Care Home: Greenhive House

What the care home does well Residents told us: `They fulfil all their obligations` `I would have gone back home if I didn`t like it here`. It is `tip top`. `The food is good and I am able to worship` Relatives told us My relative `is well looked after at Greenhive` they `keep us advised of all medical, social and emotional issues and are always available to discuss matters` `residents seem well cared for` Staff told us `I am very proud to be working here` staff `work together in harmony`. Professionals told us `individual care plans are good and address individual needs` Our observations were that the standards of care at the home are high and residents` interests are protected. Residents` needs are met through effective arrangements for care planning and close work with health care professionals. An auditing system ensures that high standards are maintained. What has improved since the last inspection? There has been a significant improvement in the standard of care planning since our last visit. The plans are reviewed monthly and take full account of needs which arise from cultural factors. Redecoration has been completed since the last visit. A reminiscence room has been created and there are plans to install a cinema room in the home. What the care home could do better: We have made one requirement as a result of this inspection. Residents` allergies must be recorded on the medication administration record. Key inspection report Care homes for older people Name: Address: Greenhive House 50 Brayards Road London SE15 2BQ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Alison Pritchard     Date: 0 2 1 2 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. 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 Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Greenhive House 50 Brayards Road London SE15 2BQ 02077409880 02076398423 connie.oppong@anchor.org.uk www.anchor.org.uk Anchor Trust care home 48 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) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 48 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia -Code DE Date of last inspection Brief description of the care home Greenhive House is a care home run by Anchor Homes, providing personal care and accommodation for 48 older people who may have dementia. The home is purpose built and was opened in 2002. The home is arranged into three group living units, each with its own living room and dining room. All of the bedrooms are single and have ensuite facilities. There is a large garden to the rear. The home is in Peckham, within a reasonable distance of the shopping centre and public transport routes. On the ground floor of the home is a separate unit which is managed by the South London and Maudsley Health Trust. It provides care for people with dementia and operates separately from Greenhive House. Potential residents are given information about the Care Homes for Older People Page 4 of 26 48 0 Over 65 0 48 Brief description of the care home home and the services available through providing information to agencies who make referrals - including Southwark Social Services social work teams for older people and Hospital discharge teams. The home has a `block contract with Southwark Social Services so all referrals are made through these routes. Information is also available through the website of Anchor Care. The homes brochure is available in the main entrance to the home. Copies of the most recent inspection reports are kept on all of the homes units, on residents notice boards, on the staff room notice board and at the homes reception area for easy access to all visitors and professional bodies. The inspection reports are also mentioned in the Anchor statement of purpose along with information about where the report can be obtained. Care Homes for Older People Page 5 of 26 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: three star excellent 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: This inspection was unannounced and carried out over a day and a half in early December 2009. While we were at the service we talked to residents, relatives and staff, looked at a range of records and spent time in lounges with residents to get a sense of their experience of life in the home. We observed a meeting between staff which took place between shifts and we had a look around the building. Everyone at the home was polite, helpful and welcoming. Shortly after our visit to the home the Registered Manager sent us a document called an Annual Quality Assurance Assessment (AQAA) which gives factual information about the service and an assessment of their progress in relation to the standards for older peoples services. We have used the information in the AQAA in compiling this report. We also have access to information about things that the Registered Manager has told us about events in the home. These are called notifications and are a legal requirement. Care Homes for Older People Page 6 of 26 Before our visit we sent surveys for residents, relatives, staff and involved professionals to complete. We received sixteen completed surveys. The views expressed have been taken into account during our visit and in writing this report. We are grateful to everyone who assisted us with the inspection. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 8 of 26 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 26 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 26 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. The admission arrangements mean that the potential service user and the home have enough time and information to make sure that the placement will be appropriate. Evidence: Service users who completed surveys said that they had enough information to help them decide whether the home was the right place for them before they moved in. The majority of people also said that they had received a contract which gave information about the terms and conditions of living at Greenhive. Senior staff from Greenhive carry out assessments so that the home is sure they can meet the needs of the potential resident. Visits can be made to the home by the potential resident and their relatives before they decide whether or not to move in. There is a six week trial period before the placement is made permanent. Care Homes for Older People Page 11 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with care which is appropriate for their needs and their health is well looked after. Evidence: We looked at a selection of care plans when we visited the home. We found significant improvements in the standard of care planning since our last visit. Residents are involved in the care planning and had signed the documents indicating their agreement with them. We discussed some aspects of some plans with staff and found that they understood the plans and their implications for care and were aware of residents rights to influence what is contained in the plans. An example is that residents are asked whether, and at what frequency, they would like staff to check on them at night time. A health care professional told us that one of the things that the home does well is care planning, stating that individual care plans are good and address individual needs. All of the residents who responded to our survey told us that they always or usually Care Homes for Older People Page 12 of 26 Evidence: received the care and support they need. In discussion residents said that they were satisfied with the care the staff provide. A resident said that the home is good at making sure [residents] are well cared for. A relative said that great care is taken of all individuals...and that her relative is well looked after at Greenhive. We saw information concerning residents health care needs in the plans and appropriate assessments are carried out at admission and subsequently reviewed. These include weight monitoring and referrals to health care specialists are made when necessary. Staff have received training in specific health care needs to assist in their care of the residents, this includes diabetes care and working with people with dementia. Four members of staff have undertaken training in footcare and residents benefit from the quick response that can be provided to a straightforward footcare need such as toenail cutting. Residents with more complex needs, such as people with diabetes, are referred to podiatrists. We looked at medication matters. Feedback that we received was that the home assists residents to manage their own medication when they wish and it has been considered safe and appropriate for them to do so. Arrangements for medication are agreed with residents and a note is kept on their file. A health care professional told us that the home manages medication matters well. We checked the records of the administration of medication found that they were in good order. Each person has a sheet with their photograph on to ensure correct identification. There was one matter that needed to be addressed - to ensure that the medication administration records includes information about residents allergies, as this was found to be missing on some of the records we saw. See requirement. When staff spoke about and to the residents it was with warmth and respect. Residents said that staff listened to them and acted on what they say. A health care professional told us that the service is always respectful of residents privacy and dignity. Staff have received training in end of life care and we noted on some files that residents wishes were noted and signed by them. The home has a visitors room available for family members to use for overnight stays when residents are very ill and they wish to be with them. The home has good relationships with health care teams including the District Nurses, the Palliative Care Team and St Christophers Hospice. Care Homes for Older People Page 13 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents have the opportunity to follow activities which reflect their interests and cultures. There is good understanding of the benefits of the activity programme. Visitors are welcomed. The meals are enjoyed by the residents, they are appropriate for their tastes, cultures and nutritional needs. Evidence: The care plans include details of residents life history and social interests. This ensures that information is available to staff to provide activities in keeping with each residents interests and needs. Residents cultural background is given prominence in the information recorded, for instance in one file we noted that the persons Irish background is noted along with the importance of celebrating St Patricks Day and having the opportunity to observe Roman Catholicism. Each year a Diversity Dayis held and this gives an opportunity for residents and staff to celebrate the many cultures represented in the home. All of the staff are involved in providing activities for residents. We spent some time in all of the lounges and in each case noted that the music playing was appropriate for the ages and interests of the residents - Andy Williams was playing in one lounge, Shirley Bassey in another. A resident commented to us its nice to have some decent Care Homes for Older People Page 14 of 26 Evidence: music playing instead of the TV. In one lounge residents were gently encouraged to dance with staff. The residents clearly enjoyed this and there was a relaxed and warm atmosphere. Residents were smiling and engaged, some were watching the dancing, at other times looking at newspapers and talking with eachother and with staff. A reminiscence room has been created in the home since our last visit. We did not see it in use but our observation is that it will provide a useful resource, There is involvement with the local community through the churches, schools and use of resources such as the library and social clubs, such as Time and Talents and the Out and About Club. Arrangements had been made for children from the local school to visit the home before Christmas. Outings to see the Christmas lights in Central London were taking place on the days that we visited the home. A minibus is available for such outings and this is an asset to the home. Residents are accompanied to local shops and restaurants.Visitors are welcome to visit at all reasonable times, they are encouraged to share a meal with their relatives if they so wish. The feedback that we received about the meals was good. Choice is available at each meal and the choice can be made at the mealtime, rather than in advance. Nutritional assessment as part of care planning is integrated into the menu planning so that choices and needs are addressed. Since our last visit the home has arranged meals so that the main meal of the day is served in the evening and a lighter meal provided at lunchtime. The Registered Manager said that they have found that residents have benefited from this change, they are sleeping better and there has been a reduction in the frequency of falls. Care Homes for Older People Page 15 of 26 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 complaints and safeguarding systems contribute to the protection of service users. Evidence: The homes complaints procedure is well publicised by its inclusion in the statement of purpose and service user guide, its display throughout the building and leaflets are available in the reception area. All of the residents and relatives who responded to our surveys s aid that they were able to talk to someone informally if they were not happy although two people said that they did not know how to make a formal complaint. This is a small minority of respondents but it may indicate the need for a reminder of the formal process for raising concerns. All of the staff who completed surveys knew what to do if someone raised with them concerns about the home. There were no upheld complaints in the last year. All staff receive safeguarding training at the time of their induction, as well as information about the whistleblowing policy. In addition staff have attended safeguarding training provided by Southwark Social Services so that they are familiar with the local policy for dealing with these issues. They also attend training about their rights and responsibilities which covers safeguarding issues. The Registered Manager has attended training in investigating safeguarding concerns. Throughout the building are notices informing staff about the alert line which is provided by Anchor Trust to Care Homes for Older People Page 16 of 26 Evidence: enable concerns to be raised. Anchor Trust is currently reviewing safeguarding processes and the results of this exercise will inform the organisation about any changes necessary. Care Homes for Older People Page 17 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The building is comfortable and suitable for the people who live there. It is well maintained and standards of cleanliness and hygiene are very high. Evidence: The home is purpose built and divided into units, each for sixteen people. Each unit has a dining room and living room with plenty of windows so they are light and airy. There is a kitchenette adjoining each