Care Home: Greengates

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What the care home does well The aim of the home is to support and encourage people to maintain and develop daily living skills. The home is situated in a residential area and is only a few minutes walk from local shops. People are enabled to attend a day centre, local college and access the local community where possible. The home provides a good range of activities such as horse riding, local walks, and social club. People are encouraged to exercise choice. There are visual communication systems in place throughout the home. This is provided in the form of photographs and symbols. The home is maintained to a good standard of cleanliness. What has improved since the last inspection? At the last key inspection two requirements were made. As required staff have received training updates in the protection of vulnerable adults and staff recruitment systems now meet the required minimum standards. Five recommendations were made at the last inspection. It was recommended that the Residents Guide be further improved to meet specific service users communication needs. This recommendation has not been implemented and remains recommended. It was recommended that more in-house activities and resources be provided, which have been implemented. It was recommended that one service user care plan details what learning takes place during the day at the day centre. This recommendation has been met. It was recommended that reasons for returns medication be added in the returns book, and it is also recommended that variable dosage is recorded and specified on the Medication Administration Record. Returns medication is now recorded but variable dosage recording was still omitted. This is now required. What the care home could do better: This was a positive inspection where people at the service benefit from a stable and staff team dedicated to meeting individual needs of people living at the home. As a result of the inspection four requirements are made. Tiles that have fallen off the splash back wall in the kitchen must be replaced so that effective cleaning can take place. It is required that the variable dose of laxatives be recorded on a person`s daily medication record. This will enable monitoring of a therapeutic dose. Monitoring of people`s weight if they are at risk of low or high body mass must be supported by a nutritional plan. Finally, the manager must consider how confidentiality can be ensured when storing care documents in the home`s lounge. A number of recommendations are made to the home. The kitchen should be upgraded by replacing worn work surfaces and damaged kitchen units. Carpetsin corridors and on the stairs are also becoming worn and would benefit from replacement. Although bathrooms have been redecorated in the last two years consideration should be given to how the bathrooms could be made more homely to improve the bathing experience. It is recommended that a current medicines reference book be purchased for the home. The home`s Resident`s Guide would be more meaningful to people who live at the service if it were produced in an easy to read format. CARE HOME ADULTS 18-65 Greengates 26 Fore Street North Petherton Bridgwater Somerset TA6 6PY Lead Inspector Mrs Judith McGregor-Harper Key Unannounced Inspection 31st March 2008 09:00 Greengates DS0000033922.V359776.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 Greengates DS0000033922.V359776.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. Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greengates Address 26 Fore Street North Petherton Bridgwater Somerset TA6 6PY 01278 663871 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) Somerset County Council (LD Services) Mrs Frances Jane Hunt Care Home 7 Category(ies) of Learning disability (6), Physical disability (1) registration, with number of places Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th September 2006 Brief Description of the Service: Greengates is a care home providing personal care and accommodation for seven people with learning disabilities including one person with physical disabilities. Greengates is a home run by Somerset Social Services (now Community Directorate). The responsible individual is Mr. David Dick. The registered manager is Mrs Frances Jane Hunt. The home is situated on the main road in the village of North Petherton. The home is within walking distance of all the amenities in the large village. The house is set back from the road and has ample parking for staff and visitors. Greengates is a large detached house. All of the bedrooms are single occupancy. Bedrooms are located on the ground and first floor. Current fees at the home are £63.95 per week. Mobility charges for use of the home’s transport vary on an individual basis from £7.58 - £16.50 per week. Greengates DS0000033922.V359776.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 star. This means that people who use this service experience good quality outcomes. This inspection took place over one day in March 2008 and was carried out by one inspector. The inspection was unannounced. Seven people were living at the home on the day of the inspection. People living at the service are aged between 40 – 58 years. Both women and men live at the home. There have been no admissions to the home since the last key inspection and there are no vacancies at the home. We were able to observe staff interactions with people living in the home and spend time socialising with people living there. We also received four survey responses from people living at the home, although key worker staff completed responses on behalf of the individual residents. We spoke with duty staff. We sent out surveys to health professionals linked to the service but to date no replies have been received. The manager Mrs. Hunt was on duty and available during the inspection process. We would like to thank the duty staff for their time and hospitality shown to the inspector. Care services