Inspection on 21/06/05 for Green Gates Nursing Home

This inspection was carried out on 21st June 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 15/12/05

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 OX2 7PT Lead Inspector Jan Walsh Unannounced 21 June 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 GATES NURSING HOME H57-H08 S27152 Green Gates uV233820 210605 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Green Gates Nursing home Address 2 Hernes Road, Summertown, Oxford OX2 7PT 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) 01865 558815 01865 514090 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 H57-H08 S27152 Green Gates uV233820 210605 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: NA Date of last inspection 7 December 2004 Brief Description of the Service: Greengates is situated north of Oxford city in the residential area of Summertown. It was originally a private house and has been extended to provide 40 bedrooms and 4 lounges and a dinning room. There is also a kitchen and laundry on the premises. Two lifts provide wheelchair access to other floors. The home is registered for 40 people over the age of 60 who require care with nursing. The home has qualified nursing staff on duty during 24 hrs per day and is furnished and equipped to provide physical nursing care. The home has a pleasant garden where residents can sit and enjoy the warmer weather. GREEN GATES NURSING HOME H57-H08 S27152 Green Gates uV233820 210605 Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector made an unannounced visit to the home lasting 6hours. During this time a tour of the building was made. The water temperature was taken in two rooms. Two care staff and one trained nurse were spoken to, plus the manager and deputy manager. Six residents were also spoken to. Five resident records and four staff records were looked at in detail. Medication and medication records were looked at plus the fire log, records of water temperatures, hoist and sling monthly checks. What the service does well: What has improved since the last inspection? What they could do better: It has been previously recommended that the residents’ plans of care should be improved to contain more detail and though some improvement has been made, residents’ records still need to have more detail and a plan of action for each of the resident’s assessed problems, to enable all staff to give good planned care. A photograph in the records would enable new or agency staff GREEN GATES NURSING HOME H57-H08 S27152 Green Gates uV233820 210605 Stage4.doc Version 1.30 Page 6 to easily identify the resident they are to work with and to ensure that the right resident gets the appropriate care. Low risk medication needs to be stored securely as this still has a potential risk to residents. The water flow and the subsequent temperatures need checking more often in the annex to enable residents to have a wash in water of a comfortable temperature. Staff files must contain a copy of their birth certificates as one of the proofs of evidence in robust staff recruitment procedures to protect residents from unsuitable applicants. If the home is unable to obtain a certificate they must inform the Commission for Social Care Inspection, and a note made in the relevant staff member’s file to this effect. Supervision of staff needs recording in more detail with personal development and organisational goals identified. This would give staff and management a complete record of what was discussed, the goals agreed and in what time span. This encourages staff motivation and allows them to develop and become increasingly competent. 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 H57-H08 S27152 Green Gates uV233820 210605 Stage4.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 GATES NURSING HOME H57-H08 S27152 Green Gates uV233820 210605 Stage4.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, 4 and 5 Prospective residents are given the information they need to make an informed choice as to whether they would like to live in this home. They are encouraged to visit prior to admission if possible, with their family and friends. If this is not possible family or friends are encouraged to visit to assess the home’s suitability. The home makes sure it is a suitable placement for the prospective resident by careful assessment of the resident’s needs and the home’s ability to meet them. EVIDENCE: Information that is given to prospective residents was seen at the time of inspection. Residents confirmed that they were given information and that relatives were able to visit to assess the suitability of the home. The manager confirmed that if the resident was not able to visit prior to admission, she visited them in their home or in hospital to carry out a full assessment of their needs. If the prospective resident is not local, a manager from another BUPA home in their area will do the assessment. Evidence of a full assessment was seen in a resident’s records. The manager confirmed that a resident is only admitted if the home can meet their needs and that this is explained to the resident and their family. The manager said that emergency admissions are GREEN GATES NURSING HOME H57-H08 S27152 Green Gates uV233820 210605 Stage4.doc Version 1.30 Page 9 not usually taken, but if they were asked to take someone they would ensure they had a full assessment by the doctor involved. The manager confirmed that all residents come for a trial period before they and the manager make a decision regarding the suitability of the home to meet their needs. On the day of inspection one family told the manager of their decision for their mother to stay. GREEN GATES NURSING HOME H57-H08 S27152 Green Gates uV233820 210605 Stage4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and10 The residents’ needs are assessed and regularly reviewed. The care is planned to meet the individual resident’s health care needs. However though some improvements have been made to the records, they still need to contain more detail to enable staff to give good planned care. The home administers medication safely but some low risk medication is not being stored securely giving rise to a potential risk to residents. Residents are treated with respect and they are able to have privacy when they wish. EVIDENCE: Basic plans of care and risk assessments, plus plans for moving and handling and any continence aids are kept in the residents’ rooms to enable care staff to have the information to hand. Evidence of this was seen in the rooms visited. Five records of care kept in the clinical room were looked at in detail. These showed evidence of other heath