Inspection on 07/07/05 for Greenfield Nursing Home

This inspection was carried out on 7th July 2005.

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 19/06/07

Greenfield Nursing Home 09/02/06

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 PR2 7AB Lead Inspector Elaine Clare Unannounced 07 July 2005 09:15 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 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 F57 F09 S6046 Greenfield V187789 070705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Greenfield Nursing Home Address Tag Lane, Ingol, Preston, Lancashire, PR2 7AB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01772 723745 01772 760836 Care First Care Homes Limited (BUPA Care Services) Mrs Alison Louise Gregory Care Home 112 Category(ies) of Dementia (48), Old age, not falling within any registration, with number other category (64) of places Greenfield Nursing Home F57 F09 S6046 Greenfield V187789 070705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person shall at all times employ a suitably qualified and experienced Manager who is registered with the CSCI. 2. The home is registered for a maximum of 112 service users to include: up to 48 service users in the category of DE (Dementia) and up to 64 service users in the category of OP (older people over 65 years of age). Date of last inspection 02/03/05 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 serve the needs of different residents and are assessed prior to admission to identify the best unit that will meet their needs. The home can provide care for 112 residents who may need nursing input and also provides care for people that suffer from dementia. There is a local garage that doubles as a newsagents across the road and a modern pub which serves food daily. The home is accessiable to the motorway and the local bus service regularly passes the home. Greenfield Nursing Home F57 F09 S6046 Greenfield V187789 070705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6 hours and was carried out to ensure that compliance had been achieved to the requirements made at the last inspection. A tour of the premises took place and staff and care records were inspected. Four of the staff on duty, eight of the 110 residents, and one visitor were spoken to. What the service does well: What has improved since the last inspection? Decoration both internally and externally and furnishings are gradually improved and those areas are starting to look more welcoming and homely. All the bedrooms have been extensively refurbished and comments from residents reflected their delight with their new surroundings. One visitor spoken to told the inspector that they had recently been involved in the review of their mothers care plan and had been asked for their comments about the care package being delivered at the home. This process is encouraged for all the residents in the home and it is seen as a positive step to improving the quality of communication between resident, family and care home. Greenfield Nursing Home F57 F09 S6046 Greenfield V187789 070705 Stage 4.doc Version 1.40 Page 6 Four staff members have been on a medication course and have updated their knowledge in this area. This was reflected in the much improved medication standard. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Greenfield Nursing Home F57 F09 S6046 Greenfield V187789 070705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Greenfield Nursing Home F57 F09 S6046 Greenfield V187789 070705 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4, 5 Residents move into the home having had their needs assessed and have been assured that these will be met. EVIDENCE: Four resident’s care documentation, which had recently moved into the home, was looked through as part of the inspection. One resident had only been admitted on the basis of a full assessment undertaken by the Registered Manager of the home. The assessment format is a pre-printed template developed by BUPA for Greenfields. The assessment covers for example personal care and physical well-being, diet and weight, including dietary preferences; sight, hearing and communication. Each resident has a plan of care for daily living, and longer term outcomes, based on the assessment and Care Plan. All services offered by Greenfields are demonstrably based on current good practice, and reflect relevant specialist and clinical guidance. Greenfield Nursing Home F57 F09 S6046 Greenfield V187789 070705 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 The health and personal care, which a resident receives, is based on their individual’s needs. EVIDENCE: The resident’s plan of care was seen to have been generated from a comprehensive assessment. The four care plans that were examined found that the plan set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the resident are met. The Care Plan had recently been reviewed just prior to the unannounced inspection. Space on the Care Plan, which allows the resident to sign his plan of care, had been left blank on all the care plans looked at. The registered manager confirmed that involving the residents and/or relative in the development of the plan of care is ongoing. One resident required additional services from the Incontinence advisor and this had been arranged by the home. There appeared to be a good relationship between the continence advisor and the home and the manager spoke of how she regular receives advice from the specialist. Greenfield Nursing Home F57 F09 S6046 Greenfield V187789 070705 Stage 4.doc Version 1.40 Page 10 Nutritional screening is undertaken on admission and subsequently on a periodic basis, a record maintained of nutrition, including weight gain or loss, and appropriate action taken was seen to be recorded in the three files looked at. Residents spoken with had no concern about having their privacy and dignity respected. The manager was observed knocking on resident’s doors and speaking with the residents in a respectful manner. A member of staff was observed assisting a gentleman with his meals. This was being performed in a sensitive and dignified way. An event that had occurred recently with a member of staff and a resident had recently involved the staff member holding the arms of the resident who subsequently fell. While this had been recorded as a violent incident it had not been recorded as a restraint. A review of the BUPA policy found that in this instance a restraint form should have been completed. The manager was made aware of the home’s procedure and was requested to complete the necessary documentation and make staff aware of the policy. Greenfield Nursing Home F57 F09 S6046 Greenfield V187789 070705 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 The capacity for social activity varies for each resident but residents are given special support and assistance to engage in the activities of daily life. EVIDENCE: The routine of daily living and activities are flexible and varied to suit resident’s expectations and preferences. Residents can exercise their choice in relation to leisure and social activities, food, meals and mealtimes and religious observance. Within the homes plan of care resident’s interests are recorded. The residents are given opportunities for stimulation