Inspection on 30/04/04 for Greenhill House - Leonard Cheshire Disability

Care Homes For Adults (18 ­ 65)Greenhill House Cheshire HomeSouth Road Timsbury Bath Bath & N E Somerset BA2 0ESUnannounced Inspection30th April 2004 Commission for Social Care InspectionLaunched in April 2004, the Commission for Social Care Inspection (CSCI) is the single inspectorate for social care in England. The Commission combines the work formerly done by the Social Services Inspectorate (SSI), the SSI/Audit Commission Joint Review Team and the National Care Standards Commission. The role of CSCI is to: · Promote improvement in social care · Inspect all social care - for adults and children - in the public, private and voluntary sectors · Publish annual reports to Parliament on the performance of social care and on the state of the social care market · Inspect and assess `Value for Money of council social services · Hold performance statistics on social care · Publish the `star ratings for council social services · Register and inspect services against national standards · Host the Childrens Rights Director role.Inspection Methods & FindingsSECTION B of this report summarises key findings and evidence from this inspection. The following 4-point scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The 4-point scale ranges from: 4 - Standard Exceeded (Commendable) 3 - Standard Met (No Shortfalls) 2 - Standard Almost Met (Minor Shortfalls) 1 - Standard Not Met (Major Shortfalls) O or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable. ESTABLISHMENT INFORMATION Name of establishment Greenhill House Cheshire Home Address South Road, Timsbury, Bath, Bath & N E Somerset, BA2 0ES Email address greenhill@swest.leonard-cheshire.org.uk Name of registered provider Leonard Cheshire Foundation Name of registered manager Mr Alan Aubin Type of registration Care Home with Nursing No. of places registered (if applicable) 37 Tel No: 01761 470533 Fax No: 01761 471409Category of registration, with (number of places) Physical disability (37) Registration number D050000709 Date first registered 2nd September 1996 Was the home registered under the Registered Homes Act 1984 as amended? Do additional conditions of registration apply ? Date of last inspectionDate of latest registration certificate 5th February 2004 yes YES 04/07/03 If Yes refer to Part CGreenhill House Cheshire HomePage 1 Date of inspection visit Time of inspection visit Name of inspector 1 Name of establishment representative at the time of inspection30th April 2004 09:30 amID CodeKaren Lynskey 088243 Mr Alan Aubin, Registered ManagerGreenhill House Cheshire HomePage 2 CONTENTSIntroduction to Report and Inspection Inspection Visits Brief Description of the Services Provided Part A: Summary of Inspection Findings Inspectors Summary Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Methods & Findings National Minimum Standards for Care Homes for Adults (18 ­ 65) 1. Choice of Home 2. Individual Needs and Choices 3. Lifestyle 4. Personal and Healthcare support 5. Concerns, Complaints and Protection 6. Environment 7. Staffing 8. Conduct and Management of the Home Part C: Part D: D.1. D.2. D.3. Compliance with Conditions ( if applicable) Providers Response Providers Comments Action Plan Providers AgreementGreenhill House Cheshire HomePage 3 INTRODUCTION TO REPORT AND INSPECTION Every establishment that falls within the jurisdiction of the Commission for Social Care Inspection (CSCI) is subject to inspection, to establish if the establishment is meeting the National Minimum Standards relevant to that setting and the requirements of the Care Standards Act 2000 as amended. This document summarises the inspection findings of the CSCI in respect of Greenhill House Cheshire Home. The inspection findings relate to the National Minimum Standards (NMS) for Care Homes for Adults (18-65) published by the Secretary of State under the Care Standards Act 2000. The Regulations applicable to the inspected service are secondary legislation, with which a service provider must comply. Service providers are expected to comply fully with the National Minimum Standards. The National Minimum Standards will form the basis for judgements by the CSCI regarding registration, the imposition and variation of registration conditions and any enforcement action. The report follows the format of the NMS and the numbering shown in the report corresponds to that of the Standards. The report will show the following: · Inspection methods used · Key findings and evidence · Overall ratings in relation to the standards · Compliance with the Regulations · Required actions on the part of the provider · Recommended good practice · Summary of the findings · Providers response This report is a public document. INSPECTION VISITS Inspections are undertaken in line with the agreed regulatory framework with additional visits as required. This is in accordance with the provisions of the Care Standards Act 2000. The following inspection methods have been used in the production of this report. The report is based on the findings of the specified inspection dates.Greenhill House Cheshire HomePage 4 BRIEF DESCRIPTION OF THE SERVICES PROVIDED. Greenhill House is a registered care home providing 20 nursing care places and 17 personal care places for people between 18 and 65 years of age with 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. The house is located in a rural position and can be accessed by car or bus; transport would be required to visit local shops. All the rooms are singles and there are two lifts giving wheelchair access to all levels. There is communal space in five areas. The home is part of the Leonard Cheshire Foundation and operates within the organisations charter and standards.Greenhill House Cheshire HomePage 5 PART ASUMMARY OF INSPECTION FINDINGSInspectors Summary (This is an overview of the inspectors findings, which includes good practice, quality issues, areas to be addressed or developed and any other concerns.)The inspector undertook an unannounced inspection to evaluate compliance to the requirements and recommendation of the previous inspection in July 2003. Occupancy on the day of inspection was full for all units: the nursing care unit (East / West wing), personal care unit (South wing) and the independent unit (Coach House). Requirements and recommendations made during the previous inspection had been appropriately actioned and now evidenced compliance to the Care Home Regulations (CHR) 2001and National Minimum Standards (NMS). There are two requirements set out in this report, following completion of this inspection. The home is to be commended for its homely environment, pleasant atmosphere and inclusion stratagies for the service users. On entering the home the inspector was greeted by service users and staff and made to feel very welcome (including being challenged by a service user to a game of draughts, which she lost !). The home has comprehensive management systems in place for recording and evidencing compliance to the CHR and NMS, which if fully completed would promote and monitor positive outcomes of care for the service users. All the service users and visiting professional the inspector spoke with were very complimentary of the home, staff and food. Choice of Home (Standards 1-5) 3 of the 4 standards assessed were met. The statement of purpose and service user guide was available at reception. All service users had now been issued with an individual copy of the service user guide. The last service user admitted to the home and another service user who had been in the home for several years verbally and visually confirmed this. The documents were also available on computer in the IT