Care Home: Greathouse Home - Leonard Cheshire Disability

What the care home does well The people admitted to the home have a comprehensive assessment by qualified staff to help ensure that their needs can be met and that they make a good choice from the information available. A relatives survey told us; `the home is welcoming and friendly at all times and all the staff appear to be confident and caring`. The individual service plans are well recorded and identified people`s personal needs and had good action plans to meet their needs and support them. People can make choices in their daily lives and influence what happens in the home. Regular meetings are held to help ensure peoples voices are heard, andthe two newly elected service users representatives are helping to ensure everyone`s views are known. People are protected by the home`s medication policies and procedures, the staff are well trained and the frequent recorded audits help to ensure standards are maintained. The manager takes complaints seriously and investigates them well to help resolve the issues, and people living in the home feel confident that their voices are heard and they can influence change. Comments in the surveys from people living in the home told us; `The manager and care supervisor are very easy to talk to and always try to solve problems for us`, `the care supervisor and manager are very helpful and supportive` and `most staff are very good` (they usually listen and act on what I say). Procedures and practices in the home help protect people from abuse. Staff are well trained to recognise abuse and act on information by always involving multi-agencies to investigate safeguarding issues. The staff we spoke to were clear about what they would do to protect people living in the home. The home is well managed by a qualified, competent and experienced registered manager and care supervisor, so that people in the home are safe and well cared for. The quality assurance procedures have developed, and regular meetings with staff and people living in the home, which helps to ensure that their views are taken seriously and action is taken. What has improved since the last inspection? The new planned menus provide a variety of food, which includes a daily vegetarian dish. Surveys from people living in the home stated that; `The food now is usually very good, `I am happy here the food has really improved`, `I am reasonably happy with the food`, `I think the new menus are really good, there is much more choice and the food is good`, and `the food has improved recently it is cooked and served properly its better than it was`. There is good evidence from the improved records and the detailed Individual Service Plans that peoples healthcare needs are well met and that the staff have the skills to ensure that healthcare professionals provide effective support. The environment has improved considerably and people living in the home have good quality accommodation. Further improvements are planned to help ensure that needs are continually met and people feel valued. Sixteen bedrooms have been decorated in 2007/2008, some have also had new furniture, curtains and flooring.Thirteen communal areas have been refurbished in 2007/2008, this has included new light fittings, flooring, furniture, curtains and artwork to decorate the walls. The new therapy room was almost finished and looked inviting and calm, it will be used for hairdressing, chiropody, and complimentary therapies such as massage and reflexology. The lounge on the first floor has a new large screen television where people can watch films and there is also a Wii, which is a computerised game simulator where people can play games such as bowling. The home provides wire free access to Internet facilities for all people in their own rooms to promote communication via e-mail to friends and family People living in the home told us they liked the improved environment and the new coffee bar, and were looking forward to the new Juice Bar opening next week where they were hoping to get a licence to sell some alcohol. The new coffee bar is a great success providing lots of different varieties of coffee, and people like to gather there in the evenings. Two people told us that they would like the coffee bar to be open more often. The surveys returned to us said `the new decoration has made a big difference`, `the home is much nicer since Joyce (manager) got the decorating done and the new furniture, when the corridor is finished it will be much nicer.` The bathing facilities have improved and the new shower wet room is being used and new changing tables have been provided. The home publishes a quarterly Greathouse News, which has photographs and reports written by people living in the home. The I T co-ordinators hours have been increased to cover one evening a week. The staff have had increased training opportunities in various subjects by outside agencies to include supporting people with personal relationships and managing challenging behaviours. People living in the home have been trained to be involved in the staff recruitment and selection process. The AQAA staff dataset told us told us that six staff are working towards the NVQ level 3 in care award. CARE HOME ADULTS 18-65 Greathouse Cheshire Home Kington Langley Chippenham Wiltshire SN15 5NA Lead Inspector Mrs Kate Silvey Key Unannounced Inspection 2nd September 2008 10:00 Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greathouse Cheshire Home Address Kington Langley Chippenham Wiltshire SN15 5NA 01249 750235 01249 758826 tim.storer@LCDisability.org www.LCDisability.org Leonard Cheshire Disability 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) Mrs Joyce Margaret Amor Care Home 25 Category(ies) of Physical disability (25), Physical disability over registration, with number 65 years of age (25) of places Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users who may be accommodated in the home at any one time is 25. The maximum number of service users in receipt of nursing care who may be accommodated in the home at any one time is 21. The maximum number of service users in receipt of personal care who may be accommodated in the home at any one time is 6. 