Inspection on 13/11/06 for Green Gates Nursing Home

This inspection was carried out on 13th November 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 Gates Nursing Home 15/12/05

Green Gates Nursing Home 21/06/05

Green Gates Nursing Home 07/12/04

Green Gates Nursing Home 06/08/04

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

CARE HOMES FOR OLDER PEOPLE Green Gates Nursing Home 2 Hernes Road Summertown Oxford Oxfordshire OX2 7PT Lead Inspector Kate Harrison Unannounced Inspection 13th November 2006 09:45 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 Green Gates Nursing Home DS0000027152.V320157.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. Green Gates Nursing Home DS0000027152.V320157.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Green Gates Nursing Home Address 2 Hernes Road Summertown Oxford Oxfordshire OX2 7PT 01865 558815 01865 514090 wilcockm@bupa.com www.bupa.co.uk BUPA Care Homes (CFCHomes) Limited 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) Margaret Wilcock Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Green Gates Nursing Home DS0000027152.V320157.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. On admission persons should be aged 60 years and over. Date of last inspection 15/12/05 Brief Description of the Service: Green Gates is a nursing home in Summertown in the outskirts of Oxford city and is part of the BUPA care home group. The home provides 24-hour care for older people who require nursing. Other services that can be arranged on request include private physiotherapy, chiropody and hairdressing. The home organises a range of activities for residents to enjoy. General practitioners from local medical practices provide medical care to residents, and other NHS services are available. The original building is a traditional Edwardian style town house, that has had several extensions and purpose-built additions made since its original registration as a nursing home in the 1980s. Although the home is registered to accommodate 40 residents, BUPA has chosen to accommodate all the residents in single rooms, with en-suite toilet and wash hand basin facilities, and therefore is able to accommodate 36 residents. There are three ground floor lounges, a dining room, and a first floor sitting room. There are attractive accessible gardens to the rear of the home. Green Gates Nursing Home DS0000027152.V320157.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 09.45 hours and was in the home for 6.5 hours. This inspection was a thorough look at how well the service is doing. It took into account detailed information provided by the home’s manager, and any information that CSCI has received about the home since the last inspection. The inspector saw all areas of the home, spoke with residents and looked at records and documents relating to the care of the residents. The inspector also discussed care with the home’s manager and with other care staff. The inspector asked the views of the people who use the services and other people seen during the inspection or who responded to questionnaires (comment cards) that the Commission had sent out. 7 residents and 10 relatives replied, as did 5 general practitioners (GPs), and their views are used in this report. From the evidence seen by the inspector and comments received, the inspector considers that this home would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. This report makes one requirement to meet regulation and some recommendations to continue the good quality of care at the home. What the service does well: What has improved since the last inspection? Residents have more control over their care as they can keep their care plans in their own rooms. Rooms have been redecorated, flooring replaced and doors fitted with fire safety equipment. More carers have been enrolled on training programmes. Green Gates Nursing Home DS0000027152.V320157.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Green Gates Nursing Home DS0000027152.V320157.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 Green Gates Nursing Home DS0000027152.V320157.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): Standard 3. Standard 6 was not assessed, as intermediate care is not provided at this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three individual’s files were examined to check the home’s admission procedure. Usually the manager or a senior nurse carries out the preadmission assessment. One resident was assessed for admission while at a hospital over 60 miles away, and the manager of another BUPA home nearby carried out the assessment. The five-page pre-admission assessment form contains all the information for the manager to decide if the prospective resident’s needs could be met at the home. Care plans were developed for all the individual files seen. One resident confirmed that she/he had received the service user guide, and the guide is available in each bedroom. Green Gates Nursing Home DS0000027152.V320157.