CARE HOMES FOR OLDER PEOPLE
Greenwood House South Parade Peterborough PE3 6BG Lead Inspector
Dragan Cvejic Key Unannounced Inspection 10th August 2007 08:30 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 Greenwood House DS0000035290.V343587.R01.S.doc Version 5.2 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. Greenwood House DS0000035290.V343587.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Greenwood House Address South Parade Peterborough PE3 6BG 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) 01733 569362 01733 568984 Greater Peterborough Primary Care Trust Susan Elizabeth Clayton Care Home 40 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (16), Old age, not falling within any other of places category (24), Physical disability (3) Greenwood House DS0000035290.V343587.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Up to three service users aged between 60 and 64 years may be accommodated at any one time 18th September 2006 Date of last inspection Brief Description of the Service: Within a few minutes walk of Peterborough city centre, Greenwood House is set in its own grounds at the end of a residential cul-de-sac. Service user accommodation is on two floors, and consists of 4 units. One unit is for 8 people with dementia care needs; another unit can accommodate up to additional 8 people with dementia; the other units offer a number of respite places, and accept people who are admitted from hospital on an ‘interim care’ basis, as well as offering permanent care to frail elderly people. Each unit has its own lounge, dining-room, bathroom, toilet and kitchen facilities, and there is a laundry, main kitchen and staff facilities. The gardens are well kept and attractive, and one upstairs lounge opens onto a large balcony with garden furniture and an array of tubs and hanging baskets. The home is owned by Peterborough City Council: the management of the home transferred to Greater Peterborough Primary Care Partnership on 01 April 2004. There is a day centre which operates from a separate lounge in the building: the manager of the home is no longer responsible for the management of the day centre. Greenwood House DS0000035290.V343587.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. A number of questionnaires were used in preparation for the site visit and a wide range of people were asked to give their view about the home: service users, relatives, staff and external professionals/visitors to the home. The summary reports of the monthly visits by the responsible individual also provided information for this inspection. As the manager was not on duty at the time of the site visit, an assistant manager provided management information. Case tracking of 4 service users, observation of the care process, a tour of the premises and checking documents were used as methodologies to obtain evidence for this report. What the service does well: What has improved since the last inspection?
The home had their own processes for identifying areas for improvement. Their well-organised quality assurance process and service users meetings’ clearly stated what could be better. The transition from the council to the Primary Care Trust, as the organisation that provided the service, was carried out during the last months and relevant changes had been implemented and became operational without losing the quality of care for service users. A user commented: “I did not even know that this change happened. Staff are still good to us and help us as they have during the past 6 years, the time I have spent here.”
Greenwood House DS0000035290.V343587.R01.S.doc Version 5.2 Page 6 Complaints procedure was reviewed, updated and in use from June this year. 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. The summary of this inspection report can be made available in other formats on request. Greenwood House DS0000035290.V343587.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenwood House DS0000035290.V343587.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Not only excellent access to information about the home, but also appropriate assessments and evidence of meeting users’ needs determined the excellent rating of this group of standards. EVIDENCE: The home’s statement of purpose was reviewed in May 2007, as well as the service user’s guide. The second document, displayed in the hallway, was produced in large print and contained summarised information about the home, making it easy for potential users to get all the information they need. The responsible individual was checking users’ contracts on each of his monthly visits to the home. This was important, as the home accommodated 12 interim care and 4 respite care service users, who stayed in the home for a limited period of time.