3rd September 2007 Date of last inspection Brief Description of the Service: Greathouse provides accommodation and care with nursing for up to 25 adults with physical impairments. The homes care planning and review systems show whether an individual is receiving nursing or personal care. One room is used for short-term care. Some people attend for day care. The service is operated by the Leonard Cheshire Disability, a voluntary organisation. Greathouse is in Kington Langley, on the outskirts of Chippenham, which offers a range of amenities. The village is also close to major road and rail links. The building has been used as a care home for around 50 years. A significant ground floor extension was added in the 1970s. There is a large garden with views over neighbouring countryside. Parking is available for visitors. A lift provides access between the ground and first floors. The entire bedrooms are for single use. There are four bathrooms for general use and a number of additional toilets. The home has a range of equipment and adaptations, designed to suit the needs of the people living in the home. Fees charged for care and accommodation vary, depending on the assessed needs of an individual service user. Information about the service is available on request and is also displayed in a number of locations around the home. A copy of the most recent CSCI inspection report is kept in the entrance hallway. Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. One inspector completed this unannounced key inspection over two days. Twentyone people were accommodated and most were seen and spoken to. Six people had a conversation with the inspector in their own rooms. We spoke to people in the communal rooms and two relatives who were visiting the home. There was direct contact with the home’s registered manager, the care supervisor, three members of the nursing/care staff, the Information Technology (IT) activity trainer and the chef. We also spoke to the activities co-ordinator and an advocate for a person living in the home A number of records were looked at including care plans, risk assessments, health and medication records. The care records of three people accommodated were looked at, two of them in more detail. The environment was inspected and staff were observed engaging with people living in the home. Surveys were returned to us from one relative, eight staff and fourteen people living in the home. The registered manager had completed the Commissions’ Annual Quality Assurance Assessment, this is an annual self-assessment about the home and is a legal requirement. What the service does well: The people admitted to the home have a comprehensive assessment by qualified staff to help ensure that their needs can be met and that they make a good choice from the information available. A relatives survey told us; ‘the home is welcoming and friendly at all times and all the staff appear to be confident and caring’. The individual service plans are well recorded and identified people’s personal needs and had good action plans to meet their needs and support them. People can make choices in their daily lives and influence what happens in the home. Regular meetings are held to help ensure peoples voices are heard, and Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 6 the two newly elected service users representatives are helping to ensure everyone’s views are known. People are protected by the home’s medication policies and procedures, the staff are well trained and the frequent recorded audits help to ensure standards are maintained. The manager takes complaints seriously and investigates them well to help resolve the issues, and people living in the home feel confident that their voices are heard and they can influence change. Comments in the surveys from people living in the home told us; ‘The manager and care supervisor are very easy to talk to and always try to solve problems for us’, ’the care supervisor and manager are very helpful and supportive’ and ‘most staff are very good’ (they usually listen and act on what I say). Procedures and practices in the home help protect people from abuse. Staff are well trained to recognise abuse and act on information by always involving multi-agencies to investigate safeguarding issues. The staff we spoke to were clear about what they would do to protect people living in the home. The home is well managed by a qualified, competent and experienced registered manager and care supervisor, so that people in the home are safe and well cared for. The quality assurance procedures have developed, and regular meetings with staff and people living in the home, which helps to ensure that their views are taken seriously and action is taken. What has improved since the last inspection? The new planned menus provide a variety of food, which includes a daily vegetarian dish. Surveys from people living in the home stated that; ‘The food now is usually very good, ‘I am happy here the food has really improved’, ‘I am reasonably happy with the food’, ‘I think the new menus are really good, there is much more choice and the food is good’, and ‘the food has improved recently it is cooked and served properly its better than it was’. There is good evidence from the improved records and the detailed Individual Service Plans that peoples healthcare needs are well met and that the staff have the skills to ensure that healthcare professionals provide effective support. The environment has improved considerably and people living in the home have good quality accommodation. Further improvements are planned to help ensure that needs are continually met and people feel valued. Sixteen bedrooms have been decorated in 2007/2008, some have also had new furniture, curtains and flooring. Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 7 Thirteen communal areas have been refurbished in 2007/2008, this has included new light fittings, flooring, furniture, curtains and artwork to decorate the walls. The new therapy room was almost finished and looked inviting and calm, it will be used for hairdressing, chiropody, and complimentary therapies such as massage and reflexology. The lounge on the first floor has a new large screen television where people can watch films and there is also a Wii, which is a computerised game simulator where people can play games such as bowling. The home provides wire free access to Internet facilities for all people in their own rooms to promote communication via e-mail to friends and family People living in the home told us they liked the improved environment and the new coffee bar, and were looking forward to the new Juice Bar opening next week where they were hoping to get a licence to sell some alcohol. The new coffee bar is a great success providing lots of different varieties of coffee, and people like to gather there in the evenings. Two people told us that they would like the coffee bar to be open more often. The surveys returned to us said ‘the new decoration has made a big difference’, ‘the home is much nicer since Joyce (manager) got the decorating done and the new furniture, when the corridor is finished it will be much nicer.’ The bathing facilities have improved and the new shower wet room is being used and new changing tables have been provided. The home publishes a quarterly Greathouse News, which has photographs and reports written by people living in the home. The I T co-ordinators hours have been increased to cover one evening a week. The staff have had increased training opportunities in various subjects by outside agencies to include supporting people with personal relationships and managing challenging behaviours. People living in the home have been trained to be involved in the staff recruitment and selection process. The AQAA staff dataset told us told us that six staff are working towards the NVQ level 3 in care award. What they could do better: Daily goals are recorded in agreement with people, however, long term goals need more input to help people reach their full potential Improvements have been made with more trips out but there should be an increased choice of activities and more planned personal goals to include the evenings, weekends, college courses and assisting some people with a work programme. The record of activities was incomplete in the personal plans seen, which may mean additional activities were not provided when required. People living in the home told us; ‘I would like more to do on Saturday and Sundays and go out more’, and ‘it would be nice to go out more at the weekend, care staff try to do activities at Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 8 weekends to stop us getting bored, but we need more trips out, the days are very long’. A member of staff also told us that people need more trips out and the home needs more staff that are able to drive the mini bus. The Greathouse News told us about some trips; two people living in the home went with two support workers to Wimbledon where they watched the men’s quarter finals this year, a visit to St Paul’s Cathedral, London for many people, and two people went to a Westlife concert at the Millennium Stadium in Cardiff. The staff told us that sometimes mealtimes required additional staff to assist people, and the manager hoped to resolve this when the volunteers arrived that day. There should be sufficient staff to assist people at all times. People were mainly concerned about the cleanliness of rooms and felt more domestic staff were needed. There was evidence that the home was not clean but as refurbishment work was in progress, with the fitting of new doors and flooring, it was difficult to assess. To promote infection control the standard of cleanliness should be higher. The surveys returned to us said; ‘Cleanliness of the rooms needs to be better with more frequent cleaning’, ‘really need more cleaners’, and ‘need more cleaners. Five people told us that the home is clean ‘sometimes’, seven told us ‘usually’ clean, and three said ‘always’ clean. The manager told us the home is currently in the process of recruiting an additional domestic cleaner. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The information recorded prior to admission is very detailed and identifies what peoples needs are to help them lead a fulfilling life. Experiences reflect that the assessments completed and the information provided lead to a good admission process for people. EVIDENCE: We looked at the pre-admission records of two people recently admitted to the home and spoke to them. The records were very detailed and included all the required information and social history. One person visited the home with relatives and decided what colour they wanted their room painted, another came for respite care before they decided. One person told us in their survey that they spent a week in this home and another before they decided to come. The care manager had visited one person in hospital and there were clear health records, which included medication. An inventory of belongings had been recorded on admission to the home and a keyworker was identified who would help ensure they had everything they needed and to help them plan their care. One person admitted said there was ‘loads’ of information in the Service User Guide and that the admission process was ‘very good’. They also told us the Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 11 staff were very good and the Information Technology room was ‘good’. They said the food could be better but if they had any problems they would feel able to speak to the registered manager. They also told us they would like to go out more, but there was a trip to Exmouth next week and an outing on a barge had been arranged. The other person spoken to said they would like to go out shopping more often. This person had a food allergy, which they said was well catered for by the chef. Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Individual Service Plans are well recorded and identified people’s personal needs and had good action plans to meet their needs and support them. People can make choices in their daily lives and influence what happens in the home. Some people have opportunities to lead a more independent lifestyle, but this could be improved upon to help ensure more people achieve long term goals. EVIDENCE: The Individual Service Plans seen were in new indexed sub-divided folders with an additional record to inform the staff when reviews were due and other important changes at a quick glance. The ISP divisions included social activities, manual handling assessments, risk assessments including a falls risk, healthcare professional involvement, personal care, nutritional assessment, tissue viability, pressure risk assessment, nursing care assessment, continence care, night care, and a support mobility plan including any special equipment required. Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 13 Individual care plans were recorded for specific problems, for example; physical, mental or social problems. There are personal profiles, which people living in the home help staff to complete, about their preferences and things that are important to them. Regular recorded reviews were seen as good as each plan of action was reviewed, this indicated to us that plans were updated when required to help ensure that all care needs were completed well and people were supported. The daily records seen were well recorded and peoples care needs were recorded, however, what they had been doing all day was not apparent, as activities were not well recorded. Trips out had been recorded, and people told us they had been out. The Greathouse News included good descriptions of trips completed by people living in the home. Daily goals are recorded in agreement with people, however, long term goals need more input to help people reach their full potential. An example of how people are being helped to improve independence is that the home is teaching some people about money