Inspection on 22/02/06 for Greenhill House - Leonard Cheshire Disability

This inspection was carried out on 22nd February 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

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... 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 Announced Inspection 22 February, 1st & 10 March 2006 10:00 nd th Greenhill House Cheshire Home DS0000020243.V280354.R01.S.doc Version 5.1 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.V280354.R01.S.doc Version 5.1 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.V280354.R01.S.doc Version 5.1 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.V280354.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 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 Staffing notice dated 5th February 2004 applies to Greenhill House Letter dated 16th January 2004 applies to additional staffing for the Coach House. 18th October 2005 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.V280354.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced and conducted over two days. The first day was spent by two inspectors reading documents, talking with residents and staff and touring the building. . The second day the lead inspector spent time on the nursing wing for an early shift, so that direct observation of the workload could be conducted. This followed concerns that the dependency levels were high and that those needs were not being fully met. Due to the Manager being on leave for the inspection a feedback session took place after the inspection. As the inspection was announced consultation with relatives and residents took place via survey forms. 29 forms were received from residents some of which were completed anonymously. The comments from them have been used in the report, or were used to explore some negative comments, such as not all residents felt as though they were consulted with. The conclusion of this inspection was that there had been some deterioration in the management of the home. This appears to have led to some systems not being used, such as one to one supervision of staff. Due to their being two inspectors a wider consultation took place with the service users and from the survey forms sent by the CSCI.More time was also spent observing the routine of the home and talking with staff. This gave a different flavour of how the home is run from the inspection last October 2005. There have been changes within the home such as job cuts in some areas. The Manager also spent time at a project part time and the two senior team leaders are no longer working. As a result of this inspection the concerns raised by the inspectors were shared with the home’s representatives at the feedback meeting. Due to them becoming a home of concern an action plan will need to be produced by the home. The Commission for Social Care Inspection (CSCI) will ensure that standards are improved and further monitoring will take place. What the service does well: The staff continue to strive to offer a high standard of care to very dependent residents. Offer a warm, respectful and professional staff team. Health care needs are responded to promptly and monitoring of changing needs takes place. Specialist advice is sought when necessary. Greenhill House Cheshire Home DS0000020243.V280354.R01.S.doc Version 5.1 Page 6 Residents are encouraged to participate in the activities available. This includes the use of the computers as well as the activities hut. Trips are arranged regularly. Residents are protected by the home’s policies and procedures for dealing with medicines. What has improved since the last inspection? What they could do better: Regain the person centred approach to all aspects of life within the home for the service users. For example: Consult with service users about the menus, and ensure that those who need assistance with their meals are treated with dignity, by assisting people individually. Service users should be provided with a choice of a hot meal at suppertime at the weekends. Ensure that all service users are consulted about life in the home through whatever means possible-regularly. Consult with service users when drawing up the care plan and reviewing it. Regain an inclusive and effective management structure to ensure that the home’s aims and objectives are being achieved. Meet the Statement of Purpose and ensure that the Service User guide and complaints procedure are accessible so that service users are aware of their rights. Provide staff with regular structured supervision, which allows for them to develop professionally and feel supported. Hold regular staff meetings so that views can be aired, staff can be empowered and the manager demonstrate a consultative and inclusive approach. Ensure that all care staff work as one team so that the nursing and residential wings are covered as one unit. Accidents/incidents need to be audited. Any risks must be identified and actions recorded to reduce that risk. Greenhill House Cheshire Home DS0000020243.V280354.R01.S.doc Version 5.1 Page 7 A more in depth review took place of the environment at this inspection. This confirmed that improvements could be made in some areas such as: Providing a second shower room on the nursing wing so that service users are able to utilise the additional facility without waiting for the one shower room to be available. Improving the homeliness of the home, for example the bathrooms and dining rooms. Considering an alternative route for the entrance to the home so that this does not cut through the residential lounge, detracting from the privacy and dignity of the residential service users. Some security also must be provided so that service users are protected from unwelcome visitors. There are no particular adaptations for those who are visually impaired. The home must provide those or not offer this as a speciality in their Statement of Purpose. 