Inspection on 31/01/06 for Greenbushes Nursing Home

This inspection was carried out on 31st January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Greenbushes Nursing Home 09/04/09

Greenbushes Nursing Home 14/04/08

Greenbushes Nursing Home 10/05/07

Greenbushes Nursing Home 09/10/06

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 Announced Inspection 31st January 2006 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.V279776.R01.S.doc Version 5.1 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.V279776.R01.S.doc Version 5.1 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 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.V279776.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of 10 places for service users receiving intermediate care, all to be located in the extension to the original building. 18 & 28 April 2005 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. Greenbushes Nursing Home DS0000064427.V279776.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was one of the two statutory inspections required in accordance with the Care Standards Act 2000. The inspector spoke to some staff, most residents and the visiting relatives of 2 residents, and together with registered manager Mrs Moore considered other evidence relating to the National Minimum Standards, as described in this report. The previous inspection took place over 2 days during April 2005; since that inspection two complaints against the home have been received and investigated by Dorset Social Care & Health, in association with the Commission. Both complaints alleged that poor care had been provided to particular residents; the allegations were not substantiated on investigation. During the course of investigation into the first complaint, the inspector conducted an additional visit to the home on 5 August 2005 and in the subsequent letter issued 7 requirements in respect of necessary improvements to the standard of the premises, and documentation associated with care provision. Following conclusion of the second complaint investigation during January 2006, the inspector again wrote to the home issuing 2 requirements for the improvement of documentation associated with care provision and medicine handling. Additional information used to inform the inspection process included the monthly reports regularly sent to the Commission by the provider organisation. The inspection was 5 hours in duration and focussed on assessment of only the most essential standards. Standards assessed and found met during the previous inspection were not reassessed during this inspection; this report should therefore be read in conjunction with the report of the previous inspection. What the service does well: The home provides good care to residents who are mainly medium and high levels of dependency and require nursing care; each resident has a documented plan of care. Residents are treated with respect, their privacy is Greenbushes Nursing Home DS0000064427.V279776.R01.S.doc Version 5.1 Page 6 protected and staff understand and meet their needs. Residents feel safe and well cared for. Residents are assisted to maintain as much independence as possible and are encouraged to maintain contact with the local community. The home is well equipped and suitably furnished; the premises are comfortable, with 3 lounges and a separate dining room. 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. Greenbushes Nursing Home DS0000064427.V279776.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenbushes Nursing Home DS0000064427.V279776.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3, 4 & 5 were assessed and found met at the previous inspection. The home does not provide intermediate care so Standard 6 does not apply. EVIDENCE: Greenbushes Nursing Home DS0000064427.V279776.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 & 9 (Standards 8, 10 & 11 were found met at the previous inspection) The standard of health care is good and is delivered in accordance with a written plan of care, to ensure staff have information necessary to provide correct care to each resident. Arrangements for handling medicines must be significantly improved to ensure that residents receive the correct medicines and that stock levels are properly monitored. An associated Immediate Requirement was issued during the inspection. EVIDENCE: Residents said they felt well-cared for and two visiting relatives expressed their satisfaction with standards of nursing care and the home in general. Risk assessments form the basis for care plans and daily records describe the care of each resident. The care records are kept in separate folders for each resident; interspersed with ‘in use’ documents were some out of date and super-ceded documents which could cause confusion and result in the Greenbushes Nursing Home DS0000064427.V279776.R01.S.doc Version 5.1 Page 10 provision of inappropriate care practice if they were followed; it is therefore recommended that out of date documents be separately stored. The home has recently obtained and commenced use of a second medicine trolley enabling one to be kept on each of the two floors to improve efficiency of medicine handling processes. Examination of medication administration records (MARs) and discussion with registered manager Mrs Moore confirmed that since at least 20 January 2006 a resident was not given a prescribed medicine because it was ‘out of stock’ in the home. Consecutive nurses had failed to report the non-availability of the medicine and the circumstance only became apparent when the inspector examined the records. Examination of MARs also indicated a number of ‘blanks’ where it was not possible to ascertain if prescribed medicines had been given or omitted. There was evidence that nurses had failed to adhere to established procedures and had instead signed to confirm administration had taken place after dispensing medicines, and before taking them to a resident – because when refused or for other reason omitted, the signatures had been crossed out. The inspector issued an Immediate Requirement for the improvement of these shortcomings. The home has not met the recommendation made in the report of the last inspection to reliably record the amount of medicine given when a variable dose (e.g. “give one or two tablets”) was prescribed. The recommendation is therefore repeated in this report. Greenbushes Nursing Home DS0000064427.V279776.