are judged against outcome groups. They allow us to judge how well a provider delivers outcomes for the people using the service, rating them as Excellent, Good, Adequate or Poor. This judgement is based on the standards looked at during the inspection process. Records examined during the inspection were two care and support plans, written risk assessments, staff recruitment and supervision records, staffing rosters, staff training records, complaints/compliments, quality assurance records, medication administration records and maintenance records. After the inspection, at our request, the home provided and forwarded a copy of the revised Statement of Purpose and details of current fee levels charged at the home. We asked the service to complete an Annual Quality Assurance Assessment (AQAA). This was completed and returned to the Commission in the required timescale. What the service does well: Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 6 The aim of the home is to support and encourage people to maintain and develop daily living skills. The home is situated in a residential area and is only a few minutes walk from local shops. People are enabled to attend a day centre, local college and access the local community where possible. The home provides a good range of activities such as horse riding, local walks, and social club. People are encouraged to exercise choice. There are visual communication systems in place throughout the home. This is provided in the form of photographs and symbols. The home is maintained to a good standard of cleanliness. What has improved since the last inspection? What they could do better: This was a positive inspection where people at the service benefit from a stable and staff team dedicated to meeting individual needs of people living at the home. As a result of the inspection four requirements are made. Tiles that have fallen off the splash back wall in the kitchen must be replaced so that effective cleaning can take place. It is required that the variable dose of laxatives be recorded on a person’s daily medication record. This will enable monitoring of a therapeutic dose. Monitoring of people’s weight if they are at risk of low or high body mass must be supported by a nutritional plan. Finally, the manager must consider how confidentiality can be ensured when storing care documents in the home’s lounge. A number of recommendations are made to the home. The kitchen should be upgraded by replacing worn work surfaces and damaged kitchen units. Carpets Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 7 in corridors and on the stairs are also becoming worn and would benefit from replacement. Although bathrooms have been redecorated in the last two years consideration should be given to how the bathrooms could be made more homely to improve the bathing experience. It is recommended that a current medicines reference book be purchased for the home. The home’s Resident’s Guide would be more meaningful to people who live at the service if it were produced in an easy to read format. 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. Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 8 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 Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 9 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): Standards 1 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a range of information provided about the service that is up to date to assist people to make an informed decision about moving into the home. EVIDENCE: The home has a Statement of Purpose that provides details of the services and facilities provided at Greengates. The Statement of Purpose was revised and updated in January 2008. A copy has been provided for the Commission. The Statement of Purpose also included an honest appraisal of issues that the service plans to address (fabric of the building). This is good practice. Both care plans inspected included a contract, which outlined what the service provides. These have been read and signed by families of people living at the service. The contract was provided in easy to understand format including symbols. Each person has their own Residents Guide in their bedroom. This promotes good practice. Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 10 There have been no new admissions to the home since the last inspection. There are no vacancies at the service. Standards relating to assessment of people’s needs prior to admission and introductory visits were assessed and met at the last inspection. Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 11 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): Standards 6, 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a detailed care plan for each person to enable individual care. People are encouraged to exercise choice and participate in all aspects of life within the home. People are supported in taking managed risks. Records relating to people are not always stored securely, which may compromise confidentiality. EVIDENCE: Care plans are maintained for each person. Two care plans were examined in detail. Care plans included a photograph and provided information regarding individual needs. This included social assessment, personal care, dietary needs, behaviour, emotional, social, health, personal interests, relationship and life skills. The care plan also includes a summary of risks. Care plans included daily entries and monthly summaries and assessments. Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 12 The Residents Guide that is provided is in a simple easy to understand format and is made available to each person living at the home. However, as commented at the last inspection it is recommended that the Residents Guide be further improved to meet people’s specific level of understanding. This could include tape recording, symbols, pictures or photographs. People are encouraged to exercise choice and independence is promoted. We observed staff communication via signing with people, where people did not have verbal skills. People were observed participating in tasks within the home and they were consulted making choices using objects of reference. The home operates a key worker system to ensure that the home continues to meet the needs of each person. We spoke with two duty staff that work as key workers. They had detailed current knowledge of the support needs of people they act as key worker too. Staff will support people in managing their finances where required. Financial records were examined at random for one person. Receipts and two staff signatures supported all entries. The money was checked and the final balance was correct. A routine monthly audit of people’s finances carried out by the provider was planned for the evening of the inspection. This was followed up by telephone call after the inspection and was reported as being found to be correct. Staff spoken with explained how people are consulted regarding the meals and menu planning. People are involved in weekly menu planning and shopping at local stores. One person was out shopping for groceries with staff support on the day of the inspection. Daily activity records are stored in the lounge for staff to access to keep daily records up to date. This can compromise confidentiality, as records are accessible to visitors. The manager must consider how confidentiality of records can be maintained if records are stored in the lounge. People’s care plans are kept in their bedroom, which promotes good practice. A visual communication board was observed in bedrooms seen to display photos of staff working on duty that day. This had been adapted to the specific communication needs of one person in order to display information in a more personalised way to assist understanding. This is good practice. Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 13 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): Standards 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers people opportunities to engage with peers, access appropriate leisure activities and exercise choice. People’s rights and responsibilities are respected. There is a choice of menu, and people indicated that they enjoyed the meals provided. EVIDENCE: People are supported in developing and maintaining daily living skills. Staff from the home will assist people in continuing to access social and educational resources. During the inspection one person was shopping in the village and another person was receiving support with living skills at a day centre. People were also being encouraged to take part in domestic tasks at the home. On the day of the inspection, seven people were at home although people came and went from the home during the day to attend planned leisure or Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 14 health care appointments. We met all but one of the people living at the service. Bedrooms were personalised with people being active in hanging decorations, rope lights, choosing photographs, making art or displaying horse riding rosettes. People access a range of timetabled activities for example; local walks, day service, horse riding, social club, Fullbrook College, swimming and gardening. There are now more structured in-house activities, more arts and craft and during the inspection four people enjoyed a DVD in the communal lounge and one person chose to play a piano in the home’s conservatory. Greengates also provides link with other social services and support a gardening and recycling project. People from Huntspill visit Greengates once every two weeks to provide this service. The home has regular contact with most people’s family members. Care plans provide details of personal and family relationships. There was evidence of key workers recording telephone conversations with family members and contact with families. One person at the service regularly goes to stay with parents who live nearby. People’s rights and views are respected. Care plans seen included a service user agreement, outlining their rights and wishes. Also, one care plan has a Life Experience checklist and action plan created by the British Institute of Learning Disability (BILD). One person accessing the service has support from a befriender. The home has a menu that provides a balanced and nutritious diet. The menu board is attractively presented with symbols and colour photographs of the meals planned for the week. The home has a booklet that contains many photographs of various meals and ingredients. People are involved in planning the menu for the upcoming week. Staff confirmed that they are able to choose alternative meals if they wished. The inspector observed a breakfast and lunchtime routine, which were relaxed and unhurried. People were also offered drinks throughout the day. Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 15 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): Standards 18, 19, 20 and 21. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with appropriate assistance to meet their personal care needs. The home supports people in accessing healthcare services. The home has a medication policy and medication records are managed safely although variable dosage must be recorded to aid health management. EVIDENCE: People are provided with support to undertake personal care tasks as required. Many people living at the service have complex behavioural and psychological care needs. Staff support people in accessing healthcare services and ensure that specialist advice is sought as necessary. Care and support plans demonstrated regular support from community learning disability and mental health specialists as well as GP or community nursing support. Records inspected in two care and support plans had up to date details of healthcare appointments and outcomes. Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 16 In two care plans examined there was evidence of individuals having their weight routinely monitored as part of a weight loss plan for one person and prevention of weight loss plan for another person. There were no nutritional pans in place to support the routine monitoring of weights. This is required. Intensive Interaction is used at the home. This is a method of providing structured and controlled physical and sensory input for people who have sensory loss or autistic spectrum disorders. Staff are provided with medication training. Currently medication is stored securely. Nobody living at the home is assessed as being able to self-medicate. We inspected daily medication records and found this to be well maintained. The Medication Administration Record file had medical footnote, list of staff signatures and photograph ID. The medication records are signed by two staff signatures and the cabinet is doubly locked. Variable dosage for a laxative was prescribed but not maintained. It must be maintained in order to establish the therapeutic dose for the individual. The home has a reference book for medications that is now 9 years old. It is recommended that the home purchase a current reference book for medicines. The home have policies in place regarding death and dying. Care plans sampled evidenced people and their family’s consented wishes. Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 17 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): Standards 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place for the protection of vulnerable adults from abuse. Staff have received an update in abuse training to protect people living at the home. The home has a complaints procedure and a responsive attitude toward listening to concerns raised. EVIDENCE: The Complaint log was seen and the home has not received any complaint since the last inspection or in recent years. The raising concerns policy is displayed in the main foyer of the home. This is also displayed in an easy to read format. The home has appropriate policies relating to the Protection of Vulnerable Adults, Whistle Blowing, and Raising Concerns policy. The Community Directorate Whistle Blowing policy is displayed in a staff area. Since the last inspection staff have received training updates in abuse awareness and the protection of vulnerable adults. The two care support staff on duty supporting the manager reported having attended training in abuse awareness and the protection of vulnerable adult within the last 12 months. They also had good awareness of processes to follow for alerting managers or outside agencies of suspicions of abuse. Duty staff reported that the manager and deputy listen to concerns raised. Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 18 One person at the home receives support from a volunteer befriender. The manager has sought CRB confirmation for this person. Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 19 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): Standards 24, 25, 26, 27, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home would benefit from some redecorating. The home has sufficient communal areas and bathrooms to meet people’s needs. The home was found to have a good standard of cleanliness. EVIDENCE: Greengates is a domestic style, detached property situated in the village. Accommodation is provided over two floors. The home comprises of a lounge, dining room, lean to conservatory, ground floor toilet, two bathrooms on both floors, laundry room and kitchen. There are sufficient communal spaces for people to access. The conservatory provides alternative space to relax in. There is a large enclosed garden at the rear of the property that provides a large patio area with picnic table and benches. People have been actively involved with gardening and growing vegetables. Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 20 Rooms are single occupancy. Most rooms have an en-suite hand basin. Some bedrooms have been redecorated since the last inspection and are personalised with their own belongings, sensory lighting and decorative posters. It was reported by the manager that more bedrooms are scheduled in for planned redecoration during this year. People will be consulted to the colour and furnishing they want for their rooms. The communal bathrooms on both floors and the ground floor toilet have been upgraded and redecorated since the last inspection but are austere in appearance. Consideration should be given to enhancing bathrooms to make them more homely to improve the bathing experience for people living at the home. There is an on-going problem with mould collecting in the ground floor bathroom. The provider has investigated this, repairs have taken place to the roof and new showering facilities were provided, but this has not solved the problem. Carpets to stairs and corridors have become worn and would benefit from replacement. Staff sleeping-in provision with en-suite facility is provided at the home. This room doubles as the home’s office. The laundry area was secure, clean and well organised. Appropriate hand washing facilities had been provided for staff throughout the home. The home had been maintained to a high standard of cleanliness. In the kitchen were records of daily fridge and freezer temperatures and food in fridges were date labelled to promote good food hygiene practice. The kitchen is clearly labelled with photographs to help people identify cupboard contents. The kitchen has recently been provided with a new fridge. The kitchen work surfaces are worn and scratched in areas and some kitchen unit doors are damaged. The home was inspected by the Environmental Health on the 5/11/07, who recommended that the kitchen units and work surfaces be replaced. Two tiles were missing from the splash back wall surface in the kitchen. These must be replaced so that thorough cleaning of the kitchen can take place. Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 21 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): Standards 32, 33, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are experienced and provide a good standard of care. Staffing levels are appropriate to meet people’s needs. Staff receive appropriate management support and supervision. EVIDENCE: Duty rotas inspected were maintained appropriately. The home is staffed daily with a minimum of three staff during the day (rising to five staff at times during the week), one waking and one sleeping-in staff are on duty at night. One new staff member has joined the service since the last inspection. Staff spoken with confirmed that they had received appropriate support and regular supervision. The staff file inspected evidenced that appraisals and supervision are being provided. Staff meeting are being provided regularly. Observation of care provided throughout the inspection process showed that the staff team are caring and demonstrated good understanding and rapport Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 22 with people living at the service. Staff spoken with confirmed that they fully understood their roles. One new staff member’s recruitment file was inspected. The file contained documents required by schedule 2 of Care Homes Regulation 2001. The induction file provides a comprehensive guidance on induction training. The staff training file was sampled and there is evidence that the staff team are undergoing a programme of training updates throughout the year. Training topics included Food Hygiene, Moving & Handling, Mental Capacity Act, Risk Assessment, Autism, Equality and Diversity training, Supervision, Fire Warden, and First Aid. Twelve of the nineteen staff completed NVQ 2 or above in care. Two more staff are currently working toward this award. This is good practice. Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 23 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): Standards 37, 38, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run. There is a relaxed and open atmosphere within the home. Appropriate actions have been taken to promote the health and safety of staff and people living at the home. EVIDENCE: The registered manager is Mrs. Hunt and a deputy team leader supports her. The registered manager has worked for Social Services for several years and has experience of managing a similar service. As part of quality assurance monitoring, monthly meetings are carried out by link worker, team leader and network manager to evaluate activities, staff training and issues directly relevant to the service. These monthly reports for Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 24 the last 6 months were inspected. They were detailed and comprehensive and set targets for addressing issues or problems found in the home. The home completed an Annual Quality Assurance Assessment (AQAA). This was completed on time and contained action plans for issues to be addressed in home. It was clear from the AQAA that the management were aware of where the service could improve. Staff spoken with stated that the manager was approachable, and that they felt listened to. Staff at the home seek people’s views on an individual basis, taking account of behaviours, verbal and non-verbal communication. There was a total communication approach and this was evident throughout the inspection process. The home displayed a current Employers Liability insurance. Fire equipment is suitably serviced and tested. All staff members had been provided with updated fire safety training, including fire drills. The electrical hardwiring certificate, portable appliances and landlord gas safety certificates have been appropriately maintained. Accidents have been recorded and an analysis completed on a regular basis. People at risk of choking had risk assessments completed and staff first aid training includes first aid management of choking. Records are kept of daily fridge and freezer temperatures, food probes and hot water temperatures. All staff hold a current Food Hygiene certificate. The home also arranges for an external agency to carry out test for Legionella annually as part of preventative strategy. Showerheads are also cleaned monthly as part of a strategy to manage the risk of Legionellas at the home. Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 25 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 3 2 X 3 X 4 X 5 3 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 2 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 2 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 2 2 3 3 3 3 X X 3 X Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 26 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. 1. Standard YA10 Regulation 17 (1) (b) Requirement It is required that further consideration be given to how confidentiality of written records can be maintained if care plans are stored in the lounge. It is required that where a person’s weight is routinely monitored because of low or high body mass index, that this be supported by a nutritional plan. It is required that variable dosage is recorded on the daily Medication Administration Record. It is required that the two missing tiles on the kitchen splash back wall be replaced. Timescale for action 01/06/08 2. YA19 17 (1) (a) Schedule 3 (3) (m) 01/06/08 3. YA20 13 (2) 01/06/08 4. YA24 16 (2) (g) 01/06/08 Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 27 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 YA8 Good Practice Recommendations It is recommended that the Residents Guide be further improved to meet specific service users communication needs. It is recommended that the home purchase a current medications reference book. It is recommended that the kitchen be upgraded with replacement work surfaces and kitchen unit doors. It is recommended that worn carpets in corridors and on stairs be replaced. It is recommended that further consideration be given to improving the homeliness of austere bathrooms to enhance the experience of bathing. 2. 3. YA20 YA24 Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greengates DS0000033922.V359776.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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