Inspection on 19/12/06 for Green Pastures Christian Nursing Home

This inspection was carried out on 19th December 2006.

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... 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 Kate Harrison Unannounced Inspection 19th December 2006 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.V322268.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.V322268.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 john@green-pastures-christian-nursinghome.org.uk Green Pastures Limited vacant 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.V322268.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 20th April 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, and the home manager is in day-to-day charge, with the nurse manager responsible for the care of residents. The home 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, and the fees range from £581 to £629 per week. There are communal rooms and bedrooms on the ground and first floors, and 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 religious beliefs. Green Pastures Christian Nursing Home DS0000027153.V322268.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. Two inspectors arrived at the service at 09.30 hours and were in the service for three hours. This inspection was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s manager, and any information that the CSCI had received about the home since the last inspection. The inspectors saw all areas of the home and looked at records and documents relating to the care of the residents. The home manager was available during the inspection visit. The inspectors asked the views of the residents, relatives and health and social care professionals about the home through questionnaires (comment cards) that the Commission had sent out. Six residents and two GPs replied to the Commission’s comment cards and their views are reflected in this report. No relatives replies were received and no relatives were seen during the inspection. The inspectors also had conversations with several residents on the day. Although the home has a strong Christian ethos, residents are treated as individuals, and the inspectors consider that this home would be able to provide a good service to meet the needs of people from different ethnic, cultural, social and religious backgrounds. What the service does well: The home provides a homely, comfortable atmosphere for residents. Residents are appropriately assessed prior to admission, and are assured that the home can meet their needs. Residents are treated with dignity and their right to privacy is upheld. The home has an activity programme in place to ensure that residents’ social and recreational interest and needs are catered for. Residents are supported to exercise choice and control over their lives. Visitors are welcome to visit at any time and this ensures that residents maintain contact with their families and friends. Residents receive a varied and appealing diet and are supported in their choice of meals in accordance with their assessed needs. Green Pastures Christian Nursing Home DS0000027153.V322268.R01.S.doc Version 5.2 Page 6 A complaints policy is in place and residents are empowered to air their concerns and complaints. The staff members take sensible measures to prevent the spread of infection. The home’s recruitment procedures are carried out effectively. The quality assurance system used at the home makes sure that the home continues to improve. 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. The summary of this inspection report can be made available in other formats on request. Green Pastures Christian Nursing Home DS0000027153.V322268.R01.S.doc Version 5.2 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.V322268.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. Residents receive an appropriate assessment prior to admission to the home. This judgement has been made using available evidence including a visit to this service. The home does not provide intermediate care. EVIDENCE: It was confirmed from information received prior to the inspection and from discussions with the manager that a number of residents have been admitted since the previous inspection. One resident discussed his admission to the home as a positive experience with opportunities to trial the home before making a decision regarding a permanent placement. Documentation was seen with regard to this assessment. This was found to be detailed with all relevant information transferred to the plan of care. Green Pastures Christian Nursing Home DS0000027153.V322268.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 Quality in this outcome area is good. Residents have an appropriate plan of care, and health care needs and wishes and preferences are noted. Residents’ privacy and dignity is respected. The home is able to fully meet the needs of the current resident group. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents’ care plans were seen and case tracking was carried out, including discussion with residents, observations and discussions with care staff. Care plans were found to be informative and included a short profile of the service user’s background, health and personal care needs, risk assessments, regular reviews and other information which would enable staff to fully meet the service user’s needs. Green Pastures Christian Nursing Home DS0000027153.V322268.R01.S.doc Version 5.2 Page 10 Health care needs were recorded appropriately and included details regarding specialist equipment supplied, visits by GPs, district nurses and the podiatrist. One GP said that Green Pastures was a ‘very efficient caring home’. The medication systems and storage were assessed. Medication administration records (MAR) were viewed and were completed correctly. Systems in place for the storage of medication would protect the safety of service users. The home has recently commissioned an external agency to audit the medication system. The results of this audit were not available at the inspection visit. However, it was confirmed that the only recommendation received was to update the medication policy in place. It was confirmed that this was being addressed. Observations were made throughout the day of excellent practices regarding the protection of residents’ privacy and dignity. Residents also reported that staff were ‘very respectful’ and one said that Green Pastures was the ‘best nursing home”. All the residents who responded to the Commission’s comment cards said that they ‘always’ or ‘usually’ received the care and support they needed. Green Pastures Christian Nursing Home DS0000027153.V322268.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. The home has an activity programme to ensure that residents’ social and recreational interests and needs are catered for. Healthy and nutritious meals are supplied, and residents are supported to exercise control over their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Daily life and social activities were assessed through discussions with residents and staff, through documentation seen and from observations made during the inspection visit. Residents spoke highly of the activity programme and all had been issued with a detailed programme of events for December, including church services, entertainers and a Christmas party. Residents confirmed that they were able to fulfil their spiritual and cultural needs whilst living in the home. This was also evident from documentation seen and information displayed around the home. Green Pastures Christian Nursing Home DS0000027153.V322268.R01.S.doc Version 5.2 Page 12 The inspection visit was during a busy period when personal care was taking up most of the care staff members’ time. However, care staff engaged in appropriate conversations whilst carrying out other duties and it was pleasant to see residents socialising in small groups around the home. It was confirmed that visitors are always welcomed. Residents were able to eat meals in pleasantly decorated dining areas throughout the home or within the privacy of their own bedrooms. Residents requiring help with meals were assisted with dignity and respect. All residents reported that they enjoyed all the meals served. Green Pastures Christian Nursing Home DS0000027153.V322268.