Inspection on 01/08/05 for Green Pastures Christian Nursing Home

This inspection was carried out on 1st August 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 Pastures Christian Nursing... 12/07/07

Green Pastures Christian Nursing... 19/12/06

Green Pastures Christian Nursing... 20/04/06

Green Pastures Christian Nursing... 15/11/05

Green Pastures Christian Nursing... 04/01/05

Green Pastures Christian Nursing... 14/09/04

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

CARE HOMES FOR OLDER PEOPLE Green Pastures Christian Nursing Home The Hawthorns Banbury Oxfordshire OX16 9FA Lead Inspector Jan Walsh Unannounced 27 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 Pastures Christian Nursing Home H57-H08 S27153 Green Pastures V235280 270605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Green Pastures Christian Nursing Home Address The Hawthorns, Banbury, Oxfordshire, OX16 9FA 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) 01295 279963 01295 701501 Green Pastures Limited Vacant Care Home with Nursing 30 Category(ies) of OP registration, with number of places Green Pastures Christian Nursing Home H57-H08 S27153 Green Pastures V235280 270605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: On admission persons should be aged 60 years and over Admittance of one named terminally ill service user Date of last inspection 04 January 2005 Brief Description of the Service: Green Pastures Christian Nursing Home is a purpose built care home located three quaters of a mile south of Banbury Cross, in North Oxfordshire. There is a supermarket and other amenities close by with easy access. The home is set behind a small coppice of mature trees, and the back opens onto an enclosed garden with lawns, walkways and comfortable seats. Green Pastures is home to 30 older people who require nursing care. The home has a strong Christian ethos that does not preclude those of other denominations and beliefs. The accommodation is on two floors serviced by a lift. Green Pastures Christian Nursing Home H57-H08 S27153 Green Pastures V235280 270605 Stage 4.doc Version 1.40 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 7.5 hours. During this time a tour of the building was made. The water temperature was taken in two rooms and a bathroom. Eight residents were spoken with and one visitor. Two care staff, one cleaner, two trained nurses, the activities co-ordinator and the home’s administration manager were also spoken with. Medication and medication records were examined plus four residents’ records of care, and four staff records were looked at in detail. What the service does well: What has improved since the last inspection? Medication procedures have been improved. Medicine training has been updated. All trained nurses who administer medication are to attend an accredited course to ensure safe storage and administration of medication. The financial records for each individual resident’s pocket money, with an individual labelled plastic wallet for the money kept, have been improved. This ensures a safe system for keeping residents’ finances. Green Pastures Christian Nursing Home H57-H08 S27153 Green Pastures V235280 270605 Stage 4.doc Version 1.40 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 Pastures Christian Nursing Home H57-H08 S27153 Green Pastures V235280 270605 Stage 4.doc Version 1.40 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 Pastures Christian Nursing Home H57-H08 S27153 Green Pastures V235280 270605 Stage 4.doc Version 1.40 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, 4 and 5 The home makes sure it is a suitable placement for a prospective resident by careful assessment of the resident’s needs and the home’s ability to meet them. They are encouraged to visit prior to admission if possible, with their family and friends or their representative, to assess the home’s suitability. EVIDENCE: The manager confirmed that the prospective resident is fully assessed before admission by the nurse manager or her representative, usually in hospital or their home. Written evidence of resident assessment was seen. The manager said that the assessment is usually a few days before admission, allowing time to obtain any special equipment needed to meet the resident’s heath care problems. The resident comes in for a trial visit and then their placement is reviewed. Written evidence was available to show this. The manager confirmed that the resident could visit prior to admission, if this was possible to arrange. The manager never books a person in unless someone has seen the room and the home first, to assess its suitability. The manager said that they give a lot of time and support to relatives before, during and after admission of the resident. Some of this was observed during the inspection. Green Pastures Christian Nursing Home H57-H08 S27153 Green Pastures V235280 270605 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 9 The residents’ health, personal and social care needs are planned, but some of the records seen were incomplete and did not always have enough detail to ensure the best possible care for the residents. Residents’ health care needs are fully met. Medication is safely administered and securely stored, protecting the residents’ safety. However, one medication instruction had been hand written on a medicine administration sheet and not signed. EVIDENCE: Resident records showed good assessment of the residents’ needs. One plan, seen for helping a resident to settle in, was particularly good. However, although the plans do contain lots of information there were omissions in the four plans of care seen, a lack of some signatures and dates and few up to date reviews of care. One resident had a high risk score for pressure area damage but no action plan to prevent this. Another plan had no weight recorded for a resident on steroids where it is particularly important to monitor this. Other residents’ records showed that weights were checked monthly. It is recommended that all forms, plans and assessments are signed and dated and residents’ records are regularly audited. A plan of care is available for each assessed health, personal and social care need and these showed some evidence of monthly review. Green Pastures Christian Nursing Home H57-H08 S27153 Green Pastures V235280 270605 Stage 4.doc Version 1.40 Page 10 Staff confirmed that all residents’ health care needs are met. Evidence was seen of regular GP visits and their new instructions. Health care assessments, health observations and monitoring by the staff were also seen. Foot care was verified by podiatry records and records of podiatrist visits. Records also verified that staff are meeting the health