Inspection on 15/06/05 for Greenside House

This inspection was carried out on 15th June 2005.

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

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

Other inspections for this house

Greenside House 26/02/09

Greenside House 23/11/06

Greenside House 27/09/05

Greenside House 11/08/04

Greenside House 12/05/04

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

CARE HOMES FOR OLDER PEOPLE Greenside House Greenside Avenue Mapplewell Barnsley S75 6BB Lead Inspector Jayne Barnett-Middleton Unannounced 15 June 2005 09:15 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Greenside House J51 S38615 Greenside V218841 150605 UI Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Greenside House Address Greenside Avenue Mapplewell Barnsley S75 6BB 01226 386600 01226 391332 None Barnsley PCT Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Miss Joanne Sharp PC Care home only 38 Category(ies) of OP Old age (38) registration, with number of places Greenside House J51 S38615 Greenside V218841 150605 UI Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The two single bedrooms with a partition screen in Flat 3 (bedroom 2 & 3) must be used as one double bedroom. The occupants of this double room must be given the option to move to single bedrooms when availlable. 2. Flat Flat Flat Flat Flat The bedrooms allowed occupancy is as follows: 1 - 7 Bedrooms all single occupancy 2 - 7 Bedrooms all single occupancy 3 - 6 Bedrooms all single occupancy and 1 double bedroom 4 - 6 Bedrooms all single occupancy and 1 double bedroom 5 - 6 Bedrooms all single occupancy and 1 double bedroom 3. Staffing levels must be maintained at or above the levels required by the April 2002 Residential Forum, Care Staffing in Care Homes for Older People. 4. Where additional services are provided eg day care, staffing for this must be over and above that required by condition 3. 5. Three of the places are registered for either OP Old Age; not falling within any other category, OR PD Physical Disability for people aged 55 years to 64 years inclusive. Date of last inspection 11 August 2004 Brief Description of the Service: Greenside House is a purpose built home, which provides a range of residential and day care services for older people. It stands in its own grounds in a residential area and is close to the centre of Mapplewell village. Adequate car parking space is provided. The home is divided into five wings that are called flats. There are four flats on the ground floor and one flat on the first floor. The home has a passenger lift. Each flat comprises seven bedrooms, a lounge/dining room, a kitchenette and sufficient toilet and bathing facilities. Greenside House J51 S38615 Greenside V218841 150605 UI Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out from 9.15 a.m to 2.30 p.m. Eleven residents, ten staff and two assistant managers were spoken to. A sample of records was examined and a partial inspection of the building was carried out. Throughout the inspection positive and professional relationships were observed between staff and service users. The inspector wishes to thank the assistant manager, staff and service users for their time and co-operation throughout the inspection process. What the service does well: The home had a warm and welcoming atmosphere and service users were comfortable to give their opinion of the service. Despite a busy schedule the staff team were helpful and made the time to talk to the inspector. Intermediate care was provided which provided service users with short term intensive rehabilitation to enable them to return home. It was evident that this service worked very well. All service users spoke positively about the care that they had received and were confident that due to the support given by the staff, they would be able to return home to live independently. All service users spoke highly of the staff team and described them as “really good”, “helpful” and “wonderful”. The staff interviewed had a good knowledge of service users care needs and were able to demonstrate the services that the home provided. The daily routines within the home were flexible. Service users confirmed that they could choose how they spent their day and could “get up and go to bed” when they wished. A good choice of menu was offered and special dietary needs were catered for. All Service users said that they enjoyed their meals and described the food as “very good”, “always plenty”, “marvellous” and “as good as your mothers”. Service users said that they were happy with the accommodation provided and described the home as “a nice place”. Greenside House J51 S38615 Greenside V218841 150605 UI Stage 4.doc Version 1.30 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. Greenside House J51 S38615 Greenside V218841 150605 UI Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Greenside House J51 S38615 Greenside V218841 150605 UI Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3 and 6. Prospective service users and their relatives were provided with the information that they needed, to enable them to make an informed decision about moving into the home. Service users were not admitted to the home without their needs being assessed. Service users admitted solely for intermediate care were provided with the appropriate facilities to maximise their independence and return home. Greenside House J51 S38615 Greenside V218841 150605 UI Stage 4.doc Version 1.30 Page 9 EVIDENCE: The Statement of Purpose had been reviewed to ensure that it met the required standard and a Service Users Guide had been produced, these provided service users and their relatives with the information that they needed to make an informed choice about living at the home. A full needs assessment was carried out for all service users prior to their admission, which confirmed that the service was appropriate for the service user, and provided staff with the information to formulate an individual plan of care. Intermediate care was provided, which provided service users with short term intensive rehabilitation to enable them to return home. Service