Care Home: Greenhill Park

What the care home does well The home has a friendly and welcoming atmosphere. People are accommodated in a well maintained environment that is clean, comfortable and well furnished. People are given the opportunity to visit the home prior to admission and are provided with information to enable them to make an informed choice. People`s health care needs are being met and that they are treated with dignity and respect by the staff. People are able to exercise choice and to make decisions affecting their care Social stimulation is provided through a range of leisure activities and visitors are encouraged and made welcome. A good standard of food is provided. People feel confident about making complaints and policies and procedures are in place to help ensure that people are protected from abuse. The staff show a caring attitude towards the people and they, in turn, spoke positively about the way in which the staff carried out their duties and responsibilities. The registered manager has the necessary experience, qualifications and skill to manage the home effectively and to meet its aims and objectives. What has improved since the last inspection? The home and gardens have been kept up to date to provide a welcoming and homely atmosphere that meets the needs of people who live there. Improvements have been made to records and other documentation including the statement of purpose, service guide, assessment form, care plans and risk assessments. Staff meetings are held frequently and formal, individual staff supervision meetings are held at the required frequency. What the care home could do better: The service has sustained its good practice since the last key inspection. However the service could improve by developing a focus on individualised and personalised support, and an innovative approach to care practices. For example: Consideration of alternative formats or ways of passing on information to people with cognitive or sensory impairments. An individual approach to assessing and managing risks to people using the service. Development of the key worker role and monthly reports, to fully involve people using the service. Consideration of putting together a life story or more personalised information withpeople who use the service. An individual approach to monitoring the social aspects of life in the home, so that the needs of all the different people who use the service can be met. It is also important that the service continues to monitor and regularly update the numbers and training needs of its staff, according to the changing needs of people using the service and current good practice. This is particularly relevant to the areas of dementia care. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Greenhill Park 24 Greenhill Park Road Evesham Worcestershire WR11 4NL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Emily White     Date: 2 1 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Greenhill Park 24 Greenhill Park Road Evesham Worcestershire WR11 4NL 0138640836 01386422248 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Michael Francis Cole,Mrs Maria Bayliss care home 24 Number of places (if applicable): Under 65 Over 65 0 24 dementia old age, not falling within any other category Additional conditions: 24 0 The maximum number of service users who can be accommodated is: 24 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 24, Old age, not falling within any other category (OP) 24 Date of last inspection Brief description of the care home Greenhill Park is a large, detached building that is situated in a quiet, residential area approximately half a mile from Evesham town centre. The home has a large, attractive garden that includes lawns, flowerbeds and sitting areas. The home is in an elevated position and enjoys extensive views over the Vale of Evesham and the Cotswold Hills. The premises are accessible to people who use wheelchairs and there is space for car parking at the front of the building. The premises have been adapted and extended in order to provide accommodation for Care Homes for Older People Page 4 of 32 Brief description of the care home a maximum of 24 older people. The home is registered to provide personal care for people over the age of 65 years who may also have a physical disability. Ten of the places are registered for people who may also have a dementia illness. People are accommodated on the ground and first floor in 18 single bedrooms and 3 double bedrooms. Twelve of the single bedrooms have an en suite facility. Two of the double bedrooms have single occupancy. Consequently, there were 22 people in residence at the time of the inspection. A passenger lift has been installed to enable the service users to have easier access to the bedrooms on the first floor. The fees range from #360.00 to #425.00 per week. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before we visited the service we looked at all the information we had received since the last key inspection. This included information sent to us by the service and any complaints or comments. We received ten surveys from people using the service, seven from staff and four from health professionals. We also looked at the annual quality assurance assessment sent to us by the manager of the service, which tells us about what they have improved, what they could do better, and some statistics about the service. We visited on a week day and the deputy manager was available to help us. We met many people who use the service and staff, and spent time observing life in the home. We followed in detail the experience of three people who use the service, which Care Homes for Older People Page 6 of 32 included meeting them and looking at records relating to their support. What the care home does well: What has improved since the last inspection? What they could do better: The service has sustained its good practice since the last key inspection. However the service could improve by developing a focus on individualised and personalised support, and an innovative approach to care practices. For example: Consideration of alternative formats or ways of passing on information to people with cognitive or sensory impairments. An individual approach to assessing and managing risks to people using the service. Development of the key worker role and monthly reports, to fully involve people using the service. Consideration of putting together a life story or more personalised information with Care Homes for Older People Page 8 of 32 people who use the service. An individual approach to monitoring the social aspects of life in the home, so that the needs of all the different people who use the service can be met. It is also important that the service continues to monitor and regularly update the numbers and training needs of its staff, according to the changing needs of people using the service and current good practice. This is particularly relevant to the areas of dementia care. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have a detailed assessment of their needs before moving to the service so they can be sure that it is the right one for them. People are given detailed information about the service to help them make a decision. Evidence: The last key inspection report recommended that the guide to the service and the statement of purpose be updated. The information now provided to people who are interested in moving to the home is detailed and includes information about how to complain. However the information is only given in one format. It would be good practice for the service to consider offering information in easy read, large print or audio formats so that people with different needs are able to understand information about the home before they move in. People using the service who sent surveys said that they had received information Care Homes for Older People Page 11 of 32 Evidence: about the home before they moved in, and had received a contract when they moved in. Comments from people using the service include, The owners and manager were very open and informative always when I moved in The owners took care and time to explain what was available and their ethos of care at the home, which was what we were looking for. The annual quality assurance assessment tells us that prospective residents are encouraged to visit the home prior to admission. A trial period of four weeks following admission is in operation, this can be extended, if necessary. The last key inspection report recommended that the assessment used to record peoples needs be updated, and use all the information in the National Minimum Standards. The annual quality assurance assessment tells us that Each resident is assessed and assured that their individual needs will be met, prior to admission to the home. Information is sought from the prospective resident, family or representative, social worker, doctor and any other relevant care professional. Admissions to Greenhill only take place when we are confident we can meet all the assessed needs of the prospective resident. This assessment can take place anywhere, at the convenience of the prospective resident and their relatives or representative. During our visit we followed the experience of one person who had recently moved to the home. Before they move the deputy manager and manager of the home carry out an assessment to make sure the home is the right one for that person. This is supported by an assessment by a social worker or other professional. We saw that the assessment form used by the home gives details of all their personal care needs as per the National Minimum Standards. It highlights the main concerns relating to that person, as well as their dietary preferences, and some social interests. There is also a life history which looks at the persons family, job and where they lived. The assessment records the persons opinion on residential care, for example, X said with a smile she will let us know when she gets there. The assessment also includes a summary, with comments such as we will encourage involvement with other residents and activities without pressure recognising X is a quiet lady who enjoys her own company. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care is based on their individual, assessed needs. The arrangements for the storage and administration of medication ensure that peoples safety and wellbeing is protected. People are treated with dignity and their right to privacy is respected. Evidence: Most people using the service who sent in surveys said they always receive the care and support and medical care they need, and a few said they usually receive the care and support and medical care they need. Comments from people using the service include: There is always someone available or will get back to you if necessary The care, support and kindness shown by all the staff is excellent. They make great effort to make residents feel well looked after, each individual matters Excellent at arranging doctor and dentist appointments, nothing is too much trouble We also received four surveys from health professionals who work with the home. These said that the home always seeks advice, respects peoples privacy and dignity, Care Homes for Older People Page 13 of 32 Evidence: helps people to live the life they choose, and responds appropriately to different needs. They also said that staff always or usually have the right skills and experience. Comments from health care professionals include: Excellent, asks for help as needed Anything I require with a patients treatment and aftercare has always been observed Each resident is individually seen and treated privately for their foot care needs Good level of communication with GPs, any problems the service contacts me to visit The annual quality assurance assessment tells us that Residents needs are fully assessed, individual care plans are drawn up using a person centred approach and their health and personal care needs are met accordingly. Each resident is assigned a key worker, someone who takes special interest in the resident, liaising with family and ensuring all needs are ascertained and met. The last key inspection report required the service to must set out in detail in care plans the specific action that needs to be taken by the staff to ensure that peoples needs are met. The report also recommended that care plans should be amended to describe the way in which peoples needs should be met, and to include sight, hearing and foot care. During our visit we followed the experience of three people who use the service, which included looking at their care plans. Peoples care plans cover their physical care needs, their social and emotional care, and their health care. Under different headings peoples needs are recorded with instructions for staff about what actions to take. Peoples personal details are recorded, the name of their key worker and monitoring records such as weight, pressure areas and nutrition. Care plans also include