CARE HOME ADULTS 18-65
Greystone House 319 Blackwell Road Carlisle Cumbria CA2 4RS Lead Inspector
Liz Kelley Unannounced Inspection 01:00 13 March 2006
th Greystone House DS0000022656.V262705.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Greystone House DS0000022656.V262705.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Greystone House DS0000022656.V262705.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Greystone House Address 319 Blackwell Road Carlisle Cumbria CA2 4RS 01228 536349 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) Mr John Sibbald Ruddick Mrs Susan Ruddick Mr John Sibbald Ruddick Care Home 24 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (24), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (24) Greystone House DS0000022656.V262705.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Registered for 24 people with a mental disorder (MD) some of whom may be over 65 years of age (MD(E)) Two service users may only share the double room if both have made a positive choice to do so. 2nd September 2005 Date of last inspection Brief Description of the Service: Greystone House is a large Victorian, two storey detached property on the outskirts of Carlisle city. It has been modernised and converted for its present use, including three purpose built extensions to the side and rear of the original building. Greystone House is home to twenty-four people who have difficulties maintaining aspects of their mental health. Two carers, a senior and the manager staff a normal shift, with two waking staff on duty at night. The Home has three lounges situated on the ground floor, one of which is a designated smoking lounge, there are also two dining areas. One of the three bathrooms is equipped with a hoist to safely assist people with physical needs. There are twenty-two single bedrooms and one twin bedded room. Fourteen of the single rooms have en-suite facilities. The Home has a central laundry and kitchen. Both laundry services and meals are provided to service users. There is a six-person passenger lift to the first floor. The Home has a private garden to the front and a smaller garden/patio area to the rear. The Home is well placed for local facilities including shops, post office and church. There is a regular bus service to the city that stops adjacent to the Home and Hammonds Pond Park is only a short walk. Greystone House DS0000022656.V262705.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second inspection of the inspection year and the majority of the important standards were covered at the inspection on the 2nd September 2005. The majority of the inspection time was spent talking to residents and their relatives about their experiences of living at Greystone House. The manager and trainee manager were also interviewed and paperwork was examined. A tour of the building was carried out. As part of the last inspection feedback cards were sent out to residents, relatives and professionals. What the service does well: What has improved since the last inspection? What they could do better:
To further strengthen the fire safety in the Home, a Fire Evacuation Plan should be drawn-up which identifies quickly and easily what staff must do in such an emergency and a plan of the home with the location of residents. Additional training should be provided to further improve the care of medications in the Home, and training on Adult Protection issues to ensure that staff have the latest knowledge to safeguard residents well being.
Greystone House DS0000022656.V262705.R01.S.doc Version 5.0 Page 6 The changes to medication procedures, on the advice of the Pharmacy Inspector, has only been in place for a few weeks and this will be looked at again on the next inspection to see that this is being followed. Areas outside of the smoking lounge smell of cigarette smoke, as a large number of residents smoke. A heavy duty extractor needs to be fitted in the smoking lounge to improve the atmosphere for other residents. 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. Greystone House DS0000022656.V262705.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greystone House DS0000022656.V262705.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were assessed and met at the last inspection. EVIDENCE: Greystone House DS0000022656.V262705.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 The staff team are skilled at supporting resident’s personal development and in encouraging informed decision-making. EVIDENCE: Residents are treated very much as individuals and their rights and needs respected and addressed. Any restrictions to individuals rights to ensure wellbeing or safety of the Home and the individual were appropriately consulted upon and consent given by the individual. This was done by using risk assessments including details of restrictions imposed on residents for example limiting cigarettes and alcohol, and these had been agreed by the resident, appropriate relatives and at review meetings with mental health professionals. New style Care Plans and risk assessments are clearer and more targeted ensuring that needs were monitored and being met. The resident plays a central role in reviewing their care plan and assessing their own mental health needs Greystone House DS0000022656.V262705.R01.S.doc Version 5.0 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The home had developed a good balance between risk-taking and a duty of care, and much of the dialogue with residents is around rights, choices and outcomes of these. EVIDENCE: Residents were supported to maintain and develop relationships with the community and were in contact with relevant professionals, such as community psychiatric nurses, to assist in developing their social skills. Residents were observed interacting in a positive manner with staff and other residents. There was lively conversation and an interest in the welfare of others in the home. Residents have a good understanding of their own mental health needs and this is discussed openly with staff and the manager. Greystone House DS0000022656.V262705.