Inspection on 01/05/07 for Greenwell House Nursing Home

This inspection was carried out on 1st May 2007.

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

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

Other inspections for this house

Greenwell House Nursing Home 12/07/06

Greenwell House Nursing Home 15/11/05

Greenwell House Nursing Home 13/04/05

Greenwell House Nursing Home 16/09/04

Greenwell House Nursing Home 08/04/04

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

CARE HOMES FOR OLDER PEOPLE Greenwell House Nursing Home Wycar Bedale North Yorkshire DL8 1ER Lead Inspector John McGarva Key Unannounced Inspection 1st May 2007 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 Greenwell House Nursing Home DS0000028028.V337918.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. Greenwell House Nursing Home DS0000028028.V337918.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenwell House Nursing Home Address Wycar Bedale North Yorkshire DL8 1ER 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) 01677 424012 F/P 01677 424012 info@fisherpartnership.com John.fisher@fisherpartnership.com The Fisher Partnership Mrs Liza Mufti Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Greenwell House Nursing Home DS0000028028.V337918.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 60 years plus Date of last inspection 12th July 2006 Brief Description of the Service: Greenwell House is a Care Home registered to care for up to 21 people over 65 years of age who require nursing care. The service is provided in a detached stone built building on three floors; the upper floors are serviced by a vertical lift. The home is located near the centre of the market town of Bedale overlooking the local bowling green. The fees charged at 30/03/07 are £375 - £600 per week. Greenwell House Nursing Home DS0000028028.V337918.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report relates to an unannounced inspection that took place on Tuesday 1st May 2007. The inspection lasted 3.5 hrs (10am to 13:30pm). There were 17 residents in the home, with one in hospital. All were receiving nursing care with the exception of one resident who required social care only. The inspection focused on the key standards and some areas of concern identified at the last inspection. An inspection of the premises took place, including a number of bedrooms, kitchen, sluice, laundry, bathroom and lounge areas. What the service does well: What has improved since the last inspection? Two new power assisted hoists and additional handling belts have been provided. Lockable space in the form of small metal boxes has been provided in each of the resident’s rooms for them to store their personal things. The CSCI reports are displayed in the office area for the staff and residents to see. Some improvements have been made to the kitchen area including: Greenwell House Nursing Home DS0000028028.V337918.R01.S.doc Version 5.2 Page 6 The walls have been tiled. Two new refrigerators provided. New windows. Pantry area has been painted. The cook has attended a ‘Safe Food, Better Business’ (SFBB) course. Two power-assisted hoists have been provided. New dining chairs and tables have been provided. New lounge armchairs have been provided. Vertical blinds for the lounge are have been ordered. New ceiling lighting panels have been provided in the lounge area. Regular meetings with the staff are taking place and this will assist in helping to keep the staff apprised of developments in the home. There is less dependency on agency care and nursing staff and this has improved continuity and quality of care for the residents. What they could do better: There are some Requirements and Recommendations from the last inspection in November 2005 that has not been fully addressed. These include: Grab rails are required to be fitted round the upstairs corridors. The sluice disinfector cannot take faeces and this presents the staff with infection hazards. There is no slop hopper sink provided in the sluice room. The location of the laundry adjacent to the kitchen and lounge is most unsatisfactory, with no ventilation or wash hand sink provided. The small extractor fan in the ceiling does not work. There is only one bathroom in the home and no shower provided and several residents have in the past expressed a desire to have a shower. There is no annual development plan for the home that the staff are aware of. There is no quality assurance system yet in place. Only three of the care staff is trained to NVQ Level 2 standard, representing 23 of the care staff employed in the home. The problem of excessive heat in the conservatory / dining room needs to be addressed. Additional adjustable height beds should be provided for the nursing cases. Greenwell House Nursing Home DS0000028028.V337918.R01.S.doc Version 5.2 Page 7 Assisted shower facilities should be provided. Additional pressure-relieving mattresses should be provided. More care staff should be trained to NVQ Level 2 standard. A satisfactory privacy catch for the toilet adjoining the lounge should be provided. 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. Greenwell House Nursing Home DS0000028028.V337918.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 Greenwell House Nursing Home DS0000028028.V337918.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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are records to evidence that the residents’ needs are sufficiently assessed so that their care plans can be developed. EVIDENCE: Evidence from the case tracked residents records confirmed that pre-admission assessment sheets are completed prior to admission. The manager usually undertakes these either in hospital or the resident’s place of residence prior to admission. Intermediate Care (Standard 6) is not provided in this home. Greenwell House Nursing Home DS0000028028.V337918.