room, with a staff member specifically trained in communication who can present this information to individual service users in a format which meets their individual needs. The home has a full admission procedure. When a vacancy arises prospective service users are visited and assessed by the manager. A multidisciplinary team would be involved with decisions on admission although the manager has the final say. There was a set of preadmission documentation, which is used for the pre-admission assessment process. Greenhill House Cheshire Home Page 6 Prospective service users are invited to the home to meet other service users. These visits are regarded as a two way process for the home to assess if the individuals needs can be met, the possible impact on the existing service users and for the prospective service user to determine if they like the home. The inspector case tracked the last admission into the home, which evidenced adherence to the homes admission policies and procedure and completion of all relevant documentation. The contracts issued did not reflect the individual breakdown of fees specifically for nursing care as is now required. The manager when assessing or reviewing individual service user needs did breakdown the fees and had these available in the individual service users files. Individual Needs and Choices (Standards 6-10) 2 of the 4 standards assessed were met. There was a range of documentation available in the (ISPs) Individual Service Plans. The documentation viewed on the nursing unit was comprehensive and overall completed to a satisfactory standard. However of the 6 ISP documents viewed on the personal care unit only 1 contained a care plan. All contained Activity of Daily Living (ADL) assessments but some of these were dated from 1999 to the most recent in 2002. Thus there was no evidence of review of service user needs; nor did they contain evidence of individual risk assessment or risk management strategies. The inspector was informed a revised ISP document was available, which will be introduced in the near future. Service users were well integrated in to the home holding regular forums and being represented in all home and local Leonard Cheshire meetings. Decision-making is only limited by the individuals disability. Lifestyle (Standards 11-17) 5 of the 5 standards assessed were met. There was a range of specialist input recorded in individual care files depending upon assessed needs, from occupational therapists, physiotherapists, speech therapists and disability equipment providers. An activity organiser is appointed along with various other craft and activity support workers. A programme of events is produced and each service user receives a copy. Activities are targeted to individuals who require one to one work as well as group activities. The home has a large well-equipped activities room, which is open five days per week and people can attend as they wish. Service users are involved in activities such as dance, swimming, yoga, skating, music, art and numerous various outings. The gardener also runs a gardening club; and local competitions are entered. There was a well equipped IT room with several computers (three of which are internet linked). The inspector observed and spoke with several users using this room who commented re their enjoyment of the facilities. The home operates an open visiting policy. The visitors book evidenced many regular visitors to the home although the inspector did not have the opportunity to speak with any visitors during the inspection. Personal and Healthcare Support (Standards 18-21) 2 of the 2 standards assessed were met. Greenhill House Cheshire Home Page 7 Service user and staff interactions were observed by the inspector to be supportive and friendly. Service users spoken with during the inspection also confirmed the helpfulness and friendliness of staff. They felt their privacy and dignity were respected and their independence promoted. A local GP carries out a weekly review of service user needs. The inspector attended the weekly review on the nursing unit during the inspection. The registered nurse provided information to the GP for individual service users in a professional and systematic manner. Concerns, Complaints and Protection (Standards 22-23) 2 of the 2 standards assessed were met. The home has a comprehensive complaint policy and procedure. All service users have a copy of the procedure and the same is on public display. The inspector viewed the complaints log, which evidenced that no complaints had been recorded since the last inspection. The home has written procedures for adult protection and actively promotes staff training and education in these areas, all staff had received updated training in the protection of vulnerable adults. Environment (Standards 24-30) 7 of the 7 standards assessed were met. Greenhill House has been extensively adapted for disabled people and is generally well designed for the function. From talking to service users and observing them it appears that they are able to move about freely and make use of the facilities without help unless it is requested. All rooms were well presented, offering appropriate furnishings and fittings relevant to assessed need. Service user bedrooms evidenced a high degree of personalisation. The general standard of décor was good throughout the home. There are sufficient communal bathrooms and toilets, which are accessible to disabled people and fitted with a range of specialist equipments to meet service user needs. Staffing (Standards 31-36) 5 of the 5 standards assessed were met. The core of the staff team are long serving and turnover generally is low. The manager informed the inspector that the home had not long completed a recruitment drive and was now fully staffed. This had served to promote continuity by reducing the use of agency staff. The staff duty rota viewed by the inspector and staff members and service users spoken with during the inspection further evidenced this. The duty rota records evidenced the home was working well in excess of its staffing requirement as determined by the staffing notice issued by Avon Health Authority (the previous registration authority for nursing care). This staffing notice now forms a condition of registration. The manager informed the inspector that this level of staffing was normal Greenhill House Cheshire Home Page 8 practice and required to meet the needs of the service users; this practice is to be commended. All new staff complete a detailed orientation and induction programme based on TOPPS standards. The training co-ordinator has responsibility to manage all staff training needs. She had completed a skills audit and training matrix, which evidenced a range of core as well as diverse skills. When tracked alongside service user and organisational need it is evident that service user nursing needs as well as the organisational objectives can be met by the current staff group. Conduct and Management of the Home (Standards 37-43) 4 of the 4 standards assessed were met. There has been no change of the management structure since the initial inspection. The registered manager Mr Aubin is now working towards the attainment of the Registered Managers Award. The staff and service users the inspector spoke to felt Mr Aubin was approachable and they expressed confidence in his leadership. All records required for the standards inspected were available in the home.Greenhill House Cheshire HomePage 9 Requirements from last Inspection visit fully actioned? If No please list belowYESSTATUTORY REQUIREMENTS Identified below are areas not addressed from the last inspection report which indicate a non-compliance with the Care Standards Act 2000 and accompanying Regulations. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard Required actions Timescale for action None Action is being taken by the Commission for Social Care Inspection to ensure compliance in regard to the above requirements. RECOMMENDATIONS Identified below are recommendations from the last inspection that have not been implemented No. Refer to Good Practice Recommendations Standard None CONDITIONS OF REGISTRATION THAT APPLY (OTHER THAN NUMBERS AND CATEGORY OF SERVICE USERS). See section CMET (YES/NO) YESGreenhill House Cheshire HomePage 10 STATUTORY REQUIREMENTS IDENTIFIED DURING THE INSPECTION Action Plan: The Registered Person is requested to provide the Commission with an Action Plan, which indicates how requirements are to be addressed with the time scale within which such actions will be taken. This action plan will be made available on request to the Area Office.STATUTORY REQUIREMENTS Identified below are areas addressed in the main body of the report which indicate noncompliance with the Care Standards Act 2000, and accompanying Regulations 2001, and the National Minimum Standards. The Registered Provider(s) is/are required to comply within the given time scales. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard * Requirement Timescale for action From 29/4/04 for new admissions and by 15/06/04 for present admissions From 29/4/04 for new admissions and by 15/06/04 for present admissions15(a)YA5Ensure the contract / terms & conditions for individual service users in receipt of nursing care clearly state the level / amount of the PCT contribution.215YA6Ensure each service user has an individual plan of care, which evidences how their needs are to be met in respect of their health and welfare.Greenhill House Cheshire HomePage 11 RECOMMENDATIONS Identified below are areas addressed in the main body of the report which relate to National Minimum Standards and are seen as good practice issues which should be considered for implementation by the registered Provider(s). The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Refer to Good Practice Recommendations Standard * None* Note: You may refer to the relevant standard in the remainder of the report by omitting the 2-letter prefix e.g. YA10 refers to Standard 10.PART BINSPECTION METHODS & FINDINGSThe following inspection methods have been used in the production of this report Direct observation Indirect observation Sampling · Pre-inspection questionnaire · Records · Care plans / Care pathways · Meals · Activities · Other enter details here `Tracking care and support Group discussion with service users Individual discussion with service users Group discussion with staff Individual discussion with staff Discussion with management Service user survey Relatives/significant others survey/feedback Visiting professionals survey / feedback Tour of premises Formal interviews Document reading Additional inspection information: YES YES YES YES YES NO YES NA YES YES YES NO YES NO NO NO YES YES NO YESGreenhill House Cheshire HomePage 12 Number of service users spoken to at time of inspection Number of relatives/significant others the inspectors had contact with Number of letters received in respect of the service CRB check for the responsible individual seen CRB check for the manager seen Certificate of registration was displayed at the time of the inspection Certificate of registration accurately reflected the situation in the service at the time of inspection Total No. of care staff employed (excluding managers) Total No. of staff with nursing qualifications employed Date of inspection Time of inspection Duration of inspection (hrs)12 0 0 NO NO YES YES X X 29/04/04 09.30 7The following pages summarise the key findings and evidence from this inspection, together with the CSCI assessment of the extent to which the National Minimum Standards for Adults (18-65) have been met. The following scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The scale ranges from: 4 - Standard Exceeded 3 - Standard Met 2 - Standard Almost Met 1 - Standard Not Met (Commendable) (No Shortfalls) (Minor Shortfalls) (Major Shortfalls)0 or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable.Greenhill House Cheshire HomePage 13 Choice of HomeThe intended outcomes for the following set of standards are: · · · · · Prospective service users have the information they need to make an informed choice about where to live. Prospective service users individual aspirations and needs are assessed. Prospective service users know that the home they 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.Standard 1 (1.1 ­ 1.4) The registered person produces an up to date statement of purpose setting out the aims, objectives and philosophy of the home, its services and facilities and terms and conditions; and provides each service user with a service users guide to the home. The statement of purpose should clearly set out the physical environmental standards met by the home in relation to standards 24.2, 24.9, 25.3, 25.5, 27.2, 27.4 and 28.2; and a summary of this information should appear in the service users guide. X X Range of fees charged From To £ £ (per week) YES Any charges for extras If yes, please state what the extras are 3 Key findings/Evidence Standard met? The statement of purpose and service user guide was available at reception. The manager informed the inspector that all service users had now been issued with an individual copy of the service user guide. The inspector was also informed the service user guide is given to prospective service users as part of the admission pack. The last service user admitted to the home and another service user who had been in the home for several years verbally and visually confirmed this when the inspector was case tracking. The documents contain pictorial indicators; The inspector was also informed staff would give verbal explanations of the contents to the current service user group and prospective service users as required. The document could also be provided in different formats based on service user needs. The manager had not received any requests from the current service user group for the documents to be supplied in an alternative format. The documents were also available on computer in the IT room, with a staff member specifically trained in communication who presents this information to individual service users in a format which meets their individual needs.Greenhill House Cheshire HomePage 14 Standard 2 (2.1 ­ 2.8) New service users are admitted only on the basis of a full assessment undertaken by people competent to do so, involving the prospective service user, using an appropriate communication method and with an independent advocate as appropriate. 3 Key findings/Evidence Standard met? The home has a full admission procedure. All service users are placed by Social Services or jointly by the Health Authority so all admissions have arrived with comprehensive assessment documentation and other care records. Any new referrals would be visited and assessed by the manager and most likely be in the company of another nurse or professionals from other disciplines. A multidisciplinary team would be involved with decisions on admission although the manager has the final say. Mr. Aubin has developed a set of pre-admission documentation to be used for the preadmission assessment process, which forms the foundation of the individual service plan/care plan. The inspector case tracked the last admission into the home, which evidenced adherence to the homes admission policies and procedure and completion of all relevant documentation. Standard 3 (3.1 - 3.10) The registered person can demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. 