Inspection on 15/11/05 for Green Pastures Christian Nursing Home

This inspection was carried out on 15th November 2005.

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... 12/07/07

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

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

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 Annette Miller Announced Inspection 15th November 2005 09:30 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.V254448.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Green Pastures Christian Nursing Home DS0000027153.V254448.R01.S.doc Version 5.0 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 Green Pastures Limited 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.V254448.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. On admission persons should be aged 60 years and over. Admittance of one named terminally ill service user Date of last inspection 27th June 2005 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. It is set behind a small coppice of mature trees and has a very pleasant enclosed rear garden. The home is registered to provide nursing care for 30 older people aged 60 and over. There are communal rooms and bedrooms on the ground and first floors. A lift is provided. The home has a strong Christian ethos, but this does not preclude those people who belong to other denominations and have different beliefs. Green Pastures Christian Nursing Home DS0000027153.V254448.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection carried out by one inspector from 9.30am to 5.30pm. During this time a tour of the building and inspection of documents took place. The inspector spoke to six residents, four staff and six relatives to obtain a range of opinions on the services provided. Ms Chipembele was appointed as the proposed registered manager in August 2005. She has not yet submitted her application to CSCI to be approved as the registered manager and this must be done. Ms Chipembele was present throughout the inspection. The organisation’s representative, Dr Fergusson, was also in the home at the start of the inspection and again at the end to receive the inspector’s verbal feedback. The Commission for Social Care Inspection (CSCI) received comment cards from three GPs, one district nurse, 16 residents and 17 relatives. The comments from health care professionals and most of the residents indicated satisfaction with the service. Eleven out of 17 relatives raised some concerns, mostly about staffing levels and food choices. These have been forwarded to Dr Fergusson to investigate and report his findings to the CSCI. Some good comments were received from relatives such as: “My mother, myself, my family (and my mother’s friends) are all extremely pleased and happy with every aspect of her care…”. “My mother is in the home and she is very well cared for. She is cared for absolutely A1”. What the service does well: The standard of the environment within this home is good providing residents with an attractive and homely place to live. Members of staff spoken to were friendly and polite and had a good level of knowledge about residents’ care needs. Access to health care services is good and the comments made by GPs on comment cards sent to CSCI prior to the inspection showed they thought the home was providing a good service. Green Pastures Christian Nursing Home DS0000027153.V254448.R01.S.doc Version 5.0 Page 6 A relative said staff were friendly and he was always made to feel welcome when he visited. He was pleased he could visit his mother whenever he wished. What has improved since the last inspection? 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 DS0000027153.V254448.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Green Pastures Christian Nursing Home DS0000027153.V254448.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards was assessed. EVIDENCE: Green Pastures Christian Nursing Home DS0000027153.V254448.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8 and 10 On the day of inspection the standard of care was found to be satisfactory. Access to health care services is good and comments received from three GPs showed that they thought the home was providing a good service. EVIDENCE: Most of the residents spoken to considered care was good and said staff were “kind and caring”. Some residents have dementia and were unable to voice an opinion, but they looked clean, well dressed and appeared content. Staff had clearly taken great care to ensure each person’s appearance was good. One relative expressed complete satisfaction with the home, but three relatives said they had some concerns. For example, one relative was unhappy that baths had been reduced from two to one a week and that staff had not informed her why this was necessary. A member of staff said that time constraints sometimes resulted in baths not being given as planned. If baths cannot be given as frequently as a resident would like, discussion should occur to keep residents and relatives informed of the situation. Green Pastures Christian Nursing Home DS0000027153.V254448.R01.S.doc Version 5.0 Page 10 A resident said her call bell was not always answered promptly, which had resulted in her experiencing occasional episodes of incontinence because she could not get to the toilet in time without help. A relative made a similar comment regarding her mother. Residents are assessed on admission to determine whether or not they are at risk of developing pressure sores and, based on the outcome of these assessments, pressure relieving mattress and cushions are supplied when needed. There were no pressure sores at the time of inspection. Sixteen comment cards were received from residents and 11 answered ‘Yes’ to the question: ‘Is your privacy respected?’ Three answered, ‘sometimes’ and two answered, ‘No’. Examples were not given when privacy was not respected and the inspector did not observe lack of respect during the inspection. Five GP practices provide medical care enabling residents to register with a doctor of their choice. CSCI received three comment cards from GPs and each doctor made positive comments about the standard of care provided. One doctor said the home was “wonderful” and another that “staff work really hard to try and create a caring atmosphere”. Green Pastures Christian Nursing Home DS0000027153.V254448.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 and 15 Overall, residents’ choices are respected enabling people living in the home to have control over their lives. The standard of food on the day of inspection was good and most residents enjoyed their lunch. However, the inspector received comments from residents and visitors verbally and in writing raising concerns about the food, indicating that there is a need to review the present catering arrangements. EVIDENCE: Two residents confirmed that they could choose how to spend their day and thought that staff had a good understanding about how to help them stay independent for as long as possible. The lunch served on the day of inspection looked and smelled appetising and the inspector checked with two residents to find out if they had enjoyed their meal and they said they had. The inspector sampled the food and found it to be hot and tasty. Green Pastures Christian Nursing Home DS0000027153.V254448.R01.S.doc Version 5.0 Page 12 A printed menu is displayed in the home, but on the day of inspection one of the main courses at lunchtime was not the same as shown on the menu. The chef explained that this was because the correct food had not been delivered to the home in time for the planned meal to be prepared. The menus for a four-week period were inspected and a hot snack was shown as a menu choice on three evenings each week, yet three relatives said hot snacks were never offered. They each said that supper consisted of soup, sandwiches and a cold dessert every evening, which they thought was unsatisfactory. One relative was unhappy that cooked breakfasts were never offered. Responses on residents’ comment cards showed nine residents liked the food, five liked it sometimes and two did not like it. A number of relatives raised concerns in writing and verbally during the inspection about the standard of food and the choices available. Green Pastures Christian Nursing Home DS0000027153.V254448.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The home’s written complaints procedure sets out clearly the stages and timescales for dealing with complaints. However, two relatives reported that they were not satisfied with the way in which their complaints had been dealt with. EVIDENCE: The home’s complaints procedure sets out the stages and timescales for dealing with complaints and a copy is displayed in reception. Information about this procedure is also contained in the home’s Residents’ Guide. However, two relatives thought the organisation did not listen or take action about their complaints. The complaints log was examined and contained information about concerns dating back to March 2005, but did not provide information about the four complaints partly substantiated that were referred to in the pre-inspection questionnaire submitted to CSCI prior to the inspection. It is recommended that all complaints/concerns are recorded in a complaints log and that a record is kept of the action taken, as well as the final outcome. No formal complaint has been received by CSCI since the last inspection, although a number of concerns were made on comment cards returned directly to CSCI. These have been passed to the organisation to investigate. Green Pastures Christian Nursing Home DS0000027153.V254448.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 On the day of inspection the overall standard of cleanliness within this home was good, providing residents with an attractive and homely place to live. The only exception was an unpleasant smell from a carpet in one bedroom. An immediate requirement was made for action to be taken to eliminate the smell. EVIDENCE: Cleanliness throughout the home was good and, with the exception of one bedroom, there were no unpleasant smells. A relative told the inspector that she had complained about the odour in her husband’s bedroom on a number of occasions and as a result the carpet was cleaned. However, this action did not solve the problem. The smell was evident on the day of inspection. There is an on-site laundry and two members of staff are employed to carry out laundry duties. Staff hand-washing facilities are prominently sited throughout the home. Green Pastures Christian Nursing Home DS0000027153.V254448.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 The high dependency of many of the residents indicates that staffing levels need to be above minimum levels. However, this is not always the situation, particularly during afternoons and evenings when only minimum levels are provided (below which staffing must not fall) and on these occasions it is possible that staffing levels will be inadequate. EVIDENCE: The inspector observed that many residents had complex care needs requiring high levels of care, and on the day of inspection staffing levels were above the minimum number required. However, the duty rotas for the period 17th October to 13th November 2005 showed that whilst mornings were generally above minimum staffing levels, the afternoons and evenings were often covered with only the minimum number of staff below which staffing levels must not fall. On the day of inspection staffing levels consisted of two nurses and five carers during the morning, one nurse and five carers for the afternoon and evening, and one nurse and three carers overnight. The acting manager and the activity organiser were additional to these numbers in the day. This was above the