professional involvement such as GP and specialist nurses. Several records did not contain a photograph of the resident to ensure new staff or agency staff can easily identify the resident to whom they are to give the appropriate care. It is good practice to have photographs of the resident on the medicine administration sheets, and in the resident records. The records contained up to date regular health monitoring observations, daily records and monthly reviews. Two records showed GREEN GATES NURSING HOME H57-H08 S27152 Green Gates uV233820 210605 Stage4.doc Version 1.30 Page 11 evidence of high risk assessments for pressure area care, but no plan of how to reduce this risk, though both residents had pressure reducing mattresses in place. One resident’s daily record sheet mentioned the resident should be having a dietary supplement and that she had had ongoing problems with a sore toe needing medical and podiatry intervention. These were not included in the resident’s actual plan of care leading to the risk of inadequate care being given. Evidence showed that the appropriate care was given in this case. Evidence was found of regular catheter and stoma care, checks and drainage, in two records of care. The manager said they had changed pharmacy in May 2005 due to some problems they had encountered previously, and the new system was working well. Records of medicine administration were seen including the records for the only resident self-administering and these were accurately filled in. The morning medication had been given; the dossett boxes in the medicine trolleys were examined to verify this. The control drug cupboard and records were checked and the medication held was found to be correct. The medicine trolleys were securely locked to the wall when not being used. However under one trolley some low risk medication was being stored such as aperients, this needs to be stored securely as it still has a potential risk to residents. All residents are treated with respect. During the inspection residents were called by the name they preferred, examples were heard of titles and surnames being used. Others were called by their first names or nickname. Evidence was seen in resident records of their preferred name. Staff were seen to knock on doors before entering. Residents confirmed they could see their doctor in privacy and that other visitors could also be seen either in their own rooms or in a small sitting room if there was a larger group. One resident confirmed she was always treated with kindness and respect. She said ‘they are always kind and say there is no need to hurry’. GREEN GATES NURSING HOME H57-H08 S27152 Green Gates uV233820 210605 Stage4.doc Version 1.30 Page 12 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 and 14 Residents are encouraged to join in social activities, and links with the local community are maintained. Families and friends are encouraged to keep in contact and are made welcome when they visit. There is clear evidence that residents are encouraged to have choice and control over their lives. EVIDENCE: One family were visiting on the day of inspection. Residents confirmed that their visitors are made welcome. Three residents said that the home meets their needs. All the rooms visited showed evidence of the residents’ personal possessions. One resident confirmed the varied activities that were held in the home from French classes to talks given by people in the community. She said large print copies of poetry were produced by the home for the poetry reading group. She said ‘the home is a very happy place, I can not praise it enough’. Residents confirmed that their cultural needs were being met and that they could practice their religion or not as they chose. One gentleman said how he went by taxi once a week to the bank and then to the supermarket to do his shopping. He said he was going out to buy a sun hat during that afternoon. He confirmed that his plan of care was behind his door. Another gentleman was in his room watching the tennis. He confirmed he likes to stay in his room and that the staff help him to bed after lunch for a rest. He said he was very comfortable and had every thing he needs. Several residents were sitting in the garden and they confirmed they had tea in the garden when the weather was nice. Staff were seen helping people in and GREEN GATES NURSING HOME H57-H08 S27152 Green Gates uV233820 210605 Stage4.doc Version 1.30 Page 13 out of the garden through the day. One resident sitting in the garden said she was given a bell so she could ring for help if she needed it. Residents confirmed they could see the doctor once a month when he does a routine visit if they wished. GREEN GATES NURSING HOME H57-H08 S27152 Green Gates uV233820 210605 Stage4.doc Version 1.30 Page 14 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 and 18 Residents and their families know how to make a complaint and that this will be dealt with appropriately. The home has arrangements to protect its residents from abuse. EVIDENCE: All new residents have the information on how to make a complaint in their information packs. A complaints procedure is also displayed in the reception area. Residents confirmed they know how to complain. They said they can also always speak to the manager if they need to. The manager said they have had no complaints recently. The manager confirmed trained staff have all received protection from abuse training. Evidence of this was found in the staff records examined and confirmed by three trained staff. Evidence was also found in minutes of two recent staff meetings, one with trained staff and the other with night staff. Two care staff said they had received abuse training whilst undertaking their awards in health and social care. The deputy manager confirmed that she had arranged a training session on abuse for Monday for care staff. A copy of the Oxfordshire Policy on Protection of Vulnerable Adults was seen on display in the office. Four staff files were looked at in detail. They all showed robust preemployment checks. No one was employed until all the statuary checks were completed. Residents confirmed they were well treated and the staff is kind and helpful GREEN GATES NURSING HOME H57-H08 S27152 Green Gates uV233820 210605 Stage4.doc Version 1.30 Page 15 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, 25 and 26 The residents live in a clean, pleasant, safe and well-maintained environment. For quite a large home it has a comfortable homely feel. However because of the problem with the water flow in the rooms in the annex, it is recommended that in these rooms the water temperatures are tested more frequently. EVIDENCE: During a tour of the building the home was found to be clean, pleasant and comfortable. Staff and residents confirmed this. The home has four lounges and a dining room. These are decorated and furnished with tasteful domestic type furniture and fittings. Residents were seen relaxing in the lounges, others were seen out in the attractive, well maintained garden enjoying the sunshine. A programme of maintenance is on-going. At the moment the windows in the original old house are being replaced. One upstairs room was just being redecorated between residents’ occupation. The manager confirmed that the repainting of the home was continual especially where areas are knocked by the wheel chairs. In one room the hot water was tested and the water had a poor flow, this was reported to the manager and immediately corrected by the maintenance man. The water temperature log was seen. The temperatures are taken monthly the GREEN GATES NURSING HOME H57-H08 S27152 Green Gates uV233820 210605 Stage4.doc Version 1.30 Page 16 last date was 1/ 6/05 Also seen at inspection was the fire log and fire training, the log of monthly hoist and sling checks these were all filled and up to date. Staff confirmed fire training, safe moving handling, health and safety training. Written evidence was seen in the staff records. Infection control training is given at induction. The induction workbooks are given to all new staff and an example has been seen. GREEN GATES NURSING HOME H57-H08 S27152 Green Gates uV233820 210605 Stage4.doc Version 1.30 Page 17 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, 28, 29, and 30 Residents are cared for by adequate numbers of well-trained and competent staff. The home has robust procedures for recruitment, but in two cases a copy of the birth certificate was not on file however other methods were used to check the identity of the person. EVIDENCE: At the time of inspection there were three trained nurses on duty including the deputy manager, plus five carers. A receptionist and the manager were also on duty. In the kitchen a chef manager, cook, and kitchen assistant, plus a work experience girl from a local school, were preparing lunch. The housekeeper and three cleaners were working in the building, plus a maintenance man. Written evidence of robust pre employment procedures was seen in place, though two files of the four staff files seen did not contain a copy of their birth certificate. Other methods had been used to certify the prospective staff members’ identities. The manager said it was not always possible to get a copy of the birth certificate from foreign staff but they always collected other proof of identity and checked the references, trained nurse pin no’s and permits of entry. Evidence of this was seen in the staff records. Evidence was also seen of Protection of Vulnerable Adults and Criminal Records Bureau data base checks. All records showed evidence of induction and ongoing training including statutory training. Written evidence showed the kitchen assistant had completed a food hygiene course, staff had completed moving and handling training. The four members of staff spoken to confirmed ongoing training. A list of training for staff was seen. One RGN confirmed she and GREEN GATES NURSING HOME H57-H08 S27152 Green Gates uV233820 210605 Stage4.doc Version 1.30 Page 18 another member of staff had had training for a rare condition specific to one resident. The manager said that the Oxford Falls Prevention specialist has been at the home for two days giving training to care staff and trained staff, in an effort to reduce the number of falls by residents. GREEN GATES NURSING HOME H57-H08 S27152 Green Gates uV233820 210605 Stage4.doc Version 1.30 Page 19 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) 36 and 38 Staff are regularly and appropriately supervised helping to produce competent, well supported staff. However records of supervision need to contain more details and have personal goals recorded to enable staff and management to have a complete record of the meeting, and to encourage staff development. The home promotes the health and safety and welfare of the residents and staff. EVIDENCE: Written evidence was seen of regular staff supervision. This is completed 6 times a year. Appropriate subjects for discussion had been chosen these were signed and dated. There was no reference to organisational or personal development though the deputy manager confirmed that these are discussed. Staff confirmed they have supervision and that different areas are discussed. The manager confirmed that all staff receive manual handling training, fire training, infection control. Written evidence of this was seen in staff records and staff confirmed this. Risk assessments are carried out for residents, written evidence was seen for the use of sides for beds, moving residents, risk of pressure area damage, for travelling in a wheelchair in a taxi. GREEN GATES NURSING HOME H57-H08 S27152 Green Gates uV233820 210605 Stage4.doc Version 1.30 Page 20 The manager confirmed that a risk assessment had been produced for the young girl working in the kitchen and that it had been given to the kitchen staff so they were aware of any risks to her. GREEN GATES NURSING HOME H57-H08 S27152 Green Gates uV233820 210605 Stage4.doc Version 1.30 Page 21 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 3 x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION 3 3 x x x x 3 3 STAFFING Standard No Score 27 3 28 3 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 x x x x x 3 x 3 GREEN GATES NURSING HOME H57-H08 S27152 Green Gates uV233820 210605 Stage4.doc Version 1.30 Page 22 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 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 7.2 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 plan of care. A photograph of the resident needs to be kept in each residents notes. It is recommended that all low risk medication is kept securely. It is recommended that the water temperatures in the rooms in the annex are taken weekly. It is recommended that if a copy of a birth certificate cannot be obtained for staff to be kept in their records CSCI must be informed and a note made in the relevant staff members file. It is recommended that surpervision records are more detailed and cover all aspects of practice, philosophy of care and staff personal needs. 2. 3. 4. 9.4 25.8 29.1 5. 36.3 GREEN GATES NURSING HOME H57-H08 S27152 Green Gates uV233820 210605 Stage4.doc Version 1.30 Page 23 Commission for Social Care Inspection Burgner House 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. 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