Care Home: Greengates

What the care home does well The service to residents is really centered around trying to treat each resident as a unique individual. Care plans are helpful and informative and guide staff to support the residents really effectively. There are interesting and thoughtful social and therapeutic activities put on for residents. Residents can enjoy a well cooked nutritious diet. Residents complaints are listened to and dealt with properly by Mrs Alcock. There is a really strong commitment to putting on a really varied range of training. There are effective ways used to monitor the overall quality of the service and the care that residents receive. The home is really well run and is run in the best interests of the residents. What has improved since the last inspection? We did not set any requirements at the last inspection. What the care home could do better: Care plans should include sufficient detail about residents full range of needs.This relates to the residents care plan that was identified at the inspection. If residents say a member of staff is, `bossy` this is fully addressed and if necessary suitable action taken. Key inspection report Care homes for adults (18-65 years) Name: Address: Greengates 697-699 Southmead Road Filton South Glos BS34 7QY     The quality rating for this care home is:   three star excellent 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: Melanie Edwards     Date: 2 8 0 9 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 Adults (18-65 years) Page 2 of 30 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 Adults (18-65 years) 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 Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Greengates 697-699 Southmead Road Filton South Glos BS34 7QY 01179236067 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Greengates04@tiscali.co.uk admin@aspectsandmilestones.org.uk Aspects and Milestones Trust care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is 15. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Mental disorder, excluding learning disability or dementia- Code MD Date of last inspection Brief description of the care home Aspects and Milestones Trust run Greengates Care Home, which is registered to provide nursing care to 15 adults with a mental disorder between 18 and 65 years old. The property is located in a busy residential area, close to some local shops and amenities. There are 15 single bedrooms of various sizes, all of which have sinks. There are parking spaces and grounds to the side and rear of the house. The fees charged for nursing care are 960 pounds a week. 15 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 30 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We did the unannounced inspection over one day. We met nine of the fifteen residents to find out their views of the home and what daily life is like for them. We met the registered manager, Mrs Jenny Alcock, three registered nurses and two care assistants. We spoke to them about their roles, responsibilities, training needs and how they assist and support residents. We saw residents being helped and supported by staff. We looked at a selection of records relating to the running and management of the home. The records we saw included a copy of the statement of purpose, the service user guide, five medication records, menus, the complaints record, the complaints Care Homes for Adults (18-65 years) Page 5 of 30 procedure,staff training records, the procedure for keeping safe from abuse , the staff duty rota, three staff employment records, quality monitoring information and the fire book. We saw two residents care plans and assessment records. We saw the majority of the environment, the only areas we did not see were a small number of bedrooms. We found that the home was operating within the required conditions of registration which we impose. The conditions of registration set out the type of care and the needs of residents as well as the numbers of residents who may stay at the home. Care Homes for Adults (18-65 years) Page 6 of 30 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 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 Adults (18-65 years) Page 7 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 30 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Residents can read a good amount of useful information to help them decide if the home is suitable for them. The help and care that residents need is planned and identified with them, before they move to the home. Evidence: To see what sort of information there is for people to find out about the home we looked at a copy of the service users guide and the statement of purpose. We were told that residents are given their own copy of the guide so they have information about the home. We saw that the statement of purpose and the service users guide both contain information about the service provided, the qualifications of the staff employed, and the accommodation. The philosophy of the home and the way that the service aims to support and help residents who have a range of complex mental health needs is clearly explained. We saw a copy of the complaints procedure in each service users guide so residents know how to complain if they need to. Care Homes for Adults (18-65 years) Page 9 of 30 Evidence: We looked at two of the residents assessment records to see how well needs are identified and then assessed. We found the assessment records were informative and they set out the residents mental health needs and social needs. We saw that residents had signed the assessment records. This is to show that residents have read and agreed with what had been identified as the care that they need. We also saw that the actions taken to support the