Inspection on 21/12/05 for Greenslades Nursing Home

This inspection was carried out on 21st December 2005.

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

Greenslades Nursing Home 12/11/07

Greenslades Nursing Home 22/08/06

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 Rachel Doyle Unannounced Inspection 21st December 2005 09:55 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.V269235.R01.S.doc Version 5.0 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.V269235.R01.S.doc Version 5.0 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 Sanctuary Housing Association (trading as Sanctuary Care) 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.V269235.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Notice of Proposal to Grant Registration for staffing/environmental conditions of registration was issued 5/12/2000 7th April 2005 Date of last inspection 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. Greenslades Nursing Home DS0000026693.V269235.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Wednesday 21st December 2005 from 09.55-13.00. One inspector focussed on Belvedere Unit and another inspector on Isca Unit. The inspectors were welcomed by the Manager (who is not yet registered by CSCI but will be applying by the end of January 2006) and able to discuss any issues in depth. They were able to tour the Home freely, look at relevant documents and speak to 6 staff (4 in detail) and 14 residents (4 had profound communication difficulties). The inspection focussed on any key National Minimum Standards, which were not looked at during the last inspection and also to follow any requirements and recommendations from that inspection and the Additional Visit, which took place on 31st August 2005. What the service does well: What has improved since the last inspection? Care planning systems on both units are good and being used well including the multidisciplinary team and the Home are working towards documenting resident/representative involvement and spiritual needs in detail. The role of the keyworker is being discussed and training sessions are planned for staff. Meals are well managed on Isca (standard not judged on Belvedere). Greenslades Nursing Home DS0000026693.V269235.R01.S.doc Version 5.0 Page 6 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. Greenslades Nursing Home DS0000026693.V269235.R01.S.doc Version 5.0 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 Greenslades Nursing Home DS0000026693.V269235.R01.S.doc Version 5.0 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 the following standard(s): Not judged on this occasion. EVIDENCE: Please see previous inspection reports for details. Greenslades Nursing Home DS0000026693.V269235.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9, 10 The staff have a good understanding of residents’ health and personal care needs, which is clearly documented in care plans with multidisciplinary working. Residents’ privacy and dignity is promoted by staff except on Isca in relation to bathroom facilities. Medication administration is well managed at the Home but improvements should be made in the storage and use of medication, which has a use by date to ensure the safety of residents. EVIDENCE: Belvedere- Three care plans were looked at. These were comprehensive with good evidence of multidisciplinary working and reviews. The inspector spoke to a professional from Funded Nursing Care who felt that staff were good at communicating nursing needs and assessments and that this was an improvement. Not all contained records of resident involvement but this is in progress within the care plan audit, along with obtaining details of residents’ wishes about spiritual needs. A letter has been sent to all residents’ representatives as appropriate and the Home are awaiting responses. The role Greenslades Nursing Home DS0000026693.V269235.R01.S.doc Version 5.0 Page 10 of the keyworker will be explained to staff and relatives in detail at the next meeting. All eye drops in the fridge were out of date. Although there were issues around all staff not communicating in a way which encourages residents’ independence and choice, all staff were treating residents with respect, maintaining privacy and delivered the service in a caring way (see NMS 14). Isca- Three care plans seen which contained reference to them being discussed with residents or in one case explanation that the resident was not able to comment on the care plan. All three showed evidence of regular review. Seven prescriptions stored in the fridge had been appropriately dated when opened and were within use by date. The fridge temperatures were being monitored, though on 12 occasions in December they had outside normal ranges; the staff nurse said this had been reported to the maintenance man and manager reported that they had checked the temperatures and found the thermometer to be faulty. Residents able to comment confirmed that staff are polite and kind with one person describing staff as “friendly”. Staff were seen communicating clearly and respectfully with residents, providing personal assistance discreetly. One new member of staff said that they had been surprised and “impressed” by colleagues’ positive attitude towards residents. Bathrooms and toilets still do not have privacy locks fitted, which has been a recommendation following previous inspections. This is now a requirement. Greenslades Nursing Home DS0000026693.V269235.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14, 15 Some good work is ongoing on Isca to help residents engage in social activities however further effort is needed to ensure that all residents are helped to access activities that meet their individual needs. In general staff ensure that residents are encouraged to maintain their independence and exercise choice but improvements should be made to ensure that all staff have good communication skills. Meals are well managed on Isca (standard not judged on Belvedere). EVIDENCE: Belvedere- In general most staff were communicating well with residents but two new staff were seen to communicate poorly with residents in the upstairs lounge. There was little eye contact, a lack of clear instructions when assisting them or standing over residents to assist with feeding and a lack of encouraging independence or choice although their manner was a caring one. One resident said that they would like the subtitles on the television. There has been a range of activities at the Home such as a Christmas party and more are planned for the Christmas period. Carers were giving some residents manicures and chatting to residents facilitating activities. The manager said that the Home had taken some residents out for a drive and had hired Freedom Wheels. More external trips will be arranged when it is warmer. The Greenslades Nursing Home DS0000026693.V269235.R01.S.doc Version 5.0 Page 12 hairdresser was visiting and said that the Home had a lovely atmosphere. The staff have worked hard to improve time spent engaging with all residents and this was evident. Four residents confirmed that visitors were welcome at any time and staff were friendly and welcoming. NMS 15 was not assessed on Belvedere. Isca- One resident said there is nothing to do at the home but records indicated that they are invited to be involved in activities but usually decline; this person’s care plan however did not clearly