Inspection on 27/03/08 for Greenwood Lodge Care Home

This inspection was carried out on 27th March 2008.

CSCI found this care home to be providing an Poor service.

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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greenwood Lodge Care Home 28/08/08

Greenwood Lodge Care Home 10/09/07

Greenwood Lodge Care Home 28/02/06

Greenwood Lodge Care Home 08/09/05

Greenwood Lodge Care Home 11/02/05

Greenwood Lodge Care Home 22/06/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Greenwood Lodge Care Home 49-55 Gotham Lane Bunny Nottingham NG11 6QJ Lead Inspector Meryl Bailey Unannounced Inspection 27th March 2008 09:30 Greenwood Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 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 Lodge Care Home DS0000026441.V361278.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 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 Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenwood Lodge Care Home Address 49-55 Gotham Lane Bunny Nottingham NG11 6QJ 0115 984 7575 0115 921 3672 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) MGB Care Services Limited ****Post Vacant**** Care Home with Nursing 19 Category(ies) of Learning disability (19) registration, with number of places Greenwood Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th September 2007 Brief Description of the Service: Greenwood Lodge is a home for people with learning disabilities, some of whom have additional physical disabilities. Trained nurses and care assistants are provided. The accommodation is provided on two floors in the main building for sixteen residents in single rooms. The main area of the ground floor is accessible to wheelchair users, but there is no lift to the upper floor. There is a two bedroomed ground floor flat next door which accommodates two residents and this is accessible by wheelchair users. The home is situated south of Nottingham in the village of Bunny. There are secured gardens at the home and car parking to the front and side of the building. The acting manager confirmed on 28/03/08 that the fees for the service range from £379.65 - £1267 per week depending on dependency needs. Further information about the home is available from the acting manager and a copy of the last inspection report is available in the office. Greenwood Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements and minimum standards of practice and it focuses on aspects of service provision that need further development. We reviewed all of the information we have received about the home since we last visited including an Improvement Plan that the company sent to us and we considered this in planning the visit and deciding what areas to look at. We did not have time to send out surveys to people living at the home. We have introduced a new way of working with owners and managers. We ask them to fill in an assessment form called an AQAA (Annual Quality Assurance Assessment). It is about how well their service provides for the needs of the people who live there and how they intend to improve their service. They have to fill this in and send it to us, because it is a legal requirement to do this. We received one of these back from the manager last year. We did this inspection with one inspector. It was unannounced and took place during two days. The first visit on 27 March 2008 lasted for 6 hours and during the course of our visit we began to find evidence of a continued breach of regulations concerning the medication administered at the home. We issued a code B notice under The Police and Criminal Evidence Act 1984 to enable us to take away copies of the medication records with a view to assessing the findings in relation to enforcement action. We later found some information missing on the copies we had taken and, as we had other concerns about the maintenance of the home, we visited again on 10 April 2008 for three hours. During this visit we issued a further code B notice under The Police and Criminal Evidence Act 1984 to enable us to take away the medication records we needed and to take photographs of the home in relation to possible future enforcement action. The main method of inspection we use is called ‘case tracking’ which involves us choosing a sample of residents and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. There were 18 people accommodated at the home at the time of this inspection. Some residents were spoken with and additional records were seen. A discussion was held with managers and the nursing and care staff on duty and care practices were observed. A full tour of the premises was made. Greenwood Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 6 English is the first language of all of the people living at the home at the moment, though some do not use speech to communicate their needs and they express themselves using some vocal noise, facial expressions and gestures. The staff team come from a wide variety of backgrounds and experiences. The registration certificate was displayed at the home and had been amended by the Commission since the last inspection to show that there is no registered manager. The company that owns this home will be expected to work with us to provide evidence of compliance and improvement to make sure they meet the requirements and provide good quality care to the people living at the home. What the service does well: What has improved since the last inspection? The cook now meets with residents on Sundays on a regular basis to plan menus. Meals are in two sittings so that those who need help from staff can receive it. Two members of staff were observed sitting with residents, encouraging and assisting them with their meals. Greenwood Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 7 The call alarm system remained