person had been recorded in the assessment records. The assessment records we saw were being regularly reviewed and updated. The information is written in the first person style.This is done to help staff who read the records see the residents from a unique perspective. The nurse in charge talked to us about how residents needs are assessed. They explained that the home has a key worker system. They told us a member of staff will be allocated to take specific responsibility for building up a really good relationship with the resident. In the AQAA document we read some really useful information about how residents are helped to choose the home and we have quoted this extract:Greengates has a comprehensive statement of purpose written in plain english which meets required standards. The service users guide is accessible and informative, contains photos of the home, a copy of the terms and conditions and information about fees. Greengates has a clear admission and discharge policy. All prospective service users are assessed by a registered nurse who is a permanent member of the team and therefore able to answer questions relating to the services the environment or local facilities etc. This is in addition to the care management assessment of individual needs. Risk assessments and potential restrictions are discussed and agreed with the service user and multidisciplinary team prior to admission in the context of Mental Capacity and Deprivation Of Liberty legislation. If needs cannot be met the reasons for this are clearly stated and explained. The staff team are suitably trained and updated on practice issues via regular training, supervision and care plans. Specialist training is provided in order to facilitate the admission of a service user with specific needs eg. Huntingtons disease, nutritional requirements. The team provides a wide skill mix and covers the range of gender, race, age and cultural diversity which promotes an ethos of acceptance and inclusion. Individuals who wish to move into Greengates are invited to visit (with friends or relatives if they wish), stay overnight or for a weekend before making a decision. All placements are subject to a three month review period. All residents have an agreed set of terms and conditions detailing all relevant information and signed by the service user and home manager. Care Homes for Adults (18-65 years) Page 10 of 30 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Residents care plans generally show clearly how needs are met. One person could benefit if there was additional information in their care plan. Residents are well supported to live a full and varied life based on their individual needs and choices. Evidence: We read two residents care plan so that we could find out how residents are supported with their mental health needs. The information we read explained really well the persons range of mental health needs and what to do to help them meet those needs. However we read in one persons records that staff had been restricting the persons access to food from the kitchen at certain times. It was explained to us by the staff that matters around food can make the person becomes very anxious. We did not see this written in sufficient detail in the care plan. It would be beneficial to the person concerned as staff would be working with the person in a consistent way in this area Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: of their life. It would help staff understand really well how to support the person in this area of their life. We saw a good level of information in the care plans about the life history of the person and what matters to them including important family and friends. The care plans had been reviewed and updated regularly. This demonstrates the care that residents need and the support they get is clearly identified. The residents concerned had signed the care plans to show that they are in agreement with it. In our discussion with the staff we met it is clear that one of the main aims of the home is to support residents to develop their independence in their daily lives. We were told a really good example of this that that residents assist in the selection of new staff. We saw some really helpful information in the care plans that we read about the potential risks the person may face and any risks from particular activities that they do. The care plans explained what to do to keep people safe and was helpful and informative. We saw residents go out with staff for a range of social and therapeutic activities. This is good evidence of how residents are well supported to take risks in their daily lives. Residents are really well supported to have regular house meetings and to set the agenda and discuss what they feel matters. In the AQAA document there is some really useful information about individual needs and choices and we have quoted this extract : Greengates uses a well established system of person centred planning which seeks to involve the resident in planning, decision making and risk taking resulting in mutually agreed care plans. Residents are fully involved in relevant decision making within the home both on an individual level (eg. meal choices, personal activities, bedroom decorations) and at group level (eg. financial expenditure, priority setting, smoking policy). Service users are actively involved in staff selection. The key worker system means that each service user has at least two nominated team members with the responsibility to seek information about individual needs and choices and ensure this is promoted in chosen life styles . Care Homes for Adults (18-65 years) Page 12 of 30 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. Residents are well supported to take part in a range of suitable