Inspection on 22/08/06 for Greenslades Nursing Home

This inspection was carried out on 22nd August 2006.

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 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 Rachel Doyle Key Unannounced Inspection 22nd August 2006 10:00 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.V292865.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.V292865.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 alisonr@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.V292865.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st December 2005 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 £503 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.V292865.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Tuesday 22nd August 2006 from 10.00-17.00. As there are two units, one providing general nursing care and one providing dementia nursing care, two inspectors undertook the inspection, each focusing on one unit. There were 34 residents living on Belvedere unit, general nursing, (3 residents were under the category ‘residential’ rather than nursing.) There were 32 residents on Isca Unit, dementia care, with 3 being in hospital at the time of the inspection. During the inspection the inspectors case-tracked 6 residents, which helps us to understand the experiences of people using the service. A number of other residents were met and spoken with during the course of the day. The inspectors also spent a considerable time observing the care and attention given to residents by staff. Staff were spoken with during the inspection, including care staff, ancillary staff, administrator and the manager. Prior to the inspection surveys were sent to relatives to obtain their views of the service provided; 7 were returned. Four resident surveys were returned. Staff were also sent surveys; 14 were returned. Health and social care professionals were also contacted prior to the inspection including GPs, community psychiatric nurses and community care workers. Two GP surveys were returned. The inspectors toured the premises, including all shared areas and the majority of residents’ accommodation. A sample number of records were inspected which included care plans, medication records/procedures, staff recruitment files, service and maintenance certificates and fire safety records. The manager had completed a pre-inspection questionnaire and the inspector appreciated the preparation undertaken by the manager to assist with this inspection and found staff very helpful on the day. What the service does well: The management team and staff have obviously worked hard to achieve improvements at the Home and the manager felt that this was moving in a positive direction. Staff felt that they were working better as a team. The standard of cleanliness on both units was very good other than relating to recent staffing arrangements, which is being addressed. The Home has undergone a process of major re-furbishment, including new flooring and carpets, new furniture for Belvedere, curtains, electric beds, mattresses and adjustable bedside tables. Greenslades Nursing Home DS0000026693.V292865.R01.S.doc Version 5.2 Page 6 Residents’ financial interests are well guarded. Staff are supported to do their jobs through the encouragement and provision of regular mandatory training. Staff were seen to be very kind and caring in general and working well as a team. The quality of meals provided is good. What has improved since the last inspection? What they could do better: Some 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 and that all residents receive regular meaningful stimulation. Staff need to attend training to ensure that they have the specialist skills to meet residents’ needs appropriately. Health care needs, especially in relation to mental health needs, must be met to ensure that residents are able to mobilise safely/according to a satisfactory risk assessment. Improvements should be made to ensure that all staff have good communication skills and consistently respect residents. In general residents have the equipment they need to maintain independence other than in the communal areas where there could be improvement. Areas in medication must be addressed. Staff must ensure that residents are offered choices and their capacity to exercise personal autonomy is maximised. Residents should be assisted with their meals in a more congenial setting and in a sensitive manner. Greenslades Nursing Home DS0000026693.V292865.R01.S.doc Version 5.2 Page 7 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.V292865.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.V292865.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home’s assessment process is thorough and ensures that the Home is able to meet prospective residents needs prior to admission. EVIDENCE: Prior to admission all residents are assessed to determine their needs so that the Home can be sure that they can meet them. These include information and assessments provided by health and social care professionals to ensure that the Home has a clear picture as to the prospective residents’ needs prior to admission. Six admission assessments were looked at and all contained satisfactory information. The manager and other delegated staff visit prospective residents at home or in hospital for the assessments and cover a comprehensive range of needs such as personal care, mobility, diet, continence and family involvement. The Home does not offer intermediate care services. Greenslades Nursing Home DS0000026693.V292865.