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Care Home: Green Close

  • Drakes Avenue Sidford Sidmouth Devon EX10 9JU
  • Tel: 01395515050
  • Fax: 01395512815

Green Close is a Care home providing accommodation and personal care people over the age of 50. It is situated a short distance from the village centre of Sidford on the outskirts of Sidmouth. The home provides intermediate care for people in East Devon. The home has four short stay beds and eighteen rehabilitation beds. The home does not admit people on a long stay basis. Referrals to this service are received from Health and Social Care professionals. The home is dedicated to helping people who may be ready to leave hospital but are unable to return home without further rehabilitation. The home can also care for those 1 6 1 0 2 0 0 8 0 23 23 people who are struggling to remain at home. The rehabilitation service offers people a stay of up to six weeks, during which intensive therapy is provided by health and social care professionals. People are assessed throughout their stay and their needs are addressed so as to ensure a safe and appropriate discharge, tailored to meet their needs. The accommodation is on three floors, with a passenger lift between each floor. All bedrooms are single occupancy and equipped with wash hand basins, TV, and nurse call points. The access throughout the home is level, and the home has a good level of equipment to assist mobility including handrails, grab rails, and assisted bathrooms. There is a lounge and dining room on each floor. Outside there are lawns and flowerbeds and a pleasant courtyard with plenty of seating. Parking is limited, although there is parking in the surrounding streets. The home also provides a venue for Age Concern Day Care on the top floor. Information received from the home indicates that there is no charge for those people admitted for Intermediate Care service. Those needing respite care are financially assessed and charged accordingly. Services that people pay for independently include newspapers and magazines, hairdressing, continence aids and medical requisites, toiletries, chiropody, confectionery and

  • Latitude: 50.701000213623
    Longitude: -3.2309999465942
  • Manager: Mr Alain David Cook
  • Price p/w: -
  • UK
  • Total Capacity: 23
  • Type: Care home only
  • Provider: Devon County Council
  • Ownership: Local Authority
  • Care Home ID: 7199
Residents Needs:
Old age, not falling within any other category, Physical disability

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Green Close.

Key inspection report Care homes for older people Name: Address: Green Close Drakes Avenue Sidford Sidmouth Devon EX10 9JU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Michelle Oliver     Date: 1 4 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Green Close Drakes Avenue Sidford Sidmouth Devon EX10 9JU 01395515050 01395512815 kath.hawkins@devon.gov.uk http/www.devon.gov.uk Devon County Council care home 23 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Service users in the category PD Physical Disability must be over the age of 50 years Date of last inspection Brief description of the care home Green Close is a Care home providing accommodation and personal care people over the age of 50. It is situated a short distance from the village centre of Sidford on the outskirts of Sidmouth. The home provides intermediate care for people in East Devon. The home has four short stay beds and eighteen rehabilitation beds. The home does not admit people on a long stay basis. Referrals to this service are received from Health and Social Care professionals. The home is dedicated to helping people who may be ready to leave hospital but are unable to return home without further rehabilitation. The home can also care for those Care Homes for Older People Page 4 of 35 1 6 1 0 2 0 0 8 0 23 Over 65 23 23 Brief description of the care home people who are struggling to remain at home. The rehabilitation service offers people a stay of up to six weeks, during which intensive therapy is provided by health and social care professionals. People are assessed throughout their stay and their needs are addressed so as to ensure a safe and appropriate discharge, tailored to meet their needs. The accommodation is on three floors, with a passenger lift between each floor. All bedrooms are single occupancy and equipped with wash hand basins, TV, and nurse call points. The access throughout the home is level, and the home has a good level of equipment to assist mobility including handrails, grab rails, and assisted bathrooms. There is a lounge and dining room on each floor. Outside there are lawns and flowerbeds and a pleasant courtyard with plenty of seating. Parking is limited, although there is parking in the surrounding streets. The home also provides a venue for Age Concern Day Care on the top floor. Information received from the home indicates that there is no charge for those people admitted for Intermediate Care service. Those needing respite care are financially assessed and charged accordingly. Services that people pay for independently include newspapers and magazines, hairdressing, continence aids and medical requisites, toiletries, chiropody, confectionery and Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means that people who use this service experience good quality outcomes. This inspection was undertaken over 8 hours in one day by one inspector. We spoke with people living there and staff and also spent time observing the care and attention given to people by staff. Prior to this inspection we sent surveys to 10 people living at the home, 5 staff and 5 health care professionals. Six surveys were completed and returned to us from people living at the home expressing their views about the service provided at the home. Their comments and views have been included in this report and helped us to make a judgement about the service provided. To help us understand the experiences of people living at this home we looked closely Care Homes for Older People Page 6 of 35 at the care planned and delivered to three people. Most people living at the home were seen or spoken with during the course of our visit and three people were spoken with in depth to hear about their experience of living at the home. We also spoke with 5 staff, including the manager, assistant manager, carers and ancillary staff, individually. A tour of the premises was made and we inspected a number of records including assessments and care plans and records relating to medication and health and safety. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at /www.oft.gov.uk . Copies of the inspection report are available from the office. Care Homes for Older People Page 7 of 35 What the care home does well: People receive good information about the home on admission and benefit from a generally good admission practice, which ensures that the home is able to meet their needs. However, written information has not been kept up to date. (See what they could do better) People spoken to during the inspection were full of praise for the rehabilitation and recuperative services provided. They said they felt the staff are giving them all the help they need in order to return to their homes. They praised the skills of the staff team, including care staff, occupational therapists and physiotherapists. Individual care plans have been developed for all people when they move to the home. Improvement is needed to ensure consistent information is recorded. (See what they could do better) Medication is well managed by staff that have been well trained. People are encouraged and supported to look after their own medicines if they wish and are able. Peoples privacy and dignity are met and promoted by the staff and management at the home. People confirmed that they are treated with respect and their privacy is protected. Social needs and meals are generally well managed. A varied balanced diet is provided and served in a pleasant atmosphere. People are encouraged to maintain contact with their families or friends as they wish and to take control of their lives during their stay at Greenclose. During this inspection we saw several visitors and staff and managers welcomed them to the home and were friendly and approachable. The focus of the home is to encourage independence so that people can return to live independently and successfully in their own homes. People are generally encouraged to exercise choice over all aspects of their daily lives. All people spoken to were very satisfied with the standard of food at the home. One said the food is excellent. The home has a satisfactory complaints process. We spoke to 11 people during this inspection and all said they would feel comfortable making a complaint, as they were sure that all staff at the home would take issues seriously. People benefit from living in a home that is very clean, fresh and where hygiene is well managed. People benefit from living in a well managed home that is working hard towards trying to make sure the home is run in their best interests. Comments received in response to surveys included; I feel as if I was staying in a Care Homes for Older People Page 8 of 35 first class hotel. The meals are excellent,another difficult to fault the service, general and personal care and wellbeing excellent, very lucky to be here and I dont think they can improve, they are all excellent. What has improved since the last inspection? What they could do better: There are not always enough staff on duty to meet the assessed needs of people using the service. People are not always made aware of information about the home being available to them when they move to Greenclose. Plans of care do not consistently include sufficient information about individuals needs and how these needs are to be met. This means that people staying at the home may not receive care in a way they prefer and need. Individuals or their representatives are not always consulted when planning and delivering care. The service does not consistently ensure that all individuals health care needs are met. This relates to specific exercises not being consistently undertaken. Risk assessments are not consistently undertaken for all people who are admitted to the service. An effective assessment of individuals abilities to look after their own medicines is not consistently undertaken before a decision is made. Assessments are not accurate and detailed. Consideration should be given to posting individual goal plans on notice boards in individuals rooms. Care Homes for Older People Page 9 of 35 People should be encouraged and supported to make choices of how they live their lives during their stay at the home. Not all staff have received training to ensure that they are competent to do their jobs. Arrangements have not been made to ensure that all staff receive manual handling training. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are admitted to Greenclose benefit from being assurred that an assessment of their health and social care needs will be undertaken. Not all people may be aware of information about the home being available to them. People admitted for intermediate care are helped to maximise their independence and return home. Evidence: Greenclose continues to admit people from hospital or their home for a period of rehabilitation and as they are usually transferred directly from hospital they do not always have a chance to visit the home beforehand. However, some people spoken to during this inspection knew about the home and others had relatives who had visited the home. One person told us they had been told they were coming to Greenclose Care Homes for Older People Page 12 of 35 Evidence: and that their GP had told them it had been chosen for them. They were happy with the way they were being cared for and told us theyve looked after me well. Some people spend a period of respite at Greenclose to allow their carers a period of rest.We saw that procedure for assessing their current needs has improved; when the referral is made by phone a series of planned questions are asked to identify any changes since their last admission