Inspection on 10/05/07 for Greenbushes Nursing Home

This inspection was carried out on 10th May 2007.

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

Greenbushes Nursing Home 09/04/09

Greenbushes Nursing Home 14/04/08

Greenbushes Nursing Home 09/10/06

Greenbushes Nursing Home 31/01/06

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

CARE HOMES FOR OLDER PEOPLE Greenbushes Nursing Home 10 Weymouth Avenue Dorchester Dorset DT1 2EN Lead Inspector Gloria Ashwell Key Unannounced Inspection 10th May 2007 13:00 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 Greenbushes Nursing Home DS0000064427.V339352.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. Greenbushes Nursing Home DS0000064427.V339352.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenbushes Nursing Home Address 10 Weymouth Avenue Dorchester Dorset DT1 2EN 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) 01305 262192 01305 261117 greenbushes@bmlhealthcare.co.uk Dorchester Care Limited Liability Partnership Mrs Elizabeth Anne Moore Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Greenbushes Nursing Home DS0000064427.V339352.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. A maximum of 10 places for service users receiving intermediate care, all to be located in the extension to the original building. One named person (as known to CSCI) under the age of 65 may be accommodated to receive care. 9th October 2006 Date of last inspection Brief Description of the Service: Greenbushes is registered to provide nursing care to older people. It is a detached house on the southern edge of Dorchester, within walking distance of the town centre. The house is surrounded by gardens laid to lawns and flowers beds, with space for car parking. During 2004 an extension providing ten additional bedrooms and a large communal room was completed. The home comprises thirty-two single and five double bedrooms; seventeen bedrooms have en-suite toilet facilities. All registered parts of the home can be accessed without the necessity to negotiate steps or stairs; there is a passenger lift and some corridors are sloped. Laundering of clothing and household linen is carried out within the home at no additional cost to residents; items requiring dry cleaning are charged additionally because it is necessary to send them out of the home for this service. A hairdresser visits the home each week; there is an additional charge for this service. A public transport bus stop, for buses to the nearby town centre, is opposite the home. Fees are charged weekly; at present fees range between £550 and £700 per person. Greenbushes Nursing Home DS0000064427.V339352.R01.S.doc Version 5.2 Page 5 Information regarding the subjects Value for Money and Fair Terms in Contracts can be obtained from the web link: www.oft.gov.uk A report entitled Care Homes in the UK - A Market Study is available on web link http:/www.oft.gov.uk/NR/rdonlyres/5362CA9D-764D-4636-A4B1A65A7AFD347B/0/oft780.pdf Greenbushes Nursing Home DS0000064427.V339352.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was a key announced inspection that took place at the home over two days, comprising a total of seven hours. Additionally, time was spent in preparation for the visit, looking at previous inspection reports and other relevant documents and preparing a plan for the inspection visit. The inspector arrived at 13.00 on 10 May 2007 and spoke to residents and staff and toured the premises. By arrangement with the manager, she returned to the home at 10.00 on 11 June 2007 and assisted by the manager and the visiting Operations Manager discussed and examined documentation relating to the care provision and administration of the home. The care records of four people who live at the home were examined in detail. The inspector was able to meet and speak with most of the residents both individually and in small groups in the communal areas. Additional information used to inform the inspection process included the reports routinely sent to the Commission by the Registered Provider. What the service does well: People considering moving into Greenbushes receive a full assessment and are provided with the opportunity to visit and spend time at the home to make sure that it is able to meet their needs. Greenbushes provides a calm and comfortable environment to elderly people requiring nursing care. On the days of inspection the home was very clean and adequately staffed. The home is well equipped, attractively decorated and suitably furnished. The standard of general nursing care is good. Residents and their representatives are generally satisfied with Greenbushes; a resident said of the staff “They’re all very good”. Greenbushes Nursing Home DS0000064427.V339352.R01.S.doc Version 5.2 Page 7 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. Greenbushes Nursing Home DS0000064427.V339352.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 Greenbushes Nursing Home DS0000064427.V339352.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): 1&3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not provide Intermediate Care so Standard 6 does not apply. The Statement of Purpose does not give clear relevant information about the home so is unlikely to provide prospective residents and their representatives with an accurate understanding of the people for whom the service is intended. The service user guide is not provided in formats alternative to a standard typed document, so may not be appropriate to the needs and capacity of individual prospective residents or their representatives; they might find it difficult to read and fully understand. Prior to admission, the needs of each proposed resident are assessed to ensure the home will be properly able to meet them. Greenbushes Nursing Home DS0000064427.V339352.R01.S.doc Version 5.2 Page 10 EVIDENCE: The service user guide is made available to all residents and prospective residents. It contains general information about the home but does not include the outcomes of the most recent user satisfaction questionnaire. The Statement of Purpose and service user guide are available in a standard format; arrangements are at present underway to provide this information in alternative formats including a picture-based system. The Statement of Purpose does not fully describe the service and the people for whom it is intended; in particular, it omits reference to the current ‘conditions of registration’ stated in the introductory pages of this report prospective service users may thereby not have sufficient information upon which to base their decision to enter the home. The records of a recently admitted resident included details of pre-admission assessment carried out by a trained nurse who visited the person in hospital. The assessment records identified the needs of the prospective resident and enabled the staff to determine that the home would be able to properly meet them. The inspector spoke to the resident and to another recently admitted resident and her visiting relatives who all confirmed satisfaction with the home. Greenbushes Nursing Home DS0000064427.V339352.