Inspection on 31/05/07 for Greenhill Park

This inspection was carried out on 31st May 2007.

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 Park 29/12/05

Greenhill Park 19/07/05

Greenhill Park 01/03/05

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

CARE HOMES FOR OLDER PEOPLE Greenhill Park 24 Greenhill Park Road Evesham Worcestershire WR11 4NL Lead Inspector Nic Andrews Key Unannounced Inspection 31 May and 4 June 2007 09:20 X10015.doc Version 1.40 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 Park DS0000063333.V338948.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 Older People. 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 Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenhill Park Address 24 Greenhill Park Road Evesham Worcestershire WR11 4NL 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) 01386 40836 01386 422248 Mrs Maria Bayliss Mr Michael Francis Cole Mrs Maria Bayliss Care Home 24 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (24), of places Physical disability over 65 years of age (24) Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: There were no conditions of registration other than those referred to on the previous page of this report Date of last inspection 29th December 2005 Brief Description of the Service: Greenhill Park is a large, detached building that is situated in a quiet, residential area approximately half a mile from Evesham town centre. The home has a large, attractive garden that includes lawns, flowerbeds and sitting areas. The home is in an elevated position and enjoys extensive views over the Vale of Evesham and the Cotswold Hills. The premises are accessible to people who use wheelchairs and there is space for car parking at the front of the building. The premises have been adapted and extended in order to provide accommodation for a maximum of 24 older people. The home is registered to provide personal care for people over the age of 65 years who may also have a physical disability. Ten of the places are registered for people who may also have a dementia illness. The service users are accommodated on the ground and first floor in 18 single bedrooms and 3 double bedrooms. Twelve of the single bedrooms have an en suite facility. Two of the double bedrooms have single occupancy. Consequently, there were twenty-two service users in residence at the time of the inspection. A passenger lift has been installed to enable the service users to have easier access to the bedrooms on the first floor. The fees range from £360.00 to £425.00 per week. Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place over two days. The home was inspected against the key National Minimum Standards with the help of the registered manager and one of the other registered providers. Various records and a number of policies and procedures that the home is required to maintain were inspected. Parts of the premises were also inspected. Individual discussions were held with three service users and three members of staff. As part of the inspection Comment Cards were issued to a number of service users and/or their relatives and to visiting professionals. A total of seventeen Comment Cards were completed and returned. Eleven Comment Cards were from the service users’ relatives and six were from visiting professionals. The majority of the responses to the questions that were asked in the Comment Cards were positive. Ten of the Comment Cards received from the relatives of the service users contained additional comments and a number of these are reflected in this report. What the service does well: What has improved since the last inspection? Since the previous inspection there had been improvements in the level of staff training and in the development of a person centred approach to care. This has been helped by a key worker system. The number and range of social Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 6 activities including outings had been increased. The premises had continued to be upgraded and improvements included the refurbishment of the dining room, the provision of new wall heaters, new vanity units and bedroom furniture and the redecoration of some rooms. The home had embarked on the ‘Safer Food Better Business’ initiative and had participated in the ‘Having Your Say’ project. 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. The summary of this inspection report can be made available in other formats on request. Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are provided with relevant information about the home and they are given a contract that contains clear details about the service they receive. The care needs of prospective service users are assessed and they are given the opportunity to visit the home prior to admission to enable them to make an informed choice. However, the information provided about the home needs to be improved. EVIDENCE: The home’s statement of purpose was clear, well-written and contained relevant information. However, the statement of purpose did not include a reference to all of the matters listed in Schedule 1 of the Care Homes Regulations. For example, there was no reference to the organisational structure of the home or to the arrangements made for consultation with service users about the operation of the home such as service user meetings, the use of questionnaires and regular discussions with the key workers. The statement of purpose must also include the number and size of all the rooms (referred to in Standard 1.1 as environmental standards), details of any specific therapeutic techniques and the arrangements made for respecting the Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 9 privacy and dignity of service users. The associated emergency procedures relating to fire precautions should include details of the arrangements made for the care and accommodation of the service users in the event of a temporary closure of the home. The out of date reference to the County Inspectorate should be deleted and the information regarding the registered manager’s training/qualifications should be updated. The service users’ guide (referred to by the home as ‘Residents’ Manual’) was also