and all assessments are based on activities of daily living, which is good practice. We spoke to one person who has been coming to Greenclose for some considerable time for a period of respite and they told us it was like going on my holidays. Before a person is admitted to the home, a copy of an assessment of a persons health and social care needs is forwarded to a coordinator at the home. The information is discussed within the enablement team and is then passed to a member of the management team. A decision is then made as to whether the assessed needs can be met by the staff, equipment, adaptations and environment at Greenclose. All those staying at the home at the time of this inspection had been referred by either social service or health care professionals. We looked at the assessments undertaken by referring professionals for 3 people. The information for all was comprehensive and detailed, providing adequate information to enable plans of care to be completed. this means that staff with be provided with sufficient information to enable them to meet individual health, social and welfare needs in a person centred way. The home has produced a Statement of Purpose and a Service User Guide that provide information about the home and the services offered. None of the people we spoke to during this inspection had been given a copy of this information before they were admitted to the home. However, comprehensive information had been provided when they arrived at the home. One person told us they had looked through this information, and was aware of the complaints procedure and the general way the service was run. One person told us they had not seen this information and was unaware there was any available. When we showed her the information folder they said they had seen the folder but were not able to look at it as it was out of their reach. When we looked through it together, the person agreed there was a lot of information, which would have been useful and reassuring if they had been given it when they first moved to Greenclose. Care Homes for Older People Page 13 of 35 Evidence: The services statement of purpose has been updated since the last inspection and a copy is available in peoples rooms and in the reception area together with the most recent CQC [Care Quality Commission] report, which means that visitors top the home can refer to up to date information about the service and how it is run. We received completed questionnaires from 6 people who are currently using, or who have used, the services of Greenclose. Four people confirmed they had been provided with enough information about the service before moving there and two had not. Three people, who responded to questionnaires, confirmed they had been provided with a contract when they moved to Greenclose, 2 had not and one didnt know. We looked at the files of three people and saw contract that had been completed and signed by the person using the service. This means that people staying at the home are made aware of their rights and responsibilities. Care Homes for Older People Page 14 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal needs are generally well met and staff respect their privacy and dignity. Health care needs are not consistently met by staff. A lack of detail in some care plans may lead to inconsistencies in care and a risk that some people may not receive all the care they need in their preferred way. Medication is generally well managed but some areas need attention to ensure safety is maintained. Evidence: Surveys received from people who had used the service told us their needs had always or usually been met. People we spoke to during our visit said staff met their needs well, particularly those who were more or less self caring. People requiring a little more help with things like personal care felt staff usually met their needs. Care Homes for Older People Page 15 of 35 Evidence: Outside professionals told us peoples needs were always, and and one usually, met. The manager told us that they have worked hard to improve care planning since the last inspection and that a new system is due to be introduced. Training is due to be provided for staff so they know how to use the care plans and this will be followed up after the care plans have been introduced. Care plans are the end point of the assessment of the persons health and social care needs and should show what care must be delivered in accordance with the service user plan for that individual. The plan becomes the yardstick for judging whether appropriate care is delivered to the individual and will reflect changes as regular assessment of the person shows changing needs. Care plans are in place for all people who use the services at Greenclose, however, information relating to individual health and personal care needs are inconsistent. We looked at three peoples care plans but, although general assessments of risks such as vision, communication, swallowing difficulties, mobility, potential misuse of drugs and self medication had been undertaken not all showed that appropriate assessments are undertaken in relation to how much nutritional support the person might need. One plan we looked at did include an assessment of a persons nutritional status and records of weight had been recorded regularly. However, the records clearly showed that this person, who is treated for diabetes, had lost 5 kg. in 3 months. No details of how this was managed or actions taken to address potential problems had been recorded. Care plans for people admitted for rehabilitation or for respite care are generally comprehensive and provide information to enable staff to meet identified care needs. However, some of the information recorded in individual plans was not consistent. Not all documents had been signed and dated. This potentially puts people at risk of their needs not being clearly identified or met. For example; the service has compiled an admission procedure check list but this had not been completed for a person who had moved into the home 6 days earlier. No care plans, or handling