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.V280354.R01.S.doc Version 5.1 Page 8 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.V280354.R01.S.doc Version 5.1 Page 9 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, 2 The information for residents is not accessible for some and does not reflect the current situation in the home, so that residents may not be fully informed. Prospective residents have their needs assessed so that the home is sure their needs can be met. EVIDENCE: 1. At the moment the Statement of Purpose is a well set out document but also not accessible to all in its present format. It also needs to be kept up to date and reflect the current situation in the home. For example there have been job cuts in the activities and computer department, which is not reflected in this document. The Service User Guide is informative. This document also needs to reflect the changing situation in the home and be amended where applicable. It was a recommendation at the last inspection that the Service User Guide be made more accessible. This had been discussed at Head Office who had decided that it would not be appropriate to do a generic guide. The General Manager is looking at ways of doing this. They are able to access a Braille service. However, this may not be sufficient to meet the needs of partially sighted people. The General Manager is considering getting a tape recording of this document which will make the guide more accessible. Greenhill House Cheshire Home DS0000020243.V280354.R01.S.doc Version 5.1 Page 10 2. Pre-admission assessments were seen in the files of those residents case tracked by the inspectors. These are comprehensive documents enabling an informed decision about the appropriateness of the placement. Greenhill House Cheshire Home DS0000020243.V280354.R01.S.doc Version 5.1 Page 11 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, 8, 9 Some care plans detail assessed and changing needs but do not all show evidence of service user involvement. Not all residents feel as though they are consulted about life in the home. Not all identified risks are recorded clearly to show where the risk has been minimised. EVIDENCE: 6. The two inspectors checked the care plans on each wing as part of the case tracking process. On the nursing wing four plans were read. Personal profiles were present. The plans for personal support gave good details of actions needed, and the resident’s remaining abilities, and were mostly written in the first person. There was evidence of referrals to heath care professionals. Assessments for the risk of pressure sore development were recorded regularly and included a record of action taken to reduce the risk. Nutritional assessments are also completed. Regular checks are done of the resident’s weight. Greenhill House Cheshire Home DS0000020243.V280354.R01.S.doc Version 5.1 Page 12 One service user had suffered a scald from a cup of tea recently, which had been recorded on the accident form but not translated into an assessment of the risk. Nor had this been recorded as a short-term problem. This plan was not written in the first person, and did not show evidence of the service user involvement. It was a detailed plan and covered emotional needs as well as a nighttime plan. The daily notes were informative and enabled the reader to track identified problems. 7. Discussions with residents showed that while they are able to make their own decisions they are reliant upon the staff to fulfil their wishes. This is explored more in Standard 33. 8. Comment cards received reflected that some residents do not feel consulted. This was discussed with the General Manager. Some residents spoken with confirmed that they do not attend the meetings held but would like to be consulted. 9. Some risks are explored in the care plan but did not always reflect the level of concern. This was particularly so for one service user who had suffered a lot of accidents. This was discussed with the nurse representative. Consent for the use of bedrails was accompanied by a comprehensive risk assessment, which is commended. Greenhill House Cheshire Home DS0000020243.V280354.R01.S.doc Version 5.1 Page 13 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): 17 Residents do not influence the menus and are not always able to have the assistance they need with their meal individually. This reduces choices and detracts from the dignity of those residents and makes the meal times disjointed. EVIDENCE: 17. The home uses a four weekly menu. Some pictorial menus were seen in the dining room. There was also a file of how much assistance each resident need with their meals and drinks. The support worker who assists with the breakfast had compiled these, and she keeps it up to date. The kitchen was clean and orderly on the second day of the inspection. There is a cleaning schedule and appropriate recordings are kept of food and fridge/freezer temperatures. The store cupboard and freezers were well stocked with a variety of labelled and economy foods. There are 4 part time cooks and a teatime assistant who has retired since the first day of the inspection. The menus are devised by one of the cooks and do Greenhill House Cheshire Home DS0000020243.V280354.R01.S.doc Version 5.1 Page 14 not include service user involvement. The inspector was told that there is always a choice of meal at lunchtime. There are two servings at most meals due to the amount of residents who need assistance with their meal. The inspector observed teatime on the first day of the inspection and breakfast on the second day, on the nursing wing. Breakfast is served by a carer who is aided by a volunteer. This starts from about 