Inspection on 11/06/07 for Greenhill House - Leonard Cheshire Disability

This inspection was carried out on 11th June 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greenhill House - Leonard... 15/01/07

Greenhill House - Leonard... 27/06/06

Greenhill House - Leonard... 22/02/06

Greenhill House - Leonard... 18/10/05

Greenhill House - Leonard... 08/09/04

Greenhill House - Leonard... 30/04/04

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

CARE HOME ADULTS 18-65 Greenhill House Cheshire Home South Road Timsbury Bath Bath & N E Somerset BA2 0ES Lead Inspector Kathy Marshalsea Key Unannounced Inspection 11th & 12th June 2007 09:30 Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 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 Cheshire Home DS0000020243.V344248.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 Adults 18-65. 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 Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenhill House Cheshire Home Address South Road Timsbury Bath Bath & N E Somerset BA2 0ES 01761 470533 01761 479917 Greenhill@LC-uk.org www.leonard-cheshire.org.uk Leonard Cheshire 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) Mrs Frances Judith Ashby Care Home 37 Category(ies) of Physical disability (37) registration, with number of places Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing- Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: 2. 3. 4. Physical disability- Code PD May accommodate up to 20 persons aged 18 years and above who require nursing care. May accommodate up to 19 persons aged 18 years and above requiring personal care. The maximum number of service users who can be accommodated is 37. 15th January 2007 Date of last inspection Brief Description of the Service: Greenhill House provides places for 20 people needing nursing care and 17 people needing residential care with a range of physical disability between the ages of 18 and 65 years old. The home also offers day care for up to 5 residents each weekday. The home is rurally situated in its own grounds. It is an old converted property with a more recent extension to the rear, and 4 adapted flats in the Coach House where people live more independently. All the bedrooms are for single occupancy. There are 2 passenger lifts giving wheelchair access to all levels. The Activities hut is outdoors and accessible by a ramp. The home is part of the Leonard Cheshire Foundation and operates within its charter. Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced visit as part of a Key Inspection of this service. I gathered information through discussions with people who live and visit the home, the Registered Manager, one Senior Team Leader, and Support Workers. Interaction and communication between staff and young adults was also observed during the course of my visit. Care plans and associated records were examined together with Risk Assessments, accident and incident reports, complaints log, medication administration, personnel and health and safety records. Other sources of evidence have been used as part of the Key Inspection process. These include the home’s action plan in response to the last CSCI inspection, the providers own monthly auditing of the service and notifications of significant events which have occurred within the home. The Pharmacy Inspector did a thorough check of the medication systems at this visit. There has been a continuation of the improvements made at the last visit in January 2007.The Manager and staff are to be commended to their commitment to improving standards and meeting requirements. What the service does well: The home provides a specialist unit for adults with a physical disability. They are able to offer services for a range of disabilities. Service users coming in to the service can be assured that they will be fully assessed and only offered a place if the home can meet their needs. There remains a clear commitment from the staff team to support people living in the home, and visit it for day care, to benefit from the services and support available to them. The home endeavours to provide a range of leisure and educational opportunities. This has been extended and includes some evening and weekend sessions. Healthcare checks are done regularly and if the home were unable to meet that need an appropriate referral is made. Service users can be sure that their health is promoted and maintained where possible. Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 6 The Physiotherapy department play an important role in maintaining abilities and maximising mobility. Planned and regular staff meetings now take place ensuring that staff feel consulted and informed. The trained nurse team has increased so that they are able to spend more time on the documentation necessary to deliver effective care. It also means they can work as an effective team supporting each other. People living in the home are able lead their own meetings, which should mean that they feel free to express themselves without any staff present. Information from the meetings gets passed to the Manager when she joins the end of the meeting. Mrs Ashby’s management style and clear leadership has improved many areas of life in the home which were inadequate. This has meant that over the last two key inspections the rating given by the Commission for Social Care Inspection has improved at each visit and the home is now a “Good” service. Positive comments on survey forms included: “ It’s a nice place and I am happy here” “ I am happy here” “ The care is very good” “ I like talking to my key worker because he listens to me. I think the manager is helping the home to be a happier place”. “ It’s a warm and welcoming place where staff are always willing to deal with any concerns we may have. They are good at encouraging our relative when they are negative, and are usually ready with some humour. I think the activities hut is excellent.” What has improved since the last inspection? All of the areas mentioned in this section were requirements or recommendations at the inspection visit: The approach to risk management has greatly improved and has been sustained since the last visit in March 2007. Any accident/fall is checked to make sure that measures staff need to take to reduce any risk is still effective. Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 7 The supervision sessions are more structured and have clear areas of strength and weakness. Training needs are also more detailed and requests honoured in most instances. Care plans are still being worked upon so that they all achieve a consistent standard but are gradually becoming a more detailed account of each person’s needs. People who live in the home are not being offered locks on their bedroom doors and “Do not disturb” signs. The staff’s response to an allegation of abuse now follows local and company procedures. The Training plan is being developed but already shows a more comprehensive content and includes some individual requests. In house training sessions for staff are to begin so that staff are better trained in the conditions of the people they are looking after. The pay phone has been moved to give people using it more privacy. The strategies for how staff should deal with challenging behaviour now show the rationale for decisions made, triggers for behaviours and if the strategies have been effective. No negative words were seen in any care documents. What they could do better: The food provided needs to be more varied, nutritious and be presented more attractively. Fresh vegetables have been requested by people who live in the home but not given. The cook needs to be informed of any special diets so that individual needs can be met. Staff and people living in and visiting the home’s knowledge of fire safety procedures such as drills needs to improve quickly. Care plans should include people’s social care needs and how staff can support them to realise those needs. The staffing levels are satisfactory but people living in the home say staff’s responsiveness to them depends upon who is on duty. This may be affecting their confidence in the staff and is going to be addressed by the Manager. There needs to be a reinforcement of the complaints procedure so that all people living in the home are aware of the process they can use. Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 8 One comment on a survey form was: “The entire lounge area could be made more attractive”. 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. The summary of this inspection report can be made available in other formats on request. Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who wish to move in to the home are given accurate information before moving in about what they can expect while living in the home. EVIDENCE: The inspector met a person who had not been not living at the home for very long. They had chosen to move from their previous home and visited Greenhill before deciding whether they wished to move in. It had been possible for a few visits to take place including an overnight visit. A service user guide had been sent to them before they made their decision to move in. They said that they had enough information about the home and its services before they moved in. They also said that they had not had any surprises about the service after moving in. A pre-admission assessment had been done by the staff, which covered the person’s holistic needs and wishes. The staff and person whom it was about had signed this. There was also a contract of terms and conditions, which again was signed by the service user. Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 11 The Statement of Purpose had been revised in May 2007. The information in this document is a fair reflection of the service provided and what is available for each person. A large print copy is kept in the main lobby of the house. The service user guide had been updated June 2007. Again it gives the reader useful information about life in the home and what each person can expect. Various attachments are included giving more detail of areas such as typical activities/trips. These documents are available on CD rom and can be used in the computer room. Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is sufficient information in the care plans for staff to know people’s health, personal and psychological needs but they need more detail of social needs. People can be assured that any risks for them are minimised as much as possible by the staff’s vigilance. EVIDENCE: Several people who live in the home were case tracked to make sure that their holistic needs had been assessed and planned for. We also wanted to make sure that they are included in this process. Five individual care plans were read and various documents related to each person’s care. Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 13 One plan was for a relatively new person and the file contained a detailed preadmission assessment. Not all of the information in here was used in the care plan including the person’s wishes socially and personally. Instructions for staff to follow were not detailed. The service user had signed the plans. The home routinely completes a personal profile and personal support plan. A skills and interests from is used to determine goals and how staff can support each person to achieve those goals. These were present for this person. Another plan was quite detailed but had no information when reviewed. This person is cared for by agency staff 24 hours a day. They have not been involved in these documents apart from writing detailed daily records. There has been a meeting between the agency staff and home staff involved in this person’s care. There are plans to have another meeting and decide how best to make the care documentation up