Inspection on 10/05/07 for Greens (The)

This inspection was carried out on 10th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greens (The) 10/10/05

Greens (The) 23/08/05

Greens (The) 03/08/04

Greens (The) 27/04/04

Greens (The) 20/01/04

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

CARE HOME ADULTS 18-65 Greens (The) The Greens 388 Chessington Road West Ewell Epsom Surrey KT19 9EG Lead Inspector Mary Williamson Unannounced Inspection 10th May 2007 11:00 Greens (The) DS0000013658.V338348.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 Greens (The) DS0000013658.V338348.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. Greens (The) DS0000013658.V338348.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greens (The) Address 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) The Greens 388 Chessington Road West Ewell Epsom Surrey KT19 9EG 020 8224 3313 Mr Navaratnam Pakthyiendra Mrs Sharmini Pakthyiendra Mrs Sharmini Pakthyiendra Care Home 3 Category(ies) of Learning disability (3), Learning disability over registration, with number 65 years of age (1) of places Greens (The) DS0000013658.V338348.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age/age range of the persons to be accommodated will be 30 - 65 YEARS although one person may be over the age of 65 and fall within the category LD(E) 10th October 2005 Date of last inspection Brief Description of the Service: The home is registered to accommodate a maximum of three residents of either gender all of whom have learning disabilities. The registered age range of the residents accommodated is thirty to sixty five years, although registered provision is also made for one resident aged over sixty-five years. The home is privately owned and registered to Mr and Mrs Pakthyiendra. The home is a detached property set in a residential area off a main road and is close to local facilities and amenities. The home provides a caring and supportive service in a homely and comfortable environment. The home is decorated and furnished to a very good standard and has a large well maintained garden. The fees charged range from £900, to £1250 per week. Greens (The) DS0000013658.V338348.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first site visit of a key inspection and was unannounced. Mary Williamson who is a Regulation Inspector undertook the inspection. The registered home manager Mrs Sharmini Pakthyiendra represented the establishment. A tour of the premises was undertaken, and a number of records relating the care of the residents and the management of the home were examined. It must be noted that the residents living in the home have profound learning/communication difficulties and their views and opinions about living in the home were limited and communicated through the help of the manager and staff team. Discussions took place with the staff and the manager who were able to demonstrate a good understanding of individual resident’s needs. They were also able to demonstrate the training they had undertaken and how they apply this on a daily basis. Recruitment procedures were sampled and two employment files were seen. These contained all the relevant documentation to comply with employment regulations. The manager completed a pre inspection questionnaire, and one relative survey, one GP survey, and one care manager survey were returned to the inspector with favourable comments about the home. The findings of this inspection were positive with observed evidence of good care practice provided by experienced staff. The Commission for Social Care Inspection would like to thank the residents, manager, and staff for their help and hospitality during the inspection. What the service does well: The home provides a high standard of accommodation, which is comfortable and homely. The standard of cleanliness and hygiene is excellent. The standard of care is good and all residents appeared well cared for. Staff were interacting with residents in a professional and positive manner. Record management is efficient and all records sampled were in good order. The catering arrangements suit the needs and lifestyle of the residents. Lunch was served in a relaxed and unhurried atmosphere. Greens (The) DS0000013658.V338348.R01.S.doc Version 5.2 Page 6 Staff recruitment and training is good with all mandatory in place and being updated regularly. The home is well managed. 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. The summary of this inspection report can be made available in other formats on request. Greens (The) DS0000013658.V338348.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 Greens (The) DS0000013658.V338348.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have access to sufficient information about the home prior to admission. Needs assessments are undertaken and contracts of occupancy are in place. EVIDENCE: The home has a statement of purpose and service user guide in place. The residents required help and support from relatives and care managers to understand this information prior to coming to live in the home. The manager undertook needs assessments prior to the resident’s admission. These assessments are detailed and provide ample information on residents needs. Contracts of occupancy are in place which outline the care provides, the accommodation offered, the fees charged, and the method and frequency of payment. These have been signed by a relative or care manager on behalf of the resident. Greens (The) DS0000013658.V338348.