Inspection on 18/10/05 for Greenhill House - Leonard Cheshire Disability

This inspection was carried out on 18th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 - Leonard... 11/06/07

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

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

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

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 Unannounced Inspection 18th October 2005 10:00 Greenhill House Cheshire Home DS0000020243.V259558.R01.S.doc Version 5.0 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.V259558.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 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.V259558.R01.S.doc Version 5.0 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 471409 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) Leonard Cheshire Mr Alan Aubin Care Home 37 Category(ies) of Physical disability (37) registration, with number of places Greenhill House Cheshire Home DS0000020243.V259558.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Staffing notice dated 5th February 2004 applies to Greenhill House Letter dated 16th January 2004 applies to additional staffing for the Coach House. May accommodate up to 20 persons aged 18 years and above requiring nursing care. May accommodate up to 19 persons aged 18 years and above requiring personal care only. Manager must be a RN on parts 1 or 12 of the NMC register Date of last inspection 8th September 2004 Brief Description of the Service: Greenhill House is a registered care home providing 20 nursing and 17 personal care places for adults between the ages of 18 and 65 years. They are able to offer care for a wide range of physical impairments. The home also provides day care for up to 5 service users each weekday. The house 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 lifts giving wheelchair access to all levels. There are outbuildings to cater for activities and workshops. The home is part of the Leonard Cheshire Foundation and operates within the organisation’s charter. Greenhill House Cheshire Home DS0000020243.V259558.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted as part of the annual inspection programme. The manager was present for the afternoon and staff assisted the inspector during the morning. Evidence was gathered by indirect and direct observation, document reading, talking to residents and staff. The inspector spent some time in the activities areas. Some feedback was given to the manager at the conclusion of the inspection. This was this inspector’s first visit to the home. Some standards were not fully explored and will be looked at during the next inspection. What the service does well: Encouraging an active and fulfilling lifestyle has a high profile within the home and is commended. The daily routines respect the resident’s individuality, dignity, privacy and promote their well being and independence. Opportunities for personal development and independence are encouraged as well as education and work initiatives. The residents benefit from a person-centred multi-disciplinary team. Physical abilities are encouraged and promoted, this is particularly enhanced by the Physiotherapy team. Health care needs are assessed and recognised and specialist advice sought when necessary. The manager and staff listen and act upon the views and concerns of residents, discussion and actions are taken before they develop into problems and formal complaints. Staff know and support the main aims of the home and have knowledge of the disabilities and specific conditions of the residents. The registered manager has the experience and qualifications to run the home. He has a person centred approach, which is communicated to the staff team. Greenhill House Cheshire Home DS0000020243.V259558.R01.S.doc Version 5.0 Page 6 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 Cheshire Home DS0000020243.V259558.R01.S.doc Version 5.0 Page 7 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.V259558.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 5 Not all residents may be able to use the service user guide in its current format; consideration should be given to using other forms. Prospective residents are able to visit the home before deciding to move there and are only admitted after a full assessment and therefore can be sure that the home can meet their needs. EVIDENCE: It was noted from a recent Regulation 26 report that the Statement of Purpose needs to be updated. This will be checked at the next inspection. The inspector spoke with a resident who had recently been admitted to he home. They confirmed that they had been given enough information to make an informed choice about moving into the home. However, they were not able to use the service user guide. They felt uncomfortable at having to ask staff so often about what was happening and how to find their way around. They did state that staff were very helpful and did not express any irritation at them asking lots of questions. These concerns were passed to the manager for consideration. Thought must be given to ensuring that the transition period after moving into the home is monitored and alternative ways sought of accessing the service user guide. Greenhill House Cheshire Home DS0000020243.V259558.R01.S.doc Version 5.0 Page 9 The inspector viewed a contract to determine if sufficient information has been included about the Registered Nurse contribution. This had been subject to a requirement at the last inspection. Although this had not been done the manager stated that the service users themselves are informed of these charges in a letter following their assessment by the PCT. It is the inspector’s judgement that residents are informed of this detail from this information. Greenhill House Cheshire Home DS0000020243.V259558.