Inspection on 08/09/05 for Greenwood Lodge Care Home

This inspection was carried out on 8th September 2005.

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 no outstanding requirements from the previous inspection report, but made 32 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 27/03/08

Greenwood Lodge Care Home 10/09/07

Greenwood Lodge Care Home 28/02/06

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 Jayne Hilton Unannounced 8 September 2005 at 1:45 pm th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 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 Acting Manager Jane Greenwood MGB Care Services Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Care Home with Nursing 17 Category(ies) of Learning Disability (LD) - 17 (Seventeen) registration, with number of places Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 11/02/05 Brief Description of the Service: Greenwood Lodge is a home for people with learning disabilities, some of whom have additional physical disabilities. Most of the service users are under 65 but a few are over and have regular reviews. The accommodation is provided over two floors and all but one of the bedrooms are single. The home is situated in the village of Bunny which has limited public transport links. The local garage also doubles as a shop and post office and is within walking distance of the home.There are secured gardens at the home and car parking to the front and side of the building Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was undertaken on 8th September 2005 by Jayne Hilton. The inspection, which took five hours, partly focused on the requirements and recommendations set at the previous inspection and those standards not inspected at the last visit, however most of the 43 standards were inspected overall due to both the manager being well organised and because evidence was available to assess the standards. A tour of the building was facilitated and two care plans were examined in detail with other care plans sampled for specific information. One staff member was spoken with and the acting manager and two residents. As most of the residents have communication difficulties and complex needs, a proportion of the inspection was carried out by observations of staff practice. Many other records were examined, including health and safety records, a sample of staff personal files, policies and procedures. The outcome for residents was seen as positive, however re-decoration of the home and improved health and safety practices would further enhance their quality of lifestyle. What the service does well: The home is well run by an effective deputy and acting manager who is to undergo the fit person process to be registered shortly. The staff team clearly have good leadership in providing good outcomes for the residents at Greenwood Lodge. The residents at Greenwood Lodge have their needs assessed and their individual aspirations are valued and developed. Each resident has a contract and the information they need to make an informed choice where they live. The residents assessed and changing needs and personal goals are reflected in their care plans and are clearly supported to take risks as part of an independent lifestyle. Resident wishes and preferences are sought and valued by staff and these are respected alongside confidentiality and regarding individual capacity and consent for participating in all aspects of life in the home. Residents are clearly able to take part in age, peer and culturally appropriate activities in the home and in the local community and are supported with personal and family relationships. The resident’s rights are respected and they enjoy their meals and mealtimes. The outcomes for residents is extremely positive regarding opportunities for recreational and leisure opportunities. Residents receive personal support in the way they prefer and require and their healthcare needs are well met, Medication management was overall satisfactory and there are good policies, Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 6 procedures and practices in place for dealing with illness and death of residents. Residents are informed of how to make a complaint and policies are in place to protect residents from abuse. The residents live in a comfortable and homely environment and resident’s bedrooms are personalised Resident’s have ample shared space and equipment to meet their specialist needs. Residents benefit from clarity of staff roles and responsibilities and are supported by competent and qualified staff who are trained and supervised well. What has improved since the last inspection? What they could do better: The quality monitoring systems need to be further developed and improved and the storage temperatures of medicines, needs to be monitored. Staff need to ensure they use the appropriate wheelchair for the individual and a recent issue discussed in a staff meeting is to be referred under the Adult Protection guidance. Staff have not undertaken any training in abuse awareness, although this is planned. The interior of the home is badly in need of redecoration and refurbishment in most areas and which have been outstanding for sometime and most of the residents’ furniture and equipment require repairs or replacements and most rooms need re-decorating. The toilet and bathroom facilities also require repairs and re-decoration and there are issues to resolve regarding door locks. There are many health and safety aspects to address to ensure the safety and welfare of residents is maintained. A review is needed for the handyman and management hours, as these are Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 7 both clearly in shortfall. Recruitment practices were found to be poor and a serious breech of legislation has been found regarding CRB’s. An immediate requirement has been set in relation to this. Thirty-four requirements are set and eighteen recommendations, mainly in relation to the environmental standards and health and safety. 