inactive on the inspection visit on 27 March 2008, but a new system had been installed by the time we visited again on 10 April 2008. The kitchen has been refitted with new cupboards, stainless steel worktops, cooker and dishwasher. There is also a new window and door. Further refurbishment is planned and a manager in charge stated that the date for work to commence to lay a new floor in the entrance hall was 3 April 2008 and this work was in progress when we visited again on 10 April 2008. The number of care staff provided through the day has been increased by one, so that the minimum staffing number is now 1 nurse and 6 care staff during the day and 1 nurse and 2 care staff at night. What they could do better: All staff must be given opportunity to read and understand the full written plans in order to ensure all needs are appropriately met. Also, they need to assess and plan specific actions to be taken to meet needs relating to visual impairment as this was omitted from the assessments To ensure adequate quantities of suitable food is provided, each person must be offered the option of having desert or fruit after the lunchtime cooked meal. They should also complete a signs and symbols picture book of meals in order to increase the opportunities for some residents to express a preference for particular foods and take part in planning menus. To ensure residents are kept safe by being given their medication as prescribed by a doctor, Medicine Administration Records must be fully completed and they must establish a system to check that all medications, including creams, are properly labelled and destroyed once they are out of date. To assist residents understand how to make complaints they should display the complaints procedure in signs and symbols. To ensure people feel listened to, staff must write down any complaints and make a written record of corresponding outcomes. To ensure that residents live in a safe and homely environment, the home must be properly maintained and kept in good working order. Residents’ wardrobes and drawers must be repaired or replaced. Bedroom floors must have appropriate coverings. They should also provide chairs in residents’ bedrooms. To ensure residents are protected by recruitment procedures, staffing records must be complete and include two satisfactory references obtained for each person employed. Greenwood Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 8 To ensure the health and safety of residents, regular checks must be made of water temperatures and action taken as required. Also, window openings need to be restricted to protect people who live there. 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 Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 9 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 Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are systems in place to assess any prospective new resident if the occasion arises. EVIDENCE: Records showed and staff confirmed the fact that there has not been any new admission to the home since the last inspection or for three years prior to that. There are no current vacancies. We found assessments contained in the files of people we case tracked. A wide range of needs were assessed and corresponding plans clarified how the needs should be met. However, specific needs relating to visual impairment were not assessed and this area of need should be included in the assessment for any future person admitted to the home so that their needs can be planned for and met appropriately. See next section. Greenwood Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care staff understand and meet the basic needs of people who use the service, but are not fully aware of all care needs so some needs may not be fully met. Risks are assessed and people are assisted to make some decisions. EVIDENCE: A sample of four care plans were looked at and these contained a lot of assessment information which led to action plans for staff to follow in order to meet peoples’ assessed needs. There was some clear guidance as to what actions staff should take. Two of the four people had been involved in preparing their own care plan and these were written so that they were directing staff in the way they wished to be cared for. One file contained information that described a person as “registered as partially sighted”, but there was no detail about the visual impairment and how this affected the care Greenwood Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 12 needed. There was no indication of how to encourage the person to use their residual vision and no information to make staff aware of the extent of visual impairment. The manager in charge stated that she was unaware of the extent of the visual impairment, but ensured the person concerned had his meals separately due to his impairment. This action was not supported by any written assessment and plan of action. At the previous inspection in September 2007, there was evidence that staff had not read the care plans. Since then the provider company submitted an improvement plan to the Commission stating that staff will be given time to read care plans and sign to confirm they have read them. During this inspection the manager in charge told us that this procedure has not yet commenced, but summaries (Five point plans) were available for care staff and these were discussed in meetings with staff. One of the care staff said they had not read the full care plans and another said they do sometimes. One trained nurse stated that the increase in staffing numbers has given more opportunity for nursing staff to read the full plans and to supervise care staff, who were not expected to read them. Staff said that residents had increased opportunities to make choices now that a wider range of activities was available with