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. Although a requirement was made about the recording in of medication, the residents receive consistently good care from kind skilled staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two individual’s care files were assessed in detail. Risk assessments were carried out to discover how the risks to the residents’ health and safety could be minimised, such as falling and malnutrition, and these were used to develop the care plans. It is recommended that the nationally evidenced based way of assessing and preventing malnutrition - Malnutrition Universal Screening Tool(MUST) developed by the British Association for Parental and Enteral Nutrition be used at the home. Guidance is available to the nurses regarding the writing of the care plans, and the home’s intention is to develop the guidance to make sure that the individual resident’s needs are all carefully documented and that staff members act to meet the individual’s needs. Some evidence was seen showing that the individual is at the heart of the care planning process, such as recording how important religious practice is to one individual, and this is good practice. Residents have easy access to their care plans and are consulted on all aspects of care. Feedback from the Commission’s comment Green Gates Nursing Home DS0000027152.V320157.R01.S.doc Version 5.2 Page 10 cards showed that the residents ‘always’ or ‘usually’ received the care and support they needed. Some care plans lacked the necessary detail, such as the date and the signature of the person completing the form, and all the detail should be completed to give the care plan the appropriate meaning. The medication is delivered weekly from a local pharmacy, and the majority comes in prepared cassettes. Other medication not delivered in cassettes is recorded as received at the home, but the receipt of the cassettes is not recorded, and this must be started. The temperature in the medicines refrigerator was too high at 11 degrees centigrade, and action should be taken to make sure that medicines stored in the refrigerator are stored at the correct temperature. All the staff were seen and heard to treat residents with care and respect, and residents told the inspector that they were treated with dignity. Four of the letters of appreciation received in last month were seen, from different families, and included comments about the skilled and caring qualities of the staff, who had ‘lovingly’ cared for the residents. Green Gates Nursing Home DS0000027152.V320157.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The routines of the home are as far as possible organised around the residents needs and wishes. The registered manager considered a recommendation in the last inspection report to hold regular residents’ meetings and after consultation decided to have weekly briefings for residents, and makes herself available for residents as necessary. A notice board displays relevant information for residents such as the times of religious services, and other home information. A recommendation was made in the last inspection report that staff should not use the residents’ communal rooms routinely for breaks or for handover to the next shift. The dining room continues to be routinely used for shift handovers, and the upstairs lounge used for staff training, and although the registered manager stated that this use by staff did not interfere with the residents’ needs, the recommendation remains. Entertainment is regularly available at the home through outside entertainers, and a manicurist, a barber and a hairdresser also visit regularly. The activities organiser works 10 hours each week to respond to residents’ activity needs, and has an interest in painting. An exhibition showing recent paintings by Green Gates Nursing Home DS0000027152.V320157.R01.S.doc Version 5.2 Page 12 several residents is on display at the home, and some residents attended a video film show on the day of the inspector’s visit. The majority of residents who replied to the Commission’s comment card question about appropriate activities said that there were ‘sometimes’ activities available that they could take part in. Some said that hearing or other disability prevented them from taking part, and it is recommended that an appropriate person investigate how individual or communal activities are made available for those residents. All the relatives who responded to the Commission’s comment cards said that they were always welcome at the home, and that they could see their relative in private. The home’s dining room is well organised, and staff members assist those residents who need help to eat in a sensitive way. The chef sees all the residents regularly to discuss their views about the food, and has a keen interest in the provision of good quality food at the home. New menus have been developed to take into account the nutritional value of dishes, and these provide a way of generally measuring the nutritional intake of individual residents. The residents, through the Commission’s comment cards and discussion with the inspector, said that the food is good. On the day of the inspector’s visit one resident said that the lunch was ‘very good’ and that the dessert was ‘excellent’. Green Gates Nursing Home DS0000027152.V320157.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaints procedure is displayed in the foyer, and gives details about whom to address complaints to and how quickly they will be addressed. The home’s manager takes complaints seriously, and residents told the inspector that they knew whom to approach in the home if they had any concerns. No complainant has contacted the Commission about a complaint since the last inspection. The home has a policy on safeguarding vulnerable adults, and staff members have had training in safeguarding the residents during 2005 and 2006. All staff members receive a copy of the whistle blowing policy when they start work at the home. Green Gates Nursing Home DS0000027152.V320157.