clear, well-written and contained relevant information. The registered manager confirmed that a copy of the service users’ guide was issued to all prospective service users. A copy of the guide was displayed on the notice board in the hall near to the main entrance. However, the service users’ guide did not include a reference to all of the matters listed in Standard 1.2. For example, there was no description of the individual accommodation and communal space provided and no reference to the relevant experience of the staff. The service users’ guide should also include a summary of the physical environment standards (referred to in Standard 1.1), a reference to the number of places provided and any special needs or interests catered for, the availability in the home of a copy of the most recent inspection report, details of the service users’ views of the home and information about how to contact local social services and health care authorities. The out of date reference to Worcestershire County Council should be deleted and replaced with a reference to the Commission for Social Care Inspection (CSCI). The registered manager confirmed that all of the service users were given a copy of their terms and conditions of residence (contract) at the time of their admission. A copy of the contract was held on the service users’ files. The contracts contained relevant information including details of the matters listed in Standard 2.2. The registered manager agreed to delete the out of date reference to the National Care Standards Commission (NCSC) in the contract and to replace it with a reference to the CSCI. The registered manager confirmed that all prospective service users were assessed prior to admission. The registered manager and registered provider usually carried out the assessments. The amount of space on the assessment form that was used for recording the care needs of prospective service users was limited. In addition, the assessment form did not include a reference to all of the aspects of care listed in Standard 3.3. For example, there was no specific reference to foot care, history of falls, weight, social interests, hobbies, religious and cultural needs and social contacts/relationships. The registered manager confirmed that prospective service users were given the opportunity to visit the home prior to admission. A trial period of four weeks following admission was in operation. The registered manager said that the trial period could be extended, if necessary. Emergency admissions were avoided, wherever possible. The registered manager said, ‘The situation doesn’t generally arise. The home is normally full and no beds are available’. Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The service users’ health and personal care is based on their individual, assessed needs. The arrangements for the storage and administration of medication ensure that the service users’ safety and wellbeing is protected. The service users are treated with dignity and their right to privacy is respected. EVIDENCE: The registered manager confirmed that all of the service users had a care plan that was based on an assessment of their needs. The care plans included a reference to all of the issues listed in Standard 3.3 except for sight, hearing and foot care. The care plans contained relevant information. However, the instructions for the interventions by staff were not always as specific as they could be and this created the possibility of omissions occurring in the delivery of care. The care plans tended to describe the service users’ needs rather than stating the way in which their needs should be met. The service users files contained relevant information including a photograph, risk assessments on pressure care, health screening profiles, monthly key worker reports, activities diary, copies of Regulation 37 notifications, details of health checks and copies of their terms and conditions of residence. Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 11 The registered manager confirmed that all of the service users were registered with GPs in one of four local surgeries. There was evidence to show that the service users were also receiving support from other healthcare professionals including the district nurse, chiropodist, the continence adviser and community psychiatric nurse. One of the service users had superficial sores and was using a pressure relieving mattress and cushions. The registered manager stated that the district nurse provided any additional pressure relieving equipment that was required. The registered provider intended to replace some of the armchairs in the lounges with chairs that had a built-in, pressure-relieving cushion. Two of the service users were awaiting a visit by a physiotherapist. Nutritional screening and risk assessments on falls were carried out in respect of each new service user at the point of admission. One service user was due to attend the ‘falls clinic’ at the local hospital within a few days of the inspection. The home had made suitable arrangements to ensure that the service users’ received appropriate dental and ophthalmic care. The service users also underwent hearing tests as and when necessary. The service users were escorted to external appointments by their relatives or members of staff. The needs of a service user with increasing levels of dependency were discussed. The registered manager was advised to obtain a stand-up hoist to enable the service user’s needs to be met more appropriately by the staff. The home used the Boots monitored dosage system for the administration of medication. The registered manager stated that the home had a positive relationship with the local pharmacist who carried out a check of the medication procedures every quarter. The medication was kept in a lockable trolley. Access to the medication was restricted to the senior on duty. The Medication Administration Record (MAR) charts contained a photograph of the individual service users to assist correct identification. The MAR charts had been completed correctly. Two members of staff signed the MAR charts when the details of the medication were written on to the MAR charts by hand. The date of