Inspection on 27/02/06 for Greenwood

This inspection was carried out on 27th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 8 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 22/09/05

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 27th February 2006 3:40 Greenwood DS0000041681.V268878.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.V268878.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.V268878.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.V268878.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. 22nd September 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.V268878.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 two and a quarter hours on 27 February 2006. A further visit was made of an hour and a quarter on 28 February 2006 to view documentation and request further information, which had not been available to view. This is the second statutory inspection for the year and should be read in conjunction with the first inspection carried out on 22 September 2005 to give an overview of all the standards to be assessed within this period. A tour of the premises took place to look at communal areas and service users bedrooms, rotas and care records were inspected. Eight service users were resident, of which seven service users were spoken with individually either in their bedroom or in the communal areas. 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 of whom two were relief staff and the cook were spoken with during the visit. Comment cards were left for service users their carers/representatives to complete after the last inspection if they wished, but none were received during the interim period. What the service does well: What has improved since the last inspection? Evidence has been provided that the Water Regulations 1999 are met and of regular maintenance of equipment and services. Regular checks of the hot water outlets accessed by service users have been maintained. Greenwood DS0000041681.V268878.R01.S.doc Version 5.0 Page 6 Maintenance issues highlighted in the report have been addressed. 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.V268878.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.V268878.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 users are appropriately placed at Greenwood. A written contract/terms and conditions is now in place to protect service users. 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, such as where there are service users resident who have been in the home longer than six months. The summary and action plan of the last report has been displayed in a suitable format for service users. The full inspection report should also be available to view. There were several new service users resident at Greenwood at the time of the inspection. It was possible to evidence that a Social Care Assessment is completed with new service users by staff from one of the Adult Social Care Department’s assessment teams, and forwarded to the home. Staff will also go to meet new service users or as demonstrated in the instance of an emergency admission liaise with carers/representatives to gain information to help staff provide the care needed. Greenwood DS0000041681.V268878.R01.S.doc Version 5.0 Page 9 A written contract between the home and the service user detailing the terms and conditions of any period of care provided has now been developed and was demonstrated to be completed with service users. Greenwood DS0000041681.V268878.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 9. 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. But however these should be subject to regular review. 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 fourth had not. Staff confirmed there had been a delay in completing reviews but were in the process of addressing this. 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. Where applicable supporting risk assessments were seen to be in place. But risk assessments should also evidence they have been subject to regular review. Greenwood DS0000041681.V268878.R01.S.doc Version 5.0 Page 11 Service users were observed being given opportunities to make decisions in all areas of their daily living whilst at Greenwood. Greenwood DS0000041681.V268878.R01.S.doc Version 5.0 Page 12 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): 14, 15 and 16. Service users are encouraged to have opportunities for personal development and supported to pursue their own interests and hobbies. EVIDENCE: Where service users stay at Greenwood for respite care this can be to give their carers a break, there may be little contact between them during their stay. However staff will support service users to contact home if they wish. One service user who has been resident in the home for a longer period spoke of their excitement at meeting a member of their family the next day. 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 were observed and some spoke of participating in a range of leisure activities. A number of service users decided they were going to attend a local social club, and others stayed at Greenwood and listened to music in their own room or watched television or a video. One stated they had chosen not to go out the previous night because it had been particularly cold. Staff were observed to treat the service users with respect. Service users do not Greenwood DS0000041681.V268878.R01.S.doc Version 5.0 Page 13 have any responsibilities for the housekeeping tasks in the home, but are encouraged to assist and keep their own bedrooms clean and tidy. Greenwood DS0000041681.V268878.R01.S.doc Version 5.0 Page 14 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, 19 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. 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, which were detailed in their individual care plans. Where 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.V268878.R01.S.doc Version 5.0 Page 15 There is one medication storage area in the home. Medication policies and procedures have been updated and representatives from ESCC have confirmed they are looking at and developing 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 one of the service users were administering their own medication. Staff spoken with on the night were not aware of and it was not possible to evidence if a risk assessment was in place to support this activity. 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 again the regular checks of the temperature had not been maintained. Regular visits are made by a pharmacist to provide advice and support. Greenwood DS0000041681.V268878.R01.S.doc Version 5.0 Page 16 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 and 23. There is a clear and effective complaints procedure in place. There are detailed policies and procedures in place to protect service users from abuse. 