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was refurbished in 2001 and has a named member of staff who is responsible for the general ongoing maintenance. The gardens are suitable for the needs of the residents, and are well maintained. A system is in place for the staff to record maintenance issues so that they can speedily be addressed, and there is a rolling programme of refurbishment. Rooms are bright and well decorated, and residents bring their personal possessions with them to decorate their rooms. Two residents told the inspector that their rooms were very comfortable and suited their needs. There are a few adjustable beds in the home, but for the comfort and safety of the staff and residents, the registered manager should consider providing adjustable beds for all the residents, unless the resident chooses not to use one. The laundry is managed at the home and one member of staff is responsible for the process. The laundry room is suitable for the purpose and the system Green Gates Nursing Home DS0000027152.V320157.R01.S.doc Version 5.2 Page 15 is well managed. Infection control measures are in place and staff are trained in the procedures. All the residents who replied to the Commission’s comment cards said that the home was ‘always’ fresh and clean. One resident told the inspector that the cleaning of her bedroom was ‘excellent’. Regular safety checks are carried out on the home’s equipment, such as hoists and the lift, and the recommendations from the last inspection visit regarding flooring and door safety closures have been implemented. Green Gates Nursing Home DS0000027152.V320157.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents who replied to the Commission’s questions about the home’s staff said that the staff members were ‘always’ or ‘usually’ available when they were needed, and that they listened and acted on the residents’ wishes. The staffing rota shows that there are usually two nurses on duty during the daytime and one at night, and usually six carers on duty in the morning, five on duty during the afternoon and evening, and three at night, and this level of cover meets the personal needs of the residents. The home also employs administrative, maintenance and housekeeping staff. The home has had some difficulty in getting assessors to help the carers gain their Level 2 National Vocational Qualifications (NVQ), and consequently has not yet reached the 50 NVQ trained care staff. The registered manager is working to address this issue, and has several carers enrolled to start the programme. Two staff files were assessed to check the home’s recruitment procedure and all the necessary detail was available. The home’s induction programme has recently been updated to meet the Skills for Care standards, and the training coordinator manages the training and updating programme for nurses and carers. The training programme is a mix of in-house and external courses, and covers mandatory and clinical issues that staff members record on their individual training logs. Green Gates Nursing Home DS0000027152.V320157.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is qualified and experienced in managing the home, and has regular meetings with staff to discuss the management of issues. Residents told the inspector that they had confidence in her management, and would approach her if they had any concerns. Annual quality questionnaires on all the topics affecting the residents are sent to residents and the results are analysed and used to improve the service. Other ongoing quality monitoring is carried out through regular visits from BUPA management and through in house monitoring, so that the service continues to improve. Few residents are able to manage their own financial affairs, and family members or other representatives usually take this responsibility. The home manages petty cash for some residents within a current account at a high Green Gates Nursing Home DS0000027152.V320157.R01.S.doc Version 5.2 Page 18 street bank, and manages NHS contributions according to the home’s policy, which is part of the resident’s contract. BUPA has a health and safety policy statement and provides training and equipment for staff members. The home has a health and safety committee to monitor the health and safety issues within the home, and to fulfil BUPA’s policy statement. Fire risk assessments were completed for the home in June 2006, and the registered manager intends to seek the local fire officer’s view of the assessments, to make sure that residents and staff are properly protected. Maintenance contracts are in place to make sure that the home’s facilities and services are in good working order, and records are well maintained. Green Gates Nursing Home DS0000027152.V320157.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Green Gates Nursing Home DS0000027152.V320157.R01.S.doc Version 5.2 Page 20 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 OP9 Regulation 13 Requirement All the medication cassettes must be recorded as received at the home. Timescale for action 30/11/06 Green Gates Nursing Home DS0000027152.V320157.R01.S.doc Version 5.2 Page 21 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 OP12 Good Practice Recommendations Ensure that residents’ communal rooms are not routinely used by staff for handover or break times. This recommendation remains from the inspection visit of 15/12/05. The nationally evidenced based way of assessing and preventing malnutrition (MUST) should be used. All the details of the care plan should be completed, including the date it was written and the signature of the individual who wrote the plan. Action should be taken to make sure that medicines stored in the refrigerator are stored at the correct temperature. An appropriate person should investigate how individual or communal activities can be provided for residents who are not able to take part in communal activities. The registered manager should consider providing adjustable beds for all the residents, unless individual residents choose not to use one. 2 3 4 5 OP7 OP7 OP9 OP12 6 OP24 Green Gates Nursing Home DS0000027152.V320157.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Green Gates Nursing Home DS0000027152.V320157.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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