Inspection on 22/04/08 for Greenfield Nursing Home

This inspection was carried out on 22nd April 2008.

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 19/06/07

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Greenfield Nursing Home Tag Lane Ingol Preston Lancashire PR2 7AB Lead Inspector Denise Upton Unannounced Inspection 22nd April 2008 09:10 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.V360801.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.V360801.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) Ltd 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) Mrs Sara Allton 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.V360801.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 1 service user in the category PD (physical disability). 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 from four units, Oak, Elm, Beech and Maple each serving the needs of different residents. Each prospective resident is assessed prior to admission to identify if the home could meet current needs and requirements and to identify the unit that would best meet their needs. Greenfield Care Home can provide accommodation for up to 112 residents some of whom may need nursing care and also provides designated accommodation for people that have a diagnose of dementia. There is a local garage that incorporates a news agency across the road and 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.V360801.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that people who use this service experience good quality outcome. An unannounced site visit, which formed part of the key inspection process, was conducted over a two-day period and a short period of time on another day. On the first day, two inspectors conducted the inspection and on the second and third days a single inspector completed the inspection. Prior to the visit the registered manager completed an Annual Quality Assurance Assessment (AQAA) questionnaire, which provided information about the residents, staff and other information, which assisted in assessing how the home was meeting the National Minimum Standards. Survey forms had been sent out prior to the visit and in total, five relatives, six residents and nine members of staff completed and returned these to express their views about the service. During the course of the site visit to this service, discussions took place with those living at the home, as well as relatives and staff. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation was viewed along with the majority of communal accommodation. The inspectors ‘case tracked’ the care of a number of people living in different units people during the site visit, but this was not to the exclusion of other residents. The total key inspection process focused on the outcomes for people living at the home. The current scale of fees is £372.00 to £716.63 weekly. What the service does well: The information gathered before admission was detailed, providing staff with a clear picture of individual needs, so that the home was able to determine how the staff team could meet the assessed needs of people. The plans of care were well written documents, providing staff with clear guidance about how the assessed needs of people living at the home were to be met and how people were supported to maintain their privacy and dignity. Residents had been involved in the care planning process and a review of care provided was conducted on a monthly basis to ensure that current needs were reflected in the plan of care. Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 6 One survey card received from a relative stated, “The care home gives the best possible care and another commented, They are attentive to my sister’s needs and ensure that she has her hair done weekly which means a lot to her. The staff are always pleasant to relatives which makes me feel that she is looked after well. The staff team work well together and were seen throughout the visit to be very caring in the way in which they looked after the residents and assisted with all personal tasks in a sensitive manner. There was a good atmosphere in the home with staff, residents and visitors very relaxed and friendly. Residents are encouraged, within their capabilities, to be individual and their personal routines and lifestyles are respected. From observations and discussions, evidence was gained to confirm that the manager and staff had a good understanding of equality and the diverse needs of the residents, which ensured that their individual needs were met. What has improved since the last inspection? What they could do better: The home should continue to work towards 50 of the care staff achieving a National Vocational Qualification at Level 2 or above so that enough care staff are adequately trained in order to deliver appropriate care. Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 7 Although some activities were provided in the home, a number of residents, relatives and staff members said that resident’s social care needs were not been met appropriately. Responses from residents’ survey forms varied in relation to activities, but the majority of residents who completed a survey said that only sometimes were suitable activities provided. One person said that there were never suitable activities made available. People who are assessed for admission to Greenfield Care Home should receive written confirmation of the outcome of the assessment and information as to whether their needs and requirements could be met at the home. 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.V360801.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.V360801.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. This judgement has been made using available evidence, including a visit to this service. The admission and assessment procedures are clear to ensure the care needs of residents are met. The home does not provide intermediate care therefore Standard 6 was not assessed. EVIDENCE: Greenfield Care Home has a formal admission process and has recently introduced a detailed and comprehensive pre admission assessment form to record information. The pre admission assessment includes visiting the prospective resident in their own home or hospital, talking with relatives, and also takes into account any health or social services assessments. This detailed record is to make sure that staff have a good understanding of the prospective residents wants, needs and wishes in order to ensure the home could meet requirements. Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 10 Prospective residents and their families are also encouraged to visit the home and spend some time in order that they can make an informed choice about moving into Greenfield Care Home. Although the pre-admission assessment is detailed, there is a requirement that the home must write to the prospective resident to inform them of the outcome of the pre admission assessment and to confirm whether the home can or cannot meet their assessed needs. At present this is not happening. The home’s manager is now aware of this requirement and is taking steps to address this issue. The records of several residents in various units were examined and all were found to contain full assessment information that had been obtained prior to admission, therefore ensuring that the home could meet the residents’ individual needs. The detailed assessments had been retained on residents’ files so that those working at the home were aware of individual assessed needs. Comments made by residents spoken with and on the Commission for Social Care (CSCI) surveys confirmed that they had been involved in the assessment process and were happy that their individual’s needs were being met by the home. Staff were able to demonstrate that they were well aware of the care needs of the individual residents and this was confirmed during the inspection through observations of the care practices being carried out. Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The health and personal care needs of people living at the home were being consistently met and their privacy and dignity was always respected. Policies and procedures provided safe guidance for staff in all aspects of management of medicines. EVIDENCE: All of the care plans seen had been developed from the information gathered prior to admission to ensure that staff were aware of the assessed needs of people living at the home. The care planning process had improved significantly and information recorded was consistently detailed, providing staff with clear guidance as to how the assessed needs of the individual residents were to be met. Residents or their relatives had been given the opportunity to be involved in the care planning process, so that they could have some input into the care provided. The plans of care had been consistently reviewed every Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 12 month to show that the needs of people were being regularly assessed so that their current needs were accurately reflected. The care plans in operation were very comprehensive and covered every aspect of the residents care needs, social, emotional, spiritual and recreational needs. Residents’ information also contained a life map completed by the activities coordinator and the resident and/or relative, including favourite colours and a lifestyle profile detailing the individual’s routines and rituals. The care plans contained some good examples of individualised care such as choices and preferences regarding gender of staff, meals and type of cutlery needed, how many pillows were required, whether the person liked the light on or off at night and the individual’s preferred routines. Care records now included a ‘relatives expectations’ care plan to ensure relatives were given regular opportunities to be involved in decisions about care. There was clear evidence of a variety of relevant individualised risk assessments in place with significant outcomes incorporated in the care plan. There was detailed action recorded for staff to take to reduce or eliminate those risks to ensure residents were safe. In the main, care plans were signed and dated by the resident or their relatives and there was clear evidence of residents and relatives being involved in the review process. The registered manager explained that every month she personally audited 10 of care plans. These were audited in detail and anything that had been omitted or written in insufficient detail was sent back to the unit for amendment. Only when the registered manager was satisfied with the detail would the care plan audit be ‘signed off’ It is clear that this system has made a significant impact and all staff with responsibility for care planning and recording are aware of the expectations and requirements. On one of the units visited, a care plan was evidenced that had recently been returned from the registered manager for amendment following a care plan audit. The senior carer was well aware of what was required and how to address the short fall prior to resubmitting the care plan to the registered manager. The Annual Quality Assurance Assessment (AQAA) questionnaire and the care records showed that a variety of external professionals were involved in the care of people living at the home to ensure that their health care and nutritional needs were being appropriately met. Survey forms returned showed that everyone was treated equally and that people felt that they received medical support when needed. One person commented that the medical support received “Couldn’t be better” and another person said, “A request for a doctor is treated rapidly”. Appropriate pressure relief was being delivered and specialised equipment was provided to make the lives of people living at the home as comfortable as possible. Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 13 A relative spoken with commented on how much her sister who was an amputee and in a wheelchair had improved since arriving at the home recently from hospital, adding that she had arrived with extensive bed sores and MRSA, both of which had significantly improved in the home. “The home have done wonders”. The relatives also said how attentive and supportive the staff had been to them as well as the resident. The way medicines were managed had improved so that people living at the home were adequately safeguarded from any medication errors or drug misuse. There were policies and procedures in place to support staff with safe practice and all staff with responsibility for the administration and recording of medicine had received appropriate medication training. Medication refresher training is mandatory to ensure staff skills and knowledge is regularly updated. Medication storage areas were secure, and there were clear records for the order, receipt, administration and disposal of medication. Medication Administration Records (MAR) were clear and completed in full. However, it was noted on one of the medication administration records observed, that handwritten medication instructions had not been countersigned signed to reduce the risk of errors. Controlled drug records were accurate and records were available to support that medication systems were monitored on a routine basis. Eye preparations and short life medication 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. In order to promote choice, any resident who wishes to take responsibility for taking their own medicine is able to do so after a risk assessment, and signing a disclaimer for this. As identified at the last inspection, 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. The manager approached the local pharmacy about this matter, however the pharmacist remains reluctant to provide a description of the prescribed tablets. Throughout the visit, observations were made of the caring approach of the staff towards the residents and the practices in the home ensured that residents were treated with respect and their right to privacy was upheld. There were many examples of staff treating the residents with dignity, for example ensuring that clothing was adjusted in a discreet manner and ensuring that any dribbling was wiped gently and discreetly. Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 14 An Agency nurse commented that the staff were careful to respect residents when washing them and always covered them with a towel during personal care. One care plan evidenced stated ‘To keep her fresh and clean as she would wish to be’. Induction training records showed that staff had been instructed to treat residents with respect and care records demonstrated that the wishes of people were respected in relation to maintaining privacy and dignity when giving personal care. Greenfield Nursing Home DS0000006046.V360801.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. This judgement has been made using available evidence, including a visit to this service. Social and recreational activities did not always meet residents’ or their relatives’ expectations. The rights of people were upheld and they could make informed choices. Residents receive a healthy and varied diet according to their assessed needs and choice. EVIDENCE: Activity organisers are employed at Greenfield Care Home with responsibility for the organisation and provision of activities, so that some social stimulation is provided for those living at the home. However, this did not always meet expectations. Out of the seven comment cards received from residents, two said that there was never any suitable activities provided, four felt that there were sometimes activities in which they could take part and one person said that there was usually activities in which they were able to participate. Nobody said that there were always activities arranged by the home that they could take part in. Comments ranged from, “If only it was possible for me to Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 16 join in”, and “With being short staffed not much going on, but will improve because we are getting more staff”, and “It would be better if we could be allowed more outside visits. The last time I was out was November 2007. Shopping – essential, is out of the question or even a little fresh air”. Relatives also voiced some concerns about the lack of social stimulation that their family member could participate in and enjoy. One relative said in answer to the question ‘How do you think the care home can improve’, wrote, “Possibly by providing more activities to stimulate their minds”. However, another relative in answer to the same question said “More activities, like more bingo” The provision of suitable activities is an area that some staff also felt could be improved. One member of staff commented that the thing the service could do better was “Provide more activities/outings for dementia clients”. Another said that there had been no activities over the weekend period and activities materials were locked away. The unit had asked for some activities/games to be left in the unit. This was provided but the boxed games had parts missing. Another carer was concerned that age appropriate activities were not provided with residents given colouring books/sheets to crayon in as a social activity. Another member of staff commented that ‘activities looked good on paper but those provided were more suitable for a kindergarten!’ On Elm unit we were told that there were two activities co-ordinators for the four units and that they usually visited twice weekly and that one of the coordinators probably stayed about one hour in Elm unit on the morning of the site visit. Comments from staff about the activities coordinators ranged from “not very good” and “could be better” to comments that activities had been a problem because the staff employed did not stay long and that they were not appropriately trained. Staff in one unit also commented that it would be helpful if there were four staff in the afternoon period to assist with activities. On one of the dementia care units the person in charge said that staff in the unit had taken into account the ‘Map of Life’ to judge appropriate activities. In the main, individual activities were preferred as the level of concentration in residents on this unit was generally poor. Although stating that it was difficult to ‘measure’ activities he felt there was always spare time in the day and staff could get involved. One carer in another unit said that care staff sometimes organised a ‘memory lane’ activity informally in the evenings but this was something that care staff organised. Residents however enjoy this time. Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 17 Discussion took place with one of the activity co-ordinators who had recently been appointed. Although enthusiastic and keen to provide a good activities programme, the activities co-ordinator stated she had no previous experience of the work and was not familiar with suitable activities for a care home accommodating people with very differing social care needs. The activities coordinator spoken with said she was just following what other activity coordinators in the home did to provide activities. It is understood that a further activities co-ordinator(s) is to be employed. When fully staffed, the activities co-ordinators will provide 70 hours per week of social activities covering all of the units. We were informed that an activities induction programme is available. The activities organiser spoken with explained that recently the activity organisers have started working in all four units for one hour each day (two units am and two units pm) and are now working two weekends a month to provide activities. A record is kept of what each resident who has joined in an activity has done in that hour period. Individual visits are only for people in bed and lasts usually for about 15/20 minutes. The activity undertaken is often restricted to talking to the resident or anything else the resident may ask, i.e., changing the television channel. The activities co-ordinator also explained that there is a plan to set up an activities course for dementia residents, although no other details were available. Some activities are regularly arranged and promoted by displaying the activities for the week on the individual unit door. These include: pampering – hands and nails, bingo, occasional days out for some residents, i.e., feeding the ducks, visits out to town but only for the individual person, film shows, reminiscence, ball games on Oak unit and armchair exercise in all units. The activities organiser also explained that an outside entertainer visits for important events, for example, significant birthdays. The chef makes a birthday cake for ‘special’ birthdays. Some residents made St George’s flags that were seen in one unit on the walls. It was intended to try to get residents out more in the summer months but this would be restricted to a few residents leaving other residents without social activity unless care staff also provided regular activities. Recently there was a tea quiz with tea and biscuits and tea tasting that residents who had attended enjoyed. One resident has been assisted to work in a flower shop one day a week. There has been an attempt to organise some activities in the evenings, although it was explained that some residents are in bed by 7:00pm. Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 18 To further promote social activity within the home, the activities co-ordinators are hoping to develop a newsletter with forthcoming events. It was also stated there was a gardening club, knitting club and music club but these activities would only suit a number of people. A wide range of activities, including mentally stimulating activities, for example, reading and discussing a news item of interest or a group crossword that would help prompt intellectual skills for the more mentally able resident, needs to be made available on a regular basis, as well as craft activities or movement activities or the very occasional outings to ensure that individual social care needs are met. We were informed by the registered manager that it was planned that the activities co-ordinator spoken with was to contact other activity organisers in other local BUPA homes for ideas and it was hoped that a course for activity organisers would be developed. The registered manager is aware that activities and social stimulation is an area that requires further development in the home to make sure that regular, appropriate activity is made available for all residents that is closely linked to the social care needs identified in the care plan. 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 suit their individual needs, preferences and capacities. As identified in the last inspection report, this is particularly important in respect of people with dementia or other cognitive or physical disabilities that may not be able to enjoy some of the general activities made available. In these situations it is important that activities are arranged to take into account their specific needs, requirements, wants and capabilities. Visitors are made very welcome and observations were made of visitors coming and going freely and the friendly way in which they related to the staff. The son of one resident, who was visiting from abroad, confirmed that home had kept him informed about his mother’s care “They are very good about keeping me informed” and they “always make me very welcome”. Another relative on a survey form also confirmed that the home, “Communicates very well” and a third person said, “The staff are always pleasant to relatives which makes me feel that she (sister) is looked after well”. Four relatives spoken with commented how welcome they were made to feel when visiting and were offered a drink. Comments about the care provided included “Wonderful” and “Very supportive”. 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. Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 19 Observation of the four weekly rotating menus showed that the meals were nutritious, well balanced and provided a wide range of foods. A choice of menu is available at each mealtime and a ‘nite bite’ menu has been introduced offering snack foods such as beans/spaghetti on toast, cakes, sandwiches, yoghurts, cheese and biscuits that is available during the evening period and throughout the night. Specialist diets are made available and blended meals are presented in such a way to make sure that each element of the meal can be tasted separately. The lounge/dining rooms in each unit were found to be relaxed areas for people to eat in, with well-presented tables and unhurried atmospheres, so that those dining were comfortable and enjoyed having their meals in pleasant surroundings. Staff appeared to be aware of the likes and dislikes of those who were unable to make their own choice and were observed to be sensitive when assisting residents to eat their meals. Specialised cutlery and crockery was provided for those needing a little help with their meals, so that independence was being actively promoted. In one unit, at the last inspection, there were concerns that residents were left in wheelchairs at mealtimes whether they wanted to be a wheelchair or not. Staff confirmed that residents are now always asked if they would prefer to eat a meal sitting in a wheelchair or a dining chair. The catering manager explained that residents were spoken with about menu planning and their suggestions wherever possible are incorporated in next menu plans. It was also confirmed that there was a sufficient budget for food provisions, including plenty of fresh fruit and vegetables that are served on a daily basis. Fresh fruit is also sent to each unit as and when requested. Most residents said they usually enjoyed the meals served. One resident said that, “the food here does you good”. A relative commented that her sister who was very ‘finicky’ over food, really enjoying the food provided and a member of staff made a comment the home served “Good home cooked food, choice of menu and additional snacks”. Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 20 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. 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. EVIDENCE: The complaints procedure was clear, accessible around the building and included in the information pack in resident’s bedrooms. From survey information and discussion with residents and their visitors it was clear they knew how to complain, whom to complain to and were satisfied that their complaint would be dealt with appropriately. Complaints were monitored to help the management team to improve the service. Since the last inspection the number of complaints made to the home has decreased considerably. Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 21 The adult protection procedure was clear and provided staff with appropriate guidance to help them to protect residents. All staff spoken with were aware of action to be taken if they suspected abuse and all care staff have now received, or are about to receive adult protection training. This will help staff to recognise abuse and respond appropriately. The registered manager explained that it is also anticipated that none care staff will also receive adult protection training through the proposed rolling programme of staff training and refresher training. In addition, breakaway technique training is to be developed that will be incorporated in the induction-training programme. Since the last inspection, an adult protection investigation has been concluded. The management team at the home acted promptly and appropriately and cooperated fully with the investigation for the protection of all residents. Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 22 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 adequate. This judgement has been made using available evidence, including a visit to this service. The standard of the environment in some areas needed to be improved to ensure all residents were provided with a well maintained, safe, clean and comfortable place to live. EVIDENCE: Since the last inspection some repair and redecoration has taken place, however there remains substantial further work required until the home provides, in all areas, a bright, welcoming and attractive place to live. Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 23 Damage to some internal walls and an external wall have been repaired and repainted and a substantial amount of money has been allocated to refurbish 21 bathrooms and toilets. This work is to begin in May 2008. It is anticipated that the refurbishment will be completed by the end of the year. In addition to upgrading walls/ceilings/floors as required in bathrooms and toilets, new equipment is to be purchased, including sovereign baths, ambi lifts and new hoists. Exposed pipework in bathrooms is to be sunk into the wall or boxed in and the walls retiled. It is understood that, except for the already renovated bathroom and toilets, there is to be a planned total refurbishment of the entire building in 2010. This will provide a significant improvement to the physical environment of the home and ensure an attractive and welcoming place to live. The walls on many of the corridors are very bland and would be greatly improved by some imaginative decoration, suited to the needs of the individual resident group accommodated to provided a more homely and stimulating environment. However, the wall in one of the units had be decorated with St George’s day flags that residents had helped to make and a nurse in charge of another unit had asked the staff in that unit to come back to him within seven days over how they could improve the environment and make it more homely. A large painted mural had also been painted on one of the walls in Beech Unit. Furniture was comfortable and generally attractive and set out in a way that residents in each particular unit preferred. Storage remains a problem but, at present, some spare bedroom capacity is currently being used as storage areas. Oak and Maple Units are using the smallest bedrooms for this, although prospective residents are being shown these bedrooms when viewing and can choose one if they so wish. There is a redecoration plan available for a two year repainting programme. Residents will have opportunity to choose the colour for their individual bedroom. Very recently, a new member of staff was appointed who will undertake gardening tasks in the summer and to work as a decorator in the winter months. No flooring has been replaced since the last inspection. Residents were asked what type of flooring they would prefer in their bedroom accommodation and this was respected. However, those people in wheelchairs and those with incontinence problems are being encouraged to occupy a bedroom with linotype floor covering, particularly in the dementia care units. Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 24 There was a recommendation in the last inspection report that appropriate locks should be provided to all residents’ bedroom doors unless there was a specific reason why this would not be appropriate. It was evidenced that, as a result of this, a letter was sent out to all residents or their relatives asking if they would like a lock on the bedroom door. The letter also explained that there was a risk assessment process in place regarding locks on bedroom doors. Residents’ wishes were respected. Nevertheless, there still remains a recommendation that an appropriate lock should be provide to any bedroom door without this facility once that bedroom becomes vacant. If a lock is not appropriate, this should be determined through a risk assessment process. If an incoming resident has made appositive choice not to have a lock to the bedroom door, this decision should be recorded and regularly reviewed. It was again pleasing to see photographs of the resident and their loved ones outside individual bedrooms of people with dementia in order to help people recognise their family and friends. The outside garden areas of the home are attractive and provided with tables and seating that residents and their visitors can enjoy in the summer months. The home was clean and tidy with no obvious unpleasant smells. Discussion with the housekeeper confirmed that there is mandatory training for all domestic and laundry staff that includes: fire training, food hygiene training, load management training, COSHH training, health and safety training and hand washing. Also, booklets are available for staff about laundry and cleaning. A number of the domestic staff team have achieved NVQ 1 and NVQ 2. A domestic assistant spoken with confirmed that sufficient cleaning materials and equipment are always available to ensure the environment is maintained to an acceptable standard. A daily cleaning schedule was in evidence that is dated and signed by staff when task completed and approved. One resident, in answer to the question ‘Is the home fresh and clean’, said, “excellent”. 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. Different colored individual laundry net bags are used for each person’s ‘smalls’ to ensure that nothing gets lost and to ensure that each person gets their own clothing back. The housekeeper explained that each person gets their laundry without loss because of the identification method in use. Only occasionally do things go astray. Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 25 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 policies and procedures for the recruitment of staff are robust and provide safeguards for the protection of the residents. Staff are competent and skilled to meet residents needs and expectations however nationally recognised training for care staff should be increased. EVIDENCE: Three staff files were looked at in detail and were found to contain all references and clearances required by law before new staff members commenced working in the home. Through examination of the files and discussions with staff, confirmation was gained that they had undergone a formal recruitment and induction process. This ensures that residents are protected and enables new staff to gain a basic understanding of the needs of the residents and how these should be met. Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 26 A recently appointed member of staff who is a Mental Health Trained Nurse confirmed that all checks had been taken before she was allowed to commence employment including CRB clearance, references, application form and formal interview. This was followed by a two-week induction period and she was then supervised until confident. This same person stated that she felt well supported by the unit manager and home manager and that there was a “good team”. The number of staff on duty was being calculated in accordance with the assessed needs of people living at the home and records showed that a good skill mix of staff made up the staff team so that residents’ needs were being met. However, staffing levels were considered to be low by one member of the care staff team spoken with, who also felt that the number of staff was judged by numbers and not by need. There appeared to be adequate levels of staff on duty at the time of the site visit. Two carers also stated on the Commission for Social Care survey forms that there should be more staff on the units. One comment was that “there is not enough time to meet the needs of the residents” but there was no indication of how or what residents’ needs were being unfulfilled. In contrast, another member of staff had written that the home was fully staffed but “occasionally due to sickness and agency not supplied, staff at the home have worked short but service users’ safety is always ensured”. The Annual Quality Assurance Assessment (AQAA) showed that agency staff was used as required, although we were told that the same agency staff work at the home so that continuity of care was maintained. This was also confirmed by a qualified agency staff member who stated that she had worked at the home as an agency worker, covering various shifts for a period of time. Residents spoken with felt that their needs were being usually well met and that the staff were patient and did not rush them when assisting them with activities of daily living. One resident said, “In all the time I have been here I have admired the people who run it” (Staff working at the home) and “Staff don’t complain but work very hard and should be much better paid. People on duty doing their very best to cope but sometimes do not come fast enough when short staffed”. Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 27 Seven residents were spoken with in one unit, all seemed very happy with their care. The ladies were having their hair done and their nails were newly polished; clothes were clean and colour co-ordinated. However, two residents had voiced concerns on the survey forms about the attitude of a small number of junior staff. One person had written, “Most of the carers are very good and well mannered but one or two are rude to old people”. Another said, “Junior carers could be more polite and respectful. Many are 50-60 years my junior and I would like a little respect”. These comments were fed back to the manager so that staff could be reminded how people may perceive comments or actions made. Relatives also felt that one of the things that the care home did well, was “They are attentive to my sisters needs and ensure that she has her hair done weekly which means a lot to her”. Another relative said, “This care home gives the people the best possible care”. Evidence was seen that training was encouraged and staff confirmed that they were enjoying attending the various courses. Through the regular supervision arrangements