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,9 Not all service users had the same level of detail or evidence of their involvement in their care plans so may not know their assessed needs. EVIDENCE: Three Individual Service Plans (ISP) on the residential wing were viewed. One file contained a well-written support care plan, which was written in the first person. Risks were explored and showed clear plans to reduce the identified risk. Assessments were present to monitor health care needs some of which led to a care plan to meet that need. The file also contained a definition and details of the implications of this person’s condition, which is good practice as it ensures that staff are well informed. The other 2 files did not give clear guidance to meeting personal care needs and were not written in the first person. However, health care needs were well documented and the various assessments showed a multi-disciplinary team approach to meeting those needs. Greenhill House Cheshire Home DS0000020243.V259558.R01.S.doc Version 5.0 Page 11 It was of concern that some risks had not been subject to a risk assessment such as the risk from scalding. This deficit must be addressed. Some assessments had not been updated recently and must be done regularly and/or as needs change. The ISP of a new resident on the nursing wing did not contain risk assessments for risks identified as part of the pre-admission process and during their initial period in the home. Some risks had been recorded in the daily notes but no actions recorded to reduce the risk. Day care files will be examined at the next inspection. Residents spoken with during this visit confirmed that they are able to make decisions about how they live their life in the home. There was a huge amount of evidence of residents leading active lives whatever their disability. The newest resident confirmed that they are able to choose the times they get up and the times they go to bed, what they eat and how they spend their day. Residents can be assured that they are enabled to make decisions about their life in the home. Greenhill House Cheshire Home DS0000020243.V259558.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 14, 16 Residents have opportunities to participate in the local community and are offered meaningful activities and social activity, which is age, peer and culturally appropriate. Dietary needs of the residents are well catered for with a balanced and varied selection of food available that meets with individual’s tastes and choices. EVIDENCE: All residents attend a variety of meaningful activities. Through discussion with staff and residents it was evident that individuals continue to be encouraged to continue with their interests and hobbies. There is support given to take part in fulfilling activities. There is consideration given to education and work skills, for example there is a mailing service as part of a work initiative scheme. Two sessions take place each week and some residents take part in this work initiative. Greenhill House Cheshire Home DS0000020243.V259558.R01.S.doc Version 5.0 Page 13 There is a structured staff team to support social needs. There is an activity co-ordinator, senior support worker-activity, computer room manager, craft instructors (art and remedial) and a support worker and driver. The home has two mini-buses and three adapted cars. These enable residents to attend appointments and social activities. The activities co-ordinator meets with the residents monthly to determine their preferred choices. In files read there was evidence of trips to events such as the cinema and theatre. A support worker is employed for the evenings and weekends to ensure that activities and/or trips can still take place. This is commended. The large well-equipped activities room was very busy during the inspection. It was evident that creative and imaginative activities take place-encouraging abilities thereby promoting self-esteem. The room contains lots of evidence of craftwork such as tapestries, ceramic tile painting and paintings. There is a reading and creative writing group, which is commended as it, enables those residents who can no longer read independently to be able to still enjoy this interest. The home has its own bar, which the manager stated creates an enjoyable leisure time. Music is played and also karaoke evenings are held. The home was due to have a party at the home the evening of the inspection for a member of staff who had retired. Residents have been supported with making choices regarding holidays. The inspector witnessed discussion about a forthcoming holiday to Spain for two residents supported by staff. There is a full time gardener who runs a gardening club for the residents and keeps the grounds in excellent condition. A member of staff supports the residents in a well-used computer room which has access to the internet. There is also a internet café for those who do not require the staff support. Residents spoken with confirmed that they are treated with respect and their dignity maintained at all times. Greenhill House Cheshire Home DS0000020243.V259558.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Health care needs are assessed and recognised and steps are taken to address those needs by the multi-disciplinary team or other specialists. Residents are protected by the home’s policies and procedures for the administration, storage and disposal of medication. EVIDENCE: The home has its own Physiotherapy Room, which contains a range of equipment. There are 2 part-time physiotherapists who establish programmes for residents and contribute to their ISP’s. Hydrotherapy sessions are taken at the RUH, Bath. A local GP carries out a weekly surgery at the home. There was evidence of optical, dental and chiropody appointments being attended. The home is equipped with pressure relieving equipment, specialist beds and chairs. All bedrooms and bathrooms have overhead hoists. Medication records were checked on the residential wing. Administration charts were up to date. Greenhill House Cheshire Home DS0000020243.V259558.R01.S.doc Version 5.0 Page 15 The manager stated that the home is in the process of changing their provider to Boots as part of an organisational contractual agreement. All staff are to be trained by Boots and this new system will be looked at during the next inspection. Greenhill House Cheshire Home DS0000020243.V259558.