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. Residents are empowered to air their concerns and complaints and are protected from any abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Complaints and protection within the home was assessed through documentation and discussions with residents. A copy of the complaints procedure was in place in the main entrance and other areas of the home, so that residents or relatives are informed about how to make a complaint if necessary. All the residents who responded to the Commission’s comment cards said that they knew how to make a complaint if they needed to. The home has not received any complaints since the last inspection visit. The home manager confirmed that a previous ongoing complaint had been resolved amicably. The Commission has not received any information about new complaints or concerns regarding the home since the last inspection. The home has received many letters of thanks from friends and family for the quality service given to residents who have resided in the home in the past. Green Pastures Christian Nursing Home DS0000027153.V322268.R01.S.doc Version 5.2 Page 14 Adult protection polices and procedures are in place and staff confirmed that they would feel empowered in ‘whistle blowing’ should the need arise. The home has not had any issues regarding the safeguarding of vulnerable adults since the last inspection visit. Eight carers and two nurses recently attended update training on safeguarding vulnerable adults. One resident told the inspector that she/he felt “very safe’’ at the home. Green Pastures Christian Nursing Home DS0000027153.V322268.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. The home is clean, hygienic and well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents who responded to the Commission’s comment cards said that the home was ‘usually’ or ‘always’ fresh and clean. One reply said that ‘great effort’ was made to keep the home fresh, and another said that one individual’s room was always ‘spotless’. The home was well decorated for Christmas, and the residents were looking forward to the Christmas Party planned for the afternoon. The home has a well-maintained garden, and two residents said that they were looking forward to the better weather so that they could take walks in the garden. Green Pastures Christian Nursing Home DS0000027153.V322268.R01.S.doc Version 5.2 Page 16 A named member of staff manages the general maintenance on a day-to-day basis, and has a system in place so that staff members can easily report issues needing attention. Regular services of the fire alarm system and of other safety features are in place. The home’s laundry is well managed and good systems are in place to prevent the spread of infection. Colour coded gloves and protective aprons are freely available for staff members, and pedal bids are used for the disposal of used items. Green Pastures Christian Nursing Home DS0000027153.V322268.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. The home is working towards having a ratio of 50 trained carers and is making progress towards the home’s induction programme, meeting the Skills for Care Standards. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s staff rota shows that there is always a registered nurse on duty, and that thought is given to where best to allocate the carers over the three wings. One nurse and two carers manage the needs of the residents at night. The majority of residents who replied to the Commission’s comment cards said that staff members were ‘usually’ available when they were needed. Although staff training is encouraged, it has not been possible to find assessors to help carers who want to take the NVQ Level 2 or 3 training, and the home has only one assessor at present. This has meant that the home has not been able to improve the ratio of trained carers, currently 27 , to the national standard of 50 . Three carers are currently taking the NVQ Level 2 course, and the home continues to work towards improving the number of assessors available to the home. Green Pastures Christian Nursing Home DS0000027153.V322268.R01.S.doc Version 5.2 Page 18 There is a named member of staff at the home responsible for organising staff training, and all the registered nurses have access to training during the year. One registered nurse has completed a course on palliative care, and two health professionals replied to the Commission’s comment cards that the home manages individuals with terminal illness very well. One health care professional commented on the variability of care assistant calibre, contrasting it with the skilled nurse staff compliment. All appropriate staff members attend mandatory training, and care staff can choose from a range of training offered over the year. The training is a mixture provided from private companies and in-house training on specific topics, plus mandatory training. The home’s induction training is being updated to meet the Skills for Care standards, and this is expected to be in place soon. One newly recruited nurse was on the induction programme, and was shadowing an experienced nurse member of staff at the time of the inspection visit. The inspector recommends, as a way of improving the skills of carers who do not have NVQ Level 2, that foundation training to the Skills for Care standards be available. This will ensure that all the carers receive training to meet the needs of the residents until the home is in a position to support carers through the NVQ Level 2 training. Three staff files were checked to monitor the home’s recruitment procedures, and all the necessary information required by regulation about staff members was available. Green Pastures Christian Nursing Home DS0000027153.V322268.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. Good quality assurance systems are in place. Residents’ financial interests are protected and health and safety of the residents and staff are taken seriously. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The nurse manager is in the process of applying to become the registered manager of the home, so this standard was not assessed at this inspection visit. Green Pastures Christian Nursing Home DS0000027153.V322268.R01.S.doc Version 5.2 Page 20 The home’s quality assurance system is varied and includes an annual survey to residents and relatives as well as daily and monthly in-house checks. The results of the 2006 survey are available and the home has plans to address any issues arising. Most of the residents cannot manage their own finances and relatives or care managers manage their financial affairs. The home manages small amounts of petty cash for a few residents, and records are kept appropriately. The home’s manager is the named health and safety person for the home. A fire risk assessment is in place and all the necessary fire safety checks are carried out. The home has a health and safety policy and provides appropriate training for staff. Green Pastures Christian Nursing Home DS0000027153.V322268.R01.S.doc Version 5.2 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 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 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score N/A X 3 X 3 X X 3 Green Pastures Christian Nursing Home DS0000027153.V322268.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP30 Good Practice Recommendations The inspector recommends, as a way of improving the skills of carers who do not have NVQ Level 2, that foundation training to the Skills for Care standards be available. Green Pastures Christian Nursing Home DS0000027153.V322268.R01.S.doc Version 5.2 Page 23 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.V322268.R01.S.doc Version 5.2 Page 24 - 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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