user requiring intermediate care were accommodated in dedicated areas of the home. Specialist health staff including physiotherapists and occupational therapists supported Service users. Service users spoke positively about the care that they had received, “the staff have been really helpful”, and were confident that they would be able to return home within the near future. Greenside House J51 S38615 Greenside V218841 150605 UI Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10. Service users individual needs were assessed. Care plans in the main contained excellent detail of service users specific rehabilitation programmes. Care plans for long stay service users were in need of review. Service users had good access to health care services, which met their assessed needs. A policy and procedure to ensure that staff adhered to the safe administration of medication was in place. The procedure for recording stock medication required some improvements to ensure that medication administered could be monitored. Service users privacy and dignity was respected. Greenside House J51 S38615 Greenside V218841 150605 UI Stage 4.doc Version 1.30 Page 11 EVIDENCE: Three Care plans set out in detail the action that was required by staff to ensure that all aspects of service users care needs were met. The Care plans had been completed with the involvement of the service user, which gave them the opportunity to agree with staff the help that they needed to live as independently as possible. The care plans checked for service users receiving intermediate care contained excellent detail of service users care needs, rehabilitation programmes and information was easy to track. One care plan checked for a service user in need of long term care had not been reviewed on a monthly basis, to reflect their changing care needs, and information was difficult to track. Service users said that their healthcare needs were met and were able to describe in detail their “exercise programmes” and the “brilliant” support that they had received to “get my legs going”. There was a policy and procedure to ensure that staff adhered to safe practices regarding medication and the protection of service users. The recording and storage of medication was checked on a sample basis. Medication had been administered appropriately. Medication that was in stock had been recorded on one medication administration sheet but the date of when the stock was received was not recorded and it was difficult to track if medication signed for had been administered. One medication administration record did not clearly identify the dose that needed to be administered. Service users were encouraged to administer their own medication. One service user confirmed “the staff asked me if I needed help” and “I keep it in my locked drawer”. Greenside House J51 S38615 Greenside V218841 150605 UI Stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15. The daily routines within the home were flexible and promoted service user choice. Service users were encouraged to maintain contact with their family, friends and the local community as they wished. Service users were encouraged to make informed decisions with regards to their daily lives. A good choice of menu was offered and special dietary needs were catered for. Greenside House J51 S38615 Greenside V218841 150605 UI Stage 4.doc Version 1.30 Page 13 EVIDENCE: Service users said that their daily routines were flexible “I can do what I like when I feel like it”. Several service users were observed to be spending time in the lounges whilst others had chosen to spend their time in the privacy of their bedroom, as “I like to read and do the crossword” and “read the newspaper and rest”. There was a pleasant enclosed patio area, which staff said was popular when the weather was warm. Service users confirmed that they maintained good links with their family and friends and that they could visit “at anytime”. A good choice of menu was offered and special dietary needs were catered for. The cook confirmed that menus were reviewed on a regular basis and that the staff kept her well informed of service users dietary requirements. Menu boards were provided in all dining rooms that informed service users of the choice of food that was available. All Service users said that they enjoyed their meals and described the food as “very good”, “always plenty”, “marvellous” and “as good as your mothers”. Greenside House J51 S38615 Greenside V218841 150605 UI Stage 4.doc Version 1.30 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. The complaints procedure was clear and accessible. Complaints made by service users and their relatives were listened to and action was taken to deal with complaints promptly. There was an adult protection procedure and all staff had received adult protection training. EVIDENCE: The complaints procedure ensured that service users and their relatives were aware of how to make a complaint and who would deal with them. Service users stated that they were satisfied with the care provided and said that they had “no grumbles”. There was an adult protection policy and procedure that promoted the protection of service users from harm or abuse. Staff confirmed that they had attended adult protection training, which enabled them to identify and report any allegations or incidents of abuse to service users. Staff described the adult protection training that they had received as “informative” and “brilliant”. Greenside House J51 S38615 Greenside V218841 150605 UI Stage 4.