Care Home: Greenwood House

What the care home does well People can be confident that there is, on the whole, a good standard of information about the home and that they can be confident that their needs are assessed before they move in. Comments added within the surveys said that the home does well as `First class care is given to all residents` and `Looks after residents with dementia with great care, understanding, patience. Nothing is too much bother.` Some of the residents said that they could not fault the care, describing it as `Very good` and `Excellent`. Comments received from the residents` surveys said that the home had improved with `Trips to the seaside. Has(sic) improved while I have been here` and that the home does well with `Entertainment.` Another person said that `...we always have a lovely time.` People can be confident that they will be listened to and that their concerns will be taken seriously.They can also be confident that they will be safe from the risk of harm. Comments from the residents` surveys said that the `Staff are very helpful` and `All the staff seem very caring & willing to help at any time.` 84.3% of the care staff have a National Vocational Qualification, level 2 or equivalent, in care with more staff working towards this desirable qualification. People benefit from a responsive and open culture of the home. In February 2008 the home was awarded 5 stars i.e. `Excellent` for its food hygiene, by the Environmental Health Officer. What has improved since the last inspection? There were no requirements or recommendations made following our last inspection. The home has taken action to improve how it monitors people`s nutritional status. What the care home could do better: The standard of recording of the assessment of people`s needs and how staff are to meet these needs is to be improved within the care plans. This is to ensure that the staff have the correct guidance in how to manage people`s individual assessed needs. The storage, recording and administration of medication must improve to ensure that people are safe and receive their medication as prescribed. Medication records must be maintained with accuracy to ensure people are protected from harm and that there is a clear audit trail within the home. A requirement has been made about this. People`s dignity must be respected at all times. This is to ensure that their human rights are valued. A requirement has been made about this.Risk assessments must be carried out for residents who access stairs and a risk assessment must be carried out with regards to part of the enclosed garden area of Dove Unit. The knowledge of some of the staff, in how to meet the special needs of people with dementia, needs to be embedded in practice when caring for people with this mental health condition. The quality assurance of the home could improve to ensure that any improvements made are sustained. Key inspection report Care homes for older people Name: Address: Greenwood House South Parade Peterborough PE3 6BG     The quality rating for this care home is:   one star adequate 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: Elaine Boismier     Date: 1 5 0 4 2 0 1 0 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 32 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Greenwood House South Parade Peterborough PE3 6BG 01733569362 01733568984 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Peterborough Primary Care Trust Name of registered manager (if applicable) Susan Elizabeth Clayton Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Up to three service users aged between 60 and 64 years may be accommodated at any one time Date of last inspection Brief description of the care home Greenwood House is located in a residential area of Peterborough, a few minutes walk from the city centre. Accommodation for 40 people is on two floors, and consists of four units. Each unit has its own lounge, dining-room, bathroom, toilet and kitchen facilities and there is a laundry, main kitchen and staff facilities. Fees range from £90.17 per week to £440.58 per week and are rated according to peoples assessed needs. Additional costs include those for hairdressing, personal shopping and private chiropody. Further information about the fees can be obtained via Care Homes for Older People Page 4 of 32 Over 65 16 24 0 3 0 3 Brief description of the care home the home. Copies of the CQC inspection reports are available at the home or from the CQC web page at www.cqc.org.uk 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: one star adequate 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: We, the Care Quality Commission (CQC), carried out this unannounced key inspection between 9:15 and 16:15 taking seven hours to complete. Before the inspection we received surveys from nine of the residents and six from the staff. We looked at information that we have received about the home since our last key unannounced inspection. The home sent us, as requested, an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. During this inspection we looked around the premises and looked at some of the documentation. We case tracked two of the thirty-five current residents. Case tracking means speaking with some of the residents and visiting their rooms and speaking with Care Homes for Older People Page 6 of 32 some of the staff who were looking after them. We compared what we saw and heard with the peoples individual records. We also spoke with and watched other people who were not part of our case tracking. We spoke also to some of the other staff, including the Manager and the Assistant Managers. For the purpose of this inspection report people who live at the home are referred to as people, person, resident or residents and the Manager and the Assistant Managers are collectively referred to as the Management Team or Team. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The standard of recording of the assessment of peoples needs and how staff are to meet these needs is to be improved within the care plans. This is to ensure that the staff have the correct guidance in how to manage peoples individual assessed needs. The storage, recording and administration of medication must improve to ensure that people are safe and receive their medication as prescribed. Medication records must be maintained with accuracy to ensure people are protected from harm and that there is a clear audit trail within the home. A requirement has been made about this. Peoples dignity must be respected at all times. This is to ensure that their human rights are valued. A requirement has been made about this. Care Homes for Older People Page 8 of 32 Risk assessments must be carried out for residents who access stairs and a risk assessment must be carried out with regards to part of the enclosed garden area of Dove Unit. The knowledge of some of the staff, in how to meet the special needs of people with dementia, needs to be embedded in practice when caring for people with this mental health condition. The quality assurance of the home could improve to ensure that any improvements made are sustained. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. 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 can be confident that there is, on the whole, a good standard of information about the home and that they can be confident that their needs are assessed before they move in. Evidence: Four of the nine residents surveys said that the person had received enough information about the home to help them in their decision where to live; three of the other residents surveys said that they did not have such information with the remaining two surveys saying that the person did not know if they had received this information or not. Information about the home, including the Statement of Purpose, was available by the visitors signing in book. We examined the Statement of Purpose with the Manager and there were some elements of this that required updating. Examples of this included changing the former names of the registration and inspection authority from Care Homes for Older People Page 11 of 32 Evidence: the National Care Standards Commission and Commission for Social Care Inspection to the current name of the Care Quality Commission. The Manager said that the information about the homes complaints procedure was also out of date and that this was also to be updated. Copies of our last inspection report and annual service reviews were on display for people to read if they so wished. One of the members of the Management Team explained the pre-admission process and this information was compared with document used when the home takes a referral for a prospective resident. On the day of our inspection we saw how the Team were using this information to assess if the home was a suitable place for the people moving in. We were also told that any person admitted from home, for respite care, the home makes sure that they visit the person, in their own home, to assess if Greenwood House can meet the persons needs. As part of our case tracking we saw letters, addressed to the residents, to confirm that their assessed needs could be met by the home. The AQAA informed us that the home provides Intermediate Care. We clarified this with one of the members of the Management Team and we were informed that Intermediate Care is not provided although interim care is: people are admitted to the home whilst recovering from a medical condition but need some support before they are well enough to return to their own home. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although people can be confident that they will receive safe and proper personal care they can not be fully confident that their health care needs, with particular regard to mental health needs and medication, will be safely met. Evidence: As part of our case tracking we looked at two peoples care records and we found that there was information about the persons life histories, including their interests, relationships and their personalities. We asked a member of the staff about their knowledge of this information and they were able to tell us about one of these two people. To improve the importance of this information the Manager said that they would place this at the front of the persons file, giving a clearer sense, to the staff, of the persons individuality. The peoples assessments of their needs were under different headings to include, for example, communication, mental health, personal care and pain control needs. The detail of the persons assessed needs were brief and we found that the frequency of when these care needs were to be met were recorded as, for example, when Care Homes for Older People Page 13 of 32 Evidence: required. For instance, where the person was assessed for pain we read that the Client may at times suffer from pain. There was no further information to guide the staff where such pain was experienced and how this affected the person. The guidance provided said that Staff to offer Client pain relief as prescribed. The frequency when such care was to be provided, as with other areas, was recorded as When required. During our case tracking we observed how the staff interacted with the people. Some, but not all, of their interactions promoted the persons sense of well-being. When people were approached by staff in a calm and respectful way we saw that the people were smiling and calm. However we noted the manner in which the staff approached the people sometimes evoked a negative sense of well-being of the person, such as unhappiness and tearfulness. The peoples care plans had a lack of staff guidance in how they should approach these two people. We looked at the care records with the Manager who agreed that the care records were insufficient in detail to give the staff the guidance that they need to meet the special care needs of these two people. We saw risk assessments were carried out to include moving and handling and the risk of falls. During our case tracking we saw one of the people independently walking down some stairs and was supported, at the bottom, by a member of the staff. We saw, as time went on, the person was becoming tired and expressed a sense of weariness, by sighing. We also saw that, on one occasion, they were slightly unsteady when standing. The Manager said that the person walked up and down the stairs regularly although we found no risk assessments for the person using the stairs. The Manager said that they would put such a risk assessment in place. Continuing with our case tracking we saw that the care records were reviewed each month and reviews had also taken place, with