CARE HOMES FOR OLDER PEOPLE
Greensleeves Residential Care Home 8 Westwood Road Portswood Southampton SO17 1DN Lead Inspector
Lorraine Parton Unannounced 2 September 2005 9:00 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. Greensleeves Residential Care Home 20051006 H55-H03 S59080 Greensleeves V265468 020905.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Greensleeves Residential Care Home Address 8 Westwood Road, Portswood, Southampton SO17 1DN 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) 023 8031 5777 023 8049 0033 Greensleeves Residential Care Home Limited Mr Paul Robert Fellingham Care Home 21 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (21), Old age, not falling within any other of places category (21) Greensleeves Residential Care Home 20051006 H55-H03 S59080 Greensleeves V265468 020905.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 22/3/05 Brief Description of the Service: Greensleeves is a care home situated in Southampton and close to local facilities. The home is registered for twenty one service users within the category of older persons and dementia care. The home provides accommodation in a range of single and double rooms which mainly have en suite facilities. The home provides two lounges, a dining room, and a kitchen, which are on the ground floor of the home and easily accessable to service users. To the rear of the property is an enclosed garden that is accessable to service users wishing to use it. Greensleeves Residential Care Home 20051006 H55-H03 S59080 Greensleeves V265468 020905.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place over 4.25 hours and the inspector was assisted throughout the inspection by the homes staff. The registered manager and provider were not present during the inspection and therefore the inspector was unable to audit all the last requirements made at the last inspection on the 22nd March 2005. The inspector only assessed 15 of the 38 standards and the majority of the inspection was spent obtaining the views of the service users about the service they receive. The other standards and requirements made at the last inspection will be assessed at the next inspection if necessary. The inspector also had the opportunity to speak to the homes staff and one visitor to the home. The homes staff were found to be professional and helpful throughout the inspection. Positive comments were received from the visitor about the homes staff and the care they provide to their relative. The inspection also involved a walk around the home and audit of some of the homes documentation relevant to the provision of care for the service users living at the home. The inspector received a pre-inspection questionnaire completed by the registered manager prior to the inspection. This provided useful background information to the inspection. The inspector did not receive any comment cards from service users or visitors to the home. Service users confirmed that they were happy living at the home and many of the service users commented on how the home provides a good standard of care and support to them. What the service does well:
The home provides a homely and welcoming environment that enables service users to access all areas of the home and garden. All service user rooms are personalised and service users are encouraged to have their own personal possessions in their rooms. Service users spoken to advised the inspector that the homes staff provide an excellent service and comments received included “I would not live here if it wasn’t nice” “nothing is to much trouble” and “ the staff are very nice”. The inspector witnessed staff interactions with service users and noted the obvious
Greensleeves Residential Care Home 20051006 H55-H03 S59080 Greensleeves V265468 020905.doc Version 1.40 Page 6 good relationships that were in place. Care plans were found to be in place and service users stated that the care that they received was good. All service users spoken to advised the inspector that the home provides an excellent choice of meals and that the quality of the meals are good. Service users stated that the home offers a variety of choices of meals. Service users who are able, participate within the home as they wish. Service users are encouraged to be independent and service users confirmed that staff support their choices in their chosen lifestyles. What has improved since the last inspection? What they could do better:
At the time of the inspection the home was accommodating eighteen service users. The home was providing two care staff, a cleaner and a cook. Several service users have varying levels of dementia and some service users ‘wander’. Staff advised the inspector that at busy times or if there is an issue in the home more staff are needed in order to meet all service user needs. The home is required to review its staffing arrangements in accordance with service user needs.