0 Key findings/Evidence Standard met? This standard was not assessed during this unannounced inspection. It was scored at 3 at the previous inspection. Standard 4 (4.1 - 4.5) The registered manager invites prospective service users to visit the home on an introductory basis before making a decision to move there, and unplanned admissions are avoided wherever possible. 3 Key findings/Evidence Standard met? In case tracking the last service user admitted to the home confirmed that they had been invited to and had visited the home pre admission. Viewings are normally undertaken in the company of a relative or social worker. Prospective service users are invited for a meal and to meet other service users leading to an overnight stay and longer if required. These visits are regarded as a two way process for the home to assess if the individuals needs can be met, the possible impact on the existing service users and for the prospective service user to determine if they like the home. A formal three-month trial is followed by a full review. Room choice is generally limited to one as vacancies arise, however the rooms are similar in layout and size. No emergency admissions are accepted.Greenhill House Cheshire HomePage 15 Standard 5 (5.1 - 5.5) The registered manager develops and agrees with each prospective service user a written and costed contract/statement of terms and conditions between the home and the service user. 2 Key findings/Evidence Standard met? Written terms and conditions and contracts are issued to all service users in line with the national minimum standards. The room to be occupied is now specified. Copies of contracts are included in the service user guide. Work is planned to produce these documents in varied formats according to the service user needs. The contracts issued did not reflect the individual breakdown of fees specifically for nursing care. The manager when assessing or reviewing individual service user needs does breakdown the fees and has these available in the individual service users files. In the contract viewed by the inspector the charge for the nursing care element exceed the NHS determination, the manager stated this was true of the majority of the nursing service users as it reflected the true cost of the registered Nursing provision for individuals. The manager used the RCN dependency tool when calculating individual service user nursing costs.Greenhill House Cheshire HomePage 16 Individual Needs and ChoicesThe intended outcomes for the following set of standards are: · · · · · 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.Standard 6 (6.1 ­ 6.10) The registered manager develops and agrees with each service user an individual Plan which may include treatment and rehabilitation, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations and achieve goals. 2 Key findings/Evidence Standard met? There was a range of documentation available in the ISPs (individual service plans) from activities of daily living (ADL) assessments, admission / contact information, review and daily reports by key workers. The documentation on the nursing unit also contained care plans, daily reports from the R/N in charge, service user risk assessments for moving and handling, to measure pressure sore development risk, falls risk, nutritional risk, consent to restrictions, inspection sheet to record serviceability of the individuals sling and generic risk assessments. Monthly weight monitoring was also being recorded. There was evidence of service user and relative involvement. The documentation viewed on the nursing unit was comprehensive and overall completed to a satisfactory standard. Most care plans were detailed, written in plain english and prescriptive of the care needs for the individual concerned, they had been regularly evaluated. A couple of the aims / objectives recorded may be unrealistic `e.g safety will be maintained, prevent from becoming stiff, prevent exacerbation. Of the 6 ISP documents viewed on the personal care unit only one contained one care plan. All contained ADL assessments some of these were dated from 1999 to the most recent in 2002. Thus there was no evidence of review of service user needs; nor did they contain evidence of individual risk assessment or risk management strategies. Staff in the personal care unit, the manager and training co-ordinator all informed the inspector of a revised ISP document which will be introduced in the near future.Greenhill House Cheshire HomePage 17 Standard 7 (7.1 ­ 7.7) Staff respect service users right to make decisions, and that right is limited only through the assessment process, involving the service user, and as recorded in the individual Service User Plan. 3 Key findings/Evidence Standard met? Decision-making is only limited by the individuals disability. The Leonard Cheshire foundation aims to facilitate and encourage choice and decision-making by service users in all life activities. All service users are offered advocacy and mentorship within the organisation. The majority of the service users have good verbal communication skills. There is a wellequipped computer room with internet access, which is well used and has staff support. Standard 8 (8.1 ­ 8.5) The registered manager ensures that service users are offered opportunities to participate in the day to day running of the home and to contribute to the development and review of policies, procedures and services. 4 Key findings/Evidence Standard met? Service users hold a forum, which meets bi monthly; all are invited including the day care visitors. There is high attendance at these meetings and minutes are kept, which the inspector viewed. These evidenced service user involvement in the running of the home and decision-making. The service users chose to have staff members present or not. The manger is invited to attend by the service users if there are specific areas / issues they wish to discuss with him. Two service users attend an organisation area forum and the homes local committee has representatives from the staff, volunteers, relatives and service users. One of the key issues for the service users continues to be discussion around the proposed re-provision of some of the services about which extensive consultation is still taking place. Some service users are also involved in staff selection. Service users interested in interviewing prospective staff receive training in interviewing skills before they undertake this role. Standard 9 (9.1 ­ 9.4) Staff enable service users to take responsible risks, ensuring they have good information on which to base decisions, within the context of the service users individual Plan and of the homes risk assessment and risk management strategies. 2 Key findings/Evidence Standard met? There was a range of individual risk assessment in the care planning documentation, along with prescriptive care plans evidencing how the risks should be managed for some service users (comments in standard 6 apply). Restrictive measures were also identified again with corresponding care plans and evidence of consultation. The organisation has Health and Safety policies. The manager has completed training in health and safety management and monitors and evaluates health and safety issues on a planned basis. A missing person policy is available.Greenhill House Cheshire HomePage 18 Standard 10 (10.1 ­ 10.6). Staff respect information given by service users in confidence, and handle information about service users in accordance with the homes written policies and procedures and the Data Protection Act 1998, and in the best interests of the service user. 0 Key findings/Evidence Standard met? This standard was not assessed during this unannounced inspection. It was scored at 3 at the previous inspection.Greenhill House Cheshire HomePage 19 LifestyleThe intended outcomes for the following set of standards are: · · · · · · · 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.Standard 11 (11.1 ­ 11.4) Staff enable service users to have opportunities to maintain and develop social, emotional, communication and independent living skills. 