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 Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 8 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 Standards Statutory Requirements Identified During the Inspection Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 9 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 standard(s) 1,2,3,5 The residents at Greenwood Lodge have their needs assessed and their individual aspirations are valued and developed. Each resident has a contract and the information they need to make an informed choice where they live. EVIDENCE: The service user guide was seen, a signs and symbols version of this has been developed and each service user has their own copy of the document. It was the opinion of the inspector that this was a positive and clear document. The Statement of Purpose now contains all of the information specified in Schedule 1, however the following recommendations are made: Expand on the privacy and dignity statement. The statement about access for copies of Inspection reports needs to be slightly amended and updated to current practice of Published Inspection Reports. Two residents Care plans were examined in detail and there was evidence of comprehensive assessments being carried out prior to the resident living at the home and these have been reviewed and updated as necessary. The assessments are base on the Roper Logan and Tierney Nursing assessment model Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 10 The home provides nursing care for residents with learning disabilities some of who have additional needs such as physical disabilities, challenging behaviours and mental health needs. All of the residents were observed throughout the inspection appeared relaxed around the staff and presented well cared for. The inspector did speak with residents at varying times during the inspection but communication was limited due to the residents having complex needs. The manager demonstrated a good knowledge of the resident’s needs and the care plans evidenced detailed information about the likes and dislikes and varying personalities of the residents. Where residents cannot express these needs because of communication needs, the staff team have made great effort to detail their observations of both verbal and non -verbal communication and what they have learned about the individual. The assessments and care plans were person centred approached and the detail evident exceeded the standard. Any restrictions that needed to be imposed for the safety of the residents were well documented. Family carers interests and needs are taken into account, subject to this being in agreement with the resident or their circumstances. Outside professional input is sought and used as required. The staff team appeared well coached on the philosophy of the home, however the inspector did not speak individually with staff about their practice on this occasion. Staff, were observed to interact appropriately with residents. The care plans provided detail of specialist equipment needed for individuals and this was seen during the inspection of the environmental standards. Terms and conditions documents are in place. Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9, 10 The residents assessed and changing needs and personal goals are reflected in their care plans and are clearly supported to take risks as part of an independent lifestyle. Resident wishes and preferences are sought and valued by staff and these are respected alongside confidentiality and regarding individual capacity and consent for participating in all aspects of life in the home. EVIDENCE: Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 12 As previously stated two care plans were examined in detail [Two others were examined for specific information]. A new format has been developed based on a person centred and approach and involves the resident wherever they are able. Visual and graphic versions are used within the plans. A key worker system is in place. It was the view of the inspector that these were well organised, clear and concise. They reflect residents’ strengths and needs. The plans contain good, detailed personal histories. There is evidence of regular reviews of action plans and risk assessments. Many of the residents in the home could not sign to indicate they have been involved in care planning however each care plan indicates the objective of the resident. It was not possible to hold an in depth discussion about care plans with the residents who were case tracked. Evidence was seen of resident meetings, which are facilitated by an external advocate. Staff, were heard offering residents a choice of activities and encouraging the resident to choose the colour of craft paper and make decisions within the craft sessions. Care plans include the preferred term of address of individuals also. Standard 7.7, Resident’s financial accounts were not examined at this inspection. The manager reported that some residents enjoyed contributing to the day-today running of the home and other did not. Some residents may use the hoover or help clearing pots away or help clean their rooms. Because of the residents complex