Greensleeves Residential Care Home 20051006 H55-H03 S59080 Greensleeves V265468 020905.doc Version 1.40 Page 7 At the time of the inspection the inspector was informed that staff do not always speak English in front of service users. This is unacceptable. The home is required to ensure that all staff when with service users respect and treat service users with dignity. The inspector was informed that care plans had been reviewed since the last inspection, however, these require further development in areas that give instruction on how care needs are to be met. The home is required to consult with infection control to look at appropriate ways to clean commodes as at the time of the inspection commodes were being washed in the bath. Almost all bedrooms contained a commode whether the service user used them or not. It is recommended that commodes are removed from the rooms where service users do not require them. 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 Residential Care Home 20051006 H55-H03 S59080 Greensleeves V265468 020905.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Greensleeves Residential Care Home 20051006 H55-H03 S59080 Greensleeves V265468 020905.doc Version 1.40 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 standard(s) none EVIDENCE: Greensleeves Residential Care Home 20051006 H55-H03 S59080 Greensleeves V265468 020905.doc Version 1.40 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, 9, 10 All service users have a care plan, however, these were found to be in need of developing to include detailed action to be taken to meet the assessed needs. Staff do not always treat service users with dignity. Service users confirmed that their privacy is respected at all times. Medication practices were safe. EVIDENCE: The inspector audited five service user plans, which were found to contain relevant care planning information, however, the action to be taken to meet needs were vague. The home had assessed the risk of falls, which had been a previous legal requirement. One care plan was reviewed with the assistance of the service user who displayed their awareness of their care plan contents. Two service users plans seen displayed that they were under sixty five and both service users are independent in most areas of their care, however, the home had completed care plans for their areas of need. Two service users who are under sixty five advised the inspector that they would like to live somewhere else and that whilst the homes staff are very good, it did not feel an appropriate place to live due to age differences. A requirement has been
Greensleeves Residential Care Home 20051006 H55-H03 S59080 Greensleeves V265468 020905.doc Version 1.40 Page 11 made for the home to review with service users, families or representatives and care managers the suitability of the placement. The home is required to ensure service users admitted are with the registration conditions. A meeting has been organised to discuss this and will be addresed seperately to the report if necessary. The home had also completed risk assessments for specific issues associated with individual service users needs. Care plans audited had not been signed by the service users or their representatives and records of reviews did not display that service users or their representatives had been involved. A requirement has been made. Service users spoken to confirmed that the homes staff, respect their views and the need for their privacy and dignity to be up held. Staff were seen by the inspector to knock on doors before entering and interacting with service users in an equal and respectful manner. Service users confirmed that they receive personal care in private and are able to receive treatments and consultations in their bedrooms in private. The inspector was informed that staff do not always speak English when with or in the company of service users. This is unacceptable. The home must ensure all staff speak English when in the home. The home operates within a medication policy and the home has a copy of the Royal Pharmaceutical guidelines. The home keeps a record of medication received, administered and returned to pharmacy. The home operates a monitored dosage system provided by the local pharmacist who visits the home on a regular basis. Staff advised the inspector that only staff who are trained in the safe handling of medication give medication. Staff training records could not be assessed and these will be audited at the next inspection. On audit of the homes medication and records they were found to be satisfactory. Previous legal requirements had been met, however, policy areas could not be assessed and this will be audited at the next inspection. Greensleeves Residential Care Home 20051006 H55-H03 S59080 Greensleeves V265468 020905.doc Version 1.40 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, 15 Service users within the categories of older persons and older persons with dementia are supported in their chosen lifestyles and encouraged to make choices about their lives. The needs and lifestyle choices of service users under the age of sixty five are not met by the home. Service users are supported in whom they choose to have contact with. All service users are supported if necessary with access to the community. Service users confirmed that the home provides excellent food of their choice. EVIDENCE: Service users spoken to advised the inspector that the home provides activities and facilities that meet their personal wishes. Some service users go out alone and access local facilities of their choice. This includes shopping, visiting friends and family and other local amenities. The home offers a range of in house activities and this includes games, musical sessions and singalongs. Service users confirmed that the homes staff ask them what they want and do their best to provide it. The home provides a range of equipment for service users to use and this includes games, books,
Greensleeves Residential Care Home 20051006 H55-H03 S59080 Greensleeves V265468 020905.doc Version 1.40 Page 13 and puzzles etc. Service users spoken to confirmed that the home supports their choices in involvement in the home and participation in activities provided by the home. Two younger service users were spoken to and they advised the inspector that whilst they get on with the staff and enjoy living at the home it is difficult due to the age differences. Service users confirmed that they participate in the home they choose and are able to enjoy going out to venues of their choice. The home is required to review with the service users their choices on where they want to live. Care managers and representatives must also be involved. Service users who wish have personalised their rooms and some rooms contain service users own furniture and belongings. Service users confirm that they have access to television and music in their rooms if they wish. Several service user rooms contained items of leisure that service users enjoy, including books, crosswords. The home has a visiting policy, which affords and encourages visitors at any reasonable time. Service users confirmed that they are able to see visitors in private in their own rooms and elsewhere in the home if not in use by other service users. A visitor to the home confirmed that they were able to visit when they wished and that the homes staff always made them feel welcome. Service users spoken to stated that the home provides good food and offers a choice of menu. Menus display a well balanced and nutritious variation, which, the staff stated are based on service users likes and dislikes. Individual choices and needs in food are catered for and this includes likes, dietary needs and special requests. The inspector was present for the lunch time meal and it was noted to be well presented and nutritious. Meal times were noted to be relaxed and service users who were being supported were not rushed and their dignity was maintained. Greensleeves Residential Care Home 20051006 H55-H03 S59080 Greensleeves V265468 020905.doc Version 1.40 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 Service users are aware of how to make a complaint and to whom. EVIDENCE: The home has a complaints procedure. Service users confirmed that they were aware of the complaints procedure and several service users advised the inspector that they would speak to the homes staff if they had a concern. Some service users stated they would discuss their concerns with their families or social workers in the first instance, who would then speak to the owners of the home on their behalf. Neither the home or the Commission for Social Care Inspection have received any complaints since the last inspection. A record of a complaint would be maintained if necessary. Greensleeves Residential Care Home 20051006 H55-H03 S59080 Greensleeves V265468 020905.doc Version 1.40 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, 20, 23, 24, 25, 26 The home is clean, safe and well maintained and provides a homely environment for service users, however, the method for cleaning commodes needs reviewing. Service users who wish have personalised their bedrooms with their own belongings. EVIDENCE: The inspector undertook a walk around the home and identified no issues in the rooms that were entered. The home was found to be homely, clean and suitable for service users. All areas of the home are accessible to service users and the garden was found to be well maintained. At the time of the inspection service users were seen to be moving around the home as they choose. All rooms seen were found to include service users own possessions and some rooms contained service users own furniture. The inspector noted that these rooms were homely and service users own choice.
