Inspection on 06/06/05 for Green Gables Nursing Home

This inspection was carried out on 6th June 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.

Other inspections for this house

Green Gables Nursing Home 26/03/08

Green Gables Nursing Home 24/10/06

Green Gables Nursing Home 11/01/06

Green Gables Nursing Home 08/02/05

Green Gables Nursing Home 26/08/04

Green Gables Nursing Home 27/01/03

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

CARE HOMES FOR OLDER PEOPLE Green Gables Nursing Home Church Lane Grayshott Hampshire GU26 6LY Lead Inspector Andrew Cole Unannounced Monday, 6 June 2005 - 10:00 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 Gables Nursing Home H54 S12199 Green Gables V229722 060605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Green Gables Nursing Home Address Church Lane Grayshott Hampshire GU26 6LY 01428 604220 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) Downing (Green Gables) Limited Mrs Margaret Lydon CRH 38 Category(ies) of DE - Dementia (38) registration, with number DE(E) - Dementia (38) of places OP - Old Age (38) Green Gables Nursing Home H54 S12199 Green Gables V229722 060605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26 August 2004 Brief Description of the Service: Green Gables is situated in the village of Grayshott on the Hampshire/Surrey border. It offers accommodation to service users over three floors. Many of the rooms offer an outlook over the village. A lift is provided for access above the ground floor. The home is registered with the Commission for Social Care Inspection to cater for service users with Dementia 65 years of age and over. Green Gables Nursing Home H54 S12199 Green Gables V229722 060605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 8 hours the manager was present throughout. A tour of the premises was undertaken and 4 staff was spoken to, as were 8 service users, 2 relatives and a visiting medical practioner. Service users and staff records were inspected. What the service does well: What has improved since the last inspection? Fire training, drills and equipment records. Dementia care needs are included in the care planning process. Areas of the home have been subject to continuing decoration and recarpeting in bedrooms and communal areas. Staff are receiving supervision and value the process. Green Gables Nursing Home H54 S12199 Green Gables V229722 060605 Stage 4.doc Version 1.30 Page 6 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. Green Gables Nursing Home H54 S12199 Green Gables V229722 060605 Stage 4.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 Gables Nursing Home H54 S12199 Green Gables V229722 060605 Stage 4.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) 3,5 The manager satisfactorily completes a pre admission assessment for prospective service users that contains details to enable staff to meet the service users initial needs. Service users and their representatives have visited prior to admission and this has enabled them to identify compatibility with the homes ethos of care and its environment successfully. EVIDENCE: A sample of service users records reviewed found pre admission assessments completed with an appropriate selection of topics and evidence of information gathered from other agencies. Three service users spoken to remembered meeting Matron prior to commencing their stay and also their relatives visited before admission; one service user commented “my daughter was made welcome and showed around”. Green Gables Nursing Home H54 S12199 Green Gables V229722 060605 Stage 4.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) 7,89 Individual plans are written clearly and regularly reviewed by staff this has enabled the care delivered to meet current needs identified by the staff. There is an absence of written evidence of the partnership approach to care planning needed in order to ensure a meeting of care needs prioritised to the service users requirements. Medical services are regular participants in the delivery of care and there is a good rapport, weekly reviews ensure a prompt response to healthcare needs. The appropriate systems for the administration of medicine are in place their implementation ensures service users medication needs are met. EVIDENCE: Individual plans are available, in those records sampled assessments were in place, regular reviews were noted. One service user spoken to said, “My keyworker writes on me” but was not aware of the care plan process or had participated in any evaluation. Care plans should be agreed and signed by the service user or their representative, none of the care plans examined contained written acknowledgement of service user or their representative’s involvement in planning care. Green Gables Nursing Home H54 S12199 Green Gables V229722 060605 Stage 4.doc Version 1.30 Page 10 Bedside restraints were in use without service users or their relative’s written consent or a documented risk assessment. A medical practioner spoken to commented positively on communication with this home. Medical reviews occur weekly “ staff are caring, they pay attention, give feedback and follow through treatment” Procedures were in operation for the safe storage, handling and administration of medications. A GP reported reviewing medications at the weekly review and a full review of the homes medication six monthly. Green Gables Nursing Home H54 S12199 Green Gables V229722 060605 Stage 4.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. A wide variety of activities both in house and external are available for service users, visitors are encouraged and made welcome; this enhances the service users daily routine. Meals are varied and wholesome and arrangements are flexible enough to meet service users needs. EVIDENCE: There is an active Friends of Green Gables group who raise money through coffee mornings and craft sales. Posters on the wall advertise activities and a small booklet is produced. Service users spoken to were aware of the activities programme and praised it, one was pleased that “the activities coordinator discusses things with you”. A physical exercise activity involving transferring a large ball was in progress during the inspection. There has been a trip out to Birdworld and the Hampshire bus is often used for outings. Four service users go to local day centres. A fete is being held in the summer, a local minister provides a service at the home once a month. Relatives and friends were present during the inspection they report being welcomed and able to visit flexibly. Green Gables Nursing Home H54 S12199 Green Gables V229722 060605 Stage 4.doc Version 1.30 Page 12 Meals during the inspection were well presented and a menu was displayed in the dining room, meals can be taken in the service users room; special diets and alternative meal selections are available. Green Gables Nursing Home H54 S12199 Green Gables V229722 060605 Stage 4.