Care Home: Greenacres

What the care home does well "Care and communication are good" and "They look after me very well" were some typical comments received about Greenacres during this inspection. The home is comfortable, clean and welcoming, with a very good environment for people who live and work there. "Training provided is very good" was a comment by one member of staff but was repeated by virtually all staff spoken to or contacted during the inspection. There is a real commitment to support and equip staff to provide a high level of care to people living in the home, including a focus on providing good and informed care for people in the home who live with dementia. Very positive comments were received from staff and visitors about the home`s manager, who is said to `have an open door policy`. "Greenacres is a very lovely home" was a comment received in a survey, and this view was confirmed by what was seen and heard during this inspection. What has improved since the last inspection? The concerns expressed in the previous inspection report about medication records have been addressed and the standard is now greatly improved and provides a safe system for those who rely on the home to help them with their medication.The additional activity or `engage` staff has improved the capacity of the home in this area and the home`s environment has been improved both by routine redecoration and by more major refurbishment, for example of the home`s garden. What the care home could do better: The home have identified in their AQAA that more outings from the home would benefit people who live there and steps are in hand to try and raise funds to achieve this. Although medication administration has been very significantly improved, there were some minor errors that indicate that the efforts put in by the care staff involved need to be maintained.The home have also identified the need to develop even further the already good standard of staff training, especially in the field of dementia as the home`s profile now means that the majority of people living there are living with dementia at some stage. One challenge facing the home is to ensure that the care needs of the now very small number of people living in the home who do not currently live with dementia continue to be met and that they, and those responsible for them continue to feel well informed about any changes in the home that may be proposed and that may affect them. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Greenacres Wellfield Close Hatfield Hertfordshire AL10 0BU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jeffrey Orange     Date: 1 6 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 26 Information about the care home Name of care home: Address: Greenacres Wellfield Close Hatfield Hertfordshire AL10 0BU 01707280500 01707280561 greenacres@quantumcare.co.uk 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) : Quantum Care Limited care home 60 Number of places (if applicable): Under 65 Over 65 60 60 60 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 0 0 0 Hertfordshire County Council first registered the home on 1st July 1992. Greenacres is a modern purpose built two- storey building, and is situated close to the centre of Hatfield with all its community facilities, health centres and clinics and with good transport links. Fees for the services range from £521 to £625 per week. Additional charges are made for newspapers, toiletries etc. (this was correct as at June 2009). Copies of the latest inspection report and contact details for the Care Quality Commission (CQC) are available from the home. The accommodation is offered in four units. It provides a home to elderly people requiring long stay residential care and specialises in the provision of care for people living with dementia. Each bedroom has en-suite toilet and wash hand basin. Each Care Homes for Older People Page 4 of 26 Brief description of the care home wing as two lounge/dining areas, a kitchenette and a night medication storage station. Each wing has an assisted bathroom and assisted shower. Other facilities available include a reception area and an activities/day area. A fully equipped kitchen is located on the ground floor, as is the administrators office and reception desk. On the first floor are the hairdressing salon and fully equipped laundry. Facilities for staff include a smoking room, staff room and changing room with shower on the first floor. The home has an enclosed garden in the centre of the building with patio areas. There is a day centre for the elderly in close proximity. Greenacres is able to offer respite care to enable families to take a break and offers day care to those who live in the community. Care Homes for Older People Page 5 of 26 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 last Key Inspection of Greenacres was on the 20th June 2007 when we assessed the care outcomes for people living there as good. In June 2008 we carried out an Annual Service Review where we reviewed all of the information we had received about Greenacres since the Key Inspection, that review concluded that care outcomes remained good. The current Key Inspection was unannounced and was carried out by one inspector. Where the report refers to we it recognises that it is written on behalf of the Care Quality Commission (CQC). The inspection began early in the morning and lasted until the early afternoon. During this time it was possible to observe the early morning routine of the home as people who live there were being helped to get up and ready for the day ahead. We also observed the mealtime experience at lunchtime and any activity sessions that took place during the day. We spoke to people who live in Care Homes for Older People Page 6 of 26 Greenacres and to visitors to the home. We were also able to speak to members of the staff team as well as to the homes manager. During the inspection we looked at some key records including those for staff recruitment, care planning and the administration of medication. This report also draws on information contained in any surveys that have been returned to us and also to the information sent to us by the home in their annual quality assurance assessment or AQAA. The AQAA is a self assessment document that sets out how well care outcomes have been achieved for people living in Greenacres. It also contains some useful statistical information, for example about staff training and complaints. We have also made use of any information that we have received about Greenacres since the last key inspection in June 2007, this could be in the form of notifications from the home of significant events affecting people who live there or from health and social care professionals associated with the home in any way and also from relatives and friends of people living in Greenacres or other people who have an interest in or experience of Greenacres. What the care home does well: What has improved since the last inspection? What they could do better: 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 set out 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 8 of 26 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 9 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering Greenacres as a home for themselves or someone they are responsible for can be assured that they will only be admitted if their needs have been thoroughly assessed and can be satisfactorily met. They can also be confident that they will be encouraged to visit the home before they make a final