needs participation of developing policies and procedures is not possible. The resident meetings do raise issues for staff and management discussion. There were good risk assessments on the files examined. These identified the risks, of who could be harmed and stated clearly the action needed to reduce the risk. Risk assessments are reviewed regularly. The doors from the home are open but the garden is secured with a keypad entry system. The use of this is referred to in risk assessments seen. All of the resident the inspector observed saw would require support to go out as the nature of their needs would render them vulnerable without this guidance. A missing person policy is in place. Residents were observed moving freely around the home. A policy is in place for confidentiality. Care plans are stored securely. Observations on the day did not raise any issues regarding this standard. Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15, 16, 17 Residents are clearly able to take part in age, peer and culturally appropriate activities in the home and in the local community and are supported with personal and family relationships. The resident’s rights are respected and they enjoy their meals and mealtimes. The outcomes for residents is extremely positive regarding opportunities for recreational and leisure opportunities. EVIDENCE: The care plans clearly identify the social and emotional, communication and independent living skills of residents and detail their spiritual needs or not as the case may be. Varying activities both in the home and in the community were well documented and observed to be happening on the day of the inspection. Direct observation would suggest that service users are engaged in activities they enjoy. Several were observed doing puzzles and crafts. One resident refused to attend swimming, of which his decision was, respected. Residents were observed sitting and walking in the garden. A minibus provides transport. Eight residents use local daycentres at varying times during the week. All residents have an activity timetable. A sample of activities from Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 14 these are as follows; Picnic at Rufford Park, snack and coffee in the community, Arts and Crafts, Getaway club, shopping, trip to garden centre, karaoke, cinema, bingo, pub lunch, cabaret show etc. Faith and light club and other groups are also attended. There is a boat trip booked for 2Oth September with a meal included. Two residents from another home attends Greenwood for day care, it is recommended that a calculation be undertaken to ensure that the home has sufficient communal space for this purpose. A portakabin has recently been erected in the garden, which will provide extra activities room space and an excellent snoozlan facility. Disability access was observed around the home and the manager reported that holidays and outings are risk assessed. Some residents were out at day services during this inspection. There is a very limited public transport system within the village, and there is transport available, which residents pay for using their Disability Living Allowance. This is explained in the terms and conditions. There was evidence in care plans regarding whether residents may wish to participate in the civic process and that staff rotas are arranged to provide extra staffing where needed. An excellent home made, menu board was seen in the dining room that informed residents of the menu and daily activities in symbol form. Further development of photographs of meals is planned. Relationships and family links are well documented and detailed in care plans of individuals. The manager reported that there were no residents engaged in personal relationships at the time of the inspection, however she demonstrated how the staff team had encouraged and facilitated a long-standing friendship of two residents who are now both able to live at the home together. Another two residents, who have shared a close friendship for many years, share a room. The manager demonstrated a good knowledge of resident’s family histories and gave examples of where residents had been supported to make contact with relatives who they had not seen for sometime. Staff, were observed to knock before entering residents rooms and some residents were said to have keys to their rooms if they chose and risk assessments were in place where this was not possible. Residents were observed to be respected in their choice to be alone or in company or just to wander around the home and gardens. Rules on alcohol and smoking were addressed in the homes policies. Alcohol was observed in the fridge for residents use. The serving of the evening meal, was observed by, the inspector, the meal was of substantial portion and looked appetising and residents appeared to enjoy their meal. The atmosphere was relaxed and some residents had chosen to eat in the garden. The resident’s nutritional needs are well met by the care plans and weight charts were in place and up to date. The manager reported that intake charts are used if concerns regarding nutritional intake are identified. A menu board was seen in the dining room that informed residents Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 15 of the menu and daily activities in symbol form. Two staff were observed assisting residents with eating, one was observed to be seated whilst doing this, which is appropriate practice and one was not. Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 16 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 standard(s) 18, 19, 20, 21 Residents receive personal support in the way they prefer and require and their healthcare needs are well met, however staff need to ensure they use the appropriate wheelchair for the individual. Medication management was overall satisfactory, however the storage temperatures of medicines, needs to be monitored. There are good policies, procedures and practices in place for dealing with illness and death of residents. EVIDENCE: There was evidence in the home of equipment being provided to assist residents. Care plans identified individual manual handling plans and mobility needs, however a member of staff was observed to use a wheelchair without footplates and the residents feet were noted to catch on another residents walking frame. It transpired later that the wheelchair used for the resident was not the residents own wheelchair and the manager stated she would address this. Action plans identified the required support and guidance needed for personal hygiene, dressing and choosing clothes. Care plans detailed additional specialist support by speech therapists, physiotherapists etc. The psychiatric and general nursing needs of residents are mainly met by the qualified staff employed at the home, however additional support is given by consultant psychiatrists, Community Learning Disability Teams and the primary Care Team and GP. Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 17 Healthcare needs of residents were found to be well documented and include annual well person checks. Two residents suffer from epilepsy and monitor alarms are used during the night for safety of the resident. This is documented within the individuals care plan, however it is recommended that relatives, advocates or social workers also sign to say they agree to this if the resident cannot sign or express this themselves. Some of the residents require high levels of nursing input, and the care plans reflect these needs well. Each care plan has a designated assessment of service user’s health needs, and evidence was seen of water low assessments, nutritional assessments and continence assessments. There appeared to be good management of continence and there were no reports of residents having pressure areas at the time of the inspection. Weight and blood pressure checks are routinely undertaken. The medication systems were partly assessed. Policies for the administration of medication appeared satisfactory. There were no storage temperatures being taken and this is a requirement under the Medicines Act to undertake this, at least daily. There are no residents who are able to self medicate. The trolley was, observed to be secured to the wall when not in use and medication was signed as given, only after visibly being observed as taken. Residents’ care plans contained information about medication and it is recommended that medication profiles be developed within the new format, which details any changes in medication, and medication reviews and addresses the capacity to consent for medication. Only qualified staff, administer medication for Greenwood Lodge, but they have not had any drug update training, which should be arranged. The pharmacist had undertaken an inspection earlier in the day and there were no reported issues identified. The home uses the Boots blister packs system. There are policies in place for dealing with dying and death and the residents/relatives wishes are well documented in the individual care plans of residents. The manager discussed the events of two residents who had died, one at the home and one in hospital. Bereavement counselling is to be arranged for a resident who has recently lost his sister and residents are supported to attend funerals should they wish to attend. Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 18 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 standard(s) 22, 23 Residents are informed of how to make a complaint and policies are in place to protect residents from abuse, however a recent issue discussed in a staff meeting is to be referred under the guidance. Staff have not undertaken any training in abuse awareness, although this is planned. EVIDENCE: There have been no complaints received by Commission for Social Care Inspection in respect of this home since the last inspection. There is a complaints procedure for the home and this is contained in the service user guide. The signs and symbols version has a picture of the manager to indicate who should be approached. It is recommended that a formal complaints template be devised and which can be kept in a ring binder file with any letters of complaint and responses etc. Policies are in place for adult protection and whistle blowing. The manager is to arrange a workshop for staff on abuse awareness in the near future. There was evidence in the staff meeting minutes that a referral to the adult protection unit and social services is required and the manager agreed she would pursue this under the reporting guidance of Nottinghamshire Committee for Vulnerable Adults. Copies of all correspondence including, notification forms need to be sent to CSCI. Policies are in place for the use restraint and all staff are trained in SCIPr Uk [Strategies for crisis intervention and prevention]. Resident’s finances were not examined at this inspection. Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24-30 The residents live in a comfortable and homely environment, which is badly in need of redecoration and refurbishment in most areas and which have been outstanding for sometime. Resident’s bedrooms are personalised but their furniture and equipment require repairs or replacements and most rooms need re-decorating. The toilet and bathroom facilities also require repairs and redecoration and there are issues to resolve regarding door locks. Resident’s have ample shared space and equipment to meet their specialist needs. There are many health and safety aspects to address to ensure the safety and welfare of residents is maintained. EVIDENCE: Greenwood Lodge does not have to meet the new environmental standards. The home is suitable in design to meet the needs of the residents and provides spacious interior and external space. The home is domestic in appearance and is in keeping within the community surroundings. There is a lounge and dining room and a large conservatory, which leads into the garden. A gazebo and selection of garden furniture provides external facilities. A portakabin has been recently erected in the garden to provide two activities rooms, an office for the manager and a meeting room. A separate path has been provided for Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 20 visitors attending meetings, to access toilet facilities without having to enter the home and resident’s personal space. The standard of décor and furnishings in the home, presents as tired, damaged or worn. Two resident’s bedrooms have been recently decorated by staff but most of all other resident’s bedrooms examined required re-decoration. ‘M’s room is a priority. The manager reported that there is a decorating plan in place, but evidence in the maintenance request records, suggests that this has been outstanding for sometime despite the manager submitting requests to the providers. The entrance, hall and stairs areas require redecoration. The dining room requires decoration. Many of the resident’s bedrooms need redecoration. Much of the bedroom furniture was observed to be broken or damaged, the inspector acknowledges that this is a consequence sometimes of the complex behaviours and needs of residents however, new furniture should be provided which is of substantial design and quality. The lounge carpet is lifting, badly worn and stained and requires replacement. The manager advised the inspector that a quote has been obtained for re-upholstering one of the suites in the lounge, however the inspector observed that the other suite requires replacing. Bathroom and toilet facilities appear adequate and a new walk in bath has been recently installed. The bathrooms and toilets examined require redecorating also. The peach bathroom requires some repair to the skirting before painting. The upstairs blue bathroom has a plaster crack which needs investigation and making good and redecoration. The walk in shower, which is tiled from floor to ceiling requires refurbishment, the tiles need re-grouting and the ceiling decorating after the black mould has been removed. Privacy locks on bathroom doors were observed not to be in working order, however the manager reported that most residents would be at risk if they locked the door or would not be able to use he bolts fitted. The staff team need to be innovative here in finding a practical and appropriate solution to remedy this issue. There were many ground floor and first floor windows without restrictors, which is a security risk for residents. Risk assessments have been undertaken for surface temperatures of radiators, however the inspector observed chairs and seating placed against radiators. The majority of radiators were not on as the weather was warm on the day of the inspection, however one was noted to be on in one of the bathrooms. No covers were in place. One resident was observed sat in the dining room, on a table adjacent to a radiator. The resident was falling asleep and leaning towards the radiator. The inspector pointed out the high risk to residents should the radiators have been hot. Call alarms are sited in resident’s rooms and work by intercom. One residents intercom was broken and the wiring hanging loose in the room. Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 21 A few resident’s rooms have washbasins. The temperature of the hot water in these outlets was either tepid or cold to the touch. The temperature of water outlets in baths and sinks in the bathrooms was recorded daily, which is good practice, however temperatures were recorded on occasions above 43 degrees. No action had been taken to remedy the situation and retest. This process needs writing into the guidance for staff, as water outlet temperatures must be regulated to 43 degrees. It was difficult to ascertain if the home has regulating valves as required by regulation and there were hot water geysers in resident’s bedrooms, which did not work. The manager was advised to seek advice from the Environmental Health Officer regarding the water storage and outlet temperatures and report back to the inspector of the outcome. There was a metal box sited under one bedroom sink, which the manager understood to be possibly be an ‘earth-ing’ connection. The EHO needs to be consulted regarding this, with a view to ensuring residents safety. Residents bedrooms appeared personalised and comfortable, however they did not contain all of the required furniture to meet the standard. Where this cannot be met for a specific reason or the resident chooses not to have the item of furniture the reason should be written in the individuals care plan. Some residents had rugs in their rooms, which could be a trip hazard and therefore need to be risk assessed and a disclaimer included in the individuals care plan if assessed as unsafe and the resident desires to still have a rug. A double room had a privacy curtain