to date and reflect what the agency staff are doing. This should include the various risk assessments related to the persons’ high risk of falling. The third plan was up to date, detailed, showed achieved goals and the involvement of the service user. It included a behavioural management plan after incidents of inappropriate behaviour. This gave staff the strategies to use to help the service user and prevent an escalation of behaviour. The fourth plan had improved since the inspector read it at the last visit. It was easier to find up to date plans and now included psychological plans. There were signs for staff to follow and recognise when they needed to intervene. There was some improvement to be made to the plan for eating after receiving dietetic advice and ensuring that monthly weights were done. The fifth plan was for someone who had lived in the home for some time. It was disappointing that this plan was purely about the person’s physical needs. There was no skills and interests profile or a personal profile. The key worker for this person said that this person chose not to join in the usual programme of activities and trips. However, they do have interests and family involvement, which needs to be recorded. It was not evident if the person had been consulted about their care plans. There was confusing information about which risk assessment to follow to try and prevent the high risk of falls, as there were several. The risk assessment for falls in all instances included each new incident/fall and if the strategies being used are still effective enough. End of life plans are also being done gradually with each service user so that staff can be confident that they will be able to honour each person’s wishes. Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The meals have not always been nutritious and balanced or attractively presented. Choices and individual preferences are not always given. EVIDENCE: “I reckon the meals are horrible. I’ve been used to having nice meals”. “The meals are generally nice but the veg is frozen and would like fresh”. “The meals are bland, flavourless. Could be much better with seasoning, colour & presentation”. “Very good meals”. “I would like a change to the meals because I don’t eat cheese and tomatoes”. “I would like the residents to have more say in the menus”. “There is plenty of choice. I think 5pm is too early for supper. I am hungry later”. Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 15 The above comments were on the survey forms received from people who live in the home. I checked the menus and how these are decided. There is a food steering group which includes several people who live in the home. This has led to the menus being changed to include some suggestions from this meeting. They also asked for the menus boards to be hung lower so that they could be easier read for anyone in a wheelchair. In April’s meeting more fresh vegetables were requested. I checked the kitchen stores and found few fresh vegetables and lots of frozen vegetables. I ate a meal which had only tinned/frozen peas with it. This was discussed with the Manager who agreed that it was possible to use fresh vegetables at each meal, and that this could happen within 2 days of the visit. Fruit baskets are put out each day and people who live in the home say that is normal. From discussions with the cook it seems that not everyone is given daily additional choices for meals. The kitchen staff ask the people who live in the residential section which of the two choices of lunch they’d like and agree an alternative if they don’t like those options. This is not done for the people who live on the nursing wing. This can lead to late requests for a different meal which then can’t be done. Any special diets are not always communicated effectively to the kitchen staff. The cook needs to be included so that enriched or special diets can be provided where necessary. At the moment there is only a teatime cook for two days a week. The Manager said it had not been possible to replace the person who left but will look at this again. It has meant that care staff have been involved in some food preparation. The manager is reviewing this. Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home receive regular support to ensure their physical and emotional health needs are met. Medication is generally well managed in the home. Some remaining difficulties with supply of medication need to be resolved. EVIDENCE: All people living in the home are registered with a local G.P. practice and there are annual health checks completed for person. Daily records show that members of the staff team had provided support in both making and attending appointments as appropriate to the individual. Contact with each health care professional is clearly recorded. Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 17 Since the last inspection staff have been asking about each person’s wishes in the event of their death or whether they would wish to be resuscitated. This is a work in progress. Various assessments are done of each person’s health risks to help staff to decide upon preventative measures such as pressure sore prevention. These assessments were up to date and reviewed as needed. Action has been taken to resolve many of the issues raised at the last pharmacist inspection. Records for one resident who looks after some of their own medicines have been improved to include details of the medicines which are self-administered and guidance for staff to make sure that this is managed safely. Systems have been introduced to enable staff to audit the stock of medicines prescribed, When required so that they can check that these have been given and recorded correctly. Training records show that medication training has been provided for care staff to help them do this task safely. Action has been taken to enable some people to be more independent