Inspection on 19/06/08 for Greenbanks Nursing Home

This inspection was carried out on 19th June 2008.

CSCI found this care home to be providing an Good service.

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

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Greenbanks Nursing Home 29 London Road Liphook Hampshire GU30 7AP Lead Inspector Christine Bowman Unannounced Inspection 19th June 2008 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 Greenbanks Nursing Home DS0000071223.V365345.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. Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenbanks Nursing Home Address 29 London Road Liphook Hampshire GU30 7AP 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) 01428 727343 greenbanks29@aol.com Buckland Rest Homes Ltd Ms Yin May Li Care Home 30 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0), Physical disability (0) of places Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP) 2. Physical disability (PD). The maximum number of service users to be accommodated is 30. Date of last inspection Brief Description of the Service: Greenbanks Nursing Home is a care home registered to provide nursing and personal care to older people of both sexes. Accommodation offered at the home consists of twenty single bedrooms and five shared bedrooms. There are large communal areas, with a separate dining room. All areas of the home are accessible to people with limited mobility. Greenbanks was formerly a Victorian family house and was converted into a Nursing Home in 1990. It has an attractive garden that is accessible to service users and there is small car parking area at the front of the home. The home is in a residential area near the centre of Liphook, a semi-rural village and is close to local amenities. The current charge is £618 -£750 per week. There are separate charges for items such as toiletries, chiropody, hairdressing, telephone and newspapers. Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. This unannounced site visit was conducted as part of a key inspection using the Commission’s ‘Inspecting for Better Lives’ (IBL) process. The site visit took place over six and a half hours and the Registered Manager, Ms Yin May Li was available throughout the day and assisted with the inspection process. A tour of the premises was undertaken and some of the residents’ bedrooms, bathrooms and communal areas were viewed. A number of staff and residents were spoken with throughout the day and residents were observed as they ate lunch, relaxed in the living areas and their bedrooms and entertained visitors. The key inspection standards for care homes for older people were assessed with regard to the outcomes for the residents living at the home. The service user guide was viewed and residents’ files including assessments, care plans, medication administration records and risk assessments were viewed and staff personnel files, including recruitment, induction and training records were sampled. The home’s quality assurance system, complaints and compliments, policies and procedures and maintenance certificates were also sampled. The service had completed an Annual Quality Assurance Assessment (AQAA) and information recorded in this, and on the inspection record since the registration of the service by a new provider, has been taken into consideration in the writing of this report. Seven completed service user surveys were returned, and relatives, on behalf of residents, had completed some. Eight staff members also completed surveys. Comments from these sources have been included in this report. References to the homes’ own quality assurance assessment have also been made. Thanks are offered to the management and the staff of Greenbanks for their assistance and hospitality on the day of the site visit and to those who completed surveys for their contribution to this report. What the service does well: Prior to admission, each prospective resident and their relatives and representatives are offered the opportunity to spend time at the home and time and effort is taken to make the experience personal. A resident’s relative commented on finding the home, ‘We did a great deal of searching and this was the best home.’ Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 6 The residents benefit from living in a comfortable, safe, pleasant, wellmaintained environment, which is clean and hygienic. Effort had been exerted to ensure this was a homely place for the residents to live. There were fresh flowers in the sitting room, framed pictures on the walls, plants, pleasant domestic lighting, and comfortable and appropriate furnishings for the enjoyment and pleasure of the residents. A resident commented, ‘Superb standards of cleanliness. I have been here for three and a half years and have never known the home to be anything but fresh and clean,’ and ‘It is a homely type of nursing home and the carers are wonderful, so patient and kind.’ Recruitment procedures were thorough to safeguard the residents and there was a core team of dedicated and loyal staff, some of whom, had worked at the home for some time, offering consistency and continuity for the residents. There was commitment to staff training and development. A staff member commented, ‘the training I have received over the last four years has been excellent,’ and another stated, ‘I have had excellent support and training from my manager.’ The manager was innovative in her methods of empowering the staff to take responsibility for their own developmental needs. The manager was well qualified and had an open and inclusive management style. Through quality assurance questionnaires and meetings, residents, relatives and representatives, and staff were encouraged to contribute their views to the development of the service. The results confirmed satisfaction with the standard of care at the home and there were many positive comments including, ‘the standard of care is very good’, ‘the staff take a personal interest in the comfort and needs of the residents, ‘I can’t speak too highly of the staff, I have encountered’, and ‘I am satisfied that my mother is well looked after in pleasant surroundings.’ What has improved since the last inspection? What they could do better: An area relatives felt could be improved upon, was in the provision of social activities. Comments included, ‘I am not sure mum’s needs are met on a oneto-one basis. She needs more stimulation to keep her mind active,’ ‘more outings and stimulation through musical entertainment,’ and ‘my relatives needs are not fully met, but it is difficult to run social activities when the staff are stretched.’ Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 7 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. Greenbanks Nursing Home DS0000071223.V365345.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 Greenbanks Nursing Home DS0000071223.V365345.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 1,3,6 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Sufficient information is available to prospective clients to help them to make a decision about the suitability of the home to meet their needs and expectations. Prospective residents individual needs are assessed prior to the offer of a placement to ensure the home is able to meet them. The home does not provide intermediate care, so Standard 6 does not apply. EVIDENCE: The home provided a service user guide, which was in large print to enable those with visual diabilities to access the information. The document gave propective residents the aims and objectives and the philosopy of care of the home in addition to describing the facilities and services offered, the qualifications of the staff team and the fees charged. The manager wrote in the Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 10 AQAA that, ‘we plan to have sample results of surveys to be included in the homes literature’. ‘Prospective service users and their families, when making telephone enquiries, are invited to visit the home at any time and no appointment is necessary’, the manager stated, ‘and they are given a copy of the service user guide and the statement of purpose to help them to make a decision about the suitability of the home to meet their needs. Five of the seven residents, who completed surveys, some with support from their relatives, stated they received sufficient information about the home before they moved in so they could decide if it was the right place for them. One resident commented, ‘We did a great deal of searching and this was the best home,’ and another stated, ‘I don’t think it is possible to be sure if it is the right place before you move in. Only time and experience will tell – in this case we are very happy with the decision.’ ‘Prospective residents are advised to have a look around at other homes to make comparisons before they make a decision and they are offered a copy of the last inspection report for the home’, the manager stated. ‘They are also invited to visit for either lunch or afternoon tea if they are able to.’ ‘All new prospective service users receive a full and comprehensive assesssment of their needs before admission, either at their home or in hospitals, by the manager or a designated Registered Nurse’, the AQAA recorded. The assessments were carried out using a recognised nursing assessment tool and included a social profile so that a plan of care could be put in place for each individual resident. The files of two residents recently admitted residents were viewed confirming this information had been recorded. The home also gathered additional information from social and healthcare professionals, relatives and friends to ensure a full profile was available to aid the assessment. Residents’ needs with respect to equality and diversity were considered in the assesment process including religious and special dietary needs and disabilities. The statement of purpose confirmed inclusion and respect with regard to prospective residents individual needs and values in matters of religion, culture, race or ethnic origin, sexuality or sexual orientation, political affiliation, marital status, parenthood and disabilities or impairments. Each new resident had an allocated nurse to monitor their clincal needs and a key worker responsible for personal care needs. Greenbanks Nursing Home DS0000071223.V365345.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 7,8,9,10 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are recorded to inform the staff of how to support them and access to health and social care professionals is promoted. Medication is handled safely, the residents are treated with respect and their right to privacy is upheld. EVIDENCE: Residents’ files sampled, contained comprehensive care plans, identifying individuals’ health, personal and social care needs. Goals were set, and support plans, giving clear instructions to the staff were set out. 100 of the staff, who completed surveys, thought they were always given up to date information about the needs of the people using the service in their care plan. Where possible, it was clear that residents were given support to remain as independent as they were able and risk assessments had been carried out to Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 12 support this. ‘Care plans are discussed with the resident or the resident’s representative and signed for where possible. We audit the care plans monthly to ensure that documentation is completed effectively to reflect the person as a whole and we continue to review and revise our care planning systems to ensure that everyone finds it easy to understand’, the manager wrote in the AQAA. A staff member commented in a survey,‘ the current staff hand-over procedure works very well in providing information about individual resident’s care and care plans are kept up to date’. Individual residents’ preferences had been considered in the drawing up of the care plans to inform the staff. Six of the seven residents who completed surveys confirmed they always receive the care and support they need and one that they usually did. This resident’s relative commented, ‘ My mother is very well cared for but she sometimes feels the carers expect her to do more for herself than she is physically able to do.’ Records were kept of intervention by healthcare professionals such as General Practitioners, physiotherapists, community nurses, chiropodists and the community psychiatric nurse. Actions to be taken as a result of the consultations were recorded to inform the staff. A physiotherapist was visiting a resident on the day of the site visit. The home had comprehensive policies and procedures in place for the safe handling of medication and a good audit trail was documented. ‘A senior registered nurse took responsibility for over-seeing the ordering, storage, administration, recording and disposal of medication and the supplying pharmacist gave advice’, the manager stated. The home carried out weekly and monthly audits to confirm the procedures were safe, and residents’ medication sampled on the day of the site visit, also confirmed that records and quantities of medication matched. The home held controlled drugs and suitable storage and recording methods were in place to ensure safety. The manager stated that residents did not usually take responsibility for selfmedication but that risk assessments would be undertaken should they wish to and that each resident had a lockable facility in their bedroom for storage. Medication was administered by trained nurses who had received extra training in the administration of medication and a list of their signatures was kept for completing the Medication Administration Records. The home had a charter of rights for the residents, which set out it’s aims and objectives in providing the highest possible standard of life and care in a warm, friendly and home-like environment. This covered the quality of life the resident could expect, the support to remain independent, the right to privacy, dignity, fulfilment and choice and the home’s commitment to inclusion with respect to equality and diversity issues. This information was available on notice boards for all to read. The manager had developed an innovative training tool for the staff to promote and maintain respect for the privacy and dignity of the residents. Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 13 The AQAA recorded, ‘Doors are closed when personal care is being provided. Staff knock and wait for a response. Privacy curtains in the double rooms are situated so that they are long enough and postitioned to ensure privacy around both the beds. All service users have lockable rooms and may lock their bedrooms if they wish, although currently no service user has chosen to do so’. This good practice was observed on the day of the site visit. The home did not have a pay phone, but a cordless phone was provided for residents to use privately and phone points in each room allowed calls to be transferred. A staff member commented on what they thought the service did well, ‘the service caters very well for the individual service users and protects their dignity and independence as much as possible.’ Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 14 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 12,13,14,15 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Residents enjoy a wide range of organised social, cultural, religious and recreational activities, maintain social contacts and receive a wholesome, appealing balanced diet in pleasing surroundings. Social and recreational activities could be more person-centred to meet individual’s needs and promote choice and empowerment. EVIDENCE: The home had a social activites co-ordinator, who arranges a varied programme of activies, which, the manager stated, is planned around the residents likes and dislikes from questionaire reviews. The AQAA recorded, ‘Residents may choose to join in, sit and watch others or go to their rooms to watch TV, listen to radios, read or have time alone’. The activites schedule was displayed on a notice board to inform everyone. Activities included movement to music, flower arranging, craft, video /DVD screening, outings, live bands and singers, bingo, lawn golf, board games, floor games, group listening books Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 15 or one to one activity for those who do not wish to partake in group activity. A minister visited on a regular, bi-weekly basis for communion and was available to visit at other times on request. ‘Some residents are visited by ministers from their own church’, the manager stated. Residents and their relatives and representatives were also informed of the available activities in the monthly news letters. ‘We have introduced reminiscence type quizzes and group listening books especially for residents with dementia and have joined the National Association for Providers of Activities, an outside expert activities agency, which helps us with ideas and makes recommendations of ways of encouraging active participation in different and varied activities,’ the manager stated. ‘The fresh air programme’ was an example of how the home was embracing healthpromoting projects. ‘We continue to seek ways to positively impact upon the daily life of our service users especially for those who suffer from confusion and dementia’ the manger stated. On the day of the site visit a craft activity was in progress in the afternoon and a group of residents were being supported to exercise their creativity in the making of cards. Comments made by relatives on behalf of residents included, ‘My mother is not well enough to take part, but I know there are activities arranged,’ ‘activities are available but my mother prefers not to take part,’ and ‘activities usually take place in the afternoon when my mother takes her afternoon nap.’ Another comment was that the provision of activities depends on the availability of staff. The home has an open visiting policy and relatives and friends were encouraged to visit. One resident spoken with stated their relatives took them out sometimes to local restaurants and another resident enjoyed attending a club in the local community. ‘Residents are actively encouraged to participate in making choices’, the manager stated. Examples given were choosing when to get up and when to retire, which clothes they would like to wear, having music on or the television, and which programmes they would like to watch. As a result of listening to the people who use the service, the home had developed a four weekly seasonal menu, which included, breakfast, lunch, high tea and supper with snacks in between on request. A choice of menu was offered at each sitting and residents were able to eat where they chose. Most of the residents were eating in the dining room and socialising on the day of the site visit, but some residents preferred to eat the meal in their bedrooms. ‘Some residents like to dine outside, when the weather permits’, the manager stated, ‘and relatives and friends may join the residents for meals.’ Three of the seven residents who returned surveys always liked the meals and four usually did. Comments included, ‘there are two good people in the kitchen, who are great cooks,’ ‘the food is of a high standard,’ and ‘my mother eats very little, but I have seen the meals and they are very good.’ The dining room was nicely decorated, lit with wall lights and a chandelier, as well as natural light from large windows, and a large ornate mirror was hung on one wall Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 16 giving a feeling of elegance. Residents spoken with said they had enjoyed their lunch and the catering manager confirmed that special diets were catered for. Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 17 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 16,18 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Policies, procedures and training ensure the staff are informed and the residents are confident that their complaints will be listened to and that they will be protected from abuse. EVIDENCE: Six of the seven residents, who completed surveys, knew who to speak to if they were not happy and 100 knew how to make a complaint. The complaints policy was prominently displayed in the home and also included in the service user guide. Clear details were given of the process to inform the residents and their relatives and representatives. The AQAA recorded that five complaints had been received, and records sampled, confirmed they had been responded to and resolved within twenty-eight days. The manager stated in the AQAA, ‘we have an open and honest culture within the home and encourage everyone to speak up and have their say’. 100 of the staff, who completed surveys, also knew what to do if a resident, a relative or representative had concerns about the home. The Commission for Social Care Inspection had received no complaints on behalf of this service. The home had an up to date copy of the local authority safeguarding procedures, no secrets documentation, and a local procedure based on this to Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 18 clarify referral details for the staff. The staff-training matrix confirmed that the majority of the staff had accessed the Protection of Vulnerable Adults training and the AQAA recorded that this training was externally accredited and updated annually. No safeguarding referrals had been made. The AQQA recorded that the mental capacity act training had also been provided for the staff, that staff have been issued with ‘safeguarding adults leaflets’ and service users are given easy to read ‘preventing of abuse’ literature to raise awareness. Staff personel files sampled confirmed that enhanced Criminal Record Bureau checks had been carrried out prior to employment to safeguard the residents. Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 19 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 19,23,24,26 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The residents benefit from living in a comfortable, safe, pleasant, wellmaintained environment, which is clean and hygienic. EVIDENCE: Access to the home, by car, was through a residential estate and a secure gate prevented the grounds of the home from being used as a shortcut to the main road at the front of the home. This protected the residents from the likelihood of strangers walking through their garden. Some of the residents in the sheltered housing adjacent to the home were able to tap in the keypad number and use the shortcut as the residents and the staff knew them. The car park was at the front of the house and the mature grounds contained trees and shrubs, well-kept flowerbeds and lawns. There were hanging baskets and a Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 20 pagoda with clematis climbing up it. Pots of plants around the entrance to the home provided a welcoming touch and there was an outdoor seating area with tables and umbrellas for the enjoyment of the residents and their visitors. A tour of the premises confirmed the home was suitable for its stated purpose and it was clear that much effort had been exerted to ensure this was a homely and pleasant place for the residents to live. There were fresh flowers in the sitting room, framed pictures on the walls, plants, pleasant domestic lighting, and comfortable and appropriate furnishings for the enjoyment and comfort of the residents. Communal areas of the home consisted of an entrance hall, a dining room and a large sitting room with a conservatory extension, which had been fitted with blinds to ensure the residents didn’t get too hot in the sun. The corridors were rather narrow and not accessible by electric wheelchairs, which tend to be wider than the manual type. The home did, however, have ramps, lifts, moving and handling aids, adjustable beds and bespoke garden furniture to enable residents with physical disabilities to access