3 Key findings/Evidence Standard met? Specialist input is provided by OTs, Physios, speech therapists and disability equipment providers. Specialist communication equipment is available such as light writers; voice synthesisers and Possum type equipment. A Christian fellowship meets at the home and a local clergyman gives communion each week. None of the residents have special cultural needs. Standard 12 (12.1 ­ 12.6) Staff help service users to find and keep appropriate jobs, continue their education or training, and / or take part in valued and fulfilling activities. 3 Key findings/Evidence Standard met? Four service users are currently attending adult education classes at the local college. Service users are also involved with remedial literacy, numeracy and writing life books. A creative writing course was also being run. The inspector observed a meeting of the reading group during the inspection. Several service users passed comment on how much they enjoyed this group. Two service users attend a Resource and Activity Centre. The activity centre is open five days per week and people can attend as they wish. The gardener also runs a gardening club; and enters local competitions. The IT room was well equipped with computers (three of which are internet linked) and associated IT equipment. The inspector observed and spoke with several users using this room who commented re their enjoyment of the facilities and staff assistance.Greenhill House Cheshire HomePage 20 Standard 13 (13.1 ­ 13.5) Staff support service users to become part of, and participate in, the local community in accordance with assessed needs and the individual Plans. 0 Key findings/Evidence Standard met? This standard was not assessed during this unannounced inspection. It was scored at 3 at a previous inspection. Standard 14 (14.1 ­ 14.6) Staff ensure that service users have access to, and choose from a range of, appropriate leisure activities. 4 Key findings/Evidence Standard met? An activity organiser is appointed along with various other craft and activity support workers. A programme of events is produced and each service user receives a copy. A record of service user participation is made along with recorded comments of service user involvement / feedback where they are able to contribute. Activities are targeted to individuals who require one to one work as well as group activities. The home has a large well-equipped activities room as well as a sensory room. Service users are involved in activities such as dance, swimming, yoga, skating, music, art and numerous various outings. The home has two mini buses and three adapted cars. A full time driver and several voluntary drivers are employed to transport service users and staff to appointments and social engagements. The range of leisure and social activity that service users are engaged with is both extensive and impressive. Standard 15 (15.1 ­ 15.5) Staff support service users to maintain family links and friendships inside and outside the home, subject to restrictions agreed in the individual Plan and Contract (subject to standards 2 and 6 if necessary). 3 Key findings/Evidence Standard met? The home operates an open visiting policy. The visitors book evidenced many regular visitors to the home although the inspector did not have the opportunity to speak with any visitors during the inspection. Some service users visit other Leonard Cheshire homes where they have friends. Staff also facilitates trips to relatives homes within staffing constrictions. A number of friendships have developed outside the home related to some of the activities listed above.Greenhill House Cheshire HomePage 21 Standard 16 (16.1 ­ 16.11) The daily routines and house rules promote independence, individual choice and freedom of movement, subject to restrictions agreed in the individual Plan and Contract (subject to Standards 2 and 6 if necessary). 3 Key findings/Evidence Standard met? The practices of staff and their interactions with service users demonstrated that they were treated with respect and dignity. Their preferred term of address is determined prior to admission; all staff are referred to by their Christian names. Some service users get their own breakfast and engage in certain household chores as they are able and wish. The service users living in the flats are expected to be much more independent. The home has flat access and lifts to all areas. Bedrooms and bathrooms have locks and a number of service users have keys to their own rooms. The kitchen is the only area restricted to service users, this is for reasons of health and safety. Standard 17 (17.1 ­ 17.9) The registered person promotes service users health and wellbeing by ensuring the supply of nutritious, varied, balanced and attractively presented meals in a congenial setting and at flexible times. 0 Key findings/Evidence Standard met? This standard was not assessed during this unannounced inspection. It was scored at 3 at the previous inspection.Greenhill House Cheshire HomePage 22 Personal and Healthcare SupportThe intended outcomes for the following set of standards are: · · · · 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 homes 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.Standard 18 (18.1 ­ 18.11) Staff provide sensitive and flexible personal support and nursing care to maximise service users privacy, dignity, independence and control over their lives. 3 Key findings/Evidence Standard met? Service user and staff interactions were observed by the inspector to be supportive and friendly. Service users spoken with during the inspection also confirmed the helpfulness and friendliness of staff. They felt their privacy and dignity were respected and their independence promoted. Care plans on the nursing unit are written to encourage the maintenance and development of independence. Service users records viewed in the personal care unit did not have specific care plans (refer to comments in standard 6). Bed time, rising times and bathing are flexible and a matter of choice however, indications are recorded in care plans. Service users and staff spoken with confirmed that this flexibility was apparent as part of the daily processes of the home. The staff are a mixed gender team and preferences about intimate care can be respected. Service users choose their own clothing and hairstyles.Greenhill House Cheshire HomePage 23 Standard 19 (19.1 ­ 19.5) The registered person ensures that the healthcare needs of service users are assessed and recognised and that procedures are in place to address them. No. of incidents where service users have been taken to Accident & Emergency during last 12 months No. of service users with pressure sores at the time of inspection (from information taken from care notes) XX3 Key findings/Evidence Standard met? A local GP carries out a weekly review of service user needs. The inspector attended the weekly review on the nursing unit during the inspection. The registered nurse provided information to the GP for individual service users in a professional systematic manner. Changes identified in meeting service user needs following the review were appropriately recorded and passed to the team. Paulton hospital provides emergency medical cover if needed. Two physiotherapists work Monday to Friday. Hydrotherapy is available at the RUH. Chiropody is offered monthly. All service users are registered with a local optician and have access to a local dentist if they wish it. The home is well equipped with pressure relieving equipment, specialist beds and chairs. Standard 20 (20.1 ­ 20.14) The registered manager and staff encourage and support service users to retain, administer and control their own medication, within a risk management framework, and comply with the homes policy and procedure for the receipt, recording, storage, handling, administration and disposal of medicines. 