Inspection on 12/07/06 for Greenwell House Nursing Home

This inspection was carried out on 12th July 2006.

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

The inspector 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

Greenwell House Nursing Home 01/05/07

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 12th July 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 Greenwell House Nursing Home DS0000028028.V303915.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.V303915.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 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.V303915.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 60 years plus Date of last inspection 15th November 2005 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 7/06/06 are £375 - £575 per week. Greenwell House Nursing Home DS0000028028.V303915.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 12th July 2005. The inspection lasted 5.5 hrs (10am to 3:30pm). There were 16 residents in the home, one of whom was in hospital and all required nursing care. The inspection focused on key standards and some areas of concern identified at the last inspection. An inspection of the premises took place, including a number of bedrooms, bathroom and lounge area. What the service does well: What has improved since the last inspection? There has been some decoration of individual rooms, corridors and communal areas. The outside of the windows has been painted. New carpeting has been provided for the resident’s rooms. Greenwell House Nursing Home DS0000028028.V303915.R01.S.doc Version 5.2 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. Greenwell House Nursing Home DS0000028028.V303915.R01.S.doc Version 5.2 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 Greenwell House Nursing Home DS0000028028.V303915.R01.S.doc Version 5.2 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): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The resident’s needs are sufficiently assessed thereby providing the information upon which the 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 or a deputy usually undertakes these either in hospital or the resident’s place of residence prior to admission. The written admission documentation was good and included all the basic information to ensure they could meet the social, emotional and care needs of the new residents. Greenwell House Nursing Home DS0000028028.V303915.R01.S.doc Version 5.2 Page 9 More detail is obtained after admission when a fuller picture of the residents needs emerges. Intermediate Care (Standard 6) is not provided in this home. Greenwell House Nursing Home DS0000028028.V303915.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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A good standard of care is being provided by staff that are well motivated. 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. The timings of the daily statements are not always recorded. This was discussed with the manager who acknowledged the importance of this and that the 24-hour clock is used for this purpose. Greenwell House Nursing Home DS0000028028.V303915.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. However, there was some evidence that this is occurring in some instances. Few residents or representatives are interested in being involved in the process, preferring that “the matron can deal with this”. All the residents spoken to made praiseworthy comments about the care staff and the quality of their experiences in the home. One said she thought, “This is as good as it gets in a care home” and didn’t regret coming into the home. She had her breakfast on a tray in her own room although she insists on sitting out of bed and at her bedside table. “ I think I deserve this at my age, which is 90 yrs. Another resident said the staff,“ put themselves about to give you what you want”. She also said she would love a shower which is not available in the home there being only one bathroom in the home. She said she had a bee sting on her finger from the previous day, and on looking at the relevant daily statement it was noted that this was faithfully recorded. She said, “I’m content, not happy, but there isn’t anywhere I think that could be better”. Only two pressure relieving mattresses are provided and more are needed. . 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. The toilet doors throughout the home are identified and the sliding door for the toilet off the main lounge had been fitted with a privacy catch. However this catch has fallen off with the result that anyone can gain entry into the toilet unrestricted when someone maybe in there. Greenwell House Nursing Home DS0000028028.V303915.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is meeting the resident’s social and dietary needs in a sensitive and caring manner. The quality of the meals provided is good with fresh vegetables and meat being routinely made available. EVIDENCE: The residents spoken to say that they decide their own daily routines. The home has an activities programme which although there is no identified activities person the care staff endeavour to implement. One resident said she “liked some of the activities depending on what they are”, Jig-saw puzzles etc but didn’t feel inclined to much more. Greenwell House Nursing Home DS0000028028.V303915.R01.S.doc Version 5.2 Page 13 The residents said that they had the choice of not having to join in planned activities. Visiting arrangements are flexible so that the residents are able to see relatives and friends whenever they wish. The comments on the food were universally complimentary and the inspector was able to confirm that the beef caserole was very tasty with meat cooked to a turn and no fat present. Fresh orange fruit juice was also provided at lunchtiome. A basic menu is provided with alternatives should the particular residents not wish what was on offer. Being such a small home with only 15 residents at present the individual preferences are easily identified and catered for. One resident said she would like to have more salads and when discussed with the manager it appeared that this wish was known to her and more salads were being planned for the future. The cook confirmed that fresh vegetable s are available at all times and that butter and full cream milk as well as semi skimmed milk is also provided. Fresh meat is delivered twice weekly. A new heated food trolley has been provided and the kitchen floor has received new PVC covering. Greenwell House Nursing Home DS0000028028.V303915.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. 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. The 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 recent times. There are records to show that there has been recent training of the care staff in abuse issues and their responsibilities in this regard. Greenwell House Nursing Home DS0000028028.V303915.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23, 24 and 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The environment presents avoidable risks to the health and safety of both the residents and staff in the home. 