decision about moving in. Evidence: When we looked at the Quantum Care personal guide for Greenacres it was seen to include a very good level of comprehensive information about the home, including what is included in the basic fee and what goods or services will be subject to an additional charge. This is all provided in a very clear and accessible format, including on- line. This means that people considering Greenacres as a home for either themselves or someone they are responsible for have access to the clear and detailed information they need to enable them to make a well-informed judgement. When we Care Homes for Older People Page 10 of 26 Evidence: looked at several assessment files for people recently admitted to the home they were seen to include the detailed information that staff would require in order to both identify and meet their needs. When we spoke to people visiting the home, and received comments from them through surveys, we were told that they had felt able and welcome to visit the home before making any decision about admission for either themselves or someone they are responsible for. When we spoke to the homes manager they confirmed that people are encouraged to visit the home, so that they can have a chance to see around the building, meet key staff and people who are already living there and decide if it is a place where they could be happy. When we spoke to one family they told us that they felt unhappy that the home was now predominantly for people living with dementia and that as a result they were moving their relative to another home. They had some concern about the process of communication about the change that had taken place in the home which they felt compromised the homes ability to meet the needs of people not currently living with dementia. They were however quite positive about the standard of care received and when we spoke to some other people who had lived in the home as the process of change to the profile of the home took place, they felt that they had been kept aware of the changes and had been able to make a reasonably well-informed decision as to whether to stay or not. When we discussed this issue with the homes manager, they outlined a process of consultation and information sharing that had taken place that appeared, on balance to be appropriate, although it is recognised that some people take a different view. Care Homes for Older People Page 11 of 26 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. People living in Greenacres can be confident that they will receive effective health and personal care support, that they will be treated with respect and as an individual and that systems and records for the administration of medication are accurate and effective. Evidence: When we spoke to people living in Greenacres they told us that they were well-cared for. Care is good and so is communication was one comment made. When we spoke to several people who were visiting the home they told us that they had always been impressed with the standard of care they had seen. Throughout the inspection visit the standard of care seen was good and whilst there was one example of a persons dignity being compromised by the way they disarranged their clothes for some time before care staff made attempts to address this in a sensitive way. In general however due attention was paid by care staff to the need to promote the dignity and respect of people living in the home, including those living with dementia. When we looked at care plans for people living in the home, we found that they were well completed, kept Care Homes for Older People Page 12 of 26 Evidence: under review and included risk assessments and other significant details affecting their care. We were able to see evidence of the engagement of people living in the home with a number of health care professionals, and we were told that medication reviews, instigated by the home, had been instrumental in moving people off of psychotropic medication or having it reduced, where that was considered safe and sensible by the medical professionals involved. This demonstrates that the home take a proactive role in maintaining the health, safety and well being of people living in the home. When we checked medication records, we found that the standard of these had improved since the last inspection, when concerns had been raised. Although there were a very small number of gaps and occasions where variable dosages had not been properly recorded, the standard overall was good and is the result of the effort and priority given by the care staff responsible to make sure good practices are maintained. The home have indicated that they would like to improve some of the detail in care plans about the life histories and significant events of people living in the home. They report to us that sometimes this is difficult if either the people concerned or those responsible for them feel unable or unwilling to provide this information. Where the information is forthcoming, it can assist more effective person centred and individualised care to be provided, based on the information, which can then subsequently be updated to take account of more recent events and developments in the lives of people who are living in Greenacres. Care Homes for Older People Page 13 of 26 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. People who live in Greenacres can be confident that they will be encouraged and enabled to exercise choice in and control over their lives including their daily activities and routines. They can be assured that they will be supported to maintain contacts within the community and with family and friends. Evidence: When we looked at care plans we found that they included details of the basic likes and dislikes of people living in the home, including any food preferences and religious affiliations. When we observed the activities in the home, being led by the homes engage workers, we saw that the system in operation was flexible, so that for example, when one person started to dance spontaneously, the engage worker was able to join in and encourage others to do so if they wished. When we spoke to engage workers, they told us that they had attended various training in providing activities for people living with dementia. We were given details of some of the activities that had taken place, for example cooking, drama therapy, St.Patricks day celebrations, skittles, hand massage and many more. The engage workers told us that they would like to be able to take people out of the home more to community activities or visits to places of interest and to this end, the homes AQAA informs us that fund Care Homes for Older People Page 14 of 26 Evidence: raising for a mini-bus is underway. When we observed breakfast and lunch, saw menus and spoke to some of the people living in the home we were able to confirm choices were offered and that peoples wishes were respected. One person living in the home told us that when they last indicated that they did not like what was on offer; They made me a lovely salad. In general any comments made about the food in the home were quite positive and where they were not they indicated that the catering staff did try and meet their needs. I am rather fussy one person suggested. We saw several visitors to the home on the day of our visit and one person told that Care and communication is good. We saw evidence from the way care staff as well as engage workers interacted with people living in the home with dementia, that the training they have all done in