Inspection on 15/12/05 for Green Gates Nursing Home

This inspection was carried out on 15th December 2005.

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 13/11/06

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 Delia Styles Announced Inspection 15th December 2005 09:50 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.V260495.R01.S.doc Version 5.0 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.V260495.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Green Gates Nursing Home Address 2 Hernes Road Summertown Oxford Oxfordshire OX2 7PT 01865 558815 01865 514090 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) BUPA Care Homes Limited 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.V260495.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. On admission persons should be aged 60 years and over. Date of last inspection 21/06/05 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 1980’s. The home has 36 bedrooms only one of which is being used as a shared room. The others are all single occupancy, and all rooms have en-suite toilet and wash hand basin facilities. 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.V260495.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection (that is, the home was informed about the inspection several weeks before) that lasted seven hours. The inspector discussed her observations and recommendations with the manager and deputy manager at the end of the inspection and left a written summary of her findings. A total of 20 comment cards (a list of questions about the service provided by the home) were received: 8 from residents; 5 from relatives/visitors; 2 from health and social care professionals; and 5 from general practitioners (who provide medical care to their patients in the home). The home also completed and returned a questionnaire to CSCI about the home’s facilities and services, staffing levels and staff qualifications before the inspection took place. During the day, the inspector toured the home; spoke with 6 residents, the manager, deputy manager, administrator and several staff members. Samples of care plans, medicine records, the complaints record and staff training records were inspected. A number of the key standards that had not been assessed during the unannounced inspection in June were looked at (‘Key Standards’ are those that the CSCI considers the most important to assess at least once every 12 months). Other standards, where recommendations had been at the last inspection, were also looked at. The inspector would like to thank the residents and staff for their time and welcome during the day. What the service does well: What has improved since the last inspection? Green Gates Nursing Home DS0000027152.V260495.R01.S.doc Version 5.0 Page 6 The new windows to the ground floor lounge used for activities have been installed: the old window frames were rotten and the old windows were prone to condensation and misting over. Residents’ room windows are being replaced to improve the soundproofing and ventilation. The training needs of all staff are being looked at, so that each person will have a clear plan for what training they have to complete, as well as courses and training they would like to do to develop their individual skills and interests to do with their work. 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 Gates Nursing Home DS0000027152.V260495.R01.S.doc Version 5.0 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.V260495.R01.S.doc Version 5.0 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 the following standard(s): These standards were not assessed on this occasion. Standard 6 does not apply, because the home does not provide intermediate care. EVIDENCE: The key standards were assessed and met at the last inspection. Green Gates Nursing Home DS0000027152.V260495.R01.S.doc Version 5.0 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 the following standard(s): 7, 8 & 10 The care planning system is satisfactory overall but needs further work to make sure that care records are updated or re-written when there are significant changes to residents’ condition and care needs, so that all staff have the information they need to carry out the care. The health needs of residents are well met with evidence of good multidisciplinary working taking place on a regular basis. Personal support and care is offered in a way that protects residents’ privacy. EVIDENCE: A sample of 5 residents’ care plans was examined. There were some important details omitted from care plans: for example, lack of updating of someone’s care plan following a speech and language therapist’s assessment, their risk assessment and understanding of this. Another resident’s care plan did not show the risk assessment and action taken in relation to their confusion and frequent falls. Care records contained very little assessment information about residents’ social and recreational care, and there were no care plans or evaluations of these important aspects of residents’ care. Green Gates Nursing Home DS0000027152.V260495.R01.S.doc Version 5.0 Page 10 The care plans are kept in individual folders in the nurses’ office and staff write entries about their care at the end of each shift in a separate Standex file. This does not encourage staff to check that their daily entries are specific to the residents’ numbered care plans and if the care given has been effective in meeting the residents’ care needs. All the staff spoken with had a good knowledge and understanding of residents’ individual care needs and preferences, but this was not reflected in the written records. Some of the residents spoken with were clearly able to discuss their care needs and could be invited to be more involved with staff in discussing, writing and agreeing their care plans, so that staff could be more confident about stating that care is given in a way that is effective, and as the resident wishes. Comment cards from GPs and health and social care professionals in contact with the home, showed that