Inspection on 30/05/07 for Greengables Nursing Centre

This inspection was carried out on 30th May 2007.

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

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

Other inspections for this house

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

CARE HOMES FOR OLDER PEOPLE Greengables Nursing Centre 54 Sandbach Road Congleton Cheshire CW12 4LW Lead Inspector June Shimmin Unannounced Inspection 30th May 2007 09:30 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 Greengables Nursing Centre DS0000069152.V333777.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. Greengables Nursing Centre DS0000069152.V333777.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greengables Nursing Centre Address 54 Sandbach Road Congleton Cheshire CW12 4LW 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) 01260 270030 01260 297848 ANS Homes Limited Mrs Ann Roberts Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Greengables Nursing Centre DS0000069152.V333777.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 21 November 2006 Brief Description of the Service: Greengables Nursing Centre is a detached, two storey Victorian house standing in its own grounds. It is on the outskirts of Congleton, approximately one mile from the town centre. The accommodation for the people who live at the home is on two floors. Access between them is by a passenger lift or one of the staircases. There are three lounges and a dining room on the ground floor. There is an enclosed patio that can be reached through the dining room. Bedrooms are single rooms, 18 of which have en-suite facilities. The rest of the bedrooms have wash hand basins in them. There is easy access for wheelchairs through the main entrance and to all parts of the home. There is always at least one first level registered nurse on duty. The weekly fees are £473.35 to £662.62. There are additional charges for hairdressing, toiletries, newspapers and chiropody. Greengables Nursing Centre DS0000069152.V333777.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on the 30 May 2007 and lasted six and three quarter hours. One inspector carried out the inspection. The visit was just one part of the inspection. Other information received about the home was also looked at. Before the visit the home manager completed a questionnaire providing up to date information about Greengables. CSCI questionnaires were also given to residents, families, and health care professionals such as doctors and nurses to find out their views. During the visit various records and the premises were looked at. A number of residents and relatives were also spoken with and they gave their views about Greengables. What the service does well: Residents and relatives are given written information about Greengables so they can decide whether the home will meet their needs. Greengables is a comfortable, friendly and well managed home. Residents and relatives said that standards of care are good. Comments such as, “very impressed with care” and “look after the patients with care and respect” were typical. A GP said, “Home provides a good standard of care …….have an excellent working relationship with the staff.” People living in the home receive attention promptly from other health care professionals so that they know their health care needs are being met in full. People who live at the home can make choices about what they do each day. People are encouraged to stay as independent as possible so that they feel more in control of their own lives. Staff are well trained and 70 of care staff have achieved NVQ level 2 or above. This means that people living in the home know that they are being cared for by skilled and competent staff. The recruitment procedures are thorough so that people are protected from possible harm and poor practice. Greengables is well maintained so that people live in clean, tidy and comfortable surroundings. People commented that it “feels like home”. Greengables Nursing Centre DS0000069152.V333777.R01.S.doc Version 5.2 Page 6 The manager has been the manager of the home for seven years and is well regarded by people living in the home, staff, relatives and visitors so that people know the home is well run. A staff member commented, “the registered manager does a lot to support her staff.” There are effective quality assurance mechanisms in place so that people know that the standards of care and facilities are being independently checked regularly. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Greengables Nursing Centre DS0000069152.V333777.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greengables Nursing Centre DS0000069152.V333777.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 (The home does not provide intermediate care so standard 6 does not apply) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are given information about Greengables, and have their needs assessed before they move in so they know their needs will be met there. EVIDENCE: Greengables provides an information file (Statement of Purpose/Service User Guide), which gives people looking for care and those living in the home information about the services and facilities provided. A copy of this file is available in the entrance hallway of the home. The content of the file is very detailed and includes all information that people would want to know about the home. A Welcome Pack is provided in every bedroom. This is a shortened version of the larger file but includes helpful information for people living in the home in an easy to read format. Greengables Nursing Centre DS0000069152.V333777.R01.S.doc Version 5.2 Page 9 The assessments of two people who had recently moved into the home were checked. The manager had assessed both people and said that she or a senior nurse would carry out these assessments. Health or social care professionals, such as doctors and social workers often provide additional information about the person which helps to show whether or not the person’s needs can be met at the home. The assessments were detailed and included information about people’s backgrounds as well as their religious beliefs, hobbies and interests. The person being assessed signs the new assessment form to show they have been involved in their own assessment. Where possible, people who may be interested in moving in are encouraged to visit Greengables first. One person said that a relative had found the home for her whilst she was in hospital. The manager said that a new care plan format was being introduced and this would provide more detail about the person’s individual preferences and wishes about their care. One family had set up a visitors’ book for a person with short-term memory loss so that the person would be able to read about friends or relatives who had visited and what they had said. Greengables Nursing Centre DS0000069152.V333777.R01.S.doc Version 