in place. GH’s room requires a new carpet. Fire risk assessments had been undertaken, the inspector advised that individual risk assessments should be added to this regarding the evacuation of residents in relation to their complex and challenging behaviours. The fire officer should be consulted regarding the fire safety issues of the portakabin. There are no CCTV Cameras in use. Grab rails are site around the home. There was a noted damp problem in the laundry, which needs investigation and remedy. Washing and drying facilities appeared adequate, however the laundry room requires re-decorating. Gloves were available. There were some door locks that were noted not to be approved safety locks with thumb turns and these should be fitted. The home was overall clean and free from malodour however the freezers in the freezer room were all very grubby on the casing and the upright freezer handle was loose. Care staff, were observed not to be wearing aprons when serving food and when in the kitchen. The practices for infection control need to be improved both in policies and procedures and regarding staff training. The kitchen standards overall were satisfactory part from the accuracy of the cooks record keeping of cleaning duties performed. Ensure liquid soap is provided in all bathrooms at all times. Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 22 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 34, 35, 36 Residents benefit from clarity of staff roles and responsibilities and are supported by competent and qualified staff who are trained and supervised well. A review is needed for the handyman and management hours, as these are both clearly in shortfall. Recruitment practices were however found to be poor and a serious breech of legislation has been found regarding CRB’s. An immediate requirement has been set in relation to this. EVIDENCE: Job descriptions and terms and conditions were observed in the six staff personal files examined. A volunteer is employed for activities and the person has undergone an induction. Staff, are undertaking NVQs [National Vocational Qualifications] and skills for work induction and some staff have done LDAF [Learning disability accreditation framework] training. Staff, are paid for 5 days a year to undertake training. The manager keeps a training file and details of training are kept on each individual staff member’s personal file. Staff have undertaken first aid, manual handling, food hygiene, fire training and health and safety, which are updated annually. Some staff have certificates for Palliative Care and bereavement in a care environment and Therapeutic Activities in a care environment. Videos have been purchased for Challenging behaviour in addition to the Skip [uk] training. Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 23 Training should be provided for epilepsy and abuse awareness and other healthcare needs of residents as the resident groups needs dictate. There was evidence of staff meetings and supervision and appraisals records were in staff files although the manager reported that supervisions had been difficult to maintain on a regular basis due to time constrictions. A rota has been devised to ensure that supervision sessions are not missed in the future. The staffing rota was not examined but the manager confirmed that this was maintained as the staffing notice and this matched with the staff observed on duty at the time of the inspection. Six staff are rotered on am shifts and five on pm shifts with two staff covering nights. Domestic and catering staff are employed in addition to this. The home shares a handyman service and as there is evidence of poor environmental standards regarding décor and maintenance, this clearly is not adequate. The needs of the residents warrant a full time handyperson to be based at the home. The manager works supernumery for only one day a week, which is not good practice. Although the care management at the home was assessed as very good it was clear that the manager needs to be super-numery for at least 90 of her working hours to effectively keep on top of the responsibilities of the Care Home Regulations 2001 and the National Minimum Standards. The manager informed the inspector that sickness and unauthorised absences were now being monitored and the problems previously experienced were now being managed well. 6 personal staff files were examined and this resulted in evidence that a volunteer had commenced work at the home prior to the provider being in receipt of a satisfactory CRB disclosure check. One new staff member was found to have commenced employment prior to the receipt of a CRB and was missing a photo. Not all staff files contained a copy of the CRB for inspection but did have the CRB number identified. Copies of CRB’s must be available for inspection, as the legislation of the Care Standards Act 2000 and the associate Care Home Regulations 2001, requires this. This does contradict with the guidance given by the criminal records bureau, however Care Homes are subject to the legislation for Care Home provision. All staff files must be available in the home for inspection. Some had to be transported from the Registered Providers head office. The policy in the home for PoVA/CRB checks needs to be updated. The CRB’s for two Directors including the Responsible Individual for the home was provided for inspection and therefore the requirement set at the previous inspection is met. The issue regarding employing staff without the required checks is a serious breach of the legislation. An immediate requirement was made at the inspection that no further employees must commence work until the provider is in receipt of satisfactory CRB/POVA and two satisfactory references. Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 24 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 40,41, 42, 43, The home is well run by an effective manager and acting manager who is to undergo the fit person process to be registered shortly. The staff team clearly have good leadership in providing good outcomes for the residents at Greenwood Lodge. The quality monitoring systems need to be further developed and improved. The registered provider has provided a business and financial plan and regulation 26 visits are now undertaken, however these must be carried out monthly as required by regulation. EVIDENCE: The manager is not yet registered with the Commission for Social Care Inspection, however an application has been submitted. The manager is a Registered Nurse (Learning Disability) and has been in post for approximately 14 months. She has recently completed her Registered Managers Award. There was evidence that the manager and deputy manager were managing the home well despite the registered provider not always being forth coming regarding requests for maintenance and the fact that the Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 25 manager works shifts a swell as undertaking management duties, including being responsible for fire alarm testing and keeping other records. There was evidence of clear leadership of staff, despite staff not being interviewed at this inspection. The manager holds regular staff meetings and good and not so good practice issues are discussed. The Responsible Individual has carried out some Regulation 26 visits but not on a monthly basis as required by the regulation. There had been a quality audit carried out on 10/6/04 but the regulation 26 is the only quality monitoring used since this time. There was a sample template of a resident questionnaire/survey but this had not been implemented. A quality of Life template seen was intended to be used prior to the Provider Regulation 26 visits but had not been implemented. The regulation 26 visit and report should not be the only monitoring tool used and the inspector advises that the manager and the registered provider visit standard 39.3 –39.7 and implement other methods of quality monitoring in conjunction with the Regulation 26 visits. The Inspector felt that the Quality of Life template could be adapted and used by key workers with residents as a tool for this purpose. The policies file was dated and reviewed and available for staff use. Some of the care plans had been taken to a staff member’s home to update, which is not acceptable practice. The manager explained that the staff prioritise resident care needs and sometimes there was not enough time for updating care plans. They were also in the process of changing over the format and structure. The care plans requested were brought back to the home for inspection. Care plans were kept secure otherwise. Other records examined were fire safety records; there were gaps in the weekly fire test records. Pat [Portable appliance testing] certification was seen. Health and safety practices overall was found to be satisfactory regarding training and policies, although as already mentioned infection control policies and procedures and training needs to be developed. There was a gas safety certificate but no evidence of the 5 yearly electrical safety check and this must be provided to the Commission. Generic Risk assessments were seen. There are some identified issues regarding the lack of window restrictors and radiator covers and some areas regarding water safety to address. Evidence must also be provided that the risk of legionella is controlled. A business and financial plan was provided, which was a requirement from the previous inspection. Insurance cover was noted to be satisfactory. Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 26 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 3 x 3 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 4 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 3 2 3 3 2 Standard No 11 12 13 14 15 16 17 x 4 4 4 3 3 3 Standard No 31 32 33 34 35 36 Score 3 2 x 1 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Greenwood Lodge Care Home Score 2 4 2 3 Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 2 2 2 C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 27 No 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 YA18 Regulation Requirement Timescale for action 8th November 2005 8th October 2005 9th October 2005 2. YA20 3. YA23 4. 5. 6. 7. YA24 YA24 YA24 YA27 12, Ensure that staff always use the 13,14, 15, appropriate equipment [wheelchair] for individual residents and that footplates are in place. 12, 13, Ensure medication is stored at 16, the appropriate safe temperature Medicines and records are kept for this on Act adaily basis. Care Make the necessary referral to Standards the Adult Protection Unit and Act Social Services Department Section regarding the identified issue 62, No discussued in the recent staff Secrets, meeting and report the outcome to CSCI. 12, 13 12, 13, Ensure all windows are fitted 16, 23 with restrictors. 23 23 23 Re-decorate the entrance, the hallways and stairs Re-decorate the lounge and dining room Re-decorate all residents bedrooms identified to the manager, prioritising Ms Bedroom. Cover all Radiators C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc 8th November 2005 8th December 2005 8th December 2005 8th Decemebre 2005 8th December 8. YA24 23 Greenwood Lodge Care Home Version 1.40 Page 28 2005 9. 