Care Home: Greenhill House - Leonard Cheshire Disability

What the care home does well The home provides a specialist unit for adults with a physical disability. They are able to offer services for a range of disabilities. Individuals coming in to the service can be assured that they will be fully assessed and only offered a place if the home can meet their needs. Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 There remains a clear commitment from the staff team to support people living in the home. The home endeavours to provide a range of leisure and educational opportunities. This has been extended and includes some evening and weekend sessions. Healthcare checks are done regularly and if the home were unable to meet that need an appropriate referral is made. Individuals can be sure that their health is promoted and maintained where possible. Individuals are supported to have a lot of control over their day to day lifes and in the running of Greenhill House. The home continues to be managed well with the individuals living in the home be the pivot of all planning. What has improved since the last inspection? Individuals have benefited from the food being more varied, nutritious and presented more attractively. This includes introducing more fresh vegetables. It is evident that the cook liaises with both the people living in the home and the care staff ensuring that specialist diets are catered for. Staff, people living in and visiting the home`s knowledge of fire safety procedures has improved with fire training and drills happening regularly. Care plans now include people`s social care needs and how staff can support them to realise those needs. Individuals are more confident in raising concerns with the home and can be confident that these would be addressed. What the care home could do better: Whilst there are no requirements relating to the environment areas in the home would benefit from being refurbished. In addition the home should review where items are stored to ensure that areas are free from hazards. The home has developed a refurbishment plan which includes redecoration and reconfiguring of the lounge and dining area in the original building to make it more homely. This will be monitored by the Care Quality Commission through the Annual Quality Assurance Assessment and future visits.Greenhill House - Leonard Cheshire DisabilityDS0000020243.V375853.R01.S.docVersion 5.2 Key inspection report CARE HOME ADULTS 18-65 Greenhill House - Leonard Cheshire Disability South Road Timsbury Bath Bath & N E Somerset BA2 0ES Lead Inspector Paula Cordell Key Unannounced Inspection 9 and 10th June 2009 10:00 th Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc 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 home adults 18-65 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 House - Leonard Cheshire Disability DS0000020243.V375853.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 House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenhill House - Leonard Cheshire Disability Address South Road Timsbury Bath Bath & N E Somerset BA2 0ES 01761 470533 01761 479917 fran.ashby@LCDisability.org www.LCDisability.org Leonard Cheshire Disability 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) Mrs Frances Judith Ashby Care Home 37 Category(ies) of Physical disability (37) registration, with number of places Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.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 either gender whose primary care needs on admission to the home are within the following categories: 2. 3. 4. Physical disability- Code PD May accommodate up to 20 persons aged 18 years and above who require nursing care. May accommodate up to 19 persons aged 18 years and above requiring personal care. The maximum number of service users who can be accommodated is 37. 11th June 2007 Date of last inspection Brief Description of the Service: Greenhill House provides places for 20 people needing nursing care and 17 people needing residential care with a range of physical disability between the ages of 18 and 65 years old. The home also offers day care for up to 5 residents each weekday. The home is rurally situated in its own grounds. It is an old converted property with a more recent extension to the rear, and 4 adapted flats in the Coach House where people live more independently. All the bedrooms are for single occupancy. There are 2 passenger lifts giving wheelchair access to all levels. The Activities hut is outdoors and accessible by a ramp. The home is part of the Leonard Cheshire Disability and operates within its charter. Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.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 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced visit as part of a key inspection process. The purpose of the visit was to review the requirements and recommendations from the visit in June 2007 and to monitor the quality of the care provided to the individuals living at Greenhill House. There have been no visits between this and the visit in June 2007. An annual service review was completed in June 2008 and there was found to be no changes in the quality of the care. This was assessed by reviewing all documentation received from the home including seeking the views of people who use the service, professionals and staff via questionnaires. The Commission for Social Care Inspection have been kept informed of any incidents that effect the wellbeing of individuals living in Greenhill House and any safeguarding referrals made to the local council in respect of abuse. From the discussions with the manager during this period it is evident that the home has taken appropriate action to protect the individuals and minimise the risks to individuals whilst not curtailing independence. The visit was conducted over two days for a total of ten hours. The visit included a full tour of the home, reviewing of care and staff documentation, speaking with individuals, staff and the deputy manager. An element of the visit included looking at health and safety. The visit was planned using information received since the last visit in June 2007. This included regulation 37 notifications in respect of incidents that effect the wellbeing of the individuals, correspondence, surveys and the annual quality assurance. The annual quality assurance assessment is completed by the service and details how they have improved, how they can evidence the care that is provided including future improvements that can be made and some statistical data. What the service does well: The home provides a specialist unit for adults with a physical disability. They are able to offer services for a range of disabilities. Individuals coming in to the service can be assured that they will be fully assessed and only offered a place if the home can meet their needs. Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 6 There remains a clear commitment from the staff team to support people living in the home. The home endeavours to provide a range of leisure and educational opportunities. This has been extended and includes some evening and weekend sessions. Healthcare checks are done regularly and if the home were unable to meet that need an appropriate referral is made. Individuals can be sure that their health is promoted and maintained where possible. Individuals are supported to have a lot of control over their day to day lifes and in the running of Greenhill House. The home continues to be managed well with the individuals living in the home be the pivot of all planning. What has improved since the last inspection? What they could do better: Whilst there are no requirements relating to the environment areas in the home would benefit from being refurbished. In addition the home should review where items are stored to ensure that areas are free from hazards. The home has developed a refurbishment plan which includes redecoration and reconfiguring of the lounge and dining area in the original building to make it more homely. This will be monitored by the Care Quality Commission through the Annual Quality Assurance Assessment and future visits. Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 7 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 House - Leonard Cheshire Disability DS0000020243.V375853.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 Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 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. Individuals can be confident that there is sufficient information available to them and that their assessed care needs can be met by Greenhill House, Contracts are in place but are not accessible to some of the individuals living in the home. EVIDENCE: The home has a statement of purpose and a service user guide. Individuals confirmed that they had been given information prior to making a decision to move to the home. The statement of purpose clearly described what the service could offer to individuals and who the home could support. This is available on CD Rom for those that prefer a more visual form of communication. An opportunity was taken to review a person’s care who had been admitted to the home within the last six months. The placement was an emergency and it was evident from reading the care documentation that a full assessment had been completed in accordance with the National Minimum Standards. The Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 10 individual’s care had been reviewed with the local placing authority involving the person, their relatives and the care staff at the home. It was evident that the person had settled in well. The assessment had formed the basis of a care plan, however there were some gaps in the care documentation that should be addressed including a pen picture of the individual, social interests and a personal care statement. Staff said that they were still gathering information as this person has non verbal communication it has taken slightly longer and the plan is to involve the family as they were the main carers prior to admission. However, what was positive when talking with a number of staff, was the knowledge of the individual’s needs and personality that had already been captured but not recorded. Staff were knowledgeable about the people they support and it was evident that care at Greenhill House is tailored to the individual. An opportunity was taken to review four contracts of care. These met with the National Minimum Standards and detailed the terms and conditions of the placement and what was and not included in the fees. However, these were not signed by the individual or their representative for three out of the four files seen. The contract could benefit from being made more accessible so that individuals can fully understand the document. Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 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. Individuals can be confident that their care needs are being met in a person centred way. Care is tailored to the individual with a good level of involvement. Documentation was not held securely which could put confidences at risk. EVIDENCE: Four persons care was looked at as a means to determine the outcomes for people living at Greenhill House. Each person had a detailed care plan, containing pertinent information relating to all aspects of daily living. Since the last visit plans have been developed around meeting people’s social needs. Information was person centred and included aspirations and goals for the future. Individuals had signed their care plans and had evidently had input in to the content. Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 12 The care plan included consent for sharing information with others including relatives and important people involved in the person’s life. Staff were conscientious about not discussing personal information in communal areas. Care was regularly being reviewed involving the individual and other professionals involved in the care of the person. Care documentation included a pen picture, personal care statement and other information to enable staff to support them. One person has been living in the home for six months and some of this information was missing. Staff said that they were still getting to know the person and wanted to involve family members who had previously cared for the individual. Staff said that due to the person having limited verbal skills it has made the information gathering process slower. However, from talking with staff it was evident that they had a good understanding of the person’s needs and personality. This should be documented. The care planning model was based on the activities of daily living with additional information relating to goal planning and meeting people’s aspirations included. It was discussed with the deputy manager on whether this model was going to be reviewed in light that this may not be accessible to all the individuals and that other models may be more effective in planning the care of the individuals for example PATH, MAP or Essential Lifestyle Planning. The deputy manager confirmed that this was being explored