Inspection on 12/11/07 for Greenslades Nursing Home

This inspection was carried out on 12th November 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Greenslades Nursing Home 22/08/06

Greenslades Nursing Home 21/12/05

Greenslades Nursing Home 07/04/05

Greenslades Nursing Home 12/10/04

Greenslades Nursing Home 07/05/04

Greenslades Nursing Home 10/02/04

Greenslades Nursing Home 05/12/03

Greenslades Nursing Home 09/05/03

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

CARE HOMES FOR OLDER PEOPLE Greenslades Nursing Home Willeys Avenue Exeter Devon EX2 8BE Lead Inspector Michelle Oliver Unannounced Inspection 09:45 12 November 2007 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Greenslades Nursing Home DS0000026693.V349324.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. Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenslades Nursing Home Address Willeys Avenue Exeter Devon EX2 8BE 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) 01392 274029 01392 279089 alison.robertson@sanctuary-housing.co.uk Sanctuary Housing Association (trading as Sanctuary Care) Mrs Alison Gaenor Robertson Care Home 67 Category(ies) of Dementia - over 65 years of age (36), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (36), Old age, not falling within any other category (31) Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd August 2006 Brief Description of the Service: Greenslades Nursing Home was built approximately fifteen years ago. It is a three-storey red brick building. Access is via a side road off one of the main routes into the city near the centre of Exeter. There are local shops and amenities close by, the city centre being approximately one mile away. ISCA wing is primarily for 36 older people with mental health/dementia related needs. Belvedere wing is for 31 older people with more general health care needs. Nursing care is provided for 67 service users in all areas of the home, by nursing care assistants who are supervised by Registered Nurses. There is one double room, which is currently being used as a single room. All residents’ accommodation is en-suite. The average cost of care is £294-682 per week at the time of inspection. Additional costs, not covered in the fees, include hairdressing and personal items such as toiletries, newspapers and magazines and private chiropody and taxis. Current information about the service, including CSCI reports, which are accessible at the Home, is given to prospective residents/their representatives. Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two inspectors and took place over 8 hours on the 12 November 2007. During the inspection 6 people were case tracked. This involves looking at peoples’ individual plans of care, and speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. As part of the inspection process CSCI likes to ask as many people as possible for their opinion on how the home is run. We sent questionnaires out to 34 people living at the home, 34 representatives, 17 health and social care professionals (including GPs and care managers) and 39 staff. At the time of writing the report, responses had been received from 5 people living at the home, 9 relatives/ representatives, 4 health and social care professionals and 15 staff. Their comments and views have been included in this report and helped us to make a judgement about the service provided. Because the majority of people living on Isca wing. [Primarily for 36 older people with mental health/dementia related needs] could not engage with the inspection process through conversation, we observed interactions between staff and the people who live at Greenslades over a period of approximately 2 hours. During the inspection we spoke to 22 people living at the home individually and 6 in a group setting, as well as observing staff and people living at the home throughout the day. We also spoke with 10 staff, a chef, the manager and deputy manager and 3 visitors/relatives. A full tour of the building was made and a sample of records was looked at, including medications, care plans, the fire log book and staff files. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk . Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Staff have worked hard to make sure that people living at the home are encouraged and supported to take part in activities of their choice. All people spoken to said that they are treated kindly by staff, feel that they are respected as individuals and are enabled to live a life as independently as they wish or are able. Some areas of the management of medicines have been improved since the last inspection. People living at the home now enjoy their meals in light, bright surroundings. Tables are nicely laid and condiments are available on individual tables. Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 7 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. Greenslades Nursing Home DS0000026693.V349324.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 Greenslades Nursing Home DS0000026693.V349324.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 & 6. Quality in this outcome area is good. Systems are in place to ensure peoples’ needs are assessed before they move into the home, promoting the success of their admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Before a person moves into the home an assessment of their individual health, welfare and social care needs are undertaken by either the manager or a suitably experienced registered nurse. This is to ensure that the home can be confident that staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. People can also be confident that their needs can be met. Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 10 Before deciding to make Greenslades their home, people are invited to spend time in the home, have a meal if they wish, meet other people living there and staff and to ask any questions they may have. Several completed questionnaires were returned to us before this inspection. People were generally happy with the admission procedure to the home and the information provided. Visitors say they visited the home before their relative moved in which helped them to make a decision about where to live. The home does not admit people who need intermediate care. Greenslades Nursing Home DS0000026693.V349324.