10. 11. 12. 13. 14. YA25 YA24 YA24 YA 24 YA24 YA26 23 23 23 23 23 23 Repair, replaster and refurbish the bathrooms as stated in the report. Replace the lounge carpet Repair and replace the lounge suites/seating Investigate the damp and make good the plaster in the laundry Re-decorate the laundry Ensure residents have hot water no higher than 43 degrees provided to the washbasins[Remove the geysers if these are not to be used]. Ensure the intercom alarm in Ms room is repaired and replaced. Replace the carpet in GHs room 8TH January 2006 8th January 2006 8th January 2006 8th January 2006 8th February 2006 8th November 2005 9th November 2005 8th December 2005 8th January 2006 15. 16. 17. YA26 YA26 YA26 16, 23 16, 23 16, 23 18. 19. YA30 YA30 12, 16, 12, 20. 21. YA30 YA34 12, Replace all broken/damaged furniture in residents rooms, ensure this is of substantial design and quality to meet residents needs. 13, Ensure that all of the freezer casings are thoroughly cleaned 13, 16 Staff must wear protective clothing for tasks undertaken ie, when undertaking personal care and serving food. Ensure sufficient stocks of disposable aprons. 13, 16 Ensure liquid soaps are provided in all bathrooms at all times. New employees must not commence work until a satisfactory PoVA/CRB check and two satisfactiory references has been obtained Copies of full CRB disclosures must be held in the home for 8th October 2005 8th October 2005 7, 9, 19 8th October 2005 8th September 2005 6.30pm 8th October Page 29 22. YA34 7,9,19 Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 inspection 23. 24. 25. 26. 27. 28. 29. YA39 YA41 YA41 YA 42 YA42 YA42 YA42 24 17 17 19 Further develop the Quality Monitoring systems in the home as required by Regulation 24 All records required by regulation must be kept in the home and available for inspection The cook must keep accurate records regarding cleaning schedules. Ensure staff have training in infection control 2005 8th December 2005 8th October 2005 8th October 2005 8th October 2005 8th October 2005 8th October 2005 8th October 2005 8th October 2005 8th October 2005 8th October 2005 8th October 2005 8th October 2005 12, 13, 17 Ensure fire safety tests are carried out weekly 12, 13, 16, 23 16, 23 Provide evidence of a five yearly electrical circuit testing certificate to the CSCI Seek advice from the Environmental Health Officer regarding regulating valves and safe water temperatures Provide evidence that a system is in place to prevent legionella Consult with the EHO regarding the safety of the earthing box in the residents bedroom Consult with the fire authority regarding the Portakabin 30. 31. 32. 33. 34. YA42 YA42 YA42 YA42 YA43 16, 23 16, 23 16, 23 12, 13, 16 Ensure seating, tables and beds are not placed next to radiators. 26 Ensure that regulation 26 visits are carried out and documented monthly 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 Good Practice Recommendations C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 30 Greenwood Lodge Care Home 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Standard YA1 YA1 YA17 YA19 YA20 YA20 YA22 YA24 YA24 YA 26 11. 12. 13. 14. 15. 16. 17. 18. YA26 YA30 YA32 YA32 YA35 YA36 YA39 YA42 Expand on the privacy and dignity statement in the Statement of Purpose. Update the information in the service users guide regarding obtaining and viewing copies of the inspection report. It is good practice for staff to be seated whilst assisting residents with eating. Include relatives or other involved professionals regarding signing agreements for any limitations imposed for residents in care plans, such as for monitor alrams etc. Include medication profiles and update son medication reviews in care plans Ensure all staff including qualified staff have update training in medicines management Formalise a template to be used for recording complaints and which can be used in a ring binder file and include letters and responses. Be innovative regarding upholding privacy of residents in bathrooms if residents cannot use door locks. Replace any locks that do not have thumb turns for exit access. Ensure that all residents have the required furniture and equipment in their bedroom as stated in the standard unless there is a justified reason for this, which should be detailed within the individuals care plan. Rugs are trip hazards and should be risk assessed for safety. If residents are at risk but choose to have these, then a disclaimer should be in place. Improve policies and practice for Infection Control Review the management hours-the manager should work 90 supernumery regarding undertaking responsibilities of registration. Review the handymans hours to ensure that the maintenance and decorating need sof the home are met fully. Provide training for staff in epilepsy and other specific health issues of residents at the home. Staff should have supervision sessions at least 6 times a year. Use the Quality of Life Template with keyworkers and residents and keep copies in residents care plans. Carry out individual fire risk assessments for residents regarding individual needs for evacuation and document this in care plans Greenwood Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 31 Commission for Social Care Inspection Edgeley House Tottle Road Riverside Business Park Nottingham, NG2 1RT 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 Lodge Care Home C03 C53 S26441 Greenwood Lodge V246052 080905 Stage 4.doc Version 1.40 Page 32 - 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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