Inspection on 13/04/05 for Greenwell House Nursing Home

This inspection was carried out on 13th April 2005.

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

The inspector 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 01/05/07

Greenwell House Nursing Home 12/07/06

Greenwell House Nursing Home 15/11/05

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 Nursing Home Wycar Bedale North Yorkshire DL8 1ER Lead Inspector John McGarva UnAnnounced 13 April 2005 10:00 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 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 Nursing Home Version 1.10 Page 3 SERVICE INFORMATION Name of service Greenwell Nursing Home Address Wycar, Bedale, North Yorkshire, DL8 1ER Telephone number Fax number Email 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 01677 424012 N/A The Fisher Partnership Mrs Liza Mufti Care Home 21 Category(ies) of Old Age (21) registration, with number of places Greenwell Nursing Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 16th September 2004 Brief Description of the Service: Greenwell House is a Care Home registered to care for up to 21 service users 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. There are 13 single rooms 7 of which have of en-suite facilities and 7 two-bedded rooms 3 of which have en-suite toilet facilities. The home is located near the centre of the market town of Bedale overlooking the local bowling green. Greenwell Nursing Home Version 1.10 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 Wednesday 13th April 2005. The inspection lasted 4.5 hrs (10am to 2.30pm). There were 20 residents in the home, all requiring nursing care. The inspection focused a number of 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, bathroom and lounge area. The care records of three residents were examined in detail and these residents were spoken with about the care they receive. There were also discussions with care staff and the manager of the home. What the service does well: Good assessment systems are in place and this helps ensure that all the residents’ health and social care needs are identified and met. All the residents spoke very favourably about the quality and quantity of the meals provided and confirmed that there was choice both a lunchtime and at the evening meal. The care staff are greatly appreciated by the residents who said they were all very kind and always busy. The clean and well-pressed appearance of the residents testifies to the attention to detail of the staff and to their constant vigilance. The manager has an open and inclusive style, which is appreciated by the staff and residents. Greenwell Nursing Home Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Greenwell Nursing Home Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Greenwell Nursing Home Version 1.10 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 standard(s) 3 and 4 The resident’s needs are well assessed and are met in a well-structured and considered way. EVIDENCE: There is an individual plastic folder for each resident within which all information in relation to them is kept and includes admission details, assessment, care plans, daily statements, nutrition assessments and weight charts. The assessment documentation inspected of three residents was of good quality and of sufficient detail so as to make it possible for the care needs to be identified and upon which foundation comprehensive care plans had been developed. The residents spoken to were able to confirm the documented details in relation to their personal assessments and felt that all the relevant information regarding, their social, mental, physical needs was appropriate and accurate. The care staff spoken to explained how they were able to meet the needs of the residents and spoke with individual knowledge of particular residents. Greenwell Nursing Home Version 1.10 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 10 There are good systems in place to ensure that the health care needs of the residents are met. The individual care plans need more detail to ensure total needs can be identified and addressed. There is also an issue of dignity, which needs to be addressed. EVIDENCE: The residents looked well cared for with clean and well-pressed clothes and looked cheerful and content. There were no malodours detected in any part of the home visited. The care plans of three residents were inspected and found to be of good quality with careful and thoughtful strategies to address particular needs or problems. The strategies which addressed one resident’s mobility and hygiene needs was particularly well described with thoughtful and sensitive observations and instructions on how to address them being recorded. Greenwell Nursing Home Version 1.10 Page 10 All the residents spoken to confirmed that the information recorded corresponded to their perceptions of their needs and requirements. However, one lady who was recorded in her file as Mrs said she was frequently called Mrs when in fact she was very definitely Miss and wished to be addressed as such. Records of regular weighing were not always present, even where weight loss had been identified as problem for the resident. This should be addressed. The residents spoken to strongly felt that the staff “were wonderful” and that their particular needs and wishes were addressed in a kindly and professional manner. The toilet doors are not identified and the sliding door for the toilet off the main lounge does not have a privacy catch. As the door opens onto the toilet, this represents a serious risk of exposure for the residents and in consequence their privacy and dignity is compromised. This was a matter discussed at the last inspection when a requirement was made that a suitable catch be fitted. A curtain rail has been purchased to screen the lounge from the corridor where the toilet is immediately located, but has not been fitted and the curtain not yet purchased. This must be progressed. Greenwell Nursing Home Version 1.10 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 and 15 Flexible visiting arrangements allow the residents to maintain good and regular contact with family and friends. The meals provided are nutritious and offer a varied diet for the residents. EVIDENCE: Residents confirmed that they could have as many visitors as they like and at any time they chose. The visitors are proffered cups of tea during their visits and there were several visitors coming and going during the inspection. In one resident’s care plans it was recorded that social isolation was a problem but that, as visitors came a lot, this “makes all the difference”. The arrangements for visiting are made clear in the statement of purpose and the service users guide for the home. All residents spoken to commented favourably on the quality and variety of the meals provided, indicating that there was choice of the main meal at lunchtime and also at teatime when a sweet is also provided. Menus provided indicated that there is a variety of mail course items and that they are rotated on a regular basis with seasonal items being made available at appropriate times. Greenwell Nursing Home Version 1.10 Page 12 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 standard(s) 16 and 17 Residents concerns are dealt with and their interests are safeguarded. EVIDENCE: There are adequate written policies and procedures in place to deal with complaints and the care staff spoken to confirm they were aware of these. Staffs knowledge of these help ensure that they were able to address any issues or anxieties of the residents. There had been no complaints in the home during the previous