0 Key findings/Evidence Standard met? This standard was not assessed during this unannounced inspection. The home had recently been inspected by the CSCI pharmacist and a separate report is available.Standard 21 (21.1 ­ 21.8) The registered manager and staff deal with the ageing, illness and death of a service user with sensitivity and respect. 0 Key findings/Evidence Standard met? This standard was not assessed during this unannounced inspection. It was scored at 3 at a previous inspection.Greenhill House Cheshire HomePage 24 Concerns, Complaints and ProtectionThe intended outcomes for the following set of standards are: · · Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm.Standard 22 (22.1 ­ 22.7) The registered person ensures that there is a clear and effective complaints procedure, which includes the stages of, and timescales for, the process and that service users know how and to whom to complain. No. of complaints made to the home during last 12 months No. of these complaints fully substantiated No. of these complaints partly substantiated No. of these complaints not substantiated No. of these complaints not yet resolved No. of complaints sent direct to CSCI Percentage of complaints responded to within 28 days 0 0 0 0 0 0 X 3 Key findings/Evidence Standard met? The home keeps full records of all comments or concerns and the outcome, none recently have amounted to formal complaints. The regional manager monitors quarterly returns of these records. The home has a comprehensive complaint policy and procedure. All service users have a copy of the procedure and the same is on public display.Greenhill House Cheshire HomePage 25 Standard 23 (23.1 ­ 23. 6) The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, or inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policy. The home has an Adult Protection procedure (including Whistle Blowing) which complies with the Public Disclosure Act 1998 and the DOH Guidance No Secrets No of staff referred for inclusion on POCA/POVA lists YESX3 Key findings/Evidence Standard met? The home has written procedures for adult protection, whistle blowing, management of aggression, abuse, bullying and management of service users money/valuables. The `No Secrets document was also available. The home actively promotes staff training and education in these areas, all staff receive training in dealing with difficult behaviours, aggression / violence and protection of vulnerable adults. Staff training records viewed evidence this commitment. Staff the inspector spoke with also confirmed the receipt and understanding of training in adult protection.Greenhill House Cheshire HomePage 26 EnvironmentThe intended outcomes for the following set of standards are: · · · · · · · 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.Standard 24 (24.1 ­ 24.13) The homes premises are suitable for its stated purpose; accessible, safe and well maintained; meet service users individual and collective needs in a comfortable and homely way; and have been designed with reference to relevant guidance. 3 Key findings/Evidence Standard met? Greenhill House has been extensively adapted for disabled people and is generally well designed for the function. Motorists when driving to the visitor car park must give caution as vehicle access runs through the pedestrian access to the connecting buildings, which service users and staff frequently use. The problem with storage of chairs, hoists and other special equipment was not an issue at this inspection. The home is well furnished and equipped. The standard of décor was good throughout the home; knocks to paintwork are a constant problem, mostly due to the use of wheelchairs. The home employs a full time maintenance manager who co-ordinates the maintenance schedules for all equipment as well as being responsible for the day-to-day repairs. The inspector spoke with the maintenance manager and viewed maintenance records. These records evidenced that their are adequate arrangements in place for servicing and maintenance of the equipment and building.Greenhill House Cheshire HomePage 27 Standard 25 (25.1 ­ 25. 11) The registered person provides each service user with a bedroom, which has useable floor space sufficient to meet individual needs and lifestyles. Total no. of single bedrooms with at least 10 sq.m usable space or additional compensatory space Pre-existing homes only (1st April 2003) ­ single bedrooms below 10 sq.m usable space or additional compensatory space Total no. of wheelchair users accommodated for in rooms at least 12 sq.m Total no. of wheelchair users accommodated for in rooms less than 12 sq.m Total no. of shared rooms at least 16 sq.m Total no. of shared rooms below 16 sq.m Percentage of places within single rooms: 100 80 - 99 Less than 80 Total no. of single bedrooms Number of single bedrooms with en suite Total no. of double bedrooms Number of double rooms with en suite YES NO NO 37 5 0 0 37 026 11 0 03 Key findings/Evidence Standard met? There have been no changes in the provision of bedrooms and they are suitable for their purpose. Many of the rooms have overhead tracking systems linked to some bathrooms. All service users have single rooms.Greenhill House Cheshire HomePage 28 Standard 26 (26.1 ­ 26.4) The registered person provides each service user with a bedroom that has furniture and fittings sufficient and suitable to meet individual needs and lifestyles. 3 Key findings/Evidence Standard met? All rooms were well presented, offering appropriate furnishings and fittings relevant to assessed need and ability as documented in care plans. A lockable storage space is provided in each room. Bedroom doors are also lockable based on assessed need; many of the social care service users access this facility. Rooms evidence a high degree of personalisation service users, with their families and/or friends / keyworker, have personalised their rooms with photographs, posters, plants, TV, hifi equipment and smaller items of furniture, etc. The standard of décor was good. Standard 27 (27.1 ­ 27.6) The registered person provides service users with toilet and bathroom facilities, which meet their assessed needs and offer sufficient personal privacy. 3 Key findings/Evidence Standard met? There are sufficient communal bathrooms and toilets, which are accessible to disabled people. Several being fitted with overhead hoists. Five rooms have en-suite facilities. All bathrooms have locks; however many of the service users require some level of staff assistance. The home has adequate sluicing facilities and washer disinfector machines. Standard 28 (28.1 ­ 28.3) A range of comfortable, safe and fully accessible shared spaces is provided both for shared activities and for private use. 3 Key findings/Evidence Standard met? There is a wide variety of communal space comprising of lounges, dining rooms, conservatories, activity rooms and quiet areas. These areas are well furnished and in general the décor is good. Service users the inspector spoke with confirmed choice of seating and flexibility in the use of the communal areas. They also enjoyed access to the bar of an evening. Staff have a suitable rest area.Greenhill House Cheshire HomePage 29 Standard 29 ( 29.1 ­ 29.8) The registered person ensures the provision of environmental adaptations and disability equipment necessary to meet the homes stated purpose and the individually assessed needs of all service users. 