minimum levels shown on the home’s staffing statement. Green Pastures Christian Nursing Home DS0000027153.V254448.R01.S.doc Version 5.0 Page 16 One resident with dementia was being closely observed in order to maintain his safety, as he wandered if left unsupervised. The activity organiser sat with this resident, which resulted in some of the planned activities not taking place. One resident said carers were “kind and caring” but that they were very busy and sometimes took a long time to answer her call bell. The organisation does not employ an evening kitchen assistant and, therefore, a carer is required to prepare and serve suppers. This reduces the number of carers available to assist residents over this period, which is of particular concern as many of the residents need help to eat. Eleven out of 17 relatives said on comment cards returned to CSCI that staffing levels were not always sufficient. Green Pastures Christian Nursing Home DS0000027153.V254448.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 35 The lines of accountability within the home are unclear and this situation is causing unrest amongst some staff members that could result in an inconsistent and unsatisfactory service. There are no effective quality assurance systems in place and this has resulted in the organisation being unaware of residents’ and relatives’ concerns. EVIDENCE: Ms Chipembele was appointed as the proposed registered manager in August 2005. Her title in the home is ‘nurse manager’. The position of registered manager has to be formally approved by CSCI and involves an interview to establish ‘fitness’ to undertake the role. Ms Chipembele’s application has not yet been submitted and this must be done. Green Pastures Christian Nursing Home DS0000027153.V254448.R01.S.doc Version 5.0 Page 18 The registered manager and the Board of Directors are legally responsible for the services provided to residents. Therefore, it is not clear why the registered manager does not have direct access and regular communication with the Board of Directors. At present this is through the home manager, as outlined in the Statement of Purpose revised in August 2005. The home manager has administrative responsibilities. The previous registered manager left the home in May 2004 and the home has been without a registered manager since. The home manager and a deputy nurse manager provided management cover until Ms Chipembele was appointed. It is recommended that the present management structure is reviewed to ensure that management roles are clearly defined and take account of the responsibility and accountability of the registered manager’s role. The inspector obtained information during the inspection that suggested some staff were not entirely happy with recent management decisions, unrelated to the acting registered manager, and this was discussed with Dr Fergusson at the end of the inspection. It is recommended that formal feedback is sought from all staff members to provide them with an opportunity to raise concerns and for action to be taken to resolve any difficulties. Four relatives said they were satisfied with the way in which Ms Chipembele dealt with matters. The staff spoken to said she was approachable and that they were satisfied with her management style. At the time of inspection there were no quality assurance systems in place to measure success in meeting the aims, objectives and statement of purpose of the home and these are required. Residents are encouraged to control their finances for as long as possible, but when no longer able to do so, a representative is involved. Under exceptional circumstances the home will look after small amounts of pocket money for residents. The money held for three residents was checked and good accounting procedures were found. Green Pastures Christian Nursing Home DS0000027153.V254448.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X X X X X X X X 2 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X X Green Pastures Christian Nursing Home DS0000027153.V254448.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP16 Regulation 22 Requirement Review the procedure for investigating complaints to ensure that complaints are dealt with effectively. All areas must be kept free of offensive odours. Review the staffing arrangements to ensure that sufficient staff are deployed to meet the needs of the people living in the home. Timescale for action 31/01/06 2 OP26 16 15/11/05 3 OP27 18 31/01/06 Green Pastures Christian Nursing Home DS0000027153.V254448.R01.S.doc Version 5.0 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP8 Good Practice Recommendations Residents’ preferences regarding the frequency of being offered a bath should be reviewed and taken into account whenever possible. The frequency of providing this service should be included within the care plan. Monitor the time taken to answer call bells to establish whether or not the response time is appropriate. Take action to reduce the time taken to respond if this is needed. Ensure that hot snacks are provided as indicated on the home’s menu. Ensure that residents’ food choices are catered for whenever possible and that an explanation is provided when these cannot be met. Keep records of all complaints in a complaints log and list the action taken to deal with the complaint and the final outcome. Appoint an evening kitchen assistant to prepare and serve suppers, and to clear away afterwards. Actively seek feedback from residents, relatives, staff and other key people as to the conduct of the home. Repeat the procedure at least annually. 2 OP8 3 OP15 4 OP16 5 6 OP27 OP33 Green Pastures Christian Nursing Home DS0000027153.V254448.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Green Pastures Christian Nursing Home DS0000027153.V254448.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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