Inspection on 17/08/05 for Greenhill Lodge

This inspection was carried out on 17th August 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Greenhill Lodge 05/07/06

Greenhill Lodge 06/02/06

Greenhill Lodge 31/03/05

Greenhill Lodge 05/08/04

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

CARE HOME ADULTS 18-65 Greenhill Lodge 22-24 Alexandra Road Watford Herts WD17 4QY Lead Inspector Alison Jessop Unannounced 17 August 2005 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 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 Stationary 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 Lodge I52 s19416 Greenhill Lodge v245046 170805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Greenhil Lodge Address 22-24 Alexandra Road, Watford, Herts, WD17 4QY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01923 241 957 01923 229 236 The Mental Aftercare Association John Warner CRH Care Home 10 Category(ies) of MD-10, PD-10 registration, with number of places Greenhill Lodge I52 s19416 Greenhill Lodge v245046 170805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home may accommodate 10 people with a mental disorder or physical disability. Date of last inspection 31 March 2005 Brief Description of the Service: Greenhill Lodge is a home offering accommodation to 10 people with long-term mental illness. It is situated in a pleasant residential street in Watford within easy walking distance of the town centre, with all the community life that offers. The residents live relatively independent lives but with staff support always available when they require it and to monitor their general state of health and wellbeing. The home also has two flats for more independent service users but these are excluded from the registered provision. Greenhill Lodge I52 s19416 Greenhill Lodge v245046 170805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over half a day by one Regulatory Inspector. Feedback was gained from several service users and staff, all of which was very positive. Service users were satisfied with the provision of care in the home and staff were observed to have good relationships with them. What the service does well: What has improved since the last inspection? A quality monitoring survey had been completed however the results of this have not yet been collated into a report. The team appear to be continually striving to improve the service and all suggestions appear to be welcomed. Some areas of maintenance work identified has been planned in the near future to further enhance the environment. Greenhill Lodge I52 s19416 Greenhill Lodge v245046 170805 Stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Greenhill Lodge I52 s19416 Greenhill Lodge v245046 170805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Greenhill Lodge I52 s19416 Greenhill Lodge v245046 170805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 &5 Robust Referral and Admission procedures ensure appropriate to ensure service users needs can be met. EVIDENCE: All applicants for Greenhill Lodge receive an introductory letter and information pack containing the Statement of Purpose and Service User Guide. The manager or deputy manager carries out a formal assessment, the method of assessment is also recorded which includes observations, discussions and practical exercise. This usually takes place at the person’s home or current place of residence with the care manager or other representative present. A visit to Greenhill Lodge is also arranged. The manager of Greenhill Lodge, Regional Manager (MACA), manager of the Mental Health Team (ACS) and Housing Officer (Aldwick Housing Association) convene a panel meeting to decide the most appropriate and urgent application. A letter of acceptance is sent and an appropriate level of introduction is agreed with the person when they move in. This can happen immediately or over several visits, which are gradually extended to become permanent. The manager stated that inappropriate referrals could be detrimental and that due to the layout of the house they are unable to accommodate service users who have a physical disability. Each service user signs a Licence Agreement when they move in, the terms and conditions of the home and charges are clearly stated. A representative Greenhill Lodge I52 s19416 Greenhill Lodge v245046 170805 Stage 4.doc Version 1.40 Page 9 that referrals are may sign on their behalf if they are incapable due to mental ill health. This would usually be a social worker or advocate. They are also given a copy of the Tenants Charter. Greenhill Lodge I52 s19416 Greenhill Lodge v245046 170805 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8 & 9. Levels of care and support appropriate to service users needs are identified and written in the care plan. Although the level of support is unobtrusive, and service users choose to stay in bed, staff need to ensure that their basic personal care and hygiene is not neglected as this can prevent further health concerns. EVIDENCE: Service user care plans are created on admission to the home. Information is gathered from the service user, Adult Care Services Risk Assessment, GP and or other sources. A risk assessment is also completed including information from the CPA. Service users had signed risk assessments and reviews and an action planning form is completed ensuring that goals continue to be achievable. Although care plans and risk assessments contained required information, more specific plans and risk management strategies could be further enhanced, as information was quite basic in some areas. One service user had requested for a sentence to be taken out of his care plan as he felt this was inaccurate. This had been done and the service user had signed in agreement. Greenhill Lodge I52 s19416 Greenhill Lodge v245046 170805 Stage 4.doc Version 1.40 Page 11 Service users confirmed that they are consulted with and found that the weekly residents meetings are beneficial. One service user prefers to stay at his own home during weekends, he keeps in contact with staff at the home regularly. This could create risks to the service user when he is staying at home and therefore an individual risk assessment is required. Greenhill Lodge I52 s19416 Greenhill Lodge v245046 170805 Stage 4.doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15,16 & 17. Service users live independent lives and access local facilities independently which is appropriate to current wishes. However, more