3 Key findings/Evidence Standard met? The home has been adapted for the use of disabled people and from talking to service users and observing them it appears that they are able to move about freely and make use of the facilities without help unless it is requested. The home has overhead tracking systems and a range of hoists and transfer equipment. The bathrooms have a range of specialist baths/showers. The call system is portable thus service users can always contact a member of staff. The home has service contracts to maintain plant and equipment.Standard 30 (30.1 ­ 30.9) The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation, published professional guidance and the purpose of the home. 3 Key findings/Evidence Standard met? On the day of the unannounced inspection the home was well presented, the standard of cleaning and general hygiene was very good; there were no offensive odours. The laundry facilities are suitable for personal laundry and the bedding and towels are laundered externally. The laundry operates at the correct temperatures where need be and have been adapted to meet water regulations. Infection control, COSHH information and assessments were available in the laundry area. There are appropriate arrangements in place for the disposal of clinical waste.Greenhill House Cheshire HomePage 30 StaffingThe intended outcomes for the following set of standards are: · · · · · · 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 homes 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.Standard 31 (31.1 ­ 31.7) The registered manager ensures that staff have clearly defined job descriptions and understand their own and others roles and responsibilities. 3 Key findings/Evidence Standard met? All types and grades of staff have job descriptions that reflect their role. The manager informed the inspector that Job descriptions are regularly reviewed. Job descriptions were now available for the varying roles carried out by an extensive group of volunteers. Induction, training and supervision have also been introduced for these staff. The core of the staff team are long serving and turnover generally is low. The manager informed the inspector that the home had not long completed a recruitment drive and was now fully staffed. This had served to promote continuity by reducing the use of agency staff. The staff duty rota viewed by the inspector and staff members and service users spoken with during the inspection further evidenced this. The GSCC Code of Conduct was available to all staff on commencement of employ. Standard 32 (32.1 ­ 32.6) Staff have the competencies and qualities required to meet service users needs and achieve Sector Skills Council workforce strategy targets within the required timescales. 3 Key findings/Evidence Standard met? All new staff complete a detailed orientation and induction programme based on TOPPS standards, which provides written and observational evidence of learning. The training co-ordinator manages the induction, foundation and mandatory training for all staff. She has completed a skills matrix and identified an annual training plan to ensure all staff receive / attend required training. The training records were up to date and the RN records evidenced relevant clinical updating. The manager informed the inspector that the home had recently appointed an NVQ trainer who works with staff completing NVQs three days a week. The inspector spoke to the NVQ trainer who confirmed that she is supporting 6 staff with their NVQ and has approximately 6 staff waiting to enrol. The manager feels the home is on course to meet the 50 training target for 2005.Greenhill House Cheshire HomePage 31 Standard 33 (33.1 ­ 33.11) The home has an effective staff team with sufficient numbers and complementary skills to support service users assessed needs at all times. Staff numbers/hours relating to the needs of service users are based on guidance recommended by the Department of Health. Personal Care No. service users High needs No. service users Medium needs No. service users Low needs Total no. of hours needed No. of staff with NVQ level 2 or above No. of Trainees registered on Sector Skills Council training programme X X X X X No. of full time equivalent Staff with nursing qualification (where applicable) No. staff hours allocated No. staff hours allocated No. staff hours allocated Total Hours Provided X X X X Nursing X X XXX3 Key findings/Evidence Standard met? There has until recently been a high usage of agency staff, this has been alleviated by the recent recruitment drive and appointment of care staff. On average there are ten staff on duty in the morning, seven in the afternoon and four at night including one sleep in. At least one RN is on duty 24hrs per day. Several days evidenced two RNs in the morning; the manager stated the aim was to increase to two RNs each morning due to the high dependency and complex nursing needs of some of the service users. The manager works supernumerary. The duty rota records evidenced the home was working well in excess of its staffing requirement. The manager informed the inspector that this was normal practice and required to meet the needs of the service users; this practice is to be commended. In addition there are various therapy staff and sufficient hours to cover housekeeping and catering duties. The home has well-developed relationships with the primary health care team and other paramedical professionals. Standard 34 (34.1 - 34. 8) The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. 0 Key findings/Evidence Standard met? This standard was not assessed during this unannounced inspection. It was scored at 3 at a previous inspection. Greenhill House Cheshire Home Page 32 Standard 35 (35.1 - 35.8) The registered person ensures that there is a staff training and development programme which meets the Sector Skills Council workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 3 Key findings/Evidence Standard met? The training co-ordinator has responsibility to manage all staff training needs. She had completed a skills audit and training matrix, which evidenced a range of core as well as diverse skills. When tracked alongside service user and organisational need it is evident that service user nursing needs as well as the organisational objectives can be met by the current staff group. On the day of inspection the training co-ordinator was completing a training session on infection control, staff the inspector spoke with following the teaching session felt they were well supported and had access to a range of training opportunities. Standard 36 (36.1 - 36.8) Staff receive the support and supervision they need to carry out their jobs. 3 Key findings/Evidence Standard met? All staff receive reqular supervision and appraisal. Regular staff meetings take place and at least a monthly meeting with the general manager. The isnpector viewed minutes of several meetings which evidenced discussion on health and safety issues, staffing, complaints, compliments and niggles. Registered nurses are delegated areas of clinical resposibility and are a resource for other staff. The organisation has grievance and disciplinary procedures.Greenhill House Cheshire HomePage 33 Conduct and Management of the HomeThe intended outcomes for the following set of standards are: · · · · · · · 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 homes policies and procedures. Service users rights and best interests are safeguarded by the homes 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.Standard 37 (37.1 ­ 37.4) The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. Registered manager qualified to level 4 NVQ in Management and care [by 2005]. NO3 Key findings/Evidence Standard met? There has been no change of the management structure since the initial inspection. The registered manager Mr Aubin is now working towards the attainment of the Registered Managers Award. Standard 38 (38.1 ­ 38.6) The management approach of the home creates an open, positive and inclusive atmosphere. 