through leisure and recreational activities. One resident spoke how care staff had recently taken him out for a walk. Around the home were posters of forthcoming entertainment acts. One resident spoke ‘ I really enjoy the different people coming to entertain us’. The home has always welcomed visitors into the home and during the inspection it was observed that a number of visitors were present. Visitors are welcomed to join their relative at meal times and enjoy a meal alongside their family or friend. Greenfield Nursing Home F57 F09 S6046 Greenfield V187789 070705 Stage 4.doc Version 1.40 Page 12 The main meal of the day was observed being taken and was much enjoyed by the residents at the home. It was a balanced, nutritious, appealing, varied and wholesome meal. The meal was taken in a congenial setting. Should a resident be out meals are kept to one side to be served at a more convenient time for the resident. Residents spoke about a recent fish and chip lunch ‘from a proper chippy, wrapped in paper’ which had been enjoyed. Greenfield Nursing Home F57 F09 S6046 Greenfield V187789 070705 Stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17 Residents and staff have a robust and effective complaints procedure, which they feel able to use. EVIDENCE: The registered person has ensured that there is a simple, clear and accessible complaints procedure, which includes the stages and timescale for the process, and that complaints are dealt with promptly and effectively. There have been no complaints made to the Commission for Social Care Inspection since the last inspection. Residents spoken with had no complaints to make about the home, they were thoroughly happy with the care they were receiving at Greenfields. Residents are free to exercise their legal rights and participate in the political process should they wish. Greenfield Nursing Home F57 F09 S6046 Greenfield V187789 070705 Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26 The home sets out to offer family–like care and has a philosophy of care that is interwoven between the style of home; it’s size, design and layout. However the dated bathrooms let the home down. EVIDENCE: The location and layout of the home is suitable for its stated purpose. It was undergoing a refurbishment programme, which was causing minimal disruption to the residents. The grounds, which include a private patio area is kept safe, attractive and accessible to the residents. Residents spoke how they had enjoyed the good weather recently and sat out around the grounds. The home has four lounge spaces for residents to enjoy and a dining area on each of the units. There are accessible toilets for residents, which are clearly marked, and close to the lounge and dining area. Some bedrooms have ensuite facilities. The home has a number of aids, hoists and assisted toilets and baths. Greenfield Nursing Home F57 F09 S6046 Greenfield V187789 070705 Stage 4.doc Version 1.40 Page 15 Individual bedrooms were looked at and found to be furnished and equipped to a very high standard that assured comfort and privacy. Bedrooms were tastefully decorated and personal items had been brought in from the resident’s own home. Where residents had chosen to share screening is provided to ensure privacy for personal care. The bathrooms in the home are dated and unappealing. They have exposed pipework, overhead toilet cisterns and cold tiled floors. In contrast to the rest of the home they are below standard. This has been brought to the attention of the previous manager and the present manager following a number of inspections. It was first highlighted as a requirement following the inspection in September 2003. The manager was required to improve the bathroom within a twelve month period and given September 2004 as a deadline. This has now passed and the bathrooms remain poor. Greenfield Nursing Home F57 F09 S6046 Greenfield V187789 070705 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Staffing levels and skills mix are adequate to meet the assessed needs of the residents. The required checks on staff are being performed to the required standard, affording residents protection. EVIDENCE: A staff rota showed which staff are on duty at any time during the day and night. The ratios of care staff to residents must be determined according to the assessed needs of residents. Domestic staff are employed and were observed during the visit. The home has a number of staff members who have their National Vocational Qualification level 2 in care. It is written in the Care Homes For Older People Standards that a minimum ratio of 50 trained members of care staff excluding those members of the care staff who are registered nurses should be employed by January 2005. In this home this has been achieved. Four staff files were looked at during the inspection and found all the necessary checks had been completed to ensure the safety of the residents. Greenfield Nursing Home F57 F09 S6046 Greenfield V187789 070705 Stage 4.doc Version 1.40 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,36,37,38 The manager has a good understanding of the areas in which the home needs to improve for the benefit of residents, and in seeking to maintain performance in other areas. EVIDENCE: The registered manager has been in post for over 12 months and meets the required standard with regard to qualifications and experience. The manager has recently gained her manager award. The registered manager communicates a clear sense of direction and leadership, which staff and residents understand. Care staff have received formal supervision at least six times a year.. Supervision covers • • All aspects of practise Philosophy of care in the home F57 F09 S6046 Greenfield V187789 070705 Stage 4.doc Version 1.40 Page 18 Greenfield Nursing Home • Career development needs It is further recommended that supervisors of the care staff attend a relevant training course to enhance their skills in this important area. The home had regularly checks on equipment and all major services. Certificates were seen that demonstrated that appliances were safe and in good working order. Fire checks were carried out regularly. Greenfield Nursing Home F57 F09 S6046 Greenfield V187789 070705 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 2 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x 3 3 3 x x 3 3 3 Greenfield Nursing Home F57 F09 S6046 Greenfield V187789 070705 Stage 4.doc Version 1.40 Page 20 Yes Are there any outstanding requirements from the last inspection? 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 19 Regulation 23(2)(d) Requirement The bathrooms throughout the home must be reasonably decorated. Correct procedures must be followed in relation to restraints in the home. Timescale for action Timscale 01/09/04 not met 01/09/05 10/08/05 2. 8 13 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Greenfield Nursing Home F57 F09 S6046 Greenfield V187789 070705 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Unit 1, Tustin Court Portway Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greenfield Nursing Home F57 F09 S6046 Greenfield V187789 070705 Stage 4.doc Version 1.40 Page 22 - 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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