Inspection on 12/09/06 for Greenhills

This inspection was carried out on 12th September 2006.

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

Greenhills 06/02/06

Greenhills 13/10/05

Greenhills 18/03/05

Greenhills 25/01/05

Greenhills 11/02/04

Greenhills 24/10/03

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Greenhills 32 St Andrews Road Bridport Dorset DT6 3BQ Lead Inspector Marion Hurley Key Announced Inspection 12th September 2006 10:00 DS0000020469.V305441.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000020469.V305441.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000020469.V305441.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenhills Address 32 St Andrews Road Bridport Dorset DT6 3BQ 01308 422159 01308 422159 greenhills@btopenworld.com 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) Dorset Residential Homes Christopher John Stevens Care Home 9 Category(ies) of Learning disability (9) registration, with number of places DS0000020469.V305441.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th February 2006 Brief Description of the Service: Greenhills is a registered care home that provides accommodation and specialist nursing care for 9 learning disabled people. The home is operated by Dorset Residential Homes, a registered charitable trust that operates a number of care homes in Dorset. Greenhills is located in a residential area close to the town centre of Bridport. It is a large detached property that has been carefully extended and adapted to meet the needs of service users; the home does not stand out from neighbouring properties in any way. The home has 3 floors, the main communal rooms and some bedrooms being on the ground floor, remaining bedrooms on the 1st floor and an office and storage area on the 2nd floor. Most of the service users have lived at Greenhills for a number of years. As the home is registered to provide nursing care, the home is in the charge of a qualified nurse at all times; staffing is provided throughout each 24 hour period, including ‘waking’ night staff. DS0000020469.V305441.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key announced inspection that took place at the home over a period of four and half hours. Additionally, time was spent in preparation for the visit, looking at previous inspection reports and Regulation 37 and 26 reports and other relevant documents. A tour of the premises took place and care records were inspected. The inspection methods used included observation of documentation, record checks, case tracking and discussions with the manager and staff. All the residents were at home; it was not possible to have in depth discussions with individuals due to their communication difficulties. However, it was evidenced through the inspection process that staff continue to have a good understanding of individuals’ needs and maintain good relationships. Inspection comment cards were received from five relatives, which indicated high level of satisfaction. Reference to additional comments maybe found in the report. The pre inspection questionnaire was comprehensively completed and provided valuable information, which was verified throughout the inspection. A copy of the last inspection report is available directly from Greenhills or from Dorset Residential Homes head office in Dorchester. Current fees are £1212.00 but may vary according to the individual’s support needs. What the service does well: The home provides a comfortable clean and homely environment. The home is decorated and furnished to a good standard. There was a friendly atmosphere and the residents met on the day of the inspection seemed happy and comfortable in their surroundings. The staff on duty demonstrated their knowledge of the residents and it was clear they enjoyed a very friendly yet professional relationship with them. The home is managed well and has a consistent, experienced staff team. DS0000020469.V305441.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. DS0000020469.V305441.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection DS0000020469.V305441.R01.S.doc Version 5.2 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 the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New residents are admitted only on the basis of a full assessment undertaken by competent persons and involving the prospective resident, family members and health and social care professionals. EVIDENCE: Prospective residents with their family and friends are invited to visit Greenhills initially to be shown around and given a basic introduction to the services and facilities available. They are then invited for tea and longer stays culminating in overnight stays. These visits form part of the assessment process to determine if the service could meet the persons’ assessed needs. If the introductions progress successfully then the prospective resident is offered a placement at Greenhills. Individual contracts set out the terms and conditions As part of this inspection the care files of two residents were reviewed, one person having been admitted to the home during the last twelve months. The specific file contained a comprehensive range of information with valued contributions from family members and other professionals. Records seen DS0000020469.V305441.R01.S.doc Version 5.2 Page 9 showed that the resident had visited the home with their family before making a decision about moving in, staff also confirmed this. The pre-assessment process included seeking advice and information from other people who knew the prospective resident, including background information, care plans and an assessment on the person’s needs provided by health & social cares professionals. Records showed that the prospective resident was well supported by relatives and significant others during the pre-admission/admission period. A copy of the statement of terms and conditions was included on the resident’s file. The contract requires slight amendment to ensure the CSCI details are correct. All terms and conditions should be signed and dated. The manager explained that generally after the first three months of the move all aspects of the person’s care and support would be reviewed and a full Life Support Plan developed. It is important that reviews are completed as soon as practical to ensure the person’s placement and individual Life Support Plans and risk assessments reflect their on going needs, abilities