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26. The home was clean, comfortable and well maintained. Service users were provided with an environment that was safe, accessible and homely. Greenside House J51 S38615 Greenside V218841 150605 UI Stage 4.doc Version 1.30 Page 16 EVIDENCE: The home was clean and tidy, which promoted a comfortable and homely environment. The home was decorated in a comfortable and welcoming manner including homely touches of pictures and ornaments. The home was divided into flats and each had sufficient sitting and dining space. Outdoor space and all areas of the home were safe and accessible to people in wheelchairs. There were sufficient toilet, washing and bathing facilities, which were close to service users bedrooms and communal areas. Several bedrooms were checked and all were clean and well decorated. Service users in long term care had been encouraged to personalise their bedrooms with photographs and mementoes, which encouraged service users to retain their own identity. Service users said that they were happy with the accommodation provided and described the home as “a nice place”. Greenside House J51 S38615 Greenside V218841 150605 UI Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30. Sufficient staff were provided that met the assessed needs of service users. A training and development programme was in place. Some staff required refresher training to update their knowledge and competence. A recruitment procedure was in place that promoted the protection of service users. Staff files needed updating to ensure that they met the required standard. Greenside House J51 S38615 Greenside V218841 150605 UI Stage 4.doc Version 1.30 Page 18 EVIDENCE: All service users spoke highly of the staff team and described them as “really good”, “helpful” and “wonderful”. Several experienced staff had recently commenced employment at the home, all confirmed that they had settled in relatively well and that the staff team had been “friendly and helpful”. A training and induction programme for staff was in place to enable them to meet the assessed and changing needs of service users. Staff confirmed that they had attended various training courses that included bereavement, adult protection, moving and handling, continence care and first aid. Several staff stated that they had not received refresher training, in particular Food Hygiene, to enable them to update their knowledge of changing practices and legislation. A recruitment policy and procedure was in place that promoted the protection of service users. Three files checked did not contain identification documents, employment history or previous employment references. The files checked did contain evidence that the employee had undertaken a criminal record bureau check. The staff that had recently been employed at the home confirmed that they had attended a formal interview and that they did have a current enhanced disclosure check. Greenside House J51 S38615 Greenside V218841 150605 UI Stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 38. The home was managed in the best interests of service users; positive comments were made about the service and the care that service users received. The health, safety and welfare of service users were promoted. However, extra care was required to ensure that cleaning materials were securely stored when not in use. Greenside House J51 S38615 Greenside V218841 150605 UI Stage 4.doc Version 1.30 Page 20 EVIDENCE: All service users spoke positively about the home and described the service as “wonderful”, “very good” and “brilliant”. Staff meetings were held on a regular basis that enabled staff to contribute to the development of the service. Some staff said that the meetings were “useful” whilst some staff stated that a daily handover would be more useful to discuss service users care needs and to keep up to date with changes within the service. The responsible individual, Mr R.W Preston, visited the home on a regular basis to check the standard of care provided and to inspect the premises. Records of these visits were forwarded to the C.S.C.I. The Staff that had recently transferred to the home confirmed that they had received appropriate support on their employment, to enable them to safely and appropriately care for service users. The assistant managers confirmed that the new staff had “settled in well”. The assistant manager confirmed that fire systems were checked weekly and that detailed records of fire drills were maintained. A handyman was employed at the home and a routine programme of maintenance was in place. All areas throughout the home were well maintained which promoted a safe environment. However, a trolley containing cleaning materials was left unsupervised, which presented a potential safety risk to service users. The staff had received training, which promoted safe working practices and the health, safety and welfare of service users and their colleagues. (Please see Staffing, Standard 30 in relation to refresher training). Greenside House J51 S38615 Greenside V218841 150605 UI Stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x x x x 2 Greenside House J51 S38615 Greenside V218841 150605 UI Stage 4.doc Version 1.30 Page 22 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 12,15 Requirement Care staff in consultation with the service user (where practical) must review all service users care plans at least once a month. Medication in stock must be accurately recorded. Medication administration records must state the dose that requires administering. Staff files must include documents as required under schedules 2 and 4 of the regulations (Timescale of 6th October 2004 not met) Staff must be provided with refresher training appropriate to their role. Hazardous substances (cleaning materials) must be securely stored, when not in use. Timescale for action 31st July 2005. 2. 3. 4. OP9 OP9 OP29 13 13 2,19 1st July 2005. 1st July 2005. 1st August 2005. 5. 6. OP30 OP38 13,18 13 30th August 2005. 15th June 2005. Greenside House J51 S38615 Greenside V218841 150605 UI Stage 4.doc Version 1.30 Page 23 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. Refer to Standard OP7 OP31 Good Practice Recommendations The care plan format (files), for long stay service users, should be reviewed, to ensure that information is easily accessible to care staff. The manager should attain a management qualification (NVQ 4 or Managers Award) by 2005. Greenside House J51 S38615 Greenside V218841 150605 UI Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Ground floor, Unit 3 Waterside Court Bold Street Sheffield, S9 2LR 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. 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