staff are able to identify their training needs. All staff completed mandatory core-training courses to ensure that there was a skilled workforce and that people had the necessary knowledge to meet the needs of the people they were caring for. Staff spoken to felt that a lot of training was provided to meet their needs and the training certificates, available on staff files, supported this. Recent training has included the Mental Capacity Act and Protection Of Vulnerable Adults training that will be completed by the end of May. There is a recommendation that at least 50 of the care staff team should have successfully achieved at minimum, a nationally recognised, National Vocational Qualification (NVQ) Level 2 qualification in care. At present, of the 75 members of the care staff team, 30 have achieved this qualification and three further members of staff are working towards this award. It is understood that in order to achieve a substantial number of care staff with this qualification, NVQ training is now planned to commence every three months with at least four people in each cohort. Staff spoken with said that they had a good staff team who worked well together. During the visit the atmosphere throughout the home was comfortable, relaxed and encouraging which ultimately resulted in residents feeling secure and their needs being met. Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 28 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. This judgement has been made using available evidence, including a visit to this service. The home is well managed by a competent person and run in the best interests of the residents. EVIDENCE: The registered manager at Greenfield Care Home is now registered with the Commission for Social Care Inspection and has the required qualifications and experience and is competent to run the home. The registered manager provides strong leadership throughout the home. During the time she has been in post, the registered manager has worked hard to improve the service and to provide an increased quality of life for residents. Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 29 Each residential and nursing unit within the home and other non-care departments have an identified manager who is involved in the development of the service and who works closely with the manager to promote high standards. There were a number of systems in place to monitor whether the service was meeting people’s needs and expectations and to determine whether the service could be improved. Annual surveys were sent out to residents/relatives and the results of these were available. Feedback on the outcome of the questionnaires is provided once the results are known. There were internal audits to monitor whether staff were following policies and procedures. 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 were provided with information through informal discussion with staff. The home has achieved the ‘Investors In People’ award. Systems were in place at the home to ensure that residents’ finances were adequately protected. 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 held in safe keeping. All transactions are appropriately recorded and secure facilities are provided for the safekeeping of monies and valuables held on behalf of the resident. In respect of residents whose monies are kept in a separate resident account held by the company, generous interest is paid on a monthly basis. Supervision arrangements have been strengthened and all staff now receive regular, pre planned, formal one to one supervision. Planned supervision dates for the year were evidenced in each unit and all staff aware of when their planned one to one supervision was to take place. A range of environmental risk assessments had been conducted, which were sufficiently detailed, showing that systems had been put in place in order to reduce the possibility of injury to people living at the home. The AQAA showed that all 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. Accidents occurring in the home had been accurately recorded so that the manager was able to audit and monitor the frequency of accidents. Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 30 Discussion with the home’s handyman and observation of documentation including detailed maintenance records again 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. This includes, monthly water hot water outlet checks, temperature of food trolley’s, hoses, showerheads and equipment. Also, monthly bed rails checks, lifting equipment and individual wheelchairs checks are completed. Greenfield Nursing Home DS0000006046.V360801.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 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Greenfield Nursing Home DS0000006046.V360801.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 OP3 Regulation 14(d) Requirement Prospective residents must be informed in writing of the outcome of the pre-admission assessment and whether their needs could be met at the home. The bathrooms throughout the home must be reasonably decorated. (Timescale of 30/09/06 not met). Timescale for action 31/05/08 2 OP19 23(2)(d) 31/12/08 Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 33 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 4 5 Refer to Standard OP9 OP12 OP19 OP19 Good Practice Recommendations All hand written entries on MAR medication recording sheets should be witnessed and countersigned by a second member of staff to confirm accuracy. A wide range of activities should be provided that meets the needs and expectations of each resident. Bland walls should be provided with some decoration suited to the resident group accommodated in that area. Appropriate locks should be provided to all bedroom accommodation without this facility once the bedroom becomes vacant. At least 50 of the care staff team should have achieved at minimum an NVQ Level 2 qualification in care. OP28 Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 34 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. Extracts may not be used or reproduced without the express permission of CSCI Greenfield Nursing Home DS0000006046.V360801.R01.S.doc Version 5.2 Page 35 - 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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