health professionals visits, monthly key worker reports, daily records, and medical actions or events. People also have a general risk assessment covering mobility, accidents, wandering, aggressive behaviour, lifting and special instructions. It would be good practice for people only to be assessed for risks that relate to their individual needs, as this will encourage a more personalised service. When considering risks for people with dementia, the service should refer to good practice guidance and consider use of language and possible causes for high risk behaviour, as well as ways to reduce the risks. This may improve quality of life for these people and could stop the high risk behaviours occurring. The annual quality assurance assessment tells us that there are a range of different people with varied needs living at the home, including people with dementia, people with very high physical needs and people with visual impairments. The service tries to meet the needs of all of these people by constantly monitoring residents individual changing needs and ensuring they receive the care they need. Care Homes for Older People Page 14 of 32 Evidence: Peoples care records show a good level of detail about peoples care needs, for example the number of staff needed to support them, equipment to be used, teeth and hair care, reasons for distressed behaviour and instructions for staff on how to manage this, and contacts with hospitals following illness. Records also show that staff carry out regular monthly reviews of peoples care plan, there are regular visits by health professionals, details of medical events, keeping of health appointments, and good monitoring and recording of accidents. Staff tell us they have enough information about people so they can meet their needs. Staff say they always have a chance to look at someones care plan, and there is a regular hand over of information. We saw regular key worker reports and daily notes recorded by staff. We noted that when there are concerns for a persons health or well being the records are very detailed, for example in relation to a persons appetite, mood and behaviour, skin and sleep patterns. Where peoples heath has improved or there is little concern the records are less detailed, for example, comments include remains the same in general, X is fine. In some peoples records there is little recorded about what assistance they are receiving on a daily basis. It would be good practice for the manager to make sure that staff are clear about the purpose of key worker reports and daily notes, and what should be written, to ensure that peoples care needs are thoroughly monitored. We noted that a review of one persons psychiatric health stated a diagnosis of Alzheimers disease and the comment lacks mental capacity. We discussed with the deputy manager that this is an inappropriate use of this term under the Mental Capacity Act 2005, as there was no indication of what decision this relates to and no records of a mental capacity assessment. It would be good practice for the service to ensure that staff are familiar with the Mental Capacity Act 2005 so people can be confident that decisions are being made in their best interests. The annual quality assurance assessment tells us that residents are offered choice regarding self administering of medication, and all residents are afforded protection by our policies and procedures. All staff administering medication are senior in role and appropriately trained and assessed to do so. We observed medications being administered appropriately and saw that people had signed an agreement to manage their own medications or have them administered by staff. We saw that storage of medications is appropriate and controlled drugs are accounted for and stored appropriately. Records show that staff are good at recording changes to medications and contacting health professionals if there are any queries. We note that staff do no write dates of opening on loose boxes of medications, which was a recommendation from the last inspection report. This is repeated because this is a good way of keeping track of medications as they are administered. Care Homes for Older People Page 15 of 32 Evidence: The annual quality assurance assessment tells us that all residents are treated with the utmost respect and dignity. Residents rights to privacy are respected. It also tells us that and area for improvement is to discuss with residents and relatives or representatives their individual wishes, choices and decisions as to care in times of deteriorating health and to include these in their care plan. We saw from records that the service works hard to promote dignity, for example staff to explain and reassure, may need prompting for decision making, recording preferences for male or female carers, and noting peoples background such as X enjoys speaking of her work as a teacher. We observed during our visit that staff speak to people using the service in a respectful manner. Fewer rooms are now shared and people have a choice as to whether they have a shared room. The service has put in place equipment such as a sensor mattress for one person to ensure other residents are not disturbed and X is safe. Staff show awareness of how to respond to peoples different behaviours in a respectful way. Comments from staff include: We always talk to people about what they need and what would help them to live at Greenhill park People are treated with the highest dignity and respect Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service offers people the chance to take part in a range of activities, and links to the community are kept up. Peoples autonomy and choice is respected. Meals are nutritious and meal times are pleasant and relaxed. Evidence: People using the service who sent us surveys say that there are always or usually activities for them to take part in. Comments from people include: I particularly enjoy the musical activities. The Easter celebration was excellent, a good day You are welcome to join in activities and there are events through the year where family are invited My mother has dementia and physically unable to participate in any activities however she is always included in outings etc It would be nice to have a few more mental activities such as organised sessions of art, painting, cards, jigsaws, quiz games or slide shows of different areas of the country, or different birds and animals The service provides a wide range of activities including outings and in