Inspection on 13/10/05 for Greetwell House Nursing Home

This inspection was carried out on 13th October 2005.

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

Other inspections for this house

Greetwell House Nursing Home 04/02/10

Greetwell House Nursing Home 26/08/09

Greetwell House Nursing Home 04/09/08

Greetwell House Nursing Home 05/09/07

Greetwell House Nursing Home 07/11/06

Greetwell House Nursing Home 05/04/06

Greetwell House Nursing Home 16/01/06

Greetwell House Nursing Home 09/03/05

Greetwell House Nursing Home 13/05/04

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

CARE HOMES FOR OLDER PEOPLE Greetwell House Nursing Home 70 Greetwell Close Lincoln Lincs LN2 4BA Lead Inspector Julie Western Unannounced Inspection 13th October 2005 09:30 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 Greetwell House Nursing Home DS0000002600.V257616.R01.S.doc Version 5.0 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. Greetwell House Nursing Home DS0000002600.V257616.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Greetwell House Nursing Home Address 70 Greetwell Close Lincoln Lincs LN2 4BA 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) 01522 521830 Dr Sharaf Abd El Monem Salem Mrs Patricia Wilson Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25), Physical disability (1) of places Greetwell House Nursing Home DS0000002600.V257616.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service user in the category of PD is on a named basis and is aged 62 years and over. Date of last inspection Brief Description of the Service: Greetwell House Nursing Home is situated in a quiet residential area of the City of Lincoln, opposite Lincoln County Hospital. There is a regular bus service into the city and a shopping centre nearby. The Home is a two storey Victorian building, which has been adapted and extended to provide personal and nursing care for up to twenty five people of both sexes over the age of 65 years. Accommodation is on two floors, serviced by a shaft lift. The home is currently accommodating one resident under the age of 65 years with a physical disability. On the day of the inspection 17 residents were being accommodated. There are gardens to the rear of the property and a limited car parking area, with further parking on the road outside the premises. Greetwell House Nursing Home DS0000002600.V257616.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 4 hours. A partial tour of the building took place and care records were inspected. The main method of inspection used was called ‘case-tracking’; this involved selecting three residents and tracking the care they received through the checking of their records, discussions with residents and care staff and observation of practices. Some policies and procedures were examined and records concerning the safety of the home were also seen. 4 of the 17 residents and 5 of the care and ancillary staff were spoken with. The Nurse in Charge was present throughout the inspection and the Manager was present for the latter part. What the service does well: What has improved since the last inspection? What they could do better: Activities need to be planned and advertised around the building; this could be achieved by an activities co-ordinator having responsibility of seeking the views of residents and establishing a programme of activities. Policies and procedures need to be updated, as does the statement of purpose. The service user guide could be made more ‘user-friendly’. A quality assurance system should be set up whereby the views of residents are sought, recorded and actioned. Greetwell House Nursing Home DS0000002600.V257616.R01.S.doc Version 5.0 Page 6 In order to achieve these tasks, the Manager needs to have more time to spend on administration/management. All staff need external training on adult protection issues. 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. Greetwell House Nursing Home DS0000002600.V257616.R01.S.doc Version 5.0 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 Greetwell House Nursing Home DS0000002600.V257616.R01.S.doc Version 5.0 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): 1-5 The home clearly sets out what it intends to do for its residents; this information needs updating. Information for residents is not so clear or easy to read. Prospective residents are encouraged to take time before making the decision to move into the home on a permanent basis. EVIDENCE: The statement of purpose needed updating; it still referred to the Commission for Social Care Inspection being a part of Social Services. The service users’ guide needs to be easy to understand and in bold print for ease of reading by residents. Residents were assigned a key care worker who assisted them to settle in. One resident described how she had been to the home for a day and taken part in the meals and daily activities before permanent admission; another said he had been for respite care and already knew the home. Greetwell House Nursing Home DS0000002600.V257616.R01.S.doc Version 5.0 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 the following standard(s): 7-11 The home’s records give a clear picture of the personal and health needs of residents and enable staff to meet their needs with sensitivity and regard for their privacy and dignity. Risk assessments could be developed. EVIDENCE: The three care plans looked at in depth had a pre-admission document, which was completed on the initial visit to the prospective resident. There was a moving and handling assessment but no other risk assessments. Care plans had been revised and now included information on residents’ backgrounds and social needs. They were reviewed regularly. There was a clear medication policy; only trained nurses administered medication and one nurse was responsible for ordering and recording of medications. The most recent inspection from the pharmacist had no outstanding issues. Residents said they felt safe and well looked after; one said ‘they’re very kind and helpful’. The staff team were observed carrying out their duties with kindness and sensitivity towards the residents, especially when attending to their personal needs. The home had a