Care Home: Greenfield Care Home

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What the care home does well Central to Greenfield`s aims and objectives is the promotion of the individuals right to live a meaning full life. People in the home enjoy living there, a relative reported that a "fantastic" service is given to their family member, a professional reported that they "treat people with infinite patience and dignity". The expert found "staff were welcoming, friendly and helpful". Staff have the specialist training and skills to support the individual. Staff have National Vocational Qualifications. Training of staff in the area of protection is regularly reviewed. People`s support plan include risk assessments, risks are managed positively to help people lead the life they want. Household routines are flexible. Meals are well balanced, nutritional and cater for the needs of people. Staff respect peoples preferences. The home is comfortable and clean. People reported that they enjoy being at Greenfield. What has improved since the last inspection? The provider, the manager and staff have worked hard to improve the standard of care delivered to people. Person Centred Planning (P.C.P.) is being developed, promoting very individualised care. People continue to be happy living at the home. A relatives committee has been established and there is a good relationship with the home. Professionals who responded to the survey forms were positive about the care provided. The environment has improved rooms have been painted, and carpets replaced. CARE HOME ADULTS 18-65 Greenfield Care Home 385/387 London Road Mitcham Surrey CR4 4BF Lead Inspector Jean Stuart Key Unannounced Inspection 4 & 5th August 2008 08:00 th Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenfield Care Home Address 385/387 London Road Mitcham Surrey CR4 4BF 020 8687 3131 020 7431 8618 fbawana@yahoo.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Greenfield Care Homes Care Home 9 Category(ies) of Learning disability (9), Physical disability (9) registration, with number of places Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Greenfield also referred to, as London Road Lodge, is a registered care home for nine residents with a learning disability. The home is on two floors of a detached property and is situated within a residential area of Mitcham. Parking is to the front of the home. Public transport bus services and the tramline are within a short distance. The home currently has eight residents. The fee range is from £1200 to £1250. Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars. This means people who use this service experience Good quality outcomes. Greenfield provides a care service for people with a learning disability living in the community. We visited Greenfield twice, one visit on 4th August 2008 at the beginning of the day from 8am to 11.20, the second visit on 5th August 2008 from 3pm until 7.45pm. The second day an expert by experience accompanied us. Experts by experience are people whose knowledge about social care services comes directly from using them. We spent eight hours and spoke with seven people, the manager and three staff members. We saw records and documents, including care plans, risk assessments, medication and food records, and the complaint log. One relative was spoken with. Survey forms were sent to people using the service, to staff and professionals. Completed surveys were received from one person, four staff, and four professionals The home completed an Annual Quality Assurance Assessment (AQAA) to tell us about the service provided, how it makes sure of good outcomes for the people using it and any planned future developments. The AQAA was completed to an adequate standard. What the service does well: Central to Greenfield’s aims and objectives is the promotion of the individuals right to live a meaning full life. People in the home enjoy living there, a relative reported that a “fantastic” service is given to their family member, a professional reported that they “treat people with infinite patience and dignity”. The expert found “staff were welcoming, friendly and helpful”. Staff have the specialist training and skills to support the individual. Staff have National Vocational Qualifications. Training of staff in the area of protection is regularly reviewed. People’s support plan include risk assessments, risks are managed positively to help people lead the life they want. Household routines are flexible. Meals are well balanced, nutritional and cater for the needs of people. Staff respect peoples preferences. The home is comfortable and clean. People reported that they enjoy being at Greenfield. Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Before agreeing admission, the service carefully considers the assessment for each person and the capacity of the home to meet their needs. EVIDENCE: A person said “I like my home” another person told the expert by experience that it is “good”. The home currently has two vacancies. Admissions only take place when the service is confident that staff have the necessary skills, abilities and qualifications to provide good quality care. Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are involved in the daily and longer term planning of their care. Person Centred Planning (P.C.P.) is now in use. Satisfactory risk assessments by the manager are in place to make sure individuals are independent but remain as safe as possible. Listening to people and consultation with relatives promotes the delivery of appropriate care. EVIDENCE: People reported on the things they enjoy and the decisions they make about their lives. It is evident that staff know the preferred communication style of each individual. Staff understand the importance of people being supported in decision making on a daily basis. The service involves individuals in the planning of care that Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 10 affects their lifestyles and quality of life. A relative reported that being at the home has improved the quality of live for their family member. Professional all reported that people can live the life they chose, one person said to this question “from my observations a definite yes”, another respondent said “they have shown they respect the needs of people”. The records show that people make their own choices about what to do. People go to day care and spend time athome following activities they enjoy such as massage. The expert by experience