Inspection on 12/07/07 for Green Pastures Christian Nursing Home

This inspection was carried out on 12th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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

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

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

Green Pastures Christian Nursing... 01/08/05

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 Stephen Webb Unannounced Inspection 12th July 2007 11:00 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 Pastures Christian Nursing Home DS0000027153.V339889.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 Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 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 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) 01295 279963 01295 701501 belinda@green-pastures-christian-nursinghome.org.uk Green Pastures Limited Belinda Victoria Woodward Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Green Pastures Christian Nursing Home DS0000027153.V339889.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 19th December 2006 Brief Description of the Service: Green Pastures Christian Nursing Home is a purpose built care home located on the outskirts of the market town of Banbury. The home is operated as a ‘not for profit’ Christian organisation through Green Pastures Ltd, and is a registered charity. The board of directors has responsibility for the home, which is overseen by the home manager, who is the registered Responsible Individual. The home has a registered manager who is in day-to-day charge of the service, and responsible for the care of residents and staff deployment and management. The home is registered to provide nursing care for 30 older people aged 60 and over, and the fees at the time of this inspection were £654 per week for a single room and £604 per week for a shared bedroom. Accommodation is provided on ground and first floors, and a passenger lift is provided. The home has various adaptations to meet the needs of residents and the ground floor is fully wheelchair accessible. There is a choice between three main lounge/dining rooms, and a further small lounge is also available. The home has an attractive, enclosed rear garden, with areas of shade and a range of seating available. The home has a strong Christian ethos, but this does not preclude residence by people who belong to other denominations and have different religious beliefs. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit from 11.00am until 6.30pm on 12th of July 2007. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from brief conversations with staff members on duty, and discussions with the manager. The inspector spoke to a number of the residents during the inspection, and some time was also spent observing the interactions between residents and staff at various points during the inspection and over lunch with the residents. Written feedback was obtained from the relatives of five residents who were broadly happy with the service provided. Two commented that the service had improved significantly recently. One relative suggested holding relatives’ meetings or inviting them to residents’ meetings to advocate for those not able to do so for themselves, and one felt that routines could be a little rigid at times. One external healthcare professional also completed an inspection comment card, and was positive about the service. The inspector also toured the premises, and ate lunch with the residents. What the service does well: Prospective residents are assessed prior to the offer of a place being made, to try to ensure that admissions are appropriate for the home. The social and health care needs of residents are addressed within the care plans and other supporting documents. Ongoing records of social and health care indicate that residents’ needs are effectively met. The home has a robust system in place to manage medication on behalf of residents. Residents’ rights and dignity are addressed within records and through the observed and recorded care practice of staff. Residents experience an appropriate lifestyle, and a range of activities and events are provided to meet recreational and social needs. The home provides well for the spiritual needs of residents from different denominations. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 6 Contact with residents’ families and friends is encouraged and supported wherever possible. Residents are enabled to make choices in their day-to-day lives and are provided with an appropriate and varied diet in a pleasant environment. The residents and relatives who responded to the inspector or to inspection questionnaires were happy that any concern they might raise would be addressed, and the manager felt the home dealt with any concerns which were brought to their attention. The home has systems and training in place to protect residents from abuse. The home provides a very pleasant environment in which to live, that has a range of adaptations to meet individual dependency needs. Standards of hygiene were good and the home has appropriate laundry facilities to meet residents’ needs. The staffing levels and skill mix within the team are sufficient to meet the current needs of residents. The home’s recruitment and vetting systems for new staff protect residents’ interests. The staff receive a sound induction and core training, as well as training in additional specialist areas. The manager demonstrated awareness of some of the potential impact of the Mental Capacity Act on the work of the home. The home is generally well run by the management team, who lead a well-trained staff team. The home has a quality assurance system in place, but to date no summary of the findings, or any actions proposed in response, has been made available to the participants. Appropriate systems are in place to manage the finances on behalf of those residents where this is necessary, and detailed records are maintained. The majority of required health and safety-related servicing had been undertaken as required. What has improved since the last inspection? A welcome booklet has been produced for residents, and they are now formally asked to identify their likes and dislikes on admission. The home has improved the range of choice of menus in response to resident feedback. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 7 Care plans are now checked on a regular basis. Bathrooms have been refurbished and new equipment provided. The surface outside the home has been improved and made safer. Staffing levels have been improved and some new training materials provided. Good progress has been made with NVQ, and recruitment has been successful to enable minimal use of agency staff to maximise the consistency and continuity of care of the residents. Various quality audit tools have been introduced. 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 Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 8 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 Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 9 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): Standards 3 and 6: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of a prospective resident are assessed prior to the offer of a place being made, to try to ensure that admissions are appropriate for the home. The home does not provide an intermediate care service. EVIDENCE: The manager undertakes a pre-admission assessment, by visiting the individual where they are living prior to a prospective new admission being confirmed. Prospective residents are invited visit the home, and also meet with the management and staff. A welcome booklet has been introduced which provides useful information to the resident or their family about the home. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 10 The resident or their representative is asked to complete a likes and preferences form on their first day, which is made available to care staff to inform their care practice and approach. The manager indicated that there are plans to amend the pre-admission assessment form to comply with the Mental Capacity Act. Within the care-planning format there was also a detailed post admission assessment out of which the care plan is devised. Two of the three sampled assessment documents were, however, undated. It is good practice for all care documents to be dated and signed by the author. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 11 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): Standards 7, 8, 9 and 10: Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The social and health care needs of residents are addressed within the care plans and other supporting documents. Ongoing records of social and health care indicate that residents’ needs are effectively met. Though none of the current residents is able to manage their own medication, the home has a robust system in place to manage this on behalf of residents. Residents’ rights and dignity are addressed within records and through the observed and recorded care practice of staff. EVIDENCE: The care plans are devised within a recognised standard format, with reference to the assessment documents and, more recently, also the home’s ‘Likes and Preferences’ form. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 12 Examination of a sample of care plans indicated a detailed format, sub-divided into relevant sections, which included evidence of some preferences, likes and dislikes, together with references to “asking the resident”, and other ways to establish residents’ preferences and address their dignity. Residents are also asked their preferred mode of address, which is recorded in their care plan. The care plans are subject to regular internal review and are audited by the deputy on a rolling programme. Dated amendments within the care plans confirm the review process, and records of the care plan audits detail any identified work needed to bring the plans up to the required standard. “External” reviews are also held periodically with care managers when a resident is local authority-funded, or the resident’s representatives/family, if they are privately funded. One of the resident’s files examined had a copy of their last local authority review on file. The newly written reviews with family members, in the other two cases, were seen on the computer, but should also be printed out and placed in the residents’ files. The care plans included records of personal care delivery, which is good practice, and other relevant aspects of care. Various risk assessments were present including those for pressure sores, moving and handling, nutrition and a general risk assessment format. A dependency profile is also completed. Ongoing general daily records are kept ,together with monitoring records for blood pressure, pulse, temperature, etc. The care plan also includes records of any health-related needs and a medication profile. There is a specific record of all contacts with external healthcare professionals, and a record of GP notes, following any visit. The home seeks advice from appropriate external healthcare professionals, including specialist nurses dealing with Parkinson’s Disease and diabetes. Available feedback from residents indicated they were satisfied with the care and support received from the staff. Two said the staff looked after them well, and another indicated non-verbally that she agreed with this. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 13 Where cot sides or safety belts are used to protect residents, the situation is first discussed with the resident’s family and care manager (if local authority funded) whose consent is sought, and a risk assessment is also written to ensure that this is an appropriate option for the individual. The home has a range of equipment and specialist adaptations in place to support the needs of residents, including specialist baths, hoists, toilet seat risers, specialist mattresses, adjustable beds and a shower seat and fully accessible shower. The garden is also fully wheelchair accessible and provided with areas of shade, a raised flowerbed and various seats and benches. The home uses a monitored dosage system to manage medication on behalf of residents. Medication is only administered by the nursing staff, who have all received medication training. Several medication cabinets are used to accommodate the majority of medication, while only that needed for the next medication round is placed in the medication trolley. The medication administration record (MAR) sheets are appropriately completed, and no recording gaps were seen in those records sampled. The quantities of medication received by the home are recorded, both on the MAR sheet and within the medication log. Unused medication is recorded and destroyed. The required medication audit trail is therefore in place. A separate system is in place for controlled drugs, the administration of which is recorded in a separate controlled drugs book, with double signatories. The deputy manager undertakes a monthly medication audit to monitor practice and recording standards, which is recorded. The home has a tissue breakdown record in place, which includes sequential photographs to monitor the progress of treatment, where this occurs. None of the residents is able to manage their own medication. Observations of the staff during the inspection indicated that they were attentive, aware of the differing needs of individuals and responded in a caring and patient manner when supporting residents. Staff demonstrated awareness of the dignity and privacy of residents and tried to involve them in conversations, rather than talking over them. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 14 Staff were also aware of knocking on doors and ensuring that residents were appropriately clothed, and provided aprons to assist residents to keep their clothing in clean condition during the meal, where appropriate, to maintain their dignity. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 15 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): Standards 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. The home provides residents with an appropriate lifestyle, and a range of activities and events are provided to meet recreational and social needs. The home provides well for the spiritual needs of residents from different denominations. Contact with residents’ families and friends is encouraged and supported wherever possible. Residents are enabled to make choices in their day-to-day lives and are provided with an appropriate and varied diet in a pleasant environment. Appropriate support is also offered where required. EVIDENCE: Activities are discussed within residents’ meetings, and the home has a senior carer who acts as activities co-ordinator. At present, according to the monthly activities planner, the activities provided tend to be concentrated at specific times of the week, dependent on the co-ordinator’s hours. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 16 There is some room for further development of the activities on offer during the parts of the week not covered by the activities co-ordinator, and for some more individualised provision for those residents who are perhaps reluctant to take part in the more group-based events. Individual activities charts within the care plans examined were not being completed consistently and could not therefore be relied upon to reflect the level of activities provided. It is strongly recommended that an individual record of activities be maintained to evidence that residents receive an appropriate level of stimulation and activity. Where a resident declines to take part in an activity, this should also be recorded to provide a true picture and assist future activities planning. Feedback to the home from their questionnaires to residents and relatives has been very positive with regard to the range of activities provided. Some of the varied and very creative events in the home have included a wild west day, red nose day and a visit from a falconer with his birds of prey. Staff have also organised a “day at the seaside” in the home with sand, buckets and spades, deckchairs and cockles provided, which was a popular event. The home also has a reminiscence box and the manager plans to borrow reminiscence items from the museum of bygones. The manager had introduced a “happy hour” on Sunday evening when residents can have a glass of sherry before their evening meal, and this was proving popular. Within the AQAA (pre-inspection questionnaire) it was indicated that the home treats residents “…as unique individuals”, and in conversation with the registered manager it was evident that the origins, culture and religious faith of residents were addressed effectively by the home. The home has a strong Christian ethos and opportunities for weekly worship are provided for various faiths, and communion is also available fortnightly. Residents can choose whether to attend these services, which are held in one of the lounges. Saints days are celebrated in the home. Two of the residents spoken with by the inspector confirmed that church services were provided regularly in the home, and that they chose to attend. Visiting is not restricted unless this is necessary or at the request of a resident. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 17 The home tries to support and maintain relationships between residents and their families wherever possible, and the manager has worked hard to positively address issues where they have arisen. The majority of the current residents were reported to have regular family contact, with some receiving frequent visits. The home tries to keep next of kin informed about any concerns or incidents such as falls, and next of kin are invited to reviews. As noted earlier in this report, residents are able to make choices in their daily lives and, where known, their preferences are recorded within their care plans. Residents can bring in various personal items to individualise their rooms, and this was evident from the bedrooms examined during the inspection. Residents are provided with an appropriate and varied diet and the chef, who had recently commenced work for the home, demonstrated a good awareness of the needs of the current residents, and the importance of the quality of meals within the residents’ day. The menus are discussed within residents’ meetings and comments are sought as part of quality assurance questionnaires. In response to resident feedback the range of choice at breakfast has been broadened, to include a cooked breakfast option, prunes, grapefruit and cranberry juice. When being assisted with their food residents were not hurried, and appropriate encouragement to eat and drink was provided. The staff members also sat down beside the resident they were supporting, and engaged with them, including conversation where possible, which is good practice. Staff had a list of the individual preferences of residents with regard to tea, coffee, etc and whether milk and sugar were taken, and individuals were offered various drink options before and after lunch. The home provided pureed meals for six residents and a low sugar diet for three at the time of inspection, and the manager indicated that other identified specialist or cultural needs and preferences would also be met. Residents are asked to choose their preferred main meal from a choice of two for the following day, except on days when a roast meal is provided, where alternatives are not routinely offered, unless a specialist diet is required. Two of the residents commented positively to the inspector with respect to the food provided. No one made any criticisms of the current meals, though one did say they had improved recently. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 18 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): Standards 16 and 18: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents and relatives who responded to the inspector were happy that any concern they might raise would be addressed, and the manager felt the home dealt with any concerns which were brought to their attention. However, the current complaints recording system is inadequate and requires improvement to enable its effective monitoring, and in order to evidence the home’s response to informal complaints. The home has systems and training in place to protect residents from abuse. EVIDENCE: The home’s complaints procedure was displayed in the entrance hall. It refers to a complaints form, which could be requested from staff. It is understood that a copy of the complaints form is also given to residents/relatives as part of the pre-admission information pack, but it is recommended that these forms are also made available in the entrance hall so that they can be obtained without recourse to staff to obtain one. The inspector was shown the home’s record of complaints, which was a folder containing a series of unbound loose documents and plastic wallets of papers. This is not an appropriate complaints record in that it did not include a record within a bound format, to prevent the removal of entries without detection, and it would have been necessary to check every individual item within the Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 19 folder to first establish that the papers were in date order, before being able to identify any complaints which had arisen since the previous inspection. A complaints log must be established, which details the date of the complaint, the details of the complainant, a brief summary of the complaint, details of the action taken to investigate the complaint and the outcome, including whether the complaint was found to be valid or not and whether the complainant was satisfied with the findings. The usual expectation is for this log to be within a bound book, ideally with numbered pages. It should be possible to establish from the log that any complaint was addressed in accordance with the home’s stated complaints procedure. Entries within the log should not include inappropriate or confidential information, and it is usual for the log to be supplemented by a separate confidential record, to contain any such details, together with copies of any related correspondence, statements or other evidence related to the matter. These records should be held confidentially, in a systematic fashion in date order, and available only for management and inspection purposes. The brief entry in the complaints log should cross-reference to any confidential background papers where these are present to indicate that additional relevant information is available. One of the residents the inspector spoke with was clear they would speak to the manager if they were unhappy about something, and another was also aware they could raise things in the residents’ meetings. Five relatives, who responded to the inspection feedback questionnaires, confirmed that they were aware of the complaints procedure, and indicated that any concern they raised would be addressed. One relative did suggest that given that most of the residents are unable to raise any issues for themselves, it would be a good idea if relatives’ meetings were also held by the home. Discussion with the manager indicated that only issues which were raised as written complaints were included as complaints within records. The majority of issues that arose were said to be resolved informally through discussion and conversation with the complainant. Whilst this is clearly a mater of judgement in each case, it is the usual expectation that such informal complaints are logged and addressed as such within the complaints log, unless they relate to minor matters which are immediately resolved. In the absence of written records of informal complaints it was not possible to confirm that they had been dealt with as described above. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 20 The Commission has not received any complaints for referral to the home since the last inspection. According to the manager there had been three written complaints since the last inspection, two of which had been resolved within 28 days. The manager and deputy indicated that, apart from recent appointees, all staff had received training on the protection of vulnerable adults from an appropriately qualified external trainer. One POVA related issue had arisen in the period since the last inspection, which was not related to the conduct of staff or management at the home, which was addressed appropriately by the manager. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 21 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): Standards 19 and 26: Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The residents are provided with a very pleasant environment in which to live, that has a range of adaptations to meet individual dependency needs. Standards of hygiene were good and the home has appropriate laundry facilities to meet residents’ needs. EVIDENCE: The home was pleasantly decorated and homely and the communal areas were bright and spacious. There are three living areas, each with a lounge, two of which are also dining areas, and an additional small lounge that can be used for visitors to meet a resident in private, as an alternative to using their bedroom. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 22 The bedrooms are personalised with residents’ own pictures, photos and items of furniture, and some individuals had their own fridge, TV, snacks, etc and preferred ‘tipple’ available in their bedroom. Three of the residents who spoke with the inspector were very happy with their bedrooms, and another indicated this via her body language and facial expression in response to a question. Bathrooms and toilets are fitted with appropriate door locks to support residents’ dignity and privacy. The bathrooms had been refurbished since the last inspection and provided with height-adjustable baths, and some bedroom carpets have been replaced with alternative flooring as part of a rolling programme of refurbishment. The home is equipped with various adaptations in order to meet the diverse individual dependency needs of residents owing to their frailty and physical disabilities, including a floor-draining shower with a new shower chair, mobile and standing hoists, a passenger lift, toilet seat-risers, wide doorways and the new height-adjustable baths and hoists, of which the home has three. The home is fully wheelchair accessible, and internal fire doors are held open during the day to facilitate ease of circulation by residents, by means of electromagnetic holdbacks, which are integrated with the fire alarm and close automatically should the alarm be triggered. The manager indicated that there were plans to add a conservatory and a new sensory room to the home’s facilities. The home’s damaged paving at its frontage has also been replaced with tarmac. There is an attractive, enclosed rear garden, with trees and mature planting which offers areas of sun and shade, a variety of seating, a raised flower bed and level, wheelchair accessible pathways with ramps where necessary. The home’s laundry facilities were appropriate for the needs of the service and the observed hygiene standards were very good, with no residual odour in evidence anywhere. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 23 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): Standards 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. The staffing levels and skill mix within the team are sufficient to meet the current needs of residents. Good progress has been made with NVQ, and recruitment has been successful to enable minimal use of agency staff to maximise the consistency and continuity of care of the residents. The home’s recruitment and vetting systems for new staff protect residents’ interests, though some improvements should be made to the records thereof. The staff receive a sound induction and core training, as well as training in additional specialist areas, although there is a need to ensure that those staff without a current first aid certificate are provided with this training. EVIDENCE: The home has an appropriate skill mix within the staff team with a manager, deputy, eight RGN’s, two of whom work nights, and twenty two carers, of whom four cover the night duties. The carers work primarily in three teams, each covering one of the living groups in the home, though they do work across these teams to provide cover where necessary. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 24 The standard staffing has been increased since the last inspection to seven carers on the early shift with one or more RGN’s, and six carers on the late shift with one or more RGN’s. Night staffing is one RGN with two carers. The home rarely uses agency staff, and the manager indicated her preference to cover shortfalls from within the existing staff team wherever possible to maximise consistency and continuity of care. New staff have been successfully recruited to replace those who have left since the last inspection. Examination of a sample of recruitment and vetting records indicated a thorough process and appropriate evidence on file of the checks undertaken. There is a written recruitment checklist which is good practice. However, it is suggested that in addition to the CRB reference number, a record is made that a POVA check has also been undertaken. It is also good practice for the record to confirm that the returned CRB check was satisfactory. A record of the applicant’s