the introduction of the Day Centre. (See Standard 12) Residents were not aware of their choice of food for lunch and no alternatives were seen, but the acting manager said that other food was available if it was clear that someone wanted something different to the meal offered. (See standard 17) There were detailed risk assessments seen in care plans including daily activities: taking a shower, making a drink, going swimming and fire safety. Greenwood Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 16 and 17 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at Greenwood Lodge have opportunities to take part in a range of activities. Regular meals are available, but choice of food is limited. EVIDENCE: One of the care staff and the cook were out on a day trip with two residents on the day of this inspection. Three other residents were at a Day Centre. A visitor was assisting some residents with a puzzle. During the afternoon two other residents went out for a walk with staff. On the second visit to the service residents were occupied in the activities room and one was using the multi-sensory room. There were some who were not occupied in any specific activity on either day and were wandering around. Some seemed happy watching television or listening to music. Greenwood Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 14 One of the residents told us of a holiday to Spain that he has planned and that he has chosen the care staff who will support him. Staff said there was a weekly disco in a local village hall where friends from other homes can come. There is a monthly faith and light service at a local church and residents go out to the local shops and pub. Details of these were included in the previous Annual Quality Assurance Assessment. Lunch was served during this inspection. This consisted of Quiche, chips and baked beans. The planned meal of Pizza and potato wedges was not available as the delivery from Asda was late. Some residents spoken with told us they enjoyed the meal they had. No dessert was offered. At the last inspection the provider was required to review mealtimes. An Improvement Plan detailed that the cook meets with residents on a regular basis to plan menus. There was a menu attached to the fridge in the kitchen, but not on display for residents. The menu contained two weeks of planned meals and fresh vegetables were included twice each week. Desserts were listed following the teatime meal of sandwiches. The manager explained that it had been the choice of some residents to have their dessert later in the day and other residents did not sit long enough to eat dessert. However, residents were not given the choice of having a dessert with their main meal on a daily basis. The Improvement plan suggested that a signs and symbols picture book would be developed by the end of April 2008. This will increase the opportunities for some residents to express a preference for particular foods and take part in planning menus. At the previous inspection there were some residents not receiving the help required with eating. On this occasion two members of staff were seen sitting with some residents, encouraging and assisting them with their meals. The Improvement Plan indicated that meals are staggered so that those who need help from staff can receive it. Asda delivered during the inspection and the receipt detailed a variety of food delivered, including fresh fruit and vegetables, sufficient to provide nutritionally balanced meals. Greenwood Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents receive individual personal support, but are put at risk when needs are not immediately met. Inconsistent medication administration and recording practices puts residents at further risk. EVIDENCE: Some people were receiving 1:1 support with washing and dressing at the commencement of the inspection. Others were already dressed and some had gone out. The call alarm system remained inactive on the inspection visit on 27 March 2008. This meant that those with limited mobility were not able to summons help when required. One person said that regular two hourly checks were made during the night and this person waited patiently for staff to come to assist at those times. The improvement plan stated that work to install the new call system would be started on 17 March 2008. This did not happen and Greenwood Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 16 a new commencement date of 31 March 2008 was given. A new system had been installed by the time we visited again on 10 April 2008 A trained nurse is always on duty and there were records referring to appointments with other medical staff. Stocks of medication and the controlled drugs were appropriately stored. The current medication was also secure. On inspection most drugs were in blister packs as dispensed by the pharmacist. There was some prescribed “Betnovate Cream” with no resident’s name on the label. The opening date was written on the label and showed that it should have been discarded by 02 March 2008. Other medications were labelled with names and in date. On examination of the Medication Administration Records a considerable number of gaps were found where it was not clear whether or not four of the residents had been given medication prescribed for them. There were also inconsistencies in the codes used to record whether or not medication was administered and one code was indistinguishable from a signature. Trained nurses are responsible for the medication and some had appropriately recorded on the reverse of the Medicine Administration Record sheets where medication was given later than prescribed times. Others had not done this and it was not clear if some medication had been prepared (Made available) and given later or destroyed. On the day following the first inspection visit