care needs of the residents. Medication and administration records were examined during the inspection. All medication was secure according to pharmaceutical regulations. All records of administration were signed. One record of a recently prescribed antibiotic was written by hand on the medicine administration sheet but not signed. This medication had been collected from a local chemist in an emergency. It is recommended that two nurses sign if medication has to be written on the pre-printed medicine administration sheets received from the home’s pharmacy. A photocopy of the prescription should be kept in the home’s records. Staff confirmed that they had received in-house training regarding medication and that a course had been arranged for the trained staff to have more formal medicine administration training in July. Written evidence was seen of this. Green Pastures Christian Nursing Home H57-H08 S27153 Green Pastures V235280 270605 Stage 4.doc Version 1.40 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 and 13 The home is to be commended on its ability to satisfy residents’ social, religious and recreational needs. Families and friends are encouraged to keep in contact and are made welcome when they visit. EVIDENCE: The manager said that the home has an activities co-ordinator and that she has worked there for nine months. She plans something different for every day and the residents really enjoy the activities. The activities co-ordinator confirmed this. Copies of the last months’ activities were seen. The activities co-ordinator explained how she managed to get different people to join in and usually had 18-24 residents involved. Activities included cookery, gardening, music, jewellery and trinket box construction, soap decoration, and a jazz, wine and cheese party. She has also arranged for the sensory bus to come twice a month starting in July for people with dementia and others who would benefit from this. The bus contains three rooms and can take up to five people at a time to enjoy the sensory activities and stimulation. Green Pastures Christian Nursing Home H57-H08 S27153 Green Pastures V235280 270605 Stage 4.doc Version 1.40 Page 12 On the day of inspection she had arranged for a special bus to take six residents, family members and some staff on a trip to Blenheim Palace with a picnic prepared by the kitchen. The residents spoken to before their departure were very excited. They said how much they enjoyed the home’s activities and the different things they could do. The home has a weekly service taken by different guest preachers and daily prayers are also said in the home. Evidence was seen of the services and confirmed by a visitor. The manager confirmed that although the home has a Christian ethos, all religions and beliefs are respected. Residents were seen on their return from their trip out. Everyone was animated. When a resident was asked how it had been, she said ‘gorgeous, gorgeous.’ Residents’ confirmed that their visitors are made welcome and several went on the trip to Blenheim. One visitor confirmed that she and other members of the family were always made welcome when they visited and this was usually several times a week. She said, ‘The staff are always friendly and a plan of the activities is left in the room so that even though Mum can no longer join in, I know what is going on’. She added, ‘It is so nice to think that Mum is well cared for and that I have no worries on that score’. Green Pastures Christian Nursing Home H57-H08 S27153 Green Pastures V235280 270605 Stage 4.doc Version 1.40 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) 18 The home has arrangements to protect its residents from abuse. In the staff records seen a copy of the birth certificate had not been kept. Some of the photographs of the staff were unclear. EVIDENCE: The manager confirmed that all staff are given a protection of vulnerable adults booklet and training courses are being provided. All new staff are to have a prevention from abuse instruction sheet given to them in their induction folders. Evidence was seen to verify this. Two members of staff confirmed that they had received training and knew what to do if they suspect abuse. Five staff files were looked at in detail and they showed robust staff recruitment procedures and checks. One care staff member was employed before the Criminal Record Bureau checks had been received but the manager confirmed that he was on induction and was working under supervision. The checks had been sent for and arrived shortly afterwards. Evidence of identity was seen and copies of passports with photographs. No copies of birth certificates had been kept, although the manager had signed to say he had seen them with other proofs of identity, and the quality of the copy of some photographs was very poor. Copies of birth certificates must be kept with a current clear photograph of the member of staff. If a birth certificate cannot be obtained, the manager must inform the Commission for Social Care Inspection and make a note in the records. In this case extra proof of identity needs to be seen and copies made. Green Pastures Christian Nursing Home H57-H08 S27153 Green Pastures V235280 270605 Stage 4.doc Version 1.40 Page 14 Residents confirmed that they were well treated and that the staff were kind and helpful. Green Pastures Christian Nursing Home H57-H08 S27153 Green Pastures V235280 270605 Stage 4.doc Version 1.40 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,. comfortable and well maintained home with a well maintained garden. However, due to the problem with the window restrictors on the first floor becoming detached, it is recommended that these are checked on a regular basis to maintain resident safety. EVIDENCE: During a tour of the building the home was found to be clean, pleasant and comfortable. Staff and residents and a visitor confirmed this. A visitor confirmed that the home is homely and welcoming. The dining rooms and lounges are tastefully decorated with domestic type furniture. Residents were seen relaxing in these rooms during the day. Water temperatures were taken in one bathroom and two residents’ wash hand basins. These temperatures were all approximately at the recommended temperature for safety. Green Pastures Christian Nursing Home H57-H08 S27153 Green Pastures V235280 270605 Stage 4.doc Version 1.40 Page 16 Two window restrictors were seen to be detached. Staff said that they occasionally become detached when the window is banged shut. This was reported to the manager and the maintenance man fixed them during the time of inspection and said that they had not been properly attached. To maintain the safety of the residents it