assessments had been completed for this person to provide staff with the appropriate information to meet the persons current health care needs and an admission check list, which should include details of the person when they Care Homes for Older People Page 16 of 35 Evidence: were admitted, had not been completed.This means that not all documentation may have been undertaken for this person or they may not have been given appropriate information about the home. When people are admitted to the home, for rehabilitation, they are included in the process of setting goals to enable them to increase their levels of independence and abilities so they may return to their own homes, if appropriate.Therapists, physiotherapists and rehabilitation staff had maintained good records of progress made towards achieving the set goals. We spoke to one person about the goals that had been set for them to achieve. They agreed that the goals had been discussed with them but told us that the actions recorded to meet goals were not been undertaken. For example, the plan indicated that to reduce swelling in my ankle elevate my leg on pillows. This was not being undertaken at the time of this inspection and we were told by the person that this was never so. Another to increase strength in my legs, daily exercises in my chair; we were told that this also was never carried out. Information also indicated that ice packs were to be used regularly but we were told that this had only happened once. some of the care plans looked at included specif exercises that care staff were to help them undertake regularly. There was no record in individual care plans to indicate that staff had undertaken this. Staff told us that it was not always possible to help people with these exercises.[ Please refer to staffing] None of the 3 files we looked at included care plans for existing health problems such a diabetes or depression. This potentially puts people at risk of not having all their health care needs met at the home.However, when we spoke to staff they were generally well aware of the needs of these people and provided us with information that was not recorded but showed that they were aware of individual needs and how to work towards meeting them. One member of staff responding to surveys felt that they were sometimes provided with upto date information about people they support and said they were usually told of changes to peoples condition at hand over between each shift. The majority of people living at Greenclose at the time of this inspection were receiving rehabilitation services.People have direct access to a therapy team and a Care Homes for Older People Page 17 of 35 Evidence: nurse during weekdays. People spoken to during this visit were very satisfied with the level of care given by staff at the home and with the assistance, encouragement and support given to maximise their independence and regain daily living skills. All those we spoke to were pleased with the quality of care provided by all staff. One person told us I was a wreck when I came here and I am wonderful now. The ethos of the service in relation to the management of medicines is that people are encouraged and supported to look after their own if they wish and are able to. An assessment of a persons ability to look after their medicines is undertaken when the are admitted to the home. The assessment includes whether they wish to medicate, any associated risks, awareness of the medicines being taken and the reasons, times to be taken, ability to open containers and to identify the medicines. Lockable facilities are provided in all bedrooms at the home. In response to surveys 2 people living at the home at the time told us they felt the service supported people to look after their own medicines or manage it correctly if this is not possible. We spoke to one person who was looking after their own medicines. We saw medicines on a table next to the chair they were sitting in. We were told that although lockable facilities were provided due to the persons lack of mobility they could not access the medicines if they were locked away so the medicines stayed beside the chair. This potentially puts people at risk as medicines are not safely stored. We looked in this persons care plan file and although an assessment had been undertaken there was no name indicating who the assessment was undertaken for, there was no evidence of the person being involved in the assessment, it did not make clear whether the person had been assessed as being able or not able to manage their medication,it was signed by the assessor only and there was no review date planned. Medicines kept on peoples behalf are stored safely and only staff who have undertaken specific training in safe handling of medicines manage them. We looked at medication records, which were well documented up to date and accurate. People confirmed that they are treated with respect and their privacy is protected. Care staff confirmed this when telling us about the homes privacy and dignity policy, when seen knocking before entering peoples rooms and when seen being discreet in offering to provide personal care or assistance. Care Homes for Older People Page 18 of 35 Evidence: However, we saw that individual goal plans continue to be posted on notice boards in individuals rooms. People told us that they hadnt been asked whether they were agreeable to this but that the plans had just been put up. We discussed this with the manager and were told that this had been discussed and it had been decided that this is the best way that people staying at the home and staff can clearly see their goals. This may compromise peoples privacy.Several people we spoke to told us they had not been consulted as to whether they wished these documents to be openly displayed although only one objected to current practice. Care Homes for Older People Page 19 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social needs and meals are generally well managed. A varied balanced diet is provided and served in a pleasant atmosphere. People are encouraged to maintain