dining room so that drinks and light snacks are easily available. Main meals are prepared in the main kitchen and brought to the units by heated trolley. Each unit has sixteen single bedrooms which have en-suite WC and shower. Service users are able to bring personal items to their rooms if they wish and the rooms we saw were bright and individualised. There are larger communal rooms for people to gather together if they wish. There are also small lounges where service users may see their visitors with more privacy. One of these rooms is available for family members to use for overnight stays. Since our last visit a reminiscence room has been created and there are plans to create a cinema room. There is an attractive and safe garden to the side of the home. The home is very well maintained, redecoration has been carried out over the last year, and the kitchenettes have been re-fitted. Security lights have been installed to the front of the buidling and there are strict controls to make sure that the car park is used solely by those authorised to do so. Care Homes for Older People Page 18 of 26 Evidence: The home is very clean and odour free, hygiene standards are very good. Infection control measures are in place and the importance of these is impressed on new staff during their induction to the home. Every service user who responded said that the home is fresh and clean and some relatives and staff commented that this was a positive feature of the home. Each service users laundry is done individually and brought back to their rooms, this reduces the risk of clothes being lost or misplaced. Care Homes for Older People Page 19 of 26 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. The stable staff team is well supported and trained. They demonstrate commitment and pride in providing high quality care. Evidence: There is a stable staff team at Greenhive with only only one member of care staff having left their post in the last year. The staff know service users well and are familiar to them. Staff are allocated to particular units and this also assists in the provision of consistent care which is of particular importance for the needs of this group of service users. On duty in each unit is a senior member of staff (Team Leader or Care Coordinator) with three care staff in the morning and two in the afternoon. At night time a senior member of staff is on duty with three members of care staff. Additional assistance and advice is available from members of the management team, (at night time through the on-call system). In the event of staff absence through sickness or annual leave some staff work additional hours or members of the staff bank are allocated to shifts. The majority of the people who responded to a query about staffing said that the numbers are adequate, some people said that this is sometimes the case, but not always. Some commented that they would like more staff to be provided, one said that this would allow more individual activities to be provided. Our observation were that staffing numbers were acceptable, and all of the service users who responded Care Homes for Older People Page 20 of 26 Evidence: said that staff were always or usually available when they need them. It would be advisable for the Registered Manager to monitor staffing levels and ensure that there are no shortages and that the residents needs are met by the staffing numbers. We observed a handover meeting which takes place between shifts with the aim of providing seamless care. We were impressed with the thoroughness and depth of the information sharing. We found that the morale of the staff team is high and they are committed to providing good care. On a survey one member of staff commented I go home after my shift with satisfaction...I am very privileged to be doing something worthwhile. This was echoed by other staff members, many of whom said that a particular strength of the home was the training provided for staff. The majority (over 80 ) of the staff team have achieved NVQ 2. More than 70 Of the senior staff team have achieved NVQ3.Those staff who have not yet achieved this level of training are working towards the qualifications. Other training staff have undertaken includes dementia care, diabetes and a range of health and safety courses. We checked a sample of recruitment records and found them in good order, with the appropriate checks and references on file. New staff are given induction training which complies with the recommendations of Skills for Care. Care Homes for Older People Page 21 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management systems are very good, and provide a clear focus for the home based on the provision of high quality care. Quality assurance systems are thorough. Health and safety is well managed. Evidence: The Registered Manager has worked at the home since it opened and before that managed a home for the local authority where some of the residents lived and some of the staff worked. She is well qualified and experienced for the role . She holds a post graduate diploma in Health and Social Care management and the Registered Managers Award.She is an NVQ assessor and continues to pursue training opportunities. In the 2009 Honours List the Registered Manager was awarded the MBE for services to older people. The Care Manager, who has a deputising role, is also well experienced and qualified and is working towards the Registered Managers Award. The management style in the home is supportive and aimed at enabling staff to provide good care for residents. The effectiveness of this is illustrated in the findings Care Homes for Older People Page 22 of 26 Evidence: of this inspection. The home has a number of quality assurance systems, both internal to Anchor and carried out by external bodies. Internally care standards and documentation are monitored by senior staff; residents, relative and staff surveys are distributed; visits as required by Regulation 26 of the Care Homes Regulations take place. Monitoring is also conducted by contracts monitoring officers from Southwark Social Services. The company has achieved the Investors in People Award. We checked a selection of service users finances. We found the records in good order and safe systems to make sure the service users financial interests are protected. The fire safety systems are checked regularly and the risk assessment was reviewed in September 2009. A fire drill took place during one of our visits. We observed that staff responded appropriately and any matters that needed to be improved were addressed. An audit of the homes infection control measures took place in November 2009 and an action plan was produced to address any matters highlighted by the exercise. Our inspection of the records and tour of the building did not highlight any health and safety concerns. We are satisfied that the management systems ensure that Greenhive is a safe place to live and work. Care Homes for Older People Page 23 of 26 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 24 of 26 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 1 9 13 An improvement to the 22/02/2010 medication recording system must be made, specifically: - residents allergies must be recorded on the medication administration record. This will ensure that staff responsible for administering medication have all the necessary information available to them. 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 Care Homes for Older People Page 25 of 26 Helpline: 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). 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