and preferred lifestyle. DS0000020469.V305441.R01.S.doc Version 5.2 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 the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Life Support Plans described the assessed and changing care needs of residents. This information helps identify the level of support each residents needs to make decisions about their daily lives. The reviewing system in the home needs to be formally implemented at least every six months and Life Support plans must reflect any changes. EVIDENCE: Records demonstrated that residents’ needs and associated risks had been carefully assessed in discussion with placing social workers and carers prior to admission and the level of support required had been agreed. DS0000020469.V305441.R01.S.doc Version 5.2 Page 11 The care /life support plans seen were well presented and contained detailed information on the individual resident. Included in the files were assessments in respect of general dependency/risk, moving and handling and daily notes. Records confirmed that all residents had regular contact with GPs, dentists, chiropodist and consultant psychiatrists. During the tour of the premises it was evident that several residents’ beds had rails fitted it is therefore very important that the use of these is regularly reviewed based on risk assessments. Observation during the inspection showed that staff and residents were very comfortable and relaxed together in each other’s company. DS0000020469.V305441.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Within the identified limitations of each person and the need to provide a safe and stimulating environment, each resident is helped to maintain an active and positive routine both within the home and the wider external community. A varied and nutritious diet is available. Choice is offered and healthy eating is promoted. EVIDENCE: During the inspection residents were seen making decisions about where they spent their leisure time, and what they wanted to be doing. A member of staff supported two residents to do some cooking during the morning producing scones to share with everyone for tea and a jelly for later. DS0000020469.V305441.R01.S.doc Version 5.2 Page 13 Residents are still able to access social and educational services provided by the local authority; during this inspection four people were seen setting off for their day services. The mid-day meal was observed and was being enjoyed by the residents. A record of menus was seen which showed that residents are offered a choice of meals. Meal times are flexible, however, everyone has breakfast, mid day meal and then an evening meal, which commences from 17:00. Residents that have been away from the home during the day are welcomed home with a drink and a cake, scones or biscuits of their choice. The staff in consultation with the residents have developed the menus. This information is recorded in their Life Support plans. From discussions with staff it was evident that they were very aware of the residents’ likes and dislikes. Resident’s plans showed that they are supported to maintain contact with their family and friends and this may be in the form of regular visits or through emails and telephone calls. The routines of the day are structured, yet flexible with staff supporting each person according to their personality and preferred timescales. Observations throughout the inspection showed staff supporting and giving residents appropriate time to complete tasks e.g. one person was vacuuming their bedroom and another sorting their laundry. Details in the support plans identified residents preferred routines e.g. one stated, “to be woken gently”, another “likes to sleep with a soft toy”, and another “likes to go to bed early”. This is good attention to detail and all the information supports staff in ensuring they meet the needs and personal preferences of all the residents. Each resident has the opportunity to take part in leisure and social activities and staff said that among the favourite activities were eating out, going to the cinema, bowling and swimming. DS0000020469.V305441.R01.S.doc Version 5.2 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 the following standard(s): 18, 19, and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive personal support according to their individual needs and staff provide both personal and emotional support. Residents are well looked after with their health and personal care needs monitored and appropriate contact is maintained with external health and social care professionals Medication is managed in a safe and acceptable way with records properly maintained. EVIDENCE: During the inspection staff were seen helping residents with the tasks of everyday living whilst ensuring their safety in the home. Included in the resident’s plans were clear detailed instructions on how the assessed care needs were to be met. The plans showed the residents’ health care needs are monitored and action taken to address any problems. Staff DS0000020469.V305441.R01.S.doc Version 5.2 Page 15 spoken with were aware of residents individual healthcare needs and how they wished to live their daily lives and be appropriately supported to achieve this. All the residents require help from staff with their prescribed medication and the care / support plans indicated if the resident had any specific needs relating to the administration of medication and one observed stated “administer with a spoonful of jam” Medication records were inspected and were being recorded appropriately. Medication was being stored and administered appropriately. Creams were dated at the time of being opened and staff have been briefed by the pharmacist as to the correct length of time for retaining creams and other medicines. Clear instructions for all staff had been added to the MAR sheet folder. DS0000020469.V305441.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory policies and procedures are in place for the protection of residents and ensuring complaints and concerns are listened to and acted upon. EVIDENCE: The home/organisation – Dorset Residential Homes has a written complaints procedure which is available at Greenhills and given to each resident / and or their relative. The manager and staff confirmed that some of the residents tell them verbally if they “have a grumble” whilst others indicate through different behaviours or gestures. Families indicated on their questionnaires that they understood the complaints procedure. The home has had no recent complaints. The manager stated that all the residents living at Greenhills have either relatives or a friend or an advocate to help them speak up or speak up on their behalf. A current series of training workshops on the protection of vulnerable adults is being organised by DRH and staff from Greenhills will be attending. DS0000020469.V305441.