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. Some issues identified at the last inspection have received attention: The toilet facility on the ground floor corridor leading to the lounge area was provided with a door catch and a curtain screen from the lounge to the toilet corridor to provide privacy. Greenwell House Nursing Home DS0000028028.V303915.R01.S.doc Version 5.2 Page 16 However the catch from the door has now fallen off and the curtain was removed due to decoration of the lounge area. There has been some improvements made to the environment and these include: Redecoration with emulsion to all the residents’ rooms, bathrooms, ceilings corridors and part of the lounge area. The outside of the window frames has been painted. New carpeting provided in bedrooms and main stairway. New lounge chairs and dining chairs have been ordered. Quotes have been requested for a properly constructed and insulated roof for the conservatory dining area, which is plastic and therefore too hot for the residents at present. Quotes for the paving of the rear garden area are also being sought. Some grab rails have been fitted round some corridors although bathrooms, lounge and toilet facilities do not so far have them. Grab rails, which have been fitted, were a point of progress given favourable mention to the inspector by some residents. 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. Only five adjustable height beds are provided for residents who require nursing care. At the last inspection it was reported that an additional two had been ordered but only one materialised. 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. There are lockable facilities provided in only eight rooms of the resident’s rooms for them to store their private things and valuables. Greenwell House Nursing Home DS0000028028.V303915.R01.S.doc Version 5.2 Page 17 An additional power assisted hoist for the third floor is required, as there are only two presently provided and moving them in and out of the small vertical lift takes time and effort. The care staff identified additional handling belts and a stand aid as being required to assist them with their work. The sluicing facilities located on the first floor are not adequate to ensure safe practice. A single hot -water tap has been located on the wall for the cleaning staff to fill buckets etc, but no sink underneath. A slop hopper sink is required to be provided to help ensure safe practice as other liquids including vomit and the contents of the cleaning staff’s buckets also need to be disposed of. 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 and the plumbing of the sluice disinfector needs to be properly assessed by someone qualified to do so. This was an issue mentioned by several care staff who feel it adds unnecessarily to their burden of work and presents them with additional avoidable hazards to the health and safety of the residents and themselves. 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. 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 not been moved for reasons, which are not clear. 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 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. Greenwell House Nursing Home DS0000028028.V303915.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Satisfactory recruitment practices are followed. There is a relatively high dependency on agency staff. EVIDENCE: There is insufficient permanent care and nursing staff and therefore agency staff are deployed to a quite high degree. Two care staff, one from Slovenia and one from India have been recruited through an employment agency and live in the adjoining property which the provider has recently rented. Two of the care staff are trained to NVQ Level 3 standard. The numbers so qualified represents 20 of the care staff and is somewhat less than the 50 national minimum standard in this regard. Four of the care staff has commenced NVQ training. Greenwell House Nursing Home DS0000028028.V303915.R01.S.doc Version 5.2 Page 19 Sufficient foundation and mandatory training takes place on a routine basis and this is coordinated through the training officer for the group four homes. 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. The personal files do not include a copy of the contract of employment as these are kept in the head office of the organisation in Harrogate. Greenwell House Nursing Home DS0000028028.V303915.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 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well managed but a quality assurance system is needed to inform staff of the outcomes for the residents in the home. EVIDENCE: The staff spoken to 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. Greenwell House Nursing Home DS0000028028.V303915.R01.S.doc Version 5.2 Page 21 The staff had not seen the last CSCI inspection report and the last report in the home is dated April 2004. There is no development plan for the home that the manager or staff is aware of. Some of the care staff has received individual supervision and this is to be rolled out for all of them 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. Service records were inspected and it was confirmed that regular servicing takes place for the hoists, gas appliances, lifts etc. Greenwell House Nursing Home DS0000028028.V303915.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 2 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 3 Greenwell House Nursing Home DS0000028028.V303915.R01.S.doc Version 5.2 Page 23 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. 2. 3. Standard OP19 OP22 OP24 23 (2) 16 (1) (2) (c) 23(2)(m) Requirement The toilet adjacent to the lounge area must have the door catch replaced. An additional portable hoist must be provided to help ensure safe practice. Lockable space and keys must be provided in each resident’s rooms so they can store their valuables. (Previous timescale of 1-9-05 not met) 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) Timescale for action 01/08/06 01/12/06 01/10/06 4. OP26 23(2)(k) 01/10/06 5. OP26 13(3) 01/10/06 Greenwell House Nursing Home DS0000028028.V303915.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 OP8 Good Practice Recommendations The timings that the daily statements are made should be recorded utilising the 24 hr clock. 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. 2 3 OP21 OP22 The provision of a shower for the home should be considered. This basic standard of provision is something that several residents said they would like to be provided. Suitably qualified persons including an occupational therapist should assess the premises. Grab rails should be provided in all corridors, bathrooms, toilets and communal rooms Additional resident handling belts should be provided. 4 5 6 7 8 OP24 OP27 OP28 OP31 OP32 Additional adjustable height beds should be provided. Efforts should be made to employ more permanent staff so that the dependency on agency staff is reduced. 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 The CSCI inspection reports should be made available to the residents and staff at the home. Greenwell House Nursing Home DS0000028028.V303915.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: 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. 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