Inspection on 14/12/06 for Green Acres Nursing Home

This inspection was carried out on 14th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

Other inspections for this house

Green Acres Nursing Home 02/12/08

Green Acres Nursing Home 01/02/06

Green Acres Nursing Home 04/05/05

Green Acres Nursing Home 01/02/05

Green Acres Nursing Home 14/07/04

Green Acres Nursing Home 06/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Green Acres Nursing Home Rigton Drive Burmantofts Leeds Yorkshire LS9 7PY Lead Inspector Sean Cassidy Key Unannounced Inspection 14th December 2006 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 DS0000001342.V299259.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. DS0000001342.V299259.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Green Acres Nursing Home Address Rigton Drive Burmantofts Leeds Yorkshire LS9 7PY 0113 2483334 0113 2406278 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) Life Style Care Plc Mrs Lynn Hart Care Home 62 Category(ies) of Old age, not falling within any other category registration, with number (62) of places DS0000001342.V299259.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st February 2006 Brief Description of the Service: Greenacres is a purpose built home located about a mile and a half from Leeds City centre. Regular bus services pass by the home and there are shops, pubs and other amenities close by. The home provides care for up to fifty service users requiring personal and nursing care. Five of those places are for intermediate care. The building meets national minimum standards for the environment. Bedrooms are generously sized and exceed space requirements. All bedrooms are designed for single occupancy with en-suite facilities. The home is on two levels, the first floor being serviced by stairs and a shaft lift. Operationally, each floor functions as a working and living unit. Both units provide lounge and dining areas. The fees for the home range between £452 and £673 per week. Extra payment is needed for hairdressing, papers, chiropody, escorts to hospital and taxis. DS0000001342.V299259.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The accumulated evidence in this report has included: • • • • A review of the information held on the home’s file since the last inspection. Information submitted by the registered provider in the pre inspection questionnaire. Information received from service users, relatives, staff and other professionals. An Unannounced visit to the home was conducted by one inspector and lasted nine hours. The majority of this time was spent speaking to residents, management, staff and relatives. The visit included a tour of the premises. A number of documents were examined which included care files, training files, recruitment files and health and safety details. What the service does well: Greenacres is assessed as a good service. Staff communicate well with the resident group and are seen to provide support and assistance where they can. Residents are enabled to keep and maintain contact with their families and friends at all times and visitors said they are made feel welcome when they enter the home. Residents said they felt their complaints would be properly investigated if they made one. The home is managed to a good standard and this is reflected throughout many areas. That has a direct positive effect on the resident care service. DS0000001342.V299259.R01.S.doc Version 5.2 Page 6 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. DS0000001342.V299259.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 DS0000001342.V299259.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 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures residents’ needs will be met by assessing them prior to moving in. Residents receive intermediate care from a trained staff group. The home can access specialist equipment when needed. EVIDENCE: Each care file examined contained evidence to show that residents had been assessed prior to moving into the home. Both residents and relatives spoken to said they were either offered the opportunity or took the opportunity to look around before deciding they wanted to move in. DS0000001342.V299259.R01.S.doc Version 5.2 Page 9 Those residents that are admitted for intermediate care receive a structured care package, which involves the care staff liaising closely with the intermediate care team. Staff receive training in areas relating to rehabilitation and residents receiving the service felt the staff were competent in their roles. DS0000001342.V299259.R01.S.doc Version 5.2 Page 10 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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care needs of residents are well provided for within the care planning and risk assessment documentation. Residents dignity could better protected. EVIDENCE: Each resident file looked at contained care planning documentation, which highlighted what that individuals care needs were and what staff needed to do to meet those needs. Staff confirmed that they were aware of these documents and that they did use them. The care files also contained a thorough risk assessment of the individual. This covered areas such as nutrition, falls and pressure areas. There were a significant number of residents that were bed bound and needed full assistance with all care needs. Although their care needs were well documented their records did not provide evidence to show they were receiving appropriate fluid and nutritional intake or receiving regular turns to DS0000001342.V299259.R01.S.doc Version 5.2 Page 11 relieve pressure areas. The manager agreed that this was needed and would be looked into as a matter of priority. Residents and relatives were positive about the way in which the home ensured their health care needs were provided for. Care records showed other health care professionals were involved in care when needed, this included, GPs, dieticians, dentists and ophthalmologists. The following are some of the comments made during the inspection: “Other professionals are regularly involved with mum’s care.” “The home is very responsive to my health needs.” “The staff speak with me regularly about my eyesight and my health.” Overall, residents and relatives spoke positively about the staff group. Comments were made about how they felt the staff respected their privacy and dignity. The area of privacy and dignity is covered in the staff induction and is covered at staff meetings. There were some