house entertainment. The annual quality assurance assessment tells us that after asking people what they wanted, they have introduced film afternoons, board games, cards and jigsaws. There is a separate section in each persons care plan which looks at Care Homes for Older People Page 17 of 32 Evidence: leisure and activities, family and friends, going out, communication, personal space and possessions, culture and faith and behaviour. Staff and people using the service tell us that they organise activities such as singing, skittles, basketball, hoopla, memory games, jigsaws, crosswords, and craft. During our visit we observed 11 people participating in hoopla and then basketball, with music playing. We observed different people with different abilities being encouraged to join in, and saw that people were smiling, singing to the music, interested and alert, following what the others are doing, and clapping. During the day we noted people making full use of the garden and laughing with the staff. Some people using the service told us that the main area they would improve would be to have more stimulating activities in the afternoons. We note that recorded information about likes and dislikes is often related to what is already on offer at the home. There is very little information about peoples hobbies and interests before they moved to the home, or their background. It would be good practice to gather a life story about a person during their assessment and after they have moved in, which would help personalise the care and support they receive and improve their quality of life, as well as improving the key workers knowledge of that person. We also note that there is very little recording of how people spend their time at the home, for example the activities logs in peoples care plans are rarely filled in. One person whose needs had increased had not had her care plan updated in this area, but it is still important for the service to consider social needs of people who are not able to get up or be active. It would be good practice for the service to review their approach to monitoring the social aspects of life in the home, so that the needs of all the different people who use the service can be met. The annual quality assurance assessment tells us that the service encourages attendance at any clubs previously visited, religious needs are met by regular church visits, twice a month services are held at the home. We actively encourage friends and family to visit or take residents out. Visitors are always warmly welcomed and offered refreshments, visitors are also invited to occasionally share a meal with their relative or friend if they wish, at no extra cost. Visitors are able to see their relative or friend in private, if they so wish. We respect residents rights to choose who they see or do not see. Staff and people using the service tell us that they have external visitors such as musicians, theatre, music for health, pets, and chair line dancing. The service has a monthly booking with the Age Concern minibus to take people out. Visits in the minibus have included a butterfly farm, and afternoon tea. The annual quality assurance assessment tells us that the service supports autonomy and choice by seeking residents views, offering choice, and supporting them to make decisions about their care and encouraging them to remain independent. Residents are Care Homes for Older People Page 18 of 32 Evidence: able to use kitchen and laundry services if they so wish. We saw minutes from a residents meeting which recorded peoples suggestions. We saw that one request for installing a handrail near the lift had been put into place. We saw from care files that there is flexibility with times of getting up and going to bed, and there is a lot of choice for meal times. Peoples care records promote independence where possible for example in methods of eating, helping people to choose their own clothing by laying clothes out in the correct order, encouraging people to make choices and do as much for themselves as possible. People who sent us surveys say they like the meals at the home. Comments from people using the service include: Meals are healthy and well balanced Meals are excellent good quality and plenty The food is very nice, very good, excellent, we eat all the time, David is an excellent chef, there is lots of choice. The annual quality assurance assessment tells us that at the request of people using the service the service has introduced cookery days at particular festivals during the year. They have also introduced smaller portion sizes with the offer of further helpings during mealtimes, and an option of spicier foods and various pasta dishes. People using the service tell us that this has happened and that they enjoyed the cookery days. During our visit we observed a lunch time. We saw staff offering choices, some people helping out, people chatting, and a relaxed atmosphere. There were choices of food and the meals looked and smelled appetising. Everyone we spoke to said they enjoyed their lunch. The chef provides a four weekly varied menu. We note that there are a lot of meat, vegetable and fish choices. The chef showed knowledge and awareness of specialty diets such as diabetes, and peoples likes and dislikes. We noted that all the store cupboards and fridges were full with good quality produce and the chef confirmed he is not restricted by a budget. Health and safety practices are being observed and the kitchen has recently been awarded four stars by their Environmental Health Officer. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a clear complaints procedure and other relevant policies and procedures to ensure that people are protected from abuse. Staff have been given appropriate information about how to act and people feel confident about making a complaint. Evidence: Everyone who returned surveys said there is someone at the home they can speak to informally if they are not happy, and everyone said they knew how to complain. During our visit we met people using the service and their relatives who all said they know how to complain and managers and staff are friendly and approachable. We saw copies of the complaint procedure which is displayed in the main entrance with the service guide. No complaints about the service have been received in the past year. The annual quality assurance assessment tells us that the homes complaints procedure is clear and contains all the relevant information. It is displayed in a prominent position in the home and all residents have a copy of it in their Residents Guide. It is also verbally brought to their attention during the admission process. We have policies and procedures in place to ensure all complaints are dealt with promptly and effectively. We have a suggestions box and will be instigating a comments book. The annual quality assurance assessment also tells us that: We operate a very strong and robust Abuse Policy, all staff are aware of this and our Whistle blowing Policy. Care Homes for Older People Page 20 of 32 Evidence: Staff have received relevant training and fully understand what constitutes abuse. Staff are aware that they will be supported if they blow the whistle on any abuse allegation. Care staff will be undertaking Deprivation of Liberty Safeguards training in 2009. Seven staff also returned surveys to us. All seven said they know what to do if someone has concerns about the home. We spoke to several members of staff during our visit. Staff say they received induction training which included protection of vulnerable adults. All of the staff we spoke to were knowledgeable about the signs of abuse and what action to take if they have concerns. During the inspection the manager was not present and we were not able to view an up to date version of the training schedule for staff. Since the inspection the manager has informed us that all staff have had updated training in the protection of vulnerable adults, and the Mental Capacity Act. The areas highlighted in the section under Health and Personal care (such as language, risk assessment and monitoring) will help staff to work with people whose communication is impaired through cognitive or physical needs. This will ensure that staff recognise when these people are expressing dissatisfaction or distress and can act appropriately. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in clean, comfortable and well-maintained surroundings. Evidence: People using the service who returned surveys said that the home is always fresh and clean. One person commented: Greenhill is excellent, always clean and never smelly. There is a programme of routine maintenance and renewal of the fabric and decoration of the premises. The home has made improvements such as treating the garden decking with anti clip coating, building a raised flowerbed, erecting a wooden bench, and putting up new curtains. During our visit we observed that peoples bedrooms are very personalised with photographs and their belongings. The house and gardens are pleasant with people making use of all areas. The time and date are displayed around the house and there are coloured signs for bathrooms, notice boards with menu choices, and regular activities. We saw that infection control procedures are observed, the house is clean and pleasant, with no odours, bathrooms and toilets are all clean with alcohol rub available and staff have had infection control training. Staff tell us they always have appropriate Care Homes for Older People Page 22 of 32 Evidence: equipment needed to keep the home clean and hygienic. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service receive good quality support from staff who are committed and well supported. The staff recruitment policy and practices ensure that suitable staff are employed and that peoples safety is protected. Evidence: Half the people who returned surveys said staff are always available when they are needed, and half said staff are usually available when needed. Everyone said that staff always listen and act on what they say. Comments include: There are always plenty of staff to help, and help is given willingly Help is always kindly and willingly given Staff who returned surveys said that there are enough staff to meet the individual needs of people who use the service. However some comments include: There is not always enough staff when some people are unwell, but then we work as a team Sometimes there is too much writing and paperwork Rotas and staff confirm that there are usually three staff working as well as the manager and deputy, with four staff at lunch time, and two staff at night. Day staff carry out laundry as well as spending time with people using the service. At the time of our visit people using the service had very varied levels of needs, for example some people are very independent, some people have advancing dementia and one person Care Homes for Older People Page 24 of 32 Evidence: requires two staff for assistance with all tasks. These needs require different actions and time spent by staff, to try to balances the lifestyle of different people. We spoke to several staff who say that generally there are enough staff but at peak times such as when medications are administered, two staff may be called to help a highly dependent person, which causes pressure for staff. Tasks such as recording and laundry also take staff away from spending time with people using the service. Most felt that peoples personal care needs are all met but the social side suffers. It is good practice for the service to continually review their staff complement according to the needs of people using the service. The needs of people with dementia need to be considered as their illness progresses. All seven staff who returned surveys to us said that their employer had carried out checks and got reference before they started employment. We spoke to several staff and looked at three staff files which confirmed that appropriate and safe recruitment procedures are happening. The annual quality assurance assessment tells us that: Care Staff are trained or training to a minimum of NVQ level 2, senior care staff are trained to NVQ level 3 and the deputy manager is currently training to NVQ level 4 and has completed the Registered Managers Award. We saw some staff files and spoke to some staff who confirmed this. All seven staff who returned surveys said that their induction covered everything they need to know to do their job, and they are given training which is relevant, helps them to understand peoples needs, and is up to date. Comments include: We are given loads of training relating to our work so we can give proper care We have a lot of support and training We met several staff who said they have had recent training in dementia, challenging behaviour, manual handling, managing incontinence, health and safety, first aid, fire, and infection control. During the inspection the manager was not present and we were not able to view an up to date