Greensleeves Residential Care Home 20051006 H55-H03 S59080 Greensleeves V265468 020905.doc Version 1.40 Page 16 During the walk around the inspector noted that commodes were being washed in the bath. A requirement has been made for the home to consult with infection control to look at alternative methods for cleaning commodes. The home has a maintenance person and repairs are carried out as and when necessary. This provides a safe environment. The home has under taken risk assessments, however, these were not fully audited during the inspection. The inspector recommended that the home undertakes risk assessments for the low first floor windows where there is a risk of service users falling through the window. These will be audited at the next inspection. Greensleeves Residential Care Home 20051006 H55-H03 S59080 Greensleeves V265468 020905.doc Version 1.40 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, The home did not appear to have adequate cover to meet the needs of the service users and the service at the time of the inspection. EVIDENCE: Two care staff, a cook and a cleaner were on duty at the time of the inspection. Staff confirmed that the home is covered by two carers, a cook, a cleaner during the day. Staff confirmed that the registered manager is additional to the staffing provided. The inspector had access to the homes rota, which also confirmed the above. Due to the absence of the manager one of the homes staff assisted the inspector leaving one carer providing care to eighteen service users. The carer did call upon another carer whilst they were supporting the inspector. Staff confirmed that they cover the home if necessary, however, if issues occur only having two carers can be difficult to meet the needs of the other service users. The home is required to review staffing levels in accordance to service user needs. Service users spoken to confirmed that they felt safe in the home and that the homes staff are always supportive and professional in their approach. On speaking and questioning staff they displayed their awareness of service user needs. Greensleeves Residential Care Home 20051006 H55-H03 S59080 Greensleeves V265468 020905.doc Version 1.40 Page 18 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) none EVIDENCE: Greensleeves Residential Care Home 20051006 H55-H03 S59080 Greensleeves V265468 020905.doc Version 1.40 Page 19 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 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 x x 3 3 2 2 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x x Greensleeves Residential Care Home 20051006 H55-H03 S59080 Greensleeves V265468 020905.doc Version 1.40 Page 20 yes Are there any outstanding requirements from the last inspection? 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 7 Regulation 15, 13 Requirement Provide more detail in care plans, risk assessments and risk management plans, to detail how service users needs are managed. This requirement remains outstanding from the last two inspections. Future non compliance may lead to enforcement action being taken. The registered manager must ensure staff accredited training in the safe handling and administration of medication. This requirement was made at the last inspection, and will be assessed at the next inspection. Review staffing levels in accordance with service user needs. Current staffing levels are insufficient. Staff must ensure that service users are treated with respect and dignity. Staff must speak English at all times when they are with or in the presence of service users. The home must ensure service users and or their representatives are fully involved in the production and reviews of Timescale for action 30/ 11/05 2. 9 13(4) 30/11/05 3. 27 18(1) 30/11/05 4. 10 12 10/10/05 5. 7 15 30/10/05 Greensleeves Residential Care Home 20051006 H55-H03 S59080 Greensleeves V265468 020905.doc Version 1.40 Page 21 their service user plans. 6. 14 12(3) Review with two service users their choices to live at the home. Consideration must be given to suitability of placement and the home must involve care managers and service users representatives. Consult with infection control regarding the appropriate ways to clean commodes. Undertake risk assessments for the risk of falling from first floor windows and implement suitable controls. 30/11/05 7. 8. 26 38 13(3) 13(4) 30/11/05 30/11/05 9. 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 24 Good Practice Recommendations Remove unused commodes from bedrooms where service users do not use them. Greensleeves Residential Care Home 20051006 H55-H03 S59080 Greensleeves V265468 020905.doc Version 1.40 Page 22 Commission for Social Care Inspection 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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