Care Home: Greenhill Lodge

What the care home does well The residents appeared content and well cared for. Those who were interviewed were complimentary about the staff. A resident commented, "I do what I want. I clean my own room. The staff will help me if I ask for help." Another resident said, "I am quite happy with my room. The staff are helpful." The staff are trained to assist and support the residents to lead a reasonably independent lifestyle. The members of staff present during the site visit interacted well with the residents in their care and were readily available to assist them. In a recent questionnaire survey by us, all the residents gave positive feedback about the care and service provided. A couple of residents felt that the place could be more tidy but they emphasised that it is not due to the staff. A resident commented, "People do make a mess, especially some residents." Another resident said, "The cleaner makes a good job of it but some of the residents make a mess." What has improved since the last inspection? Since the last inspection, the provider has employed a deputy manager who will commence working on 11/08/08. Equality and diversity are promoted within the home. The current staff team come from diverse cultural, gender, and religious backgrounds. This enhances their ability to adequately meet the care needs of residents and to assist them to access their chosen place of worship. The home has a quiet room (nonsmoking lounge), that can be used as a prayer room for residents whenever required. CARE HOME ADULTS 18-65 Greenhill Lodge 22-24 Alexandra Road Watford Hertfordshire WD17 4QY Lead Inspector Yoke-Lan Jackson Unannounced Inspection 2nd July 2008 15:30 Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenhill Lodge Address 22-24 Alexandra Road Watford Hertfordshire WD17 4QY 01923 241 957 01923 229 236 greenhilllodge@together-uk.org www.together-uk.org Together Working for Wellbeing 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) Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10), Physical disability (10) of places Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home may accommodate 10 people with a mental disorder or physical disability (when associated with mental disorder). Date of last inspection 5th July 2006 Brief Description of the Service: Greenhill Lodge, provided by a charity organisation, is a home offering accommodation to 10 people with mental health conditions. It is situated in a pleasant residential street in Watford within easy walking distance of the town centre. The residents live relatively independent lives but with staff support always available. Staff also monitor their general state of health and wellbeing. All the bedrooms are for single occupancy. The bathroom and toilet facilities are nearby. The home does not have a lift and would not be suitable for service users with restricted mobility. The main administrative office, the laundry room, the kitchen, the dining room and the communal rooms are all on the ground floor. There is an attractive back garden with a patio and seating area that is accessible to residents. The home also has three flats for more independent people under the supportive living scheme. These are excluded from the registered provision. The home charges £743.42 per week. Information about the home and the service it offers is contained in the Statement of Purpose and the Service Users Guide. A copy of these and the most recent CSCI inspection report are available in the home. Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means the people who use the service experience good quality outcomes. The unannounced inspection was carried out on 09/06/08. The registered manager was present. The home has 9 people in residence. The inspection included a tour of the premises. Time was spent observing how the staff interacted with the residents. Staff and residents were spoken to and key documents were examined. Information received by us (The Commission for Social Care Inspection) since the last inspection was reviewed. This included the written survey questionnaires and the Annual Quality and Assurance Assessment (AQAA) which providers of registered services are required to complete. The AQAA focuses on how the outcomes are being met for people using the service. What the service does well: What has improved since the last inspection? Since the last inspection, the provider has employed a deputy manager who will commence working on 11/08/08. Equality and diversity are promoted within the home. The current staff team come from diverse cultural, gender, and religious backgrounds. This enhances their ability to adequately meet the care needs of residents and to assist them Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 6 to access their chosen place of worship. The home has a quiet room (nonsmoking lounge), that can be used as a prayer room for residents whenever required. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective clients can be assured that a pre-admission assessment will be completed before they are admitted to ensure that the home can meet all their care needs. EVIDENCE: The pre-admission documents of existing clients were seen in the care plan folder. One resident had been transferred to another care home following a hospital admission as the home could no longer meet their care needs. The home manager said that the vacant room needs major refurbishment and redecoration before anyone is admitted. A thorough assessment of care needs will be carried out before a client is admitted. Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are given every opportunity to make everyday choices with staff respecting their preferences and requests thus enabling them to achieve independent lifestyles. Each person has a written care plan so that staff can identify their goals and care needs appropriately. However, the written care plan is not in person-centred format. EVIDENCE: All the residents have mental health conditions and they are supported to make decisions about their lives with assistance when needed. The home has a key-working system to ensure that each resident is consulted on all aspects of life in the home and that they are supported in the choices made. Residents’ care needs are reviewed monthly and there is an annual review that involves the resident, their relatives, the social worker and other healthcare professionals. The written care plans are updated accordingly to ensure staff are aware of any change in residents’ care needs and objectives. Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 10 Each resident has a written care plan. The written care plans examined were individualised with risk assessments documented and individual care needs identified and included reviews of care needs. However, the care plans were not written in person-centred format. Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can expect that their rights will be respected and that they will be encouraged to lead an independent lifestyle and engage in communal activities and maintain contact with their friends and family. A healthy diet is promoted which meets people’s needs and expectations. EVIDENCE: The daily routine promotes independence and individual choice. Most of the residents have their own planned routine and staff monitor and assist when required. The residents are encouraged to participate in valued and fulfilling activities and are encouraged to make use of local leisure facilities. Most of the residents are out during the daytime either shopping or attending day centre or leisure activities. There is a monthly day trip and the residents decide where they want to go. Members of staff give support and accompany them. Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 12 On the day of the site visit it was noted that two of the residents were relaxing in the garden with their visitors at teatime. A resident was busy assisting a member of staff to clean the kitchen after the evening meal. Another was occupied tidying the bedroom. Another resident was relaxing outside the front of the house with a can of drink and a cigarette after the evening meal. Residents are given a choice of menu and healthy eating is promoted. There was a bowl of fresh fruit in the dining room. The weekly menu was on display in the kitchen. A member of staff said that the residents choose what they want. Each member of staff takes turns to cook the meals. Sometimes residents prefer takeaway food and they are supported to do so. Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are treated with dignity and receive individual care and support in the way they prefer and require, including a full range of health care facilities. They are protected by the home’s medication policy and procedures. EVIDENCE: Staff have a good working knowledge of the residents’ conditions and their preferences, and deliver care and support accordingly. On the day of the site visit, all the residents appeared content and relaxed. The home has the support of health care professionals such as the General Practitioner and the Community Mental Health Team. Behavioural concerns are referred to them for immediate assessment. The support plans regarding each resident’s physical and emotional health care are assessed regularly. Recently one of the residents has had an emergency referral requiring hospital admission. All medicines are stored in the drug cupboard attached to the wall in the administrative office. It was noted that there was no opening date on the Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 14 containers of medicines that were in use. In the Medication Administrative Charts (MAR) charts examined, it was noted that some medicines had been crossed off or discontinued without any indication of the date and the time they had been crossed off. The handwritten notes on the MAR charts do not have the signature of the author and it was not clear when the instructions had been written. In one case it was not clear when the dosage had been altered. Similarly, the daily notebook of the same resident had no details of the prescribed medicines that had been reviewed and the dosage that had been changed on the day by the doctor. However, there were contemporaneous notes on the new dosage written by another member of staff. Since the inspection, the home manager has addressed these shortfalls and has arranged for all members of staff to attend refresher courses on the safe administration of medication and the proper recording in the MAR charts and the daily notes. Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that they will be listened to and that they will be protected from self-harm and abuse. EVIDENCE: All the residents are aware of the complaints proceudure. Any concerns raised by individuals and at residents’ meetings are taken seriously and acted upon appropriately. All complaints are responded to within twenty eight days and if the complainant is not satisfied with the outcome of their complaint they are given support to take further action. Since the last inspection, the home has not received any complaints and there were no safeguarding incidents reported. The manager said that all members of staff have had training on issues regarding abuse and the protection of vulnerable as well as on the Whistleblowing policy. Arrangements are being made for new members of staff to attend training as soon as possible on the joint agency Safeguarding Adults (Adult Protection) Procedures of Hertfordshire County Council Adult Care Services. Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 25 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that the management is working towards making the environment more homely, safe and comfortable to live in. EVIDENCE: The home manager conducted a tour of the premises, which appeared reasonably clean and tidy. Over the last three years there had been vast improvement made to the interior of the building, including redecoration in some of the bedrooms. The manager said that six other bedrooms will soon be redecorated. However, one of occupied bedrooms has severe damp and urgent work is required to cure this. Since the inspection, refurbishment is being carried out in one of the other bedrooms so that the resident can move from the bedroom that is damp. The resident has agreed to this move. The manager said that the second administrative office on the first floor will be converted into a bedroom to Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 17 replace the one that is damp. Building work will be carried out shortly to cure the damp following which the room will be used as an administrative office. The broken bedroom door (a fire door) and the broken window in the laundry room have been replaced. The hole in the ceiling in the dining room has been repaired. The thermostatic valves controlling the mixer taps have been replaced in some of the bedrooms and the hot water temperature is being monitored and recorded regularly to ensure the safety of the residents. Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 33, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that the home has an effective staff team who will support them and can be confident that they are safeguarded by the home’s robust recruitment policy and procedures. EVIDENCE: On the day of the site visit, the skill mix and the staffing level were adequate for the current group of residents. A number of new staff have been recruited and a newly appointed deputy manager will commence working on 11 August 2008. The residents are involved in the recruitment of new staff. The home’s recruitment policy and procedures have been followed and the new workers only commence work after the Criminal Bureau Record (CRB) checks and the Protection of Vulnerable Adult (POVA) Register checks had been cleared. The staff files examined included training certificates, supervision notes and evidence of CRB clearance. All recruitment records are securely kept. Each member of staff has supervision six times a year and there is an annual staff appraisal. Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 19 New staff have a period of induction including mandatory training. The new Project Manager has implemented a training plan, which is used to monitor staff development and training needs. There is a rolling training programme, including Equality and Diversity and the Safeguarding Procedure. Since the inspection visit, the manager had given in-house training on the safe administration of medication and proper recording of the Medication Administration Record charts. Six members of staff will be attending an Advanced Medication Training course at the head office of the organisation on 31/07/2008. Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 38, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that the care and service provided will continue to improve. They can be assured that their health and safety are promoted and protected. EVIDENCE: The standards of management and administration of the service have been well maintained. The current Home Manager will be leaving the service once a new manager has been appointed. As a resulted she has not registered with the Commission. The post for a replacement has been advertised. From 11/08/2008, the home will have a Deputy Manager. The Area Manager provides additional support to the team. Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 21 The provider carries out an annual quality assurance and monitoring survey. This includes written questionnaire feedback from residents, relatives and others. The audit documents were readily available for inspection. There is a monthly proprietor’s report in compliance with regulations. All records for the protection of the residents are kept secure and handled in accordance with the Data Protection Act 1998. The servicing records have been well maintained. The Annual Quality Assurance Assessment (AQAA) forms issued by the Commission were received on time for this inspection. The information provided was detailed and has been included in this report. Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 3 3 X X 3 X Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 23 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. 1. 2. 3. Refer to Standard YA20 YA20 YA24 YA25 4 YA35 Good Practice Recommendations It is recommended that all handwritten notes and instructions on the Medication Administration Record (MAR) charts should be dated and signed by the author. It is recommended that the opening date be clearly written on each new container of medicines that are in use. It is recommended that the home has a rolling maintenance programme in place and that all maintenance work be completed as soon as possible for the comfort and benefit of the residents. It is recommended that all staff have refresher training on the recording, safe handling and administration of medication. Greenhill Lodge DS0000019416.V367633.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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