version of the training schedule for staff. The service has recently set up a rolling training programme with an external company, which will cover infection control, protection of vulnerable adults, health and safety and fire, dementia, food hygiene, medications, mental capacity act and challenging behaviour. It is important that the service continues to monitor and regularly update the training needs of its staff, and considers specialist training according to the needs of people using the service and current good practice, in particular dementia care and personalisation. Care Homes for Older People Page 25 of 32 Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager is experienced, competent and caring. The management of the home is based on a positive approach, openness and respect for peoples best interests, rights and safety. Systems are in place to monitor and develop the quality of the service. Evidence: Comments from people using the service include: There isnt one member of staff who is less helpful or pleasant than the others. Everyone is very kind and caring, they couldnt do any more to make this a more wonderful caring home. Its excellent and Im very happy here. Michael and Maria lead and manage by excellent example. The registered manager has been the manager of the home since February 2005. She completed the Registered Managers Award training in July 2006 and the NVQ level 4 training in March 2007. We met the deputy manager during our visit who showed a good knowledge of the service and competence to manage in the managers absence. Care Homes for Older People Page 27 of 32 Evidence: The deputy manager is currently training to NVQ level 4 and has completed the Registered Managers Award. The annual quality assurance assessment also tells us that the manager and deputy have recently attended courses in report writing, record keeping course, and care planning. The annual quality assurance assessment was completed on time and had a lot of detail about how the service is improving. The service carries out some quality assurance audits and makes sure it involves people using the service and their representatives. This is done through care plan reviews, key workers, residents meetings, questionnaires to relatives or visitors, questionnaires to people using the service, the suggestions box and any complaints. In developing the key worker role and monthly reports, the service should consider recording the views and opinions of individual people using the service, which will help to develop more personalised support and involve people in how their service improves. If peoples money is held in safekeeping it is kept in a locked cabinet in a locked room. Access to peoples money is restricted to the registered manager, deputy manager and one of the registered providers. The money is kept together in one large amount. A separate record is maintained of peoples individual accounts and transactions are recorded. Staff meetings are held quarterly and staff supervision or reviews are held every two months. We met staff who confirmed they have regular supervision and support from staff. Staff who returned surveys to us said that they always have enough support, experience and knowledge to meet peoples needs, and that that the manager regularly gives them support and meetings to discuss how they are working. Comments from staff include: The managers always try to help and support us The manager is very approachable and listens to the staffs problems and needs regarding work A requirement from the last key inspection was that risk assessments must be carried out and recorded for all the safe working practice topics covered in the National Minimum Standards. A random sample of health and safety records shows that risk assessments are complete and health and safety checks are being carried out. We spoke to staff who are aware of health and safety issues and who has responsibility for these. The annual quality assurance assessment tells us that the registered manager and deputy manager have attended a risk assessment course. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 It would be good practice for the service to consider offering information in easy read, large print audio or other formats so that people with different needs are able to understand information about the home before they move in. When considering risks for people with dementia, the service should refer to good practice guidance and consider use of language and possible causes for high risk behaviour, as well as ways to reduce the risks. This may improve quality of life for these people and could stop the high risk behaviours occurring. It would be good practice for people only to be assessed for risks that relate to their individual needs, as this will encourage a more personalised service. It would be good practice for the service to ensure that staff are familiar with the Mental Capacity Act 2005 so people can be confident that decisions are being made in their best interests. It would be good practice for the manager to make sure that staff are clear about the purpose of key worker reports and daily notes, and what should be written, to ensure that peoples care needs are thoroughly monitored. Page 30 of 32 2 7 3 7 4 8 5 8 Care Homes for Older People 6 9 The date of opening should be recorded on the outside of loose medicine packets, so that the service can keep track of medications as they are administered. It would be good practice for the service to review their approach to monitoring the social aspects of life in the home, so that the needs of all the different people who use the service can be met. It would be good practice to gather a life story about a person during their assessment and after they have moved in, which would help personalise the care and support they receive and improve their quality of life. It would be good practice for the service to consider developing a complaints guide in formats that people with visual and cognitive impairments are able to understand, or provide regular opportunities for verbal reminders of the process, such as at key worker meetings. In developing the key worker role and monthly reports, the service should consider recording the views and opinions of individual people using the service, which will help to develop more personalised support and involve people in how their service improves. 7 12 8 12 9 16 10 33 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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