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The residents’ needs are assessed and met in a professionally planned and programmed manner. EVIDENCE: Individual plastic covered folders are available for each of the home’s residents into which all information relating to their needs are kept. The care plans are specific to the individual resident and identify all the information needed to help the care staff deliver the care required. There are thoughtful and relevant comments and observations made in relation to all the aspects of the residents needs. The timings of the daily statements are now routinely recorded deploying the 24-hour clock. Greenwell House Nursing Home DS0000028028.V337918.R01.S.doc Version 5.2 Page 11 There is no specific identified place for the resident or their representative to sign to evidence that they were consulted or agreed to the care plan. Few residents or representatives are interested in being involved in the process, preferring that the staff deal with these matters. The matter of a place to sign (Standard 7.6) was discussed with the manager and she agreed to bring it to the attention of the newly appointed area manager. All the residents spoken to made positive comments about their care and the quality of the food. One lady said ‘I love the food, have nothing to complain about and I am a very lucky lady to have found this home. Only two pressure relieving mattresses are provided and more are needed. The manager said that she had asked for an additional two but no sign of them yet. The medication room on the third floor of the home provides for satisfactory storage of the medications and `there is a small hand washing sink provided to help ensure save practice. The ‘Nomad’ seven-day blister pack system is employed and is supported by a local pharmacist. There was indication of good practice taking place in the receipt, storage, administration and disposal of the medications. Greenwell House Nursing Home DS0000028028.V337918.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is meeting residents’ social and dietary needs in a satisfactory manner. EVIDENCE: The residents make their own decisions about their daily routines. The home has an activities programme which, although there is no identified activities person the care staff endeavour to implement. Visiting arrangements are flexible so that the residents are able to see relatives and friends whenever they wish. The comments on the food continue to be very positive. A basic menu is provided with alternatives should the particular residents not wish what was on offer. Fresh orange fruit juice was also provided at lunchtiome. Greenwell House Nursing Home DS0000028028.V337918.R01.S.doc Version 5.2 Page 13 Fresh vegetable s are available at all times and butter and full cream milk as well as semi skimmed milk is also provided. Fresh meat is delivered twice weekly. The cook has attended a ‘Safe Food, Better Business’ (SFBB) course. Some improvements have been made to the kitchen area and are included in the environmental part of this report. Greenwell House Nursing Home DS0000028028.V337918.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a relevant complaints procedure and the staff has received abuse awareness training. EVIDENCE: The complaints procedure of the home meets the required standard and care staff are aware of how to respond to any complaints made by either the residents or their representatives. There have been no complaints made about the service either to the home or the CSCI in the past year. Staff confirmed that they had received recent training in abuse issues. Greenwell House Nursing Home DS0000028028.V337918.R01.S.doc Version 5.2 Page 15 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): 19,20,21,22,23, 24 and 26. People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment continues to present a challenge and infection control risks for both the residents and staff. EVIDENCE: The premises meet the standards for homes registered before 2002. With four shared rooms and thirteen single rooms, 38 of residents are sharing a room when the home is full. Seven of the single and three of the shared rooms have benefit of en-suite toilet facilities. Greenwell House Nursing Home DS0000028028.V337918.R01.S.doc Version 5.2 Page 16 A number of matters are outstanding from previous inspections include: There is a lack of storage facilities throughout the home with the consequent clutter of equipment located in corridors, stairwells, lounge and bathroom. The roller press for the laundry is still located on the top floor stair landing area. Grab rails are required in the first floor corridors to help facilitate the resident’s self-movement throughout the home. Only five adjustable height beds are provided for residents who require nursing care. The manager said that she has requested an additional two. Some of the single rooms are less than the minimum standards for new homes and therefore too small to accommodate adjustable height (profiling) beds as they take up more space than a traditional divan type bed. The manager felt that ‘King fund’ type beds rather than ‘Profile beds’ may be more satisfactory in these confined spaces. There are three communal toilets available, but only one on the ground floor. The sliding door for the toilet off the main lounge had been fitted with another privacy catch. However, this catch, which is set at right angles to the door, is not suitable for the purpose as it sticks out, catching the clothing of the staff and residents alike. Additionally the bolt has been bent and inconsequence cannot be actuated. A ‘ Stand aid’ would assist the staff with the transfer of the residents between surfaces. The sluicing facilities located on the first floor are inadequate. A single hot -water tap has been located on the wall for the cleaning staff to fill buckets etc, but no sink underneath. Since the removal of large clay sink from the staff toilet there is no appropriate sink for the cleaning or care staff to use. A slop hopper sink is therefore required to help ensure safe practice. The sluice disinfector cannot cope with faeces and in consequence the care staff have to go to a toilet to deposit the commode contents. This is not satisfactory or safe practice. This was an issue mentioned by several care staff at the last and this inspection who feel it adds unnecessarily to their burden of work and additional avoidable hazards to the health and safety of the residents and themselves. Greenwell House Nursing Home DS0000028028.V337918.R01.S.doc Version 5.2 Page 17 The location of the laundry facilities next to the lounge and kitchen constitutes a risk of infection and cross infection for residents. There is no hand-washing sink or any ventilation to the laundry room. There is an extractor fan in the