Inspection on 19/06/07 for Greenfield Nursing Home

This inspection was carried out on 19th June 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Greenfield Nursing Home 22/04/08

Greenfield Nursing Home 09/02/06

Greenfield Nursing Home 07/07/05

Greenfield Nursing Home 02/03/05

Greenfield Nursing Home 21/06/04

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

CARE HOMES FOR OLDER PEOPLE Greenfield Nursing Home Tag Lane Ingol Preston Lancashire PR2 7AB Lead Inspector Denise Upton Unannounced Inspection 09:00 19 & 20th June 2007 th 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 Greenfield Nursing Home DS0000006046.V338190.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. Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenfield Nursing Home Address Tag Lane Ingol Preston Lancashire PR2 7AB 01772 723745 01772 760836 CLIFFORR@BUPA.com www.bupa.com BUPA Care Homes (CFHCare) Limited 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) Care Home 112 Category(ies) of Dementia (48), Old age, not falling within any registration, with number other category (63), Physical disability (1) of places Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The home is registered for a maximum of 112 service users to include: up to 48 service users in the category of DE (Dementia), up to 63 service users in the category of OP (older people over 65 years of age) and 1service user in the category PD (physical disability). 9th February 2006 Date of last inspection Brief Description of the Service: Greenfield Care Home with Nursing is part of BUPA care homes and is situated on the outskirts of northern Preston. The home is a purpose built modern property made up of four units. Oak, Elm, Beech and Maple. Each unit serves the needs of different residents who are assessed prior to admission to identify the unit that will best meet their needs. The home is currently registered to accommodate up to 112 residents. This includes people assessed as requiring nursing care, people assessed as requiring assistance with personal care and the home also provides care for people affected by dementia. There is a local garage/newsagent across the road from Greenfield Care Home along with a modern pub that serves food daily. The home is accessible to the motorway and the local bus service regularly passes the home. Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a midweek day and the majority of the following day and in total spanned a period of approximately fifteen hours. On the first day, two inspectors conducted the inspection and on the second day a single inspector completed the inspection. During the course of these visits, all of the key national minimum standards identified in ‘Care Homes for Older People’ were assessed. The inspector’s spoke with the manager, cook, administrator, handyman, an activity organiser, a member of the domestic care team and a variety of qualified nurses and care staff during the inspection. In addition, individual discussion took place with eight residents, five relatives and a District Nurse. Brief informal general discussion also took place with several other residents, in communal areas of the home. Time was also spent observing the midday mealtime in one unit and sitting with residents. A number of records were examined and a complete tour of the building took place. Prior to the inspection, nine residents completed the Commission For Social Care Inspection (CSCI) survey and eleven relatives/carers also completed the Commission for Social Care Inspection relative/carer survey. This provided further information on how residents, relatives/carers felt that Greenfield Care Home was meeting the needs and requirements of people who live at the home. The majority of comments made were positive with a few constructive criticisms. Information was also gained from the Annual Quality Assurance Assessment completed by the manager. The total key inspection process focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. The current scale of fees is £374.00 to £682 50 weekly. What the service does well: The home has a group of staff that work well together and want to provide a good quality of care for people that live there. Residents spoken with were comfortable living at the home and got on well with the staff team. One relative said that, “ I am happy that there always seems to be enough staff to care for my mother. They always make sure she eats and drinks and they keep her clean and comfortable. I am pleased with the overall care provided.” Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 6 There is a good system in place to make sure that the individual needs and requirements of any prospective resident are known before a new resident is admitted. This makes sure that the home can provide the level of care and support required. There are also good systems in place to find out what residents and their relatives/friends feel about how the home is meeting individual needs and requirements. This encourages people to have their say and helps bring about changes in the home. Greenfield Nursing Home has also been awarded the ‘Investor In People’ award, which is a nationally recognised quality assurance system and only awarded when a home has achieved a certain standard. What has improved since the last inspection? What they could do better: Care plans that tell staff what the individual resident can do independently and what help they require or what interests they have could be better to inform staff of all the requirements of the individual including social, religious and cultural wants and needs. An activities programme is available however some people feel that there are not enough activities suited to their needs for them to participate in. The manager at the home is aware of this and is trying to make sure suitable activities are provided regularly both within the home and the wider community. The recording of medication administered could on occasions be more accurate to help protect residents. Further members of staff should be provided with nationally recognised training that is specific to the job undertaken by that care staff. This would ensure a well-qualified staff group that offers a consistent service to residents. Greenfield Nursing Home DS0000006046.V338190.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. Greenfield Nursing Home DS0000006046.V338190.