relatives, on behalf of the residents. Eight of the nine residents surveys said that the person always or usually received the care and support that they needed; all of the nine residents surveys said that the home made sure the person got the medical care that they needed. Comments added within the surveys said that the home does well as First class care is given to all residents and Looks after residents with dementia with great care, understanding, patience. Nothing is too much bother. We spoke with some of the residents living on Mallards unit and they said that they could not fault the care, describing it as Very good and Excellent. We saw a resident, who did not have English as their first language, being spoken to by a member of staff and both were talking in their shared first language. We saw the positive effect that this had on the resident as they were freely engaging in this social Care Homes for Older People Page 14 of 32 Evidence: interaction. According to the AQAA We have access to the Older Peoples Team who support us with falls, CPN, Dietician, Continence etc. The AQAA also told us that people have access to the district nurses, chiropody and optician services. We saw, from our examination of the two case tracked peoples records, that they had had access to health care professionals to include a dietician, psychiatric services, general practitioners and a speech and language therapist. A referral had been made, by the home, for a person to be assessed by a dentist. We saw a district nurse visiting the home to assess and provide additional support and advice to people who the home had identified as having additional nursing needs. People were wearing clean clothes and had clean hair and fingernails. One of the people who we case tracked visited the in-house hairdresser and we saw, when we spoke with them, that they were enjoying the experience. From the other persons record of their personal monies we saw that they had visited the same hairdresser during the previous weeks. According to the AQAA the home identified areas where improvements could be made with monitoring peoples level of nutrition. Action had been identified to improve this area to include Introduce MUST training throughout the home (Must is an acronym for Malnutrition Universal Screening Tool). We saw recorded evidence that the staff training in this area had, and was, taking place. We saw that the MUST assessment had been introduced and that action had been taken, to include weekly weights and giving nutritional supplements to the two people who we case tracked. Some of the residents surveys indicated that the matching of residents may have some negative effect on some of the peoples sense of well-being. According to the members of the Management Team action has taken place to address some of these issues. We looked at how medication is recorded, stored and administered. We saw that medication brought into the home was being recorded by a member of the Management Team, to include the name, quantity and frequency of when the medication was to be given to the resident. This demonstrated that the home had an audit trail for medication coming into the home. With one of the members of the Management Team we looked at the storage of medication throughout the home. We saw that medication was stored in trolleys, in the individual units and within a treatment room. The medication trolleys were Care Homes for Older People Page 15 of 32 Evidence: secured to the walls and were locked when not attended to. Where oxygen was stored appropriate safety notices were seen. The air temperature of the treatment room was recorded each day and this was satisfactory in maintaining the quality of the medication. The air temperatures of where medication is stored elsewhere in the home were not monitored. We tested two of the areas, in Robin unit and Dove unit, and found that the air temperatures were not in excess of 25 degrees centigrade. The temperatures of the drug fridge were recorded each day and these demonstrated that the recordings for, at least from the 11th April 2010, were recorded as 0 degrees centigrade and below. We looked inside the fridge and found ice had built up although no action had been taken to ensure that the quality of the medication was maintained. In Robin unit we found a bottle of medication kept in a metal box, that was held in a food fridge. The box and fridge door were not locked. Immediate action was taken to remove this medication, to the drug fridge in the treatment room, to ensure no unauthorised person or resident could appropriate this medication. At the beginning of the inspection we saw a member of care staff obtain a set of medication keys (a member of the Management Team confirmed that these were medication storage keys): these keys were retrieved from an unlocked desk drawer which was located in one of the management offices - which we saw was accessed by visitors and residents. Action was taken to ensure that medication keys were kept on the person, responsible for giving medication, at all times and we saw this safe practice was carried out when we visited other areas of the home. Controlled drug medication was stored in a correct and secure way and the amounts available reconciled with the associated register. The register had no record of the name and address of the dispensing pharmacy and immediate action was taken to amend these records to give a clear audit trail. We observed how medication was given and recorded on two of the units. On Mallards unit we saw that medication was given in a hygienic way and peoples dignity and choice were valued. On Dove unit we heard a member of staff asking one of the people, who we case tracked, to take their medication. The approach and manner of the member of the staff evoked a negative sense of well-being of the resident. We discussed our full findings with the Management Team and we were told that such a compromise of peoples sense of well-being and dignity, by staff, was unacceptable and disappointing. Care Homes for Older People Page 16 of 32 Evidence: We saw medication records were accurately signed on Dove unit although we found that this was not the case on Mallards unit: the medication administration records were signed before the medication was given. This poses a risk that if medication is not administered