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Inspection on 16/08/05 for Glebe Court Nursing Home

Also see our care home review for Glebe Court Nursing Home for more information

This inspection was carried out on 16th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Staff spoken to demonstrated a good understanding of adult protection issues identification of abuse and related procedures. Staff demonstrated a good understanding of key working and identification of service user care needs. The inspector discussed risk assessments and staff gave a good account of their understanding of the types of risk presented. The manager feels that the home provides good palliative care and works closely with the Hospice team who has a high opinion of the care provided at Glebe Court.

What has improved since the last inspection?

Service users are getting a better standard of care from the carers and there is clearly a reduction in the number of service users with pressure sores. The manager took on board the views of the service users and changed around the sitting room and dining room. The inspector was told the service users prefer the current seating arrangement. There is now a planned programmed of redecoration.

What the care home could do better:

The general appearance of the home at the time of inspection was that some parts of the home are in need of redecoration, refurbishment and maintenance. The practice of leaving a linen trolley should be reconsidered and maybe a cupboard downstairs should be found to store linens for the rooms downstairs. This trolley is untidy and unsightly.

CARE HOMES FOR OLDER PEOPLE Glebe Court Nursing Home Glebe Way West Wickham Kent BR4 ORZ Lead Inspector Cheryl Carter Unannounced 16th August 2005 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 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. Glebe Court Nursing Home G51-G01 S10135 Glebe Court V244913 16-08-05 Stage 4 doc.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Glebe Court Nursing Home Address Glebe Way, West Wickham, Kent BR4 ORZ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8462 6609 Glebe Housing Association Ms Gillian Payne Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Glebe Court Nursing Home G51-G01 S10135 Glebe Court V244913 16-08-05 Stage 4 doc.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Staffing notice issued 10 October 1997. Imposed 1 April 2002. Date of last inspection 11/01/05 Brief Description of the Service: Glebe Court is a purpose built care home for the nursing care of older people. The home is set in its own grounds on Bencurtis Park. There is car parking to the front of the home and a sheltered garden to the rear. The shops at Coney Hall are within walking distance for people with unrestricted mobility and various bus routes from Coney Hall or West Wickham. Glebe Court Nursing Home G51-G01 S10135 Glebe Court V244913 16-08-05 Stage 4 doc.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted over two half days in the presence of the registered manager. There were 49 service users in occupation. The inspector met with the staff available on duty to gain insight into staff understanding of the care needs of service users, and to assess the level of competency of the staff team in ensuring the welfare of service users. The inspector also had the opportunity to speak to service users and visitors to the home. What the service does well: 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. Glebe Court Nursing Home G51-G01 S10135 Glebe Court V244913 16-08-05 Stage 4 doc.doc Version 1.40 Page 6 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 Standards Statutory Requirements Identified During the Inspection Glebe Court Nursing Home G51-G01 S10135 Glebe Court V244913 16-08-05 Stage 4 doc.doc Version 1.40 Page 7 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, 4, 5, 6 There are systems in place to ensure that residents admitted to Glebe Court Nursing Home know that their needs will be met. EVIDENCE: The home has a current Statement of Purpose and Service User Guide that met this standard. Pre-admission assessments are undertaken with prospective service users prior to moving to the home. This takes place in the service user’s own home or in hospital. From the files seen it was evident that the needs of service users are being met within the home. Glebe Court Nursing Home is registered to admit older people with nursing needs. All new service users are invited to visit the home before moving in if this is possible. The admission policy indicates that new service users are observed closely during the first few days to ensure their safety and welfare in the home. The home does not provide intermediate care. Glebe Court Nursing Home G51-G01 S10135 Glebe Court V244913 16-08-05 Stage 4 doc.doc Version 1.40 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10, 11 There are systems in place to enable staff to meet the identified individual needs of the service