the Responsible Individual for the provider company informed the Commission that disciplinary proceedings would take place with respect to those staff that had not appropriately followed medication procedures. Greenwood Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Procedures about complaints and protection are in place, but these are not fully understood by staff, leaving residents and others unsure whether or not their concerns would be dealt with. EVIDENCE: There was a complaints procedure on the wall in the entrance hall. This was typed in full English and gave appropriate information for anyone who wanted to complain about their care. One person was asked about this and responded that he did not know how to make a complaint or who he would need to speak with. The improvement plan states that the procedure had been discussed in a residents’ meeting and two other formats are being prepared, one on paper in signs and symbols, which some residents understand and the other will be an audio version for residents to listen to. Neither of these were available at the time of this inspection. There was an appropriate file and forms for complaints to be written down, but none had been completed. A neighbour had made a verbal complaint, but staff had not written anything about this in the complaint file. The outcome was not recorded. Since the last inspection seven staff have undertaken training regarding safeguarding vulnerable adults, using a video and answering questions about their awareness. However staff spoken with had not been made aware of the new local Nottinghamshire procedures for dealing with allegations and Greenwood Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 18 suspicions of abuse. A copy of the old procedures was appropriately destroyed during the inspection to avoid confusion with the new booklet now in place. The provider company is currently reviewing policies and procedures and reference to the new Nottinghamshire procedures can now be included. Greenwood Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 30 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Some attention is being given to the poor state of repair of this home, but until refurbishment work is complete residents are living in an environment which is only partially suitable. EVIDENCE: Since the last inspection the kitchen has been refitted with new cupboards, stainless steel worktops, cooker and dishwasher. There is also a new window and door. Further refurbishment is planned, but when this inspection commenced there were rotting floorboards in the entrance hall and these were covered with a carpet that held malodours. The manager in charge stated that the date for work to commence on this area was 3 April 2008 and this work was still in progress when we visited again on 10 April 2008. Greenwood Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 20 A tour of the premises was made during this inspection visit and at least half of the bedrooms had drawer fronts or handles missing from chests of drawers and wardrobes. Some of these were noted as broken at inspection in September 2007. The floors of some bedrooms were covered in old linoleum and one room had several rips in the lino made by staff moving furniture around. Some bedrooms contained a chair, but most did not. When asked, one resident said that he would like a chair, but did not know that he could have one. Some of the openings of windows of bedrooms and bathrooms had been restricted for safety and security, but some had no form of restriction and most of those that did were not sufficiently restricted. A sharp wire was found protruding though a windowsill in one room and the manager contacted the handyman, who came immediately to remove it for safety. As a result of a risk assessment it is not suitable for the resident of this room to have curtains and external shutters have been fitted instead. In another room some curtains had not been secured properly. In another, the wires from the call system were left uncovered. Several rooms were in need of decorating. Cleaning was taking place during the inspection. A housekeeper was employed and works 35 hours each week to keep the home clean. This is effective though odour remained from old carpets and floors. The laundry room was appropriately equipped. Greenwood Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are supplied in sufficient numbers, but residents are not fully protected by recruitment practices. EVIDENCE: Since the last inspection the number of care staff through the day has been increased by one, so that the minimum staffing number is now 1 nurse and 6 care staff during the day and 1 nurse and 2 care staff at night. In addition the service employs a cook and housekeeper. On the first day of this inspection the cook and one of the care staff were out for the day with two residents. One of the care staff was working in the kitchen and her records showed that she had been trained in food hygiene. We observed that she was appropriately dressed for working in a kitchen We looked at the staff files of all those on duty and found that there were no references for three care staff, but there was evidence of Criminal Records Greenwood Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 22 Bureau checks having been carried out for all staff. The manager in charge contacted the company’s office and reported that an employment agency had carried out checks on the three staff concerned, but there was no available evidence of satisfactory references. There were records of various training that staff had done since the last inspection. This included Infection Control, Mental Capacity Act, Autism, Falls Awareness, Moving and Handling, Record Keeping, and specific training for assisting with one particular resident. Staff confirmed they had taken part