and enjoy all areas of the home and garden to the same extent as those who were ablebodied. The home had a wet room to enable those who find bathing difficult, to shower, and specialist baths were provided in two of the four bathrooms. Residents’ bedrooms viewed were clean and fresh and some residents had brought items of their own furniture, pictures, photographs and decorative items such as ornaments and lamps and had their own televisions to make their bedrooms more personal. The manager stated that if new residents did not have a television, the home provided them with one. The furniture provided by the home was attractive and of good quality and many of the bedrooms had benefited from refurbishment, which had been carried out to a high standard and was well co-ordinated with respect to colours. The manager stated that all bedrooms are refurbished when they are vacated and new residents are encouraged to choose their own colour schemes and carpets and curtains. Some of the bedrooms viewed had ensuite toilet and washing facilities and all had a nurse call facility in case of an emergency. Appropriate laundry facilities were provided and hand washing facilities were available to promote infection control. Staff training records confirmed that infection control training was included in the mandatory annual updates for all the staff. 100 of the residents, who completed surveys, thought the home was always clean and fresh. Comments included, ‘The standards of hygiene and cleanliness are very good,’ ‘Superb standards of cleanliness. I have been here for three and a half years and have never known the home to be anything but fresh and clean,’ and ‘It is a homely type of nursing home and the carers are wonderful, so patient and kind.’ A staff member commented with respect to what the home does well stating, ‘the service maintains a friendly environment conducive to working, warm for Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 21 visitors and relatives and meets the needs of the service users. Independence for service users is promoted as much as possible.’ Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 22 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 27,28,29,30 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. A stable, safely recruited and well-trained staff team meet the needs of the residents and ensures they are in safe hands at all times. EVIDENCE: The staff rota showed that a trained nurse was always on duty to support the carers and that there were five/six carers working in the mornings, four in the afternoon/evenings and two overnight. An extra twilight person was employed because the residents chose their bedtimes, which were flexible. The manager stated that, ‘if the number of residents choosing to go to bed later rose, more staff would be employed’. The home had its own bank staff to call upon for absences, and the manager stated that agency staff were not used. Two of the eight staff, who completed surveys, thought there were always enough staff to meet the individual needs of all the people who use the service and six thought there usually were. One staff member commented, ‘we are fortunate to have enough carers and it is only sometimes when someone is sick that there are insufficient, but we do have bank staff to call upon.’ Six of the eight residents who completed surveys, confirmed the staff were always available when they needed them and one that they usually were except when rather busy.’ Other Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 23 comments included, ‘I am more than satisfied with the care provided by dedicated staff,’ and ‘I am very happy with Greenbanks. (On behalf of my mother) The staff are helpful, attentive and caring.’ The home also employed an administrator, a catering manager, a relief cook, catering assistants, a head housekeeper, four domestic staff, a laundress and a maintenance person/gardener. Records confirmed that at least 50 of the care workers had achieved a National Vocational Qualification (NVQ) at level 2 and two care staff had recently completed a NVQ at level 3. Two domestic staff had completed the NVQ in housekeeping and one kitchen assistant had completed the NVQ 2 in catering. ‘Six carers have applied for the apprenticeship in care which is an NVQ3 equivalent’, the manager stated. A staff member commented, ‘most of us have NVQ at level 2 or 3 or are working towards one. We also have inhouse training helping us to understand and meet the individual service users needs and be professional.’ One staff member commented, ‘over the past four years I have had excellent support and training from my manager and achieved NVQ at levels 2 and 3 and am completing on-going training for NVQ at level 4. Staff personnel files sampled were bound to protect the confidential information contained within them. Recruitment checks had been carried out prior to the offer of a post and full employment histories, with gaps explained and reasons for leaving had been completed, to ensure that only those suitable to work with vulnerable people would be considered for employment to safeguard the residents. Recruitment was in line with equal opportunities. The AQAA recorded that, ‘we have an equal opportunity policy, so that staff are treated with the same respect whoever they are and whatever their choice, as we would treat our residents.’ 100 of the staff, who completed surveys, confirmed they had checks carried out before they started work such as Criminal Record Bureau checks and references. The manager also stated that she always called referees on the telephone to confirm their identity as part of a safe recruitment process. A programme of staff training and development was in place and induction was in line with the Skills for Care Common Induction Standards. 