Greenwood House DS0000035290.V343587.R01.S.doc Version 5.2 Page 9 Service users’ files checked, contained detailed descriptions of initial assessments carried out prior to admission. The manager sent a letter to all service users on admission, confirming that the home was capable of meeting their assessed needs. The letter was in users’ files. A Polish service user enjoyed the advantage of having a Polish staff member who he chatted to. A letter from the relative of a user was displayed: “Just a short note to say a BIG thank you for looking after my mum so well.” Greenwood House DS0000035290.V343587.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users healthcare needs were appropriately assessed, recorded and met in an organised way that promoted their well being, independence and with full respect for their dignity. EVIDENCE: All four service users’ files checked contained detailed and up to date care plans. Care plans were clearly related to initial assessments. A note on the assessment stated: “Allergic to Penicillin and bee stings”. This information was highlighted in the users care plan and risk assessment. The dates corresponded and showed regular frequency of reviews. Risk assessments were signed by two people showing that the home paid the required level of attention to detail in protecting service users, while promoting their independence and autonomy. Appropriate charts were kept to allow staff to closely monitor specific needs and frequent changes that affected service users’ health. In an example of skin
Greenwood House DS0000035290.V343587.R01.S.doc Version 5.2 Page 11 care for a user with psoriasis, affected areas of the body were described in the skin care section of the care plan. “This is my life” section of the file contained likes, dislikes and preferences of service users. These notes went into details such as: “Prefers a number of pillows”, in the section called: “Preferred bedding.” Staff were observed administering medication. Stored in the medication room, medication was appropriately and safety kept. The assistant manager was checking with GP when there was an ambiguity of changed medication. The staff member who administered medication asked the assistant manager when she had any doubt about the change of medication recorded a day before. Medication blister packs were stored in each unit, reducing the risk of errors. Controlled drugs were appropriately stored and recorded, according to the checked records for two service users. Privacy and dignity were respected and helped create a friendly but professional atmosphere. Service users and staff were observed communicating during breakfast: “Anyone for more toast?” staff member politely asked. “Yes, please, could I have two toasts?” a user responded and two extra slices of toast were served to him. A user wanted to have his breakfast in his pyjamas and staff respected this wish, but made sure he had his shoes on and agreed with him to get dressed after breakfast. Greenwood House DS0000035290.V343587.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users wishes were respected and helped the home organise daily life according to users preferences, while maintaining an appropriate level of support and care that ensured the safety and well being of service users. EVIDENCE: Daily routine in the home was created as service users wished. Several users were up on the inspectors’ arrival in the morning hours and explained: “We quite like to get up early. We have breakfast and then enjoy a cup of tea together.” Recording service users’ preferences went a step ahead of the basic, for example it stated “Likes reading books by Dick Frances.” Another file demonstrated that religious observance was also recorded and respected: “Goes to church on Sundays”. The home offered various activities, but the users stated that this area could be better. They understood the staff’s duties and showed patience while waiting for staff to come sit and chat with them. A user expressed her feeling
Greenwood House DS0000035290.V343587.R01.S.doc Version 5.2 Page 13 about activities: “ We do not have many activities as staff are busy, but they are very good with us. They do a good job.” All four checked files contained evidence that relatives were helping service users with their finances. The management was still observing finances to ensure the protection of service users. They were fully aware of the external protection process related to their service user and waited to hear the outcomes. All service users spoken to and comments from the questionnaires praised the food. The menu was displayed in the hall. Two staff members were observed helping service users who needed significant help to eat, in a patient and dignified way. Greenwood House DS0000035290.V343587.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were well protected from abuse by clear working practices, preventative measures and clear complaints procedure. EVIDENCE: A complaints procedure was included in the service user’ guide. It had a clear time scale. The home did not have any recorded complaints in their complaints records. They did, however, record 3 received concerns and the satisfactory outcomes of their investigations. The procedure was reviewed and updated in June this year. Service users were safeguarded from abuse by policies, procedures, working practices and actions taken when necessary. A case of potential abuse was prevented when a service user under distress and experiencing mental health deterioration was referred to a psychiatrist when the risk of abuse was identified. Greenwood House DS0000035290.V343587.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was safe, comfortable and bright and service users were free to go to any part of it, but also benefited from the organisation of the home in units that made it easier for orientation, especially for users affected by dementia. EVIDENCE: A tour through the home provided evidence of a comfortable, safe and homely environment. The responsible individual regularly reported on the physical state of the home, as he checked one or two units in detail during each monthly visit. A maintenance man was spoken to during the inspector’s visit and confirmed that there were no major outstanding issues and all minor faults were dealt with in time.