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): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of nursing care is good and care documentation ensures that staff have sufficient information upon which to base their care practice and to ensure that residents are all treated with respect and their rights are upheld. Medicines prescribed by doctors are safely stored and correctly administered. EVIDENCE: Care records of 4 residents were examined and found to contain risk assessments forming the basis for care plans and daily records describing the care of each person. However, there was insufficient evidence that individual residents or their representatives had been involved in the development and review of planned care provision; this report contains an associated recommendation. Greenbushes Nursing Home DS0000064427.V339352.R01.S.doc Version 5.2 Page 12 In accordance with a requirement made at the previous inspection, a falls policy/procedure has been developed and implemented. Medicine handling is carried out by registered nurses and medication administration records were properly kept indicating that residents receive prescribed medicines at the correct times and in correct amounts. Residents wishing to do so can manage their own medicines; at present none have chosen to do so. Residents are treated with respect and their privacy and dignity is protected at all times. Residents believe they are properly cared for; comments received during the inspection included “It’s very good….I’m quite satisfied”. Greenbushes Nursing Home DS0000064427.V339352.R01.S.doc Version 5.2 Page 13 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social and leisure activities are suited to the preference and ability of residents. Residents are encouraged to maintain contact with the local community and visits by their friends and relatives are welcomed by the home. Meals provide good nutrition and are liked by residents. Most residents take meals in the large dining room on the ground floor; others receive them in their bedrooms. EVIDENCE: The home employs an Activity Organiser for 30 hours each week to arrange local excursions, visiting entertainers, one-to-one and small group social and recreational activities. Greenbushes Nursing Home DS0000064427.V339352.R01.S.doc Version 5.2 Page 14 In recognition of a recommendation made in the report of the previous inspection, the role of this person has been reviewed to ensure routine availability to all residents; whenever possible, care staff accompany residents to hospital (previously, these ‘escort duties’ had often been carried out by the activity organiser). Accordingly, the frequency and variety of organised recreational and social activities has been improved. Visitors are welcome at any time and those the inspector spoke to said they are always made to feel welcome and placed at ease by the staff. Residents believe they are shown respect and properly treated; comments made during the inspection included “When I ring the bell they come quickly”. Meal provision has been the subject of recent review and a system of ‘enhanced diets’ is provided to residents who are assessed to be at risk of poor nutrition due to their condition. The manager said “We have listened to the residents” and accordingly the home has altered the menu to include more ‘finger foods’, fish, milk shakes and light meals. Greenbushes Nursing Home DS0000064427.V339352.R01.S.doc Version 5.2 Page 15 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 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure provides information on the procedure to follow to persons wishing to make complaint; all complaints are recorded and investigated but on one occasion since the last inspection the home has not properly adhered to its adult protection procedure. EVIDENCE: To ensure residents and their representatives have access to the complaints procedure it is included in the service user guide to the home and a copy is provided to each resident. Residents know how to complain and feel confident that if they had concerns or complaints they will be listened to and taken seriously. During the inspection a resident said that if there were cause for complaint “I would tell the manager”. During February 2007 a relative made two written complaints to the home alleging the ill-treatment of a resident by a particular member of staff. The home investigated and a written reply had been made to the complainant. The member of staff remains in the home’s employ and the outcome of the investigation was that there had been misunderstanding between the care worker and the resident, based on cultural issues. No further issues have been Greenbushes Nursing Home DS0000064427.V339352.R01.S.doc Version 5.2 Page 16 raised concerning this matter by the resident or relative and it is believed that the matter has been satisfactorily resolved. The inspector advised that a closing letter should be sent by the home to the staff member, clearly stating the outcome, and particularly noting if the allegation has or has not been substantiated. In accordance with the guidance of the Department of Health document ‘No Secrets’ and the home’s own policy/procedure for safeguarding adults, instead of conducting internal investigation this matter should have been reported to Dorset County Council (the lead investigator for such matters) and to the Commission. All staff have received training in the understanding and prevention of abuse; discussion with the manager and the Operations Manager indicated that the person responsible for the failure to properly report the allegation is no longer in the organisation’s employ. Greenbushes Nursing Home DS0000064427.V339352.R01.S.doc Version 5.2 Page 17 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Most parts of Greenbushes, particularly the newest parts of the premises provide a well-appointed and comfortable home. Some bedrooms and a sitting room in the older part of the building are scheduled for improvement to promote the greater comfort of residents. On the day of inspection the home was clean, pleasant and hygienic and there was evidence indicating that this is the usual standard of provision. Greenbushes Nursing Home DS0000064427.V339352.R01.S.doc Version 5.2 Page 18 EVIDENCE: Greenbushes is a partly traditionally built house, and partly purpose built extension. There are bathrooms equipped for the use of persons requiring assistance and comfortable communal rooms. In the older part of the building there are some first floor rooms including a small sitting room which present a somewhat bleak and institutional appearance; there is an ongoing programme of