support could be gradually introduced with engagement in local activities and facilities, this could assist to build self esteem and prevent depressive episodes. EVIDENCE: Throughout the inspection two of the service users were noted to have stayed in bed for most of the day. A lot of time appears to be spent smoking and sitting around in the communal areas. The staff team do try to balance the right to privacy and choice with the need for motivation, stimulation and responsibilities however this is a slow process and needs to be done sensitively as this could be detrimental. The staff team have recognised this and are currently implementing new procedures to overcome this. One service user said that he likes to be involved and enjoys going out with staff and other service users. He said that the level of leisure activities is appropriate. Greenhill Lodge I52 s19416 Greenhill Lodge v245046 170805 Stage 4.doc Version 1.40 Page 13 Several Service users are going to Bognor Regis for one week with staff and were looking forward to this. On the day of the inspection one service went out to town with a member of staff to purchase some new clothes for his holiday. The manager stated that service users are supported in voting and have access to the local polling station, which is directly across the road. Service users who attend coffee mornings and other groups accessing the local church. Greenhill Lodge I52 s19416 Greenhill Lodge v245046 170805 Stage 4.doc Version 1.40 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19 &20 The home has robust policies and procedures which ensures that any errors or gaps are minimised which is particularly important for those whose medication is essential in maintaining their mental health well being. EVIDENCE: The manager explained and demonstrated the medication policies and procedures in the home. The Boots Monitored Dosage System works well and the home receive an inspection from Boots pharmacist every three months. Staff were observed administering medication and a two-person approach ensures that this is administered correctly. Weekly in-house audits are carried out to ensure that PRN medication is correct. Although none of the service users currently self medicate, procedures are in place to accommodate this with a double locked system available in service users bedrooms for the safe storage of medicines. Greenhill Lodge I52 s19416 Greenhill Lodge v245046 170805 Stage 4.doc Version 1.40 Page 15 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 standard(s) 22 Service users appeared to be confident in raising concerns should this be necessary however not all were aware of the complaints procedure. This could prevent service users from being satisfied that their complaint has been fully resolved. EVIDENCE: A letter had been received from Environmental Health Department as a complaint had been made from a local resident about the noise level on one occasion at the home. The manager stated that this was when a service user was unwell and became very distressed. The manager had received the complaint on the day of the inspection and a discussion was held about how this was to be taken forward. Greenhill Lodge I52 s19416 Greenhill Lodge v245046 170805 Stage 4.doc Version 1.40 Page 16 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 standard(s) 24,25,26,27,28 &30 Décor in the communal lounges and dining areas are light and bright offering an uplifting environment to its service users. EVIDENCE: Most of the areas of the home have been re-decorated and the bright colours and soft furnishings offer a homely atmosphere. The home looked clean and tidy on the day of the inspection. Most of the service users are heavy smokers and designated smoking rooms were apparent due to the stale smell of tobacco. One service users bedroom visited was quite heavily stained and smelt of tobacco. There was also a large patch of damp caused by a leaking pipe. However, the manager stated that the housing association are due to re-plaster this soon. Several other improvements to the home will also be made. The garden offers a quiet space for service users to sit and a summer house and seating area to the back of the garden can provide some private time to service users and visitors. The staff at the home attend to the garden and the service users sometimes help out with this. Greenhill Lodge I52 s19416 Greenhill Lodge v245046 170805 Stage 4.doc Version 1.40 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of the above standards were inspected on this occasion. EVIDENCE: Greenhill Lodge I52 s19416 Greenhill Lodge v245046 170805 Stage 4.doc Version 1.40 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38, 40 &41 The management and staff team have clearly worked hard to improve all aspects of Greenhill Lodge and its policies and procedures thus enhancing the lives of the service users. EVIDENCE: The team appear to be dedicated to their work and hope to further enhance the service provided. The management team delegate responsibility equally within the team motivating and promoting development and innovation. Robust procedures are used to safely store and record service users money. Audits are completed by staff at the beginning and end of each day to ensure that service users are protected from financial abuse. A recommendation was made for details of service users bank accounts to be removed from care plans to further promote security. Greenhill Lodge I52 s19416 Greenhill Lodge v245046 170805 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Greenhill Lodge Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 3 x x I52 s19416 Greenhill Lodge v245046 170805 Stage 4.doc Version 1.40 Page 20 No Are there any outstanding requirements from the last inspection? 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 9 Regulation 13(4) (c) Requirement An Individual Risk Assessment of service user staying at his own home at weekends must be completed. Timescale for action By 31/8/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 23 Good Practice Recommendations Bank account details should be removed from care plans and stored securely. Greenhill Lodge I52 s19416 Greenhill Lodge v245046 170805 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City, Herts AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greenhill Lodge I52 s19416 Greenhill Lodge v245046 170805 Stage 4.doc Version 1.40 Page 22 - 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!