Inspection on 04/05/05 for Green Acres Nursing Home

This inspection was carried out on 4th May 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Green Acres Nursing Home 02/12/08

Green Acres Nursing Home 14/12/06

Green Acres Nursing Home 01/02/06

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 Rigton Drive Burmantofts Leeds LS9 7PY Lead Inspector Sean Cassidy Unannounced 4 05 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. Green Acres J52 S1342 Green Acres V 04052005 Stage 0.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Green Acres Address Rigton Drive Burmantofts Leeds Yorkshire LS9 7PY 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) 0113 2483334 0113 2406278 Life Style Care Plc Mrs Lynn Hart Care home with nursing 55 Category(ies) of Old age (55) registration, with number of places Green Acres J52 S1342 Green Acres V 04052005 Stage 0.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st Feb 2005 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. Green Acres J52 S1342 Green Acres V 04052005 Stage 0.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out by two inspectors and lasted a full day. The purpose of the inspection was to make sure the home was operating and being managed to a satisfactory standard for the benefit of residents. The inspectors spoke to several service users and members of staff. A number of documents were examined which included care plans and other records. What the service does well: What has improved since the last inspection? What they could do better: Green Acres J52 S1342 Green Acres V 04052005 Stage 0.doc Version 1.30 Page 6 The information pack known as the Service User Guide, should be more accessible to the residents and relatives. No residents or relatives could recall seeing these documents, which contain important information regarding their stay. Improvements must be made in the way the home assesses and plans the care that is to be provided to residents. Evidence was found to show that the homes usually good standards in this area had fallen, which was acknowledged by the manager and deputy during feedback. This also was the case for resident risk assessments in areas such as pressure areas, nutrition and falls. Resident care plans should involve all care staff and not remain the remit of the qualified staff. Residents must be involved with all of the above processes where possible. Although privacy and dignity appeared to be well respected overall, evidence was found to show that there remains room for improvement in this area. Residents stated that more could be done to provide leisure activities within the home and opportunities to access facilities outside of the home as well. Mealtimes could be made more sociable within the home and better interaction and assistance should be given to residents. The quality and provision of food should be reviewed and improved as meals and drinks were not served at a temperature acceptable to all residents. The complaints procedure should be made more accessible to residents and their relatives as none were able to identify what the process is for making a complaint. Improvements must be made with regards to providing specialist training to staff in Understanding Dementia and providing Supervision to care staff. The manager must review the health and safety practices of the care staff to ensure that service users are not placed at risk of harm. 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. Green Acres J52 S1342 Green Acres V 04052005 Stage 0.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Green Acres J52 S1342 Green Acres V 04052005 Stage 0.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,5. Residents are not enabled to make an informed choice about moving into the home, as trial visits to the home are not consistently offered. The home is not able to give assurances that service users needs can be met, as they are not all assessed prior to admission. EVIDENCE: A Statement of Purpose and a Service user guide has been developed. These documents are sent out to all prospective service users and their families, however, no resident or service user could confirm that they had seen these documents. Not all residents were assessed prior to moving into the home and trial visits were not offered consistently. Green Acres J52 S1342 Green Acres V 04052005 Stage 0.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10 Not all residents have been provided with or involved in developing care plans. Not all residents’ health care needs were fully met due to the lack of a care plan. The home attempts to ensure residents are treated with respect and their dignity is respected. EVIDENCE: Four resident care files were examined. Two files had no care plans. Those with care plans were found to be comprehensive, detailed and included good risk assessments. All documents were reviewed on a monthly basis. Residents and relatives spoken to stated that they had not seen a care plan and had no involvement with drawing them up. This was evidenced in the documentation as only one showed relative involvement. Not all care plans identified the resident’s health needs and assessments for nutrition, falls and pressure area care were not carried out consistently. Care staff