opening was usually recorded on the outside of the medicine packets. One exception to this practice was noted during the inspection. The home had a controlled drug cabinet that complied with the Misuse of Drugs (Safe Custody) Regulations 1973. The controlled drug register was up to date and correctly maintained in respect of four service users that were in receipt of controlled drugs. There was an appropriate system for recording the receipt and return of medication. Copies of the prescriptions were retained by the home. The home had a dedicated fridge in which medicines that required cold storage could be kept. A daily record was maintained of the temperature of the fridge when it was in use. The registered manager agreed to place the fridge in a more accessible position when it became necessary to bring it back into use. A list of the names and signatures of the staff involved in the administration of medication was maintained. The list was in the process of being updated. The registered manager confirmed that all the staff involved in the administration of medication had undertaken the ‘Care of Medicines’ accredited training provided by Boots at Worcester College. The home’s medication policy and procedures should be reviewed in accordance with the Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 12 guidelines produced by the Royal Pharmaceutical Society of Great Britain. Two service users administered their own medication. Their ability to selfadminister safely had been subject to a risk assessment. A lockable facility had been provided in the service users’ bedrooms to ensure the safekeeping of their medication. The staff with whom discussions were held understood the importance of upholding the service users’ privacy and dignity. The responses that were given to the questions they were asked about personal care giving reflected good practice. It was confirmed that examinations and treatment provided by visiting professionals were carried out in private. Some service users had their own telephone. A mobile handset should be provided to enable all the service users to make and receive telephone calls in private. Mail was given to service users unopened. The service users wore their own clothes and their clothes were appropriately labelled. The staff received instruction during their induction on how to treat the service users with respect. Portable screens were provided in the three double bedrooms. Bedrooms that accommodate two service users should be provided with permanent curtain screening. The service users with whom discussions were held confirmed that they were treated with respect and that their right to privacy was maintained. The Comment Card from the relative of one service user stated, ‘I have been very impressed with the way my father is looked after. He is treated with kindness, affection and respect and as an individual. I have nothing but praise for the manager and staff. Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The home promoted the service users’ quality of life by seeking their views, offering choice, supporting them to make decisions about their care and encouraging them to retain contact with their relatives and to remain independent. EVIDENCE: The home provided a wide range of social and leisure activities including ‘Music for Health’, and ‘Pets as Therapy’, every two weeks. The hairdresser visited the home every week and Bingo was played every Sunday afternoon. There had been outings to various places including Evesham Arts Theatre, Stratford Butterfly Farm, tea dances and pub lunches. The home received visiting entertainers including musicians and a magician. The service users were enabled to visit the local Roman Catholic and Anglican churches every week. Twice a month a service was held at the home, one of which was a Communion service. One of the care assistants had designated responsibility for arranging social activities. The forthcoming activities were displayed on the notice board. A diary of activities was maintained in respect of each service user and these recorded each activity in which the service users had participated. Raffles were held three times a year and the money that was raised was used to supplement the service users’ activities fund. Special occasions were celebrated e.g. Christmas, Easter and birthdays. Children from the local school visited the home at Christmas. The service users expressed Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 14 their satisfaction with the range of activities provided. The Comment Card from the relative of one service user stated, ‘Every effort is made to make the residents happy and comfortable with a warm and friendly homely feeling. Special efforts are made with lots of activities’. There were no unreasonable restrictions regarding the visiting arrangements. Visitors were requested to avoid coming at mealtimes and not to visit after 10.00 pm without prior notification. The service users’ right to refuse to see their visitors was respected. The service users confirmed that they were able to see their visitors in private and that their visitors were always made welcome and offered a cup of tea. The Comment Card from the relative of one service user stated, ‘Excellent care and support given to residents and full discussions with family at all times. A very friendly and warm welcome is given to all’. The registered manager said that training on person centred care had recently been introduced to help ensure that the service users’ right to exercise choice was maintained. It was stated that service users were encouraged to exercise choice in all aspects of their daily routine. Service users’ meetings had not been held recently but were due to re-commence on 15 June 2007 and would continue to be held every four weeks. Information about the local advocacy service was displayed on the notice board. Information about the local advocacy service and the service users’ right of access to the personal records held about them by the home should be included in the service users’ guide. The home had participated in ‘Having Your Say’. The service users confirmed that they were enabled to make choices in regard to matters