for some of the individuals. This would be good practice. Staff had a good knowledge on the care needs of people and clearly described how they were supporting the individual. Some staff have worked in the home for many years and were really positive about the changes that have happened over the years to the benefit of the people they support. It was evident that there was a culture of “can do” which did not hinder the individuals. It was evident from talking with individuals and staff that the care was tailored to the person. Although staff said that sometimes it can be difficult due to the staffing levels and many of the individuals require support with personal care which means that some individuals may still not be up and dressed till late morning. However, the shifts are planned so that in the main those that prefer to get up later are left till last. Staff said that there are weekly diary meetings to ensure that there is sufficient staff to enable individuals to attend appointments or activities external to the home. Individuals spoken with confirmed that they had a key worker, a named carer who assists the individual with making appointments, personal shopping and reviewing and delivering the care. Key worker time is allocated to each individual on a regular basis. However it was clear from talking with both care staff and the activity staff there is good communication so that individuals can be assured of a consistent approach. This was evident with staff from both the Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 13 residential and nursing care unit as individuals move freely between both units so staff have to have knowledge about the care needs of all individuals. Care files included information on areas of risk. This covered all aspects of daily living. It was evident that the staff explored how to minimise the risks without curtailing the individual’s independence. Documentation covered social activities, areas to ensure a person stays healthy including nutrition, wound care management and other areas that were pertinent to the individual. These had been reviewed and updated as a person’s needs had changed. The home ensures in the main information about individuals is stored securely to ensure that it remains confidential. However an unlocked filing cabinet containing archived documentation in the wheel chair charging area of the nursing wing. Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 14 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): This is what people staying in this care home experience: 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. Individuals are very much part of Greenhill House and are encouraged to be as active as they would like. Activities are organised both in the home and the local community. There is a good level of control and empowerment given to individuals living in Greenhill House. Friendships and contact with family are encouraged and promoted within the home. There have been improvements to the menu planning in the home and this is evidently being kept under review. EVIDENCE: From talking with individuals, staff and the activity manager and records viewed it was evident that individuals are encouraged to participate in regular activities both in the home and the local community. Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 15 Individuals said that the home has an activity centre where they can participate in arts and crafts, gardening, woodwork, games and other social activities. In addition regular trips are organised to the theatre, cinema, local pub and places of interest. It was evident from talking with the activity manager that where an individual expressed an interest in participating in activity this would be supported. Individuals confirmed that they were supported to go on holidays and trips are organised both in this country and abroad. Previous holidays include a Mediterranean cruise, Caribbean cruise, and a recent trip to Spain, Butlins, Scotland and Weymouth. Holidays are tailored to the individual either in small groups or on a one to one basis. The activity manager maintains a record of all activities organised and monitors participation to ensure that it is fair and equitable and suited to the individual’s needs and aspirations. An example was given where it was noted that one person did not wish to participate in group activities so more one to one was offered to that particular person. From talking with the activity manager and the staff it was evident that a person’s disability did not hinder the individual. Individuals were fully consulted on the activities organised. Individuals confirmed that they could keep contact with friends and family either with staff support or independently. Individuals have access to a computer suite that has special adaptations for people with a physical disability. Individuals were observed using social networking sites and had access to email facilities. Individuals confirmed that family can visit the home whenever. Some individuals are supported to visit older relatives in care homes in the surrounding areas. It was evident from talking with staff there was a commitment for individuals to maintain contact with people they wanted too. Care files included a consent form detailing what care information can be shared and with whom. This is good practice. There were two public telephones, it was noted that these were in the entrances halls to the two units. Whilst it was noted that these were not private, a member of staff said that there is a cordless telephone that individuals can access to make private calls. Some of the individuals have their own telephone line in their bedrooms or mobile phones. The home has a large core team of volunteers who assist with social activities both in the home and the local community. Volunteers go through a similar recruitment process as the carers ensuring their suitability to work with vulnerable adults. Individuals have access to a monthly hairdresser (however individuals are supported to attend local hairdressers of their choice if preferred), a visiting Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 16 aroma-therapist and other local community groups are encouraged to visit the home. It is evident that the home is part of the local community with those that are able accessing the local facilities of the village independently and others being supported to attend a monthly Jazz group or social functions that are organised in the village. Greenhill House organises summer fetes and theme nights which is open to the people living