5.2 Page 10 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 and 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 that people receive is based on their individual needs to make sure they get all the care they need in the way they prefer. EVIDENCE: The care plans of two people living in the home were seen. The registered manager said that a new care planning system was being introduced. The new care plans were more focused on the individual needs and wishes of people living in the home. The way in which the care plans were written showed that people’s unique needs were being recognised and met. Where possible the care plan was drawn up with the person but if there were difficulties communicating with the person then the nurse would speak to a close family member or someone who knew the person very well. The care plans also included risk assessments to make sure that possible risks were recognised and plans drawn up to reduce them. Greengables Nursing Centre DS0000069152.V333777.R01.S.doc Version 5.2 Page 11 The manager said that each person living in the home had a named nurse who was responsible for drawing up their care plan and a keyworker who was the first point of contact for that person and had responsibility for making sure they had everything they needed. This means that each person knows who to speak to about any needs. One person living in the home confirmed that staff were aware of her individual needs. Another person who had memory problems was not aware that they had a care plan. Care plans are reviewed at least once a month but more frequently if any issues arise. Care records showed that support and advice for each person who lives at the home is received from health care professionals such as doctors, specialist nurses and chiropodists. The manager was finding it difficult to find a dentist who would visit the home but said that contact would be made with the local Primary Care Trust to look for a solution. Several people with some degree of challenging behaviour live at the home but staff were seeking advice about managing the needs of these people. A GP said, “staff manage the more challenging behaviours of some extremely well”. Medicines were being managed quite well. There were a few gaps on the medication administration records where staff had omitted to sign for medicines that had been administered. Where people were refusing to take medication a record was made and discussions held with the GP so that a decision could be made about the course of action to take. The list of medicines that could be administered to a person without a prescription for a short period of time needed to be updated so that people who had recently moved to the home would be included. The people who live at Greengables are treated with dignity and respect. Staff knocked on the doors of bedrooms before entering and talked to people in a way that was respectful. People said that staff treated them with respect and were “very good”. Greengables Nursing Centre DS0000069152.V333777.R01.S.doc Version 5.2 Page 12 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are helped to take part in activities so they can stay stimulated and active. EVIDENCE: A new activity coordinator has been working at Greengables for the last four weeks. She works five days a week and was doing craftwork with a small group of people during the visit. People said that they enjoyed these sessions and that they did not have to join in if they did not wish to. Books and newspapers were available. Trips out of the home included shopping trips, pub lunches and day trips. Several hairdressers visit Greengables so that people have a choice of hairdresser. The local library provides books etc for the home and local schools occasionally perform at the home. Entertainers also provide monthly performances. Young people from a local school had recently helped to prepare a sensory garden at the home with raised garden beds which are accessible to people in wheelchairs. The garden is to be opened at the end of July 2007. People at Greengables are also involved in raising money for a local children’s home. Greengables Nursing Centre DS0000069152.V333777.R01.S.doc Version 5.2 Page 13 A minister from a local church visits the home on the last Wednesday of every month. All are welcome to join in Holy Communion. Ministers from other denominations visit on request. Friends and relatives are able to visit at any reasonable time although they are encouraged to avoid meal times. Visitors said they were made to feel welcome. People can express choice in a number of ways, for instance about meals and when they get up and go to bed. One person wanted to have the main meal at lunch rather than in the evening and this was made possible. Meals were of a good standard and people had a choice of food at every meal. People living in the home made positive comments about the good quality of the food, one person commenting, “I love them” and “food’s champion”. One choice at lunch was a pizza slice, which was not an appropriate choice for one particular person. The manager said that she knew of this and would be discussing the various options with the cook. Greengables Nursing Centre DS0000069152.V333777.R01.S.doc Version 5.2 Page 14 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure so people have information about how to make their concerns known. There is also a thorough adult protection procedure for the home so that people are protected from harm but some staff still need to receive training in order to make sure that they know what they must do if they suspect abuse is happening. EVIDENCE: There is a complaints procedure for Greengables that is displayed in the entrance to the home and included in the information file (Statement of Purpose/Service User Guide) at the entrance to the home. Most people who returned comment cards to CSCI said they knew how to complain. However, information about the complaints procedure is not included in the Welcome Pack given to each person who lives at the home so they may not know what to do if they have any concerns about the home. The manager said that there have not been any complaints about the home. There is a policy at the home on the protection of vulnerable adults. The manager said that more than a third of staff have done training on protecting people from abuse and that the remaining staff would be doing it during the following two months. Greengables Nursing Centre DS0000069152.V333777.R01.S.doc Version 5.2 Page 15 The manager and a senior nurse were due to attend training about the Mental Capacity Act so they will know what steps need to be taken to comply with it when it is implemented later this year. The manager confirmed that currently there was no one living at Greengables without a family member or friend willing and able to act on their behalf. Greengables Nursing Centre DS0000069152.V333777.R01.S.doc Version 5.2 