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans reflect care provided, and include individual risk assessments. EVIDENCE: Care plans were sampled and are well maintained. These are written based on the needs assessment, input from the resident whenever possible, information from the relatives and care manager, and other relevant reports. Care plans are reviewed regularly within the home. The funding authorities undertake annual reviews of care. The residents have non -verbal communication skills and are supported by staff to help them make decisions about their daily life through the use of gestures, signs and body language. One resident can make her needs known by taking one by the hand and physically showing what they want, and another was observed to refuse to do a specific task. Risk have been identified and assessments included in individual care plans, for example moving and handling, eating and choking, bathing, medication, fire, road safety, and use of transport. These are reviewed regularly. Greens (The) DS0000013658.V338348.R01.S.doc Version 5.2 Page 10 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. 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. The home encourages residents to take part in activities within and outside the home. The service has regard for the residents having contact with the local community and their relatives. Nutritional needs are being met. EVIDENCE: Two of the residents attend the local Gallway day centre for selected activities every week. One resident is retired and has an activity programme organised by the home. All residents enjoy flower arranging, music therapy, aromatherapy, manicures, and cake baking. Shopping trips, meals out, local walks, and trips to places of interest are also offered. The manager stated that a holiday in the Isle of Wight is being planned for later this year. Family links are maintained and relatives are welcome in the home at any reasonable time. Relatives are also encouraged to participate in care reviews and the care planning process. Friendship groups are also maintained and residents can visit friends in local homes and can also invite friends from other homes to tea. Greens (The) DS0000013658.V338348.R01.S.doc Version 5.2 Page 11 Spiritual needs are supported and the manager stated that the local vicar visits the home. One resident attends the Synagogue with a member of staff. The kitchen is domestic in nature and is in keeping with the layout of the home. It also includes the dining area. Menus are planned over a four- week period and are based on a healthy living plan. The staff team have a good knowledge of the resident’s likes and dislikes, which are also clearly documented. Staff and residents go shopping for the food. Lunch on the day of the inspection included a beef casserole, selection of vegetables, and potatoes. This was followed by a choice of puddings and a fruit smoothie. All staff have a certificate in food hygiene. Greens (The) DS0000013658.V338348.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Resident’s health care needs are being met in their preferred manner. The medication procedure in place protects residents. EVIDENCE: Personal care is offered to residents as outlined in individual care plans, for example one resident prefers her bath in the evening which is clearly documented. The arrangements in place to meet the health needs of residents are satisfactory. All the residents are registered with a local GP who will visit the home if residents get too distressed by visit to the surgery. Dental treatment is available at Bourn hall. Chiropody is available at Longmead Clinic at a charge of £10. There is psychology and psychiatric support when required. The home has a procedure in place for the administration of medication. Anachem Pharmacy provided all the medication to the home in blister pack format. The medication recording charts were sampled and were well maintained. The medication is stored safely. All the staff that administer medication have been trained in safe medication practice, with regular update training evident on staff files. Currently none of the residents living in the home self medicate. Greens (The) DS0000013658.V338348.R01.S.doc Version 5.2 Page 13 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. 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. Residents are dependent on relatives and staff to air their views. There is an abuse awareness policy in place. EVIDENCE: The home has a complaints procedure in place, which is also available in pictorial format. A copy of this is also included in the service user guide, which in kept in resident’s rooms. The residents living in the home are very much reliant on staff members and relatives to make a complaint on their behalf. There is a complaints register available, however no complaints have been received. There are several letters of thanks, and positive feedback surveys on file. The home has an abuse awareness policy in place and all staff receive regular training regarding safeguarding adults from abuse. Yellit 1 Training undertook the most recent training. Certificates of attendance were seen on staff files. The home also has a copy of Surrey’s Multi Agency Safeguarding Vulnerable Adults procedures in place. A discussion took place between the manager and the inspector regarding her attending training in these procedures, and a requirement has been made accordingly. Greens (The) DS0000013658.V338348.