and how to identify it and use it on their own. People are able to make decisions about their day to day living and routines are flexible, for example people can have breakfast when they like. Regular meetings are held to help ensure peoples voices are heard and the two newly elected service users representatives are helping to ensure everyone’s views are known. The people living in the home told us ‘ if I don’t like the food I can have an alternative’, ‘ it would be nice to go out more at weekends’, ‘my goal is to go to college’, and ‘ I go on holidays with DISAWAY, which is for people with disabilities and organised separately to the home where I meet other friends’. At a recent meeting people living in the home were asked how the Service User Guide could be more easily accessible for people in different formats. The IT trainer was helping people to explore different mediums, for example a DVD guide where photos and a slide show could be incorporated, and an audio tour for people with visual impairments. We looked at the minutes of the meeting where everyone’s input was recorded. We also looked at the latest minutes of the Food Steering Group meeting where people living in the home looked at the new menus started in July 2008. The menu’s were discussed in detail, including the contents of each meal, and many good points were recorded and possible changes that will help to ensure people do have what they enjoy eating and can alter the menus regularly to meet changing views. An example was that crumpets and hot dogs were a welcome addition to the supper menu. Another meeting was arranged to discuss the final two weeks of the planned menus. Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12, 13, 14, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have their dietary needs met and are able to influence what food is provided. There are plans to introduce a new nutritional assessment tool, which will help identify people at risk more easily. Improvements have been made with more trips out but there should be an increased choice of activities and more planned personal goals to include the evenings, weekends, college courses and assisting some people with a work programme. The record of activities was incomplete in the personal plans seen, which may mean additional activities were not provided when required. EVIDENCE: We looked at the week’s activity plan, which included a quiz, art group, painting, cooking, shopping and word games. The manager told us last week was busier and that the following evening Morris dancers were coming to the home. Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 15 We visited the activity room and spoke to people taking part in a word quiz and, news and views were being read out of the newspaper for people to hear about current affairs and discuss them, should they want to. There were three activity staff and two young volunteers were due to arrive from Germany on the second day of the inspection. They are a regular addition to the staff as two volunteers had just returned to Germany and were a great success with the people living in the home. We spoke to the activity co-ordinator who told us that people can do what they want, however, there was no specific budget but the Trust usually provides everything that is asked for. One person living in the home said they were planning to go to Hobbycraft to buy more craft items, and would be meeting the activities coordinator to decide what items to purchase as they felt they should be ‘doing more things’. The activities co-ordinator also manages the day care clients and helps to bathe them when required. We were told that generic risk assessments are completed for activities, these should include specific needs where required, particularly when going out where people may be more at risk. The co-ordinator told us that there had been two boat trips, the theatre, pantomime, and pub lunches arranged and enjoyed. There is usually ten pin bowling and the cinema twice a month, and trips to the safari park at Longleat, the Zoo and Stonehenge had been achieved this year. We looked at photographs of the outings in the home and in the newsletters, for example; two people living in the home went with two support workers to Wimbledon where they watched the men’s quarter finals this year, a visit to St Paul’s Cathedral, London for many people, and two people went to a Westlife concert at the Millennium Stadium in Cardiff. The home has a large activity kitchen with a dining area where people make birthday lunches and invite a friend. They have also made bread, biscuits and cakes in the kitchen. We looked at the IT unit, which was being used and we spoke to the trainer there. The room is pleasantly decorated and people like the support they get to learn new skills on the computer and use the web camcorder. The IT trainer has increased her hours to include one evening each week. The lounge on the first floor has a new large screen television where people can watch films and there is also a Wii, which is a computerised game simulator where people can play games such as bowling. The Trust has a new Volunteer Co-ordinator helping to plan outings and raise funds. The home utilises volunteer support to promote integration within the local community and provide individual support for specific goal setting. There are plans to visit Sandringham and Disneyland and the manager has found a company who will do abseiling activity holidays for people with disabilities. Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 16 The home provides wire free access to Internet facilities for all people in their own rooms to promote communication via e-mail to friends and family. There are plans to redecorate the activity room and the sensory room to make them more inviting. The home is planning new visitors accommodation where it is hoped friends and relatives visiting people living in the home can ‘stay over’ and enjoy their company for longer. There are plans for people to have more contact with the community by taking part in more events locally, and assisting some people to have access to a work programme. There are laundry facilities for people living in the home to help them become more independent. The new coffee bar is a great success providing lots of different varieties of coffee, and people like to gather there in the evenings. Two people told us that they would like the coffee bar to be open more often. People living in the home told us; ‘I would like more to do on Saturday and Sundays and go out more’, and ‘it would be nice to go out more at the weekend, care staff try to do activities at weekends to stop us getting bored, but we need more trips out, the days are very long’. A member of staff also told