with their medication for example one person comes and asks for their medication at the time they want to take it. Another person, who is unable to handle their own medicines, rings a buzzer when their medicine is due and staff go and administer it. This allows these people to take some control over their medication. All the medicines seen were stored securely. A new medicine cupboard has been bought for the nursing unit to improve the storage facilities. A supply of medicines for use as homely remedies is available, with books to record their use. Medicines administration record sheets indicated that medicines have been administered as prescribed by the doctor and several checks of medicines confirmed that they had been given correctly. Recent changes to the pharmacy system used by Leonard Cheshire have caused some difficulties with the supply of medicines to Greenhill House. For example one prescription was missing from the last order, which meant that one resident had to miss one of their morning medicines. Staff have met with representatives from both the pharmacy and the doctors surgery to try and resolve the problems. However, further action is needed to make sure that the correct prescribed medicines are always available for residents. It is recommended that staff check the prescriptions and resolve any discrepancies with the doctor before they are sent to the pharmacy for dispensing. Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Some people need to be reminded about how to make a complaint and reassured that the complaint will be taken seriously. People who live in the home are protected from abuse by the staff following the polices and procedures. EVIDENCE: The manager said that she had not received any complaints since the last inspection visit. She uses any complaints as a learning opportunity and a chance to improve their service. As four people had stated that they did not know how to make a complaint in the survey forms, we agreed that everyone should be given the home’s complaints procedure and remind about it by their key worker. The inspector spoke with several people about how they felt about making a complaint. Two said that they would not make a complaint to the home but would talk to family/friends instead. This was because they did not feel completely confident that the matter would be dealt with. With their permission this was passed onto the manager. Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 19 The staff had dealt with a recent allegation of abuse in a competent and effective manner. This was from support workers through to the Nursing supervisor and then the Manager. The allegation involved two service users and actions were taken to make sure of their well-being. The relevant agencies, Social Services and the Commission for Social Care Inspection were contacted so that a multi-agency approach was used. A meeting was held and an action plan agreed. This was checked at the inspection visit and further actions had been taken to ensure that both people were happy with the situation. A member of staff approached the inspector to report concerns about a member of staff’s attitude to staff and service users. With their permission these concerns were passed to the Manager for investigation. Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Some areas of the home need to be made more homely and comfortable. Staff’s knowledge of Fire safety needs to improve to better protect themselves and the people who live in and visit the home. EVIDENCE: The inspector toured the building to make sure it was clean and hygienic. All areas seen looked clean and there were no unpleasant odours. I saw during a tour of the building that some new sofas had been purchased on the residential wing. This area remains difficult to make homely and comfortable due to the size of the room. Most people who spoke with the inspector on that section had lived at the home for some time and were used to their surroundings. The use of shutters to divide the room had been tried and was not successful. Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 21 Since the last visit people who live in the home have been asked whether they would like a key to their room and/or a “please do not disturb sign”. These forms were seen in care files. For those people who want a key but are not able to use a traditional one, an adapted one is being bought. After having comments about it at the last visit the pay phone has been moved to give people using the phone more privacy. Bathrooms on both floors are functional and would benefit from being made more attractive. During the visit new flooring was being laid in the nursing wing, which was causing some disruption. An action plan had been given to staff so that this disruption was minimised. The work being done made the fire alarm activate and the fire brigade attended. Staff’s response to the unexpected alarm was muddled and unclear about which Fire Marshall was in charge. Day care clients also were not sure about procedures. It will be a requirement that the fire procedures are communicated to all people who come into the home and staff. Another unannounced fire drill is to be done to test these procedures within a month of this visit. Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home are supported by some staff who are sensitive to their needs, others need to be better trained to do this. EVIDENCE: There were seven comments on survey forms about how the care delivered depends upon who is on duty. This was also the same for whether staff listen and act upon what they say. This was explored during this visit. There were 5 empty beds in the home during our visit. Staff on both floors looked busy but not rushed; people being looked after said they are usually attended to quite promptly. In addition to the care and nursing staff there are other support staff such as volunteers, activities staff, a gardener who runs a gardening club, a maintenance person, kitchen and domestic staff and Physiotherapists. Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 23 There has been an emphasis on improving teamwork by the Manager so that staff work as one team rather then in their specific areas. The person who works in the Coach house helps staff on the nursing wing and there are overseas volunteers who are trained to assist people with tier meals and drinks. After talking with people who live in the home the conclusion was that some staff are not sensitive to the person when they are delivering care. I spoke to some people living in the home about this and was told that some staff talk over the person to each other. Some staff take more care over what they are doing than others. This was discussed with the Manager and Nurse supervisor. They said that staff are often reminded about not talking over people and including them in conversations. They were disappointed with the comments in the survey forms. This is to be talked about at staff meetings and reinforced in supervision sessions. Since the last visit a temporary training and development officer is in post while a permanent officer is employed. Many mandatory courses have been organised. Trained Staff are also going to be doing in-house sessions related to conditions the people who live in the home have. The first one is booked for June 2007 on epilepsy. Supervision records were checked to see if the quality of the sessions had improved and if training requests had been honoured. Four sets of notes were checked, the content had improved and had both strengths and weaknesses were noted with goals to overcome weaknesses. It was possible to track training requests, which were either honoured or an explanation given as to why that couldn’t be honoured yet. The frequency of sessions is not always as often as is recommended but the overall quality meets the required standard and should better support staff to fulfil their job description. Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager has created a philosophy of empowerment for everyone involved in the home’s life. EVIDENCE: Since the last inspection the Manager Mrs Ashby has passed the fitness process with Commission for Social Care Inspection to become the registered Manager of the home. Over the last two inspection visits and through other contact with Commission for Social Care Inspection she has shown her competence at running the service and improved areas which had previously been inadequate, and in some instances had meant a failure to meet the Regulations. Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 25 The overall rating of the home has improved and evidence gathered during this visit has meant that the home has become a “good” service. Staff spoken with said that she has an open management style and has improved empowerment for people who live in the home and staff. Various meetings are held regularly for different departments within the staff group and for people who live in the home. Minutes of these meetings show that areas needing to change are brought to the meetings and suggestions welcomed. For example at the last inspection visit a recommendation was made of more privacy to be given for people when they were using the pay phone. This was brought to the “residents” meeting and how best that could be achieved. Over the course of a couple of meetings it was decided to move the phone to a more private location. The monitoring of the service is done in various ways. The organisation does an independent annual audit of the service, and after an action plan is produced for any areas which need to improve. The heads of departments meet monthly to ensure that standards are being maintained. These also result in actions to be taken for any weaknesses which are kept at subsequent meetings. The provider’s representative also conducts monthly monitoring visits, which result in a report given to the manager and sent into the Commission for Social Care Inspection. This includes talking with people who live in the home to make sure that they are satisfied with their care. People the inspector spoke with who live in and visit the home for the day had been made aware of this inspection visit and had completed survey forms. Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X X X X Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA17 Regulation 16(2)(i) Requirement Timescale for action 2 YA24 The registered person shall ensure that the food produced is 18/06/07 suitable, wholesome and nutritious, varied and properly prepared. This should include the choices of varied fresh vegetables. 23(4)(d)(e) The registered person shall ensure, by means of fire drills 11/07/07 and practices at suitable intervals, that all staff and where possible service users, are aware of the procedure to be followed in the case of fire. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA18 Good Practice Recommendations Care plans should include social needs and what support is needed to meet those needs. All staff should offer support in a way which maximises service users privacy, dignity, independence and control. DS0000020243.V344248.R01.S.doc Version 5.2 Page 28 Greenhill House Cheshire Home 3 YA20 4 5 YA17 YA22 To make sure that the correct medicines are available for residents, it is recommended that staff check the prescriptions and resolve any discrepancies with the doctor before they are sent to the pharmacy for dispensing. The cook needs to be told about any special diets for people living in the home. People who live in the home need to be reminded about the complaints procedure in whatever way is suitable for them. Greenhill House Cheshire Home DS0000020243.V344248.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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. 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