Inspection on 22/03/10 for Greenways

This inspection was carried out on 22nd March 2010.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greenways 24/11/09

Greenways 08/12/08

Greenways 29/01/08

Greenways 02/08/07

Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Random inspection report Care homes for older people Name: Address: Greenways Marton Road Long Itchington Nr Southam Warwickshire CV47 9PZ zero star poor service 01/12/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sandra Wade Date: 2 3 0 3 2 0 1 0 Information about the care home Name of care home: Address: Greenways Marton Road Long Itchington Nr Southam Warwickshire CV47 9PZ 01926633294 F/P01926633294 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Carole Mary Webb Type of registration: Number of places registered: Conditions of registration: Category(ies) : Kirkley Limited care home 27 Number of places (if applicable): Under 65 Over 65 27 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is: 27 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 27 Date of last inspection Brief description of the care home Greenways was originally a domestic dwelling and has been converted into a residential care home. It is situated in the quiet village of Long Itchington and can accommodate up to 27 elderly people. The home offers personal care to people over Care Homes for Older People Page 2 of 12 0 1 1 2 2 0 0 9 Brief description of the care home the age of 65 years. The home is not registered to take people in any other categories. People needing nursing care receive this from the visiting community nurses. An extension has recently taken place to add another three bedrooms to the home. There are local shops which are around a 15 minute walk from the home and there are public transport links to Leamington Spa, Rugby and Southam within a five minute walk from the home. The bus stop being located by the village pond. There is a door into the home which has level access for wheelchairs and people with mobility problems although this is not the main entrance. Accommodation for people is provided over two floors and all bedrooms are for single occupation, several of the rooms have ensuite facilities. There is a communal dining room and one large lounge with two small quiet areas in the home. There is also a relatives room where people can meet in private. There is one shower/wet room and four bathrooms with assisted facilities such as bath chairs to support people into the bath. There is garden and patio area where people and parking to both the front of the home and in a car park which is accessed down the side of the garden area. The owners are involved in running the home and there is a full time manager and a team of carers and ancillary staff. At the time of this inspection the fees for the home were up to £364 to £485. These are published in the Service User Guide. Extra charges are made for hairdressing and chiropody. Fees are subject to change and should therefore be confirmed with the service. Care Homes for Older People Page 3 of 12 What we found: This random unannounced inspection was undertaken to check compliance with Statutory Requirement Notices we issued to the home in relation to Regulation 13, 12 and 15. This is explained in more detail below. We visited the home on Monday 22 March 2010 between 9.50am and 3.50pm. The manager was on annual leave so we conducted our inspection with the assistance of the provider and senior carer. Regulation 12, the service was required by 9 February 2010 to:Put in place systems to ensure proper provision for the care of people who use the service. Ensure that the particular care needs of individuals with multiple disabilities and confusion are addressed to minimize the potential for harm while in bed. During our last visit we established that a person with bedrails on their bed had tried to climb over these during an episode of confusion and had fallen along with the back rest that was on the bed and the mattress. There was no risk assessment in place for the use of these. We looked again at this care file during this visit to establish any changes in practice and to determine if the persons confusion had developed any further. It was evident that since the last inspection a risk assessment had been developed for the use of the bedrails. The risk assessment was signed by the manager to say she had discussed the use and risks associated with the use of these with the person and staff. There was nothing in writing confirming that the person or their next of kin had agreed to the use of the bedrails in line with the homes policy on this. This issue was highlighted during our visit to the home in November/December 2009. The risk assessment stated that the person was likely to climb over the bedrails but they did not present with any signs of confusion. We looked at the daily records for January, February and March 2010 and it was clear that the person was displaying episodes of confusion. Staff gave explanations as to why they felt the person could become confused and when asked how they were managing this stated that if they felt it was an infection they would call the GP. A GP visit had been made following an incident in January when the person had become agitated, was shouting and trying to get of bed. An infection was suspected and tests carried out. Staff said they found the person attempting to get over over their bedrails. It was not clear from discussions with both day and night staff that there was any clear system in place for managing this persons confusion and distress particularly at night to prevent them from the risk of falling. From talking to night staff it was clear that this person was presenting with signs of confusion on a regular basis increasing the risk that this person could again attempt to climb over their bedrails and fall. Care Homes for Older People Page 4 of 12 This requirement was not met. Regulation 15, the service was required by 12 February 2010 to:Put in place effective arrangements to keep under review the service users written plan as to how the service users needs in respect of his health and welfare are to be met and revise it as appropriate. Ensure the service users plans are kept up-to-date to address the health and welfare needs of residents in their beds. For one of the care plan files we viewed we found:The Resting and Sleeping Care plan stated that the person could use the call bell but in fact they were shouting out at night for staff as opposed to using it. It was therefore not clear that the person could actually use it or if their confusion was preventing them from using it. A member of staff said I dont think x is wise enough to use the call bell, if x calls or shouts we go to x. The care plan should give an accurate reflection of what is happening so that staff are clear about the support they need to provide to meet the persons needs. The risk assessment in place for bedrails said the person did not present with signs of confusion but daily records and discussions with staff demonstrated that they