Care Home: Greystones

What the care home does well Greystones provides an environment which is supportive, homely and where individuals receive a care which meets not only their personal needs but also their social needs. There is a relaxed and friendly atmosphere with staff who clearly have a high level of commitment to the home and the work they do in supporting and caring for individuals who live in the home. This was confirmed by comments made to the inspector and responses from the questionnaires: "this home is the best in the west" "couldn`t find a better home then this I am sure" " staff all very caring and give you the help you want" (residents) "the staff make my relative feel secure and amongst friends who care about her" "I think the home is excellent value for money" "It is unpretentious but delivers a very high standard of care" "always very friendly and helpful a lovely friendly home". (relatives) There are good systems in place such as care planning which provides a strong base for providing the care needed by individuals who live in the home.The expert by experience commented that she felt "altogether the impression was a well run home with thoughtful and kind staff who were really interested in the best welfare of residents." She also reported her conversation with one individual: "The first lady I spoke with was a very sprightly 94 year old who had been a resident for 12 years. She had kept a hotel during her lifetime with her husband and during the time I was with her she expressed her satisfaction with both the food and the ``kindness of the staff``. As she had experience of hotel life it spoke highly that after 12 years there she still felt completely happy with the standard set at Greystones." What has improved since the last inspection? The last inspection identified a number of areas which required improvement specifically around records and administering medication and improving the environment through additional facilities. These areas were looked on this visit and it was noted that the necessary improvements have been made and record keeping had improved and changes made to meet the care needs of individuals through the installing of shower facilities and the fitting of a hearing loop system in the communal lounge of the home. What the care home could do better: There were no areas of practice identified from this inspection that required improvement. CARE HOMES FOR OLDER PEOPLE Greystones Hayesfield Park Bear Flat Bath Bath & N E Somerset BA2 4QE Lead Inspector Jon Clarke Unannounced Inspection 17th January 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000008150.V352070.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000008150.V352070.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greystones Address Hayesfield Park Bear Flat Bath Bath & N E Somerset BA2 4QE 01225 317972 F/P 01225 317972 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.bcvs-homes.co.uk BCVS Homes Patricia Joan Ball Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places DS0000008150.V352070.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 26 persons aged 65 years and over requiring personal care only 22nd August 2006 Date of last inspection Brief Description of the Service: Greystones is one of three homes owned and managed by Bath Centre for Voluntary Service, a registered charity. The home is an adapted older property located close to the local shops of Bear Flat and the amenities of Bath. It offers accommodation for up to 26 older people with residents rooms located on the ground and first floor with lift access. Seven of the rooms have en-suite facilities. There are very spacious lounges on the ground and first floor, a dining room. There is also a conservatory, which is used as an alternative dining area overlooking the attractive gardens that have ramped access. The main concern of our homes is the residents quality of life. The philosophy of our homes is to look after residents in a caring and sympathetic way, so that their privacy and dignity are respected and to encourage active independence where possible (From BCVS philosophy statement) DS0000008150.V352070.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced visit to the home as part of an inspection. The inspector was accompanied by an expert by experience who spoke with 5 individuals who live in the home. The discussion was about life in the home particularly activities which take place, the opportunity to exercise choice and the routines of the home. A number of records were looked at including care plans, staff records (recruitment and training), health and safety records and arrangements for the administering and management of medication. Before this inspection Have Your Say questionnaires were sent to the home for individuals who live in the home, relatives, health professionals and staff. Responses were received from 11 residents, 8 relatives, 6 staff and 6 health professionals. As part of this inspection the manager completed a Annual Quality Assurance Assessment (AQAA) which set out the areas of practice based around the National Minimum Standards summarising what the home does well, the evidence for this, what they could do better and how they have improved in the last 12 months. The information from the AQAA and questionnaires has been used to help make a judgement about the quality of care provided in the home. What the service does well: Greystones provides an environment which is supportive, homely and where individuals receive a care which meets not only their personal needs but also their social needs. There is a relaxed and friendly atmosphere with staff who clearly have a high level of commitment to the home and the work they do in supporting and caring for individuals who live in the home. This was confirmed by comments made to the inspector and responses from the questionnaires: “this home is the best in the west” “couldn’t find a better home then this I am sure” “ staff all very caring and give you the help you want” (residents) “the staff make my relative feel secure and amongst friends who care about her” “I think the home is excellent value for money” “It is unpretentious but delivers a very high standard of care” “always very friendly and helpful a lovely friendly home”. (relatives) There are good systems in place such as care planning which provides a strong base for providing the care needed by individuals who live in the home. DS0000008150.V352070.R01.S.doc Version 5.2 Page 6 The expert by experience commented that she felt “altogether the impression was a well run home with thoughtful and kind staff who were really interested in the best welfare of residents.” She also reported her conversation with one individual: “The first lady I spoke with was a very sprightly 94 year old who had been a resident for 12 years. She had kept a hotel during her lifetime with her husband and during the time I was with her she expressed her satisfaction with both the food and the kindness of the staff. As she had experience of hotel life it spoke highly that after 12 years there she still felt completely happy with the standard set at Greystones.” What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000008150.V352070.