negative privacy and dignity issues identified during the inspection, which the home must review. Residents and relatives said that it was not uncommon for their privacy to be invaded by another resident coming into their rooms when they are not invited. This caused concerns for them. During meal times, residents, plates were emptied into a ‘slop’ bucket beside them in the dining room. This practice is not acceptable. On entering the home a lady was being assisted into an awaiting ambulance. When she asked where she was going the person pushing the chair just said to hospital whilst continuing to push the chair. The lady asked again and seemed confused about the situation. Instead of stopping and coming around to the front of the chair to face the lady and explain properly where she was being taken she was just pushed onto the awaiting ambulance and driven away. She was also dressed rather scantily for the weather in a white cardigan that was dirty. During lunch one of the residents quietly asked one of the carers if she could go to the toilet. The carer shouted across the dining hall that a resident needed the toilet and could somebody give her a hand. It took about 10mins for the chair and lifting belt to arrive before the lady could finally go to the bathroom. These issues were highlighted with the manager during feedback and assurances were given that they would be looked into. The home has a medication policy that includes a risk assessment for selfmedication and homely remedies. The resident medication charts examined showed that the administration procedure was sound. The local doctor who attends the home said that the administration of medication is at a good standard. DS0000001342.V299259.R01.S.doc Version 5.2 Page 12 DS0000001342.V299259.R01.S.doc Version 5.2 Page 13 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home attempts to promote the social and cultural interests of the residents. Not all residents are happy with the food provided by the home. EVIDENCE: Feedback from residents and their relatives was positive regarding the provision of activities within the home. Regular entertainment is provided from outside and residents are able to attend if they wish. “There are lots of things to do here. I can go if I want or I can choose not to. That suits me.” “Mum is provided with loads of things to do. She loves the group sessions in the home.” “I leave here happy that mum is happy.” A member of staff now works as an activities coordinator and consults with residents and relatives about what activities could be provided. The activity coordinator has attended training courses in this area to assist her with fulfilling her role. DS0000001342.V299259.R01.S.doc Version 5.2 Page 14 The care files examined included a care plan that highlighted the social interests of the resident and a care plan was in place to help meet those needs. Records were kept to show what activities individual residents had been involved in. Up to date information was displayed in a number of areas around the home. This information was not accessible to the majority of the residents due to the position it was displayed. Residents and relatives spoken with said that they were happy with the visiting arrangements available within the home. Relationships with friends and family were promoted. This was evidenced in some of the care file documentation. Resident rooms were decorated to a good standard. Many rooms were very personalised and contained residents’ furniture from home. There was differing feedback from residents with regards to the standard of food provided. Some were quite happy whilst others felt it could improve. Three said that it didn’t meet their taste. The lunchtime meal was observed in two different settings. Residents use a lounge on the first floor to take their meals. Those that want to go down to the ground floor dining room can do so. Residents that needed assistance with their meals received it in an appropriate manner. It was noted that staff had very little interaction with residents during the mealtime, which made it feel less of a social event. Two residents living at the home had different cultural needs in relation to food. This was catered for with one resident but not another. The menus are displayed in the home. Access to these menus is poor as the majority of residents are not able to read them due to the font size of the print and also where they are situated on the walls. No residents spoken with knew where the menus were displayed. DS0000001342.V299259.R01.S.doc Version 5.2 Page 15 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with information regarding complaints. Residents are appropriately protected by the Adult protection systems adopted by the home. EVIDENCE: Residents and relatives spoken to said they felt informed about how to make a complaint if they wished to do so. They also expressed confidence that the home would properly investigate their complaint if they made one. The complaint procedure is well highlighted throughout the care home. The home has an Adult Protection Policy, which gives clear guidance to assist staff with following the procedure if needed. Two recent adult protection issues were identified in the home and were dealt with and recorded as highlighted in the policy. One incident was reported to the manager, which placed a resident at risk of harm. This was presented to the manager and she was asked to refer this to the adult protection team. DS0000001342.V299259.R01.S.doc Version 5.2 Page 16 Adult protection training is provided to the staff working at the home. The majority of those spoken to possessed a very clear understanding about adult protection issues and how to manage this issue if it presented itself to them. DS0000001342.V299259.R01.S.doc Version 5.2 Page 17 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives spoken to expressed satisfaction with the facilities offered by the home. The home offers a pleasant, clean and hygienic environment. EVIDENCE: The home is purpose built, is located close to local amenities and a regular bus service is available. Lounge areas are large and furnishings have been thoughtfully placed to establish smaller sitting areas. The building appeared well maintained, was tidy, comfortable and free from unpleasant odours. The manager informed the Commission that routine maintenance and decoration is an ongoing process. There is wheelchair access to a patio area with an DS0000001342.V299259.R01.S.doc Version 5.2 Page 18 enclosed