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 and 21 The handling of medication has improved in the home, with the manager reviewing many of the practices to ensure that residents medications are handled safely and competently by staff. EVIDENCE: Since the last inspection a Pharmacy Inspection visit was carried out by the Pharmacy Inspector for Commission for Social Care Inspection. This resulted in a major review of all areas of medication handling, storage, administration and dispensing. The recommendations of this report were discussed with the manager, and many of these new procedures and practices had only recently been put in place. Therefore medications will be a focus for the next inspection. The manager was recommended to find a training course for staff on the care of medicines. Staff have a good understanding of the needs of elderly residents and have been involved with nursing teams in the care of terminally ill people. The manager is also seeking specific train for staff on this area. Greystone House DS0000022656.V262705.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The home has a satisfactory complaints system with residents being able to express their views on the home, and these being acted upon. The home has good systems in place to protect the rights and well-being of residents. EVIDENCE: Residents were observed freely expressing opinions on the home to staff. Residents said that they would feel able to speak to any of the staff and approach the manager with any issues they had. Residents said that they had been given a brochure with ways to make a complaint. Those residents spoken to said they would approach the manager with any issues and felt confident that any concerns would be resolved. The Home has induction training that covers adult protection issues and the various forms of adult abuse. Staff also have a good knowledge of mental health and the various strategies to support residents. The home has established working relationships with Community psychiatric nurses, psychiatrist and mental health social workers and frequently make referrals and seek advice on residents being supported at the home. The manager and staff were not as familiar with the latest Multi-disciplinary guidance and a recommendation was made to attend an up-to-date course on Adult Protection. Greystone House DS0000022656.V262705.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 The care staff and cleaners ensure that the home has good standards of cleanliness and is kept tidy. However areas outside of the smoking lounge smell of cigarette smoke. EVIDENCE: The smoking room is well used by a large number of residents and unfortunately the smell of smoke is not just confined to this room, and the manager needs to address this. This has been commented upon at a previous inspection whereby one resident had requested a move of bedroom due to this problem. A heavy duty, not general domestic, extractor needs to be fitted in the smoking lounge. However overall the home is kept clean and tidy, and the manager has introduced effective cleaning rotas for both care staff, night staff and domestics. Greystone House DS0000022656.V262705.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 The home has developed a comprehensive training course and allocated resources to ensure that staff are equipped to deal with the care of residents. EVIDENCE: Training for the Home, along with staff supervision has been given a priority to assist in a move towards meeting this Standard. The trainee manager had been given responsibility to develop supervision and staff training. This had included developing an Induction Pack and individual training plans for each person. These were in good detail and six staff were qualified to NVQ 2 in care. Other recent training had been First aid, Diabetic awareness, and short courses on mental health and dementia awareness. A Community Psychiatric Nurse had commented “The staff attend relevant course, at the local mental health clinic, where they learn to deal with behaviours and get an insight into mental health diagnosis i.e. schizophrenia, depression, anxiety and dementia. The manager has drawn-up a training profile for the home which sets out future training and the benefits expected for residents living in the Home. The manager is also undertaking the Registered mangers Award, and attends other training course relevant to the efficient running of the home, for example she had recently completed a Fire Wardens course. Greystone House DS0000022656.V262705.R01.S.doc Version 5.0 Page 15 Staffing has been reviewed and weekend staff have been strengthen to increase the number of seniors in the Home. Greystone House DS0000022656.V262705.R01.S.doc Version 5.0 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were assessed and met at the last inspection. EVIDENCE: Greystone House DS0000022656.V262705.R01.S.doc Version 5.0 Page 17 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 X X X X X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 X X X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X 2 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X X X X 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Greystone House Score X X 2 3 Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000022656.V262705.R01.S.doc Version 5.0 Page 18 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2 3 Standard YA20 YA42 YA30 Regulation 13 23 23 Requirement Staff must have training in Adult Abuse and Protection An Evacuation Plan must be produced for the home in the event of a fire An adequate extractor must be installed in the smoking lounge Timescale for action 30/06/06 14/04/06 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA20 Good Practice Recommendations Staff should receive training in the safe handling of medications Greystone House DS0000022656.V262705.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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