were not able to confirm the care needs of the residents they cared for that day as they stated they are not involved with the care plans as they are the remit of Qualified Staff. Green Acres J52 S1342 Green Acres V 04052005 Stage 0.doc Version 1.30 Page 10 One resident with dementia had a gate on his door that kept him in his room. Staff stated that this was to prevent him from wandering as staff were unable to monitor residents whereabouts. This could be seen as a form of restraint ways should be identified to enable residents in the home to freely wander. Two residents were admitted from a local hospital and were assessed as needing an Intermediate Care Service. This service was not available at the point of admission, which the home admitted. Their care was therefore compromised by this action. Residents said that they felt that they were spoken to appropriately and politely and evidence of this was observed during this inspection. Staff were seen to knock on doors before they entered even when they were open. However, residents privacy and dignity was seen to be compromised as some staff were seen administering personal care in corridors, leaving doors to service users rooms open without consultation and getting residents ready for bed at five o’clock without any evidence that some form of agreement had been obtained. Green Acres J52 S1342 Green Acres V 04052005 Stage 0.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 The home does not ensure that the expectations and preferences of resident’s social, cultural and recreational needs are met. Families and friends are made welcome in order to assist residents to maintain contact. Residents’ views should be considered regarding the quality food and mealtimes should provide an opportunity for conversation and social contact. EVIDENCE: There were no activities seen during the inspection and no evidence could be found to show what activities were planned for the week. Residents spoken to said that the activities girls had not been working for a while and that nothing had been provided apart from watching television. The care plans case tracked showed that social interests were not being recorded or planned for. A new enthusiastic activities co coordinator has recently been employed and is presently attempting to record the social interests of the service users so that relevant activities can be provided. Residents stated that they very seldom get an opportunity to get out of the home and that they were “quite bored.” Televisions were on in most rooms regardless of whether the resident wanted them on. Residents said that they were happy with the visiting times as they felt these were quite flexible. Green Acres J52 S1342 Green Acres V 04052005 Stage 0.doc Version 1.30 Page 12 The quality and provision of meals is below standard. A menu was displayed on a wall in the dining room but residents said they did not know what was on the menu until it was presented to them. The interaction of some staff with residents during mealtimes was minimal and one resident needinig assistance with eating did not get it. At lunchtime service users on the first floor were seated in lounge chairs with side tables, as there were no dining tables. This led to each person being isolated. The system for serving food on the first floor left food standing on plates for some time before being distributed and some residents possibly receiving cold meals. Residents stated that their hot drinks were served tepid. This was checked and confirmed. The cook said that food was left for night staff to give to residents during the evening. However, residents said they were not offered any snacks after four thirty in the evening after tea was served. Green Acres J52 S1342 Green Acres V 04052005 Stage 0.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Residents and relatives are not aware of the complaints process or how to complain if they need to. EVIDENCE: The complaints record file showed the complaints made are appropriately investigated within the correct timescales. The complaints process is displayed in the main entrance but residents and relatives said that they were not aware of the complaint procedure or how to go about making a complaint. Green Acres J52 S1342 Green Acres V 04052005 Stage 0.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23,24,26. Not all residents rooms are suitably furnished to reflect the needs of the occupants. The home appears clean, pleasant and hygienic. EVIDENCE: The home was found to be clean and free from offensive odours. Some of the residents rooms were found to be very sparse with little visual interest and others seemed to be well furnished with personal items. Some residents and relatives/friends expressed dissatisfaction with the availability of seating in rooms, as they often had to sit on the edge of the resident’s beds. Green Acres J52 S1342 Green Acres V 04052005 Stage 0.doc Version 1.30 Page 15 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, 30 Staffing levels should be adjusted so that care needs of all residents living at the home can be met according to circumstances. Residents felt assured that carers were kind and trained to do their jobs. However, the staff group still require supervision and