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000008150.V352070.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home undertakes full and comprehensive assessment of prospective residents so that they are able to make an informed decision about the capacity of the home to meet health and social care needs. EVIDENCE: A number of pre-admission assessments were looked at and showed a good level of information about the health and social care needs of the individual. Included is a dependency profile which helps the home in making a decision about admission also included is health questionnaire. Where the individual is known to social services a copy of their assessment is also obtained and copies of these were seen. A questionnaire is also undertaken about the daily routines of the individual. DS0000008150.V352070.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care Planning and arrangements for meeting health care are good providing staff with the necessary information so that the health and social care needs of residents are met. Arrangements for managing resident’s medication make sure that resident’s health needs are protected. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld. EVIDENCE: A number of care plans were looked at and showed detailed information about care tasks associated with personal hygiene, dressing/undressing and mobility. Moving and handling assessments had been completed and reviewed regularly. All had been reviewed on a regular basis and there was record of local authority undertaking a review. Reviews are held with family members where possible and there written evidence of a daughter attending a review of an individual. Risk assessments had been completed in one instance where an DS0000008150.V352070.R01.S.doc Version 5.2 Page 10 individual was an insulin dependant diabetic though it did not include actions for staff to take in event of health concerns i.e. low sugar level. The home has the support of district nurses in managing this person health needs. Monthly dependency profiles are completed, as a measure of individual care needs. Arrangements for the storage and management of medication in the home were looked at and showed that the storage is satisfactory. Administering records were looked at and had been completed as required with no gaps in recording. Controlled drugs are stored securely and recorded in CD register with two staff signatures. Stock of controlled drugs were checked against that recorded and were found to be correct. Returns of medication are recorded and signed by the pharmacist or their representative. One individual is managing their medication through the use of a dossett system a risk assessment had been completed. Community health services are provided with regular visits from chiropodist and optician. Individuals have full access to other community health services and district nurses visit the home where necessary. A comment received from a G.P. stated that the home “always seems very caring and go out of their way to look after my patient”. Other comments were received from district nurse “always contact us if concerned about patients that belong to our surgery” “care staff always listen to our views, concerns and response appropriately” and “Greystones is one of the better residential homes”. Individuals who live in the home who responded to questionnaire (11) said 10 “always” 1 “usually” to Do you receive the medical support you need? This was also confirmed by individuals spoke with on the day of my visit “they are very good if I need to see a doctor only have to say and always get to see him quickly if not the same day”. Individuals I spoke with said how they felt the home was very “relaxed place to live” “do as I wish”. One person said how she felt “able to do as I liked it for me to chose”. When asked about the approach from staff individuals said that staff were always “respectful” “they treat me well and I don’t feel they could do better”. When asked about privacy and whether this was respected all those I spoke with said that they always felt this always happened. A comment from a district nurse said that she always “saw patients in either their room or in treatment room respecting individual privacy and dignity”. Staff were observed throughout the visit speaking to individuals in a respectful and sensitive manner. DS0000008150.V352070.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for meeting the social and recreational needs of residents are good and there are opportunities for residents to maintain links with family, friends and the local community. The home’s practice and routines are flexible and enable residents to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home. EVIDENCE: Individuals I spoke with were all very positive about daily life in the home they spoke of the “relaxed and friendly atmosphere” where “your life is your own”. They felt there was “little routine” “I can choose how I spend my time if I want to be in my room that’s not a problem”. When asked about activities again there was positive comments “enough for me” “always something on the staff try their best”. Activities included quizzes, exercise and importantly “just talking”. Respondents to the questionnaire said that there was 9 “always” 1 “usually” and 1 “sometimes” to Are there activities arranged by the home that DS0000008150.V352070.R01.S.doc Version 5.2 Page 12 you can take part in? The expert by experience spoke to individuals about the activities in the home and reported: “The other point which came up with several residents was the arrangements that were made for outings. They were due to attend a Pantomime shortly, and during last Autumn they had been taken to a Flower show and there were also Quizzes and bingo arranged from time to time. There was a Mini Bus which they were able to make use of and they all said how much they appreciated the various things that had taken place over Christmas. Two churches visited regularly and Communion was brought if wanted. A short distance away were a row of shops that could be visited if you wished and if necessary someone would go with you.” Individuals said their visitors are always made to feel welcome and they felt there was no restrictions on their having visitors. A comment from a relative stated “ always very friendly and helpful, a lovely friendly home”. In talking with individuals about the menu and food provided in the home all spoke positively about the quality and choice available: “I enjoy the food here always good” “always a choice” “meals very good” “nicely served plenty of choice”. In response to questionnaire 6 individuals said “always” 4 “usually” and 1 “sometimes to Do you like the meals in the home? One relative stated that the “quality of food is good”. The expert by experience reported “enquired about food and choice and was told that there was always a choice of three main courses, that the food was varied and no one seemed to have any complaints at all. One lady particularly said how good the food was and I noticed that the dining room was very nicely laid out with fresh napkins.” DS0000008150.V352070.