activities. Residents are well supported to be a part of the community and to have personal relationships if they want to. Residents rights are protected. Resident can enjoy a well balanced choice of meals at the home. Evidence: In the AQAA document there is some really useful information about residents lifestyle and choices and we have quoted this extract :The appointment of the activity coordinator and trial of an activity support worker from October has enhanced opportunities for residents to enjoy individual and group leisure activities. Most of the Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: residents have had the opportunity for a holiday away from Greengates at a venue of their choice (three people have been too unwell to go on holiday so far this year). Person centred planning focuses on personal development plans and aspirations, key workers are responsible for supporting the resident to work towards these. We make good use of local community facilities, shops, pubs, sports centres, as well as using specialist groups such as Rethink. We operate a friendly and flexible visitors policy and facilitate visits to the homes of residents families and friends. We have worked hard to support residents to maintain rebuild friendships and family relationships. Our motto is Do as you would be done by and mutual respect between all who live and work at Greengates is an important aspect of our philosophy. Meals are healthy, nutritious and varied. Our cook seeks the views of the residents, knows their likes and dislikes well and offers a choice of preferred meals. Special diets, pork free, diabetic, low potassium, lactose and gluten free are all well catered for. We use Four Counties community transport to enable residents to attend chosen activities at community venues. We have a dedicated project manager to work with residents to develop the Enterprise initiative. This will provide opportunities for residents to become involved in charity fund raising events, gain work experience skills and become actively involved in local and national groups. Mrs Alcock told us that there is a relaxed and flexible policy for residents who wish to receive visitors. She told us residents are supported by staff to keep in touch with people who matter to them. We saw this information explained in the service users guide. We saw art works on display through out the home. The home has its own art room and there are voluntary arts and crafts fund raising projects taking place involving residents and staff. These are really good examples of how residents are encouraged to take part in meaningful activities. There are chickens being cared for in the garden and this is a really good example of a therapeutic activity for residents to be part of if they want to. We looked at a copy of the current records of meals that residents have eaten over the last four weeks. We saw there were a variety of dishes recorded as available for each day. We saw a daily menu in the dining room telling people what meals were going to be served that day. We also saw a notice board where people can tell the cook what meal options they like or do not like. The residents told us that the cook comes and asks them what meals they would like on a really regular basis. This is a really good way that residents make choices in their daily lives. We saw a varied choice of meal options available for the residents. Meal choices included a range of Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: traditional, nutritional meals. The lunchtime meal of scrambled eggs, fresh tomatoes and toast looked healthy and appetising. Care Homes for Adults (18-65 years) Page 15 of 30 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Residents are well supported with their physical and mental health care needs. Residents medication is handled given out and disposed of safely. Evidence: In the AQAA document there is some really useful information about personal health care and support and we have quoted this extract:Service users personal care requirements are detailed in their care plans and personal care statements. Same gender assistance is given priority. Personal care is delivered in a sensitive and respectful manner. Care plans give comprehensive information about service users physical, mental, social and emotional needs. The deputy home manager has special responsibility for overseeing the clinical needs of service users at Greengates. All service users are registered with a local GP and have regular optician, dental and chiropody checks. Specialist resources are accessed via the GP as required. Most of our service users are supervised by a consultant psychiatrist and care review meetings, including medication reviews are held at least six monthly. Those service users who do not have direct psychiatric input can be referred as required by their GP. Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: There are comprehensive procedures in place to ensure safe administration and storage of medications. We enjoy a good working relationship with South Glos. and Bristol Primary Care Trusts and hospital teams. One of our residents contracted swine flu and was nursed in isolation to prevent infection of other residents. Our local swine flu policy was followed and no other resident contracted the virus. To find out some more about how residents are supported to meet their care needs we read two care plans. We found that there was really helpful information in both care plans. The care plans showed how to give the right support and care for the residents who have very complex mental health needs. The care plans had been reviewed and amended regularly. This show us that the home keeps a really, close eye on residents needs to make sure they can still give them the