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff on Belvedere Unit have a good general understanding of residents’ health and personal care needs, which is clearly documented in care plans with multidisciplinary working. Staff on Isca Unit have an understanding of residents’ basic health care needs but there was a lack of appropriate knowledge relating to residents’ specialist needs, which is reflected in care documentation. Health care needs are not consistently met to ensure that residents are safe. Residents’ privacy and dignity is generally promoted by staff but there was evidence of a lack of respect at times. Medication administration is well managed at the Home but improvements should be made in the storage and use of medication to ensure the safety of residents. Greenslades Nursing Home DS0000026693.V292865.R01.S.doc Version 5.2 Page 11 EVIDENCE: The care plans of six residents were inspected, three from each unit. Care plans on Belvedere were generally comprehensive and included social histories, the residents’ explanation of their admission, good personal care plans detailing the level of assistance required by staff and good wound care information. All had regular reviews although there were no records of family or resident involvement in care planning. Some details were lacking such as details and actions relating to comments; ‘nursed in bed’; ‘observe for aggressiveness’; ‘very deaf’ ; but not detailing how they communicate, ‘unable to do activities’; and ‘wandering aimlessly’. Health professional input records were good. One care plan on Isca stated that the aim of admission was to provide a safe environment for the resident who was prone to falling. The care plan detailed the mobility aids and support required. These were not used throughout the inspection. This resident had fallen, been found on the floor or found to have unexplained bruising on at least eight occasions in the past three weeks. This resident has bruising on the face and has skin tears to the arms, head and legs. Falls and incidents resulting in injury should be reported to the manager via accident records. Only one fall had been reported using this system. The same care plan identified that this person ‘can be aggressive’. The care plan did not show that attempts have been made to find the cause of this behaviour or to put strategies in place to prevent it. When asked staff said that they had received training in how to do this but had not done this with this resident. The records show that the GP has been requested to prescribe medication to ‘get (the resident) to calm down’. A Community Psychiatric Nurse had been consulted but when asked staff were unaware of any advice given. Another care plan identified that the resident requires one to one ‘supervision and observation’. The Primary Care Trust is paying for this service for four hours each day. Records show that this interaction usually takes the forms of walks, which take place on most days. Records do not show how long for and there is no record of any observations made although staff report that this resident is much calmer and is no longer receiving medication to manage challenging behaviours. Another care plan records that one resident is experiencing a type of drug withdrawal and has challenging behaviour. There is evidence of poor communication between staff resulting in staff making welfare decisions that might not always be appropriate. The details of this were discussed with the manager. Medication records were checked and found to be in order. In general the system for storage is secure. However, some medications due to be returned to the pharmacy were not being stored securely in a locked cupboard as per the procedure described by staff. Care plans do not include instructions on when ‘as needed’ sedatives should actually be used for each resident. Greenslades Nursing Home DS0000026693.V292865.R01.S.doc Version 5.2 Page 12 The temperature of the medication fridge is recorded at between 7 – 100C for approximately two weeks. The fridge contains antibiotics that should be stored at 50C. It was not recorded on some creams in bedrooms when they had been opened. These creams have a restricted shelf life. Staff observed residents’ right to privacy on both units. Personal care was given in private and locks have been fitted to bathroom and toilet doors as required at the last inspection (some seen by the inspector and others reported by the Home as done). Staff on Belvedere Unit often used names other than the resident’s preferred name, although not unkindly and there was some baby-talk and talking over residents or not always telling residents what they were going to do prior to doing it. One resident needed new clothes, as theirs were very frayed. However, staff were seen to be kind and not uncaring. One resident said how lovely it was to have someone to talk to and another said ‘oh yes, it’s much better than my last home and the girls are very good.’ Greenslades Nursing Home DS0000026693.V292865.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although the Home makes an effort to offer creative and organised activities for residents this does not ensure that all residents social needs are consistently met in appropriate ways, especially for those with communication limitations. Staff do not consistently ensure that residents are offered choice and control over their lives. Meals are nutritious and offer a balanced and varied diet but residents are not always assisted as to promote a congenial setting. Contact with families and friends is flexible and generally promoted well within the Home. EVIDENCE: Five of the six care plans inspected detailed the residents’ previous interests and social history. The Home has an activities organiser who is employed for 34 hours per week. The manager reports that some residents have enjoyed gardening during the good weather and that a member of staff has brought her Greenslades Nursing Home DS0000026693.V292865.R01.S.doc Version 5.2 Page 14 Shetland pony to the home which residents have enjoyed. There were lovely photographs of residents enjoying time in the garden with staff. One care plan said that the resident likes making things out of wood. There was no evidence in the care plan that the resident is supported to do this. Staff do not think this has happened. Staff generally felt that they did not do 1:1 sessions with residents as much as they have in the past and activities recorded were often organised activities such as ‘a trip to the quay’. There were few records of 1:1 sessions with residents and records suggested