interview is retained, which is good practice, and copies of ID verification are also retained, though this was not in place in one of the examined files. The deputy manager takes the lead on training and NVQ for the service. Good progress continues to be made with NVQ within the team for non-nursing staff, with ten carers now having NVQ Level 2, and a further seven in the process of this, of which some have internal, and some external, assessors. The induction was said to comply with the Common Induction Standards and a written induction record is in place, which is dated and signed off on completion. Staff are given a copy of the General Social Care Council Code of Practice. The induction training was said to include input on addressing cultural and religious diversity. The training programme covers the required core training and was reportedly provided by appropriately qualified trainers. In addition there are various additional specialist courses made available, including training on diabetes and Parkinson’s Disease. The summer training programme includes courses on Managing Difficult Behaviour, Falls in the Nursing Home, Palliative Care and Managing Incontinence, all provided by external trainers with appropriate experience. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 25 There is an expectation that staff attend at least four training sessions each year and their hours are paid if they are not already on duty at the time. There are also upcoming courses on Manual Handling and Alert to Abuse, which are mandatory for all staff. Additional training in first aid is, however, required as there were only seven staff with a current first aid qualification. The nurses undertake the required “SPIN” courses as well as some of the other training available. Two staff spoken to confirmed that they had a good training package available to them, and that staffing levels had been improved which had enabled them to better meet the needs of the residents. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 26 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): Standards 31, 33, 35, 36 and 38: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally well run by the management team, who lead a well-trained staff team. However, the absence/unavailability of key policies and procedures documents or a collective policies and procedures file to provide clear written guidance to staff, is of some concern, and could compromise the welfare of residents. The home has a quality assurance system in place but, to date, no summary of the findings or any actions proposed in response has been made available to the participants. Appropriate systems are in place to manage the finances on behalf of those residents where this is necessary, and detailed records are maintained. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 27 Some further development of the accident recording systems in the home is required, and the manager needs to review accident records on a regular basis to identify any patterns or concerns. The majority of required health and safety-related servicing had been undertaken as required. If testing of the portable electrical appliances has not been undertaken in the past year, arrangements should be made for this to be done to maximise the protection of residents and staff from the risk of a fire due to faulty equipment. EVIDENCE: The registered manager is appropriately qualified and experienced to manage the service, and maintains up to date knowledge through ongoing attendance on a range of training courses. She has extensive nursing experience and is on the waiting list to undertake her Registered Manager’s Award. She has attended recent training refreshers on manual handling, first aid, risk assessment, staff development and the Mental Capacity Act. The manager works some shifts from time to time to understand the day-to-day issues faced by the staff. She makes time to see day and night staff regularly and has instigated a system of staff appraisal, and although a systematic supervision routine has not yet been fully established, some supervisions have already taken place. The home has a quality assurance system in place, a cycle of which was last undertaken in September 2006. Although a summary of the survey findings is provided to the provider directors, no summary has yet been made available to the survey participants, detailing the survey results and any proposed action to address any issues. A summary of the findings of the quality assurance survey should be made available to residents/their representatives and ideally to all those invited to participate, since this values their contributions and opinions and may encourage future participation. The manager indicated that the only issue of note which arose related to the quality of meals, which had since been addressed through the employment of a new chef and menu changes, particularly to the breakfasts. An annual development plan for the home is produced, called an “Annual Review Action Plan”, which is again an internal document, but it does detail the identified priorities for the home over the ensuing year. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 28 From discussion with the manager it appeared that a number of the required policy and procedure documents were either not in place, or at least were not readily available to the manager and staff. There did not appear to be a collective “policies and procedures” file in place containing all of the relevant guidance for staff It was not possible to locate policies/procedures on “record keeping”, “recruitment”, “sexuality and relationships”, “smoking”, “missing residents” or “racial harassment”, all of which would be expected to be present. These, and any other missing policy procedure documents, must be located or compiled, and made available to all staff to read. It is good practice for them to be held collectively within a policies and procedures file, and to obtain signatures from all staff to confirm that they have read and understood the documents, to provide a degree of accountability. In the light of the new Mental Capacity Act, it is also suggested that an appropriate procedure be devised in relation to the home’s resulting responsibilities, including the assessment of individual residents’ “mental capacity” with regard to decision making on an ongoing basis, and the recording of this process. The home has an on-site financial administrator who manages residents’ funds on their behalf. Only the administrator and the manager can have direct access to residents’ funds, though a resident’s keyworker can request small sums to purchase items on behalf of a resident where they have requested them. The home does not manage bank accounts on behalf of residents. Individual resident’s allowance monies, provided by next of kin, are kept within individual zip-wallets together with a record card of any monies in and out and receipts for any purchases. Examination of the home’s accident records indicated that although the required collective record of accidents was in place, details of accidents were not being placed on the relevant resident’s case record as part of their care history, as is also required. The manager should ensure that individual records of resident’s accidents are placed within their case records. There were few recent recorded accidents relating to the three case-tracked residents but, in three cases, the record indicated that staff carelessness may have been a contributory factor in the resulting (minor) injuries. The manager should review accident records regularly, and address any such issues which emerge from their analysis. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 29 The individual accident forms examined had been completed appropriately, with the exception of the non-inclusion of its sequential index number from the tear-off accident pad, but included relevant details of the accident and the action taken in response. The index number should be added to each form since it helps to ensure the completeness of the overall accident record, and identifies where any forms are missing. Examination of a sample of health and safety-related service certification indicated that the majority of required checks were up to date. The manager forwarded copies of some additional certification to the Commission, following the site visit, but no certification for the annual testing of electrical appliances could be located. This testing is an annual requirement and arrangements should be made for this to take place if a current certificate cannot be located. It is important for health and safety-related records to be retained by the home for subsequent inspection, and it is recommended they are filed together so that they can be readily located during inspections. The home had a fire risk assessment in place but this appeared to comprise a selection of formats, some of which were undated, which made it hard to establish which were the most recent items. The fire risk assessment had, however, been reviewed in December 2006. It is good practice for all documents to be signed and dated to enable their effective review. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 30 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 4 8 4 9 4 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 31 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 OP16 Regulation 22 Requirement Timescale for action 12/09/07 2 OP30 13 3 OP36 12 The provider/manager must ensure that an appropriate complaints recording system is established, which enables the level of all complaints to be readily identified, as well as evidencing that complaints have been appropriately addressed in accordance with the home’s complaints procedure. The manager must make 12/10/07 arrangements for any care staff without a current first aid qualification, to receive this training, to ensure that all care staff can administer appropriate first aid where necessary. The identified policies and 12/09/07 procedures must be located or compiled, and must be made available to be read by relevant staff, in order to guide consistent and appropriate care practice. Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 32 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 Consideration should be given to how the activities programme might be extended throughout the week, and it is recommended that individual records of resident’s take-up or declining of activities, are maintained. It is recommended that copies of the complaints form are made readily available in the entrance hall, without recourse to staff. The provider/manager are recommended to make the suggested improvements in recruitment records to fully evidence that required checks have been undertaken. The provider/manager should consider the provision of a collective policies and procedures document, which is countersigned by all staff to confirm they have read and understood the contents. A summary of the findings of the quality assurance survey should be made available to residents and their representatives. The manager should establish a regular cycle of supervision for the care and ancillary staff to support their practice and career development The manager should ensure that individual records of residents’ accidents are placed within their case records, and that the completed accident records are reviewed on a regular basis. The provider/manager should ensure that the required annual testing of electrical appliances takes place if it has not been done within the last year. 2 OP16 3 OP29 4 OP33 5 OP33 6 OP36 7 OP38 8 OP38 Green Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 33 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 Pastures Christian Nursing Home DS0000027153.V339889.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!