Inspection on 14/04/08 for Greenbushes Nursing Home

This inspection was carried out on 14th April 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

Greenbushes Nursing Home 09/04/09

Greenbushes Nursing Home 10/05/07

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 Unannounced Inspection 14 & 22 April 2008 10:00 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.V362283.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.V362283.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 www.greenbushes-nh.co.uk Dorchester Care Limited Liability Partnership Mrs Beverly Jane Welch Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Greenbushes Nursing Home DS0000064427.V362283.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. 10th May 2007 Date of last inspection Brief Description of the Service: Greenbushes is registered to provide nursing care to older people. The home is managed by BML Health Care on behalf of the provider organisation: Dorchester Care Limited Liability Partnership. Greenbushes 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; the fee range quoted in the service user guide at the time of inspection was (per person) from £550 for a shared room, from £600 for a single room and from £700 for single room with en suite hygiene facilities. Greenbushes Nursing Home DS0000064427.V362283.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.V362283.R01.S.doc Version 5.2 Page 6 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 this service experience good quality outcomes. This was a statutory inspection required in accordance with the Care Standards Act 2000. There have been no inspection visits to the home since the previous key inspection which took place on 10 May 2007. The first visit of this inspection was unannounced; the inspector arrived at 13.30 on 14 April 2008, toured the premises and spoke to residents, visitors, staff and the Registered Manager. By arrangement with the registered manager the inspector revisited the home at 10.00 on 22 April 2008 and with the Registered Manager and the visiting Operations Manager discussed and examined documents regarding care provision and management of the home. The General Manager of the management organisation was present at the conclusion of the inspection. The duration of the inspection (both visits combined) was 4 ¾ hours. The inspector also spoke to the nursing, care and household staff and most of the residents accommodated at the time both individually and in small groups in the communal areas, and observed staff interaction with residents and the carrying out of routine tasks. During the inspection, particular residents were ‘case tracked’; for example, for evidence regarding Standards 3, 7 and 8, records relating to the same residents were examined and the residents spoken with. In advance of the inspection ‘Have Your Say’ questionnaires were issued to service users by the Commission via Greenbushes; 22 completed forms were returned (3 from residents, 17 from residents relatives/representatives, 2 from staff of the home) and the information they contained has been used to inform the findings of this inspection. During this inspection compliance with all key standards of the National Minimum Standards was assessed. What the service does well: Greenbushes Nursing Home DS0000064427.V362283.R01.S.doc Version 5.2 Page 7 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 nursing care is good. Residents and their representatives are generally satisfied with Greenbushes; a resident said “I love it…they don’t crowd you…but there’s always somebody if you need them……the staff are marvellous”. 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. Greenbushes Nursing Home DS0000064427.V362283.R01.S.doc Version 5.2 Page 8 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.V362283.R01.S.doc Version 5.2 Page 9 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.V362283.R01.S.doc Version 5.2 Page 10 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 & 4 (The home does not provide intermediate care so St 6 does not apply) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prior to admission, the needs of each proposed resident are assessed to ensure the home will be properly able to meet them. EVIDENCE: The records of a recently admitted resident included details of pre-admission assessments carried out by two senior nurses when they visited the prospective resident at the previous address. In advance of making the decision to enter the home the closest relative of the prospective resident visited Greenbushes to view the premises and meet residents and staff. Greenbushes Nursing Home DS0000064427.V362283.R01.S.doc Version 5.2 Page 11 Following pre-admission assessment of each prospective residents needs and circumstances it is recommended that the home writes to them confirming the agreement and ability to provide accommodation and care. Greenbushes Nursing Home DS0000064427.V362283.R01.S.doc Version 5.2 Page 12 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 health and social care needs of residents are met by suitably trained staff; doctors and other professionals visit as necessary and residents receive the medicines they have been prescribed. EVIDENCE: The care records of 6 people who live at the home were examined in detail and found to contain risk assessments forming the basis for care plans and daily records describing the care of each person. There was evidence that individual residents or their representatives had been involved in the development and review of planned care provision. 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 Greenbushes Nursing Home DS0000064427.V362283.R01.S.doc Version 5.2 Page 13 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. (Reference is made in this report under Standard 33, regarding the prompt managerial response associated with aspects of staff behaviour.) A ‘Have Your Say’ questionnaire received in advance of the inspection from the relative of a resident stated “They keep X clean, make sure she has her medication. They all do their best. Everyone at Greenbushes has been v kind to X” and during the inspection a resident said “I am very happy here”. Greenbushes Nursing Home DS0000064427.V362283.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): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are underway to provide all residents with opportunities to engage in social and recreational activities. Residents are encouraged and supported to pass the time according to individual preference. A choice of menu is provided and meals are nutritional but there is room for improvement to ensure they are routinely appetising and suitable for all residents. EVIDENCE: Since the departure of the previous Activity Organiser during February 2008 the home has engaged visiting entertainers to enhance the daily routines of residents; at the time of the first visit of this inspection a musician was entertaining a large group of residents in the main lounge – many were participating in the singing of traditional music. A replacement Activity Organiser is in the process of being recruited, to be employed for 30 hours each week to arrange local excursions, visiting one-toone and small group social and recreational activities. Greenbushes Nursing Home DS0000064427.V362283.R01.S.doc Version 5.2 Page 15 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. ‘Have Your Say’ questionnaires received in advance of the inspection from the relatives of residents stated “We can visit any time, no need to make appointment” and “Very approachable staff; management are usually available to talk to”. Residents believe they are shown respect and properly treated; comments made during the inspection included “wonderful….the atmosphere…the staff…I feel safe”. However, a number of residents commented that on a number of recent occasions the way in which food had been cooked was not suitable for their needs. In particular it was said that sometimes the meat had been too tough to easily cut and chew, and frozen peas had been insufficiently boiled to soften them. These matters were discussed with the registered manager during the inspection; it is recommended that prepared meals are routinely monitored to ensure that food served to each resident is suitable for them, with particular regard for individual needs and preferences. Greenbushes Nursing Home DS0000064427.V362283.