affecting their care, what and where they ate, the clothes they wore and the time they got up and went to bed. The cook said that she prepared the menu in consultation with the service users. A copy of the four-week menu was displayed in the dining room. The care staff asked the service users each day what they would like to eat for their lunch and teatime meals. A choice of food was provided. Meals and drinks were served at appropriate times and drinks and snacks were available throughout the day. Supper was served at about 8.30 pm. The special dietary needs and preferences of service users, including those that were vegetarian and diabetic, were catered for appropriately. One service user required staff assistance when eating. The home had embarked on ‘Safer Food Better Business’ standards. A record was maintained of the food, fridge and freezer temperatures. A cleaning schedule was in place in the kitchen. The cook confirmed that all of the kitchen equipment was in proper working order. The dining room was pleasantly decorated and provided a congenial setting in which to eat. The record of the food provided showed that the service users received a wholesome and balanced diet. The food that was observed being served during the inspection was appealing and nutritious. The service users spoke positively about the food. One service user said, ‘The food is very good and nicely presented and there’s always enough. The staff always come round Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 15 to ask if you want any more’. Another service user said, ‘We have an excellent cook and the food is very good. We’re never rushed at meal times’. Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The home has a clear complaints procedure and other relevant policies and procedures to ensure that service users are protected from abuse. Staff have been given appropriate information and training and the service users feel confident about making a complaint. EVIDENCE: The home’s complaints procedure was clear and contained relevant information. An amendment was made to the procedure during the inspection. The Commission for Social Care Inspection had received no complaints against the home since the previous inspection. The registered manager also stated that no complaints had been made against the home. A folder for recording any complaints that may be made against the home in the future was introduced during the inspection. The service users with whom discussions were held said that they felt confident about making a complaint. They also confirmed that the registered manager, registered providers and staff were approachable and felt that, if it was necessary to make a complaint, it would be dealt with quickly and appropriately. The interaction between the staff and service users that was observed during the inspection was positive. The Comment Card from the relative of one service user stated, ‘In the years that I have been visiting Greenhill the staff have always been most helpful and I have never had reason for complaint’. The home had a brief policy and procedure on the protection of vulnerable adults from abuse that was combined with the home’s ‘whistle blowing’ policy. A copy of the procedure was displayed on the service users’ notice board in the Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 17 hallway near to the main entrance. The home also had a copy of the Department of Health guidance ‘No Secrets’. The staff had received training on abuse awareness delivered by an external training agency on 2 November 2006. The registered manager stated that all the staff had been issued with leaflets on the protection of vulnerable adults and that the home’s policy and procedure for the protection of vulnerable adults had been discussed in staff meetings and that it also formed part of the staff induction. The registered manager also confirmed that no incidents of alleged or suspected abuse had occurred within the home or had been reported to her or otherwise come to her attention since the previous inspection. The registered manager confirmed that she had had no reason to refer any member or former member of staff for consideration for inclusion on the POVA register. The home had policies and procedures on ‘Dealing with Aggression’ and ‘Physical Restraint’. The home’s policy and procedure on ‘Residents’ Finances’ did not include all of the issues referred to in Standard 18.6. However, the registered manager subsequently confirmed that all of the issues were covered in the service users’ guide, the service users’ contract and/or the staff terms and conditions of employment. The out of date reference to the ‘County Inspectorate’ in the policy on ‘Residents Finances’ should be replaced with a reference to the Commission for Social Care Inspection. Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The service users live in clean, comfortable and well-maintained surroundings. However, some aspects of the environment need attention in order to ensure the comfort and safety of the service users. EVIDENCE: The location of the home was suitable for its stated purpose. The home was accessible and well maintained. The registered provider stated that any items that required replacement or repair were dealt with straight away. A maintenance book was maintained but there was no written programme of routine maintenance and renewal of the fabric and decoration of the premises. A written programme should be introduced and this could include, for example, the provision of garden benches, new curtains in the lounges and the proposed purchase of nine armchairs with built-in pressure relieving cushions. The gardens were attractive and accessible. Parts of the surface of the driveway at the front of the premises were uneven and in need of repair. These posed a potential safety hazard. There was a pleasant, external patio at the rear of the premises constructed with decking where the service users were able to sit in warm weather. Decking is known to be hazardous in damp conditions and Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 19 whilst this may not be the case at present the area should be subject to a risk assessment. There were