Inspection on 22/09/05 for Greenwood

This inspection was carried out on 22nd September 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greenwood 26/06/07

Greenwood 01/06/06

Greenwood 27/02/06

Greenwood 28/02/05

Greenwood 06/10/04

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

CARE HOME ADULTS 18-65 Greenwood 16 Dalmeny Road Bexhill on Sea East Sussex TN39 4HP Lead Inspector Judy Gossedge Unannounced Inspection 22nd September 2005 15:45 Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 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 Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 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. Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Greenwood Address 16 Dalmeny Road Bexhill on Sea East Sussex TN39 4HP 01424 210383 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) chris.davies@eastsussex.gov.uk East Sussex County Council Mr Christopher Davies Care Home 16 Category(ies) of Learning disability (16) registration, with number of places Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That a maximum of sixteen (16) service users are accommodated. That only service users with a learning disability are accommodated. That service users will be aged between eighteen (18) years and sixtyfour (64) years on admission. 28th February 2005 Date of last inspection Brief Description of the Service: Greenwood is run by East Sussex County Council (ESCC). It is a purpose built property on two floors, set in its own grounds in Bexhill-on-Sea. It is situated near to the town centre with its shops and access to main rail routes. Accommodated are a maximum of sixteen adults with a learning disability for periods of respite care or short term care for periods up to six months. Service user accommodation comprises of sixteen single bedrooms, and there is a range of communal areas for service users to access. The majority of bedrooms and communal areas are on the ground floor. There is also a one bedroom self contained flat on the first floor which is currently used to provide more specialised respite care and meet the individual needs of one service user. A garden is at the side of the home and a central courtyard is accessible. Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over four and a quarter hours on 22 September 2005. This is the first statutory inspection of this year. A tour of the premises took place to look at communal areas and service users bedrooms, rotas and care records were inspected. Twelve service users were resident and there were also some service users attending an evening respite service which is run on Thursday night. Five service users who were resident were spoken with individually in the communal areas, and a further service user who was in the home using the evening respite facility. Due to communication difficulties it was not possible to speak to all service users individually, and so the opportunity was also taken to observe the interaction between staff and service users in the communal areas. The Manager was not present and two senior care officers, and three Support Workers and the cook were spoken with during the visit. Comment cards were left for service users their carers/representatives to complete after the inspection if they wished. Three relatives were also spoken with by telephone after the inspection. The CSCI has also sent separate correspondence to the Responsible Individual for ESCC to raise concerns at the recruitment processes and lack of evidence of recruitment documentation in place on site for all its registered services. What the service does well: There is a detailed Statement of Purpose, Service Users Guide, and feedback from service users who have stayed on the unit is available to give prospective service users and their carers information about the home. Service users and relatives spoke positively about the small established staff team who have been able to provide continuity of care. Service users are encouraged and supported to pursue their own interests and hobbies. There was evidence that service users were enabled to have choice and flexibility in daily routines, meals and activities. Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 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. Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 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 Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5. Detailed information about Greenwood is available to be viewed prior to any admission for respite or short term care to the home. There are pre-admission procedures in place to ensure that service user admissions are appropriately placed at Greenwood. Service users have not been protected by the provision of a written contract/terms and conditions with the home. EVIDENCE: There is a detailed Statement of Purpose and Service Users Guide available to view. The Statement of Purpose needs to be kept up-to-date and detail the current service being provided. There are service users resident who have been in the home longer than six months. There is regular quality assurance information collated for service users and their carers/representatives to read. The Manager subsequently stated that a copy of the last report is kept in the main office, but relatives are not aware of how to access inspection reports in the home and staff on the night were not sure where this was kept. There were no new service users resident at Greenwood at the time of the inspection. So it was not possible to evidence, but the Manager has previously stated and staff confirmed on the night that a Social Care Assessment is completed with new service users by staff from one of the Social Services Department’s Assessment Teams, and forwarded to the home. Staff will also Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 Page 9 go to meet new service users and their carers/representatives to gain information to help them provide the care needed. A written contract between the home and the service user detailing the terms and conditions of any period of care provided has not been in place, but has now been developed and is in the process of being introduced. Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 7. The service users individual plans in place adequately provide staff with the information they need to ensure that service users individual care needs are met. Service users are enabled to make decisions in all areas of their daily living during their stay. EVIDENCE: Four service users individual plans (profiles) were viewed, which were detailed, and are drawn up annually where possible with the service user. Three had been subject to a six monthly review to ensure that the agreed goals are being met. The individual plans are kept together in large folders, some were worn and were not all secure in the folder. The current system for storing the care plans could be improved, possibly with a contents page and dividers, to make information contained within more readily accessible. A number still did not have a photograph of the service user in place. Service users were observed being given opportunities to make decisions in all areas of their daily living whilst at Greenwood. Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 and 17. Service users are encouraged and supported to pursue their own interests and hobbies. The meals on the unit are good offering both choice and variety and catering for any special dietary needs. EVIDENCE: Service users continue to attend their daily activities as they would at home, and returned to Greenwood that evening from a number of different venues attended during the day. Service users spoke of participating in a range of activities in the local community. One stated there had been to trip to a pub and Hastings during their stay and that ‘I love it here.’ Another service user commented ‘I like everything here, and I like the company.’ All service users commented they enjoyed being at Greenwood, all the carers also stated their relative really enjoyed their stays in the home, and one stated ‘It is brilliant.’ All stated their relative would not go if they did not enjoy it. Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 Page 12 Service users were observed and some spoke of participating in a range of leisure activities. A number of service users decided to go out some for a drive on the mini bus and to have an ice cream, another group were going for a trip into Eastbourne, and some stayed at Greenwood and listened to music in their own room or watched television. One service user organised a disco prior to dinner in the activities room and a number were seen to play pool individually or together. All the relatives confirmed that they are welcomed to the home and maintained contact by visiting but mainly by telephone. The majority of the service users ate their evening meal in the main dining room with the rest using other communal areas in the home. The evening meal consisted of pork chops with mushroom sauce, rice pudding and fruit which all the service users ate some with assistance. Their evening meal was appetising and well presented. Staff and service users ate together and discussed their day and the proposed evening activities. The mealtime was relaxed and friendly. Service users spoke well of the food provided. One relative confirmed that a special diet had been provided to meet their relatives individuals needs. Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 20. Care and support is provided which is flexible and sensitive to individual service users. It was observed that positive relationships had been formed between staff and service users. There are detailed policies and procedures in place in relation to medication which need to be followed to protect service users. EVIDENCE: The sample individual care plans viewed, service users and staff spoken with, and observations during the inspection confirmed that care and support given is sensitive to the individual care needs of each of the service users. Records referred to specialist advice and guidance which had been sought. All relatives commented that they were happy with the overall care provided and felt that staff had a good understanding of their relatives care needs. Relationships between staff and service users and the care given was observed to be very good, and service users were treated with respect at all times. Service users were observed to need a range of assistance with personal and health care needs, and which was detailed in their individual care plans. As service users only stay at Greenwood for respite care or short term care, they remain with their own GP if local, or will visit the local surgery and register on a temporary basis. Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 Page 14 There is one medication storage area in the home. Medication policies and procedures have recently been updated and ESCC are looking at further training for staff to ensure that all the training requirements are met. Service users bring medication in with them for the period of respite care and at the time of the inspection none of the service users were administering their own medication. The storage and records viewed of medication administered were adequate. Documentation is not clear for when medication is taken out of the home to day care facilities. Where medication is stored in a refrigerator the regular checks of the temperature had not been maintained. Regular visits are made by a pharmacist for advice and support. The Inspector was made aware on the night of investigations into suspected mal-administering of medication. The CSCI had not been informed and should have been notified as a significant event. Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22. There is a clear and effective complaints procedure in place. EVIDENCE: The organisation has a detailed compliments and complaints policy and procedure in place. Any complaints received are monitored through the line management arrangements in place within the organisation. The complaints log was not available to view and the Manager subsequently stated there had been no complaints have been received since the last inspection. The CSCI have not received any complaints in relation to Greenwood. Not all the relatives were aware of the formal complaints procedure in place and it should be ensured that the procedure is available to reference if required. But all relatives confirmed that they would feel comfortable raising any concerns they may have with staff. Where two relatives had felt it necessary to raise a concern they had been very happy with the way that it had been dealt with and the outcome. Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 and 30. The standard of the environment is reasonable within the home providing service users with a comfortable environment to receive respite care. EVIDENCE: Greenwood is not far from the town centre, and service users are able to access a range of activities locally. Décor in the home is to a reasonable standard but there is evidence of wear and tear, and furnishings are of a reasonable quality and domestic in style. The tour of the building highlighted storage of old furniture on the patio, a carpet gripper rod missing at the entrance to one of the bathrooms, a broken toilet seat, a fire extinguisher stored on the floor and the carpet in the activities room badly stained. There are sixteen single bedrooms all of which meet the minimum space requirements. Only one bedroom has en-suite facilities, but there are sufficient toilets and a selection of assisted bathing facilities to meet individual service users care needs. There are three lounges, a dining room, and a large activities area for service users to access. The smallest of the lounges is used as a smoking lounge for Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 Page 17 service users who wish to smoke and service users were observed using all these facilities participating in a range of activities. At the time of the inspection the unit was clean, hygienic, and free from offensive odours. Policies and procedures are in place to control the spread of infection. It was not evidenced during the inspection that the Water Supply Regulations 1999 are being met. The Inspector understands that an assessment has been made for the home but it could not be evidenced that the work required has been completed. Routine checks of the fire equipment was viewed and were adequate. Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 34. Staffing levels were adequate to ensure that all the care needs, the health safety and welfare of the service users resident were met. ESCC recruitment policies and procedures need to be followed in order to protect service users. EVIDENCE: The atmosphere in the home was relaxed on the day of the inspection, and the staffing in place was adequate to meet the needs of current service users resident. It enabled staff to provide one to one support for a service user, for two trips out to be arranged and service users remaining in the home to be supported in their chosen leisure pursuits. Feedback from the relatives confirmed that they were welcomed by the staff group, there was good communication. One comment was received that staff sometimes seemed very busy and could not always facilitate all the activities due to be provided during the evening. Staff also commented that there had been periods since the last inspection when it had not always been possible to maintain staffing levels and there had been a high reliance on relief and agency staff. The service users spoken with spoke well of the care provided. All recruitment is co-ordinated by the personnel section at ESCC’s head office, which the Inspector has visited and viewed sample documentation to support the recruitment process in place. Some gaps in the required documentation Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 Page 19 were found and this has been raised with the Responsible Individual of ESCC for a resolution. In future recruitment practices will need to be demonstrated at the home as part of any inspection completed. It was not possible to evidence that all permanent and relief staff have a Criminal Records Bureau check in place. Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39. Robust quality assurance systems are in place enable service users and their carers/representatives to give their views on the service provided at Greenwood. EVIDENCE: The Manager has worked for East Sussex County Council for many years as a senior manager, and is in the process of completing the NVQ Level 4 in Care. There have been opportunities for the Manager to undertake periodic training, including the Certificate in Management Studies, Manual Handling Risk Assessor training, NVQ Assessor training, and is a SCIP trainer. There are opportunities for service users to put forward their views about the home and the care that they receive, which informs ESCC and staff in the home of the quality of the service being provided. An annual development plan for quality assurance is now in place in the home. Regular monthly visits by a representative of the organisation, which are recorded to meet the requirements are in place. Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 Page 21 Standard 42 was not inspected and an update on outstanding issues have been requested. But fire procedures were viewed and it was not possible to evidence that a regular fire check for the home has been completed and recorded. It was not clear from the recording of fire drills that all staff had attended this training as required. Nine of the hot water outlets accessed by service users were tested, and all were delivering water at close to the recommended safe temperature of 43 C. Checks on the hot water temperatures were seen and should be regularly maintained Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 X X 2 Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 X 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X X 3 1 X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Greenwood Score 3 X 2 X Standard No 37 38 39 40 41 42 43 Score X X 3 X X X X DS0000041681.V259155.R01.S.doc Version 5.0 Page 23 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 YA1 Regulation 5 (1) Requirement That the most recent inspection report is available to view in the home. This issue is outstanding since 31.03.05. That a system to ensure a photograph of the service user is in place. This issue is outstanding since 31.04.05. That a clear policy is in place to follow around the administration of medication when the service user is absent from the home. That the maintenance issues highlighted in the report are addressed. That evidence is supplied in relation to adherence to the Water Regulations 1999. This issue is outstanding since 31.04.05. That evidence is provided to confirm recruitment procedures ion place and that all existing staff and relief staff have completed a satisfactory Criminal Records Bureau check. This issue is outstanding since 31.12.04. That staff receive appropriate fire training to the required DS0000041681.V259155.R01.S.doc Timescale for action 30/10/05 2 YA6 17 (1) (a) 30/11/05 3 YA20 13 (2) 30/11/05 4 5 YA24 YA30 23 (1) (a) 13 (4) (a) 30/11/05 30/11/05 6 YA34 19 (1) (b) (i) 01/01/06 7 YA42 23 (4) (d) 30/11/05 Greenwood Version 5.0 Page 24 standard. The CSCI will receive written confirmation of what will be in place to meet this requirement. This issue is outstanding since 31.04.05. That confirmation is received that staff have attended as required fire drills. That records relating to the maintenance of the equipment in the building is available to view. That evidence is sent to the CSCI that a current gas certificate is in place and the hoists have been serviced as required. This issue is outstanding since 31.04.05. That regular checks of the hot water outlets accessed by service users are maintained. That the CSCI are notified of any significant event which has occurred in the home. That confirmation is sent that the regular fire safety audit is completed and maintained to meet the organisations requirements. 8 YA42 13 (4) (a) 30/11/05 9 10 11 YA42 YA42 YA42 13 (4) (a) (c) 37 (1) (e) 13 (4) (a) 30/10/05 30/10/05 30/11/05 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 YA20 Good Practice Recommendations That the regular check of the temperature where medication is stored in a refrigerator are maintained. Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greenwood DS0000041681.V259155.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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