us that people need more trips out and the home needs more staff that are able to drive the mini bus. A person living in the home told us that they were entertaining everyone at the weekend in the coffee bar with a duo called ‘The Mighty Maybe Morons’. Families visit the home and the inspector spoke to three that regularly visit. One person living in the home is engaged, his fiancée regularly visits and they plan to live independently as soon as they can. Advocates are used when people need additional help or representation to make decisions or have concerns about their care needs. We spoke to an advocate who had helped a person living in the home make a complaint about certain aspects of their care, which the manager had dealt with. The planned menus provide a variety of food, which includes a daily vegetarian dish. Lunch was observed, there had been concerns about the need for more staff support at meal times, three staff were seen supporting people well with their lunch, which was unhurried. However, additional staff would have prevented people waiting to be fed as at least one person had to wait. The manager told us that the volunteers due to arrive that day would be helping at meal times. People told us that they choose their meals the day before and that there was enough choice. The roast lamb meal looked appetising, it was followed by apple pie and custard. Special diets are catered for, which include, vegetarian, gluten free, diabetic and soft diets. Surveys from people living in the home stated that; ‘The food now is usually very good,‘ I am happy here the food has really improved’, ‘ I am reasonably happy with the food’, ‘I think the new menus are Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 17 really good, there is much more choice and the food is good’, and ‘the food has improved recently it is cooked and served properly its better than it was’. We looked at the kitchen and spoke to the staff there, it was clean apart from the floor, which may need replacing. All kitchen staff are trained in food hygiene and one assistant had just started a catering course at a local college. Fresh fruit and vegetables were available and used daily, and the chef was waiting for the delivery of an additional milk refrigerator. The Environmental Health Officer visited the kitchens in February 2007 and the manager told us that the home had met any requirements. Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19. & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is good evidence that peoples healthcare needs are well met and that the staff have the skills to ensure that healthcare professionals provide effective support. People are protected by the home’s medication policies and procedures, the staff are well trained and the frequent recorded audits help to ensure standards are maintained. EVIDENCE: Since the last inspection the manager has introduced a record sheet for all doctors visits to help ensure continuity of care and to inform all staff about changes to healthcare needs. We recommended this record incorporates all healthcare professionals that support people, for example; dieticians, occupational therapists, community psychiatric nurses, speech and language therapists and tissue viability nurses. There is also a new record for discussion with relatives about healthcare needs that people living in the home agree to. Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 19 A new Urgent Care Line has recently been provided for any nursing home requiring an immediate response from the doctor. We were informed that it works well as the line was used for someone having a seizure. We looked at a protocol for seizures, which was well written. We looked at how the nursing staff manage wound care and spoke to the care supervisor about practices. The wound care records include a body map and after each dressing the wound is described and the size calculated. The wound care support plans were well recorded and the tissue viability nurse also records her finding and advice there. We looked at photographs of a wound, which included a measure for size comparison and the date. Acute wounds are photographed weekly and chronic stable wounds every six months. Wound care reviews were well recorded. The personal support plan dictated by the person receiving support was well recorded and identified how many staff were required to complete care correctly. There were some good records regarding continence care and nursing staff are well trained to complete catheter changes when required. Individual risk assessment forms are completed as required, and some good written actions were seen. We looked in the homes physiotherapy room and spoke to the physiotherapist working there and two people using the equipment. We saw peoples Support Mobility Plan that the physiotherapist completes to ensure that everyone has the correct therapy delivered regularly to promote mobility while enabling people to maintain or improve independence. The people receiving treatment said they had progressed well and liked using the equipment and felt well supported. This is a good service, the physiotherapist has an assistant and ensures that people also have individual sessions in their own rooms when required. The physiotherapy room was a little cluttered and would benefit from a bit more space for equipment. Some people also go swimming locally, which helps with their mobility. It was clear from the Individual Service Plans (ISP) seen that people’s healthcare needs were being met with regard to the dentist, optician, etc. and there was evidence that one person had been referred to CRUSE Bereavement Care after a family bereavement. Any additional nursing requirements are also documented in the ISP’s. We looked at the medication storage and records in the office and observed a medication administration round near lunchtime. The home uses a monitored dosage method of administration and a spot check audit by us was correct. The medication policy was in place, which included a homely remedy policy for any medication given but not prescribed. The Nursing and Midwifery Councils guidance for medication administration was also available for the nurses to refer to. Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 20 We recommended that a copy of the Royal Pharmaceutical Society’s guidance should also be obtained for reference. The home had a new British National Formulary that they use as a reference. There were protocols for any ‘as required’ medication, but one for the use of an inhaler should be more specific. All the ‘as required’ medication was stored together as a safety precaution to avoid misuse. The administration records were well recorded, which included any drug allergies known. The record for the return of medication to the pharmacist was clear. Controlled drugs were correct and well recorded. Medication with a narrow therapeutic index were well managed to ensure that blood tests revealed the correct beneficial dosage to avoid toxicity, for example Warfarin. We checked a Warfarin administration record, which was clear and well recorded. We looked at the regular audit completed by the care supervisor, a drug error had been recorded and the homes drug error form had been completed and the doctor informed, there were no adverse effects. Leonard Cheshire Disability also completes an audit, which was recorded as ‘good’. We saw the nurses Advanced Training Record for medication administration completed by all the nurses this year. The nurses instigate medication reviews to the doctors, and the supplying pharmacist will complete individual reviews as required. The home plans to encourage people to self-medicate and enable them to become more independent. Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager takes complaints seriously and investigates them well to help resolve the issues, and people living in the home feel confident that their voices are heard and they can influence change. Procedures and practices in the home help protect people from abuse. Staff are well trained to recognise abuse and act on information by always involving multi-agencies to investigate safeguarding issues. EVIDENCE: We looked at the homes service user friendly complaints procedure, a timescale should be added to the procedure in line with the regulations, that a reply must be received within 28 days of receipt. ‘Have your say’ leaflets are also available in the home about how to complain. The AQAA told us the home had received six complaints in the last twelve months and 85 had been resolved within 28 days. Five had been upheld and one was still being investigated. We looked at an example of how complaints are investigated and the information recorded, we were pleased to see that social workers are involved in complaints involving people living in the home and review meetings are held where required. The manager had completed ‘Complaints Training’ the previous week. Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 22 The AQAA also told us that the manager utilises Leonard Cheshire Disabilities Regional Complaints Co-ordinator and personnel to provide guidance and support. The manager completes a quarterly visual audit of complaints received, to see if there are any trends and to help ensure that the quality of care is maintained for people in the home. There have been complaints about the cleanliness of the home, the facilities provided and some care issues that were discussed with the manager, and it was judged that the complainants were satisfied with the investigations, as they did not implement the next stage in the complaints procedure. Issues are raised at the service users representative meetings so that people can raise them locally and nationally. The minutes of these meeting were unavailable, but we spoke to the two representatives of the home. One representative said the home has improved and they felt able to talk to the manager openly about any concerns raised and that they would be dealt with. Cleanliness of the home, however, remained an issue. Only one of the people living in the home that returned surveys to us said they did not know how to make a complaint. Comments in the surveys told us; ‘The manager and care supervisor are very easy to talk to and always try to solve problems for us’, Debbie (care supervisor) and Joyce (manager) are very good’, ’the care supervisor and manager are very helpful and supportive’ and ‘most staff are very good’ (they usually listen and act on what I say). We spoke to a relative and an advocate whom had recently made complaints that the manager was attempting to resolve. The manager had informed us about the complaints and explained what actions had been taken to resolve them. The manager plans to record all informal concerns raised in the home. The home has a comprehensive protection of vulnerable adults policy and procedure. They also have the Department of Health No Secrets ‘whistle blowing’ guidance and staff are given a copy at induction. All staff have been trained in the protection of vulnerable adults and safeguarding procedures. The staff we spoke to were clear about what they would do to protect people living in the home. The AQAA informed us that four safeguarding issues had been investigated in the last twelve months. The manager had informed the Commission and a multi-agency investigation was implemented where required to help ensure that people were protected and action was taken. We looked at two examples of recording people’s personal monies. There was a running total and two signatures and all receipts had been kept for purchases. The monies in the safe were correct and a clear audit trail was seen. The goal is to help people look after their own money. Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment has improved considerably and people living in the home have good quality accommodation. Further improvements are planned to help ensure that needs are continually met and people feel valued. The home is not always as clean as people would like and expect, and to promote infection control. EVIDENCE: We looked at the environment with the manager and discussed where further improvements could be made. The manager gave us the maintenance plan for the home, there have been considerable improvements since the last inspection to include. Sixteen bedrooms have been decorated in 2007/2008, some have also had new furniture, curtains and flooring. There are three bedrooms to be refurbished in 2009. Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 24 Thirteen communal areas have been refurbished in 2007/2008, this includes new light fittings, flooring, furniture, curtains, a new large screen television and artwork to decorate the walls. There are plans to refurbish several communal rooms in 2009, these included the sensory room, activity room and the activity kitchen. We looked at all the areas in the home and some work was in progress. The home had provided good lighting to replace the strip fluorescent lights in the corridors and there was improved lighting in the upstairs lounge. The refurbished lounge on the ground floor was furnished to a high standard with some contemporary artwork and new furniture in the redecorated entrance hall, possibly reflecting younger adults tastes. The new therapy room was almost finished and looked inviting and calm, it will be used for hairdressing, chiropody, and complimentary therapies such as massage and reflexology. People living in the home told us they liked the improved environment and the new coffee bar, and were looking forward to the new Juice Bar opening the following week where they were hoping to get a licence to sell some alcohol. The surveys returned to us said ‘the new decoration has made a big difference’, ‘the home is much nicer since Joyce (manager) got the decorating done and the new furniture, when the corridor is finished it will be much nicer.’ The bathing facilities have improved and the new shower wet room is being used and new changing tables have been provided. We noted a few areas that required attention, but the maintenance plan has identified some to be completed by the end of December 2008. People can regulate their radiators to control the temperature of bedrooms, but may need staff to help with access. Individual concerns from people living in the home were shared with the manager, and included the replacement of some bedroom furniture, the provision of a desk, and keeping rooms generally more tidy. We looked in the laundry room, which was well organised, and the laundry person told us about the system for naming items of clothing and following infection control procedures. People were mainly concerned about the cleanliness of rooms and felt more domestic staff were needed. There was evidence that the home was not clean but as refurbishment work was in progress, with the fitting of new doors and flooring, it was difficult to assess. To promote infection control the standard of cleanliness should be higher. The surveys returned to us said; ‘Cleanliness of the rooms need to be better with more frequent cleaning’, ‘ really need more cleaners’, and ‘need more cleaner. Five people told us that the home is clean ‘sometimes’, seven told us ‘usually’ clean, and three said ‘always’ clean. The manager told us the home is currently in the process of recruiting an additional domestic cleaner. Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 25 Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff are well trained, qualified and experienced to meet peoples needs, and are well supported with regular supervision and staff meetings where training needs are identified. The people living in the home are included in the homes good recruitment practices, which help to safeguard them. EVIDENCE: We looked at all the Criminal Records Bureaux and Protection of Vulnerable Adults information since the last inspection, and one recruitment record in detail. We also looked at the immigration record for overseas staff. The home has a good system for recruitment, which includes an application to identify any gaps in employment that need to be explored, two references and a record of the interview. The records seen were well written and we also looked at the training certificates for two staff. People living in the home are included in the recruitment procedures and join in with the interviews. Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 27 We looked at the staff induction booklet, which was very good and contained all the areas required by Skills for Care. The induction is completed in the home over three days. We looked in the refurbished training room upstairs and spoke to the training officer who works fourteen hours each week. The training officer told us that the home has all the appropriate training resources. We spoke to a nurse and one of the care staff about training and both agreed that they had lots of training. One staff member is a skills instructor for manual handling in the home, and said that they were well supported by the care supervisor, a registered nurse, who was a very good team leader, and formally supervised them every two months. The senior carer spoken to was responsible for all six residential care people living in the home and had achieved NVQ level 3 in care and also had many years experience working at the home. The carer told us the registered manager supports her well and is ‘very approachable’, and the home provides good training. The AQAA told us the home had held training sessions for staff to understand people’s personal relationships and sexual needs. The staff continue to receive disability equality training, delivered by a trainer with disabilities. The regional communications officer is planning to deliver training for staff in communication. Regular bi-monthly staff meetings take place and we looked at the minutes, the nurses have separate staff meetings to discuss clinical issues. Concerns raised by the people living in the home were discussed with the staff to resolve the issues. The manager told the staff she was planning to recruit an additional staff member over and above the recommended staffing numbers. Training was also discussed and a dietician from the PCT was arranging some in-house training for all staff soon. Future meetings were to be held at the same time as the people living in the home had their meetings to try and allow more staff to attend their meetings. At the nurses meeting the new medication guidance from the Nursing and Midwifery Council was discussed, and training to help staff understand some psychological aspects of caring for people with mental health needs. We looked at a copy of the training completed and planned and all mandatory training for example first aid, manual handling, food hygiene and health and safety had been addressed. We also looked at one staff training folder, which was comprehensive and well maintained. The AQAA staff dataset told us told us that of the twenty care staff twelve have NVQ level 2 qualification or above and six staff are also working towards the NVQ level 3 in care award. Three of the homes eight bank staff have achieved NVQ level 2 in care. The home is fully staffed with Registered General Nurses at all times and the care supervisor also had supernumerary hours to complete administration Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 28 during the week. The home also employs a physiotherapist and staff to support the day care people. Only six staff had left the home in the previous twelve months, and none had been dismissed for misconduct. Regular agency staff are used when there are care/nursing staff sickness or annual leave. The home also employs eighteen staff not involved with care/nursing to include catering, activities, IT, training, maintenance, gardening, administration, laundry and domestic duties. We discussed the cleaning duties, and the manager was planning to employ an additional cleaner as obviously this was a current problem. We looked at the staff rotas and there are usually eight staff each morning, six in the afternoon/evening and three on duty during the night. The manager said this was sufficient to meet peoples needs and there was no evidence