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 Greenfield Nursing Home DS0000006046.V338190.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): 3 Quality in this outcome area is good. Greenfield Care Home has a system in place to assess the needs and requirements of prospective residents prior to admission. This is to make sure that the home can provide the level of care and support required and fulfil the expectations of the prospective resident. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People are only admitted to the Home if their individual needs and requirements could be addressed. It was clearly evident that the needs of people wishing to move to Greenfield Nursing and Residential Care Home had been assessed prior to admission, so that the staff team were confident that individual requirements could be adequately met. Prior to admission a senior member of staff visits the prospective resident in their current environment to undertake the initial assessment of current strengths, needs, wants and wishes Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 10 and to provide further information in respect of the home and facilities and services provided. This is coupled with an invitation for the prospective resident and/or their family to undertake an introductory visit to the home to assess the accommodation for themselves, meet staff and existing residents in order to make informed choice. The pre admission assessment carried out by the senior member of staff at the home is often further supplemented by information made available from professional assessments undertaken by a social worker or through hospital discharge information. This combined information then provides the basis of the initial care plan. One person spoken with said that no one from the home had visited her before she was admitted. However, an assessment was available on file to show that her needs had been determined before admission to the home. Three relatives spoken with said that they had been given enough written and verbal information about Greenfield Care Home to decide if the home was a suitable place for their relative to live. The manager explained that a new kind of form is being introduced to record information about the individual needs and requirements of a prospective resident. This form is very comprehensive and should provide staff with sufficient information to devise a detailed care plan to include the medical/personal care, social, religious, cultural and emotional needs of the prospective resident. Greenfield Nursing Home DS0000006046.V338190.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 adequate. Although in the main there is a clear care planning system in place, the information provided is on occasions inadequate and does not provide staff with the information they need to ensure a consistent service. The health care needs of residents are well met with evidence of good multi disciplinary working taking place on a regular basis. The systems for the administration of medication are generally good however staff do not always follow the home’s procedures for recording the administration of medication that could potentially place people who use the service at risk. Generally privacy and dignity is addressed well at this home that ensures people are treated with respect. This judgement has been made using available evidence including a visit to this service. Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 12 EVIDENCE: During the course of the inspection, the care of four people living in different units at the home was ‘case tracked’. Care records showed that relevant assessments had been conducted on admission for those requiring some level of nursing care input, which provided staff with information about the nursing needs of people living at the home. For example, the plan of care examined on one house was, in general, wellwritten and provided staff with clear guidance about the needs of this individual and how these needs were to be appropriately met. However, the plan in relation to dementia care could have been more detailed, so that staff were informed of how these specific care needs could be best met. This plan of care was not being consistently followed in day-to-day practice, as recorded instructions indicated that this one person needed to take in a certain amount of fluid each day, in order to prevent dehydration. However, this was not being monitored or recorded, to ensure that the instructions were being followed. In another house the plan of care examined was very well-written, showing that all assessed needs, in relation to health and personal care, had been taken into consideration when drawing up the care plan, so that staff knew how to provide a good level of care for this individual. Any changes to the care needs of this person were clearly reflected and the plan of care had been reviewed on a monthly basis to ensure that current health and personal care needs were recorded. However, there was little evidence available to demonstrate that social care needs had been taken into account when developing the plan of care, to show that the resident was supported in maintaining any leisure interests or religious/cultural needs whilst living at the home. There was no evidence to show that the resident or their relative had been given the opportunity to be involved in the care planning process, thereby, allowing them to make some decisions about the care provided. A variety of risk assessments had been conducted in respect of this person, so that any hazards were identified and methods implemented in order to eliminate or reduce the element of risk. The commitment to developing a holistic care plan was variable. The level of information recorded on the plans of care seen varied in detail and tended to focus on what a person’s dependency needs were rather than also highlighting what that person strengths were and how these could be promoted. Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 13 Some of the of care plans seen identified an aim but did not necessarily direct staff as to how this aim was to be achieved. For example, one care plan stated, “To maintain privacy and dignity at all times” but failed to direct staff how this was to be achieved. In another instance the care plan stated, “to offer diversional therapies” but not which diversional therapies and how and when these were to be offered. Likewise the commitment to undertaking or review relevant risk assessments was mixed. It was noted that a specific resident had bedrails fitted to her bed. Although a bedrail risk assessment form was available in the case file this had not been completed even though the bed rails were in use. A manual handling assessment has also not been completed. In another situation a resident was observed to have to have a bruised face. It is understood that this was the result of a fall from the end of her bed when bedside rails were in place. Although a risk assessment had been undertaken in respect of the bedrails, there was an instruction to review the risk assessment every three months or sooner. There was no evidence to suggest that this had been done. It was also evident that even after the injury had been sustained this had not prompted an automatic review of the risk assessment in place in respect of the bedrails. Relevant risk assessment should always be undertaken when a risk has been identified. The significant outcome of the risk assessment should be incorporated in the individual plan of care to ensure all staff are aware of the findings. All risk assessments should automatically be reviewed on at least a monthly basis in conjunction with the review of the care plan. Records seen showed that a variety of other professionals were involved with the care of people living at the home, to ensure that their health care needs were being fully met. A district nurse was visiting the home on the day of the site visit in order to administer insulin to a residential resident. She confirmed that she visited the home daily and that the staff were always co-operative and that she had no concerns about the care of the people living at Greenfields. One person living at the home confirmed this when stating, “the staff look after me very well and they are kind to me”, and another stated, “staff do things for me, but they are short staffed and are always very busy”. In general, the management of medications was satisfactory, so that people living at the home were adequately safeguarded from any medication errors or drug misuse. However, not all hand written entries on the medication administration records had been signed, witnessed and countersigned to reduce the possibility of any errors being made when writing out the prescriptions. Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 14 There were several gaps on the medication administration records observed, so it was not possible to determine, in these instances if medications had been consistently administered. This suggests that staff are not checking the medication properly prior to administration or signing the medication administration record immediately after administration. In order to protect residents it is essential that the correct procedures for the administration and recording of medication be consistently followed. The medication cassettes did not show a description of the tablets prescribed, therefore staff may not have been sure which tablets had been refused or omitted for any reason. Eye preparations were dated on opening so that staff, were aware of the expiry date. Where variable dose medications had been prescribed, the amount administered was recorded on the medication administration records. A record was retained of medication destroyed so that the possibility of the misuse of drugs or medication errors was minimized. Residents spoken with felt their privacy and dignity was respected and that staff were sensitive when they needed help with personal care. Staff in the main, were seen to be respectful and mindful of residents feelings with one resident saying, “They (the staff) respect me as a person. They respect my privacy and provide me with dignity”, and another commented, “the staff are all very good but they are always extremely busy” Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 15 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. Residents are encouraged to maintain contact with the local community and their family and friends to ensure these relationships are sustained. Residents experience a lifestyle that does not always satisfy their social or recreational interests and needs. Dietary needs of residents are well catered for with a balanced and varied selection of food available that in the main meets service users taste and choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As evidenced during the course of the site visit, social relationships are encouraged either through family/friends visiting at a time of the resident’s choice or visits out in the community. Five relatives spoken with all felt that they were made welcome to the home. One said, “We are always offered a drink”, and another commented, “I feel very comfortable visiting the home”. Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 16 Although residents spoken with felt that a good standard of health and personal care was provided at Greenfield Care Home, comments about social activities made available were more mixed. Evidence of social activities taking place on a regular planned basis within the home was available however the amount of time made available for staff directed activities were limited. One resident spoken with also said, ““There are not many activities provided, but yesterday we played bingo”, and another commented, “There are no trips out, but I don’t get bored. I have my TV and radio to keep me occupied and I like reading.” Another person said, “We go out sometimes and sometimes we sit and watch the entertainment here. I like living here”. A programme of activities was displayed in each house, so that those able to access it were aware of the entertainment and pastimes available. A relative, who lives some considerable distance from the home, also commented on a Commission for Social Care Inspection survey that, “My mother is intelligent and not at all senile. She walks very well but does not get out enough i.e. trips to town etc. She went six months without a trip out”. Another relative stated when asked how the care home could improve “maybe more activities. Keep them more stimulated. On nice days get some fresh air outside” Currently there is one full time activity coordinator and two part time activity organisers who work a few hours a week. There is a timetable for activities facilitated by the activities coordinator that