50 of the staff, who completed surveys thought their induction covered everything they needed to know about the job when they stated but the other 50 stated it mostly did, as they had been employed some years ago. Staff training and development files sampled showed that induction training had been signed off as completed. The staff-training matrix showed that mandatory training had been accessed along with other training to support the staff with respect to the needs of the residents. This included dementia training, coping with aggression, diet and nutrition and risk assessment. The AQAA recorded that two staff had received specialist training in palliative care and more sessions Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 24 were booked. The home had been working with outside specialists, training groups and peer networking for best practice in falls management, diabetic care and nutrition. The AQAA recorded that, ‘mental capacity act training has been rolled out to all of the staff from October 2007 to the current time and we intend to introduce an externally verified accredited mental capacity training module for all the staff following recent cascade training to consolidate knowledge in this field and to ensure that all have the same level of knowledge’. The manager also stated, ‘we are planning on having additional equality and diversity training’. 100 of the staff, who completed surveys confirmed they are being given training which is relevant to their role, helps them to understand and meet the individual needs of the service users with respect to equality and diversity issues, and keeps them up with new ways of working. A staff member commented, ‘the training I have received over the last four years has been excellent.’ The manager was innovative in her methods of empowering the staff to take responsibility for their own developmental needs, and had set up a system for monitoring and recording training undertaken to facilitate the identification of training needs. Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 25 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 31,33,35,38 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Good leadership and systems in place ensure the home is run safely and in the best interests of the residents. EVIDENCE: The Registered Manager was well qualified as a Registered Nurse and holds a postgraduate Diploma in Management Studies (DMS). She has over twenty years of experience in both nursing and in management. The manager stated that she undertakes regular clinical updates and training, and the staff progress chart confirmed this. Her management style was open, transparent Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 26 and empowering and a staff member commented, ‘I have had excellent support and training from my manager.’ Another staff member stated, ‘I have worked in four homes in different parts of the country and Greenbanks scores very highly in my assessment of these homes. The staff work well here, as a team, and are happy in their work’. Systems were in place to ensure the views of the residents, their relatives and representatives and the staff contributed to the running of the home. Quality assurance questionnaires had been completed and visiting social and health care professionals had also been included. The results confirmed satisfaction with the standard of care at the home and there were many positive comments including, ‘the standard of care is very good’, ‘the staff take a personal interest in the comfort and needs of the residents, ‘I can’t speak too highly of the staff, I have encountered’, and ‘I am satisfied that my mother is well looked after in pleasant surroundings.’ An area relatives felt could be improved was in the provision of social activities. Comments included, ‘I am not sure mum’s needs are met on a one-to-one basis. She needs more stimulation to keep her mind active,’ ‘more outings and stimulation through musical entertainment,’ and ‘my relatives needs are not fully met, but it is difficult to run social activities when the staff are stretched.’ The results had been collated and used to inform the annual development plan. Staff and residents meetings were held to enable their views to be sought to contribute to the continuous development of the service. Some residents managed their own money and there were lockable units in each room for those whose wished to use them. The manager stated that the home looks after small amounts of money for it’s residents, that double signatures were required for transactions, receipts kept, and that audits were carried out monthly. The health, safety and welfare of the residents was promoted by regular staff training in moving and handling, fire safety, first aid, food hygiene and infection control. Certificates were viewed on staff personnel files to confirm this. The Annual Quality Assurance Assessment, completed by the manager confirmed that policies and procedures with respect to health and safety were in place, and that the essential maintenance of equipment had been carried out according to manufacturers’ recommendations. A sample of certificates were seen on the day of the site visit confirming that maintenance checks had been carried out in a timely fashion. Some things the staff thought the home did well were, ‘it creates a happy informal atmosphere for the residents, where their wishes are respected,’ ‘the service at Greenbanks always considers the well being of their residents first. I think this service is providing quality life for its service users,’ and ‘takes good care of the service users, visitors, family members and staff.’ Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 27 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 3 X 3 X X X 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 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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. Refer to Standard Good Practice Recommendations Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Greenbanks Nursing Home DS0000071223.V365345.R01.S.doc Version 5.2 Page 30 - 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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