garden suitable for those service users who may wander. Access to the building is via an intercom system, on entering there is a reception desk where visitors are welcomed and where access to the administrator and an appointment to see the manager may be made. The home has just recently completed an extension, which has been decorated to a high standard. The home has systems in place to ensure the standard of cleanliness is maintained at all times. It was clean and tidy on the day of inspection. The Laundry facilities are managed to a good standard and residents and relatives expressed satisfaction with the quality of the laundry service. Soiled clothing is washed following the correct guidelines and there are policies and procedures in place to assist staff with Infection control issues. DS0000001342.V299259.R01.S.doc Version 5.2 Page 19 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, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall, the staffing levels are suitable to ensure the care needs of residents are met. The recruitment procedure is good. More training is needed to ensure the staff are appropriately equipped to meet the resident care needs. EVIDENCE: The home has developed a rota system that clearly identifies numbers of staff that are on duty each week. The home is based on two levels and the staffing for each level is clearly highlighted. Residents and relatives spoken to felt that the numbers of staff on duty were suitable and that they felt well attended. Two residents said that the staff always attend quickly and they didn’t have to wait long. Residents and relatives spoken to felt the staff were unhurried and had time to sit and chat during the course of their working day. The inspector observed this during the visit. The inspector identified a problem with staffing during the inspection. One resident with dementia was prone to walking into other people’s rooms, which was quite frightening for them. An alarm system on the resident’s door alerts staff when the room has been vacated. During meal times, when staff were busy, they were seen to just turn the alarm of and not check on the resident. DS0000001342.V299259.R01.S.doc Version 5.2 Page 20 This is poor practice and defeats the object of the alarm system. This was highlighted to the manager. This is an indicator that suggests a need for a review of staffing levels on this unit. The employment records of the most recent staff members employed by the home were examined and found to be in good order. All the necessary documentation needed before employment could commence was obtained. The training records examined showed that the staff receive the appropriate mandatory training in areas such as moving and handling and infection control. Registered nurses do attend updates in areas such as palliative care, continence care and wound care. Care staff are not benefiting from training in the areas of care need relevant to the resident group. These include areas such as continence care, pressure area care, diabetes, aggression and most importantly dementia. Staff spoken to confirmed that training in these areas is not provided. Staff spoken to confirmed that they were unfamiliar with the care needs of people with dementia and felt they would benefit greatly from training in this area. The home has now achieved the target of ensuring 50 of the care staff are trained to NVQ Level 2 or above. This is good practice. DS0000001342.V299259.R01.S.doc Version 5.2 Page 21 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, 35, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager regularly reviews the quality of the care provided within the home to ensure it is improved and maintained. Residents’ finances are well protected by the systems adopted by the home. The home has systems in place to assist them with ensuring the resident’s health and safety is protected at all times. DS0000001342.V299259.R01.S.doc Version 5.2 Page 22 EVIDENCE: The home has a robust quality assurance tool, which the manager is actively involved in. The results of quality assurance surveys are correlated and presented in the entrance hall of the home on an annual basis. Once again, the way in which this is presented must be reviewed to ensure it is accessible to residents and written in a more suitable format so that they can understand it. The inspector examined random financial records of residents living at the home. These records were kept accurately and up to date. Receipts were kept for every transaction. The staff training records show fire training and manual handling training is regularly provided to staff by the home. Water temperature checks are also checked on a regular basis and the environment is suitably risk assessed. DS0000001342.V299259.R01.S.doc Version 5.2 Page 23 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 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 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x 2 3 DS0000001342.V299259.R01.S.doc Version 5.2 Page 24 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. 1 Standard OP8 Regulation 12 Requirement The registered person must ensure that appropriate records are kept and maintained so that residents’ needs are met. (This refers to nutritional and fluid records of dependent residents.) The registered person must ensure the privacy and dignity of the residents is respected and promoted at all times. The registered person must ensure that all residents with different cultural tastes regarding food are appropriately consulted and provided for. Menus must be accessible to residents and written in a format that is more suitable for them to read. The registered person must ensure appropriate levels of staff are on duty at all times. The registered person must ensure all staff working in the care home receive training that ensures they are able to meet the care needs of the resident group. DS0000001342.V299259.R01.S.doc Timescale for action 28/02/07 2 OP10 12 31/03/07 3 OP15 12 30/04/07 4 OP15 12 01/03/07 5 6 OP27 OP30 18 18 28/02/07 30/04/07 Version 5.2 Page 25 7 OP37 12 The registered person must ensure all information provided to residents takes into consideration any disability that may hinder access to it. 31/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000001342.V299259.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 DS0000001342.V299259.R01.S.doc Version 5.2 Page 27 - 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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