take place twice a week in each unit. However these are in the main group activities and do not appear to link into any individual social/recreational interests identified on the individual care plan. The activities coordinator acknowledged that the coordinator’s time is stretched and stated that an additional full time activities coordinator would make a real difference. Although some residents are given opportunity to go out with the activity coordinators, this is often a very small number of residents, may be two from each unit at a time however this leaves the rest of the residents on that unit without any input from the activities coordinators. It is understood that plans are in place for an additional full time activity coordinator is to be appointed in the near future Some ‘in house’ activities do however take place and the activities coordinator stated that she did try and find something for each resident to do whatever their dependency level. Birthday parties are arranged, local school choirs visit at Christmas and Easter, entertainers visit the home, arts and crafts, film shows, armchair exercise, music, sing a long are all arranged and reading/talking with residents does take place. Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 17 ‘One off’ events are also arranged and residents are helping to arrange a “Fruity Friday” and a summer fair that is planned to take place in the near future. The home’s manager is aware that this is an area that should be further developed. This would ensure that as many residents as possible are given opportunity for stimulation through leisure and recreational activities both inside and outside the home that suits their individual needs, preferences and capacities. This is particularly important in respect of people with dementia or other cognitive or physical disabilities who may not be able to enjoy some general activities made available. In these situations it is important that activities arranged take into account their specific needs, requirement and wants that is clearly identified on their individual care plan. Residents at Greenfield Care Home are encouraged to maintain control of their own financial affairs for as long as they wish to and have capacity to do so or are assisted in this task by their family. Details of advocacy services are made available for residents to access if and when they choose. Information was displayed in the reception area telling people how they could contact the local advocacy service should they wish to appoint a person to act on their behalf. Lunch was observed being served on one of the units. People were asked what they would like for their lunch from the menu available. It was noted that a high number of people sitting at the dining tables were in wheelchairs, which did not always promote choice. People were not routinely asked if they would like to sit in a dining chair and although it is recognized that people may prefer to sit in their wheelchairs when dining, then this should be written in the plan of care. The management of meals on this unit should to be reviewed so that the dignity of people living there is better promoted. One member of staff was seen to be standing at the dining table whilst assisting two people with their lunch at the same time. The staff member carried out this activity in a disinterested manner, during which very little conversation took place. Another member of staff was seen assisting one resident with her lunch in an unhygienic manner by blowing on the food before offering the food to the resident. This concern was raised with the nurse in charged of the unit at the time of the observation who dealt with the situation in a confidential manner. It was pleasing to see that specialized cutlery and crockery was provided for those needing a little help with their meals, so that independence was being actively promoted. Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 18 It was also pleasing to see that a ‘Nite Bite’ menu had been introduced so that people living in the home were able to access snacks and beverages throughout the night if they so wished. One person living in another unit said, “the food is lovely,” And another person said, “The food is very good. Don’t let them tell you otherwise, it is delicious”. However two relatives passed comment on a Commission for Social Care Inspection survey form about the food served in that they would like to see more nutritious meals served. One of these relatives also commented that food sometimes goes cold when it is left on one side until a carer is available to assist the resident to eat their meal. Other relatives however were pleased with the meals served describing the food as ‘very good’. Another relative wrote, “The meals are lovely and fresh and hot and you have a choice of food” The catering facilities were visited and were found to be clean, tidy and well organized, with a good supply of fresh fruit, vegetables and general food items, showing that people were provided with a nutritious diet. Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 19 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. The home has a satisfactory complaints system Complaints are handled objectively and residents are confident that their concerns would be listened to. There is a vulnerable adult procedure in place to ensure a proper response to any suspicion or allegation of abuse however some staff have yet to receive training in respect of this topic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaint procedure at Greenfield Nursing Home is made available to residents in the written information they receive at the time of their admission and is displayed in communal areas of the building. Since the last inspection, 25 complaints were received ‘in-house’ and investigated. The vast majority of these were resolved within 28 days. 22 of the complaints received were upheld. A number of residents and relatives spoken with were aware that the home had a complaint procedure and knew whom they should speak with if they had a complaint. One resident said, “ If I needed to make a complaint I would tell the nurse” However another resident said they would not know how to make a complaint or what they would do if they were unhappy about something. It is Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 20 suggested that residents are reminded about the complaint