Greenwood House DS0000035290.V343587.R01.S.doc Version 5.2 Page 16 A gazebo in the back garden and lovely garden furniture were provided for service users to enjoy in nice weather. There were no restrictions for service users concerning going out to the garden. Each unit had its’ own kitchenette and smaller dining room and users could enjoy small and cosy rooms to sit and talk to each other and to staff. This arrangement was in particular good for the allocation of staff tasks and provided an opportunity for direct contact of staff with service users. Quality furnishing also created a homely environment. The laundry room was equipped with semi-industrial washing machines and a tumble drier. The ironing room was in a separate room and the users’ laundry was thus protected from damp, once it was washed and dried. The home also had an effective infection control policy and procedure that was reviewed in June this year. Greenwood House DS0000035290.V343587.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Competent staff provided reassurance to service users that their needs, wishes and preferences would be respected and met. Organisation, team-work and staff effectiveness exceeded minimum standards. EVIDENCE: Staffing was a real asset to this home. Well-trained, experienced, knowledgeable and caring staff members worked as a team in an organised manner that created a supportive and caring atmosphere in the home. An open atmosphere also was seen when staff approached senior staff for support and clarification when they were not sure what to do. The staff rota was created according to a daily routine and users’ needs. Each unit had a board with staff photos making it easier for service users to remember them and feel familiar with staff working in their units. Matching the national background of a Polish service user and staff member showed that the home paid attention to equal opportunities. Seventeen staff already held and two were currently doing their NVQ training and the percentage exceeded expected 50 of NVQ qualified staff. Three staff’s files checked showed that the robust recruitment procedure was followed and ensured better protection of service users by detailed checks carried out on all staff.
Greenwood House DS0000035290.V343587.R01.S.doc Version 5.2 Page 18 Training offered to staff expanded from mandatory subjects to the subjects related to service users’ conditions and successful management. The latest included management skills necessary for effective management of the home and the outcomes could be seen in very organised and effective staff work. Greenwood House DS0000035290.V343587.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The effectiveness of the management team, which influenced a high level of safety and welfare of service users, determined the excellent scoring of management that ensured satisfaction and respect for service users. EVIDENCE: The manager’s RMA certificate from 2005 was displayed, demonstrating not only the qualification gained, but also the manager’s competence to run the home. Greenwood House DS0000035290.V343587.R01.S.doc Version 5.2 Page 20 Effectiveness was seen through well organised daily work, through an open and inclusive atmosphere and through service users satisfaction with the way the home operated. The ethos created in the home satisfied both service users and staff, who appeared to be motivated, creative and committed to the home’s objectives and aims. Quality assurance was a process that ran on a monthly basis. A specific area was reviewed each month, while respite service users’ views were collected weekly, to ensure all users had an impact on the way the home was run. Service users were supported in dealing with their finances by their families, and the records showed that the staff at the home knew who was involved with service users, ensuring better protection. Staff were well supported and regularly supervised. The observation of care processes showed that staff were not hesitant to approach, and ask about or discuss any issue with the senior management team within the home. Safe working practices were respected and in place. Certificates of indemnity insurance, gas safety records, water temperature records and other health and safety documents were in health and safety folder. The records were accurate and up to date. Incidents and accidents were appropriately reported and analysed within the home in order to prevent re-occurrence and improve the safety of service users. Greenwood House DS0000035290.V343587.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 3 4 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 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 3 3 3 X X X X X 3 STAFFING Standard No Score 27 4 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X 3 3 X 3 Greenwood House DS0000035290.V343587.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Greenwood House DS0000035290.V343587.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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