no handrails on some parts of the corridor walls. The change of floor level on the first floor meant that some of the service users had to walk up four stairs without any mechanical assistance. A risk assessment must be carried out in respect of each of the service users accommodated in the bedrooms in this part of the first floor to ensure that they are able to manage the stairs safely. The last visit by the Fire Safety Officer took place in July 2005. The registered provider confirmed that there were no outstanding fire safety issues. The Environmental Health Officer had visited the home on 26 June 2006. The registered provider confirmed that all of the issues highlighted for attention as a result of the visit had been addressed. The home had a ‘no smoking’ policy in operation within the premises and there was a designated smoking area for staff. The home had a small staff room. There was also a large bathroom that was also used as a hairdressing salon for the service users. Standard 21 was not fully inspected on this occasion. However, the home’s response to the two requirements that were made in regard to Standard 21 as a result of the previous inspection was assessed. The first requirement was that staff must ensure that when service users are bathed the temperature of the water is suitable. The requirement had been implemented. The registered manager confirmed that the temperature of the bath water was checked and recorded prior to each service user being bathed and that the water temperatures were monitored every month. The second requirement was that worn flannels and towels must be replaced. The requirement had been implemented. The premises were clean and tidy and, apart from one bedroom, free from unpleasant odours. The laundry was appropriately sited and included hand washing facilities and paper towel and liquid soap dispensers. The laundry contained a tumble dryer and one washing machine that had a sluice facility. The laundry floor finishes were impermeable and these and the wall finishes were readily cleanable. Protective gloves and aprons were available for use by staff. The staff cleaned manually the commode pots that were used. The home did not have appropriate facilities to carry out this task and manual cleaning is not the recommended method of decontamination. Disposable commode pots should be used. The service users with whom discussions were held felt that the standard of cleanliness within the home was good. They also expressed their satisfaction with the standard of laundering of their own clothes. Three requirements were made as a result of the previous inspection. The first requirement was that infection control policies and procedures must be adhered to and staff must receive training on infection control. The requirement had been implemented. The staff had received training in infection control on 24 February 2007. However, the infection control policy and procedure needed to be reviewed in accordance with relevant guidance. The second requirement was that soiled laundry must be appropriately bagged and laundered. The requirement had been implemented. It was confirmed Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 20 that red foul-laundry bags were used and that these could be placed directly into the washing machines. The third requirement was that substances considered hazardous must be appropriately stored. The requirement was regarded as having been implemented. There was a lockable cupboard for storing hazardous substances. However, arrangements should be made to ensure the safe storage of the washing powder that was not kept in the lockable cupboard. Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory staffing levels are provided and staff receive relevant training to enable them to develop appropriate skills to meet the service users’ needs. The staff are committed to the care of the service users and they are supported to provide good quality care. The staff recruitment policy and practices ensure that suitable staff are employed and that the service users’ safety is protected. EVIDENCE: Details of the staffing levels and a copy of the two-week staff duty rota were made available for inspection. The information provided showed that the number and deployment of care staff were sufficient to meet the needs of the service users and the stated aims and objectives of the home. Additional members of care staff were on duty at peak times of activity during the day. Two members of staff were on waking duty at night. Two of the registered providers resided on the premises for the majority of time. Details of the hours worked by the registered provider should be included on the staff duty rota. The home employed four domestic staff, two full-time and two part-time and a cook. The service users spoke positively about the staff. One service user said, ‘I’ve never once felt I’m in the way. If the staff can help you they will. They’re all very helpful. There’s not one of them I wouldn’t feel happy with. The staff are very kind to me. I’m not made to feel a nuisance’. Another service user described the staff as ‘very hard working’. Another service user stated, ‘I get attention at night. We never get neglected’. The Comment Card from the relative of one service user stated, ‘My relative is extremely happy at Greenhill. She has excellent facilities and is looked after Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 22 very well. Since moving to Greenhill her health etc has improved greatly’. Another Comment Card stated, ‘My mother is so well looked after at this home. She is extremely happy. The couple who run it and the staff are wonderful and cannot do enough for all who live there’. Another Comment Card stated, ‘Very well run care home. Staff/owners are always willing to help in any way’. Another Comment Card stated, ‘After visiting other alternatives I feel the size and the personal care is much better than most since there is a family feel to the organisation’. The home employed a total of thirteen care staff. Nine of the care staff had completed NVQ level 2 training or above. This exceeded the 50 trained members of care staff required by the National Minimum