procedure and whom they should speak with if they were unhappy about anything. Greeenfield Nursing Home has a variety of policies and procedures for the protection of people who live at the home. These include an Adult Protection Policy based on the `No Secrets in Lancashire` document and a whistle blowing policy to protect residents from abuse or discrimination. As part of the organisations staff-training programme, some staff have been provided with adult abuse training. However there is still a number of staff that have yet to receive this important training. This was confirmed by a qualified member of staff who also stated that she felt staff working with people with dementia should also be provided with breakaway technique training and restraint training in order to protect both themselves and residents. It is understood that adult abuse training with be provided to staff that have not undertaken this training through a rolling programme of staff training. Two members of the care staff team spoken with were clear of their responsibility should an allegation of abuse be made to them by a resident. Currently one alleged adult abuse enquiry is ongoing. The management team at Greenfield Nursing Home responded quickly and appropriately to this issue for the protection of residents. Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 21 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): 16 & 18. Quality in this outcome area is adequate. The décor and the layout of internal accommodation is variable. Although resident accommodation does not pose a risk to residents, it does not always create a pleasing and pleasant place to live in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at Greenfield Nursing Home live in a generally safe environment however areas of the building are in need of attention including refurbishment and redecoration in order to provide a more homely place to live. Although some bathrooms have been updated recently and it is understood that this will be an ongoing programme, a substantial number of bathroom and toilets still require updating. A number are uninviting and bare looking and clinical and do not provide a pleasing or attractive environment. In one Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 22 bathroom a number of tiles were missing or broken, in various other bathrooms, including those recently updated, extensive pipe work was exposed that clearly did not provide a domestic type environment and in another bathroom the ceiling needed to be repaired and attention given to the flooring. In one unit, an over the toilet frame was not fixed to the wall. This meant that a resident could have sustained an injury if the toilet frame has slid away from them or if a resident had put any weight on one side of the toilet frame this could have caused it to tipple over. This was discussed with the manager at the time of the visit and the matter was attended to. It was very obvious that the safe storage of equipment at the home is a serious issue. A variety of bathrooms were cluttered with equipment and used as equipment storage areas. This impacted on availability of bathrooms in registered accommodation for residents to access and again did not provide a pleasant environment. These should be removed to a more appropriate storage area so that people living at the home are given the opportunity to use these bathrooms, if they so wish. Like wise some of the corridors were bare, looked institutional in character and in some places were badly damaged and in need of repair to ensure that the maintenance of this home was maintained to an acceptable standard. These areas could have been greatly improved by bright and modern redecoration suited to the resident group accommodated, that residents help to choose to provide an interesting and a more pleasing environment. Some bedrooms were also very sparse looking, with bland painted walls and little decoration. This again did not present as a homely environment. In some bedrooms a lino type of flooring was provided rather that carpet. Whilst this may be appropriate in some situations, in some instances there was little evidence to suggest that carpet was inappropriate for the current occupant. Furniture was comfortable and generally attractive. However the layout of the lounge area in some units were institutional looking with seating round the outside of the large room rather than in smaller groups that would allow residents and relatives/visitors to talk easily in more convivial surroundings. However in another unit, the lounge area was comfortable and nicely organized so that people were sitting in small groups in order to encourage conversation and interaction. This provided a more homely environment. This issue was also commented on by a relative who completed a Commission for Social Care Inspection comment card when it was stated, “ Have the lounge area more like a ‘lounge’ with the chairs spaced attractively rather than lined up close together against the wall. This makes conversation very difficult when visiting. A separate ‘quiet’ lounge, away from the television would also be an improvement”. Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 23 It was pleasing to see photographs of the resident and their loved ones outside individual bedrooms of people with dementia in order to help people recognize their family and friends. However, in one bedroom on this house there was a strong odour, which did not provide a pleasant environment for the person living in this room. Other bedrooms were odour free. It was noted that bedroom doors in some houses were fitted with lockable devices so that the privacy and dignity of people was protected. The manager told the inspectors that the people living in this unit were able to retain their own bedroom door keys if they so wished in order to safe guard their personal belongings. One person said, “I am happy with my bedroom. It is comfortable”. However in other areas, bedroom doors had not been provided with a lock. A lockable devise on each individual bedroom door should always be considered. Whilst it is acknowledged that for some people holding their own key to their bedroom may not be appropriate, this should be determined through a risk assessment process and highlighted in the care plan. If a resident who has capacity chooses not to hold the key to their bedroom the risks should be