users. EVIDENCE: All service users have a care plan, which shows their identified individual needs and the actions to be taken by the staff as to how those needs will be met. A nursing assessment is completed. Care plans included details addressing mobility, nutrition, personal hygiene, skin care, mental and physical wellbeing social activities and interests. The inspector spoke to a visitor to the unit on the day of the inspection who complained about the way his relative’s possessions were handled after her death. The policy on death and dying is vague and needs to be reviewed. (Recommendation.1). At the time of the inspection no service user administered his/her own medication. The registered person shall make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. (Req.1) Glebe Court Nursing Home G51-G01 S10135 Glebe Court V244913 16-08-05 Stage 4 doc.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 The home has a range of activities. Meal times are well managed and meals are varied and well balanced. EVIDENCE: During the inspection the inspector observed staff interacting with service users through conversation and activities. Visitors are encouraged to the home any time during the day and evening. The inspector observed that all the services users room doors were left open whether they were in or out of the room. The registered manager must ensure that the opinions of the service users are sought as to whether they wish their doors to be left open throughout the day. (Recommendation 2). A menu was available showing a choice of meals offered to service users daily. Glebe Court Nursing Home G51-G01 S10135 Glebe Court V244913 16-08-05 Stage 4 doc.doc Version 1.40 Page 10 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 The systems in place to record and deal with complaints are inadequate. There are systems in place to protect service users from abuse. EVIDENCE: A complaints policy and procedure was available. There were two recorded complaints since the last inspection. The inspector is concerned that not all complaints are recorded and suggests that that all complaints regardless of how trivial it may seem needs to be recorded, action and outcomes recorded, in line with the complaints policy. Comments made by some service users, staff, and visitors suggest that the Homes response towards complaints or concerns i.e. communication needs to be improved. The inspector is concerned about these comments. During the inspection some visitors and staff also raised the issue. The registered person shall ensure that any complaint made under the complaints procedure is fully investigated. (Req. 2) The registered provider must address the issue of effective communication to avoid the possibility of misunderstandings over Home policy. Recommendation 3 The home has a policy on the protection of vulnerable adults and staff demonstrated knowledge with this policy and what action needs to be taken if there is a suspicion of abuse. Glebe Court Nursing Home G51-G01 S10135 Glebe Court V244913 16-08-05 Stage 4 doc.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 24, 25, 26 The standard of the environment within his home needs to be improved in order to provide service uses with an attractive and homely place to live. The home is in need of some internal redecoration to ensure the home is comfortable for service users. EVIDENCE: A tour of the premises found all areas clean and tidy. Some concerns were identified: • • • • • • The home is in need of some decoration. There was a trolley with linen left on the corridor this was very untidy. The linen appears to be left on the trolley for easy access. Carpets on the ground floor were dirty The staff room is in need of redecoration and refurbishment. One bathroom was being used to store paints and mattresses The bathroom hoist was left in the corridor G51-G01 S10135 Glebe Court V244913 16-08-05 Stage 4 doc.doc Version 1.40 Page 12 Glebe Court Nursing Home The kitchen was in a muddle on the day of the inspection and obviously in need of refurbishment. • One sink in the kitchen was being propped up. • There were no paper towels at the sink. • The freezers temperatures were being recorded however on opening the freezer with the frozen vegetables, all the vegetables were in the freezer and had defrosted. The inspector asked for these to be disposed of immediately. • A tour of the premises found toilets situated throughout the premises and all areas of the building are accessible for those service users/visitors with mobility impairment. A slow moving lift is available. • Some parts of the ground floor had an odour of urine. The inspector met with the association’s director and confirmed that there are plans to refurbish the kitchen. The registered person must ensure that the premises are kept in a good state of repair. (Req. 3) The registered person must ensure that all partss of the care home are kept clean and resonably decorated. (Req. 4) Glebe Court Nursing Home G51-G01 S10135 