in the surrounding area. The home has a licensed bar which is open regularly for the individuals living in Greenhill House. It was evident from talking with individuals that it was a sociable home, should individuals want to participate. One individual said that during the week there is always plenty to do including evenings however it can be quiet on the weekends and occasionally boring. Staff said they were aware of this and were trying to address the balance. The activity manager said that groups are organised on the weekends but it is not as well staffed during the weekends. There is a core group of staff and volunteers who support individuals with activities at the weekend. Activities on the weekends included small group trips, fishing, monthly music and movement groups, supporting individuals to visit family and attendance at Church. Overseas volunteers work during the weekend and organise games including table tennis and Wii games. Individuals have regular meetings which they chair themselves on a monthly basis and then periodically advocates external to the home assist in this process. It was clear that where required individuals would be supported to access advocacy services. Individuals were consulted on activities, menu planning, health and safety, decoration of the environment informed about staffing changes and have input in to the quality assurance initiatives. Individuals are supported to choose the colour scheme for their bedrooms. During the last visit it was noted that some of the individuals expressed dissatisfaction with the meals. However from talking with individuals this has since improved. A food questionnaire had been sent to all Leonard Cheshire Homes for individuals to complete with an action plan to address specific areas identified. Comments from individuals during this visit included “I like the food there is a lot of choice, “it is passable”, “the homemade food is good but I do not like the tinned food”. The latter comment was discussed with the Housekeeping Manager and she was aware of the issue and said that it is now rare for tinned food to be used. One person said that there is not always enough. It was evident that this had been discussed at a recent house meeting involving the individuals and this was being addressed by the manager. From looking at the menu it was varied, healthy and nutritious. Catering staff were aware of the specialist diets with a clear list. The deputy manager said that this is regularly reviewed and updated. Individuals have a nutritional Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 17 assessments completed and where relevant weight is monitored. The home liaises with the speech and language team in respect of eating and swallowing issues. Care files where relevant included information on supporting individuals that were prone to choking. The home has a special adapted kitchen to support individuals in being more independent in preparing and cooking meals on the nursing wing. The deputy manager said that a similar area is being developed in the residential wing. Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 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. Individuals can be confident that their personal and health care needs are being met. Individuals are protected by the home’s medication procedures and practices. EVIDENCE: Individuals care files included how they would like to be supported and by who. Each person had been consulted on whether they would like a male or female member of staff. It was evident that the care provided was tailored to the individual and that people were encouraged to be as independent as possible. Staff described how they supported people including how they ensured that a person’s dignity and privacy was respected. Individuals have a do not disturb notice on their bedroom doors for they use. Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 19 One individual has told staff that they only want minimal information recorded about them as they can clearly say to staff how they want to be supported. This is respected and clearly documented in the plan of care. Records are maintained of all health care appointments and the outcome. The home has recently introduced a record specific for this as previously this was recorded in the daily records where it could be lost over a period of time. Individuals have access to a wide range of professionals and specialist services. Individuals are registered with a local GP. Where individuals stay at the home for respite a temporary arrangement is made with the local surgery. Individuals are supported to attend the surgery and the local GP visits the home on a weekly basis, alternating between the two areas of the home. The home employs two physiotherapists to assist individuals with their mobility, aids and adaptations. Records were maintained of the interventions. Bathrooms have been specially adapted to suit individuals with a physical disability. These are in the process of being refurbished with additional aids being provided, including a walk in drying machine. Care files included information about equipment to assist individuals with mobility and personal care. Staff training records and conversations with staff evidence that they had attended training in manual handling and this was updated at periodic intervals. One of the staff stated they had attended training to enable them to complete manual handling assessments and train staff. She confirmed that training is regularly organised for staff. The home has ensured that there are 3 manual handling skills trainers in total. The medication system was reviewed in the residential area. There were clear records of medication entering the home, administration and disposal. The senior carers administer the medication in this area and the registered nurses in the nursing wing. Staff have attended training on the system in use by the local pharmacist as evidenced in conversations with staff and training records. When reviewing the medication administration record it was noted that the instructions were limited to “as directed”. The senior carer on duty said that they were liaising with the prescribing GP to ensure that this was expanded. This is strongly recommended. Where individuals are able they are supported to self administer their medication. Risk assessments are in place detailing the support and guidance that is required. Lockable storage has been provided for this purpose. The home has experienced four deaths in the last twelve months. Staff said that this was an emotional time. However, it was evident from the Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 20 conversations that the team have supported each other and the individuals living in the home. From talking with staff it was evident that there was a lack of training on bereavement and loss although one member of staff said they do liaise with the local hospice for advice. Staff have available to them a counselling service which they can use in the event of something traumatic happening to them at work including death of a person living in the home. Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 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. Individuals are supported to speak out about the service that is provided to them. Good systems are in place to protect individuals. EVIDENCE: Individuals spoken with confirmed they knew how to complain and it was evident that they felt comfortable talking to the staff working in the home. From talking with staff it was evident that where individuals are non-verbal they monitor body language to ensure that the individuals are happy participating in activities and with their care support. Where individuals do not communicate using words guidance is available in the care files on their preferred method. The Annual Quality Assurance Assessment completed by the provider identified that there was some work needed to ensure that individuals are aware of the complaints procedure as this has come from audits completed by Leonard Cheshire Homes. Greenhill House has yet to go through the audit. It was evident that individuals have recently been reminded of the complaints procedure during a house meeting. Staff said that all individuals living in the home are given a copy of the service user guide which includes a copy of the home’s complaint procedure. Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 22 The home has a complaints procedure and a complaint log. From the complaint log it was evident that individuals and their relatives are empowered to raise concerns about the service. Individuals are encouraged to make suggestions informally and formally through the monthly house meetings. The deputy manager described how in the past the home has not had a culture where individuals have raised concerns, but this has improved under the direction of the new manager. This manager has been in post for three years. It is evident from talking with the deputy manager that concerns are not seen as negative but as a means to improve the care that is delivered and improve the experiences for people who use the services of Greenhill House. Individuals have regular meetings and steering groups where they can raise concerns and make suggestions about improving the service. It is evident that individuals are empowered to speak out about the care they receive. The home has made one safeguarding referral and has worked closely with the local placing authority and the Care Quality Commission. The manager has kept everyone informed and has taken appropriate action to address the concern. Staff were well informed about the procedure to follow in the event of an allegation of abuse being raised. Clear guidance was available in both the residential and the nursing wing of the home. The deputy manager stated that she and the manager had recently completed an abuse investigation course for senior staff in relation to safeguarding. From talking with staff it was evident that they had all recently completed the in-house training on safeguarding and were well informed. Some staff have also attended the local council’s training on safeguarding. Good safeguards were in place relating to protecting individual’s finances. Many of the individuals take care of their own finances and have lockable facilities in their bedrooms. For those individuals that need support with finances good systems were in place to protect them, including records of all expenditure, receipts and signatures. Where able the individual is encouraged to sign for all expenditure. Individuals make a contribution towards transport costs this is based on usage and records were maintained in respect of this. This contribution was clearly documented in the home’s contract. Policies and procedures were in place relating to protection including whistle blowing, adult protection guidance and financial policies. Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Greenhill House is suitable for individuals with a physical disability. However some areas would benefit from being refurbished and updated to make it more homely and appealing. However, this did not distract from the care that was being provided. EVIDENCE: Greenhill House is situated in a rural area on the outskirts of Timsbury. It is a large building which has been extended over the years. Greenhill provides both residential care and nursing care to individuals with a physical disability. Communal areas and bedrooms are on the ground floor with offices situated in the main building on the first floor. The first floor can be accessed by a lift. Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 24 The residential area is situated in the older part of the building. There is a large dining room and lounge area. It is evident from talking with staff and the maintenance person that the home is exploring how these areas can be made more homely. The bar is situated in this area and it is evident that people like to sit and relax there. Whilst great attention has been paid to making bedrooms personalised some areas of the home lack that personal touch in the main this is corridors, bathrooms and some of the communal areas. Some areas of the home are used as storage areas including bathrooms, corridors and the main entrance to the unit where nursing care is delivered and IT suites. Staff, the deputy manager and the maintenance man confirmed that some works were being completed on these areas but it had been a slow process. It was evident that the corridor in the residential part of the home was being decorated and new fire doors were being installed. The maintenance person said that new automatic door closures were being fitted to fourteen doors as it has been identified that this would benefit the individual. Other areas of the home identified for improvement were the bathrooms. It was evident that the staff team were looking in general to improve the feel of the home for the benefit of the individuals. A concern was raised that visitors could walk straight into the Eastwest wing (nursing wing) as it was not clearly signposted how to get to the reception area or that in fact there was a door bell. The