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has clear procedures in place and this enables individuals to make a complaint and voice their views about the service they receive and to know that they will be listened to and actions taken where necessary. The home makes sure that as far as possible residents are protected from harm by having policy and procedure about the Protection of Vulnerable Adults and providing training to all staff in this area. EVIDENCE: Respondents to the Have Your Say questionaire said they knew how to make a complaint. Individuals I spoke with all said how they would speak to “one of the staff” or the manager. One individual said they felt staff “listen to what we have to say” and another “something would be done about I am sure”.All respondents said that staff “listen and act on what you say”. No complaints had been made since the last inspection. The home has a Safeguarding Adults policy which sets out practice in the event any allegation of abuse is made. Staff have completed BANES Vulnerable Adults training. In talking with individuals who live in the home they all spoke of how they felt safe and how staff always spoke and behaved in an appropriate manner towards them. DS0000008150.V352070.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe and hygienic environment for the residents and staff. People who live and work in the home benefit from a warm, welcoming and well-maintained environment. EVIDENCE: There are good arrangements in place to maintain a hygienic and clean environment and at the timeof the visit the home was clean and free from offensive odours. Individuals said that the home “is always lovely and clean” “they keep the home very clean never any smells”. All respondents to the questionaire said that the home is “always” fresh and clean. In walking around the home and looking at communal areas and individuals rooms it was evident that there is a good standard of decoration and maintainence. There is ongoing DS0000008150.V352070.R01.S.doc Version 5.2 Page 15 decoration and since the last inspection shower facilities have been installed and number of rooms decorated. It is planned to decorate the ground floor hallway and fit new carpets. DS0000008150.V352070.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing arrangements in the home are generally satisfactory so that the needs of residents can be met in an efficient way with care being provided by skilled and competent staff. The recruitment and selection of staff is undertaken to make sure that as far as possible the health and welfare of resident is protected. EVIDENCE: Staffing rotas were looked at for a period of 5 weeks they showed that generally there were 3 staff on duty am 2 pm with senior care. Night duty staff available from 9pm to 7am with sleep-in manager. During this period there had been limited use of agency staff to ensure there was adequate staff on duty. In talking with individuals they spoke of “staff always there if we want them”. Questionnaire respondents said that 7 “always” and 4 “usually” staff available when you need them. One relative commented, “nothing seems to be too much trouble for the staff. Help is always given promptly and sympathetically” and another “the attitude of staff is to be commended”. Previous inspection had confirmed that the recruitment practice of the home is as required. One new member of staff has been appointed since the last DS0000008150.V352070.R01.S.doc Version 5.2 Page 17 inspection and record of recruitment showed that full and detailed application had been submitted, two references and Criminal Record Bureau check had been obtained. Training records were looked at for four members of staff. They had all completed the required “mandatory” training: moving and handling, Safeguarding Adults, Health & Safety. In addition they had undertaken Pallative Care training, Infection Control, Stroke Care, Team working, Dementia. A staff member commented that “you get the right kind of training when and if necessary”. I was unable to confirm whether any staff had completed Mental Capacity Act training this is recommended for manager and deputy if not all staff. DS0000008150.V352070.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good opportunities for residents and others to express their views about the service they receive. The practices of the home help to make sure that the health, safety and welfare of residents and staff are protected. EVIDENCE: The manager was not present during this visit however in talking with individuals they spoke positively about her approach “someone we can talk to” “she very approachable”. She has extensive experience of working with older people in a care setting and has worked at Greystones for a number of years being made Registered Manager in 2007. DS0000008150.V352070.R01.S.doc Version 5.2 Page 19 Resident’s meeting are held on a regular basis the last being in December 07. Topics discussed included activities, menus and informing residents of changes in the home. In addition questionnaires had been circulated with 10 responses in September where individuals were able to comment on the quality of care provided in the home. An Activities questionnaire was also issued and relative’s questionnaire was also circulated. The manager had responded to one relative about concern they had. However there was no action plan or summary of responses from these questionnaires and action plan to address issues or suggestions made. Health and Safety records were looked and confirmed that weekly fire alarm tests are undertaken as were monthly emergency lighting tests. A Fire assessment has been completed and fire training for staff took place in April and May 07. The fire system was last inspected March 07, gas safety report 03/07/07 and lift service 08/02/06 (this should be undertaken yearly). Equipment such as hoists and bathing were inspected and serviced in Aug 07. DS0000008150.V352070.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 3 DS0000008150.V352070.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP33 Good Practice Recommendations Complete summary of responses and action plan from quality questionnaires that could be made available to individuals in the home and relatives. DS0000008150.V352070.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000008150.V352070.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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