Page 16 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well laid out and maintained so that people live in safe and comfortable surroundings. EVIDENCE: A tour of the home was made. Greengables is a homely, pleasant, comfortable home for people to live in. The standard of fixtures and fittings is good. There are a number of lounges and a dining room so that people can have a choice of where to sit. There is also an inner courtyard where residents can sit out during warmer weather. The maintenance man has been involved in coordinating and building a sensory garden with a pond that is due to be completed before the end of July 2007. People living at the home were looking forward to this. Greengables Nursing Centre DS0000069152.V333777.R01.S.doc Version 5.2 Page 17 All parts of the home were clean and tidy. No unpleasant smells were noticed. There were adequate supplies of protective clothing to prevent cross infection, which staff were using. Greengables Nursing Centre DS0000069152.V333777.R01.S.doc Version 5.2 Page 18 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff receive training in order for them to maintain and develop their skills when providing care. Recruitment procedures are thorough so that people are protected from possible harm or poor practice. EVIDENCE: Staffing levels at Greengables are good. There were enough staff on duty during the visit to meet the needs of people living in the home. People said that they did not often have to wait a long time when they rang the bell for help. Staff seemed friendly and said that they enjoyed working at Greengables. Many staff have worked at the home for a number of years, which provides stability and continuity for the people living there. People living at the home said that they found the staff very helpful and caring. A relative commented, “my relative tells me he is happy and could not be better looked after if he was the King of England”. Recruitment records were looked at for two new staff members. These contained all the necessary information including security checks from the Criminal Records Bureau and two references. When staff start work at the home they are given an induction booklet. This is linked to the nationally recognised Skills for Care foundation standards so that staff are working to Greengables Nursing Centre DS0000069152.V333777.R01.S.doc Version 5.2 Page 19 standards that are accepted in other care environments and are of a good standard. The manager encourages staff to undertake training relevant to their role. Information provided by the registered manager before the inspection indicated that 70 of care staff have achieved NVQ level 2 in care. Staff had received training in mandatory subjects such as fire safety and moving and handling and other topics such as the safe use of bedrails and diabetes. Student nurses on placements work at Greengables as well as young people from local schools on work experience. Greengables Nursing Centre DS0000069152.V333777.R01.S.doc Version 5.2 Page 20 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 and 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 managed in a way that ensures the health and well being of people living at the home are promoted. EVIDENCE: The manager has eleven years management experience and has just completed NVQ level 4 in management. In addition to this the manager has a degree in Health Education, is a moving and handling and fire safety trainer and has kept herself up to date by undertaking other training courses relevant to her role. The manager is well regarded by staff, people living in the home and relatives. One relative commented, “all the staff, not only medical, but administrative Greengables Nursing Centre DS0000069152.V333777.R01.S.doc Version 5.2 Page 21 and service work together as a team”. A staff member said, “The best manager I’ve had……..most approachable person”. The manager provided details of a recent survey carried out at the home to find out how satisfied people living there were with the service and facilities provided. The results showed that the home achieved a very high percentage of 100 for privacy, 94 for cleanliness, 93 for the quality of care, activities and respect and 60 for information and numbers of staff. The manager said that following the results of the survey, action was taken to put any matters right. Senior managers representing BUPA visit Greengables once a month to review the quality of care and facilities. They send CSCI a copy of this report. BUPA also carry out a survey to find out what staff think about the registered manager. The manager audits the care plans and medicines to check that standards are being met. Information provided to CSCI by the manager before the inspection showed that there are no residents who handle their own financial affairs. The manager said that residents receive their full personal allowance to use as they wish and that records are held of the management of personal allowances. Moving and handling training records showed that most of staff had undertaken this training. Records on fire safety tests were also seen. All staff have undertaken a refresher fire safety training course in the last year and at least one fire drill in the last six months. Information provided by the manager before the inspection indicated that equipment and facilities were serviced at least once a year. A sample of maintenance records were seen and found to be accurate and up to date. Four staff members have undertaken training in first aid. The manager said that all nurses working at the home stated that they felt confident to carry out first aid in an emergency so that there is always someone competent in first aid on duty at all times. Greengables Nursing Centre DS0000069152.V333777.R01.S.doc Version 5.2 Page 22 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 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Greengables Nursing Centre DS0000069152.V333777.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations Staff should always sign the medication administration record when a medicine has been administered so that there is proof that medicines have been given as prescribed. The “homely remedy” list should be updated so that it includes people who have recently moved into the home. The complaints procedure should be included in the Welcome Pack so that people living in the home know what to do if they have any concerns about the home or its staff. All staff should undertake training in adult protection so that people who live at the home are protected from possible abuse. There should always be a person qualified in first aid on duty so that people are protected in an emergency. 2 3 OP9 OP16 4 5 OP18 OP38 Greengables Nursing Centre DS0000069152.V333777.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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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