8.30am. All residents come to the dining room for their meals. By 10am 11 residents had their breakfast and the last one started theirs at 11.10am. This is obviously not a satisfactory arrangement as the lunch is then served at 12.30. As so many need to be fed their meal it is not possible for the staff, with the current system, to help more than one person at a time. This meal is staggered due to the residents waiting to be helped up. The teatime observed also was unsatisfactory. There are less nursing staff on duty during this time and no one is allocated from the volunteers to help. There are 3 support workers and one trained nurse on the afternoon shift. This again leads to a situation where there are insufficient staff trying their best to assist all 20 residents. In order to do this 2/3 people are helped with their meal at one time. Despite this some people had to wait for others to finish their meal before they could be helped. This situation does not promote the residents dignity and respect. The inspector stayed to observe the teatime meal. There were 3 support workers on duty and one trained nurse. It was noted that there were no tablecloths used, nor place mats or condiments. There was room at each table for 4 wheelchair users to sit. A teatime assistant who obviously was familiar with the residents served the meal. Choices were offered for meals and drinks. The 3 support workers also helped to serve the meal but were also helping to feed some residents who were not able to do that for themselves. There were 16 in the dining room. Each worker supported 2 residents at a time with their meal. That meant that the meal had to be done at separate times for some residents while they waited to be assisted. The manager needs to consider whether this is satisfactory. The inspectors established via discussion with staff that the situations witnessed were not a one-off but represented a current pattern. The residents spoken with told the inspector that at weekends they are only served sandwiches and are not consulted about the menus. They also stated that the staff work hard but that at weekends it is boring because there are not enough staff to enable them to go out or do activities. Greenhill House Cheshire Home DS0000020243.V280354.R01.S.doc Version 5.1 Page 15 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, 20 Staff do provide sensitive care and personal support but are unable to maximise choices for the residents on the nursing wing. Medication systems protect the residents. EVIDENCE: 18. Personal support is being compromised on the nursing wing by the dependency levels of the residents and the static staffing ratio. Some residents are not able to choose when they rise due to the staff having to work in pairs to assist most residents. There are usually four support workers for the majority of the morning as one support worker goes to assist serving breakfast. Sometimes there are two trained nurses but rotas show that there is often one on duty. Gender preferences are recorded but there is more female staff so that choice cannot always be given. The inspector observed the staff working consistently to get residents up as fast as they could. This is in order for them to be able to have their breakfast and to be up to do things. Greenhill House Cheshire Home DS0000020243.V280354.R01.S.doc Version 5.1 Page 16 There is staff dissatisfaction with the pressure they face at this high level of dependency. They do not have the time to spend talking to the residents in the way they would like to or like having to ask them to wait for help sometimes. The Physiotherapy team gives additional support and there was evidence of external dietician and speech therapy input. 20. Medication records were checked on the nursing wing. The Boots Monitored Dosage system is now used. The records of administration were clear and consistently signed. There were also records of controlled drugs, mediaction received and returned to the supplier. A separate record is kept for respite residents drugs. There is an agreement with GP’s for the use of homely remedies. Greenhill House Cheshire Home DS0000020243.V280354.R01.S.doc Version 5.1 Page 17 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): 23 Although residents are protected from abuse, staff need clear guidance about the local guidelines for actions in the event of an allegation of abuse. EVIDENCE: 23. The abuse policy held on the nursing wing was checked. It was unclear when it was written, but did not give clear guidance on the local policies for dealing with this issue. A local policy would be beneficial so that staff are very clear that the decision making is a multi-agency decision. One member of staff and one service user talked to the inspector about this issue. The staff member was very clear that in the event of having any suspicions or being told about an allegation of abuse she/he would be sure to report this to the senior person on duty. The service user felt confident with all the staff to pass on any concerns they had, and be confident that they would be believed, and that their concerns would be acted upon. Staff are offered training in this area but some are in need of being updated. The home dealt with a situation where a referral was made to the local abuse protection team who asked the home to investigate it themselves. This was dealt with satisfactorily and the CSCI kept infor med. Greenhill House Cheshire Home DS0000020243.V280354.R01.S.doc Version 5.1 Page 18 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, 27, 28, 29, 30 The communal area on the residential wing is not homely or comfortable. The dining areas on both wings are functional but also not homely. There are no adaptations for sensory impairments. There are insufficient bathing facilities on the nursing