found that “there is enough staff to help them do what they wanted and get to places”. Independence and choice is promoted by the home. The Expert by Experience interviewed two people, and was told about the two lounges and “physio, massage puzzles and musical games”. People also “did cookery and were involved in household chores”. We saw that some people when going to the centre always walk with staff; others took the allocated bus to the day centre. Independent living skills are promoted and people are encouraged to do things for them selves if possible. Each support plan has a satisfactory risk assessment, which indicates the area of risk and how it is managed. With the move to Person Centred Planning, care plans are now focused on people’s needs, wishes and aspirations. Plans showed peoples’ desire to go swimming more often, to go horse riding and the steps that are necessary to achieve this. One professional confirmed that they had “supported a person to go swimming” and provided one to one support for them. The expert by experience found choice around getting up and going to bed times. “bedtimes varied according to what people were doing the next day”. People spoke of staying up late “watching snooker and darts on TV”. Four care plans were sampled. These had details on physical, emotional and social needs. The key worker system allows staff to work on a one to one basis with people, and to work to time scales for tasks to be achieved. The care plan is a working document and reflects the care being delivered. This is supported by entries made in each person’s daily diary. Daily diaries could be more detailed concerning when and where an event took place. The manager spoke of meetings about what is happening in the house and how the “residents protection committee” gives the relatives views of the service. We saw minutes of meeting held by this committee. The regular review of peoples needs are carried and signed by the care worker. The person attends the major review and if they wish, the family and the allocated care manager. Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 11 Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15, 16,17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to enjoy a range of activities, both at home and in the community, meeting with family, visiting clubs , and activities of their own choosing. Meal times are viewed very positively and are seen as an enjoyable time. EVIDENCE: People reported they enjoyed “seeing family” and memories of holidays were spoken about. We saw that swimming was planned with family. Such activities are carried out with the assistance of staff as required. A professional reported “they demonstrated a flexible approach to meeting the activity needs of people”. Another person stated “they make sure people have day time activities to go to”. Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 13 The service understands the importance of enabling people to achieve their goals and be integrated into community life. Goals have been identified as a part of the care plan. Some people visit the “gateway club in the evening”, relatives call into the home, and take people out. People are planning to go to a barbeque at the local day centre. A person spoke of going shopping with a carer, and attending church on Sunday. When at home, the records show that people watch T.V., listen to music, play with games, and play the keyboard. The expert was also told about these choices. The expert by experience reported that the food looked “appetising and people had help to eat if they needed it.” We heard people being are offered some choice with regard to what they eat at meal times. Meals are well balanced and highly nutritional and cater for the varying dietary needs of people. As required some people were served with soft food. For people who have difficulty eating staff give assistance, it was noted by the expert that a person who “touches the staff members hand” controlled the process when ready to eat another spoonful. A variety of cups/beakers are used to enable people to drink with more independence and dignity. The expert noted “equipment like plate guards and bibs being used appropriately”. We saw that meals are served outside of the main meal slot if this is what people prefers. Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive effective personal and health care support based on individual needs and preferences. Knowledgeable staff deliver good care recognising physical and emotional needs. Staff training is given in the home’s medication policies and procedures protect people from harm. EVIDENCE: We found the delivery of personal support to be individual and flexible, consistent and reliable. A person centred approach by promoting the best interests of the person reflects the right to dignity. Individual support was given depending on the activity, and the individual’s needs. Staff respect users preferences. Staff were receptive to statements made by non verbal people, the expert saw an illustration of how when a shower is needed a person they will bring a towel to a member of staff Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 15 People’s health care needs were documented in their health care plan, a community nurse helps to monitor their health care. Personal support is responsive to the preferences of the individual. People are encourage to fully utilise their physical abilities and the expert by experience found that a persons use of a wheel chair has been greatly reduced “due to the encouragement of the staff and the physio” and “this enabled them to improve their quality of life”. If people are unable to balance the home has a weighing scale that can be put on a hoist, as noted by the expert by experience this means people can “keep an eye on their weight”. Staff are trained in health care matters, and arrangements are made on specialist areas as required. We saw medication removed for administration purposes from the cupboard by staff, this was dealt with in an appropriate manner. The medication record showed that all medication is signed for when people accept the medication and another member of staff checks the record. The files reflect medication training and staff confirmed this. The expert by experience observed medication as it was given and noted that people were encouraged to swallow tablets, and this is checked by staff. Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People feel safe and secure in the service provided. People are protected from harm by appropriate training for staff. EVIDENCE: The complaint procedure is in the Statement of Purpose/service users guide. A makaton version of the complaint procedure is on the notice board in the dining area. Staff know the importance of taking view seriously and of listening and responding to issues raised. Three complaints have been raised since the previous inspection. All three complaints were dealt with appropriately. The three professionals in their surveys had no reason to complain. In January 2008 there was a safeguarding concern dealt with by the local authority. The matter was resolved through developing a better understanding of the issue. Staff records indicate they have received training in abuse and neglect, to minimise the risk to people. People expressed no concerns about their lives at the home. People mentioned to the expert by experience, several staff who they could talk to also they felt comfortable going to the manager. The expert by Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 17 experience ound that “they could tell staff or the manager anything they wanted” a person said “the manager has time for me”. Relatives have formed a “residents protection committee”. Staff informed that expert that family and friends meet three monthly and act as advocates for individuals. Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The accommodation provides for the requirements of the individual, and has aids and adaptations. It has single rooms, a many of which have ensuites. The environment is clean, safe and comfortable The home is maintained to an excellent standard. EVIDENCE: People were positive about the environment provided. One person said they have “a nice room”. The expert by experience found Greenfields to be “well decorated, looked pleasant, clean and tidy and well furnished”, and “there was plenty of space for people including the wheelchair users. It felt comfortable”. Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 19 There is a selection of communal areas both inside and outside. People have the choice of where to sit. The house was well equipped to meet peoples needs. The expert by experience found there are “walk in showers, support rails where needed, non slip edges to stair treads and stays on doors to stop them closing too quickly” . Many rooms have ensuite facilities and there are sufficient toilets to enable immediate access. The garden is pleasant. It was confirmed by the expert by experience that the garden is well used by people and they have barbeques, also it has a “swing for people who need physical support to sit”. The expert found “the lounge /diner area very noisy, with the TV and CD music on” this was individuals choice. We found the home well lit, clean and tidy and smelt fresh. Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All recruitment checks are complete before a person starts work. Staff have benefited from mandatory training, and National Vocational Qualifications (NVQ). Staff are appropriately trained to support people. EVIDENCE: When asked by the expert by experience about staff, people there is enough staff to help them what they wanted and go places”. Positive comments were given “I love them” “they’re nice”, another person “smiled and nodded enthusiastically”. We found that people and staff seemed “comfortable and at ease with each other”. During the inspection staff were consistently available to meet the needs of people. Staff demonstrated a good knowledge and understanding of people. When asked by the expert about the staff We saw staff got on well with people and the atmosphere was light hearted and relaxed. Staff have the skills to communicate effectively with people. Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 21 Staff reported that they have National Vocational Qualifications (N.V.Q.) level two and three and have taken courses in moving and handling, medication, and food hygiene. Individual training certificates supported this. Professionals reported that the staff are very open to their suggestions and one person said “from my observations, yes” they have the right skills. The manager demonstrated that the service has an understanding of equality and diversity throughout their recruitment process employing staff of different genders and from different cultures. The manager has been able to employ staff who reflect the gender of people living there. Staff reported that their references were collected and CRB check carried out before they were employed. The staff files supported this. Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the necessary skills and qualifications to discharge their duties. The manager has a clear vision and is searching for continuous improvement to the service in the best interests of the people. EVIDENCE: The manager has the required qualifications and experience to run the home. She has a clear understanding of the key principles and focus of the service. There is a strong focus on equality and diversity and promoting human rights, an aspect of this is the opportunity to develop friendships. Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 23 The manager ensures that all staff are trained in health and safety matters. Individual training records reflect this and regular updates are planned ahead. Policies and procedures are regularly reviewed. Feedback on the service is sought on a regular basis from the “residents protection committee” who are people’s advocates. This evaluation of the service should also formally include people living at the home and stakeholders in the community eg GPs, social services, community nurses. Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 x 26 x 27 x 28 x 29 x 30 4 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 2 x x 3 x Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 25 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The registered person should ensure the Statement of Purpose and service users’ guide is produced in a format suitable for people who live at the home. This evaluation of the service should include not only the relatives but people living at the home and stakeholders in the community eg GPs, social services, community nurses etc. The evaluation will help to identify the areas the service does well in and the areas that can be improved. 2 YA39 Greenfield Care Home DS0000061460.V365572.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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