visitors book was situated in both units however it was not so prominent in the southeast wing. The main entrance to the nursing wing was being used as a place to charge wheelchairs again this did not enhance this particular area. The maintenance man said that this was being rectified as there is an area designated for charging wheelchairs but this had become a dumping ground for items that are no longer required. It was noted that there was a filing cabinet in this area that contained archived care records and it was unlocked. This must be addressed. In another corridor there were suitcases and a photocopier again this did not enhance the homely appearance of the home. Greenhill House is a specially adapted home for individuals with a physical disability and equipment was in situ to enable individuals to be as independent as possible. This includes widened corridors, hand rails situated throughout the building and personal care aids including hoists and specially adapted bathrooms. As already mentioned there are two lifts one to reach the first floor of the main building and the other to access the nursing care unit, gardens, activity centre and the car park to the rear of the property. The grounds of Greenhill House have been well tended by the gardener and the individuals living in the home. Bedrooms overlook small gardens. From talking with the gardener it is evident that he consults with individuals on what Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 25 they would like to see. The home has recently developed a sensory garden. The home has won awards for the work undertaken on the gardens. The home has a computer suite which has a number of computers with aids to assist the user. This area was being used by a number of people living in the home. A member of staff is employed to assist individuals and they are supported by volunteers. Individuals were observed accessing all parts of the home both independently and with staff. It is evident that the corridor areas take some knocks from the wheelchairs and would benefit from redecoration. The home throughout was clean and free from odour. Staff are employed to assist with the housekeeping tasks. The home has a separate laundry facility which was fit for purpose. A person was employed to complete the laundering of clothes. There are no requirements relating to the environment as it was evident that some works were being undertaken both during the visit and planned for the forthcoming year however it still remains that the overall appearance of the home is adequate. Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 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. Individuals are supported by competent and caring staff who have a generally a good understanding of the needs of the individuals. The home is adequately staffed but it is evident that at times this can be stretched where care needs of individuals increase. Good communication systems are in place to support the staff and ensure a consistent approach. EVIDENCE: Greenhill House provides personal care and nursing care. There are two units and each has a designated staff team. Although staff can work in both areas. The home is staffed with at least ten care staff in the morning (with an additional two staff working each area to assist with breakfasts) and eight care staff in the afternoon/evenings. A registered nurse works 24 hours a day. In addition to the care staff the home employs catering staff, domestics, a driver, and activity staff (4), laundry staff, maintenance and an administrator to Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 27 enable the care staff to focus on providing the care. Four staff are employed at night with one sleep in member of staff. The home has approximately seventy volunteers who assist individuals living in the home with activities. On the day of the visit there were at least six volunteers providing support with games, gardening, accessing the computer and just sitting with individuals chatting. Care staff were knowledgeable about the people they support and it was evident that a personal approach to care was being adopted. Three staff in the nursing wing stated that at times it can be very busy especially in the mornings and with seven staff to thirteen people it can be just before lunchtime that the last person is assisted with getting up depending on how the morning has gone. A high number of individuals need two staff to support them with personal care. It was evident from talking with staff that those that need to go out early for day care or appointments are assisted first with those that like a lay in left till the end. Staff acknowledge that sometimes individuals can be upset with the timings. Staffing levels are reviewed at weekly diary meetings to plan for additional staffing when required to accompany individuals to appointments or social outings. In light of the above, it would be good practice for the staff who are responsible for assessing individuals prior to them moving in look at the needs of the individuals presently accommodated to ensure that the staffing levels are appropriate. So that the needs of the person can be met whilst balancing the needs of the group. Individuals spoken to during this visit described good satisfaction with the staff support that is in place with no negative comments received. Recruitment information for staff was reviewed in respect of three newly appointed staff. All documentation was in place to demonstrate a robust recruitment process had been undertaken ensuring that staff are suitable to work with individuals living in the home. Volunteer staff undergo the same checks as employed staff. Once staff have been successfully appointed they complete an induction and have a period of probation. The Annual Quality Assurance Assessment confirmed that this can be extended where there are concerns about a staff member’s performance. Staff confirmed that they had completed an induction and that there is a period where they are mentored by a more experienced carer. The Annual Quality Assurance Assessment provided evidence that the home is working towards meeting the government’s target of 50 of the workforce Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 28 having a National Vocation Award. Six staff have an NVQ, five are near completion and a further 3 staff are due to start. Staff spoken with said there was a good level of training and that the organisation is willing to send staff on courses. The home is in the process of developing specific staff to cascade training to the care staff. This