they are confident about the way in which the home’s staff communicate and work with them. They are happy with the way in which the home is run and consider that the standard of care given to residents is good. Residents spoken with said that staff are respectful and considerate when helping them. Staff were observed to knock on residents’ room doors and to wait for an answer before going in. Only one bedroom is a shared room and this has curtain screening between the beds to protect the residents’ privacy. Green Gates Nursing Home DS0000027152.V260495.R01.S.doc Version 5.0 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 the following standard(s): 12 & 15 There was some evidence that the range of activities and recreational opportunities for residents is less since the last inspection. The meals in the home are good, offering both choice and variety and catering for special dietary needs. EVIDENCE: There has been some reduction in the variety and number of planned activities and entertainment in the home, due to the retirement or ill health of some people who had provided regular services in the past. A new activities coordinator is due to start work in the New Year, so it is hoped that a new programme of individual and group activities will be available again. Residents raised concerns with the inspector about the use of the ‘Green room’ for staff breaks and handover reports because it is the designated sitting room used for residents’ activities. It was felt that if staff use the room, it disrupts residents’ planned activities and prevents residents from going in. Sitting and dining rooms are the communal areas for residents, and staff should have residents’ agreement if they wish to use the room occasionally for meetings or training purposes. This was discussed with the home’s manager and deputy, who said that they would look at using a more appropriate room for staff handovers and break times. Green Gates Nursing Home DS0000027152.V260495.R01.S.doc Version 5.0 Page 12 The inspector joined four residents for lunch in the dining room. There are two lunchtime sittings for residents, with those residents who need more staff assistance having their meal first. The tables were each very attractively set with a Christmas ornament and centrepiece, linen tablecloths and napkins. Lunch was a three-course meal: a starter, three main course and two dessert choices. Residents were offered sherry (or other alcohol drink if preferred), fruit juices or water, with their meal. The chef was available to oversee the meal service and check with residents about their satisfaction with the food. The inspector’s fellow diners were all very appreciative of the food – the choices, quality and quantity. Five of the 8 comment card responses were ticked ‘yes’ in answer to the question ‘do you like the food’; 3 respondents ticked ‘yes’ and added ‘mostly’ to this question. Staff were attentive and patient when serving residents with their food, and tactfully helped anyone who needed it. Green Gates Nursing Home DS0000027152.V260495.R01.S.doc Version 5.0 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 the following standard(s): 16 The home has a satisfactory complaints system with some evidence that residents feel that their views are listened to, though some were not confident that these would be acted upon. EVIDENCE: The home has a very clearly written colour brochure – ‘Residents and relatives information’ – that explains how residents can make suggestions and complaints. There are feedback cards and a suggestions box in reception and a copy of the ‘Complaints’ policy on display. Each resident also has a copy of the ‘Complaints’ policy in their Welcome Pack kept in their room. When asked about whom they would go to with any concerns, residents varied in their replies – some saying they would raise these with any of the trained nurses and others with the home’s manager. The residents’ and relatives’ information brochure states that all new residents are allocated a key carer/named nurse. Residents spoken with were not aware of which member of staff was their ‘named carer’ (or key carer). This may be because there have been recent changes in the staff team as people have left. Green Gates Nursing Home DS0000027152.V260495.R01.S.doc Version 5.0 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 the following standard(s): 24 The standard of the environment in this home is very good, providing residents with an attractive and comfortable place to live. Residents own rooms are homely and arranged with their own possessions to suit their individual needs and preferences. EVIDENCE: Residents spoken with were very pleased with their rooms and the way in which they had been able to have their furniture layout rearranged to suit their particular needs. All areas of the home were very clean and attractively decorated ready for Christmas. Green Gates Nursing Home DS0000027152.V260495.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 30 The staffing numbers and skill mix are satisfactory, though some residents said that recent staff changes have affected the consistency of care they receive. The arrangements for the induction and training of staff are good with evidence of a planned programme of training and development for all staff. EVIDENCE: From looking at copies of the duty rotas, discussion with residents and reading comment cards the inspector considered that the home provides the number and skill mix of staff to care for the residents. Agency staff are rarely used however, there were 3 comment cards that referred to several long-standing staff who had left over recent months, and that this was unsettling for residents. One resident felt that generally the standard of care was ‘alright’ but in their view the staff are now ‘too rushed’ - there had been a disruption in care routines and staff were perceived as being ‘less friendly’, perhaps because they were new to the home and were not yet settled into their roles. BUPA homes have a customer service programme for staff called ‘Personal Best’ to help staff to provide care to residents in a way that suits each individual resident, rather than routines of care that are for staff convenience. All staff have mandatory training in health and safety topics, and protection of vulnerable adults. One of the registered nurses has the role of training coordinator and is looking at the training needs for all the qualified staff. The programme of National Vocational Qualification training for staff is in place with Green Gates Nursing Home DS0000027152.V260495.R01.S.doc Version 5.0 Page 16 evidence that the home is working hard to achieve the recommended proportion of care staff who have NVQ Level 2 or above. Green Gates Nursing Home DS0000027152.V260495.