3 Key findings/Evidence Standard met? The manager operates an open door policy and spends a lot of time out in the home alongside the staff offering support and supervision as need be. The staff and service users the inspector spoke to felt Mr Aubin was approachable and they expressed confidence in his leadership. Staff have delegated responsibilities and are enpowered to develop their roles. The home has an established whistle blowing policy. Staff and service user meetings have open agendas.Greenhill House Cheshire HomePage 34 Standard 39 (39.1 ­ 39.10) Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in achieving the aims, objectives and statement of purpose of the home. 0 Key findings/Evidence Standard met? This standard was not inspected during this unannounced inspection. It will be the main focus of the next inspection. Standard 40 (40.1 ­ 40.6) The homes written policies and procedures comply with current legislation and recognised professional standards, covering the topics set out in Appendix 2 of the National Minimum Standards for Adults (18-65). 0 Key findings/Evidence Standard met? This standard was not inspected during this unannounced inspection. It was scored at 3 at a previous inspection. Standard 41 (41.1 ­ 41.3) Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 3 Key findings/Evidence Standard met ? All records required for the standards inspected were available in the home. Monthly Regulation 26 reports are now received at the CSCI as is required. The boilers and hoist/bath equipment has been serviced. The fire log book was up to date and in order, training and drills have taken place. Accident records were properly completed. The residents register was up to date and in order as was the staff register. The residents inventory of personal possessions had been updated. Standard 42 (42.1 ­ 42.9) The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. 3 Key findings/Evidence Standard met? The organisation has Health and Safety policies and procedures and employs a Health and Safety Advisor. The manager has responsibility for health and safety within the home. Hot water temperatures were monitored monthly by the maintainence manager and pre each bath by staff. There is a system in place to manage the risk of legionella. Annual PAT testing had commenced, electriacl and gas saftey records all evidenced compliance to review and maintainence guidelines. All staff had received mandatory training in load handling, first aid, fire safety, food hygiene and health and safety. The home has several trained first aiders. Food hygiene training for catering staff has taken place.Greenhill House Cheshire HomePage 35 Standard 43 (43.1 ­ 43.7 ) The overall management of the service (within or external to the home) ensures the effectiveness, financial viability and accountability of the home. 3 Key findings/Evidence Standard met ? This standard was not assessed during this unannounced inspection. It was scored at 3 at the previous inspection.Greenhill House Cheshire HomePage 36 PART C(where applicable)COMPLIANCE WITH CONDITIONSYES Condition Compliance May accommodate up to 20 persons aged 18 years and above requiring nursing care. CommentsYES Condition Compliance May accommodate up to 17 persons aged 18 years and above requiring personal care only. Comments One service user in the personal care unit (south wing) may be funded for nursing care. Mr Aubin is to investigate this and clarify to the CSCI.Condition Compliance Manager must be RN on parts 1 or 12 of the NMC register. CommentsYESCondition Staffing notice dated 24/07/1996 applies. CommentsComplianceYESLead Inspector Second InspectorKaren LynskeySignature Signature SignatureRegulation Manager Mark Dunford Date 17th June 2004Greenhill House Cheshire HomePage 37 Public reports It should be noted that all CSCI inspection reports are public documents.Greenhill House Cheshire HomePage 38 PART DD.1PROVIDERS RESPONSE TO IDENTIFIED STATUTORY REQUIREMENTSRegistered Persons comments/confirmation relating to the content and accuracy of the report for the above inspection.Please limit your comments to one side of A4 if possible Thank you for forwarding a comprehensive report. I could not find any factual inaccuracies and you will see that I have attached the work plan to meet the requirements laid down in your report. You will see that I have asked for additional time to meet these requirements by a further month. This is partly due to the report unfortunately not having been forwarded to Greenhill, as the regional office thought a further copy had been produced. I will endeavour to keep you informed of developments and changes/problems through regulations 26 and 37. Staff reading the report have said to me that they thought you had captured the nature and spirit of the home and their personal commitment to the lives of the residents/service users at Greenhill. A P Aubin Services ManagerAction taken by the CSCI in response to provider comments:Greenhill House Cheshire HomePage 39 Amendments to the report were necessaryNOComments were received from the provider Provider comments/factual amendments were incorporated into the final inspection report Provider comments are available on file at the Area Office but have not been incorporated into the final inspection report. The inspector believes the report to be factually accurateYESYESNONote: In instances where there is a major difference of view between the Inspector and the Registered Provider both views will be made available on request to the Area Office. D.2 A written Action Plan, which indicates how requirements are to be addressed and stating a clear timescale for completion, was submitted and will be kept on file and made available on request.You will also note that the Commission has identified in the inspection report good practice recommendations and it would be useful to have some indication as to whether you intend to take any action to progress these. Status of the Providers Action Plan at time of publication of the final inspection report: Action plan was required YESAction plan was received at the point of publicationYESAction plan covers all the statutory requirements in a timely fashion Action plan did not cover all the statutory requirements and required further discussion Provider has declined to provide an action planYESNONOOther: enter details here NOGreenhill House Cheshire HomePage 40 D.3PROVIDERS AGREEMENT Registered Persons statement of agreement/comments: Please complete the relevant section that applies.D.3.1 I, Sue Jones, of Greenhill House Cheshire Home, confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) and that I agree with the requirements made and will seek to comply with these. Print Name Signature Designation Date General Manager 10 June 2004 Sue JonesNote: In instance where there is a profound difference of view between the Inspector and the Registered Provider both views will be reported. Please attach any extra pages, as applicable.Greenhill House Cheshire HomePage 41 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!