Standards. Therefore, the recommendation that was made as a result of the previous inspection in regard to NVQ level 2 training had been implemented. It was pleasing to note that the deputy manager and three senior care assistants had completed the NVQ level 3 training. It was also pleasing to note that the deputy manager was hoping to complete the NVQ level 4 and Registered Managers’ Award training in September 2007. The files of three members of staff were inspected. The files included an application form, job description, two written references, evidence to show that an enhanced CRB disclosure check had been obtained prior to the commencement of their employment, proof of the person’s identity including a photograph and a copy of a staff contract. The registered manager confirmed that all the staff had undergone a CRB check and had been issued with a contract and a copy of the code of conduct and practice set by the General Social Care Council. Two requirements were made in regard to Standard 30 as a result of the previous inspection. The first requirement was that all staff must receive induction training to National Training Organisation specification within six weeks of appointment to their posts. The requirement had been implemented. The home had its own induction programme that helped to identify individual training needs. In addition, new members of staff that did not have any previous relevant experience undertook a two-day induction training programme provided by an external training organisation. The second requirement regarding the provision of foundation training was no longer applicable and has, therefore, been deleted. The staff were asked to confirm in writing that they had read and understood the home’s policies and procedures. The registered manager stated that this information formed part of the individual staff training and development assessments and profiles. Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The registered manager is experienced, competent and caring. The management of the home is based on a positive approach, openness and respect for the service users’ best interests, rights and safety. Systems are in place to monitor and develop the quality of the service. EVIDENCE: The registered manager had relevant experience and was competent to run the home. She had been the registered manager of the home since February 2005. The registered manager had completed the Registered Managers’ Award training in July 2006 and the NVQ level 4 training in March 2007. She had previously been the registered provider of a care home for older people between August 1993 and November 1998. Since taking up her position in 2005, the registered manager had undertaken additional, short-course training on various relevant topics. The training included accredited medication training (February 2005), practical skills in the care of people with dementia Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 24 (July 2005), moving and handling (November 2005 and more recently), first aid at work (December 2005), food hygiene (March 2006), protection of vulnerable adults from abuse (November 2006) and person centred care (May 2006). It was pleasing to note that the majority of the staff had also undertaken the same training. The registered manager displayed an ethos of being open and transparent in her management of the home. She was service user focussed and led and supported a strong staff team who had been trained to a high standard. One of the service users said that the registered manager was ‘always very willing to help’. A requirement was made as a result of the previous inspection that a quality assurance system must be introduced in accordance with the requirements of Regulation 24 and Standard 33. The requirement had been implemented. The home had introduced a commercially produced quality assurance system that had been purchased in June 2006. The quality assurance system related to each section of the National Minimum Standards and required the registered providers to score the home’s achievements annually against each of the Standards. At the end of each section both the strengths and the areas that were in need of improvement were highlighted. The system for recording the action that had been taken and the improvements that were made needed to be formalised. Questionnaires had been issued to both the service users and their relatives during November 2006. The results of the questionnaires had been analysed but not published. Questionnaires had not yet been issued to stakeholders in the community. The service users were encouraged to retain responsibility for their own money. The registered manager confirmed that no one employed by or connected with the running of the home acted as an agent or appointee on behalf of any of the service users. However, money was held in safekeeping for fourteen service users. The money was kept in a lockable tin in a lockable cabinet in a lockable room. Access to the service users’ money was restricted to the registered manager, deputy manager and one of the registered providers. The money was kept together in one large amount. However, a separate record was maintained of the service users’ individual accounts. The accounts were checked and these were correct. The registered manager audited the records periodically. The last audit was carried out on 20 April 2007. The registered manager was advised not to keep unnecessarily large amounts of the service users’ money in the home. The registered manager confirmed that personal possessions were also held in safekeeping on behalf of service users. Standard 36 was not fully inspected on this occasion. However, the home’s response to the requirement that was made as a result of the previous inspection was assessed. The requirement was that care staff must receive formal supervision at least six times a year. The requirement had been implemented. The registered manager stated that she and the registered provider were responsible for staff supervision. She confirmed that all the staff Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 25 received formal, individual supervision at the required frequency. In addition, staff reviews (appraisals) were being used and it was intended that staff meetings would be held every two months. The registered provider and one of the care assistants had undertaken the fire warden’s training. The care assistant was deputy fire warden for the home and was responsible for maintaining the fire safety records. All of the staff members except three had undertaken fire safety awareness training on 15/10/06. The registered provider had reviewed the home’s fire risk assessment on 12/06/07. The home’s risk assessment on Legionella had been reviewed on 03/02/07. However, a risk assessment had not been carried out in respect all the safe working practice topics referred to in Standards 38.2 and 38.3 e.g. moving and handling, first aid and boilers and central heating systems. Thermostatically controlled mixer valves had been fitted to all of the hot water outlets used by the service users. It was also confirmed that opening restrictors had been fitted to all of the windows. Every quarter the registered manager carried out an analysis of the accidents to service users. The registered manager confirmed that all the staff had read the last quarterly review dated 16 April 2007. The home had a health and safety policy. The annual fire alarm and emergency lighting checks had been carried out on 29 May 2007. The passenger lift had been serviced on 25 January 2007. The two hoists and tilt bath had been serviced on 8 and 10 February 2007. The gas safety record was dated 17 April 2007. PAT testing had been carried out on 25 April 2007. The home held all of the relevant information regarding COSHH and RIDDOR. The home also had a valid electrical safety certificate. Staff training had been provided in respect of food hygiene on 10/03/06, the protection of vulnerable adults from abuse on 02/11/06, person centred care on 03/05/07 and moving and handling on 25/05/07. The cook had also undertaken food hygiene training at an advanced level. The registered manager also confirmed that the majority of staff had undertaken first aid at work training within the past two years. Training in the care of people with dementia had been provided on 12/09/05 and was due to take place again on 26/06/07. The registered manager had not undertaken any training in risk assessment. A requirement was made as a result of the previous inspection that a fire resistant hatch that complies with fire safety must be fitted to the serving hatch between the kitchen and the dining room. The requirement had been implemented. Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The care plans must set out in detail the specific action that needs to be taken by the staff to ensure that all aspects of the service users’ needs are met. Risk assessments must be carried out regarding the safety of the driveway and the decking on the rear patio, the provision of handrails in all of the corridors and in respect of the service users who are accommodated on the first floor regarding their ability to access their bedrooms using the stairs and any necessary action taken to ensure the safety of the service users, staff and visitors. Action must be taken to ensure that bedroom 3 is kept free from offensive odours. Risk assessments must be carried out and recorded for all the safe working practice topics covered in Standards 38.2 and 38.3. Timescale for action 31/07/07 2 OP19 12,13 31/07/07 3 4 OP26 OP38 16 13 30/06/07 31/07/07 Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 28 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 8 9 10 Refer to Standard OP1 OP1 OP3 OP7 OP8 OP9 OP9 OP10 OP10 OP14 Good Practice Recommendations The statement of purpose must be amended so that it includes all of the information detailed in Regulation 4 and Schedule 1. The service users’ guide should be amended so that it includes all of the information detailed in Standard 1 as outlined in the guidance given in this report. The form that is used for assessing prospective service users should be amended in order to include a reference to all of the aspects of care referred to in Standard 3.3. The service users’ care plans should be amended in order to include a reference to sight, hearing and foot care. A stand-up hoist should be obtained to enable the needs of one service user to be appropriately met. The date of opening should be recorded on the outside of the medicine packets. The home’s policy and procedure for the administration of medication should be reviewed and, where necessary, revised in accordance with relevant guidance. A mobile handset should be provided to enable service users to make and receive telephone calls in private. Fixed curtain screening should be provided in double bedrooms where more than one service user is accommodated. The service users’ guide should include information about the local advocacy service and a clear statement that the service users have a right of access to the personal records held about them by the home. A programme of routine maintenance and renewal of the fabric and decoration of the premises should be produced and implemented. Disposable commode pots should be used. The policy on infection control should be reviewed and, where necessary, revised in accordance with the Guidelines for Infection Control for Care Homes produced by the Herefordshire and Worcestershire Local Health Protection Unit. Arrangements should be made for the safe storage of washing powder. DS0000063333.V338948.R01.S.doc Version 5.2 Page 29 11 12 13 OP19 OP26 OP26 14 OP26 Greenhill Park 15 16 OP27 OP33 17 OP33 18 OP38 The staff duty rota should include the hours worked by all the staff including the registered persons. The results of service user surveys should be published and made available to current and prospective service users, their representatives and other interested parties, including the CSCI. The views of stakeholders in the community e.g. GPs, district nurses and other visiting professionals, should be sought on how the home is achieving goals for service users. The registered manager should undertake risk assessment training. Greenhill Park DS0000063333.V338948.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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