that some residents could go some time without meaningful stimulation. One care plan on Isca did not have any details of the resident’s life, social history or interests. This resident has profound communication difficulties and challenging behaviour. When the inspectors arrived this resident was sitting in a chair facing the wall. Staff thought she might have put herself there or that she was there because she hits out at other residents. When asked about how they engage residents with dementia type illnesses staff indicated this is the activities co-ordinator’s role. Staff said that there had been a trip out to Sidmouth and but only one person from the Isca Unit had gone. During the inspection it was observed that a member of staff was usually present in the room with residents. They were observed responding to residents and making cups of tea and coffee. However, no meaningful engagement of residents appeared to take place other than in a supervisory role. Care plans do not contain instructions for staff on how they might achieve this with each resident. One resident said ‘nothing happens here’. Another said ‘I do nothing but sit here mostly’. Residents on ISCA are not offered choices. At lunchtime for example, although there was a choice of two meals, residents were not offered this choice. The manager reports that residents are asked on the previous day what their choice of meal is. This is too far ahead for people with dementia to make a meaningful choice. Condiments were not offered. One resident who asked for salt was given an empty salt-cellar. A member of staff went to get more but by this time the resident had decided she did not want to eat anymore. A resident was given coffee but staff were unaware that the resident takes sugar and this was not recorded in her care plan. A resident was given a biscuit and when they complained it was hard was told it was not. This resident’s care plan indicated that they wear false teeth. They were not wearing them. On Belvedere staff made some attempts to offer choice but this was not seen to be consistent, for example in relation to choice of seating, clothes and what residents wanted to do. Staff gave assistance to residents who needed help with their lunch. One staff member stood over two residents whilst feeding them in a hurried manner and not telling them what food was coming or waiting for them to finish a mouthful. There was no rapport between staff and those residents with limited communication skills. One inspector took lunch with the residents on Greenslades Nursing Home DS0000026693.V292865.R01.S.doc Version 5.2 Page 15 Belvedere, the other observed lunch on Isca. Food was hot and was nicely presented although condiments were not pro-actively offered. Aids such as plate guards were used to help residents to eat independently. Greenslades Nursing Home DS0000026693.V292865.R01.S.doc Version 5.2 Page 16 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): 16, 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 good complaints procedure and people feel that they can raise any issue of concern, which will be listened to and acted upon. Residents are protected from abuse as sound procedures and practice are in place other than relating to bed rail use. EVIDENCE: Nearly all staff have or are signed up to attend Protection of Vulnerable Adult training. Staff were aware of what abuse was and said that they would inform the manager. The Home has the Alerters’ Guide and the No Secrets video available. The manager has also recently updated their knowledge of POVA procedures and recent POVA incidences have generally been managed safely. The Home has only had 2 complaints recently, which were responded to well. Only official written complaints are recorded and it was discussed with the manager that recording ‘concerns’ brought to staff may be good practice to ensure that there is good communication and actions taken. The manager has an open-door policy and relatives often walk in when visiting. Care plans include records relating to the use of bed rails for residents’ safety. There was no evidence of resident involvement in the decision-making and sometimes little relative/multidisciplinary team involvement. Some care plans said that a resident had never fallen but had rails in place as they were at risk of falling. There was no reason stated as to why they were at risk or resident discussion. Greenslades Nursing Home DS0000026693.V292865.R01.S.doc Version 5.2 Page 17 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): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is generally clean and well maintained but improvement should be made in cleaning residents’ rooms. EVIDENCE: All areas of the Home were generally clean and residents spoken to confirmed that this was usually the case. Bedrooms are clean and bright. They are personalised with for example mementos and photographs. Some bedrooms did not have bedside lights. Cleanliness was generally good but attention had not been paid to dusting residents’ belongings, shelves and personal items. One staff member said that it was difficult to be consistent with cleaning as rotas and areas changed, which made them feel frustrated. The manager said that a new domestic system was being looked at. On Isca there is no evidence that the environment has been adapted to meet the needs of those residents living with dementia. The manager said that they Greenslades Nursing Home DS0000026693.V292865.R01.S.doc Version 5.2 Page 18 were planning to start ‘person-centred care’ training, which would also include looking at the environment. During the inspection the garden door was not open and was blocked by tables so residents would not be able to go out easily if they wanted to, especially those with communication difficulties. Residents in the dining room/lounge had to call for help, as the call bell system is not available to them. It is noted that some residents would be unable to use the bell but this should then be addressed and actions recorded in the care plans. Greenslades Nursing Home DS0000026693.V292865.R01.S.doc