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. People know how to complain and are confident their complaints are listened to. Service users are safeguarded against risks of abuse in its various forms. 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 march 2008 a relative made a written complaint to the home alleging that standards of general care had been poor; the home investigated and 8 days after receiving the complaint held a meeting with the relative, with Minutes recorded. No further issue has been raised concerning this matter by the resident or relative. The complaint was promptly and properly managed. Greenbushes Nursing Home DS0000064427.V362283.R01.S.doc Version 5.2 Page 17 All staff receive training on the safeguarding of vulnerable persons and the home has implement associated policies and procedures. A concern raised by Social Services during routine review of a particular resident was fully investigated by Social Services during February 2008, in accordance with ‘safeguarding protocols’ and the Minutes of the closing meeting stated “there are no areas causing concern”. Greenbushes Nursing Home DS0000064427.V362283.R01.S.doc Version 5.2 Page 18 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. The home is properly equipped, comfortable, clean and suited to the needs of residents. 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, and a range of hoists to assist residents with impaired mobility. There is an ongoing programme of improvement to ensure the premises and equipment remains of good standard; specialist nursing beds and equipment for pressure relief are in good supply. Greenbushes Nursing Home DS0000064427.V362283.R01.S.doc Version 5.2 Page 19 On the day of inspection the home was clean, tidy and comfortable throughout; there were no unpleasant odours. At present, the staff call point of one bedroom is not in working order; the room is close to the staff office and the resident uses a hand-bell to summon assistance. As an interim measure this appears satisfactory; arrangements are underway for the entire call system to be replaced and it is recommended the necessary works are undertaken at the earliest opportunity to ensure all residents have access to a working call point. Work is underway to improve the grounds at the rear of the home; flower beds have been prepared for planting to provide an attractive outlook from nearby bedrooms. Greenbushes Nursing Home DS0000064427.V362283.R01.S.doc Version 5.2 Page 20 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. The home promotes the achievement of nationally recognised care qualifications. EVIDENCE: The home is at all times 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.V362283.R01.S.doc Version 5.2 Page 21 The records of two recently employed staff members were examined and found to contain all essential information including written references, 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 new staff, 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; clear records of staff training, supervision and appraisal are kept, indicating that all staff receive training appropriate to their needs. Nursing and care staff are required to undertake (and as necessary update) training in core subjects including fire safety, moving and handling, food hygiene, adult protection and emergency aid. Greenbushes Nursing Home DS0000064427.V362283.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. The home is properly managed, operates in the best interests of service users and protects them from risks of harm. EVIDENCE: Since the last key inspection Mrs Beverley Welch has become the registered manager; she has worked at the home for a number of years and was previously the deputy manager. She is well respected and liked by residents and staff. Greenbushes Nursing Home DS0000064427.V362283.R01.S.doc Version 5.2 Page 23 Mrs Welch receives support and supervision from the Operations Manager who visits frequently. The home has extensive processes for quality assurance; satisfaction surveys are periodically issued and the home has developed and implemented processes of internal audit reflecting aims and outcomes for service users. With the exception of safekeeping small amounts of cash on behalf of 2 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. The use of bedrails by some residents is in accordance with assessment, care planning and relevant Health & Safety guidance. Portable bedrails are rarely used; with few exceptions rails permanently fixed by the manufacturer to profiling beds are used. During the inspection a sample of records regarding equipment servicing and maintenance were examined and found to be in good order. There are good processes for staff induction and training and for the formal supervision of staff. All staff are supervised and each has a personal profile containing records of appraisal ensuring that performance standards are monitored and training needs are identified, in the interests of providing good care to residents. The home has a written assessment of the ‘Health & Safety’ of the premises and working practices and keeps records of fire safety checks and tests, including drills and staff training. Greenbushes Nursing Home DS0000064427.V362283.R01.S.doc Version 5.2 Page 24 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 2 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 2 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 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Greenbushes Nursing Home DS0000064427.V362283.R01.S.doc Version 5.2 Page 25 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 OP4 Good Practice Recommendations Following pre-admission assessment and consequent awareness that the identified needs can be met, the home should write to the prospective resident confirming the ability to properly care for them. Prepared meals should be routinely monitored to ensure that food served to each resident is suitable for them, with particular regard for individual needs and preferences. The necessary works should be undertaken at the earliest opportunity to ensure all residents have access to a working ‘staff call point’. 2. 3. OP15 OP22 Greenbushes Nursing Home DS0000064427.V362283.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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.V362283.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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