Glebe Court V244913 16-08-05 Stage 4 doc.doc Version 1.40 Page 13 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 The Home did not demonstrate that their procedures for the recruitment of staff provide the necessary safeguards to offer protection to people living in the home. EVIDENCE: All new staff are recruited in line with an equal opportunities policy and procedure. This includes gaining two written references and completion of an Enhanced Criminal Record bureau check. Four staff files were viewed, three files did not clearly indicate the CRB approval numbers on the files although the manager confirmed that all staff have CRBs. One file did not have a job description. The Registered provider must ensure that all staff has the necessary checks on file. (Req. 5) A number of staff have completed the Level 2 NVQ. The home employs a number of registered nurses. All new staff receive a programme of induction. Subjects covered during the induction period are Moving and Handling, Confidentiality, Health Promotion Infection Control, Food Handling Fire Training. One the day of the Inspection there were sufficient numbers of staff with a varied skill mix to meet the needs of the service users. Glebe Court Nursing Home G51-G01 S10135 Glebe Court V244913 16-08-05 Stage 4 doc.doc Version 1.40 Page 14 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 36, 38 Some of those interviewed expressed concerns that communications within the home could be improved, this aspect requires further consideration and developmental impetus. EVIDENCE: The manager is a qualified and registered nurse and holds an honours degree and a management qualification. The inspector spoke to three service users, relatives and four members of staff. Some of the relatives spoken to were critical of the running of the Home. The provider manager must ensure that the home is conducted in a way to maintain good personal and professional relationships with each other and with service users and staff.(Req. 6) The regilarity of staff supervision does not meet the required Minimum Standards. The Registered Manager must ensure that staff receive regular supervision according to the Minimum Standards of at least six time a year. (Req. 7.) The testing of Portable Appliances were out of date. Glebe Court Nursing Home G51-G01 S10135 Glebe Court V244913 16-08-05 Stage 4 doc.doc Version 1.40 Page 15 The Registered Provider must ensure that the yearly Portable Appliances testing is being undertaken. (Req.8) Glebe Court Nursing Home G51-G01 S10135 Glebe Court V244913 16-08-05 Stage 4 doc.doc Version 1.40 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION 2 2 3 3 x 3 2 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 3 2 2 3 x 2 x 2 Glebe Court Nursing Home G51-G01 S10135 Glebe Court V244913 16-08-05 Stage 4 doc.doc Version 1.40 Page 17 Are there any outstanding requirements from the last inspection? 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. 1. Standard OP10 Regulation 12.4.(a) Timescale for action The registered person shall make 03.11.05 suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. The registered person shall 03.11.05 ensure that any complaint made under the complaints procedure is fully investigated. The registered person must 03.11.05 ensure that the premises are kept in a good state of repair. The registered person must 03.11.05 ensure that all partss of the care home are kept clean and resonably decorated. The registered person must 03.11.05 ensure that all staff has the necessary checks on file. The registered provider and 03.11.05 registered manager must ensure that the home is conducted in a way to maintain good personal and professional relationships with each other and with service users and staff. The Registered Manager must 03.11.05 ensure that staff is receiving regular supervision according the Minimum Standards of at least Version 1.40 Page 18 Requirement 2. OP16 22.3 3. 4. OP19 & 20 OP26 23 23 (d) 5. 6. OP29 OP32 19.5 12.5 7. OP36 18.2 Glebe Court Nursing Home G51-G01 S10135 Glebe Court V244913 16-08-05 Stage 4 doc.doc six time a year. 8. OP38 13.4 The Registered Provider must ensure that the yearly Portable Appliances testing is being undertaken. 03.11.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP11 OP14 OP16 Good Practice Recommendations The registered person must ensure that there is a written poolicy on the death oof a Service user and not just a checklist. The registered manager must ensure that the opinions of the service users are sought as to whether they wish their door to be left opened all day. The registered provider must address the issue of communication and the relationship between the Manager, her service users, staff, and visitors. Glebe Court Nursing Home G51-G01 S10135 Glebe Court V244913 16-08-05 Stage 4 doc.doc Version 1.40 Page 19 Commission for Social Care Inspection Sidcup Area Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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