specialist dementia training. EVIDENCE: Staff spoken to said that they did receive an induction training and that they felt it was very beneficial to them. Training is provided to staff and those spoken to said that they felt they were able to identify what training they would like to go on. Supervision is not given consistently to care staff working within the home therefore safety guidance can be left to the interpretation of individual staff, to the detriment of residents wishes. Staff have not yet received training in the care of people with dementia. Some staff spoken with stated that they felt there was a definite split in the care staff between those that smoked and those that didn’t. Feelings of inequality in the workload were expressed. This was conveyed to the manager. Staffing levels did not reflect the needs of residents. This was due to the fact that the call bell system on the ground floor had been out of action for five days and staffing was not increased to ensure service users health and welfare was not compromised. The Commission issued an immediate requirement. This Green Acres J52 S1342 Green Acres V 04052005 Stage 0.doc Version 1.30 Page 16 required the home to increase the staffing levels to reflect the needs of the residents and also to provide the Commission with an action plan as to how the call bell system would be repaired. Green Acres J52 S1342 Green Acres V 04052005 Stage 0.doc Version 1.30 Page 17 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) 38 The health and safety of service users is not fully protected. EVIDENCE: The call bell system was out of order and had been for five days and therefore the health and safety of service users was being put at risk. The manager did not report this serious incident to the Commission. The manager and deputy manager were not on duty and the person in charge was unable to give clarity on when the problem would be rectified. An immediate requirement was issued for the home to provide the Commission with details of how this matter would be corrected. A door was left ajar by staff smoking in a designated area outside of the home. Reconstruction work is taking place on a new extension and the fencing in place to prevent access was not secured. Staff were also seen to be mobilising residents in wheelchairs without foot rests. These omissions placed service users at risk. Green Acres J52 S1342 Green Acres V 04052005 Stage 0.doc Version 1.30 Page 18 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 2 x 2 x 2 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 x 15 2 COMPLAINTS AND PROTECTION x x x x 2 2 x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x 2 Green Acres J52 S1342 Green Acres V 04052005 Stage 0.doc Version 1.30 Page 19 yes 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. 2. 3. 4. Standard 1 3 7 8 Regulation 5 14 15 12 Requirement The registered person must provide residents with a copy of the service user guide. All new residents must be assessed prior to admission. A service user plan must be written after consultation with the resident or representative. The registered person must ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of residents.(This refers to the absence of risk assessments in some resident files.) The registered person must make suitable arrangemnents to ensure the home is conducted in a manner which protects the privay and dignity of service users. The registered person must consult service users about their social interests and nmake arrangements to enable them to engage in local, social and community activities. The registered person must ensure that residents receive adequate quantities of suitable J52 S1342 Green Acres V 04052005 Stage 0.doc Timescale for action 30 June 2005 Immediate 31 May 05 30 June 2005 5. 10 12 30 June 2005 6. 12 16 31 July 7. 2005 15 16 30 June 2005 Green Acres Version 1.30 Page 20 wholesome and nutritious food. 8. 27 18 The registered person must ensure that suitably qualified, competent and experienced persons are working at the care home in such numbers as is appropriate to protect the healtha ndd welfare of residents at all times. The registered person must ensure that the care home is conducted to make proper provision for the health and welfare of the residents. 31 July 2005 9. 38 12 31 May 2005 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. Refer to Standard 5 7 15 Good Practice Recommendations The registered person should ensure that prospective residents are invited to visit the home or move in on a trial basis. Care staff should be aware of the care needs as prescribed in the residents care plan. A snack meal should be offered to all residents in the evening and the interval between this and breakfast the following morning should be no more than 12 hours. Green Acres J52 S1342 Green Acres V 04052005 Stage 0.doc Version 1.30 Page 21 Commission for Social Care Inspection Aire House Town Street Rodley LS13 1HP 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. Extracts may not be used or reproduced without the express permission of CSCI Green Acres J52 S1342 Green Acres V 04052005 Stage 0.doc Version 1.30 Page 22 - 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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