from people that their needs were not being met apart from more trips out and the cleanliness of the home. The staff told us that sometimes meal times required additional staff to assist people, and the manager hoped to resolve this when the volunteers arrived that day. We observed a hand over between shifts and information was relayed well to help ensure continuity of care. Staff comments in our surveys told us; ‘Leonard Cheshire training is very good and covers a wide range of topics, access to outside training is also very good so it is easy to maintain PREP (Post Registration Education Practice)’, ‘generally there are very good staffing levels’, Greathouse is very well run home, which provides a friendly atmosphere and has some very good staff’. ‘the manager has worked very hard since taking over to improve the lives of the service users, if approached by staff who have a problem she is very supportive’, ‘ we need more activities and trips out allowing care staff to support but not to reduce the level of care staff on the floor’, ‘sometimes staffing levels are bordering on unsafe’, ‘I never meet with the manager there is no support’, ‘ activities and trips are heavily dependant on volunteers’. All the comments from the staff surveys were shared with manager to discuss both negative and positive comments. Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 29 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed by a qualified, competent and experienced registered manager and care supervisor, so that people in the home are safe and well cared for. The quality assurance procedures have developed, and regular meetings with staff and people living in the home helps to ensure that their views are taken seriously and action is taken. EVIDENCE: The registered manager is experienced and has made many improvements since she became the registered manager for the home in 2007, she has previously managed other services for Leonard Cheshire Disability. The care Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 30 supervisor is a registered nurse and works with the manager to ensure safe practices in the home and supports the staff with supervision. The staff must know when the registered manager is on duty and it should be on the duty rota. In a home this size it would be expected that the registered manager is in full time day-to-day charge of the home and has continual contact with the people living in the home. There are weekly meetings of the senior staff in the home to include the activities co-ordinator, and we looked at the minutes from a meeting in July 2008. Topics included administration, care and hotel services. The home’s administrator manages the financial arrangements, which includes people’s personal monies. The administrator is also responsible for the maintenance of personnel files and is also developing the homes surveys to cover forty different areas. The manager completed an AQAA for us, which was detailed and informed us of any changes and planned improvements in the service. Quality assurance surveys are completed to include the people living in the home and the staff. Audits of the findings are completed and action taken when required. We looked at an action plan for people living in the home taken from survey results and the heading included ‘What we will do to respond’, ‘Who will take the lead’, ‘We will do this by’ and ‘How we will check we have done it’. The topics covered were medication, evening routine, activities, promoting independence, Individual Service Plans and menus. We also looked at the results of a catering survey and from that the new menus have been developed. We looked at the action plan from the staff surveys for 2008, which included actions that the LCD Central Directors visit the home and talk to staff, service users and volunteers. The AQAA told us that the maintenance and servicing of equipment in the home is complete. The health and safety officer for LCD South West completes an annual audit of the home and visits quarterly, managers attend regular meetings with the officer. The staff report faults in the maintenance book, an example during the inspection was that a hoist was not working correctly and the supplying company came and put it right. The record for wheelchair servicing was seen. The manager informed us that electricity installations were being serviced the following week. The fire safety records were correctly completed and the sliding doors in the home have now been changed, which was a requirement by the fire safety officer. We looked at a completed regulation 26 visit for May 2008, by the trust, which was well recorded and mentioned the use of agency staff at weekends. Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 X 25 3 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 32 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 YA14 Regulation 16 (2) (n) Requirement The registered manager must ensure that there is an increased choice of activities and more planned personal goals to include; the evenings, weekends, college courses and assisting some people with a work programme. A record must be kept of all activities achieved. The registered manager must ensure there are sufficient staff to enable people to have their meals in a dignified manner and not wait to be supported. Timescale for action 01/11/08 2 YA33 18 (1) (a) 01/11/08 3 YA30 23 (2) (d) The registered manager must 01/11/08 ensure that all areas of the home are kept clean to provide a dignified environment for people and promote infection control. Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 33 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 OP8 Good Practice Recommendations We recommend that the record of doctors visits and the outcomes should also incorporate all healthcare professionals that support people, to help ensure information is easily accessible for continuity of care. We recommend that a copy of the Royal Pharmaceutical Society’s guidance should also be obtained for medication reference. There were protocols for any ‘as required’ medication, but we recommend that one for the use of an inhaler should be more specific. A timescale should be added to the complaints procedure in line with the regulations, that a reply must be received within 28 days of receipt. The registered manager must be on the rota or alternative arrangements recorded for all staff and people living in the home to see, so that they know when she is on duty in the home. 2. OP9 3. OP9 4. OP16 5. OP37 Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greathouse Cheshire Home DS0000015913.V369903.R01.S.doc Version 5.2 Page 35 - 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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