CARE HOME ADULTS 18-65
Greenhill House Cheshire Home South Road Timsbury Bath Bath & N E Somerset BA2 0ES Lead Inspector
Kathy Marshalsea and Jon Clarke Key Unannounced Inspection 26th & 28th June 2006 10:00 Greenhill House Cheshire Home DS0000020243.V302169.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.V302169.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.V302169.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 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) www.leonard-cheshire.org.uk Leonard Cheshire Mr Alan Aubin Care Home 37 Category(ies) of Physical disability (37) registration, with number of places Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 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. 22nd February 2006 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.V302169.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was announced and is the home’s first key inspection. This determines the rating for the home and will inform the Commission how often the home will be inspected over the next three years. The inspection took two days with two inspectors as they spent time separately on each wing of the home. This covered the nursing care and residential care wings. The manager and care supervisor were present and assisted the inspectors. The Pharmacy Inspector inspected the Medication systems separate to the main inspection. A Requirement was made for the home to improve their recording of: Controlled Drugs and unwanted medication and medicines coming into the home and medicines supplied in original packs must be administered as prescribed and accurately recorded. This is contained in a separate report. The key standards were inspected and the inspectors also spent time talking and being with those residents who they were case tracking. This also included talking with their key worker to gain as much information about the person and their needs as possible. The inspectors toured the premises and talked to as many residents as possible. Documents were also read. The inspection concluded with the inspectors feeding back their findings to the manager. An immediate requirement notice was issued for failure to fully comply with the previous requirements to record risk assessments for the residents. A letter was sent to the responsible individual to inform them of the Commission’s concerns at this deficit. As a result of that and other deficits the Commission has requested a meeting with the line manager of the home and the Responsible Individual. What the service does well:
The residents benefit from a stable staff team, many who have been working at the home for several years. One staff member commented, “ I see the person not the disability”. The staff work hard to provide a high standard of care to people who have complex and continuing needs in a professional and friendly manner. Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 6 Heath care needs, which can be fluctuating, are responded to promptly and specialist advice sought when necessary. The Physiotherapy department play an important role in maintaining abilities and maximising mobility. Residents are encouraged to participate in the various group activities and events. Residents spoken with said: “It’s a good place to live and I go out, but I would like to go to the pub and cinema more”. “The staff are very helpful, there are choices of food and I don’t get fed up”. “ The staff are approachable and usually listen to how I would like things”. The staff team are very committed to providing the best life possible for the residents by ensuring that they go out with them in their own time. What has improved since the last inspection?
The cycle of staff supervision sessions is now in place to offer support and a debriefing time. There are more staff meetings but the opportunity for all to attend had been compromised by the times of those meetings. Mealtimes have been reviewed and discussed. There were mixed views from staff about whether this had improved. The improvement is dependent on the number of volunteers who are present and is not necessarily consistent enough to make a marked and sustained improvement. There is now a menus committee. There have been some efforts to provide activities at the weekends. This is limited by staffing levels and lack of transport so in-house events are being planned. Recruitment processes are improved and comply with current legislation. Efforts are being made to make the Statement of Purpose and Service user guide available in alternative formats. There were mixed views about whether the residents are being consulted more. Some staff and residents said yes but some said they weren’t. A second shower has been installed on the nursing wing.
Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 7 The care supervisor is in post and has non-clinical time rostered. This is enabling the process of more consultation with residents about their care plans and goals. What they could do better:
At the last two inspections a requirement had been made for service user risk assessments to be completed. This included strategies being agreed to minimise any risks and review them, including after an accident/incident. This was to be completed by 30th May 2006. On the first day of this key inspection, 27th June 2006, both inspectors on each wing reviewed the risk assessments. They did not meet the required National Minimum Standards and therefore the associated requirement. This was partly because there were no management strategies. The forms used were Workplace risk assessments, which are not suitable for assessing individual needs and risks. There was also no consistent evidence from talking with staff that they have enough information to reduce hazards for service users. Assessment of risks after an accident/incident was also not being done-two examples of this were for a fall out of bed and a choking incident for 2 different service users. The manager Mr Aubin had been reviewing the accident records but this had not led to any pro-active work. Staff spoken with had been informed that they should not complete risk assessments until they had been sent on a training course. Care plans also did not direct staff in how to minimise risks if the risk was mentioned, and some risks were not mentioned at all, for example the risk of choking in an eating & drinking plan. An immediate requirement notice was issued on 27th June 2006 for risk assessments to be completed and include management strategies to minimise the risk whenever possible. This should include pre-admission assessments, after an accident/incident and for all health care risks. This was to start from 27th June 2006. On 29th June 2006 risk assessments had not been completed. Information given to staff at the meeting held on the 28th June 2006 had not stressed the importance of changing the approach to risk, or that the changes required had resulted from the first day of the inspection. No information was given to the inspectors about how other staff were going to be informed. Further monitoring visits will be conducted to ensure that this does happen.
Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 8 There was a general lack of awareness of the National Minimum Standards for Adults amongst the staff spoken with during the inspection. The involvement of service users in decision-making relies heavily on their relationships with staff, and the recognition of non-verbal communication or recognition of behaviours. Advocacy becomes part of the staff’s role. This should include ensuring that any “complaints” are passed on and that full social opportunities are explored. If this is being achieved then it needs to be recorded reducing any risk of this position being abused. Some of the ways service users could be empowered is not being achieved. This is partly due to there not being an ethos of pro-active information giving to service users in a format suitable for them. This should be for the Statement of Purpose, Service user guide and complaints procedure and quality assurance process. This has been a requirement in the home’s first inspection after the National Minimum Standards were introduced in April 2003. The non-compliance over this long a period of time endorses the poor response to empowering the residents through information giving and the imaginative ways in which this may need to be done. Staffing numbers continue to be of concern. It is recognised that the numbers of staff on duty during a 24-hour period exceed the staffing notice. However, the adequacy of staffing levels must be monitored according to the dependency levels of the residents, and include opportunities for social events and trips out. This time needs to be flexible to meet the age related social occasions some residents might enjoy. For example five residents spoken with during the inspection said they would like to go the pub and live music events in the evenings. The staffing levels in the evenings do not allow this flexibility and therefore the staffing levels during the 5-10pm shifts must increase. Discussions with staff and residents confirmed that most trips only take place because staff act as escorts on their day off or after their shift finishes. This time is not paid for or given back to staff as time owing. Being able to be part of the local community during the evenings and weekends is limited due to staffing numbers and transport. These shortfalls must be addressed. The provider has responded by stating, “ in practice trips in staff’s own time would be under 5 of the trips.” This will be checked at the next inspection. It was noticed that there could be difference between opportunities for residents on the nursing and residential wing. Meetings are often held on the residential wing and the wide screen purchased is on that wing. The inspectors were told that not all residents on the nursing wing can come down to the residential so will be missing out on some events. Thought should be given to creating equal opportunities for all residents.
Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 9 Staff spoken with during the inspection were not aware of the local policies and procedures for how to refer any allegation of abuse. The home’s policy does not cover local policies. A local policy needs to be produced and kept updated. Involving staff in the BANES training programme for abuse will arm them with updated local procedures and awareness of their role in protecting vulnerable adults. The environment remains dated and the standard of décor poor. There is a very homely area on the residential wing, the quiet lounge, however the two doors enabling access to this room are heavy and do not have automatic closures. Residents are not able to access this room without someone helping them. This deficit must also be addressed as a matter of priority to offer a quieter and more private and homely lounge for residents to use independently. Privacy and dignity for residents could be improved by equipping them with lockable doors. There has been a poor response to Quality Assurance surveys completed by the home itself. It was unclear during the inspection why this should be unless only those residents who are more able were asked. This will be followed up at the next inspection as it is of concern that not all residents are involved in the running if the home and can influence what happens. Care plans seen were not holistic, and had no end of life planning despite some residents having a life limiting condition. There was not consistent evidence of the resident’s involvement. The use of restraint needs to be fully recorded and reviewed at regular intervals. This should include the use of wheel and armchair straps. Care staff who are now key workers are not involved in the in care planning & reviews despite them having an intimate knowledge of their residents. This shortfall should be addressed. Residents do not lead their meetings so may not be able to feel free to discuss issues or choose the agenda. 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.V302169.R01.S.doc Version 5.2 Page 10 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.V302169.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is poor… This judgement has been made using available evidence including a visit to the service. Work is ongoing to make the documents informing the residents of their rights to be made more accessible for them as individuals but some of the information in them does not reflect the actual situation in the home and needs to be amended. EVIDENCE: 1.The Statement of Purpose and Service User guide have been updated in May 2006. Despite this there seem to be some inconsistencies between the service that is provided and the service that is described. For example the trips out in the evenings to pubs and restaurants. The documents either need to be revised to fully reflect the actual service provided or for the service described to be provided. Both documents were seen in the lobby after entering the home. They were presented in large font in large files. It may be difficult for most wheelchair users to read these documents independently. Plans are being made to put these documents onto a CD and so be available in the computer room. Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 12 Thought still needs to be given to making the documents accessible for all service users (residents). A deadline was set at the last inspection of this being fully achieved by 30th September 2006. 2.The home has a new pre-admission assessment tool. The care supervisor showed it to the inspector. Discussion took place about the importance of gaining as much information about any health risks so that this could be planned for before the admission took place. This will be checked at the next inspection. Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 13 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, 7, 9 Quality in this outcome area is poor… This judgement has been made using available evidence including a visit to the service. There is still insufficient detail of social and personal support detailed in the care plans. This could mean that staff are not uniformly informed about the residents and their holistic needs. Records of monies held for residents did not show sufficient signatures to verify the transactions. Residents cannot be assured that any risks to their well being are properly assessed and the risk minimised wherever possible. EVIDENCE: 6. The 10 care plans viewed on both wings did not reflect a holistic view of each person. The assessed needs were mainly physical and did not always show the changes read in other documents such as the daily notes. Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 14 Eating and drinking plans did not describe any risks associated with that for example choking or scalding; there had been incidents of this nature. Staff spoken with were aware of some risks. No consistent strategies were in use and staff often only informed if they were on duty when the incident happened. The personal profiles on both wings gave the most useful information about the person and in some instances were written in the first person. Otherwise there was little in the way of social care planned and how the home were going to support the person in their goals and interests. Health care assessments were present and being reviewed 3-6 monthly. There were lots of unnecessary documents in the files making it difficult to reach the most relevant and up to date documents. The process of fully involving the residents in the reviewing of their care plan has begun. The care supervisor has plans to make this possible by allocating some administrative time of the trained staff to be able to spend the time with their residents to do this properly. An inspector spoke with one resident who had just had this done and said” it was very good and I got a lot off my chest”. Another resident spoken with had obviously achieved a very good level of communication with his key worker who was present with the inspector to assists with communication. This was not in the care plan and so needs to be updated. One key worker had spent some considerable time with one resident supporting them and their family. Information necessary to support the residents at the end of their life has not been planned for. This deficit was for all the plans read. The manager stated that the home were discouraged from doing these plans by the organisation. This will be discussed at the meeting between the organisation and CSCI. On the residential wing there was an inconsistency of evidence of the residents involvement in the reviewing of their care plan. One plan did not contain any information about their resident’s support needs or any equipment they might needs, nor their dietary likes/dislikes and any cultural needs. This person had been at the home for some time. Key workers spoken with were very knowledgeable about the residents they were responsible for and often act as their advocates. They liaise with the families and spend time with the residents on their days off. This commitment is commended. 7. Records of monies held by the home on behalf of the residents were checked. The signatures of the resident and/or two members of staff were not always present. Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 15 9. The accident records were checked. When cross-referenced with the care plans and the workplace risk assessments completed showed that there was no recorded evidence of strategies decided to reduce any identified risk. See the section “What they could do better”. Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 16 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): 12, 13, 14, 16, 17 Quality in this outcome area is poor… This judgement has been made using available evidence including a visit to the service. Residents are able to attend the activities centre but do not go out in the community enough. Age appropriate activities are not freely available due to restrictions of staffing levels and transport. The daily routines do not fully promote individual choices. Support for mealtimes is not planned sufficiently to make the mealtimes a dignified and experience. EVIDENCE: Some residents spoken with commented that they would like to go out in the community more. The home does have dedicated transport but is not normally available during the evenings and at weekends. This was confirmed by the home’s own residents’ survey forms done in June 2006.
Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 17 There is a full and varied range of opportunities available through the activities centre, which is open 5 days a week. When speaking with residents there were very positive comment about the opportunities available to them: “lots to do here” “I never get bored coming here “ “ I always come here its so good” Activities include drawing, painting, tapestry, gardening. Opportunities are also available for relaxation and creative writing these take place in a lounge area of the home. In talking with the “activities team” there was a strong sense of real commitment to providing a quality service to residents. A real strength is the strong team with a good mix of staff including a qualified occupational therapist; artist and I.T. based skills and experience. There is clearly a reliance on volunteers particularly when offering individual activities for those who do not attend the activities centre this could be an area for the team to build on rather then the focus at present of group activities. A factor in this is clearly the availability of staff. There are also opportunities to attend community-based groups such as PHAB, Riding for the Disabled, Village Wine Circle. Previously residents have attended local college for independence skill training however this is no longer available. The inspector was informed however that a tutor from Bath College would be providing classes in the home. An area identified for improvement was that of activities during the weekend, this has been raised by residents of the home. Efforts are being made to provide appropriate activities outside of the home and in the home. There is generally a lack of community-based activity. At the time of this inspection a screen was being fitted so that films can be shown at the weekend. Some residents go on planned holidays abroad accompanied by staff. There is also the opportunity for them to do an exchange visit at another home within the group. The service user guide needs to clarify the funding of these holidays and the contribution the resident has to make towards staff costs. Residents who are not able to use a key, do not have different ways of locking their bedroom doors. 17. The mealtimes remain a concern. The breakfast meal is served as and when residents get up. This can be as late as 11am on the nursing wing. As lunch is then served between 12-13.00 those residents who ate later may not want to eat a full meal then. It also means a long period of time between teatime and breakfast. It has not been assessed whether this has a negative impact on the health of residents. Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 18 There are overseas volunteers who are the home for a period of 9 months. Part of their role is to help at mealtimes. There are 2 volunteers at the moment who are not always available. For example the day after the inspection their rotas showed that there was no one available. This is not giving the consistent support needed to make the mealtimes flexible and meet individual needs as the requirement stated following the last inspection. Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents are not always able to receive personal support in the way they prefer and require. Resident’s healthcare needs are assessed and recognised with procedures in place to address them. (This does not include accident reporting). Medication procedures on the residential wing need to be improved. EVIDENCE: 18.The numbers of staff on duty still compromises the nursing care delivered. The afternoon numbers drop and for the busy 5-10pm periods there are only 3 care assistants on duty with a registered nurse. These numbers are insufficient to deliver individualised care. One care assistant had recognised this deficit and volunteered to work a twilight shift for 2 days a week. Staff reported that this is positive due to the fact that they can then work in pairs to assist residents to bed. The manager agreed that this deficit needed to be covered every day.
Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 20 The CSCI will also be looking at whether the sleeping in shift for the Coach house is necessary. The care plans must show the preferred routine for those residents who cannot easily communicate their needs and preferences. This is not done consistently at the moment. The key worker system has been introduced in the home recently. This system is designed to offer residents their own person, who they have chosen hopefully, to offer them consistency and continuity of support. Some residents spoken with knew their “special nurse” and warmly described their relationship with that person. 19.Residents’ health care needs are assessed and there is support for NHS facilities in the locality such as the primary health care team. Records and residents confirmed that they are able to see the GP when necessary and in private. Prompt referrals are made for any problems. The way accidents are reviewed has not been effective. 20.Medication systems were checked on the residential wing. Administering records were looked at and showed good practice. However, in one instance there was no record of residents being offered or refusing “as required” mediation. This was discussed with the manager. Practice around the use of Paractamol for staff and residents needs to be more rigorous in that several boxes were being used generally. This is poor practice. If they need to be given regularly then they need to be prescribed for that person. A separate box should be kept for staff use and recorded as such. A staff member confirmed that the approach of the home is that where able individuals manage their own medication. A resident subsequently confirmed this. A generic risk assessment had been completed and reviewed. Staff had completed relevant training in this area. There was no confirmation that medication had been returned to the Pharmacist. Records must improve to show the safe disposal of unwanted medicines. Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 21 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, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The complaints procedure is not in a format, which is accessible for all residents, so they rely upon staff recognising their dissatisfaction and taking action on their behalf. Some staff are unaware of the local interagency policies and procedures for dealing with abuse and would benefit from attending the training linked to these. EVIDENCE: 22.The homes own survey forms confirmed that they have not yet been completely successful in promoting the complaint’s procedure. The home had a comprehensive organisational policy and a leaflet “Have your say”. There is no other format at the moment. The manager stated that there had been no formal complaints since the last inspection. The inspector saw a thank you letter from a relative after the death of their loved one at the home. This stated “ The care and friendship given to them over the past year was second to none-please thank everyone.” Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 22 23.The organisation’s policy for abuse does not cover the local policies and procedures for dealing with this issue. A copy of the BANES policy is held in the nursing wing but staff spoken with were not aware of the contents. The training given is in-house but this should now incorporate the BANES training for staff at alerters and investigators levels as appropriate. Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 23 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The house is homely only in parts. Parts of the house do not have the adaptations needed to meet the dependency profile of residents currently accommodated. There is inadequate provision for resident’s privacy. EVIDENCE: There are no adaptations for anyone with a sensory impairment. If there are any future admissions with this impairment then consideration should be given to providing the adaptations to the environment before the admission takes place. RESIDENTIAL WING. The entrance area to the home has been altered since the last inspection. Visitors have been re-routed away from walking directly into the lounge on the residential wing. An intercom system is present which the main office answers. The dining area and lounge remain functional rather than homely.
Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 24 The bedrooms whilst providing adequate accommodation in terms of size are dated in their design in that there are poor arrangements for ensuring privacy. The only means of ensuring privacy or security is by use of keys which taking into account the level of disability of some residents would not be a way they can easily use. There need to be other options available. There is limited communal space and no area of the home provides total privacy. Additional lounge area is available however there is no access available to residents for residents who use a wheelchair or need automatic doors. NURSING WING The lounge is homely and was being used during the inspection. The bedrooms seen were individualised. One resident showed the inspector the devices he has to promote his independence. Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 25 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): 34, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Recruitment processes are robust and so protect residents but could be developed to include the meaningful involvement of residents in staff selection. Staff are benefiting from receiving supervision. EVIDENCE: 34. Records were checked for the last four employees successfully recruited. The records showed a consistent approach to ensuring that the necessary information is obtained before employment starts. This is an improvement since the last inspection. Residents are not actively involved in staff selection. Registered nurses employed have had their registration checked with the Nursing, Midwifery Council to guarantee that they have an up to date PIN number. Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 26 35. There is a dedicated Training & Development Manager. Some staff commented that they would like to have some training in the conditions of the residents they look after. These views will need to be addressed by the home and the outcomes will be checked at the next inspection. It may be of benefit to carry out training needs assessment for the staff team as a whole. 36. Supervision records were reviewed and staff asked about supervision. Those asked confirmed that these sessions have started and that most staff had received a session since the last inspection. Training needs are now being identified. These sessions should be complemented with an annual appraisal for each staff member with their line manager to review performance against job description. Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 27 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): 37, 38, 39 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The manager is not managing the home in a way that means its meets its stated purpose, aims and objectives. Residents do not yet have meaningful involvement in making decisions about the development of the home. EVIDENCE: 37/38. The Manager has been in post for 14 years and clearly has a real commitment to providing a quality service to the residents. He has an understanding of the varied and at times complex needs of individuals. Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 28 However, there some concerns about areas, which have been identified at this and the previous inspection as needing improvement, to make sure there are consistent and safe practices in the home. The Manager has made a real effort to address the concerns but has not always achieved positive outcomes for the residents. The information given at staff meetings is vague and does not fully inform the listeners. Information is not consistently shared with staff that were not at the meeting. 39. Strategies for ensuring that residents themselves affect the way the service develops have not yet been achieved – for example, ways of enabling residents to lead their own meetings have not been found. 42. The Fire log was checked. This confirmed that the safety tests are being conducted at the recommended intervals. The information about who attended each fire drill was not present there but the manager said this was recorded on each wing. The inspectors did not check this. Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 29 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 X 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 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 X 16 X 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 1 1 X X X X X Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4&5 Requirement Ensure that the Service User guide and Statement of Purpose are fully accessible. Ensure care plans are holistic and encompass end of life wishes. Ensure residents themselves, or two members of staff, sign records of the monies given to residents. Document and review any restraint used. a) Record identified risks to residents to show evidence that the risk has been considered and strategies are agreed and reviewed. b) Record any identified risks following an accident/incident to any residents and minimise the risk. Timescale for action 30/09/06 2 YA6 15 31/10/06 3 YA7 17(2), Sch.4.9 30/08/06 4 5 YA9 YA9 13(7) 13(8) 13(4) 30/09/06 27/06/06 Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 31 6 YA14 16(2)(m),(n) Ensure appropriate activities, including community-based activities, are provided for all residents at the weekends and evenings as stipulated in the Statement of Purpose. 18(1)(a) 13(2) Ensure consistent assistance is given at mealtimes. Ensure Paracetamol prescribed for one resident is not be used for another resident or staff member. a) Ensure residents unable to easily communicate verbally are asked regularly if they have any complaints or dissatisfaction about the service they receive. b) Record the outcomes of such enquiries and act on them as necessary. 31/10/06 7 8 YA17 YA20 30/06/06 30/06/06 9 YA22 22 31/07/06 10 YA23 13(6) 31/08/06 a) Ensure the in-house policy on prevention of abuse accords with locally agreed multiagency procedures. b) Ensure that staff are aware of their role in preventing or reporting abuse within locally agreed multiagency procedures. 11 YA28 12(2) Enable residents to have independent access to the quiet lounge. Ensure enough staff are working on each shift appropriate to the health and welfare of the residents. Specifically, the 5-10pm shift needs to have increased cover for 7 days rather than 2.
DS0000020243.V302169.R01.S.doc 31/08/06 12 YA33 18(1)(a) 31/07/06 Greenhill House Cheshire Home Version 5.2 Page 32 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 4 5 6 7 Refer to Standard YA23 YA24 YA25 YA34 YA35 YA36 YA39 Good Practice Recommendations Arrange for staff to attend protection of vulnerable adult training provided by the local authority. Provide lockable doors for bedrooms. Explore ways of offering each resident privacy in their room. Actively involve residents in staff selection. Carry out training needs assessment for the staff team as a whole. Provide staff with an annual appraisal with their line manager to review performance against job description. Explore ways of enabling residents to lead their own meetings. Greenhill House Cheshire Home DS0000020243.V302169.R01.S.doc Version 5.2 Page 33 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
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