the medication records would not be accurate. With the exception of one medication left for a person to take with their meal we saw people were observed, by the staff, when they were taking medication. However we saw that this practice could not have been carried out, at least on this occasion. We saw within the incident and accident records that, on the 24th March 2010, a resident was found with A rubber glove knotted with (their) meds (sic) in and one tablet dident (sic) belong to (them). People who we spoke with, on Mallards unit, said that the staff were Very good and that they knocked on their doors before entering. Carrying on with our case tracking we saw a variance in how peoples dignity was valued. We saw that some of the staff were kind, caring and patient although this was not always the case. We reported our full findings to the Management Team. Care Homes for Older People Page 17 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. People can be confident that their social needs are, on the whole, being met. Evidence: Seven of the nine residents surveys said that the home always or usually arranged activities that the person could take part in; one of the other surveys said that this was sometimes the case with the remaining survey saying that the person did not know about such arrangements. Comments received from these surveys said that the home had improved with Trips to the seaside. Has(sic) improved while I have been here and that the home does well with Entertainment. Another person said that ...we always have a lovely time. Some people told us that they were bored as there was not enough to do. The Management Team said that attempts had been made to encourage residents to take part in activities, such as evening entertainment, although they had encountered reluctance from some of the residents. As part of our case tracking we looked at how people were engaged in activities and we found that some of the staff were engaging people in throwing and catching a soft ball and assembling a jig saw. We also saw a member of staff in supporting a person Care Homes for Older People Page 18 of 32 Evidence: in making a cup of tea. Comparing information in the peoples life histories and with their records of activities we found that there was insufficient evidence to suggest that these were being tailored to peoples individual needs. We were told, for example, that people have taken part in the activity of painting-an interest recorded in one of the peoples life histories- although we found no recorded evidence that this had occurred during the last two weeks of March 2010. In Dove lounge we found a box of skittles although we found no other objects to engage the residents: the Management Team said that they had to modify the environment, recently, to ensure that peoples safety was maintained. We were told that, during 2009, some of the residents went to see a pantomime, had Christmas dinner out of the home and we saw records that told us people had picked flowers from the surrounding gardens, had played dominoes, been shopping and had watched television, for example. The Management Team said that activities is an area that they continue to review to improve; this was to include sensory boards and reminiscent therapy for people with dementia. Peoples records, the visitors signing in book and from our observations noted that there is no restriction imposed for when and where people can receive their guests. We saw in the rooms that we visited people can bring their own possessions into the home. Eight of the residents surveys said that they always or usually liked their meals with the remaining survey saying that they sometimes liked their meals. Comments received from the residents surveys said that the home Make(s) lovely food sometimes. Suggestions about the food were sometimes entered within the residents surveys, for example, the home could do better with providing More sugar puffs on the menu and I would like to have a level teaspoon of sugar in my tea. The people we spoke with said that the food was Excellent. For lunch we saw there was a choice available of beef cobbler with carrots and cabbage or a baked potato with baked beans. Information about what was on the days menu was seen in all of the units visited. On Mallards unit we asked two of the people if they could see the information written on the board and this was done with a degree of difficulty. The Care Homes for Older People Page 19 of 32 Evidence: Manager explained that the choice of vegetables is not included on the menus as they are provided according to their availability and the season. They explained that the menus are under review and has considered, and would continue to do so, how residents information about their meals could improve. The menus that we examined showed that people have a choice of a cooked breakfast, a variety of choices for lunch and tea and we saw that people were having drinks offered to them throughout the morning and at lunch time. In the lounge of Dove unit we watched how the staff helped the people with their food and drink. People were encouraged to be as independent as possible and when they needed assistance this was done on a 1:1 basis, telling us that peoples lunch time experience was valued as was their dignity. In 2010, during a safeguarding investigation, it was found that the home could improve the way it monitored and reviewed peoples nutritional status. The AQAA said that improvements had been made with this although none of the staff had attended training in understanding malnutrition and how to help the people with their food. Since we received the AQAA action has been taken by the home to improve this area of residents care. Care Homes for Older People Page 20 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. People can be confident that they will be listened to and that their concerns will be taken seriously. They can also be confident that they will be safe from the risk of harm. Evidence: According to the AQAA the home provides Information on how to complain is kept in Room Folder for each client. All complaints are recorded and dealt with quickly. The AQAA told us that, within the last twelve months, up until we received this completed document in March 2010, the home had received eight complaints with the majority (7) being resolved within the 28-day required time period. Four of these were substantiated and one of the complaints was still under investigation. We looked at the record of complaints and we discussed this area with the Manager who told us that there was no recurring theme to the complaints. We were also told that the complaint, which was not resolved within the 28-day time period, was due to an investigation carried out by an external agency, as requested by the home. We have received no complaints against the home. All of the residents surveys said that the person knew who to speak to if they were unhappy about something and all of these said that the person knew how to make a formal complaint if they so wished. All of the six surveys from the staff said that the Care Homes for Older People Page 21 of 32 Evidence: person knew what to do if any person had a concern about the home. The people we spoke with said that they had nothing to complain about but they would speak with the Manager if they had a concern or complaint to make. Since our last key unannounced inspection we have received two allegations of suspected abuse against some of the residents and the AQAA noted that there have been three such allegations. The home followed the correct reporting procedures and took the appropriate action to reduce the risk of any harm against any of the residents. None of the allegations were substantiated. All of the residents surveys said that the staff always or usually listened to what the person said to them and acted on this. The staff who we spoke with showed that they had a knowledge of what constitutes abuse and would report such untoward incidents via the homes management hierarchy. They said that they had contact numbers for external safeguarding agencies although these were not at the home. We saw that the Management Team had received information leaflets about safeguarding and we were told that these were received the day before our inspection. The Manager said that these would be made available in the reception area for any person living, working or attending the home. To promote the safeguarding awareness the Manager said that they would place this information in the staff room. Care Homes for Older People Page 22 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 a clean home that is generally well maintained but could be more homely. Evidence: On entry to the home we found it to be friendly and welcoming due to information available and from the reception of the staff. One of the residents surveys said that the home could do better to Improve areas of homer (sic) re: decoration and up-dating. Improve rolling programme to replace furniture. One of the residents surveys said that the home could do better with Maybe a bit of decorating & freshening up a little. During the tour of the premises, with one of the members of the Management Team, we found evidence that there is an ongoing refurbishment programme. For example we saw that one of the corridors was in the process of being redecorated and within one of the rooms, room 2, a new carpet was provided. In room 7, we were told that a stain to the carpet had been treated and would be replaced if the treatment was unsuccessful. The walls of the corridors had pictures and we saw that there were ornaments and pictures in most of the lounge areas. The storage of disposable gloves and aprons, for Care Homes for Older People Page 23 of 32 Evidence: example in bathrooms and on Robin unit, could be better as these were in sight, giving these areas a clinical feel (the items on Robin unit were immediately placed in a cupboard by the member of the Management Team). We found, in a corner of a dining room on Mallards unit, a hoist and a pair of electric weighing scales, in full view of the residents. In addition there was a metal filing cabinet and a cardboard box with moving and handling equipment. Such storage of equipment detracted from the homely feel of the room. We noted a number of posters and reminders for staff, including those for infection control, in areas accessed by the residents. The Management Team explained that these were in place as advised by an external agency although it was agreed that such notices take away some of the sense that Greenwood House is a residential home. Gardens were maintained according to the season with spring flowers in borders and centre pieces. A member of the Management team told us that residents and their relatives had contributed to improving the gardens by bringing in plants and planting them in the gardens. The garden area of Dove unit was enclosed to enable residents to walk about. The ramp down to the garden area had safety rails. With a member of the Management Team we looked at the risk of harm posed by a drop of approximately ten inches from the patio area to the lawn as there was no such safety rail. We were told that residents access the garden both independently and with the support from the staff. The Manager explained the historical difficulties with obtaining the installation of the existing safety rails. In the interim period we were told that a risk assessment of this unsafe area would be carried out by the home to ensure people were safe in going in and out of the garden. Records of hot water temperatures were seen and these were satisfactory. We also tested the temperature of hot water accessed by residents in one of the baths and we found that this did not exceed 40.5 degrees centigrade. All of the residents surveys said the home was always or usually clean and fresh and we found no mal odours. The AQAA noted that improvements had been made, with regards to infection control measures due to the Purchase of Paper Hand towel dispenser, soap dispensers and bins for general and clinical waste. The AQAA noted that, during 2009, thirty-three members of staff had attended training in the prevention and management of infection. One of the staff surveys indicated that some people admitted from hospital do so with existing infections although, as we have no record of any spread of these infections, we believed that the homes infection control Care Homes for Older People Page 24 of 32 Evidence: measures were robust. Care Homes for Older People Page 25 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 can be confident that they are safe due to the