right support and care. We saw some of the staff on duty help and support the residents in a kind and sensitive way. We also discussed with the nurse in charge the care needs of the residents. The nurse demonstrated that they had a really good understanding of residents mental health needs. We looked at the way that residents medication is given to them, stored and disposed of to see if this is done correctly. We looked at the medication administration charts of five residents. The medication administration charts were legible up to date and had the signature of the nurse giving out the medications. This helps demonstrate medication is given to residents safely. We also saw extra information written by the nurses at the home explain the ways that people like to take their medication as well as what they are for. This information should mean residents are given medication in the way that suits them best. The stock of medication we saw was satisfactorily organised. We saw a nurse signing in medications amount and quantity in a record to show that medicines have arrived at the home from the pharmacy and are stored safely. Care Homes for Adults (18-65 years) Page 17 of 30 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. Complaints are dealt with really well by Mrs Alcock. There are effective ways in the home to keep residents safe from abuse and harm. Evidence: In the AQAA document there is some really useful information about complaints and protection and we have quoted this extract : Complaints are encouraged as a sign of an open and honest culture. Residents are encouraged and assisted to complain and staff advocate on their behalf if necessary. All complaints are taken seriously and fully investigated. The results are reported back to all individuals concerned. Follow up with Safeguarding Adults managers is initiated as required. Complaints by one resident about another are ideally resolved through discussion and negotiation. Group complaints can be aired at residents meetings Residents are encouraged to discuss and review complaints procedures at fortnightly residents meetings. A copy of the complaints policy is included in the service user guide. All staff have received safeguarding adults and Mental Capacity Act training. We checked the complaints records to see how complaints are dealt with by the home. There had been a number of complaints made by residents about other residents since before the last inspection. We could see from the information we read that residents are listened to and given a chance to make their views known, if they feel they have been treated wrongly by another resident. We also saw that where needed action is Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: always taken by the home. In our discussions with staff who we met they conveyed to us an understanding of the importance of supporting residents to make their views known if they are unhappy about any aspect of life in the home. All of the residents who we met said they could talk to the staff if they need to. We saw a copy of the complaints procedure kept in the home. This has our contact information as well if people need to get in touch with us We were told by residents that there are regular residents meetings. The meetings are used as a way for residents to make known any complaints they may have. This is a way residents take control in their lives and can make complaints if they need to. We saw a copy of the homes policy relating to the issue of protection of vulnerable adults from abuse. The policy is to help to guide staff to take the correct course of action if they ever have to respond to an allegation of abuse. The staff do training courses in understanding the principle of the protection of vulnerable adults from abuse. The staff we spoke to had an understanding about the subject of abuse and how they protect residents in the home. Care Homes for Adults (18-65 years) Page 19 of 30 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. Residents live in a safe,suitable and homely environment. Evidence: Since the last inspection the home has had a purpose built two floor extension built on to it. The numbers of people who live at the home has increased to fifteen. The main building is two houses that have been converted into one property built over two floors, which can be reached by stairs only. There are three ground floor bedrooms for people who may not be able to walk up stairs. The original building is over one hundred years old. There are five single bedrooms all with en-suite toilet and shower facilities in the new building as well as a spacious quiet lounge. One resident who lives in the new building kindly showed us their room. They said they like living there. There is also an additional light and airy dining area,as well as the facilities in the original house. There is access to all part of the home for all residents. The residents we saw looked relaxed and in their surroundings. The bedrooms look personalised with residents personal possessions, photographs and pictures are displayed in some rooms that help to create a more personal feel to rooms. Residents we met told us they had been able to chose the colours of the paint for the walls of their bedrooms. This is a really good way to give residents choices in their daily lives. Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: Furniture and fittings are provided including a wardrobe a comfortable chair a bedside cabinet and a chest of drawers in each room. We saw residents artworks on display in their rooms and throughout the home.This makes the environment look more homely. Bedrooms in the original part of the home do not have en-suite facilities however there are toilets, a shower or bathrooms located close to bedrooms on each floor. In the original part of the house there is dining room situated on the ground floor, as well as a television lounge and a designated smoking lounge, this is a popular room as a number of residents are smokers. In the AQAA document there is some really useful information about the home environment and we have quoted this extract : Greengates provides a comfortable and homely environment for the people who live here. Residents take pleasure and pride in their bedrooms and are encouraged to decorate to their taste and display their personal possessions. The main house has recently undergone a comprehensive refurbishment and offers modern, clean and contemporary surroundings, including refurbished bathrooms, toilets and showers. The annexe provides additional accommodation for individuals who need ground floor accommodation and has specialist facilities such as an assisted bath. Health and safety checks are carried out regularly and all concerns acted upon to ensure a safe environment. Residents are encouraged to take a pride in their home and have agreed, allocated chores which are rotated on a monthly basis eg. laying tables for dinner, buying a daily newspaper at the local shops. Maintenance and repairs are carried out as required by the company John Dean contractors. Communal areas are comfortable, relaxed and informal. Residents are fully involved in choosing the colours, fixtures and fittings throughout. All residents who have been assessed as having additional needs have the specialist equipment they require to maximise their independence. We employ a housekeeper every day to ensure the home is kept clean and hygienic. Comprehensive infection control policies are in place and additional training has taken place for staff in view of the swine flu threat. Nurse call and fire systems have been reviewed and updated. Care Homes for Adults (18-65 years) Page 21 of 30 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Residents are cared for by a sufficient number of competent staff. The staff are well supported and supervised in their work. Recruitment practises are safe and protect residents. Evidence: Residents made some really positive remarks to us about the staff and the support that they are given. One resident said,they are looking after me very well, they look after my every need, another person said,Im attended to very well by the staff they are very attentive. We were told by residents that a staff member was allegedly,bossy. We relayed these opinions to Mrs Alcock to act on and she agreed to do this. We checked the number of staff on duty for the last four weeks to see if there are enough staff on duty to support the residents properly. We saw that there is a registered nurse on duty at any time of the day or night,as the home is a registered nursing care home. There are four support staff on duty for a morning shift and three on duty for an afternoon shift. There are two staff at night. Mrs Alcock works full time Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: hours Monday to Friday and she is supported by a full time deputy manager as well. There are also extra care and nursing staff on duty if needed to offer extra support to residents. There is also a full time domestic worker and a full time cook employed to offer extra care and support in the home. We looked at staff employment files of three care staff. We saw two written professional references taken up for all new staff prior to offering work at the home. All staff complete do a criminal records bureau check before starting employment. These checks aim to make sure the home takes on only suitable people to work with residents. The staff who we met told us that they feel really well supported in their work. The staff also said they have regular one to one meetings with a named supervisor. This is done to guide and support staff in their work. We saw records that confirmed for us staff have regular one to one support meetings,with an experienced fellow member of the staff team. In the AQAA document there is some really useful information about the staff who care for the residents and have quoted this extract : Greengates has a competent, stable and well trained team which has an excellent skill mix. This provides service users with staff who have a range of professional, vocational and life skills. The home has an annual training plan and all staff receive regular statutory training. Greengates has an annual business plan which details objectives for the coming year in relation to residents, staff and environment. Staff have regular supervision and support meetings. Each member of staff has a personal development plan which contains learning objectives and the means to achieve them. Learning objectives are linked to the annual business plan and residents needs. The well being of team members is recognised as having a direct relationship with the quality of care and support provided to service users. Nursing staff maintain their post registration education and practice and recognise their professional responsibilities to regularly update practice. The majority of the care staff have National Vocational qualifications,(NVQ) to level 2 or above and two staff are currently working towards NVQ3. We have a dedicated activity coordinator and plan to employ an activity support worker A number of staff have delegated responsibilities such as health and safety, ordering supplies, finance record keeping, ordering medications etc. The Trust has a comprehensive recruitment and selection policy and all staff are checked and undertake probation and induction training which meets national Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: standards. Service users are actively involved in staff selection. The number of staff on duty meets and often exceeds minimum staffing numbers required and is sufficient to meet resident needs. We have cook and housekeeper support so care staff can concentrate on meeting residents needs. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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. Greengates is really well run. The health and safety of people at the home is maintained. Evidence: In the AQAA document there is some really useful information showing how the home is being really well run.We have quoted this extract, as we think it shows how the home is being run in the best interest of the residents: The manager is suitably qualified for the post and has twenty six years of management experience in the care environment. Leadership style and decision making are participative and service users interests are at the core of policy and practice. Systems and practices at Greengates are based on well established and proven methods but equally take account of new evidence and innovation in practice. The staff team are familiar and knowledgeable with regard to policies and procedures and know when to seek management advice and support. There are regular staff meetings and sound communication systems in the home. Record keeping and policies and procedures within the home are relevant, comprehensive and audited annually. Confidentiality and security of personal Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: information is safeguarded. The staff team undertake regular training in fire safety, manual handling, food hygiene and first aid. Fire systems are regularly checked and maintained. Maintenance within the home is well organised and responsive to need. The home is visited at least monthly by a senior Manager. Health and safety legislation is reflected in organisational and in-house policy and practice. Audits are carried out at regular intervals. Residents monies are safeguarded in compliance with organisational standing financial instructions and in-house policies and procedures. These are audited internally and externally. Staff are recruited according to comprehensive recruitment and selection policies and require full references and police checks prior to employment. One resident said to us that they see Mrs Alcock a lot and she was,alright. We saw Mrs Alcock talking to residents and supporting them. We noticed how comfortable residents were to approach her and ask for help. The staff said Mrs Alcock was approachable and they could go to her with any problems at anytime. As we have already referred to there are residents house meetings and residents can set the agenda. Residents are also involved in the recruitment of new staff in the home. These are really good examples of the open management style of Mrs Alcock. Mrs Alcock talked to us about her plans for the continued development of the home for the benefit of the residents. One recent way of enhancing daily life for residents is a fund raising project involving residents and staff aimed at offering residents more opportunities to do things that they enjoy in the community. We saw the results of a recent very detailed quality monitoring exercise that had been carried out by a member of staff who works for Aspects and Milestones Trust and who is a mental health nurse. We could see that the overall standards of care and service for residents had been looked at really closely. Really good practice had been identified, however areas that may need improving had also been written about in good detail. This is a really good way of checking the care residents receive and improving standards even more. We found that residents records were satisfactorily maintained up to date legible and in order. The records relating to the management of the home were also satisfactorily maintained up to date and in order. The records were kept secure in the home and available to staff when needed. We have referred to other records elsewhere in the report. Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: The environment looked safe and satisfactorily maintained throughout. There are health and safety audits carried out of the whole environment on a very regular basis. These aim to address health and safety areas through the home. Staff do regular training in health and safety matters including first aid, food hygiene training and moving and handling practices. This should help protect residents health and safety if staff are knowledgeable and well trained in these health and safety principles and practices. The fire logbook records showed fire alarm tests are being carried out. There are also fire drills carried out on a regular basis to help protect the health and safety of residents and staff. We saw that the kitchen was tidy and organised. We saw checks of kitchen fridges and freezers are maintained to ensure they are operating within food safety guidance levels. We saw records to demonstrate that high risk foods are temperature probed before serving to ensure the food has reached above minimum required temperature. We saw staff who are directly involved in care duties were serving food to residents and going into the kitchen wearing suitable protective aprons to minimise the risks of cross infection from their uniforms onto food or surfaces in the kitchen. Care Homes for Adults (18-65 years) Page 27 of 30 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 Adults (18-65 years) Page 28 of 30 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 1 7 Ensure all care plans explain how to support people in sufficient detail. This recommendation relates to the care plan identified at the inspection. Care Homes for Adults (18-65 years) Page 29 of 30 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. 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