wing. EVIDENCE: On the nursing wing the lounge carpet has been replaced since the last inspection, improving this area. The staff are only using one shower room at the moment which is causing some difficulties. The other bathrooms are not popular with the residents, even the Parker bath. Some bathrooms are not being used for bathing and are being utilised as storerooms. There are plans to fit another shower but it is unclear when this is gong to happen. There are plenty of spacious toilets on this wing. There is also a smaller room where computers are held for those residents who are able to negotiate them themselves. This also holds a couple of dining tables and was used by some day care clients during the inspection. There is no staff room on this wing. This makes it difficult for the staff to leave the unit for a break. Greenhill House Cheshire Home DS0000020243.V280354.R01.S.doc Version 5.1 Page 19 The dining rooms are functional but uninteresting. Tableclothes and place mats are not used on the nursing wing so the tables are also drab. Condiments were not present and no menus were displayed. The residential wing’s lounge is sited in the entrance to the home. There is no security for this area during the day. Visitors can walk straight into the lounge which is intrusive. There is a lounge which is used as a quiet lounge for the reading group. It is attractively decorated and nicely furnished. Residents need assistance to access this area. There is also a conservatory area which is not utilised to its potential. These issues were discussed at the feedback meeting. Accessibility for the visitors’ toilet could be improved. It is reached via some steps and a narrow corridor. It was also noted that there was no disabled parking spaces at the front of the building. It was also noted that the service users toilets did not have locks but an engaged/vacant sign. Bedrooms viewed were very personalised and were clean with no unpleasant odours Greenhill House Cheshire Home DS0000020243.V280354.R01.S.doc Version 5.1 Page 20 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): 33, 34, 35, 36 There is an effective staff team, but there are not sufficient numbers on the nursing wing at peak times such as mealtimes. Staffing levels should be reviewed regularly to reflect residents changing needs. The home’s recruitment procedures must be better implemented to properly protect residents. Residents do not benefit from supervised and supported staff. EVIDENCE: 36. The General Manager does the Manager’s supervision; notes showed that these are held regularly. Other supervision notes showed that senior team leader had not been supervised since October 2004. This is of concern as this member of staff had been suspended subject to possible disciplinary measures. The notes for the various disciplines of staff did not evidence that regular supervisions are taking place. Only one file seen for care staff had had a supervision session this year. The plan for 2005/06 also showed a lack of planning for this. When questioned about this staff were aware of the need to do this but have struggled to find the time. 35. A Training matrix is completed. The training officer keeps the file, certificates are not held in staff files. Five files were viewed; some topics seen Greenhill House Cheshire Home DS0000020243.V280354.R01.S.doc Version 5.1 Page 21 were related to the conditions experienced by the residents in the service. Most were mandatory topics and as no training needs are being identified, as supervision sessions are not being held this must be addressed. Fire training records were also looked at; 11 staff watched a video in Jan 06, 5 in November 2005 and 2 in October 2005. This is done regularly but it was unclear whether the night staff receive their 3 monthly update. 34. The home has recently recruited staff. The records of 2 support workers were checked. One did not contain any references nor had a CRB been applied for. The home was using the CRB dated September 2005. There was evidence of identity. The staff member had already started in post and was doing their induction. There was also a gap of two months before the person started this post. This was passed onto the General Manager for actioning. The member of staff was sent home while references were sought. An immediate requirement notice was issued to ensure that no further staff commence their employment until the necessary employment checks are in place. The other file did contain two references; they did not have a CRB for the organisation, from their last employer. There was also no proof of this person’s identity. 33. An activities team and physio complement the staff team during the week. This is not the case at weekends. Residents spoken with stated that weekends were boring and wished that they had things to do. The support worker employed to provide some activity at the weekends and evenings concentrates on taking a group out. This can often be residential residents, and as this staff member works for 21 hrs a week, inevitably not all benefit from her time. There is a trip to church on a Sunday. The bar is also open at the weekends on the residential wing. On the nursing wing there is a high dependency level with the same numbers of staff that have not increased as the dependency has increased. In order to confirm this the inspector shadowed the staff on the nursing wing during an early shift. Please refer to Standard 18. Greenhill House Cheshire Home DS0000020243.V280354.R01.S.doc Version 5.1 Page 22 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, 39, 42 Residents are not benefiting from the leadership and management approach of the home. Some service users are not confident that their views underpin the development of the home. Quality assurance monitoring takes