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) 16,18 A complaints procedure is in place and readily available. Service users believe their complaint would receive attention and action this serves to improve the quality of care delivered. The home has procedures and training in operation to protect adults vulnerable to abuse. EVIDENCE: There was an adequate complaints procedure on display with a complaints book in the main reception area. There were no complaints recorded or reported. Staff and service users spoken to were aware of the format for complaints and felt free to make a complaint usually directly to matron. Staff spoken to have received training in abuse issues they were able to identify types of abuse, preventative and interventionist action. Records of training received were found in staff files Green Gables Nursing Home H54 S12199 Green Gables V229722 060605 Stage 4.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) 19,20,21,22,24,26. Improvements to the décor have been made and the home is comfortable and pleasant, further planned improvements in furnishings and décor will enhance the environment to a good standard. Ready access to lifting and handling equipment would maximise independence and reduce waiting for service users. EVIDENCE: Since the last inspection the home has continued with their redecoration programme as well as some new carpets in service user rooms and communal areas. Lounge and dining areas are separate and appropriately furnished with lounge chairs and settees; service users have a choice of rooms to occupy. The garden area is accessible by two ramps and has garden furniture that includes tables and chairs. The provision of toilet and bathing facilities is adequate and remains unchanged from previous inspections. Green Gables Nursing Home H54 S12199 Green Gables V229722 060605 Stage 4.doc Version 1.30 Page 15 Most service users use a wheelchair therefore the current limited provision of lifting/handling equipment means delays may occur before assistance is given. Bedrooms are homely and many have a variety of personal possessions and furniture. The home was clean to a good standard, it smelt fresh. Green Gables Nursing Home H54 S12199 Green Gables V229722 060605 Stage 4.doc Version 1.30 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 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) 27,29,30 Overall a picture of staff with positive service user relationships but a high workload was present. At times this meant a timely response to meet needs was not possible. Training is positively promoted recognizing the needs of staff and service users, this will provide a staff group able to identify and plan to meet service users needs. EVIDENCE: At the time of inspection 34 service users had wheelchairs, this creates a high dependency rating in addition to the number of persons with a dementia. Staff and service users identified extra staff as an area for improvement; the manager is hoping to increase the number of qualified staff per shift. Service users felt the staff are “second to none” “ look after you pretty well” though there were also comments about delays in attending service users and being left waiting. Recruitment procedures and records in the sample of four examined were found to be well kept, comprehensive and safely stored in the main office. Staff spoken to recounted an appropriate experience during interview and appointment. Staff feel supported in identifying and meeting training needs, supervison occurs and is valued by the staff. Copies of training certificates and achievements were located in staff records examined. Six staff are studying for NVQ 2. Green Gables Nursing Home H54 S12199 Green Gables V229722 060605 Stage 4.doc Version 1.30 Page 17 Green Gables Nursing Home H54 S12199 Green Gables V229722 060605 Stage 4.doc Version 1.30 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 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) 31,36,38 The manager is experienced and well regarded by staff and service users. Attention is required to the skill mix for such a high dependency level in an environment that is not purpose built in order that safety and well being can be ensured. A great deal of manual handling was noted with a restricted mix and quantity of equipment this might place staff and service users at risk. Storage for wheelchairs is inadequate. EVIDENCE: The manager is an experienced nurse with who was commented on favourably by all persons spoken to as approachable and helpful. The manager will complete her registered managers award this year; she is also attending a trainer’s workshop for a recently purchased dementia care training package. Two corridors leading to a fire exit contained a number of parked wheelchairs and a hoist. Inspection of records revealed that fire procedures, training, equipment and records were regularly reviewed, current and implemented as required. Green Gables Nursing Home H54 S12199 Green Gables V229722 060605 Stage 4.doc Version 1.30 Page 19 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 x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 2 3 2 x 3 x 3 STAFFING Standard No Score 27 2 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x 3 x 2 Green Gables Nursing Home H54 S12199 Green Gables V229722 060605 Stage 4.doc Version 1.30 Page 20 no 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 22 Regulation 13(5) Requirement You must reassess the manual handling needs of the service users and evidence the availabilty of adequate equipment to meet the needs of the high percentage of wheelchair users. You must ensure that when bed restraints are used they are risk assessed,agreed with the service users or their representative and care planned. You must ensure that all corridors are free from obstruction and that the storage of wheelchairs and lifting equipment does not impede access to fire exits or provide an obstacle to a safe thoroughfare . Timescale for action September 2005 2. 7 13(7)(8) September 5th 2005 3. 38 13(4)(a) September 5th 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. Refer to Standard 7 Good Practice Recommendations Service users involvement and agreement in constructing and implementing care plans should be recorded. H54 S12199 Green Gables V229722 060605 Stage 4.doc Version 1.30 Page 21 Green Gables Nursing Home 2. 27 You should conduct a staffing review to evidence your ability to meet the needs of a high number of service users with complex physical and mental health needs. Green Gables Nursing Home H54 S12199 Green Gables V229722 060605 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton Hampshire SO15 1GW 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 Gables Nursing Home H54 S12199 Green Gables V229722 060605 Stage 4.doc Version 1.30 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!