Version 5.2 Page 19 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): 27, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents generally benefit from friendly staff in sufficient numbers but staff on Isca do not always have a good understanding of residents’ needs. The procedures for the recruitment of staff are robust and consistently protect residents. EVIDENCE: All mandatory staff training was up to date or in progress. Staff felt that they were well supported by management. However, staff on Isca did not show an understanding of the needs of residents with dementia/mental health needs and training was limited in relation to dementia care and communication skills. (See National Minimum Standard textbox 7, 8, 10). The manager said that this was being looked into and training course sought. Staffing levels were good and staff felt that they were satisfactory numbers to meet residents’ needs. Three recruitment files were looked at and contained the required documents. Greenslades Nursing Home DS0000026693.V292865.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ financial interests are safeguarded. There are reliable systems in place to ensure the good health and safety of residents. EVIDENCE: Staff fire training and manual handling is up to date. There is a maintenance man who keeps the Home well maintained and staff communicate via a repair book. 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. The corporate quality assurance system is very good and issues have been addressed. There is also a monthly audit in various topics and a representative from Sanctuary conducts monthly visits and sends reports to CSCI as required. Greenslades Nursing Home DS0000026693.V292865.R01.S.doc Version 5.2 Page 21 Four residents’ financial records were looked at and these were all correct. The Home does not act as appointee for any residents and there is an invoicing and petty cash system. The Home now has a Health and Safety representative. The electrical wiring certificate is due and Head Office are dealing with this. All equipment within the Home was seen to be regularly checked such as hoists and assisted baths. Greenslades Nursing Home DS0000026693.V292865.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 X 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Greenslades Nursing Home DS0000026693.V292865.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. 1. Standard OP8 Regulation 12 (1) (a) (b) Requirement Timescale for action 22/10/06 2. OP8 13 (4) (c) 3. OP9 13 (2) You must ensure that the care home is conducted so as to promote and make proper provision for the health, care and welfare of service users. (This relates to the need to ensure that the psychological health is monitored and preventative and restorative care provided.) You must ensure that 22/10/06 unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. (This relates to the need to ensure that actions are taken to protect those residents identified as being at risk from falls.) You must make arrangements 22/10/06 for the safekeeping and handling of medicines received into the home. (This relates to the need to store medicines requiring refrigeration at the appropriate temperature; to record when and why ‘as needed’ medications should be given and to the need to store medications awaiting return to the pharmacy safely.) DS0000026693.V292865.R01.S.doc Version 5.2 Greenslades Nursing Home Page 24 4. OP12 16 (2) (m) 5. OP14 12(3) 6. OP30 18 (1) You must consult service users 22/10/06 about their social interests and make arrangements to enable them to engage in social activities. (This relates to the Isca unit.) You must, for the purpose of 22/10/06 making proper provision for their health and welfare, so far as practicable ascertain and take into account service users wishes and feelings. (This relates to the need to ensure that residents are offered choices and their capacity to exercise personal autonomy is maximised.) You must ensure that at all times 22/10/06 there are suitably qualified, competent and experienced persons working at the Home that are appropriate for the health and welfare of residents. (This refers to staff on Isca relating to specialist training and competency monitoring). 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 planning and details relating to descriptions of residents’ needs and evidence of resident/family involvement in care planning. You should ensure that all medication that has a ‘use by’ date is clearly labelled with either the date of opening or the date that it is due for disposal. 2. OP9 Greenslades Nursing Home DS0000026693.V292865.R01.S.doc Version 5.2 Page 25 3. OP12 4. OP14 5. OP15 6. OP19 7. 8. OP22 OP26 You should ensure that all care plans on Isca 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. It is recommended that all staff are skilled in communicating with residents in a way which encourages independence and choice and that residents are spoken to in a way which maintains respect. You should ensure that residents are assisted, through the giving of information at appropriate times or other means, to make choices in relation to what they eat and drink in a congenial setting and that condiments are offered. You should ensure that all bedrooms have bedside lights unless a risk assessment/residents’ choice states otherwise. You should ensure that residents on Isca are able to access the garden and that the environment has been assessed to enable the Home to better meet specialist dementia care needs. (see Dementia Voice/Alzheimer’s Society or other specialist organisations for advice). You should ensure that residents have access to call bell systems in communal areas. (This refers to Isca). You should ensure that all areas of the Home are kept clean including residents’ rooms and personal items of furniture. Greenslades Nursing Home DS0000026693.V292865.R01.S.doc Version 5.2 Page 26 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.V292865.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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