is recommended that these restrictors are regularly checked. If there is a continuing problem with this type of restrictor, the home might consider changing them for another kind. A member of the domestic staff was spoken to she and confirmed the infection control procedures for the washing and for cleaning the home. The home has its own laundry with two industrial type washers and two dryers. Hoists were seen and showed the date when they were recently serviced by a specialist organisation. Evidence was seen of regular fire training and a comprehensive induction programme including care of hazardous substances. Staff members confirmed regular training in fire prevention and moving and handling residents. The garden was seen to be well maintained. It had a gazebo in one corner to provide shade for the residents in the hot weather. Green Pastures Christian Nursing Home H57-H08 S27153 Green Pastures V235280 270605 Stage 4.doc Version 1.40 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 skilled and competent staff. The home has robust procedures for recruitment. However, the home needs to keep a copy of the birth certificate and a current photograph of each staff member in their records, to show proof of identity of each staff member and therefore help to ensure the safety of the residents. EVIDENCE: At the time of inspection there were two trained nurses and six carers on duty. One cleaner and one cook were also in the home. A copy of the week’s rota was seen to verify staffing levels on other days. The activities co-ordinator, a receptionist and the home’ s manager were also present. Written evidence was seen of statuary training plus training in diabetes, bereavement and palliative care. Individual staff training files were not seen as the acting nurse manager was on holiday and she had the key to the training file cabinet. Staff on duty confirmed their induction training and statuary training in fire, moving and handling and using the hoist. One carer confirmed her induction and said that the carers kept their induction workbook, but a copy of a blank one was made available to the inspector. She also confirmed that she shadowed another member of staff for a month when she first started. She had also received training in dementia care and has recently started her National Vocational Qualification in Health and Social Care Level 2. Green Pastures Christian Nursing Home H57-H08 S27153 Green Pastures V235280 270605 Stage 4.doc Version 1.40 Page 18 Another carer spoke of the different skills she had obtained and training she had received at the home and in previous care work. The registered nurses confirmed training and updating for themselves and for care staff. The activities co-ordinator confirmed that she has received training to intermediate level in facilitating activities and that she has had a recent Criminal Records Bureau check. Evidence was seen in staff records of robust recruitment procedures. However, although the manager had signed to say that he had seen the evidence of identity and listed those seen, he had not kept a copy of the birth certificates and some photos were very poor. He also stated that it is not always possible to get a birth certificate from the prospective candidate but that he always got other evidence of identity. It is recommended that the home retains a current photograph plus a copy of the staff member’s birth certificate in all staff files. If a birth certificate cannot be obtained it is recommended that the manager informs the Commission for Social Care Inspection and a note is also made in the staff member’s record. Green Pastures Christian Nursing Home H57-H08 S27153 Green Pastures V235280 270605 Stage 4.doc Version 1.40 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) 37 and 38 The home promotes the health, safety and welfare of the residents and staff. Sensitive information in residents’ records was not being kept secure. This, however, was secured at the time of inspection. EVIDENCE: The manager confirmed that all staff receive manual handling training, fire prevention training and abuse training. This was confirmed by the members of staff interviewed. Written evidence was also seen. Evidence of risk assessment was seen in residents’ records for moving and handling, pressure area risk and dietary risk. Staff confirmed that they had received care of hazardous substances training at induction. One staff member confirmed infection control procedures. Green Pastures Christian Nursing Home H57-H08 S27153 Green Pastures V235280 270605 Stage 4.doc Version 1.40 Page 20 Most records are kept securely in the offices. The manager confirmed that these are kept locked when no one is using them. Plans of care containing sensitive information are kept in boxes at the desk on each floor so that care staff have easy access to them. These have lockable lids but were not secured at the time of inspection. The manager confirmed they are not usually locked but would see that they are in future or explore other ways of keeping the information secure. Green Pastures Christian Nursing Home H57-H08 S27153 Green Pastures V235280 270605 Stage 4.doc Version 1.40 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 x x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 x 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 x x 3 x x x x x x 2 3 Green Pastures Christian Nursing Home H57-H08 S27153 Green Pastures V235280 270605 Stage 4.doc Version 1.40 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 None 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. 2. 3. 4. 5. Refer to Standard 7.2 9.3 25.1 29.1 37.3 Good Practice Recommendations It is recommended that all care plans are filled in carefully with a signature and date and that the care plans are reviewed monthly and regularly audited. It is recommended that any medication collected by staff in an emergency, and added to the sheet, is checked and signed by two nurses and a copy of the prescription kept. It is recommended that window opening restrictors are checked on a regular basis. It is recommended that a copy of the birth certificate is kept in all staff files with a current photograph as evidence of idenity. It is recommended that all sensitive information regarding residents is kept secure. Green Pastures Christian Nursing Home H57-H08 S27153 Green Pastures V235280 270605 Stage 4.doc Version 1.40 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. Extracts may not be used or reproduced without the express permission of CSCI Green Pastures Christian Nursing Home H57-H08 S27153 Green Pastures V235280 270605 Stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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