recruitment and training of the staff although people with dementia care needs can not be fully confident that all of the staff are competent and knowledgeable about how to care for them. Evidence: All of the nine residents surveys said that the staff were always or usually available when the person needed them. The majority (5) of the staff surveys said that there was always or usually enough staff on duty with the remaining survey saying that this was sometimes the case. We timed the response of the staff to call bells and these were answered within less than three minutes duration. According to the AQAA people should receive consistent care as the Retention of staff is good- many staff employed for a number of years. Comments from the residents surveys said that the Staff are very helpful and All the staff seem very caring & willing to help at any time. People should be in safe hands as, according to the AQAA, thirty-two permanent care workers, twenty-seven of these have obtained a National Vocational Qualification, level 2 or equivalent, in care i.e. 84.3 with more staff working towards this desirable qualification. Care Homes for Older People Page 26 of 32 Evidence: We examined three staff files and found that all the required information was available to protect residents from the risk of unsuitable staff. The majority (5) of the staff surveys said that their induction training had prepared them to do their job very well or mostly with the remaining survey saying that this was not quite the case. All of these surveys said that the person received ongoing training that helped them feel able to do their job in a safe and competent manner. We looked at three of the staff training files and we saw that they had attended training in topics such as dementia care, management of medication and health related conditions commonly found in older people. The Manager said that, due to our findings, refresher training in dementia care would be considered for the staff caring for the people with such a mental health condition. Care Homes for Older People Page 27 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. People benefit from a responsive and open culture of the home. The standard of the quality assurance could be better to ensure improvements and standards are maintained. Evidence: The Manager, who has worked in the care industry for a number of years, is supported by three Assistant Managers and we have referred these people collectively, for the purpose of this inspection report, as the Management Team. We found that the Management Team were responsive and open to our inspection findings and found these to be valid. We found that there was a positive attitude to learning and improving the standards of care following the findings of this inspection. On the basis of this open culture and the confidence we have that the Management Team will take action to address the issues raised in this inspection, we have judged this area to be good. Care Homes for Older People Page 28 of 32 Evidence: The AQAA was completed to a satisfactory standard and demonstrated that the home has a good quality assurance system in place that monitors and reviews the standard of the service provided and where improvements need to be made and what action is to be taken to improve any identified deficiencies. In 2009 the home carried out a survey and 19 questionnaires were received. Analysis of these were seen and the home was reviewed favourably, by the respondents in areas such as dignity and support of the people. Copies of the two most recent reports of visits carried out by a representative of the registered owner were seen and these contained reviews of areas such as complaints and the environment. We found no records of peoples views about the home and we found no record of reviews/audits of areas such as care plans and medication-some of the areas where we identified improvements need to be made. At our last inspection we awarded the home an Excellent quality rating. However, due to our findings of this 2010 inspection, we found that the quality rating has not been sustained, due to the standards of care planning, medication and dignity issues resulting in adequate quality outcomes for residents. This is indicative that perhaps the quality assurance of the home could be better. As part of our case tracking we checked how the home safeguards peoples personal monies. We also checked another residents personal monies and the associated records. We found that there is a clear audit trail of monies coming in and going out. We found that the peoples individual records reconciled with the amount of monies available. People should be safe as, according to the AQAA, service checks are in date for hoists, fire detection and fire fighting equipment and portable (electrical) appliances. The AQAA also noted that Manager, Assistant Managers and Night Staff hold Full First Aid at Work certificates. The AQAA informed us that four of the catering staff and forty one of the care staff have attended training in safe food handling. Records of the health and safety checks were seen and records of the staff training in health and safety were also seen. Our findings supported the information provided by the AQAA. In February 2008 the home was awarded 5 stars i.e. Excellent for its food hygiene, by the Environmental Health Officer. We saw records of temperatures of food fridges and freezers and all of these with the exception of one, were satisfactory. The Manager explained that a faulty seal was found on the mal-functioning fridge and arrangements were being made to replace this piece of equipment. Care Homes for Older People Page 29 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 30 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 1 9 13 Medication must be stored, recorded and administered in accordance with the associated regulations. This is to ensure that people are not placed at risk to their health from unsafe practices 23/04/2010 2 10 12 People must be treated with dignity and respect at all times. This is to ensure that peoples human rights are respected and that they do not suffer from psychological harm. 18/04/2010 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 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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