Care Home: Greenhill

What the care home does well Greenhill is an exceptionally well presented property. It was purpose built approximately six years ago. It was designed with help from occupational therapists so that it would meet the needs of people who live there and with adaptations for those with limited mobility.GreenhillDS0000042521.V375686.R01.S.docVersion 5.2The people that we spoke with told us that part of the reason that they had chosen the home because it was modern and light. Individual bedrooms are larger than the minimum expected standard, well appointed and all of them have en-suite facilities, which would be able to be used by people who need wheelchairs. Several relatives said they liked the fact that it didn’t look, to them, like a nursing home and also that it was always very clean and fresh. The Mission Care Group has developed comprehensive information packs so that anyone considering moving into the home would be able to see what services they offer. If they then decided to come and live there, when a room became available, a senior staff member would undertake a health needs assessment to make sure that they could provide the care that was required. They then come back and discuss this assessment with staff so that placements are only offered if the home is confident of their ability to meet the resident’s needs. This assessment then forms the basis of a care plan, which sets out, the way that individualised care is to be delivered in the way that the resident prefer. The people who were spoken with during the inspection considered that life in the home suited them. They told us “I feel safe here” “staff are very kind to me”, They agreed that they were able to make choices and decisions about how they wanted to spend their days including choosing the clothes that they wanted to wear and when they wanted to get up or go to bed. They said that the food served in the home was “very nice”” “quite good,” and that there is always a choice. They told us that it was of good quality and there was always variety. They also told us that they like the activities that are arranged for them and photographs are on the walls which show them enjoying themselves at various events. Records that are maintained by the home as evidence of their commitment to the health and safety and protection of the people who use the service were all in order. What has improved since the last inspection? At our last inspection we considered that residents were being well cared for but we highlighted some issues relating to their care plans and the supporting documentation. At this visit we found that they had been improved upon and were reflective of the care and support that people needed. Any problems that are being experienced by residents are being identified, and interventions are reviewed regularly to make sure that any changes are addressed. There is evidence that residents and their relatives have been able to contribute to this process as well and influence the way that care is being provided. Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Our last visit also highlighted some concerns about staffing levels in the home. This has now been partially addressed in as much as there are enough staff on duty however, there is a reliance on agency or temporary staff. The home is in the process of trying to recruit more permanent staff and meanwhile, to try and minimise the impact on residents, they try to employ temporary staff that have worked in the home before. When we spoke with some of these staff they were able to confirm that they are often employed by the home and they seemed to know the residents well. Previous concerns about the lack of staff training are also being addressed. We were able to see that mandatory training is up to date and that the majority of care staff have achieved an NMVQ qualification to at least level 2. Those who have not are working towards it. What the care home could do better: Since the last inspection the home has been registered to care for more people who have dementia. We had some discussions, with one of the providers, about the importance of meeting the needs of people in the home who do not have dementia as well. The home is aware of the need to continue with their recruitment campaign and establish a strong team of staff who are employed on a permanent basis in order to reduce the numbers of temporary staff on duty. We did not issue any requirements at this inspection. Key inspection report CARE HOMES FOR OLDER PEOPLE Greenhill 5 Oaklands Road Bromley Kent BR1 3SJ Lead Inspector Alison Ford Unannounced Inspection 4th June 2009 09:00 DS0000042521.V375686.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 2 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 Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenhill Address 5 Oaklands Road Bromley Kent BR1 3SJ 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) 020 8290 9130 020 8290 9131 info@missioncare.org.uk. www.missioncare.org.uk Mission Care Ani Grace Manayin Care Home 64 Category(ies) of Dementia (44), Old age, not falling within any registration, with number other category (20), Physical disability (9) of places Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE (maximum number of places: 44) Old Age, not falling within any other category - Code OP (Maximum number of places: 20) 2. Physical Disability - Code PD (maximum number of places: 9) The maximum number of service users who can be accommodated is: 64 5th June 2008 Date of last inspection Brief Description of the Service: Greenhill is a nursing home, registered with The Commission for Social Care Inspection to provide care for up to 64 residents. The home is a modern, purpose-built facility, which opened in 2003. It is located in a residential road close to Bromley town centre with its wide selection of amenities. Public transport links are good and there is a limited amount of off street parking to the rear of the home. Accommodation for residents is provided over three floors and there are two large passenger lifts so that all parts of the home are easily accessible. All of the bedrooms are well furnished and have en-suite facilities. The ground floor has been designated to care for elderly people who may also have a physical disability and the first and second floors for elderly frail people who may also have dementia. Adaptations have been made throughout the home to make sure that residents, who may be confused are safe. The kitchen is located in the basement and laundry services are undertaken at another, nearby, Mission Care home. Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 5 Fees at the time of this inspection range from £590 - £995 weekly. There are additional charge for services such as chiropody and hairdressing, and these would be discussed prior to admission. Different pricing arrangements are in place for people who fund their placements privately as opposed to those whose funding is arranged by the local authority. Copies of the homes Statement of Purpose and their guide to the home can be requested from them. A copy of their latest inspection report can also be seen at the home or alternatively can be downloaded from the Care Quality Commission website www.cqc.org.uk Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good, quality outcomes. This report follows a key inspection of the service which was an unannounced visit, lasting around six hours. During the day, we were able to walk round the home and we spoke with many of the residents, their relatives and members of staff on duty. We also looked at various records and documentation that the home is required to maintain as evidence of their commitment to the health and safety of the people who use the service. We assessed a sample of care plans and spent time observing residents in the home to try and reflect on what it is like for them living there. We spoke with the cook, looked at menus and kitchen records and the lunchtime meal was served during our visit. When writing this report we have also taken into consideration other information that we have received throughout the year such as the notification of incidents and complaints and the results of surveys that we have sent to people who live in the home. We received eleven of these back from people who use the service and all of the comments were very positive and complimentary about the home and the staff. In addition, the homes manager sent us their Annual Quality Assurance Assessment. This is a self assessment document that tells us how they are meeting their aims and objectives and about their plans for the future. It was very clear and comprehensive and showed us that they know how they might make further improvements in their service. What the service does well: Greenhill is an exceptionally well presented property. It was purpose built approximately six years ago. It was designed with help from occupational therapists so that it would meet the needs of people who live there and with adaptations for those with limited mobility. Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 7 The people that we spoke with told us that part of the reason that they had chosen the home because it was modern and light. Individual bedrooms are larger than the minimum expected standard, well appointed and all of them have en-suite facilities, which would be able to be used by people who need wheelchairs. Several relatives said they liked the fact that it didn’t look, to them, like a nursing home and also that it was always very clean and fresh. The Mission Care Group has developed comprehensive information packs so that anyone considering moving into the home would be able to see what services they offer. If they then decided to come and live there, when a room became available, a senior staff member would undertake a health needs assessment to make sure that they could provide the care that was required. They then come back and discuss this assessment with staff so that placements are only offered if the home is confident of their ability to meet the resident’s needs. This assessment then forms the basis of a care plan, which sets out, the way that individualised care is to be delivered in the way that the resident prefer. The people who were spoken with during the inspection considered that life in the home suited them. They told us “I feel safe here” “staff are very kind to me”, They agreed that they were able to make choices and decisions about how they wanted to spend their days including choosing the clothes that they wanted to wear and when they wanted to get up or go to bed. They said that the food served in the home was “very nice”” “quite good,” and that there is always a choice. They told us that it was of good quality and there was always variety. They also told us that they like the activities that are arranged for them and photographs are on the walls which show them enjoying themselves at various events. Records that are maintained by the home as evidence of their commitment to the health and safety and protection of the people who use the service were all in order. What has improved since the last inspection? At our last inspection we considered that residents were being well cared for but we highlighted some issues relating to their care plans and the supporting documentation. At this visit we found that they had been improved upon and were reflective of the care and support that people needed. Any problems that are being experienced by residents are being identified, and interventions are reviewed regularly to make sure that any changes are addressed. There is evidence that residents and their relatives have been able to contribute to this process as well and influence the way that care is being provided. Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 8 Our last visit also highlighted some concerns about staffing levels in the home. This has now been partially addressed in as much as there are enough staff on duty however, there is a reliance on agency or temporary staff. The home is in the process of trying to recruit more permanent staff and meanwhile, to try and minimise the impact on residents, they try to employ temporary staff that have worked in the home before. When we spoke with some of these staff they were able to confirm that they are often employed by the home and they seemed to know the residents well. Previous concerns about the lack of staff training are also being addressed. We were able to see that mandatory training is up to date and that the majority of care staff have achieved an NMVQ qualification to at least level 2. Those who have not are working towards it. 