twelve months. The care staff spoken to confirm they were aware of how to contact the advocacy service in Richmond and information in regard to this service is on display on the notice board. Residents spoken to were aware of the impending election and confirmed that they will have a postal vote for the election in May. Greenwell Nursing Home Version 1.10 Page 13 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 standard(s) 19, 21, 22, 23, 24, 26. Significant investment is required to ensure the home is safer and more pleasant for the residents to live in. Greenwell Nursing Home Version 1.10 Page 14 EVIDENCE: The premises meet the standards for homes registered before 2002. A number of matters are outstanding from the last inspection that needs to be addressed. There are several physical impediments to providing adequate care in the somewhat confined space available in some areas. • The general décor to the home is tired and in need of redecoration. • The outside windows require painting. • Some of the sash windows are in need of attention and two in the lounge are unable to be opened causing heat gain problems in the warmer weather. • Suitably qualified persons including an occupational therapist have not assessed the premises and such an assessment would be of benefit to the provider in helping to identify an improvement strategy. • There is only one bathroom available for use with a Parker type bath on the top floor of the home. • The toilets are not clearly identified. • The toilet facility on the ground floor corridor leading to the lounge area does not offer privacy to the service user when the door is opened. • There are no grab rails fitted round corridors, bathrooms or toilet facilities. • Four rooms on the 1st floor are each accessed down one step and two rooms on the 2nd floor are accessed down two steps. • There is a lack of storage facilities throughout the home with the consequent clutter of equipment located in corridors, stairwells, lounge and bathroom. • Only 4 adjustable height beds are provided for service users who require nursing care. • There are lockable facilities provided in only a few service users bedrooms for the storage of medications, money or valuables. • The lack of provision of satisfactory laundry facilities constitutes a risk of infection and cross infection for residents. • 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. This can create problems with leakage and flooding. A slop hopper sink should be provided to help ensure safe practice. The manager said that the provider is planning to rent adjacent buildings that would then be used to relocate the kitchen and laundry and provide a staff room. Greenwell Nursing Home Version 1.10 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28, 30. The residents receive a good standard of care from the well-prepared and motivated staff. EVIDENCE: There is only two of the care staff trained to NVQ Level 2 standard representing 15 of the care staff employed in the home. However an additional four staff have commenced this training and two have embarked upon the higher NVQ Level 3 training. When the four staff completes their courses, the home will then meet the required 50 standard. The home provides sufficient foundation and mandatory training on a routine basis. Greenwell Nursing Home Version 1.10 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 35. The resident’s benefit from an open and inclusive management approach but more formal consultation to identify their wishes is needed. EVIDENCE: The manager holds irregular meetings with the staff to keep them informed about routine and planned developments for the home. Care staff confirmed that this was the case and believed they were kept in the picture in regard to matters of interest to them. The interaction of the manager and staff was observed to be warm and supportive and the residents spoke very highly of her. There is no annual development plan for the home that staff are aware of. There is currently no quality assurance system in place, which would identify the wishes and opinions of the residents. This was a requirement from the last inspection in September 2004. Greenwell Nursing Home Version 1.10 Page 17 The home has embarked upon the Investors in People Award. Relatives deal with all personal monies relating to the residents. The relatives of three residents have enduring power of attorney and two have accessed the services of the advocacy service based in Richmond. There is a training officer who oversees the training over the three homes in this group of homes and also organises the mandatory training in Moving & Handling, Health & Safety and Fire safety and First aid. Care staff spoken to confirmed they had received this training and at the recommended intervals as well as specialist training provided free by the local hospital in cancer and palliative care. There had also been recent training provided in the safe handling of medicines and some staff are doing a distance-learning course in food handling. The training records confirmed the conversations with the care staff in this regard. Greenwell Nursing Home Version 1.10 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 x 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 1 x 1 1 3 1 x 1 STAFFING Standard No Score 27 x 28 2 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x x 3 1 x 3 x x x Greenwell Nursing Home Version 1.10 Page 19 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 10 Regulation 12(4) (a) Requirement A privacy catch must be fitted to the toilet adjacent to the lounge area.(Previous timescale of 1-105 not met) The sash windows must be kept in working order. The outside of the windows must be repainted. All parts of the home must be kept reasonably decorated. (Previous timescale of 1-3-05 not met) Adequate storage facilities must be provided.(Previous timescale of 1-3-05 not met) Lockable space must be provided in each of the residents rooms for the storage of medicines, money or valuables.(Previous timescale of 1-3-05 not met) A plan to address the unsatisfactory laundry arrangements must be submitted.(Previous timescale of 1-3-05 not met) A slop hopper type sink must be provided in the sluice room.(Previous timescale of 1-305 not met) A quality assurance programme must be introduced. (Previous timescale of 1-3-05 not met) Version 1.10 Timescale for action 1-5-05 2. 19 23(2)(a)( b)(d) 1-9-05 3. 4. 22 23 23 (2) (i) 23 (2) (m) 1-9-05 1-9-05 5. 26 23 (2) (k) 1-9-05 6. 26 13 (3) 1-9-05 7. 33 24 (1) 1-9-05 Greenwell Nursing Home Page 20 8. 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 7 Good Practice Recommendations Information in regard to the residents should be accurate. Where indicated, the residents weight should be recorded at least monthly to provide safe monitoring of their general health. All the toilets should be clearly identified. the premises should be assessed by suitably qualified persons including and occupational therapist. Grab rails should be provided in corridors, bathrooms,toilets and communal rooms. the provider should plan to improve the access to the individual rooms that have step access. Additional adjustable height beds should be provided. The provider should endeavour to have 50 of the care staff trained to NVQ Level 2 standard by the end of 2005. 2. 3. 4. 5. 6. 7. 21 22 22 23 24 28 Greenwell Nursing Home Version 1.10 Page 21 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. Extracts may not be used or reproduced without the express permission of CSCI Greenwell Nursing Home Version 1.10 Page 22 - 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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