CARE HOMES FOR OLDER PEOPLE
Greensleeves 19 Perryfield Road Southgate Crawley West Sussex RH11 8AA Lead Inspector
Mr E McLeod Unannounced Inspection 2nd May 2006 09:30 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 Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 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. Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Greensleeves Address 19 Perryfield Road Southgate Crawley West Sussex RH11 8AA 01293 511394 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) Mrs Jean Thompson Kennedy Gisbey Mrs Jean Thompson Kennedy Gisbey Care Home 41 Category(ies) of Dementia - over 65 years of age (41) registration, with number of places Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th September 2005 Brief Description of the Service: Greensleeves is a care home providing accommodation and personal care for up to forty one older (over the age of 65 years) persons. The owner and manager is Mrs Jean Gisbey. The home is situated in a residential area of Crawley, being close to the town centre, local amenities and transport links. Greensleeves consists of two linked houses and a large purpose built extension. There are two units, largely based upon residents needs. Both units have their own lounges, dining areas and gardens. Bedrooms are on two floors, with a lift serving most rooms on the first floor. The gardens are safe and accessible for residents to use and enjoy. There is off-road parking for staff and visitors. Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was arranged to follow up recommendations and requirements made at the previous inspection. Lead inspector for the visit to the premises was Mr E. McLeod, and second inspector was Mrs A. Taggart. The inspectors had met to plan the inspection visit and review evidence available. The inspectors made a tour of the premises, and spoke with a number of residents, their relatives, staff and managers. A number of care plans and care records were sampled, including three sets of pre-admission records. Documents such as accident and complaints records were sampled, and policies and procedures including those for the protection of vulnerable adults were sampled. Care practice was observed, and an inspector was present during the serving of a lunch. The outcomes for residents were found to be good. The inspectors would like to thank all residents, relatives, staff and managers who contributed to the inspection. What the service does well:
Good information is available for residents and prospective residents on the service provided. Good arrangements are in place for trial stays and visits, and for the assessment of a resident’s needs. Residents’ health needs are being met, and residents have a good quality of life, and are well cared for. Routines are unhurried and flexible. Staff are friendly and approachable, and treat residents with respect and in a caring manner. Residents say they feel well cared for. Good meals are being provided in the home. Complaints in the home are being handled objectively and fairly. The premises provide a comfortable, homely environment for residents. The home is clean and hygienic, and decoration and furnishings are of a good standard. Communal areas in the home are arranged to ensure the comfort of residents and to maintain a sense of homeliness. The gardens are well maintained, accessible, and prettily laid out. A large number of care staff have the National Vocational Qualification (NVQ) in care, and some other staff have commenced or are about to commence this.
Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 Page 6 Numbers of the staff on duty on the day of the inspection were ensuring the needs of residents were being met, including their need for social contact and stimulation. Residents have a good quality of life, and staff are ensuring residents have opportunities to remain active and do things they enjoy such as singing, dancing and crafts. There were many smiles seen on the day of the inspection. What has improved since the last inspection?
There has been an improvement in the care plans provided, which are now recorded on file records and are more up to date. These are now placed in residents’ bedrooms, and are therefore now more accessible to care staff, residents and relatives. A new medication system has been put in place, whereby individual dispensations of medication is being provided by the pharmacist, which are renewed on a monthly basis. Improvements to the premises since the previous inspection have included the decoration of four bedrooms and the two lounges, a new carpet in one lounge and new flooring in the main dining room. A recognised staff induction training is now in place. 11 care staff now have NVQ 2 or equivalent qualifications, and a further 5 staff have commenced or are due to commence NVQ2. Mrs Gisbey, the registered manager, has been continuing to update her training in different areas of management practice. Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 Page 7 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. Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 Page 8 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 Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 Page 9 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 the following standard(s): The statement of purpose and service user guide should be updated. Good arrangements are in place for trial visits and stays and assessing if the resident’s needs can be met in the home. Pre admission assessments should provide more information on the person’s established routines, interests, and personal history. Outcomes for residents were assessed as good. EVIDENCE: The Statement of Purpose and Service User Guide were last updated in May 2004 and provide good information for residents and prospective residents on the service provided. Information on the relevant qualifications and experience of the register provider, manager and staff in these documents Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 Page 10 need to be updated, and the service user guide should include service users’ views of the home. Individual contracts/ statements of terms and conditions of residence which included required information were available on care records sampled. Pre admission assessments for three residents were seen. The inspectors suggested that the home’s pre admission assessment should include more information on the prospective resident’s established routines, interests and personal history to assist better care planning for residents. Registered provider and manager Mrs Gisbey advised the inspectors that before admission a resident visits for the whole day for assessment, which is further reviewed over a three month trial period during which there is a formal review meeting with the resident and relatives after six weeks. Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 Page 11 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 the following standard(s): There has been an improvement in the care plans provided. Where relevant, guidelines for staff on dealing with aggressive incidents should be provided on the care plan. Care plans should include some provision for the resident’s individual interests and established routines. Residents’ health needs are being met. Outcomes for residents have been assessed as good. EVIDENCE: Care plans are now provided in individual binders which are held in the resident’s bedroom. Records of care routines are also held in the resident’s bedroom. These therefore can be seen more readily by staff, the resident and their relatives. Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 Page 12 Some risk assessments were sampled, and inspectors felt that these sometimes needed expanding – for example, where a resident can be aggressive at times, clear guidelines for staff on this should be included in the care plan to ensure that staff are responding in a consistent way to such incidents. Care plans sampled did not always include a personal history of the resident or their interests. Medical visits are being separately recorded. Mrs Gisbey advised that she encourages relatives to arrange optician and audiology appointments, as it is not always appropriate for residents to have these needs assessed by a visiting service. Care plans seen indicated that residents’ health needs are being monitored, and services such as chiropody are made available. Mrs Gisbey advised that each resident’s medication is reviewed by their GP. A new medication system has been put in place, whereby individual dispensations of medication are being provided by the pharmacist, which are renewed on a monthly basis. Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Residents have a good quality of life, and are well cared for. Residents receive a balanced diet, and good meals. Outcomes for residents were assessed as good. EVIDENCE: On the day of inspection, a hairdresser was visiting the home and there was a musical entertainer in the afternoon. A circle of residents was dancing to the music and singing along, and there were many smiles. A programme of activities was posted in the home, which included planned outings and arranged performances, and staff interviewed added that there were activities provided every day for residents. One member of staff said she enjoyed doing fun things with residents, especially arts and crafts and an exercise group, and that she had recently helped take some residents out to a theatre. She said some residents enjoy dancing and singing along to “the old songs”, and two new CD players had been bought for this purpose. She added that it was “a good home for interaction”.
Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 Page 14 All residents have their breakfast in bed, and routines observed by inspectors such as meals and getting up in the morning were unhurried and flexible. Menus showed that a variety of good quality home-cooked food is available and likes and dislikes are recorded. The menu of the day is written up on a board so that people can choose an alternative if they wish to do so. The main choice for lunch on the day of the inspection was lamb stew, mashed potatoes, fresh vegetables and banana custard. Supper was to be ham and eggs, bread and butter and strawberry and cream or cake. Special diets can also be catered for and the cook has been on a healthy eating course. All residents were very positive about the food provided Staff were noted to be friendly and approachable, and to treat residents with respect and in a caring manner. Residents said they felt well cared for. Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 Page 15 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 the following standard(s): A good complaints procedure is in place, and complaints are dealt with fairly. The policy and procedures on adult protection need to clarify that the local authority should be advised of adult protection or suspected adult protection incidents, and that it is the local authority and/ or if appropriate the police, not CSCI, which have responsibility for the investigation of adult protection incidents. Staff training in local adult protection procedures should be provided. Outcomes for residents were assessed as good. EVIDENCE: The complaints policy and complaints records were seen. Records seen indicated that complaints are being handled objectively and fairly. Mrs Gisbey has advised the Commission that the home does not handle any money on behalf of residents. A policy and procedures on the protection of vulnerable adults dated May 2004 were sampled. These procedures give the impression that CSCI will investigate adult protection incidents whereas it is the police or local authority social services department that will investigate adult protection incidents. Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 Page 16 Staff are receiving adult protection training, but this does not include training in local adult protection procedures. Mrs Gisbey said that the staff handbook reminds staff of the responsibility of the provider to refer staff who have been shown to have acted in an abusive way towards residents to the Protection of Vulnerable Adults register. Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 Page 17 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 the following standard(s): The premises are fit for purpose, and provide a comfortable, homely environment for residents. The home is clean and hygienic, and decoration and furnishings are of a good standard. Outcomes for residents were assessed as good. EVIDENCE: There are two lounges and two dining areas, and these are arranged to ensure the comfort of residents and to maintain a sense of homeliness. One bedroom sink unit was found to be in poor condition, but otherwise bedroom furnishings were found to be of good quality, and bedrooms were comfortable and homely. Residents and their families have assisted in personalising their bedroom. Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 Page 18 The home is decorated to a good standard. The gardens are well maintained, accessible, and prettily laid out. All areas of the home visited were clean and hygienic. Two trip hazards were identified, one of which was corrected before the end of the inspection – Mrs Gisbey advised that a rail pole was on order to reduce the risk on the two steps identified as the second hazard. Improvements to the premises since the previous inspection have included the decoration of four bedrooms, and the two lounges, a new carpet in one lounge and new flooring in the main dining room. Work has been carried out to level a raised step in the entrance to bedrooms 3 and 4. A door security system has been provided. Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): A recognised staff induction training is now in place. The care staff team continue to have access to the National Vocational Qualification (NVQ) in care, and to achieve qualification in this. Staff must receive regular training in manual handling. The number of staff on duty is sufficient to meet the needs of the residents presently accommodated. One to one staff supervision should be provided a minimum six times per year, cover all recommended topics, and should be recorded. Outcomes for residents were assessed as good. EVIDENCE: Evidence of a recognised staff induction training programme now being in place was provided. No manual handling training has been provided since the previous inspection, and it was observed that some staff training records indicate refresher training in manual handling was overdue. Mrs Gisbey advised that it is anticipated that manual handling training will be provided for staff some time after June 2006. Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 Page 20 Mrs Gisbey said that enough staff were first aid trained to ensure there is a qualified first aider on each shift. Mrs Gisbey advised that staff supervision is being provided sometimes individually and sometimes in groups, but that staff supervision was not being recorded. Numbers of staff on duty on the day of the inspection were ensuring the needs of residents were being met, including their need for social contact and stimulation. Recruitment records sampled were in good order, and this assists in protecting residents from harm. A list of staff employed has been provided to the Commission. 21 care staff are employed, of whom (Mrs Gisbey advised) 11 have NVQ 2 or equivalent qualifications, and a further 5 staff have commenced or are due to commence NVQ2. Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): An annual quality audit which includes the views of residents, relatives and relevant others on the service must be undertaken and the outcomes published. An annual development plan for the home should be provided. The provider must review the accessibility of call bells. Outcomes for residents were assessed as good. EVIDENCE: Mrs Gisbey said there was no annual development plan in place for the home, and was advised by inspectors on how this can help show how the home is setting itself new objectives for the service which take into account views expressed by residents and relatives. Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 Page 22 Mrs Gisbey said views of relatives were sought during coffee mornings, but no record is made of these conversations and there is no published outcome from quality reviews like this that are carried out. We advised Mrs Gisbey that according to records seen PAT tests were overdue – she said she had been advised by an electrician that only moveable electiral items like vacuum cleaners needed to be tested. The inspectors advised that this was not the case. We asked about call bell cords being in a raised position – Mrs Gisbey said that due to memory loss many residents didn’t know what the cord was for, and mistook them for light switches. The inspectors noted that in the double bedroom there was one call bell and that this was probably positioned too far away to be easily reached by either resident. Mrs Gisbey provided her evaluations of accidents which are being carried out each year and shared with staff. The provider has advised the Commission that recent checks have been carried out for fire equipment (April 06), gas installation (November 05), lift service (April 06), and emergency call systems (January 06). Mrs Gisbey advised that she has been continuing to update her training in different areas of management practice. Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 Page 23 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 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X X 3 3 3 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? yes 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 2 Standard OP38 OP3 Regulation 18 (1) (c) (i) 14 Requirement All staff must receive training appropriate to the work they are to perform. Pre admission assessments should provide more information on the person’s established routines, interests, and personal history to help in the writing of care plans with residents. Care plans should include some provision for the resident’s individual interests and established routines. The policy and procedures on adult protection need to clarify that the local authority should be advised of adult protection or suspected adult protection incidents, and that it is the local authority and/ or if appropriate the police, not CSCI, which have responsibility for the investigation of adult protection incidents. Staff training in local adult protection procedures should be
DS0000014541.V290928.R01.S.doc Timescale for action 28/07/06 30/06/06 3 OP7 15 30/06/06 4 OP18 13.6 30/06/06 4 OP18 13.6 30/06/06 Greensleeves Version 5.1 Page 25 provided, to ensure staff are aware of the steps that must be taken when an incident of abuse has taken place or has been suspected. 5 OP33 24 An annual quality audit which includes the views of residents, relatives and relevant others on the service must be undertaken and the outcomes published. 28/07/06 6 OP7 15 7 OP1 6 Where relevant, guidelines for 30/06/06 staff on dealing with aggressive incidents should be provided on the care plan. The statement of purpose and 28/07/06 service user guide should be updated to ensure residents and prospective residents have current information on the home. 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 OP36 Good Practice Recommendations One to one staff supervision should be provided a minimum six times per year, cover all recommended topics, and should be recorded. An annual development plan for the home should be provided, to show how the service is to be improved in the near future. The provider must review the accessibility of call bells, to ensure that all residents have good access to call bells. 2 OP33 3 OP38 Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 Page 26 Greensleeves DS0000014541.V290928.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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