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 The home’s manager is very experienced in her role and the home has a clear management structure so that senior staff all have defined areas of responsibility. The systems for resident consultation are limited, and more effective ways of getting residents’ views should be considered so that they are more confident that their views are acted upon and that they can influence decisions about how the home is run. The systems for accounting and management of residents’ personal monies are good and protect residents’ financial interests. The home has good systems in place for the regular maintenance and upkeep of the building and equipment, and regular training for staff in health and safety topics, so that the health and safety of residents and staff is protected. Green Gates Nursing Home DS0000027152.V260495.R01.S.doc Version 5.0 Page 18 EVIDENCE: The manager, Ms Wilcock, is a qualified nurse and has been a manager in elderly care for 18 years. She has managed Green Gates since 2001. She has achieved the Registered Manager award. The home carries out regular internal checks on the quality of its premises and care that are reviewed by senior managers for BUPA. An independent company does a yearly customer satisfaction survey: this involves questionnaires for residents who are able to complete them, or to their relatives if they cannot. The home does not have regular residents’ meetings, though the manager and her deputy said they are readily available to residents and visitors on a daily basis, and at the regular seasonal social events such as the summer fete and Carol concert. The inspector suggested that regular residents’ meetings would give residents more opportunities to discuss their views on the home and facilities with the staff and managers, and raise any suggestions. Also a newsletter could be considered to provide information and invite articles and comments from residents and staff. The accounting and financial procedures in place to safeguard residents are well organised and audited. A recommendation was made that the home should provide written information about how residents could request sums of money from their personal allowances. The administrator is usually available (or the home manager in his absence). Additional written information for residents about the administrator’s hours was drawn up during the inspection and will be given to new residents in future. Three recommendations were made as a result of the inspector’s observations during a walk around the building. The floor covering in the shared room ensuite was uneven and could be a trip hazard. The door to the en-suite needed adjustment as it would not close and would compromise a resident’s privacy when using the en-suite. There were containers of a prescribed skin cream and lotion in the shared room, one of which was marked with the name of a resident not living in the room and one of which had passed its ‘use by’ date. Staff should only use prescribed skin preparations for the person for whom the product was prescribed and should discard any out of date items, as the product may have deteriorated and cause the resident harm. Green Gates Nursing Home DS0000027152.V260495.R01.S.doc Version 5.0 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X 3 X X STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Green Gates Nursing Home DS0000027152.V260495.R01.S.doc Version 5.0 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. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations * Ensure that care plans are sufficiently detailed to show the action that needs to be taken by staff to meet the health, personal and social care needs of service users. New health problems need to be added to the plans of care. * Combine the ‘daily statement’, and carer’s check list with the information in each resident’s care folder so that the daily entries are more relevant to the listed care need, and show evaluation of the care given. * Residents and/or their advocates should be involved in the drawing up of their care plans and where possible should read and sign them to indicate their agreement with the content. Regular review meetings with the doctor, key staff, resident and their representative could be planned, and used as a time to check that the care and written records were accurate. Ensure that prescribed skin creams and lotions are only DS0000027152.V260495.R01.S.doc Version 5.0 Page 21 2. OP9 Green Gates Nursing Home 3. 4. OP12 OP33 5. OP38 used for the person for whom they are prescribed and are discarded by the ‘use by’ date. Ensure that residents’ communal rooms are not routinely used by staff for handover or break times. Consider holding regular residents/relatives meetings and the introduction of a home’s newsletter to increase the opportunities for residents to raise suggestions and to share ‘news and views’. Repair or replace the flooring, and adjust the door closure to the en-suite of the first floor shared room. Green Gates Nursing Home DS0000027152.V260495.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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 Gates Nursing Home DS0000027152.V260495.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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