ceiling but it is not working. The provider has now rented a large adjacent building that was envisaged would accommodate the laundry and provide staff and storage accommodation. However, the laundry has so far not been transferred. With only one bathroom on the top floor of the home and no showers, there are problems in the residents getting as much bathing as they would wish. The transfer of the laundry would allow for the provision of a shower and this was a facility mentioned to the inspector by several residents during previous inspections as a deficit they would like to see remedied. Suitably qualified persons including an occupational therapist have not assessed the premises. Such an assessment would be of benefit to the provider in helping to identify an improvement strategy. There have been some improvements to the environment since the last inspection, including: Two new power assisted hoists have been provided. Lockable space in the form of small metal boxes has been provided in each of the resident’s rooms for them to store their personal things. Improvements made to the kitchen area include: The walls have been tiled. Two new refrigerators provided. New windows. Pantry area has been painted. New dining chairs and tables have been provided. New lounge armchairs have been provided. New ceiling lighting panels have been provided in the lounge area. Vertical blinds for the lounge are have been ordered. Two power-assisted hoists and additional handling belts have been provided. Greenwell House Nursing Home DS0000028028.V337918.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29 & 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Satisfactory recruitment practices are followed. The dependency on agency staff has been reduced. EVIDENCE: There has been a reduced dependency on the use of agency staff and this has improved the continuity of care for the residents. Three care staff from Slovenia, India and China has been recruited through an agency and there are some language problems evident. Two of the care staff is trained to NVQ Level 3 standard with another one trained to Level 2. Two of the care staff are soon to commence NVQ training. The numbers so qualified represents 23 of the care staff and is less than the 50 national minimum standard in this regard. Sufficient foundation and mandatory training takes place on a routine basis and this is coordinated through the training officer for the group four homes. Greenwell House Nursing Home DS0000028028.V337918.R01.S.doc Version 5.2 Page 19 The care staff confirmed that they were sufficiently supported insofar as training in Fire Safety, Adult abuse, Health & Safety, Moving & Handling is concerned and each has a training plan in their personal file. Not all the personal files include a copy of the contract of employment as some are kept in the head office of the organisation in Harrogate. Greenwell House Nursing Home DS0000028028.V337918.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is well managed by an experienced nurse. A quality assurance system is needed to inform staff of the outcomes for the residents in the home. EVIDENCE: The registered manager is a qualified first level nurse and has been involved in caring for elderly people for many years both in the NHS and the private care sectors. She has not undertaken training for the Registered Manager’s Award or equivalent management qualification. Greenwell House Nursing Home DS0000028028.V337918.R01.S.doc Version 5.2 Page 21 The staff confirm that the manager is approachable and that there are regular meetings convened with them. Some of the care staff have worked in the home for many years and very much liked the ambiance and philosophy of the home. There is no development plan for the home that the manager or staff is aware of. Individual supervision has been started and this is to be rolled out for all care staff in due course. There is no quality assurance system in place at the present time and they are awaiting the CSCI AQUA quality assurance system, which is shortly to be introduced. The home is not involved in any of the finances of the residents. The CSCI reports are now displayed in the office area for the staff and residents to see. The Health & Safety risks due to poor sluicing and laundry arrangements need to be addressed. Greenwell House Nursing Home DS0000028028.V337918.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 3 8 3 9 3 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 3 1 2 2 2 2 2 X 1 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Greenwell House Nursing Home DS0000028028.V337918.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES 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 OP26 Regulation 23(2)(k) Requirement Plans to transfer the laundry to the adjacent building must be implemented. (Previous timescale of 1-9-05 not met) A slop hopper type sink must be provided in the sluice room. (Previous timescale of 1-9-05 not met) The toilet adjacent to the lounge area must have the door catch replaced. Timescale for action 01/08/07 2 OP26 13(3) 01/06/07 3 OP19 23 (2) 01/06/07 Greenwell House Nursing Home DS0000028028.V337918.R01.S.doc Version 5.2 Page 24 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 OP22 Good Practice Recommendations Suitably qualified persons including an occupational therapist should assess the premises. Grab rails should be provided in all corridors of the home. 2. 3. 4. 5 OP24 OP28 OP31 OP8 Additional adjustable height beds should be provided. The provider should endeavour to have 50 of the care staff trained to NVQ Level 2 Standard. The manager should acquire NVQ Level in Management award. An identified space in the documentation for the resident or their representative to sign to evidence their involvement in the care plan process should be provided. Additional pressure relieving mattresses should be provided. 6 7 OP21 OP29 The provision of a shower for the home should be considered. Copies of all the staff contracts of employment should be kept in their personal file in the home. Greenwell House Nursing Home DS0000028028.V337918.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Greenwell House Nursing Home DS0000028028.V337918.R01.S.doc Version 5.2 Page 26 - 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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