in this training. Induction and foundation training was established, but only one of the care staff had completed a National Vocational Qualification in care at level 2. Greenwood Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Changes in management have led to inconsistencies in the conduct of the service and residents’ health, safety and welfare are not fully promoted and protected. EVIDENCE: The manager in charge on the day of this inspection had previously been registered as manager at this service, but has moved to another home owned by the same provider. There is a new Acting Manager who is currently on holiday. He has been the manager for the 2 weeks and has not yet applied to be registered with the Commission. Staff said that they know how to contact a manager at all times. Greenwood Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 24 Staff said the fire alarm was tested weekly and the fridge and freezer temperatures were checked daily. Some records were seen of these checks, though there were no records for 26 and 27 March 2008. Temperatures on inspection were seen at safe levels. The fire evacuation procedure was displayed using signs and symbols. The manager in charge told us there had been consultation with the Fire Officer about the new kitchen door and another visit from the fire officer was awaited. There was a safe external area for residents to walk around, with a high fence and locked gate. As reported in the Environment Section of this report, there were some specific risks to safety, health and welfare of residents found during this inspection. A sharp wire was found protruding though a windowsill, but this was attended to on request. Some openings of windows had no form of restriction and most of those that did were not sufficiently restricted for safety and security. At the last inspection in September 2007, we found that there had been high water temperatures recorded at the flat. We checked this on 10 April 2008 when we found evidence that recent records of temperatures had not been kept, but we took the temperature during that day and found it to be safe at 40C. Greenwood Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 25 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 Standard No Score 1 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 1 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 X 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 2 X 2 X X 2 X Greenwood Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 Regulation 14 Requirement To ensure needs are fully assessed, all areas of health and social care needs must be included in the pre admission assessment and this includes sensory impairment. To ensure all needs are appropriately met, include actions to be taken to meet needs in every aspect of health and welfare in the written plans and ensure all staff read and understand the full written plans. To ensure residents are given their medication as prescribed by a doctor, Medicine Administration Records must be fully completed. This requirement had a timescale of 17/10/07, which has not been met. Enforcement action is now being considered. To ensure safe administration of medication establish a system to check all medications, including creams, are properly labelled and destroyed once they are out of date. To ensure complaints are fully DS0000026441.V361278.R01.S.doc Timescale for action 31/05/08 2. YA6 15 31/05/08 3. YA20 13 (2) 27/03/08 4. YA20 13 (2) 01/05/08 6. YA22 22(3) 01/05/08 Page 27 Greenwood Lodge Care Home Version 5.2 7. YA23 13 (6) 8. YA24 23 (2) (b) and (c) 9. YA34 17 (2) 10. YA42 13 (4) 11. YA42 13 (4) investigated they must be recorded with corresponding outcomes. To ensure residents are fully safeguarded from abuse staff must be made aware by training or otherwise of the procedures for investigating allegations or suspicions of abuse. To ensure that residents live in a safe and homely environment, the home must be properly maintained and kept in good working order. Residents’ wardrobes and drawers must be repaired or replaced. Bedroom floors must have appropriate coverings. To ensure residents are protected by recruitment procedures, staffing records must be complete and include two satisfactory references obtained for each person employed. To ensure the health and safety of residents, regular checks must be made of water temperatures and action taken as required. To ensure the health and safety of residents, all windows must be assessed and openings sufficiently restricted to prevent entry or exit via windows. 01/05/08 31/05/08 01/05/08 01/05/08 31/05/08 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 YA16 Good Practice Recommendations Complete work to develop a signs and symbols picture book to increase the opportunities for some residents to express a preference for particular foods and take part in DS0000026441.V361278.R01.S.doc Version 5.2 Page 28 Greenwood Lodge Care Home 2. 3. 4. 5. 6. YA17 YA22 YA26 YA35 YA42 planning menus. Offer each person the option of having desert or fruit after the lunchtime cooked meal on a daily basis. To assist residents understanding display the complaints procedure in signs and symbols. Provide chairs in residents’ bedrooms unless they are not required or removed due to safety reasons. Support staff to achieve National Vocational Qualifications at level 2 in care. Establish a system of regular health and safety checks to eliminate risks to the residents from hazards in the environment. Greenwood Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact 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 © 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 Lodge Care Home DS0000026441.V361278.R01.S.doc Version 5.2 Page 30 - 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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