will be based on the needs of the individuals living in the home. All staff attend a disability awareness course and an empowerment course as part of their induction with periodic updates. Some staff have attended Mental Capacity Training and Disability and the law. It was evident from talking with staff that people were being empowered and their rights were respected. The home employs a training co-ordinator who oversees the training. It is evident that staff have attended mandatory training including health and safety, first aid, food hygiene, infection control, manual handling, fire and safeguarding training. Other training is available including clinical training on specific care needs and value training in respect of disability and the law. Areas that could be improved could be wound care training for the care staff, sing language and bereavement and loss. The latter because staff have experienced four deaths in the last twelve months and whilst it is evident that support is in place it could give a better insight into how it affects individuals. Sign Language as it was noted that some of the individuals use this as a way to communicate and from talking with staff they had not attended training in this area. Staff described a good working environment where generally staff morale is good with a good level of employment satisfaction. Some staff have worked in the home for many years. Staff said that there has been a period where staff were leaving but generally this was for personal reasons but during this time the home was reliant on agency staff and this did effect morale. The deputy manager said that presently there is only one staff vacancy and this was being advertised. The home employs approximately 38 care staff and eleven have left in the last twelve months. The deputy confirmed that in the main this has been for personal reasons with one member of staff being dismissed. There are good support mechanisms for staff where they can express their views including regular staff meetings, supervisions and informally on a day to day basis. Records were maintained of these. It was evident that they can discuss issues relating to care with both the deputy manager and the manager. Staff handover information between each shift both verbally and in a written format. Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 29 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 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 individuals benefit from a well managed home which is a safe place to live in. Individuals are involved and consulted in the running of the home. EVIDENCE: Mrs Ashby is the registered manager for Greenhill House. She has been in post for approximately three years. Mrs Ashby is a registered general nurse and is in the process of completing the Registered Manager’s Award which has now been replaced with the Leadership and Management Qualification. It was evident from talking with the deputy, staff and individuals in the home that Mrs Ashby has made many improvements to the home to the benefit of Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 30 the people living there. Staff described an open door approach to management. Systems are in place to monitor the quality of the care provided with all departments being quality assured at regular intervals from care through to maintenance to activities. Examples were seen during the visit with records maintained. Individuals are encouraged to be part of the process with their views being sought at meetings and through questionnaires. The home forwarded the Annual Quality Assurance Assessment when asked. This provided good information about how the service was doing, how they could evidence this and what improvements were planned for the future. In addition there was some statistical data. From reading the AQAA it was evident that the individuals had been involved and they comments had been included. This is good practice. Audits are completed at regular intervals in respect of health and safety and appropriate checks are being completed on the equipment in use in the home. Documentation was in place supporting this. This included hoists, the lifts, electrical appliances and gas. The maintenance person had a developed a comprehensive matrix when areas required testing. Water was thermostatically controlled and routine checks were completed by the maintenance person. Information relating to chemicals hazardous to health was in place with appropriate storage. The home has five vehicles and records were seen of checks completed to ensure the safety of the individuals. Drivers complete competence training prior to driving the home’s vehicles. Records were maintained. The home employs a driver, who has an advanced driving course and is able to check staff’s competence when driving the home’s minibuses. Fire records were viewed and all checks on the environment had been completed including fire training for staff and participation in fire drills. The person responsible for this was informed by the training co-ordinator when staff required this. It may be beneficial for this information to be kept with the fire records so that the maintenance person can keep this under review. Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 31 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 3 3 3 4 3 5 2 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 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000020243.V375853.R01.S.doc 3 3 3 3 2 LIFESTYLES Standard No Score 11 3 12 4 13 3 14 3 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 3 x x 3 x Version 5.2 Page 32 Greenhill House - Leonard Cheshire Disability No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA5 YA20 YA24 YA24 Good Practice Recommendations Where possible ensure that individuals or their representative have signed their contract of care. Liaise with the prescribing GP to ensure that the medication administration record includes full instructions in relation to medication and not “as directed”. Ensure of visitors are aware how to enter the home and the main entrance with clearer signposting from the top car park. Ensure adequate storage is in place for equipment and that areas like bathrooms and corridors are not cluttered. Greenhill House - Leonard Cheshire Disability DS0000020243.V375853.R01.S.doc Version 5.2 Page 33 Care Quality Commission North West Citygate Gallowgate Newcastle uponTyne NE1 4PA 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. 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. 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