identify what they would like to do. Two other residents’ care plans about activities did not provide sufficient detail identifying what activities they would like to be helped to pursue. Other residents asked were content that there is enough to do. The activities coordinator was seen working with 3 residents, looking at the day’s newspaper, she described varied activities that residents are involved with and had good knowledge about the personal history of residents discussed. Staff spoken with confirmed that they have time to sit with residents, to talk, look at books or pamper them and were seen doing so. Residents were positive about the food provided. Staff were seen assisting residents with drinks and offering residents a choice of biscuits mid morning. One resident was not aware that drinks can be requested at any time. Residents confirmed that they can spend time around the home where they chose, getting up and going to bed when they want. Some residents were seen having drinks in their rooms others in the lounges. A 2nd lounge area has been made accessible to residents on the second floor; greater use of the home’s shared space means that the atmosphere was more relaxed than on previous inspections. Greenslades Nursing Home DS0000026693.V269235.R01.S.doc Version 5.0 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 the following standard(s): Not judged on this occasion. EVIDENCE: Please see previous inspection reports. Greenslades Nursing Home DS0000026693.V269235.R01.S.doc Version 5.0 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 the following standard(s): 22, 26 The environment is clean and well maintained. In general residents have the equipment they need to maintain independence other than in the communal areas where there could be improvement. EVIDENCE: Belvedere- All residents’ rooms had adequate call bell systems but the call bell system in the lounges is unable to be used by residents who are less mobile as there is no lead. Four residents commented on this and one said that they had had to shout for help in the past. There were regularly staff popping into the lounges although there are short periods of ten minutes when a call bell may be needed. All areas of the Home were clean and residents spoken to confirmed that this was usually the case. The manager said that carers at night are now responsible to ensure that wheelchairs are kept clean and this is included on the night carer jobs list. Greenslades Nursing Home DS0000026693.V269235.R01.S.doc Version 5.0 Page 15 Isca- Residents said that they are happy with the standard of cleanliness around the home. The inspector looked in eight residents’ bedrooms, bathrooms and shared areas; they also looked at a couple of wheelchairs; all were generally clean. One lavatory was seen to be very dirty at around 11.00; when checked at 11.45 the inspector saw that it had been cleaned thoroughly. Greenslades Nursing Home DS0000026693.V269235.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 Staff are supported to do their jobs through the encouragement and provision of regular training. EVIDENCE: A recently employed member of staff confirmed that they had been required to attend training about maintaining health and safety, fire and moving and handling residents in her first days at the home. They said they were happy with their induction to working at the home and felt well supported; confirming that they were asked to complete the homes induction pack. This person said that they had been told they could their NVQ3 when they had been at the home for 6 weeks. A longer-serving member of staff said that staff receive regular training regarding caring for people with Dementia/manual handling/fire/ health and safety. The manager said that the Home encourages staff to obtain NVQ qualifications. There are 17 staff with NVQ 2, 3, or equivalent. Five further carers are working towards the NVQ award out of 40 carers in total. Greenslades Nursing Home DS0000026693.V269235.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 There are reliable systems in place to ensure the good health and safety of residents but improvements must be made relating to quality assurance. Residents’ financial interests are well guarded. EVIDENCE: The manager started in August 2005 and is currently not registered but will apply to CSCI in the near future. The Home uses a corporate quality assurance tool annually using questionnaires to residents and relatives, which can be anonymous. This is then collated. A mini survey was done in June 2005 relating to some topics but there has been no QA process for 2005. This must be done as a priority. Residents spoken to felt that they could speak to the staff and be listened to and a resident/relative meeting was held with 11 people attending this month. Minutes were seen; another is planned for February 2006. Three residents’ monies and records were looked at. These were well managed and correct. The Home has a detailed corporate policy on Greenslades Nursing Home DS0000026693.V269235.R01.S.doc Version 5.0 Page 18 Management of Service Users’ Money and Financial Affairs, which is comprehensive. The financial audit was seen for 2005, which showed good practice. Nearly all staff are up to date with Fire training and further sessions are planned. The administrator does fire and health and safety training including competency check questionnaires. All fire equipment was checked appropriately. The Home has their own PAT tester. Statutory training in Manual Handling is provided by another Home through, videos, workbooks and sessions. Greenslades Nursing Home DS0000026693.V269235.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X 3 STAFFING Standard No Score 27 X 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score N/A X 1 X 3 X X 3 Greenslades Nursing Home DS0000026693.V269235.R01.S.doc Version 5.0 Page 20 No 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 OP10 Regulation 12 (4) Requirement You shall make suitable arrangements to ensure that the Home is conducted in a manner which respects the privacy and dignity of residents. This only refers to the need for privacy locks on bathrooms and toilets on Isca. You shall maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the Home, including nursing and supply to CSCI a report making this available to residents. Timescale for action 21/02/06 2 OP33 24 21/03/06 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 It is recommended that all medication, which has a use by date on opening are clearly labelled and used within the recommended period or disposed of when out of date. DS0000026693.V269235.R01.S.doc Version 5.0 Page 21 Greenslades Nursing Home 2 3 4 OP12 OP14 OP22 It is recommended that all care files on Isca contain detailed information and assessment about residents’ choice, preferences and capacity in relation to activities. It is recommended that all staff are skilled in communicating with residents in a way which encourages independence and choice. It is recommended that call bells in the communal areas have accessible alarm facilities. Greenslades Nursing Home DS0000026693.V269235.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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 Greenslades Nursing Home DS0000026693.V269235.R01.S.doc Version 5.0 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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