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. One complaint has been received since the last inspection. The CSCI have not received any complaints in relation to Greenwood. There are detailed policies and procedures in place in relation to vulnerable adults. Staff spoken with confirmed that they had received training in adult protection procedures and were aware that any concerns should be reported to a manager. The Manager subsequently confirmed that further training for staff is imminent to provide staff with an update on the policies and procedures. Greenwood DS0000041681.V268878.R01.S.doc Version 5.0 Page 17 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 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 in the large activities room, Furnishings are of a reasonable quality and domestic in style. Since the last inspection several bedrooms have been redecorated and new carpeting provided. 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 two lounges, a dining room, and a large activities area for service users to access. Greenwood DS0000041681.V268878.R01.S.doc Version 5.0 Page 18 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 has been evidenced that the Water Supply Regulations 1999 are being met. Routine checks of the fire equipment was viewed and were adequate. Greenwood DS0000041681.V268878.R01.S.doc Version 5.0 Page 19 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): 32, 33, 34 and 35. 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 two service users and service users in the home to be supported in their chosen leisure pursuits. It was evidenced that staffing levels are continually reviewed due to the changing service users on the unit with varying care needs. There is still a high reliance on relief staff working in the home. On duty during the evening were three relief staff alongside the homes permanent staff. Feedback in general was that this was a high number of relief staff on a shift but that this was unusual. Two were spoken with one had worked for ESCC for a number of years with experience of within a number of learning disability services and the other worked just at Greenwood. Staff demonstrated they were committed, interested and motivated in their work role. They spoke of a supportive team and of a team working well together. Greenwood DS0000041681.V268878.R01.S.doc Version 5.0 Page 20 The Manager subsequently confirmed that just over fifty percent of the homes permanent staff hold an NVQ Level 2 in care. This figure does not include relief staff working in the home and currently there are a number of staff vacancies, which have not been included in this calculation. Three care staff are also working towards this qualification. All recruitment of ESCC staff is co-ordinated by the Personnel Section at ESCC’s head office. The Manager has confirmed and demonstrated that the requirement to evidence staff information/recruitment is in the process of being addressed. Although not all the information was available to view, evidence to confirm the recruitment process for two new staff was seen. The Manager was not able to confirm that all staff have a satisfactory Criminal Records Bureau (CRB) check in place. Two new staff have been recruited since the last inspection it was not possible to evidence but the Manager confirmed that induction training is being provided. The two relief staff spoken with also confirmed they had received an induction. ESCC has detailed induction/foundation training in place which new staff are expected to complete. Greenwood DS0000041681.V268878.R01.S.doc Version 5.0 Page 21 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): 37 and 42 Training and/or updates for staff to ensure the health, safety and welfare and safety of service users and staff need to be maintained. EVIDENCE: The Manager has worked for East Sussex County Council for many years as a senior manager, stated he has completed the NVQ Level 4 in Care and has just commenced the Registered Managers award. 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. Staff records viewed showed that staff had not all received moving and handling training/updates as required. One relief worker spoken with who had commenced work in the home towards the end of last year had not received moving and handling training. The Manager confirmed that new training run by ESCC on infection control is about to be cascaded down to staff. Options to Greenwood DS0000041681.V268878.R01.S.doc Version 5.0 Page 22 provide first aid training/updates are being considered. It was not possible to evidence that all staff had attended a fire drill as required. A detailed check of the environment and fire precautions is carried out to meet the timescales as detailed in ESCC’s policies and procedures. The organisation has now implemented a system to evidence that the maintenance of equipment and services has been carried out. Greenwood DS0000041681.V268878.R01.S.doc Version 5.0 Page 23 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 3 3 X X 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 2 2 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Greenwood Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score 2 X X X X 2 X DS0000041681.V268878.R01.S.doc Version 5.0 Page 24 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 and 30.10.05. That service users individual plans are regularly reviewed. That a system to ensure a photograph of the service user is in place. This issue is outstanding since 31.04.05 and 30.11.05. Timescale for action 30/04/06 2. 3. YA6 YA6 15 (2) (b) 17 (1) (a) 31/03/06 30/04/06 4. 5. YA93 YA20 4 (a) (b) (c) 13 (2) 6. YA20 13 (2) That risk assessments are evidenced as being subject to regular review. That where service users are self medicating a risk assessment is in place and staff aware of the outcome of the risk assessment. That a clear policy is in place to follow around the administration of medication when the service user is absent from the home. This issue is outstanding since 30.11.05. 30/04/06 31/03/06 30/04/06 Greenwood DS0000041681.V268878.R01.S.doc Version 5.0 Page 25 7. YA34 19 (1) (b) (i) That evidence is provided to confirm that all existing staff and relief staff have completed a satisfactory Criminal Records Bureau check. This issue is outstanding since 31.12.04 and 01.01.06. That staff receive appropriate training /updates in moving and handling. A system is put in place to ensure staff receive training/updates as required in safe working practices. That confirmation is received that staff have attended fire drills as required. This issue is outstanding since 30.11.05. 30/04/06 8. YA42 23 (4) (d) 30/04/06 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 is maintained. Greenwood DS0000041681.V268878.R01.S.doc Version 5.0 Page 26 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.V268878.R01.S.doc Version 5.0 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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