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a homely, comfortable and safe environment. There are good standard of hygiene and cleanliness within the home. EVIDENCE: The home is located a short distance from Bridport town centre and has a large pleasant and accessible garden to the rear, a patio directly accessible from the kitchen and ample car parking facilities. Staff and residents share an interest in the garden and this is evident from the flower containers and positive recycling and composting. Greenhills provides homely, comfortable and practical accommodation for the residents. The home is spacious, bright and cheerful, airy and clean throughout. DS0000020469.V305441.R01.S.doc Version 5.2 Page 18 The premises are in keeping with the local community and well maintained. Shared space for residents include a very spacious lounge, good size dining room, kitchen and separate laundry. All the bedrooms are pleasantly and individually decorated. Specialist beds and equipment have been fitted and in use to meet residents’ specific needs. Bedroom door locks are available for those residents wishing to use this facility. Risk assessments are completed to ensure the safe use of keys/locks Residents observed during the inspection looked relaxed and were moved about the home comfortably and without any restrictions. The recent and extensive refurbishment work has successfully been completed since the last inspection and the additional communal space is very welcome. DS0000020469.V305441.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear and understood management structure, with staff understanding their different roles and responsibilities. Staff are well supported in their roles resulting in good quality of direct care being provided to residents. EVIDENCE: The home has a well-established staff team some of whom have worked at Greenhills for many years. Some residents are very dependent on staff help with personal care and some have mobility needs. Records of rotas and discussions with the manager and staff confirmed that there was always a minimum of two staff on duty and most shifts had three staff. Both staff and the manager stated that when there were only two people on duty this was “a tough shift” and inevitably left staff having to divide themselves between all the residents. A comment card have also identified the problem of only having two staff on the rota appeared most frequently in the afternoon shifts. The manager needs DS0000020469.V305441.R01.S.doc Version 5.2 Page 20 to consider how he may address this issue and ensure there are more shifts with a minimum of three staff working. Staff training records were checked and included both mandatory training in health and safety related subjects and also areas of personal development and issues directly related to the care and support of individual residents. The personnel files of two staff were reviewed and this evidenced that all necessary checks and been completed prior to appointment. DS0000020469.V305441.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from a well run home. The manager is qualified and competent to run Greehills. There are systems in place designed to promote and protect the health and safety of both residents and members of staff. Staff are committed to the well being of residents. EVIDENCE: Greenhills has a competent staff team, which is well managed by an experienced and qualified manager. DS0000020469.V305441.R01.S.doc Version 5.2 Page 22 The management approach is open and positive with a clear sense of direction and leadership. Through discussion with the manager and staff it was evident there continues to be an inclusive atmosphere within the home. The management and organisational (DRH) systems and structures enable the service to run effectively. Residents clearly remain the focus of the service. The use of a keyworker system supports each person living within the home. This together with the use of independent advocates has created a structure that allows each resident to contribute to the home within which they live. A quality assurance system needs to be developed which can consider all aspects of the service delivery, informally the standards are monitored continually through regular one to one sessions with residents and staff meetings. The pre inspection questionnaire was completed which provided valuable information, which was verified throughout the inspection process. Polices and procedures are in place that ensures the residents’ safety and welfare is protected. The registered provider’s representative makes regular visits to the home and produces a comprehensive report of their findings, which are sent to the Commission regularly. The fire log was examined. There is a fire risk assessment in place and staff have been provided with fire safety training, the last instruction being on 07:04:06 & 14:07:06. The fire alarm systems and other equipment are regularly checked. The generic health and safety checks, which cover all areas of the home, fridge/freezer and water outlet temperatures all indicated regular monitoring and recording. DS0000020469.V305441.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X DS0000020469.V305441.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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 YA6 Good Practice Recommendations Further evidence to demonstrate the residents’ plans are reviewed at least six monthly to reflect changing needs need to be clearly presented in the residents’ records. All risk assessments should be dated and regularly reviewed to reflect any changing needs or strategies to minimise risk to the resident. Staffing numbers/hours must be flexible to reflect the needs of the residents at all times. 2 YA9 3 YA33 DS0000020469.V305441.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 DS0000020469.V305441.R01.S.doc Version 5.2 Page 26 - 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. 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