contact with their families or friends as they wish and to generally take control of their lives during their stay at Greenclose. Evidence: People admitted for rehabilitation have a timetable of activities and exercises designed to increase mobility. Some of these sessions will be carried out with a physiotherapist, and some will be carried out with the care staff. Exercise classes are also provided to increase their general well being. Six people responded to surveys sent prior to this inspection. Three confirmed that there were always, two usually and one sometimes activities arranged by the home that they can take part in. Daily activities are organised by care staff on a daily basis according to how busy they are. Activities provided include individual therapy sessions, daily exercise sessions, Care Homes for Older People Page 20 of 35 Evidence: occasional sing a longs, and visits from musicians. People are encouraged and supported to maintain their religious beliefs and a Communion service is held monthly at the home. People told us a hairdresser visits the home regularly and one person said they enjoy the regular church service at the home provided by a local church. During this visit several people were enjoying chatting to each other, reading newspapers and books, watching TV programmes and listening to music of their choice. The focus of the home is to encourage independence so that people can return to live independently and successfully in their own homes. People are encouraged to exercise choice over all aspects of their daily lives, including self administration of medicines, choice of food, daily activities. One person we spoke to told us that they preferred to spend time in their room, reading or listening to the radio, only leaving the room to go to meals.They told us they particularly enjoy a television programme that coincides with the usual time the evening meal is served, so they are unable to watch the programme. We were told that they have asked if they could have their meal later but were told that they needed to go to the dining room at that time. One person in response to what could the service do better commented would like more freedom to make my own choices instead of being told what to do. This means that people could be potentially at risk of not being able to make a choice as to how they live their lives whilst at the home. Four people who responded to surveys confirmed that they always and two usually enjoyed the meals served at the home. In response to what does the home do well one person commented food and another I feel as if I am staying in a first class hotel. The meals are excellent. Compliments to the cook. Two dining rooms are provided on each floor, both of which are light, homely and comfortable where people were seen enjoying their meal and socialising.The dining tables were attractively laid with pretty tablecloths and napkins. A kitchenette is also available where people may prepare their own meal if they choose. People are encouraged and supported to maintain their independence, however for those needing assistance this is provided in a sensitive way. All people spoken to were at the time of this inspection were very satisfied with the Care Homes for Older People Page 21 of 35 Evidence: standard of food at the home one saying the food is very good. A choice of meal is offered at both main meals time but if there is anything a person does not like the cook will provide an alternative. Specialist diets and individual requests are well catered for at Green Close including diabetic and vegetarian. The meal seen during this inspection was tasty, well cooked, very attractively presented, with portions to suit individuals. Menus were not freely available to inform people of choices but the main meal was advertised in the dining room. People who responded to surveys that staff listen and act on what people say. During our visit there were several occasions where staff offered people choices in a meaningful way. Staff responded to peoples requests in a polite way, saying things like of course and thats no problem. People are encouraged and supported to maintain links with family and friends during their stay at Greenclose. People may receive visitors at any time an during this inspection and when we looked at the visitors signing in book this confirmed. Staff welcomed all visitors and were helpful and polite. Care Homes for Older People Page 22 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints process. Staff have a good knowledge and understanding of the forms of abuse thereby ensuring that people are protected at the home. Evidence: The homes complaints procedure is displayed in the entrance hallway and a copy is included in the welcome folder that is supplied in individual rooms. We spoke to 10 people during this inspection and all said they would feel comfortable making a complaint, as they were sure that all staff at the home would take issues seriously. All but one of those who responded to surveys confirmed that they knew how to make a complaint and who to speak to if they were unhappy about anything at Greenclose and wanted to make a complaint. One person commented I dont need to make a complaint and I am happy. None of the people we spoke to during this inspection had made a complaint but assured us that if they were unhappy they would not hesitate to speak to one of the manager or any member of staff. One complaint has been made to Greenclose since the last inspection. This was taken Care Homes for Older People Page 23 of 35 Evidence: seriously and investigations into the issues were undertaken and the complainant was provided with the outcome of the investigations.we were told that the complainant was satisfied with the outcomes and the way the complaint was dealt with. Staff confirmed they had received training in safeguarding adults and were aware of safeguarding adults procedures, which helps to protect people in their care. Staff showed a good understanding of issues and confirmed they would report any suspicions of poor care to a senior member of staff