Inspection on 22/08/06 for Greystones

This inspection was carried out on 22nd August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Greystones 08/02/06

Greystones 27/09/05

Greystones 09/03/05

Greystones 30/09/04

Greystones 04/03/04

Greystones 30/10/03

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

CARE HOMES FOR OLDER PEOPLE Greystones Hayesfield Park Bear Flat Bath Bath & N E Somerset BA2 4QE Lead Inspector Jon Clarke Key Unannounced Inspection 22nd August 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Greystones DS0000008150.V304136.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Greystones DS0000008150.V304136.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greystones Address Hayesfield Park Bear Flat Bath Bath & N E Somerset BA2 4QE 01225 317972 01225 317972 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) BCVS Homes To Be Appointed Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Greystones DS0000008150.V304136.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 26 persons aged 65 years and over requiring personal care only 8th February 2006 Date of last inspection Brief Description of the Service: Greystones is one of three homes owned and managed by Bath Centre for Voluntary Service, a registered charity. The home is an adapted older property located close to the local shops of Bear Flat and the amenities of Bath. It offers accommodation for up to 26 older people with residents rooms located on the ground and first floor with lift access. Seven of the rooms have en-suite facilities. There are very spacious lounges on the ground and first floor, a dining room. There is also a conservatory, which is used as an alternative dining area overlooking the attractive gardens that have ramped access. The main concern of our homes is the residents quality of life. The philosophy of our homes is to look after residents in a caring and sympathetic way, so that their privacy and dignity are respected and to encourage active independence where possible (From BCVS philosophy statement) Greystones DS0000008150.V304136.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place over one day. As part of this inspection a number of documents were looked at including care plans, daily records, training and health & Safety records. There was also an opportunity to talk to residents about the quality of care provided in the home. A number of staff were also spoken with about the care they provide. Pre-Inspection questionnaires were sent to the home and 13/19 residents responded with comments about the care provided in the home. These have been used to inform this inspection. What the service does well: What has improved since the last inspection? What they could do better: Greystones DS0000008150.V304136.R01.S.doc Version 5.2 Page 6 There were two areas identified from this inspection, which need addressing. There was poor practice in making sure accurate records are kept of medication administered to residents of the home placing individuals health at risk. Improvements in the environment of the home would better meet the needs of residents specifically the provision of hearing loop system in lounge area and providing of shower facilitie. 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. Greystones DS0000008150.V304136.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greystones DS0000008150.V304136.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The quality rating in this outcome group is good. This judgement has been made using available evidence including a visit to the service. The home undertakes a comprehensive pre-admission assessment enabling them to make an informed decision about the capacity of the home to meet the individual’s health and social care needs. EVIDENCE: Records were looked at which included the homes assessment and also where the individual is known or has been assessed by a local authority a copy of their assessment is obtained. The home’s assessment is very through and includes dependency profile and health questionnaire. Greystones DS0000008150.V304136.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The quality rating in this outcome group is good. This judgement has been made using available evidence including a visit to the service. There is a good standard of care planning so that staff have the necessary information to meet care needs. Residents health care needs are met through the provision of community based services. The home fails to make sure the health of residents is fully protected through accurate recording of medication required and administered by staff. Residents are treated with respect and rights to privacy are upheld by the home promoting a supportive and caring environment with committed and competent staff. EVIDENCE: A number of care plans were looked at and showed good practice in this area. There was full and detailed information about individual needs including ability with regard to dressing/undressing, mobility, personal hygiene. Reviewing practice is good so care information accurately reflects the situation and needs of the individual. Moving & Handling assessments are completed and regularly reviewed, as were risk assessments where necessary. Monthly Dependency Greystones DS0000008150.V304136.R01.S.doc Version 5.2 Page 10 profiles are undertaken again this provided an measure of the homes capacity associated with resident’s care needs. Arrangements for meeting health needs of residents are good with regular visits to the home by chiropodist and optician. Where necessary residents receive dental treatment. In the event residents need medical treatment on a daily or weekly basis this is provided by the community nurse service. Medication records were looked at and there were significant shortfalls in the recording: in one instance there was no evidence that an individual had received the prescribed medication over a period of a month, in two others prescribed medication (paracetamol) there was no evidence it had been offered/refused by the individuals. In addition the home must record in care plans the circumstances where PRN medication is given and recorded in daily record of care where and why given. Storage arrangements are good with secure storage of all medication. Returns are accurately recorded and signed by the pharmacist or their representative. As far as possible there is flexibility in the routines of the home such as going to bed. One resident stated that she felt there were no restrictions in the home and “could do what I like its up to me”. When asked a number of residents said that they felt their privacy was respected, staff always knocking on rooms and waiting to be invited in and this was observed by the inspector during this inspection. Greystones DS0000008150.V304136.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The quality rating in this outcome group is good. This judgement has been made using available evidence including a visit to the service. Residents of the home are given good opportunities to meet their social, religious and recreational needs and able to maintain contact with family/friends and the local community. The practices of the home help in making sure that residents are able to exercise choice in their daily lives. The dietary needs of residents are met with a balanced and varied menu which meets resident’s tastes and choices. EVIDENCE: Generally residents spoke positively of the leisure activities provided in the home. Staff undertake regular activities such as quizzes, exercise and residents spoke of the “enjoyable outings”. In response to pre-inspection questionnaire (13 respondents) 9 said always activities they can take part in 4 usually. One resident spoke of how the staff “always have time for you” another said that “everyday there is something going on”. Religious services are held in the home. Greystones DS0000008150.V304136.R01.S.doc Version 5.2 Page 12 The home recognises the importance of residents maintaining links with family and friends and visitors are always encouraged. Where able residents use local community resources and staff will accompany residents if this is necessary. Wherever possible residents are encouraged to manage their own financial affairs offering assistance if this is needed. The manager doesn’t have control or manage any resident’s affairs this being undertaken by the individual or their representative. Residents are positively encouraged to choose how they spend their day and there is a “relaxed and friendly atmosphere” in the home. One resident said when asked about the routines of the home and her daily routines “as near as being in your own home as you can get” another “spend my time as I wish don’t feel there are any real restrictions here”. In talking with residents about the menu and food provided in the home there were very positive comments about the variety and choices: “food excellent, always choice and always high standard” “meals are very good and varied” “homemade feeling and taste”. On the day of the inspection the meal was well presented and looked appetising. There was an unhurried atmosphere and staff were available to offer assistance in a sensitive way to those residents who needed it. Greystones DS0000008150.V304136.