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 (Standards 13, 14 & 15 were found met at the previous inspection) The quality of daily life in the home is generally good with residents assisted to maintain as much independence as possible. Arrangements for the provision of drinks and snacks should be improved to ensure that residents receive sufficient to drink and that drinks are properly served. Social and leisure activities are suited to the preference and ability of each resident. EVIDENCE: Residents are generally satisfied with the home; comments made to the inspector included “it’s certainly better than it was…the staff are better…I think that now it’s very good”. Since the previous inspection the range and frequency of recreational activities has been expanded; an activities organiser is employed for 30 hours each week and provides group and one-to-one activities including occasional excursions. Greenbushes Nursing Home DS0000064427.V279776.R01.S.doc Version 5.1 Page 12 The inspector observed the serving of mid-morning drinks and noted that some residents had a biscuit placed in their hand and no plate provided on which to place it. During the tour of the home the inspector observed a number of drinks placed beyond the reach of residents, including beakers left on tables by the side of residents confined to bed. The inspector assisted a number of residents to drink, including some confined to bed, who said they were thirsty and seemed glad of the inspectors interventions. It is recommended that the home reviews and improves procedures for delivering drinks and providing associated assistance to residents who require it. Greenbushes Nursing Home DS0000064427.V279776.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Complaints are managed properly and residents said they feel their concerns are listened to and taken seriously. The home has introduced measures to protect residents from abuse. EVIDENCE: Residents feel confident that if they had concerns or complaints they will be listened to and taken seriously. The home keeps records of all complaints received and investigated. Since the last inspection two complex complaints regarding standards of care involving aspects of Adult Protection, have been investigated by Dorset Social Care & Health; the main parts of the complaints were not upheld but some requirements and recommendations were issued to the home by the Commission. The home has developed and implemented written policies and procedures for the protection of residents from abuse or neglect and has provided staff with associated training. Greenbushes Nursing Home DS0000064427.V279776.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26 were found met at the previous inspection EVIDENCE: Greenbushes Nursing Home DS0000064427.V279776.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 30 (Standard 29 was found met at the previous inspection) The home employs enough staff to meet the needs of residents and to ensure their safety and comfort. Staff receive appropriate training to ensure they are competent to carry out their jobs. EVIDENCE: Staffing levels are provided in accordance with the assessed needs of residents. Registered manager Mrs Moore and student nurses are supernumerary; they are not included in the ratio of care staff to residents, by which staffing levels are determined. The inspector spoke to a number of staff, including a student nurse, care workers and household staff. All expressed support of management and the home, and said there were good opportunities for training. The provider organisation employs an independent trainer to supply instruction to staff on a variety of subjects including infection control, moving & handling, fire safety and food hygiene. Nurses are encouraged to receive training on subjects relevant to their work; the subjects of recently attended sessions include the use of nutritional Greenbushes Nursing Home DS0000064427.V279776.R01.S.doc Version 5.1 Page 16 assessment tools, the care of persons with swallowing difficulties and vulnerable skin. The home employs 14 care staff including 5 with a National Vocational Qualification (NVQ) in care. Two care staff are currently training for this award and will enable the home to meet the recommended standard for at least 50 of care staff to hold NVQ in care. Greenbushes Nursing Home DS0000064427.V279776.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 (Standards 31, 33, 36, 37 & 38 were found met at the previous inspection) The home does not manage the finances of residents. EVIDENCE: The home does not manage the finances of any resident; residents either manage their own monies or have relatives or lawyers undertake this on their behalf. Staff work in accordance with a collection of written policies and procedures to ensure continuity of approach and safe working practices. Greenbushes Nursing Home DS0000064427.V279776.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X X Greenbushes Nursing Home DS0000064427.V279776.R01.S.doc Version 5.1 Page 19 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 OP99 Regulation 13 Requirement All prescribed medicines must be accurately administered and recorded. Timescale for action 31/01/06 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 OP99 Good Practice Recommendations When a variable dose is prescribed (e.g. ‘give one or two tablets’) the actual amount given on each occasion should be recorded. This recommendation is repeated from the report of the previous inspection. The home should review and improve procedures for delivering drinks and providing associated assistance to residents who require it. 2. OP1212 Greenbushes Nursing Home DS0000064427.V279776.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greenbushes Nursing Home DS0000064427.V279776.R01.S.doc Version 5.1 Page 21 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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