pointed out to the resident and their decision recorded. It was pointed out by a member of staff, that certain residents have to stay in their bedroom accommodation even though that particular person would benefit from the stimulation of being with other residents. It is understood that this is because the person’s bed or specialist chair cannot go through the bedroom door and staff cannot use a hoist if the resident is unsafe. The same member of staff said that as there is only limited time to spend with residents that are not in the lounge area and this impacts on the quality of life of the individual concerned. The home was clean and discussion with a member of the domestic staff team confirmed that sufficient cleaning materials and equipment is available to ensure the environment is maintained to an acceptable standard. The laundry area was suitable for the needs of people living at the home and it was well organised, providing sufficient equipment, so that laundry was completed in a timely fashion. Detailed policies were in place at the home to ensure that the control of infection was being adequately met so that the health and safety of people living there was appropriately safeguarded. . Laundry services are appropriately sited away from kitchen and dining areas and do not intrude on residents. The outside area of the home was attractive and provided with seating however the wall outside the laundry department was damaged and in need of repair in order to provide an acceptable standard of maintenance throughout the home. Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 24 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. There is a good skill mix of staff providing an appropriate service to people living at the home. The number of care staff that have achieved a nationally recognised National Vocational Training (NVQ) in care is limited. Staff should be encouraged to undertake this qualification in order to help ensure a good quality, consistent service is provided. There is a structured and robust recruitment process applied in order to protect residents. Induction training provided to care staff meets national guidelines. This ensures that people are trained to do their job. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff duty rota examined showed which staff were on duty at any time of day or night, demonstrating that a good skill mix of staff and adequate staff numbers were deployed to ensure that the assess needs of the people living at the home were being sufficiently met. Additional staff are on duty at peak times of activity and sufficient ancillary staff are employed to ensure standards Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 25 in respect of domestic and catering arrangements are maintained. During the daytime and evening period, designated care staff were normally assigned to the same unit so that consistency of care was being provided. However a number of comments were made about staffing levels at the home. In answer to the question on the CSCI survey forms ‘Do you always receive the care and support you need?” one person wrote ‘always’ “ but I sometimes have to wait a long time to be toileted because the staff are very busy”. Another relative wrote “Not always. We think because of staff shortages” Another resident in answer to the same question stated “If they are not available they are busy somewhere else”. A further comment from a relative said “Sometimes the patient has to wait for some time to be taken to the toilet, after they have asked and this can be distressing for them”. However another comment by a relative stated “ I am happy that there always seems to be enough staff to care for my mother. They always make sure she eats and drinks and they keep her clean and comfortable. I am pleased with the overall care of my mother”. The recently appointed manager stated that she was aware that comments had been made about the staffing levels in the home but considered this to be more related to time management issues and inherent routine practices within the home rather than insufficient staff on duty. It is understood that the manager is planning to review the current practices and address this issue. There is a commitment to the training and development of all staff at Greenfield Nursing Home. However, the number of care staff that has successfully achieved a nationally recognised NVQ Level 2 qualification in care is limited. It is recommended that at minimum, at least 50 of the care staff team should be qualified to NVQ Level 2 in care in order to provide a good quality and consistent service. A small number of care staff are currently undertaking this training and a further small number of staff has achieved a more advanced NVQ Level 3 of this award. BUPA Healthcare has in place a structured recruitment policy and procedure that helps to protect residents. Since the last inspection, new members of staff have been appointed. From observation of four recently appointed staff member’s personnel file, it was evident that the recruitment policy and procedures had been followed. This included an application form, health questionnaire, formal interview, references and a Criminal Records Bureau (CRB) POVA clearance had been obtained prior to the applicant actually taking up post at the home. A recently appointed member of staff confirmed that procedures had been followed and she was not allowed to take up post at the home until satisfactory references and a CRB (POVA) clearance had been received. Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 26 An induction-training programme is provided that was comprehensive and detailed and compliant with a nationally recognised induction-training programme for care staff. This is provided to care staff within the first six weeks of their employment to ensure they were deemed competent to do the job expected of them. A variety of mandatory training courses were provided for staff to ensure that people working at the home were kept up to date with current practices and so that they were encouraged to maintain their personal development. However, some training records showed that updates were needed in a number of training areas and although infection control issues were covered on induction, only basic information was provided at that stage. More in-depth infection control training should be available to ensure that staff are fully aware of measures to reduce the possibility of cross-infection. Likewise it was evident that some staff have received dementia care training but it was difficult to establish just who had received this training as a full staff-training matrix was not available and it was unclear if the training records held in the houses were up to date and accurate. A Clinical Service Manager has now been appointed who will review current training and establish a new training plan for the staff team. People living at the home spoken with were positive in their comments regarding the staff group. The interaction observed between staff and those living at the home was friendly, informal and comfortable, which made those living at the home appear happy and content. Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 27 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): 31,33,35,36 & 38. Quality in this outcome area is good. The manager is qualified, experienced and supported by the senior staff in providing clear leadership throughout the home. The home regularly reviews aspects of its performance through a good programme of self-review and consultations, which include seeking the views of residents, staff, relatives and other people associated with the home. Financial procedures in respect of residents monies and the safekeeping of valuables is robust, this protects the interests of people who live at the home. Systems are in place to ensure as far as possible the health and safety of residents, staff and visitors. This judgement has been made using available evidence including a visit to this service. Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 28 EVIDENCE: At the time of the site visits, Greenfield Nursing Home did not have a manager registered with the Commission For Social Care Inspection. The home had been without a manager for approximately four months and it appears that during this time standards had been allowed to slip. However, a new manager was recently appointed and an application to register this person as registered manager will be submitted to the Commission For Social Care Inspection. The prospective registered manager is a registered nurse, well qualified and experienced and has also undertaken a variety of further training to increase her skills and knowledge base. Staff spoken with made positive comments about the recently appointed manager and felt well supported by her. One member of staff felt the manager was “very good, very keen”. Effective quality monitoring and quality assurance systems are in place and the home has achieved the ‘Investors In People’ award. The home regularly reviews aspects of its performance through a good programme of self-review and consultation. This includes annual anonymous resident/relative feedback questionnaires to establish if the home is meeting resident/relative expectations. Feedback on the outcome of the questionnaires is provided once the results are known. A stakeholder questionnaire is also provided to other professionals such as General Practitioners and District Nurses for their opinion as to whether the home is providing a good quality service. In addition, residents and relatives provide information through informal on going discussion with staff. The external management of the organisation also conduct a monthly internal quality audit with detailed feedback given to the wider organisation and registered manager. Staff team meetings have recently been re-established at regular intervals and minutes were displayed on each house and also were available in the staff room so that people could read about any discussions that took place during the meetings. The registered manager told us that information was also passed onto staff through their unit managers, memorandums and notices, so that staff were kept well informed of any relevant information. Resident’s financial interests are safeguarded by the corporate financial procedures adopted by the home. All residents wherever possible, are encouraged to remain financially independent or assisted in this task by a family member or independent advocate. However good accounting systems are in place for when staff are required to handle residents monies or items Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 29 held in safe keeping. All transactions are appropriately recorded and secure facilities are provided for the safe keeping of monies and valuables held on behalf of the resident. In respect of residents who’s monies are kept in a separate resident account held by the company, generous interest is paid on a monthly basis. There is a programme of staff supervision in place however to date this seems to have been inconstantly applied. Supervision arrangements are devolved throughout the home and it was evident from the supervision records observed that staff supervision occurs more frequently in some units than in others and that in some instances little detail is recorded. As recommended, all qualified and care staff should receive formal one to one supervision. At minimum, staff supervision should cover all aspects of practice, philosophy of care in the home and career development needs and should be provided at least six times a year. This would provide opportunity to discuss individual issues in order to establish and agree any actions required. Daily informal supervision is a routine feature at the home to ensure that staff are sufficiently competent to undertake their roles. It is understood that a new one to one supervision form is to be introduced in the near future and more regular one to one supervision will take place. The Annual Quality Assurance Assessment completed prior to the site visit showed that systems and equipment within the home had been appropriately checked so that the health and safety of people living at the home was protected. This was confirmed by examination of a random selection of service certificates. Greenfield Nursing Home ensures safe working practices are maintained through implementation of the home’s policies and procedures and staff training in respect of health and training issues. All members of the care staff team receive mandatory health and safety training covering a variety of topics including moving and handling, fire training, food hygiene, and first aid training that is generally updated on a regular basis. However as previously stated in this