available to service users to allow them to raise any concerns. Service users were given the opportunity to exercise their rights. Appropriate steps were being taken to reduce the risk of harm or abuse to service users. EVIDENCE: The complaints procedure is found within the statement of purpose, and Service Users Guide, which is displayed. All service users spoken to said they had no complaints and would know whom to talk to if they did. A complaints record is kept and the home had not received any complaints since the last inspection. The CSCI had not received any against the home. All staff before commencing employment at the home should have had a POVAFirst check as part of an enhanced CRB disclosure for the protection of vulnerable service users at the home. There had been one new member of staff since the last inspection. For the protection of the service users one member of staff had been dismissed and referred to POVA at the time of this inspection. All service users are registered to vote either by post or by being taken to the local polling station. Greenhill House DS0000015979.V265847.R01.S.doc Version 5.0 Page 14 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; 22; 23; 24; 25 and 26. Service users live in a homely, well-maintained, clean environment where they can enjoy the privacy of their own bedrooms or socialise in a variety of communal areas. EVIDENCE: All communal areas and at least ten bedrooms were seen at this inspection. The home was compliant with the local fire department and environmental health department. Service users seen were accommodated in single bedrooms on the ground floor, which are fitted with a wash hand basin. Service users are encouraged to personalise their rooms. Service users spoken with informed the inspectors that they were happy with their rooms. Communal areas consist of small sitting areas, two television lounges, a conservatory, dining area and paved garden area. Greenhill House DS0000015979.V265847.R01.S.doc Version 5.0 Page 15 The home is equipped with handrails along all corridors to promote independence. Corridors are wide and accessible by wheelchairs. There were ramps to facilitate easy access to the grounds. Many service users were seen using walking aids and appeared confident when using them. A company Occupational Therapist can give the home advice and support. Rooms sampled during the inspection had large windows overlooking the grounds. Emergency lighting was available throughout the home and was checked on a monthly basis. Records of bath temperatures had been maintained. An outside contractor tests all other hot water outlets. On the day of inspection the home was free of any offensive odours. All areas were clean and well maintained. The laundry facilities were adequate for the number of service users. There was a sluicing facility on the washing machines and access to an outside drying space. There were hand-washing facilities for staff in the majority of rooms where personal care was provided, and as discussed must be monitored to ensure it is always available. Gloves and aprons were seen for staff use. Greenhill House DS0000015979.V265847.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27; 29 and 30. The home’s recruitment procedures for staff mainly protect service users from the risk of abuse, however the company must ensure that POVAfirst checks are received before staff commence at the home. The numbers and skill mix of staff were adequate to meet the needs of current service users. Staff morale was good. EVIDENCE: Duty rotas were recorded and reflected the staff on duty at the time of the inspection. Copies were given to the inspector as part of the inspection process. Staffing levels exceeded minimum levels on the morning of the inspection. Service users and staff spoken to at inspection commented on how they felt the home was adequately staffed at all times. The homes own bank staff were used to cover any shortfalls. At the time of this inspection 22 service users were residing at the home. Staff training at the home is on a rolling programme and includes, for example, mental health awareness training, abuse awareness, risk assessing, NVQ 2 and 3 in care and health and safety training which includes: • Manual handling DS0000015979.V265847.R01.S.doc Version 5.0 Page 17 Greenhill House • • • • Infection control First Aid Basis and Advanced Food Hygiene And Fire Awareness training. Staff appeared relaxed and happy on the day of inspection and told the inspector that they enjoyed working at the home. Service users complimented the staff group. There had been only one member of staff employed since the last inspection. The individual recruitment file contained all documentation required by current legislation, however had commenced employment prior to receipt of a POVAfirst check. The manager explained that once this was recognised the member of staff was asked not to work until the check came back. One member of staff had been dismissed and referred to POVA at the time of this inspection. Greenhill House DS0000015979.V265847.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31; 32; 36; and 38. The registered manager continues to effectively manage the home. The home is committed to staff training. The systems in place for ensuring the health and safety of service users and staff were good. EVIDENCE: Bernice Parfitt continues to effectively manage the home. This was evident from comments received from service users, staff, relatives and health care professionals. Service users and staff spoke highly of the manager. Mrs Parfitt is responsible for the implementation of company policy in respect of all care home services and management of staff and all tasks in line with the Care Standards Act 2000. Greenhill House DS0000015979.V265847.R01.S.doc Version 5.0 Page 19 It was evident having spoken to staff and service users on the day of inspection, that the manager continues to communicate a clear sense of direction, and lead the staff in a way that they understand. Mrs Parfitt has completed and gained a National Vocational Qualification to level 4 in care and has completed the Registered Managers Award. She has commenced further training with Acacia in regard to Management Development. This shows a commitment to continuous professional development. The area manager had recorded monthly Regulation 26 visits and was undertaking a visit on the day of the inspection. Staff had received formal supervision and records of dates were seen. All service histories were current. The fire records were examined, the home conducts weekly fire checks. The emergency lighting and fire equipment servicing was up to date. Emergency lighting was tested on a weekly basis. The Electrical Hard Wiring was checked 20/12/04 Gas servicing was up to date. Portable Appliance Testing was due – January 2006 Records indicated that staff attended regular fire training. There were a total of 63 accidents recorded since July 2005. The large amount and reasoning was discussed with the manager. All accidents are audited and action taken to minimise the risk of falls. Two accidents had resulted in fractures. There has been one death at the home since the last inspection. The home has informed the CSCI of any serious incidents. The kitchen was clean and well organised and records were up to date. Greenhill House DS0000015979.V265847.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 3 3 3 3 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X 3 X 3 Greenhill House DS0000015979.V265847.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? 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 OP7 Regulation 15 Timescale for action All care plans must reflect 28/02/06 individual service users current care needs and be kept under review. All staff must follow the homes 28/02/06 medication policies at all times. A person must not commence 28/02/06 work at the home without a POVAfirst check, at least, being in place. Requirement 2. 3. OP9 OP29 13(2) 19 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Greenhill House DS0000015979.V265847.R01.S.doc Version 5.0 Page 22 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 House DS0000015979.V265847.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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