did. There was no clear information in the resting and sleeping care plan about what was agreed in terms of managing this persons confusion, agitation and distress at night. This is an important element of assessing the risk of falls of the person to ensure their health and safety. Staff told us that if they felt concerned that the person could fall out of bed due to them being confused or agitated they could sit the person in the chair or call the doctor but this information was not recorded in the care plan as being the agreed course of action for staff to take. The nutrition care plan was blank on the first page with no evidence of review. The second page showed the person was able to eat independently but daily records showed the person had difficulty with co-ordination and on two days had been assisted to eat by staff. There was no mention in the care plan that on any occasion they may need assistance with eating. Staff spoken to were not clear exactly how the person had been assisted to eat. If clear records are not maintained this could result in an oversight in care and the person may not be appropriately supported. Staff confirmed that they did not complete daily records for night time for this person and that any information they felt relevant would be communicated to staff or written on the handover report in the morning. The handover reports seen contained limited information and did not demonstrate the support each person had received during the night. This means the home cannot demonstrate they are supporting people appropriately at night. This requirement was not met. Regulation 13, the service was required by 1 February 2010 to:Care Homes for Older People Page 5 of 12 Put in place effective arrangements to make sure that people who use the service received where necessary, treatment, advice and other services from any health care professional. Refer individuals who experience unplanned weight loss to an appropriate healthcare professional without unreasonable delay that could compromise their health and wellbeing. Since the last inspection the home had referred a person who had lost a significant amount of weight to their GP for further investigation. An explanation for this had been identified and this was recorded in the persons records. The service also had implemented charts for staff to complete to help monitor the food and fluid intake of people. Some of these charts were not always clear in showing the amount taken or what the food items were. For example staff may have written weetabix but then not recorded how much the person was given and how much they had eaten. This is important so that an accurate record of what the person has had can be established to make sure this is sufficient to support their health. It was not evident that for one person the home had reported the repeated episodes of confusion to a health professional to establish if there was a reason for this and to check if there was any specific care required to support them through this. Staff spoken to only made reference to reporting to the GP any suspected infections which may cause confusion as opposed to reporting ongoing symptoms of confusion. This requirement was not met. The service was advised that failure to take this action in regards to complying with the Statutory Requirement Notices issued could result in prosecution without further notice or warning. In addition to the above the service was also issued with requirements relating to Regulation 14 and 37 as follows:Regulation 14, the service was required by 31 January 2010 to:Undertake risk assessments for any person who is assessed as requiring bedrails or has bedrails fitted to minimise any potential risk. A risk assessment tool had been developed and this had been implemented for those people checked as requiring them. This requirement had been met. Regulation 37, the service was required by 31 January 2010 to:Report to the Care Quality Commission all accidents and incidents which impact on the wellbeing of people. The accident and incident records were checked for the period following the last inspection up to the day of our visit. We found that we had been notified of those Care Homes for Older People Page 6 of 12 accidents that should have been reported to us. This requirement was had been met. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 All people that use the service must have a current and up-to-date care plan in place. This is to ensure their needs are identified as well the staff actions required to maintain their health. 31/01/2010 2 8 13 Specialist support such as 01/12/2009 the advice of GPs/District Nurses must be sought promptly to ensure resident health care needs are managed effectively. Records are to demonstrate any specialist support sought and given. Remains Outstanding. Following continued non compliance this matter has been referred to the Regional Enforcement Team Care Homes for Older People Page 8 of 12 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Effective arrangements must 01/02/2010 be made to make sure people who use the service receive where necessary, treatment, advice and other services from any health care professional. This is so the service can ensure people receive appropriate professional support to maintain their health. Statutory Requirement Notice not met. 2 7 12 Systems must be put in place to ensure proper provision for the care of people who use the service. The particular care needs of individuals with multiple disabilities and confusion must be addressed to minimise the potential for harm while in bed. This is to ensure people receive the care and support required to meet their needs. 09/02/2010 Care Homes for Older People Page 9 of 12 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Statutory Requirement Notice not met. 3 7 15 All people that use the service must have a current and up-to-date care plan in place. This is to ensure their needs are identified as well the staff actions required to maintain their health. 4 7 15 The service must put in place 12/02/2010 effective arrangements to keep under review the service users written plan as to how the service users needs in respect of his health and welfare are to be met and revise it as appropriate. In addition the service must ensure that service users plans are kept up-to-date to address the health and welfare needs of residents in their beds. This is to ensure the needs of people are clearly identified and any staff support needed can be provided to meet these needs. Statutory Requirement Notice not met. 5 8 13 Specialist support such as 22/03/2010 the advice of GPs/District Nurses must be sought promptly to ensure resident health care needs are managed effectively. Records Page 10 of 12 22/03/2010 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action are to demonstrate any specialist support sought and given. This is so the service can demonstrate the health care needs of people are being met. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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