or the manager. During this inspection staff were kind, caring and respectful to all people they were caring for. Care Homes for Older People Page 24 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a home that is very clean, fresh and where hygiene is well managed. Evidence: The home is purpose built and accessible throughout. It is arranged over three floors, with a passenger lift between each floor. On each floor there is a lounge and dining room, toilets and bathrooms. It is located in a residential area, close to shops and bus services. The home was spotlessly clean at the time of this inspection and information about cleanliness was displayed for all to read. People spoken to say the home is always clean and fresh and the domestics work very hard and have high standards. The home pays exceptional attention to cleanliness and the prevention of infection, and encourages visitors to do the same. A good supply of protective clothing, hand washing facilities and hand cleansing gel are provided throughout the home for staff and visitors. Staff spoke about precautions taken to prevent spread of infection, confirmed that equipment is always available and were aware of, and understood, the homes health and safety policy. Care Homes for Older People Page 25 of 35 Evidence: A maintenance person is employed and the home is well maintained and decorated. A maintenance book is kept in an office and staff write in any faults or minor repairs that need attention. The maintenance person looks at this book daily and records showed action is taken promptly. The home also employs a laundry person. The laundry was clean and tidy. Clothes were being taken to peoples rooms during this visit and all were well ironed and presented. People praised the quality of the laundering and the speed at which it is done.Surveys from people using the service told us that the home was always clean and fresh. One person wrote, Keeps a well regulated home and a clean one and makes sure all laundry needs are catered for. The home has ample specialist equipment to help maximise peoples independence. Corridors have handrails to help people walk; there are a number of hoists and standaids, and various walking aids to assist people. There is a separate treatment room, where therapists can work one to one with people, and a small kitchen where people can practice their skills. The home is generally safe for people; radiators are low surface heat to reduce the risk of burning to people. Windows on the upper floors are restricted to prevent accidents from falls, and water temperatures are regulated to prevent harm from scalding. Surveys from people using the service told us that the home was always clean and fresh. One person wrote, Keeps a well regulated home and a clean one and makes sure all laundry needs are catered for. Care Homes for Older People Page 26 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The number of staff on duty throughout the day and night do not always meet peoples personal and health care needs. People benefit from being cared for by staff that are qualified and competent and protected by the homes robust recruitment practice when staff are recruited. Evidence: The manager aims for there to be 4 carers on duty at the home during the mornings, 3 during the afternoons and two at night. The manager is on duty throughout the day plus an assistant manager and ancillary staff such as chef, domestics and laundry person. All the people we spoke with during our visit told us that staff were available when needed and that staff generally respond quickly when they ring for assistance. Comments included, staff are wonderful and always very busy and staff are usually busy but very kind. During this visit staff, although they were busy, attended to people in an unhurried manner and were patient and kind. In surveys returned before this inspection, the only member of staff who responded told us there was never enough staff to meet the individual needs of all the people who use the service. This was confirmed by all staff we spoke to at the time of this inspection who told us Care Homes for Older People Page 27 of 35 Evidence: that staffing levels had been reduced recently. They said there was only enough time to meet peoples basic needs but not to spend time with them or engaging them in meaningful activities. Staff also told us that a lot of people have exercise plans but carers cant undertake them, we just dont have the time. We were told that staffing levels had been reduced recently. We were told that at the time of this inspection 4 people living at the home needed 2 staff to help them transfer and another requiring 2 staff was admitted during the inspection. Three staff, and an assistant manager are on duty during the afternoon/evening, which means that when 2 staff are assisting people it leaves only 1 member of staff and an assistant manager available to other people living at the home. Throughout the night there are 2 staff on duty to attend to all people living at the home 5 of which need both staff to attend to them at any one time. Staff told us that sometimes an assistant manager is also on duty from 9.30pm 7am. The manager said they continued to monitor staffing and dependency levels to ensure that people got the support and care they needed. We were told that staffing levels would be increased when required to meet the needs of people using the service. A comprehensive hand over is given to all staff when they come on duty. This is to ensure that all staff are aware of up to date information about all people currently living at the home. staff we spoke to were well informed about people and gave us more information than was recorded in care plans. It was obvious they knew them well and understood their individual needs. Weekly meetings are held at the home involving the manager, social workers, members of the rehabilitation team, a registered nurse who works at the home and other health care professionals who may be involved in peoples care. During this meeting individuals progress is discussed and action plans are drawn