improvement to ensure provision of an attractive and essentially domestic environment. On the day of inspection the home was clean, tidy and comfortable throughout; there were no unpleasant odours. Greenbushes Nursing Home DS0000064427.V339352.R01.S.doc Version 5.2 Page 19 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home employs enough staff to meet the needs of residents and to ensure their safety and comfort and maintenance of the good condition of the premises. Recruitment practices ensure the protection of residents from potentially unsuitable staff. Staff receive appropriate training and are competent to carry out their jobs. EVIDENCE: The home is at all time in the charge of a trained nurse and staffing levels are provided in accordance with the assessed needs of residents to ensure that at all times sufficient staff are available to properly meet their needs. All staff spoken with during the inspection were enthusiastic about their work and felt that they provided a good standard of care to residents and are properly supported by the management and training provision. Greenbushes Nursing Home DS0000064427.V339352.R01.S.doc Version 5.2 Page 20 The records of two recently employed staff members were examined and found to contain all essential information including written references, an interview assessment, health details and evidence of identity. Criminal Records Bureau (CRB) disclosures are obtained for all staff in advance of employment. The home has developed and implemented a comprehensive induction process for all trained nurses, designed to ensure their familiarity with all aspects of the home and a clear understanding of their responsibilities. There is an enthusiastic approach to staff training; each month a training day takes place and all staff are required to undertake (and as necessary update) training in core subjects including fire safety, moving and handling, food hygiene and emergency aid. In addition, recent subjects led by a visiting professional trainer have included dementia care, wound care and end of life care. At present at least 50 of the care staff hold National Vocational Qualification in care, or an equivalent qualification; the home thereby meets the associated standard. Greenbushes Nursing Home DS0000064427.V339352.R01.S.doc Version 5.2 Page 21 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is properly managed, staff understand their work and receive training enabling them to properly care for the accommodated residents. The quality assurance system should be further developed to provide evidence that residents remain satisfied with all aspects of the home. The home does not manage the finances of residents. The premises and equipment are properly maintained in good condition to ensure provision of a comfortable and safe environment. Greenbushes Nursing Home DS0000064427.V339352.R01.S.doc Version 5.2 Page 22 EVIDENCE: Since the previous key inspection the registered manager has left the homes’ employ; Greenbushes is at present in the day to day charge of a trained nurse who application to become the registered manager is currently being processed by the Commission. The manager receives support and supervision from the Operations Manager. The manager is used to working in the home as the ‘head of care’ and demonstrates competency in this work. There are good processes for staff induction and training and for the formal supervision of staff. The systems for quality assurance should be enhanced to provide a systematic cycle of planning-action-review, reflecting aims and outcomes for residents. With the exception of safekeeping small amounts of cash on behalf of 3 residents (with records kept of all transactions) the home does not manage the finances of residents; residents who are unable to undertake this responsibility personally have nominated relatives, friends or other representatives to do this on their behalf. Records are kept of accidents, details of investigation and periodic audit, to ensure that risks can be identified and minimised. Staff trained in First Aid and health care are on duty in the home at all times. Examination of records indicated that staff receive training in fire safety at the required frequencies, and arrangements for the periodic checking of fire alarms and emergency lighting are generally satisfactory. Until recently a maintenance person employed some months ago had been unaware of the necessity of testing/checking the fire safety equipment; however, this work continued to be done on a quarterly basis by external engineers so that although the weekly and monthly checks did not take place, there were periodic checks. This oversight was identified by the manager and arrangements have now been made for the regular in-house maintenance of this equipment. The use of bedrails by some residents is in accordance with assessment; the manager records regular safety checks of the rails. To ensure full compliance with relevant Health & Safety guidance it is recommended that persons involved in assessing, installing, maintaining and checking bed rails receive training in this work. Greenbushes Nursing Home DS0000064427.V339352.R01.S.doc Version 5.2 Page 23 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 2 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 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Greenbushes Nursing Home DS0000064427.V339352.R01.S.doc Version 5.2 Page 24 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 OP1 Regulation 4 (1) also 6 Requirement The Statement of Purpose and service user guide must be improved to provide prospective service users with sufficient information to enable them to make an informed choice regarding admission to the home. The service must ensure that residents are protected from abuse and that established policies/procedures for the reporting and investigation of allegations are properly adhered to. Timescale for action 01/10/07 2. OP18 13 01/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP7 Good Practice Recommendations The statement of purpose and service user guide should be made available in alternative formats. Residents and/or their representatives should be involved DS0000064427.V339352.R01.S.doc Version 5.2 Page 25 Greenbushes Nursing Home 3. 4. OP33 OP38 in the development and periodic review of the care plan. The systems for quality assurance should be enhanced to provide a systematic cycle of planning-action-review, reflecting aims and outcomes for residents. All persons involved in assessing, installing, maintaining and checking bed rails should receive training in this work. Greenbushes Nursing Home DS0000064427.V339352.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Greenbushes Nursing Home DS0000064427.V339352.R01.S.doc Version 5.2 Page 27 - 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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