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. Health and personal care needs are well met and recorded in individual plans of care. Further improvements would ensure that care is delivered in a person centred way. Medicines are mostly safely managed although some areas have the potential to place people at risk of harm. The privacy and dignity of the people who live here is respected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We spoke to several people during this inspection and all confirmed that they receive personal and healthcare support in an individual manner and are generally happy with the care given, staff respect their right to privacy and feel they are all treated equally and as individuals. Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 12 In surveys people who live at Greenslades said they receive the care, support and medical care they need. Relatives, in surveys, said that the home meets the needs of their relatives and that they receive the support and care they expected or that was agreed. Care plans are well organised and easy to access and to read. We looked at six people’s care plans in detail and all showed that appropriate assessments are undertaken in relation to the risk of people falling, developing pressure sores and in relation to how much nutritional support the person needs None of these people have developed pressure sores and all are maintaining their weight or are gaining weight. Although not recorded, staff demonstrated an in depth knowledge of peoples food preferences and a good understanding of the importance of this when helping to meet someone nutritional needs. There is evidence that referrals to health and social care professionals are made when needed. These include dentists, opticians, chiropodists, psychiatric nurses and general practitioners. The majority of the people living at Greenslades are registered with a doctor who visits the home each week. The weekly visit is followed up by a meeting between senior nurses, manager and deputy where all peoples’ health and care needs are discussed and reviewed. We saw good examples of this in care plans. One health care professional commented, “ I find the staff at Greenslades go to a lot of trouble to address care issues and to monitor treatment and medication. Changes to the way care is planned show that staff are trying to make the planning of care more person centred. However, information within them demonstrates that this has yet to be fully achieved. One care plan relating to planning the care for someone who is expressing their sexuality is impersonal and very general. Another care plan relating to planning the care for someone who has a dedicated carer for part of the day does not provide staff with sufficient information in how to meet this persons needs. Care plan reviews take place regularly. For example one person is to be monitored as they can be verbally aggressive and this is reviewed monthly. However, the care plan does not accurately record episodes of aggression, what prompted them or what prevented or stopped them. When spoken with staff have this information, but do not always record it in depth. Reviews do not seem to incorporate this information when deciding whether the plan of care remains relevant or not. Another care plan records a person’s behaviour that is challenging the service. Staff are instructed to record what might have caused this, the actions they Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 13 have taken and the outcome of that. However, staff completing these are not always recording the information that would help senior staff to determine what actions need to be taken to prevent the behaviour which is challenging the service. Evidence of individuals or family involvement in the process of reviewing plans of care was inconsistent. Some indicated that the individual had been involved, some the family but for some there was no evidence of any involvement. This means that not all people are given choice in relation to their health or social care needs. Plans of care include some detailed information about what care individuals needed and how this is to be carried out by staff. However, peoples’ individual strengths are not consistently recorded. This puts people at risk of losing whatever degree of independence they may have. For example information included in one plan of care stated that the person needed “all assistance with personal care”. There was no reference to how they may be supported or encouraged to take part and therefore to retain some independence. Some details were lacking such as details and actions relating to comments such as; ‘nursed in bed’; carry out “ regular observations’; and ‘shouting’. However, a plan for another person stated the aims were to “ maintain a high standard of personal hygiene without interrupting [their] freedom to do the things [themselves]”. Although care plans did not consistently record how care and support had been assessed, or how it was to be carried out, in an individual way, staff were able to speak about peoples’ health, social and personal care needs in a person centred way. People spoken to during this inspection were “very happy” with the level of care they receive, all thought staff were “lovely, friendly, helpful and supportive”. This means that people can be confident that the needs will be met at the home but that the collecting and recording information of how people choose to be cared for needs improvement. We looked at how the medications are managed in the home generally and in relation to the 6 people we case tracked. We found that medicines were stored securely on both Belvedere and Isca wing. We saw two registered nurses giving out medicines during this inspection. They took time with people, made sure a drink was available and did not hurry those who took their medicines slowly. We looked at medication records and all confirmed that medicines are usually checked and signed into the home by a registered nurse. A medication record for one person indicated that a doctor had prescribed two medicines for them. Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 14 Records indicated that one had been given regularly and the other not at all. Only one prescribed medicine was available at the home during this inspection. Care plans and records of doctors’ visits were checked but no information was available to explain why one was not been administered. This potentially puts people at risk of not being given the correct medicines as prescribed by a doctor. It was noted that another person had been prescribed inhalers. The date on which the inhalers were opened and used was clearly recorded on the device. This reduces the risk of them being used beyond the date of expiry. The nurse in charge confirmed that all inhalers are replaced every 28 days. However, it was noted that the inhaler would be empty after only 25 days if the prescribed dose were given as instructed. This means that people could be at risk of not receiving medicines as prescribed. We looked at the record of controlled drugs being used at the home. All were accurate and up to date. We looked at the medicines and records relating to three people living on the Isca Unit. Some people are receiving medicines prescribed to be given ‘when needed’. There are some instructions for staff about the circumstances under which they should be given, but these are very general and lack detail. When staff give these, they are not recording the reason why they were given and the effect the medication had on that person. We also looked at how well the home ensures that the privacy and dignity of the people who live there is protected. Staff described how they respect people’s dignity by knocking on their doors and waiting to be invited in before entering, ways of carrying out personal care discreetly and according to peoples’ wishes. People confirmed that they are treated with respect and their privacy is protected. All personal care was carried out in private and people wear their own clothes, which were generally very well cared for. During this visit we also saw some examples of ways in which the staff treat people living at the home with respect. For example during a ball game between some people with dementia and a carer, the carer was called away. She apologised to all those playing and said she would be back as soon as she could. When she returned she again apologised and checked that people were ready to resume the game. Other carers were heard saying ‘excuse me’ to people as they passed them. Greenslades Nursing Home DS0000026693.V349324.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 good. People who live here benefit from having easy contact with their friends and family and from a varied and wholesome diet. Although the Home provides activities, which many people can join in, this may not provide adequate stimulation and interest for all people currently living at the Home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The activities co-ordinator reports that the activities have recently been reviewed. She says this is partly to help prevent boredom, but she also explains they are trying to include activities which carers can help people to join in with easily. She reports this will include activities such as reading poetry, reading the daily newspaper and giving hand massages/painting people’s nails. Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 16 We saw people enjoying having their nails manicured. When asked what pampering is provided for men, staff told us that they enjoyed their nails being manicured also. Care plans did not contain comprehensive records about what might engage people living here. However, we saw some activities taking place. Some people were doing a jigsaw, some people were playing with a large soft ball and one person was having a story read to them. One person we case tracked sat very quietly in a corner with music playing close to her. When we checked with staff and with their visitor they say this is just what this person likes – seeing what is happening, not joining in and listening to music. Some people were in their bedroom either watching television or listening to music. External entertainers are brought in to add variety to the activity programme and on the day of this visit people were enjoying some musical entertainment. In response to a questionnaire received before this inspection a member of staff commented that the home could improve by “ provide more mental stimulation in activities. Have more one to one time with clients”. During this visit we saw a number of people sitting comfortably in two lounges. Some people were watching TV and some talking to a volunteer who visits the home to spend time with people. On two occasions carers were sitting in the lounges with the people they were caring for, but limited involvement or interaction was taking place. Staff spoke about how they offer, support and encourage people to make choices. For example, people can choose when they get up or go to bed, take part in activities, choice of meals and where they sit. People are encouraged to bring personal items with them when they move into Greenslades. Many of the rooms seen during this visit had been personalised with pictures, ornaments, photographs and small items of furniture. All people spoken to say they enjoyed the meals served at the home. People living on the general unit are able to choose their meals the day before and on the Isca wing people are offered a choice as the food is served. Staff say that they help people to make choices by showing them the options. This enables people to use all their senses in deciding what to eat. We observed part of the luncheon serving and saw that people who needed help got this from staff. We saw people being offered choices and condiments. Information received before this inspection states that current menus are being revised to offer more choice at suppertime. In response to a questionnaire a member of staff commented that the home could do better by “ provide better teatime menu for the clients, also more snacks available out of hours”. Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 17 Relatives & friends are encouraged to participate in the daily life of the home and the home operates an open visiting policy. Visitors say they can come and go as they please and often visit at different times of the day. One person says they like to visit their relative during meal times to make sure they get the help they need. Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 18 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. The home has a good complaints system which ensures that people living at the home and relatives are able to express their views and be listened to People living at the home are protected from abuse by staff who have received the necessary training and are aware of the procedures to take. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the home’s Complaints Procedure is displayed in various accessible places throughout the home, advising people living at the home and relatives/ representatives who to contact if they have a complaint. A copy of the procedure is given to all people when they move into the home. The manager confirmed that all complaints are investigated and are seen as an opportunity to develop or adjust services and to listen to constructive criticism from people. We looked at the home’s record of complaints and noted that they had been investigated, records of outcomes were in place and any actions taken in Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 19 response. Since the last inspection a complaint has been made to the CSCI. The home was asked to investigate this following their procedure, which they have completed. When we observed interactions between staff we saw some staff respond to those people with dementia, who cannot make their complaints or grumbles known, with sensitivity and patience. For example, one person indicated they were unhappy. The carer took the time to find out what might be making this person unhappy and then took action to remedy this. This person then settled. However, another carer did not take enough time to ‘listen’ to this person. They assumed they wanted a game that had been put near to them. They gave this to this person and left the room. The person banged the toy against the table, sat back and stared into space. Staff spoken with say they have received training in ‘safeguarding adults’. They demonstrate a good understanding of what abuse is and what to do if they suspect and/or see this. However, recordings in care plans show that some people living here are presenting safeguarding issues. A visitor said that although the staff are excellent and caring, they are concerned that not enough steps are taken to protect people living here from each other. A referral/alert has not been made to the safeguarding adults team as should have happened. This was discussed at the time of this visit and appropriate action has since been taken. In response to a questionnaire a care manager, commented, “ I have no concerns that if I have a problem they will address it and let me know the outcome”. Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 20 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 & 26Quality in this outcome area is good. People benefit from living in a home that is safe, well maintained and has a homely atmosphere. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Greenslades is well maintained and provides comfortable accommodation for people living here. Visitors say that their relatives’ bedrooms are personalised to suit them. Rooms visited during this visit were homely and most had been personalised with their own belongings and some small items of furniture; all were well decorated and fresh. We noticed that one bedroom, unlike the others, had few photographs and/or personal possessions. When we checked with the visitor of the person whose bedroom this is, they say this is their choice and that historically this person had hated what they considered to be clutter. Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 21 The home is well furnished and maintained to a good standard. Staff record any maintenance or repairs that are needed throughout the home. The home employs a maintenance person to ensure necessary repairs are carried out in a timely fashion. The inspector had a full tour of the building unaccompanied and all the areas were extremely clean and fresh. Hand washing facilities are provided in all rooms and bathrooms to ensure good hygiene practice at the home. The laundry facilities were clean and well organised. Hand washing facilities, antibacterial gel dispensers, aprons and gloves are provided in the washroom. All laundry is managed at the home following robust procedures to prevent cross infection. Everybody was well dressed at the time of this visit and several said that their clothes are well looked after. The manager said that the laundry service is monitored to ensure peoples’ clothes do not go missing In response to a questionnaire a member of staff commented, “The general appearance of the home has deteriorated and does not give a true account of the care home. Attention should be given to the general upkeep of the home ensuring that the clients needs are met i.e. hot running water for basic care”. During this visit, temperature of hot water at various places, including bathrooms and private rooms were checked and all were satisfactory. Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 22 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. The number of staff on duty throughout the day and night meets peoples’ basic health care needs however some peoples’ social needs are at risk of being compromised by the number of staff on duty. Residents are protected by the home’s recruitment procedure. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the staff rota and found that there are always Registered Nurses on duty. There is always one working on Belvedere Unit and two working on the Isca Unit during the day and one at night. In addition there are usually 6 carers on each unit in the morning, 5 or 6 in the afternoon and 2 on each unit at night. In addition the home employs ancillary staff At the time of this inspection there was nothing to suggest that people’s basic needs were not being met. All mandatory staff training was up to date or in progress as this is undertaken on a rolling programme to make sure all staff are up to date. Staff felt that they were well supported by management. Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 23 We looked at the recruitment files of three members of staff who have been recruited recently. These contain all the checks that are recommended to prevent unsuitable staff working with vulnerable people. Checks include two written references and a police check. Ensuring the recruitment procedure is consistent and that all required information is obtained for all employees will protects people, as only those who have undergone this robust procedure will be employed to work at the home. The manager has recently adopted a new induction training package for staff. This is based on National Standards as is recommended. Staff say they receive lots of training which they find helpful. In particular they say the training they have received relating to dementia has helped them in their everyday practice. This means that trained competent staff care for people living at the home. Comments made in response to questionnaires included, “ There always seems plenty of staff and they are always available to talk if required. Staff nurses always know what is happening with my clients” and” I have no problems with the home but sometimes it is not easy to understand what staff are saying”. In reply to “are staff available when you need them” one person living at the home commented “ usually, but I expect that they are busy. They have a lot of work to do”. People and visitors say that the staff are lovely and some staff were named repeatedly as being particular helpful and kind. Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 24 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 & 38 Quality in this outcome area is good. There is clear leadership and guidance to staff to ensure people living at the home receive consistent care in a reasonably safe environment. The home has good systems in place to consult with people over the standard of facilities and services provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has many years of relevant experience in the management of care homes and works hard towards meeting National Minimum Standards. Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 25 The manager operates an “open door” policy at the home and people are encouraged to speak to her or the deputy at any time they are there. The home has good systems in place to consult with people over the standard of facilities and services provided. There is a suggestion box in reception which is checked on a weekly basis,residents / relatives meeting are held every 2 - 3 months. Minutes of the meeting are made available and copies are left at reception and posted on notice boards. The home also carries out an annual quality assurance audit, from which an improvement action plan will be developed. This means that people have a say in the running of their home. People living at the home were recently asked to complete a questionnaire asking them their views on certain aspects of the home. The results of this survey have not yet been included in the home’s statement of purpose. This means that people who may be considering moving to Greenslades will not be aware of what people who are living there already feel about the service. Also people living at the home and others who have taken part in a survey should be made aware of the outcomes. This was discussed with the manager during this visit. Records looked at during this inspection included, individual plans of care, including risk assessments, daily reports and monitoring records, administration of medicine records, staff files and rotas, menus and records of accidents at the home. Records were well maintained and were securely stored. Records show that staff undertake regular training in the prevention of fire. The fire logbook indicated that fire alarms are regularly checked. Staff receive mandatory training, including first aid and manual handling, all of which was found to be up to date at the time of this visit. We observed good practice in relation to moving and handling those people who needed support. The home does not deal with any financial affairs of the people living there other than to hold, if required, a sum not exceeding £100 in the safe for them. Records are maintained of money held and safeguards are in place to ensure balances are checked. We looked at the records and found them up to date and accurate. Information received prior to this inspection indicates that water systems are tested monthly for legionella, all equipment in the home is regularly tested in accordance with requirements, water temperatures are checked monthly in Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 26 relation to the risk of legionella and water temperature is controlled by thermostatic valves and there is a maintenance plan for fire equipment, hoists, chair lift and call bell system. We looked in the kitchen and found it clean, tidy and well organised. All food was covered and kept at the correct temperature. The Environmental Health Officer visited in August and made two recommendations. One has already been carried out and the other (renewing the floor in the walk in fridge) is planned for next year. All radiators are covered and windows are fitted with restrictors. All sinks and baths are fitted with thermostats to ensure that water is not excessively hot. A representative from Sanctuary Care conducts monthly visits and sends reports to CSCI as required. This helps to ensure that people live in an environment that has systems in place to keep them safe and free from harm. Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 27 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 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 3 17 X 18 2 3 X X X X X X 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 3 3 2 X 3 X X 3 Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15[1] Requirement Care plans must set out details of peoples’ health, welfare and social care needs. This is to make sure that all aspects of peoples needs are monitored, changes noted and planned to be carried out in a person centred way People living at the home and/or their representatives must be involved in developing and reviewing their individual care plan and a record must be made of this. This is to make sure that care is being carried out as people wish, in an individual manner. You must make arrangements for the safekeeping and handling of medicines received into the home. This relates to the need to: Recording when and why ‘as needed’ medications should be given and the outcomes. Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 29 Timescale for action 12/01/08 2. OP7 15(1) and Sch 3 12/01/08 3. OP9 13 (2) 12/01/08 To make sure that medicines recorded on medication charts are given, or noted that they have been discontinued. To make sure that sufficient medication is available to cover the period it has been prescribed for. 4. OP12 16 (2) (m) You must consult service users about their social interests and make arrangements to enable them to engage in social activities of their choice. This requirement was made at the last inspection. Some improvement has been made. 5. OP33 24[2] The results of surveys should be published and made available to people living at the home, their representatives and other interested parties, including the CSCI. This is to make sure that peoples’ views on the home are available. 12/03/08 12/01/08 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 OP7 Good Practice Recommendations You should ensure that care plans have clearer action DS0000026693.V349324.R01.S.doc Version 5.2 Page 30 Greenslades Nursing Home planning and details relating to descriptions of peoples’ needs and evidence of resident/family involvement in care planning. 2. OP12 You should ensure that all care plans contain information about residents’ choice and preferences and that all residents are regularly offered appropriate activities to meet their social needs and that this is recorded. All allegations and incidents of abuse should be followed up promptly and action taken recorded. 3. OP18 Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Greenslades Nursing Home DS0000026693.V349324.R01.S.doc Version 5.2 Page 32 - 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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