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 Residents can be assured that their views are taken seriously and acted upon by the home’s staff and manager. EVIDENCE: Evidence gathered during the inspection confirmed that residents’ views and concerns are acknowledged and actions taken where possible to resolve issues. One concern raised with the inspector and passed onto the manager was taken seriously and followed up by him. There were no complaints for investigation received by the home since the last inspection. Greenhill House Cheshire Home DS0000020243.V259558.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28, The general décor is looking “tired” and does not create a homely and comfortable environment. Opportunities for residents to access all areas of the home are limited. EVIDENCE: The environment was not a focus of this inspection. However, the inspector’s first impression on entering the building was one of a tired looking entrance area, which was not homely. Many areas of the home are in need of redecoration and some carpets are in need of replacing. As a matter of priority the carpet in the upstairs lounge must be replaced. The corridor carpets though clean are heavily stained so do not benefit aesthetically from being cleaned regularly. These will need to be replaced. There was also a general impression the home looked cluttered, this may be because there is limited storage space for the equipment used. One resident was concerned at the lift in their area, which had broken down the previous weekend. The inspector checked this and found that although it had been resolved this is a frequent problem. Despite the home’s best efforts Greenhill House Cheshire Home DS0000020243.V259558.R01.S.doc Version 5.0 Page 18 to resolve this problem the panel is old and keeps malfunctioning. It is a matter that needs to be fixed permanently. Greenhill House Cheshire Home DS0000020243.V259558.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 Residents benefit from clarity of staff roles and responsibilities within the multi-disciplinary team. The skill mix of staff support residents assessed needs but the numbers of staff on duty may not be sufficient to meet all needs. EVIDENCE: Since the last inspection there has been a change in the skill mix of the staff on duty. Of the 10 staff on during the morning shift 2 are now trained staff instead of 1. This leaves 7 carers for the main house and 1 carer to assist in the Coach House. From evidence gathered during the inspection the inspector determined that this is now having an impact on staff’s time. While there was no evidence that this is having a detrimental effect on care delivery these arrangements are having an impact on the staff and may eventually affect the staff’s effectiveness. The hours needed for nursing and personal care therefore need to be kept under review and altered according to need. The manager acknowledged that this had been noticed, and that he had discussed this with his line manager and was reviewing this situation. This will be monitored at the next inspection. Greenhill House Cheshire Home DS0000020243.V259558.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 The residents’ benefit from a person-centred management style which meets the home’s stated purpose. EVIDENCE: Evidence gathered during the inspection confirmed that Mr Aubin communicates a clear sense of direction and leadership. He has an inclusive management style and is very aware of his responsibilities. He is open to suggestion and has obvious detailed knowledge of the residents. They confirmed that they see him regularly and he is available to them. Mr Aubin has been spending time away from the home recently while he is overseeing the organisation’s project in Warminster. This time away must not have a negative impact on his managerial time at Greenhill where he should be full time. The CSCI must be informed formally if this situation is to continue. Greenhill House Cheshire Home DS0000020243.V259558.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 X X X 3 Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X 2 X X LIFESTYLES Standard No Score 11 3 12 4 13 X 14 4 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score 3 X 3 X X x CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Greenhill House Cheshire Home Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x 4 X X X X x DS0000020243.V259558.R01.S.doc Version 5.0 Page 22 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 2 3 4 Standard 24 1 6 9 Regulation 16(2)(c) 4 15 13(4) Requirement Replace the carpet in the upstairs lounge. Update the Statement of Purpose. Ensure all care plans on the Residential Unit reflect current and changing needs. Record identified risks to show evidence that the risk has been considered and strategies are agreed and reviewed. Draw up and implement a programme of redecoration. Send a copy of the programme to the CSCI. The lift, which keeps breaking down, must be permanently repaired. Review the care hours provided to ensure they meet residents’ changing needs. Timescale for action 18/12/05 18/01/06 18/01/06 18/11/05 5 24 16(1) 18/12/05 6 7 24 33 23(2)(n) 18(1)(a) 30/11/05 30/11/05 Greenhill House Cheshire Home DS0000020243.V259558.R01.S.doc Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard 1 Good Practice Recommendations Try to ensure that the Service user guide is accessible for all service users. Greenhill House Cheshire Home DS0000020243.V259558.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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. 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