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. Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3,6 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home has recognised the concerns that people may have about moving in and introduced measures to make this transition easier for them, pre-admission assessments are in place to ensure that their needs will be met. This home does not offer intermediate care, this standard does not apply. EVIDENCE: We considered that the pre-admission process in this home is particularly good and helps to alleviate anxieties that may be felt by prospective residents and avoid unsuitable placements. A comprehensive guide for residents and their relatives has been produced which outlines the services that will be provided by the home and gives lots of Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 11 useful information to help people decide if life in the home will suit them. Copies of these documents are left in resident’s bedrooms for them to read and refer to. For residents whose placement is funded by the local authority, a care manager’s assessment would be obtained prior to admission. This would explain, in detail, the care and support that they would need. For people who fund the placement themselves and, in practice, also the majority of those with local authority funding, a senior member of staff would undertake a needs assessment to make sure that the home would be suitable. Having done this, they then discuss the placement with the staff in the home so that everyone knows when the person will be arriving and how they will need to be supported. An offer letter is sent to the resident confirming the placement and the ability of the home to meet their needs. Other residents in the home are also told about the person who will be coming in and information is sent to all the other departments in the home including the kitchen, domestic team, maintenance department and the activities coordinator. A greetings card is put in the person’s new bedroom to welcome them to the home. If they were able, a potential resident would be encouraged to visit the home to see if they liked it. In reality, most people are quite frail when the time of admission comes however, their relatives would be encouraged to participate in the process. We were able to talk to one resident, who had recently been admitted and she was able to explain the process to us. She told us that someone had come to assess her needs and she had been able to visit before she made up her mind to come and live in the home. She also told us how helpful everyone had been and how they had helped her to settle in. The home has recognised that this process could be further improved by producing information for residents in alternative formats / languages. Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,10 People using the 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 all have an individual care plan and they told us that their needs are being met in a way which suits them. Medication policies and procedures are in place to ensure their safety. EVIDENCE: All of the residents that we met on the day of the inspection looked clean and well cared for. They were nicely dressed and ladies were obviously able to have their hair done regularly. People that were unwell and being nursed in bed looked comfortable and appropriate aids and adaptations are in place to help prevent them from developing pressure sores. Each resident has an individual care plan and these have all been updated since we last visited. We found them to be comprehensive and they have been individualised in order to consider residents daily living activities. The information that is in them ensures that all staff know how they prefer to be supported and cared for. They include moving and handling assessments, risk Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 13 assessments, and the monitoring of factors which might indicate a resident’s susceptibility to pressure sore formation. Nutritional scores are in place and residents are weighed regularly. We could see that some residents and their relatives had been involved in the care planning process and they are all reviewed regularly so that any changes are identified. Staff displayed a good knowledge of the people that they were caring for and were able to tell us about their previous lives and achievements. They said that they felt knowing this information helped them to understand more about them. Residents have access to services from a chiropodist, optician and dentist and a doctor visits the home twice a week. Residents are able to keep their previous doctors if they wish and it is feasible. Advice would be sought from a tissue viability nurse, dietician and continence advisor if required. Some of the care staff have had additional training in foot care to supplement the services supplied by the chiropdists. Practices in the home with regard to medication were assessed on each floor and found to be satisfactory. Medication is stored appropriately in locked trolleys and administered by trained nurses. There are lists of the signatures of those who are authorised to give medication, photographs of residents on their record sheets and both the homes medication policy and the guidelines from the Nursing and Midwifery Council. There is also a policy in place to show the procedures to be used in the administration of covert medication. Unwanted and unused medication is disposed of according to current regulations. The home is now implementing The Gold Standard Framework in conjunction with the local hospice, to improve care for people who are nearing the end of their lives. They are hoping for accreditation for this later on this year. In some care plans there was evidence of advance care planning, showing that discussions had taken place with residents and their families about how they wished to be treated should they become more unwell or in the event of their death. This information is also being shared with the “out of hours” doctors’ service in order to prevent unwanted hospital admissions. Residents we spoke with confirmed that staff were always respectful, shutting doors when personal care was being given and always knocking before entering their rooms. They told us that they felt safe and that staff were very kind. One said “they are all wonderful” another that “they are always cheerful and chatty”. On the day of our visit we found them very friendly and approachable. Staff have all received training on the subject of privacy and dignity. Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 14 Since the last inspection the registration of the home has changed slightly in order to allow the admission of more people who have a diagnosis of dementia. During the inspection we had some discussion with the providers about how they would manage this process in order to ensure that the needs of those without dementia were also considered. Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14,15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This service suits the needs and preferences of those who live there. They enjoy the activities that are arranged for them and the meals that are served. Their families and friends are always made welcome. EVIDENCE: People that we spoke to during the inspection told us that they were happy living in the home. They said that they were able to make choices and decisions about how they wished to spend their days, including the clothes that they wanted to wear, the time that they got up in the morning and went to bed at night and when they had a bath or shower. There is a wide range of activities organised for residents to join in with if they want to and the activities organiser works in the home three times a week. She tries to provide both group activities and one to one sessions for people who do not want to mix with others. In addition there is musical entertainment and organised trips out of the home. Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 16 There is a timetable however, it is flexible according to the preferences of the residents. The home also has an enthusiastic volunteer group “The Friends of Greenhill” who organise fundraising events to provide extra money for entertainers who visit on a monthly basis. Pictures around the home showed residents taking part in various events that have been held. Local churches provide pastoral support and residents are helped to practice any faith that they choose. Some residents are able to attend church and services, including communion, are also held in the home for those who wish to attend. Although the home has a Christian ethos they have recognised that some people may follow other faiths and try to support that. Relatives and other visitors that we spoke with said that they always felt comfortable coming in to the home and that staff always welcomed them. The lunchtime meal was served during the inspection and was observed on the ground and second floor. Generally it seemed to be a pleasant experience for residents There was a choice of food; it was hot and nicely presented, everyone had a drink as well. Those people who needed help were offered it and plate guards were in use for others. Drinks would always be available throughout the day and the chef told us that he provides homemade cake for afternoon tea. Supper includes a hot dish as well as sandwiches and special requests can always be met. Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16,18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have access to a complaints procedure, which ensures that any concerns that they raise will be managed and resolved appropriately. There are measures in place to help to ensure their safety and well being. EVIDENCE: The home has a complaints procedure, which is displayed in the home. Details about how to raise any concerns are also in the resident’s guide, which is in their bedrooms. When we talked to residents and relatives they were confident that should they have any issues of concern they would be addressed promptly. The Commission has not received any complaints about the service since the last inspection. The home keeps a complaints record and we saw that any issues had been addressed according to the procedure. Referrals are made to the local authority for investigation under safeguarding guidelines wherever necessary. Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 18 We looked at some staff records of people who had been employed since our last visit. They showed that all of the documents that we require them to have were in place and appropriate clearance is received from The Criminal Records Bureau prior to them starting work in the home. This ensures that people who have been judged as not being suitable to work with vulnerable people have been prevented from doing so. Staff receive regular training about adult abuse and displayed an understanding of what it was and how they would report any concerns that they had. Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 26 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service live in a well-maintained purpose built home which suits their needs in a comfortable way. EVIDENCE: The home is a purpose built facility, which opened less than six years ago. It was designed with help from occupational therapists so that it would meet the needs of those who live there. People that we spoke with told us that they had chosen the home because it was modern and light. Individual bedrooms are larger than the minimum expected standard, well appointed and all of them have en-suite facilities, which would be able to be Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 20 used by people who need wheelchairs. Beds are height adjustable and fitted with pressure relieving mattresses. Residents have been encouraged to personalise their bedrooms with pictures, ornaments and small pieces of furniture, they are able to lock their doors if they want to and they have a lockable drawer in their rooms for any personal effects. There are communal areas on each floor, which are used for sitting, activities, and dining. These