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The quality rating in this outcome group is good. This judgement has been made using available evidence including a visit to the service. The home has created an environment where individuals are able to express their views and make a complaint and know that action will be taken if this is necessary. The home through its policies and procedures and necessary training makes sure that as far as possible residents are protected from abuse. EVIDENCE: The home has a complaints procedure of which residents when asked were aware of and how they could make their views or any dissatisfaction known “I would always speak to member of staff and they would do something” was a typical comment made by residents. “I wouldn’t hesitate to say if I was unhappy about something” “never had reason to complain” “staff listen to what you have to say”. No complaints have been made since the last inspection though there was a record of dissatisfaction regarding issues such as food and these had all been addressed. The home has a vulnerable adults policy, which sets out the practice in the event allegations of abuse are made. Staff have completed BANES Vulnerable Adults training. When asked residents said they felt safe in the home that staff always treated them appropriately. Greystones DS0000008150.V304136.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The quality rating in this outcome group is good. This judgement has been made using available evidence including a visit to the service. The home is clean and hygienic and offers a homely and well-maintained environment. Improvements could be made to the environment of the home to give greater choice to residents and address individual care needs and give greater opportunities for those with hearing impairment to fully participate in the activities and life of the home. EVIDENCE: There are good arrangements for maintaining a hygienic and clean environment and at the time of this inspection the home was clean and free from offensive odours. A number of residents said that the home “is always nice and clean” All respondents to the pre-inspection questionnaire said the home is “always” fresh and clean. Improvements have been made to the décor of the home since the previous inspection and this has maintained the good standard of decoration in the Greystones DS0000008150.V304136.R01.S.doc Version 5.2 Page 15 home. The inspector was advised that further decoration is planned in areas of the home. There are no showering facilities available in the home and this was commented on by two residents. This has been discussed previously with the home either the provision of disabled level access showers or over bath showers could be made available to residents who are able to use such facilities independently or with assistance. There is no hearing loop system available in the communal areas of the home particularly where activities are held and again difficulties in participating in activities because of hearing impairment was commented on by a resident. Greystones DS0000008150.V304136.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,30 The quality rating in this outcome group is good. This judgement has been made using available evidence including a visit to the service. The staffing arrangements in the home ensure that there are sufficient staff on duty to meet the care needs of residents. The necessary training is provided so that staff are competent and skilled in provided the care required to residents of the home. EVIDENCE: Staffing rotas were looked at and sowed that adequate staff are available to meet the care needs of residents: 3 am, 2 pm, evening (6-9pm) 2 and 2 night waking staff. In additional there is senior on duty. When asked about the availability of staff one resident said that “staff very caring, respond well when I need any help” and another “they give you time” “always patient”. Training records for all nigh shift members of staff were seen and showed that all had completed the mandatory areas of training: Fire, POVA, Moving and Handling and First Aid. Other areas of training offered to staff included Confusion and Dementia, Infection Control, Palliative Care and Understanding Depression in the Elderly! Greystones DS0000008150.V304136.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,38 The quality rating in this outcome group is good. This judgement has been made using available evidence including a visit to the service. The management and staff of the home make every effort to make sure the home is run in the best interests of residents and opportunities are provided for residents to comment on the quality of the service they receive. The practices of the home with regard to health & safety are good and protect residents and staff as far possible. EVIDENCE: Residents are very much encouraged to express their views and regular Residents Meetings are held. These provide an opportunity for residents to comment on the care they receive and make suggestion. Residents have raised issues such as alarms whilst in the garden and repairing of pond and these are Greystones DS0000008150.V304136.R01.S.doc Version 5.2 Page 18 being addressed. Questionnaires have also been issued to residents and relatives asking for their views. The inspector was unable to see the responses but a summary is to be provided to the CSCI. Heath & safety records were seen and showed that the required checks of fire systems are made including weekly fire alarm tests and monthly emergency lighting tests. There are yearly fire system and equipment servicing and also servicing of other equipment such as hoists. Gas Safety certificate issued 15/03/06. Accident records were seen and these were completed correctly. Greystones DS0000008150.V304136.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X 3 Greystones DS0000008150.V304136.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 12 (1a) 13 (2) 17 (1a) Schedule 3 (3i) 12 (1a) Requirement Ensure where medication is prescribed full and accurate administering records are kept to promote and make proper provision for the health and welfare of residents. Ensure record made and guidance given when prescribing PRN medication. Record to be kept of circumstance when given to individual. Provide at appropriate places sufficient showers. Ensure there is appropriate equipment particularly in communal areas available to residents who have hearing impairment. Timescale for action 22/08/06 2. OP9 22/08/06 3 4 OP19 OP9 23 (2j) 12 (4b) 30/12/06 30/12/06 Greystones DS0000008150.V304136.R01.S.doc Version 5.2 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Greystones DS0000008150.V304136.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Greystones DS0000008150.V304136.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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