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents live in a homely, comfortable and well maintained home. The standard of cleanliness is very good. EVIDENCE: The home is comfortable, well maintained, decorated and furnished to a high standard. Communal accommodation includes a large lounge and activity area, which overlooks a well maintained large rear garden. Residents have unrestricted access within the home and garden. Individual bedrooms have been decorated to a very good standard and are personalised to reflect individual personalities. One resident was very keen that the inspector sat on a particular chair in her bedroom while she proceeded to show off her favourite possessions. Residents appeared very relaxed and confident within the home. The standard of cleanliness and hygiene is excellent in all areas of the home. There is an infection control policy in place and the laundry facilities meet the needs of the home. Greens (The) DS0000013658.V338348.R01.S.doc Version 5.2 Page 15 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. 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. A competent and qualified staff team, who have been recruited according to the home’s recruitment policy, supports residents. EVIDENCE: The staffing arrangements were discussed with the manager and the duty rota evidenced two staff on duty throughout the day, and one staff who undertakes a sleep- in duty. These arrangements are sufficient to meet the assessed needs of the residents. The home has a recruitment policy in place, which safeguards the residents. Two staff employment files were seen. These are well maintained and include all the required employment documentation including two written references, an employment history and a CRB (Criminal records Bureau) disclosure. The manager informed the inspector that Yellit 1 Training is responsible for the training of staff within the home. Staff undertake a period of induction followed by foundation and development. Staff have a record of training undertaken in their personal files, which includes medication safety, first aid, abuse awareness, fire safety, management of violence and aggression, food hygiene, positive approach to autism, challenging behaviour management, and health and safety. NVQ training is ongoing with two staff having achieved NVQ level 2 and one with NVQ level 3. One staff member is also a registered nurse. Greens (The) DS0000013658.V338348.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 39 and 42. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well run home that promotes health and safety. Quality assurance monitoring systems are in place. EVIDENCE: The home is very well managed by the registered manager who is also the provider. She has an NVQ level 4 in management and several tears experience in the provision of care for residents with learning disability and a challenging behaviour. She has a very good understanding of the needs of the residents in her care. There are good management support systems in place when the manager is off duty, including a qualified nurse, and senior support workers. Quality assurance is monitored by questionnaires being sent to relatives, and health care professionals associated with the home. These are retained on file and were sampled during the inspection. There is good positive feedback from relatives regarding the standard of care provided by the home. Other feedback Greens (The) DS0000013658.V338348.R01.S.doc Version 5.2 Page 17 from the psychiatrist, director of the music therapy project director and the hairdresser was all very good. Health and safety is promoted and all staff have training in health and safety including COSHH procedures. Risks assessments are in place for all identified risks and safe working practice. Fire safety practice is observed and fire alarms are tested and recorded weekly. A recent visit by the fire safety officer recommended that new fire extinguishers to be provided, which are now in place. There is also a risk assessment in place undertaken by the fire officer. Greens (The) DS0000013658.V338348.R01.S.doc Version 5.2 Page 18 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 3 2 3 3 X 4 X 5 3 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 4 25 4 26 4 27 X 28 X 29 X 30 4 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 3 15 3 16 X 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 4 X 4 X X 3 X Greens (The) DS0000013658.V338348.R01.S.doc Version 5.2 Page 19 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 YA23 Regulation 18(1) (c)(i) Requirement It is required that the registered manager attends the surrey County Council Multi-agency training in safeguarding Vulnerable Adults Timescale for action 18/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Greens (The) DS0000013658.V338348.R01.S.doc Version 5.2 Page 20 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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. Extracts may not be used or reproduced without the express permission of CSCI Greens (The) DS0000013658.V338348.R01.S.doc Version 5.2 Page 21 - 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. 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