report, it was noted that some staff require some health and safety updates and it was evident that in one instance the food hygiene training undertaken by one member of staff had not been put into practice. Accidents had been appropriately recorded. However, these were not retained in accordance with data protection regulations, as the personal details of people living at the home were not kept in a confidential manner. The hoists were being serviced at the time of the site visit to ensure that Moving and Handling equipment was safe for use in order to protect the safety Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 30 of people living at the home. Fire safety equipment had been regularly serviced which promoted the safety of people living at the home. Discussion with the home’s handyman and observation of documentation including detailed maintenance records confirmed that various routine health and safety checks are maintained on a daily, weekly, monthly, quarterly, half yearly and annual basis to the internal and external environment of the home. Environmental risk assessments are in place. However one qualified member of staff raised concerns about washing hands under running water to prevent the spread of infection and the lack of soap dispensers and paper towel dispensers in resident bedrooms and how this could impact on infection control. It is suggested that this matter be given some consideration. Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 4 2 X 2 Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? YES 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 OP19 Regulation 23(2)(d) Requirement The bathrooms throughout the home must be reasonably decorated to provide a comfortable, domestic type environment. (Time scale of 30/09/06 not met) Timescale for action 31/12/07 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 3 Refer to Standard OP7 OP7 OP7 Good Practice Recommendations Care plans should be further developed to provide a holistic account of strengths and needs including social, religious and cultural requirements. Risk assessments should be undertaken whenever a risk is identified and automatically reviewed monthly as part of the formal care plan review. Wherever possible, the individual resident and/or their relative should be fully involved in the care planning process and sign the care plan as acknowledgement of their acceptance and understanding of the content. All hand written entries on the medication administration records should be signed, witnessed and countersigned to DS0000006046.V338190.R01.S.doc Version 5.2 Page 33 4 OP9 Greenfield Nursing Home 5 6 OP9 OP9 7 OP12 8 OP15 9 10 11 12 OP9 OP16 OP18 OP19 13 14 OP19 OP19 15 OP19 16 OP19 reduce the possibility of errors being made. Medication should be consistently checked before being administered and the medication record signed immediately after the medication has been administered. The medication cassette should indicate a description of the tablets prescribed to ensure staff are aware which medication had been refused or omitted for any reason. It is recommended that the pharmacy supplying the home be approached about this matter. It is recommended that further activities both ‘in-house’ and the wider community appropriate to the needs of the individual be introduced to ensure residents remain socially active and socially stimulated. People should be asked if they would prefer to sit in a dining chair rather than a wheelchair when eating a meal. If people prefer to eat in a wheelchair this should be recorded in the care plan. The management of meals on the house observed should be reviewed to ensure the dignity of residents is upheld and good food hygiene practices adopted by all staff. It is recommended that residents be reminded of the home’s complaint procedure and who to speak to if they had any concern/complaint. The current rolling programme of staff training in respect of adult abuse should continue until all staff have received this training. Storage areas in the home should be provided to prevent equipment from being stored in bathroom accommodation. All bathroom accommodation in resident accommodation should be fit for purpose and available for residents to access and use in safety. The internal environment of the home should be homely, comfortable and well decorated to suit the requirements of each individual resident group accommodated. Carpet or other appropriate floor covering should be provided in all bedroom accommodation unless there is a specific reason for a lino type floor to be provided for the current occupant. Findings of risk assessments should be recorded with outcomes identified on the care plan. All bedroom accommodation should be fitted with an appropriate locking mechanism. If it is not appropriate for the resident to hold the key to their bedroom this should be determined through the risk assessment process and highlighted in the care plan. If a resident with capacity chooses not to hold a key to their individual bedroom this should be recorded. Consideration should be given to ensuring that the DS0000006046.V338190.R01.S.doc Version 5.2 Page 34 Greenfield Nursing Home 17 18 19 OP19 OP28 OP30 20 21 OP36 OP38 environment does not prevent residents from accessing communal areas of the home if they so wish in order to prevent social isolation. The wall outside the laundry area should be repaired to provide an acceptable standard of maintenance throughout the home. At least 50 of the care staff team should have achieved at minimum an NVQ Level 2 in care. All mandatory training that requires updating should be provided as soon as possible. More in-depth training should be provided in respect of some topics for example infection-control training. Relevant training should be provided to all staff including dementia care that should include instruction on how to protect themselves and resident’s accommodated. Formal one to one staff supervision should take place at least six times a year. Accident records should be maintained in accordance with data protection guidelines. Consideration should be given to ensuring infection control measures are adequate in individual bedroom accommodation. Greenfield Nursing Home DS0000006046.V338190.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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. 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