have been fitted with loop systems to aid those whose hearing is impaired. There are also bathrooms with aids and adaptations and some have ceiling hoists. There are handrails and ramps throughout the home to allow easier access and call bells in all areas. There are public telephones available in the hallways and some residents have chosen to have a phone installed in their rooms. Passenger lifts allow people to move freely throughout the home however, to ensure the safety of residents, they cannot be operated without the use of a swipe card held by staff members. The home was very clean and fresh on the day of the inspection and those spoken with said that it was always so. Alcohol hand cleansers, aprons and gloves are available throughout in order to help with infection control. There are hand washing facilities’ in each resident’s room and all general toilets, bathrooms and the dining rooms. Laundry is sent out of the home to one of the other homes in the group. Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29,30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are always enough staff on duty to meet the needs of residents although there is some reliance on agency staff. People who use this service say that they are well cared for by kind caring people. EVIDENCE: The people that we spoke with commented very positively about the staff that care for them and told us that they were very kind and respectful. They told us “they are so kind” “nothing is too much trouble”. Staff members we observed were interacting well with residents especially those who have dementia. There was a very cheerful atmosphere in the home with some of them laughing and singing while other staff took the trouble to sit down and talk to people. Each floor is staffed by both trained nurses and care staff. One nurse on each floor has been designated as a “clinical leader” and has accountability for that area. Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 22 We looked the off duty rotas and these highlighted the fact that there is some reliance on agency staff. The home is currently trying to recruit more staff to address this shortfall. Meanwhile, they try to employ temporary staff that have worked in the home before to give some continuity for residents. Those agency carers that we spoke with had a good understanding of the residents and told us that they were booked to work in the home on a regular basis. Staff training in the home has improved since the last inspection and we could see that mandatory training had all been updated. In addition there have been sessions in first aid, report writing, and dementia. New staff members were able to tell us about the induction programme they had undertaken when they first started in the home. The majority of care staff have gained an NVQ qualification to at least level 2. Those who have not are currently undertaking the course. Staff files that we saw showed evidence of robust recruitment procedures and appropriate clearance from the Criminal Records Bureau. This helps to ensure that residents are protected from those who have been judged as being unsuitable to be working with vulnerable adults. Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35,38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in the best interests of the people who live there and by an experienced and well qualified person. Quality assurance systems are in place to ensure that residents are able to influence the care that they receive and they can be assured that their financial interests are being safeguarded. EVIDENCE: The home is currently being managed by Ms Ani Grace Manayin. She is a very experienced nurse with additional qualifications which are relevant to this role. She is gradually building a competent and motivated team of staff in the home with clear lines of accountability. Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 24 Each of the floors is managed individually by a clinical leader however, they report directly to the Registered Manager. She visits each floor on a daily basis and if necessary will put on a uniform and work alongside the staff. An open door policy encourages staff to come and talk with her and sessions are held specifically for them to do this on a weekly basis. Supervision and appraisal is in place for all staff members and there are regular staff meetings. There is a quality assurance programme designed to gather the views of those who live in the home or visit and use them to influence the provision of care and services’ As a part of the process a resident’s questionnaires are distributed in all of Mission Cares Homes. Responses from the last one were in the main positive with most people saying that they were happy with the situation within the home. There are also regular meetings held for residents and their relatives to enable them to voice their opinions and The Commission distributed questionnaires prior to this inspection. The home returned its Annual Quality Assurance Assessment when it was requested. It was very clear and comprehensive and outlines the plans that they have for improving the service during the forthcoming year. It gave us the dates that various services and equipment were serviced and showed that a maintenance programme is in place ensure the health and safety of residents and staff members. A brief tour of the kitchen was undertaken. The last inspection made by the Environmental Health Officer had rated the kitchen as 5 star. Most residents either manage their own finances or, more usually, have a relative or representative to do this for them. For those people whose finances are managed by the home, there were clear and comprehensive records being kept with invoices and receipts. Greenhill DS0000042521.V375686.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 Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO 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. Refer to Standard Good Practice Recommendations Greenhill DS0000042521.V375686.R01.S.doc Version 5.2 Page 27 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: 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. 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