place but needs to reach all residents. The health, safety and welfare of residents is promoted and protected. EVIDENCE: 38. Before the inspection was completed the organisation responded to the management deficits by seconding another manager on a short-term basis. This is to work on the action plan and satisfy the requirements made and regain a position where the service is well managed. Greenhill House Cheshire Home DS0000020243.V280354.R01.S.doc Version 5.1 Page 23 39. The inspector was told that an annual quality assurance questionnaire is used and analysed, the results are published and recommendations made. Residents meetings arranged by the activities co-ordinator. The minutes from these were read. An agenda is drawn up. 8 residents attended the last meeting; minutes from the meeting were agreed. Issues of proposed changes were discussed. Strategies also need to be developed for enabling residents to voice their views and to affect the way in which the service is delivered. Minutes checked showed that 8-12 residents attend these meetings. A wider consultation must be done so that all residents feel consulted. 42. There is a Health & Safety committee which last met in February 2006. Areas covered were outstanding items such as hoists tracking, PAT testing, bed and mattress audit, and the need to complete more fire evacuations. The minutes of the February meeting were not available and will be checked after the inspection. There is a Health & Safety audit from the H & S advisor who reviews the progress of the action plan produced from his recommendations. Fire risk assessments were last done in April 2005. The handyman completed these. No action plan was produced from this assessment, which determined that there were sufficient detectors and that the risks were reduced by the compartmentalisation in the event of a fire. In the August Health & Safety meeting the staff had raised concerns about the difficulties of evacuating residents if their wheelchair was on charge. It was agreed that an evacuation chair be bought as a way of assisting this process. It was not clear if this had been bought. Staff questioned about fire safety were clear about the procedures and their responsibilities. They also stated that the wheelchairs are put on charge as a matter of routine and are never left to run down. Fire drills records show all staff attending one recently. Alarm tests are done weekly, periodic tests done by supplier; other tests are being conducted in a timely way. General workplace risk assessments were looked at; there was no date on them. Hot water outlets are tested and recorded. Precautions are taken to reduce the risk of Legionella. Greenhill House Cheshire Home DS0000020243.V280354.R01.S.doc Version 5.1 Page 24 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 2 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 x 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 2 28 2 29 2 30 3 STAFFING Standard No Score 31 X 32 x 33 2 34 2 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X 2 2 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 2 X 3 X x 2 2 X X 3 X Greenhill House Cheshire Home DS0000020243.V280354.R01.S.doc Version 5.1 Page 25 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA34 YA9 Regulation 19(1)(b)(i) 13(4) Requirement No persons shall be employed until the information required under Schedule 2 is obtained. Record identified risks to residents to show evidence that the risk has been considered and strategies are agreed and reviewed. This is a repeated requirement Any identified risks following an accident/incident to any residents must be recorded and the risk minimised. A revised date of 13/03/06 was agreed for this to commence. To ensure that the Service user guide and Statement of Purpose are accessible. For staff to begin to receive regular supervision For enough staff to be working each shift appropriate to the heath and welfare of the residents. Mealtimes must be conducted to offer dignity, choice and respect. From 30/04/06. Residents must be consulted about the menus. Greenhill House Cheshire Home DS0000020243.V280354.R01.S.doc Version 5.1 Page 26 Timescale for action 22/02/06 30/05/06 3 4 5 YA1 YA36 YA33 4&5 18(2) 18(1)(a) 30/09/06 31/03/06 30/04/06 6 YA17 12(4)(a)(b) 16(2)(i) 7 8 YA8 YA33 9 10 11 YA14 YA27 YA33 12 YA6 There must be a variety of meals offered at teatime at the weekends. 12(3) All residents must be consulted about all aspects of life in the home. 21(1) Staff must be consulted regularly through staff meetings about the conduct of the home. 16(2)(m)(n) Appropriate activities to be provided for all residents at the weekends. 23(2)(j) Another shower must be installed on the nursing wing. 18(1)(a) Trained nurses need to be given non-clinical administration time to enable them to fulfil the responsibities of the senior nurse role. 15(1) For the care plans to be drawn up in consultation with the service user and/or their representative. 31/03/06 30/05/06 31/03/06 31/03/06 30/04/06 22/02/06 31/03/06 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 3 Refer to Standard YA17 YA40 YA36 Good Practice Recommendations Present meals in a congenial setting. Compile an in-house policy on prevention of abuse so that staff are aware of their role in locally agreed procedures. a) Identify the training and development needs of staff during supervision sessions. b) Provide staff with an annual appraisal with their line manager to review performance against job description. Actively involve residents in staff selection. Carry out training needs assessment for the staff team as a whole. DS0000020243.V280354.R01.S.doc Version 5.1 Page 27 4 5 YA34 YA35 Greenhill House Cheshire Home 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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