dementia care has enabled them to provide stimulation and interest throughout the day, sometimes on a one-to-one basis. The home have recognised that these interactions are important although they are not always captured in records. Care Homes for Older People Page 15 of 26 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. People who live in Greenacres can be confident that if they wish to make a complaint they will be able to do so and that they will be listened to and appropriate action taken. They can also be assured that they are protected by the training given to staff to enable them to recognise abuse and what action to take if it is seen or suspected. Evidence: People who live in Greenacres or the people responsible for them told us that they knew how to make a complaint and confirmed that they felt more than able to raise any concerns with the manager or their team. Details of Quantum Cares complaints policy and procedure is readily available and well-publicised and the services of Age Concern Advocacy are available and publicised with monthly visits taking place. The home informed us in their AQAA that in the past year there had been 6 complaints all of which were dealt with within 28 days and one of which was upheld. The AQAA indicated that there had been three safeguarding referrals made by the home, the CQC is aware that there is one still ongoing. Quantum Care and the home have and are co-operating fully with this process. Care Homes for Older People Page 16 of 26 Evidence: This, together with confirmation from care staff spoken to and training records seen that safeguarding training is provided for all staff indicates that people living in Grenacres are protected from abuse as far as that is possible and that any complaints or concerns raised will be dealt with appropriately and taken seriously. Care Homes for Older People Page 17 of 26 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 living or working in Greenacres can be assured that the environment is safe, comfortable, clean and well-maintained. Evidence: In their AQAA the home set out the improvements that have taken place since the last inspection in June 2007, these include new kitchen units and flooring and soft furnishing in bedrooms. The manager also believes that the appointment of a housekeeping manager has assisted any issues around the environment to be identified and dealt with at an early stage. When we spoke to people who live in the home or who were visiting the home, they commented on the fact that there were no problems with unpleasant smells and that they felt the environment was clean and pleasant. When we walked around the home and with their permission went into the bedrooms of people who live in the home, we found that the standard of cleanliness was good and that the rooms were personalised to reflect the personalities and interests of the people whose rooms they were. The homes environment has been modified in order to help people living with dementia find their way around and to feel comfortable. We found that the garden has been set out and provided with seating to enhance its accessibility and effectiveness and on the day of the inspection it was being well used by people living in the home Care Homes for Older People Page 18 of 26 Evidence: and their visitors. Care Homes for Older People Page 19 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Greenacres can be assured that they are protected by the recruitment policies and procedures followed by the home and that there are sufficient numbers of care and ancillary staff, with the training, support and skills required to meet their needs. Evidence: People working in the home told us in surveys that they had all been subject to a rigorous process of recruitment, including the necessary checks and references and this was confirmed from the sample of recruitment files that we looked at for recently recruited staff. When we spoke to people living in the home they were very positive about the standard of care received from the staff. They are very good was one very typical comment received. When we looked at training records and spoke to staff, they confirmed that they receive a good level of training at a basic level and are all encouraged to take further developmental and more advanced training as well in order to improve their skills and knowledge base. Quantum Care have a structured programme of dementia care training, most if not all of the staff spoken to had already received the initial training and many had undertaken more advanced dementia care training. Training records seen confirmed a high level of training being undertaken and planned. The majority of staff who responded to our surveys told us that there were always enough staff on duty to meet the individual needs of all the people who live in Care Homes for Older People Page 20 of 26 Evidence: Greenacres. The only area of any concern raised appeared to be the co-ordination of work as between day and night staff, although this was not pursued with the inspector during the inspection at all and there were no adverse comments made about night staff by anybody living in the home. In their AQAA the home informed us that they now have five dementia champions who promote best practice within the home when caring for people living with dementia. All of the above suggests that people living in Greenacres are both overwhelmingly happy with the care they receive but are also receiving care from a well-trained and dedicated staff team. Care Homes for Older People Page 21 of 26 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. Greenacres is a well managed and run home and people who live or work there can be confident that their best interests are at the forefront of decision making. Evidence: When we spoke to care staff, people living in the home, relatives and visitors they were overwhelmingly positive about the way that the home is managed and run and about the manager and her team. Communication is good, her door is always open was how one relative put it. The manager indicated that she felt well-supported by Quantum Care and in turn her staff felt well-supported by her. The manager is very good was how one staff member expressed it. The records we saw of quality assurance undertaken both within the home and externally by the area management of Quantum Care indicate that the views of people living in the home and those responsible for them are sought actively and acted upon wherever possible. The AQAA was well-completed and was a realistic document, borne out in practice by what we saw and heard during the inspection process. When we asked staff about supervision Care Homes for Older People Page 22 of 26 Evidence: and looked at supervision records we found that there is a regular system to support and supervise staff in place and this is all to the benefit not only of the staff concerned but also those people who live in the home. When we checked the records and processes for the handling of money on behalf of people who live in Greenacres we found that it was essentially robust and thorough and subject to both internal and external checks to ensure that the financial interests of the people who live in the home are protected. Care Homes for Older People Page 23 of 26 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 24 of 26 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 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 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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