up. During the last 12 months training undertaken by staff includes food hygiene, infection control, medication management and moving and handling. However not all staff have undertaken all training provided. According to training records no staff have received training to use a hoist, 6 staff currently need refresher Care Homes for Older People Page 28 of 35 Evidence: training on infection control and although 32 staff received manual handling in 2008 there was no evidence that 5 members of staff have undertaken any training in manual handling. Individual records are kept of training undertaken by staff ensuring that updates or gaps in training can be easily identified however these were not always clear. This was discussed with the manager. Staff at the home are eager to undertake training and were able to highlight their individual needs during this visit. Ensuring that all staff are up to date with current good practice will protect people by ensuring that they are cared for by competent staff. No staff have been recruited since the last inspection and we were told that the team worked well together and morale continued to be good. The service continues to use agency staff but this has decreased, which means people receive better continuity of care. Care Homes for Older People Page 29 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the best interest of people that live there. Evidence: People, who use the service, and staff, benefit from the management approach at Greenclose. The manager has experience and qualifications in health and social care. The quality of the service provided by the home is checked using regular quality survey questionnaires, results of which are audited by the manager and providers, the Local Authority. Staff and residents meetings are held, both providing an opportunity for the manager to give and receive information about the home. Management seek feedback during peoples stay ensuring that any issues are addressed, recorded and action taken as required People are also given questionnaires when they are discharged from Greenclose. This ensures that standards of health, social care and welfare needs will be maintained and Care Homes for Older People Page 30 of 35 Evidence: a programme of continuing improvement developed at the home. People will benefit by being assured that the home is working towards delivering high standards of care. Most people retain responsibility for their own cash and valuables during their stay at Green Close and we saw inventories of personal belongings brought to the home in individual care plans. A system for ensuring that all staff receive formal supervision, which provides an opportunity for staff to discuss aspects of practice and training and development needs, has been developed since the last inspection. The manager provides regular supervision for the assistant managers at the home, who have also received training to ensure that they can deliver supervision to staff. Staff meeting are held regularly and minutes of the meetings are available to inform staff of the outcome of meetings. This means that communication between staff and management is encouraged and supported. All staff have received fire prevention training at intervals recommended by Devon Fire and Rescue Service. When people are admitted to the home rehabilitation staff complete assessments of individuals mobility and complete a plan to enable staff to assist them appropriately. However, not all staff have received manual handling training. Records indicated that 5 staff require training/updating. This means that people using the service, and staff, are at risk of injury due to lack of up to date training in techniques to assist people to move. One carer we spoke to clearly described good infection control procedures and they had received recent updates in the procedures. However, according to training records 6 staff currently need refresher training. All records seen were securely stored and would be made available to people living at the home, or their representative with their consent. The manager told us that an assessment of identified hazards and associated risk relating to the environment, including fire hazards, has been undertaken which contribute towards ensuring that Greenclose is a safe place to live. Care Homes for Older People Page 31 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 27 18 Staff must be employed at 16/11/2009 the home in such numbers as are appropriate for the health and welfare of service users. To ensure that SUs needs are met. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 People should be made aware of information about the home being available to them when they move to Greenclose. In order to deliver care to people in a way they prefer and need, you should ensure that plans of care consistently include sufficient information about individuals needs and how these needs are to be met. Individuals or their representatives should be consulted when planning and delivering care. 2 7 3 8 Risk assessments should be undertaken for all people who are admitted to the service. Care Homes for Older People Page 33 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 4 8 The service should ensure that all individuals health care needs are met. This relates to specific exercises not being consistently undertaken. 5 9 An assessment of individuals abilities to look after their own medicines should be undertaken before a decision is made. Assessments should be accurate and detailed. 6 7 10 12 Consideration should be given to posting individual goal plans on notice boards in individuals rooms. People should be encouraged and supported to make choices of how they live their lives during their stay at the home. All staff should receive training to ensure that they are competent to do their jobs. Arrangements should be made to ensure that all staff receive manual handling training. 8 9 30 38 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 35 of 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!

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