comprehensive Care of the Dying Policy and staff recounted how they had received training on death and dying within their National Vocational Qualification training. Greetwell House Nursing Home DS0000002600.V257616.R01.S.doc Version 5.0 Page 10 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): 12-15 Social activities are not well promoted and do not create a variety of events and activities for residents to choose from. The residents exercise choice about their routines and what meals they want to eat. EVIDENCE: The home does not have an activities co-ordinator; activities are therefore very much down to which staff are on duty and are mainly on an ad hoc basis. On the day of the inspection, residents were sitting in one of the lounges and knitting or watching television. Some residents with good mobility were able to come and go as they pleased and one resident regularly attended a local club. Although some residents said they went out with their relatives, others said that they would like to go out more and that they used to have more activities than was the present case. The Manager said that due to the drop in numbers staff hours had been cut and this left less time to devote to activities and events. All residents praised the new chef and said that meals had improved a lot since his arrival. The menus were being reviewed and new menus contained less fat and were more varied. There was a use of fresh vegetables and fruit. It was recommended that the daily menu was displayed in the dining-room. Greetwell House Nursing Home DS0000002600.V257616.R01.S.doc Version 5.0 Page 11 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16-18 The home’s complaints procedure is clear and gives residents and their relatives the confidence that comments and concerns will be listened to; there is a robust adult protection procedure. Staff need formal training on adult protection issues. EVIDENCE: Residents spoken with said they did not wish to complain but knew how to make a complaint. The home had received two complaints in the last twelve months; both had been addressed within the given time. There was a clear complaints procedure and an adult protection procedure, which was linked to the Local Authority procedures. The Manager had arranged for training on challenging behaviour and staff had watched a video on adult protection issues, but recognised that external training on adult protection should be given to all staff. Greetwell House Nursing Home DS0000002600.V257616.R01.S.doc Version 5.0 Page 12 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): 19-22, 26 The residents live in a generally comfortable and pleasant environment with both private and communal space, which is on the whole suitable for their needs. EVIDENCE: The home has a rolling maintenance rota and recent improvements have included the redecoration of several bedrooms, the clearing of the gutters, the laying of gravel to the flowerbeds to prevent weeds growing and the repair of the dining-room window. The carpets in the first floor corridor and in one of the bedrooms were still wrinkled from the previous inspection; the handyman said that an order had been placed for new carpeting to these areas. The home was free from odours with the exception of Room 14, which also had no mirror. Bedrooms did not have a lockable facility for residents to place their valuables. Residents were afforded a great degree of choice over how they personalised their rooms. The garden offered seclusion and there was a patio outside the dining room where residents could sit out in good weather. Greetwell House Nursing Home DS0000002600.V257616.R01.S.doc Version 5.0 Page 13 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 Staff numbers are in sufficient quantity and staff members are suitably qualified and competent; staffing does however need to be looked at, particularly with a view to extra hours for administration and activities. EVIDENCE: Staff numbers are in sufficient quantity on the staff rota for them to be able to care for the residents, but the hours of all staff have been reduced recently. This has left no time for co-ordinated activities or one-to-one input with residents. The Manager’s hours are included in the staffing numbers and she only has 6 hours a day allocated to paperwork and managerial duties; she currently takes work home to as there are not enough hours to complete her administration tasks. The residents were positive about the care they received from the staff; one resident said ‘they are kind and friendly’. Training records showed that all staff had recently received statutory training on fire procedures and basic food hygiene. Some staff members had not received training in adult protection; this needs to be external. Four staff members had achieved the National Vocational Qualification at Level 2 with one currently undertaking it and one staff; member had NVQ Level 3. Greetwell House Nursing Home DS0000002600.V257616.R01.S.doc Version 5.0 Page 14 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, 36-38 The home is managed competently and the staff are supported and supervised in carrying out their respective roles. The views of residents need to be recorded formally and used to form the basis of an action plan to improve the standard of care in the home. EVIDENCE: The Manager of the home has been an RGN for 26 years; most of her life has been spent in the Health Service. She does not have the Registered Manager’s Award since she is planning to retire. The home sends out questionnaires to residents and relatives and regularly asks residents for their views on the running of the home. It was recommended that all questionnaires were collated in a ‘quality assurance’ folder and that residents’ views on the meals served were also recorded. The manager is still in the process of reviewing all policies and procedures. Monthly visit reports must be forwarded to CSCI in accordance with Regulation 26. Greetwell House Nursing Home DS0000002600.V257616.R01.S.doc Version 5.0 Page 15 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 2 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 2 3 3 3 X X X 2 STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X X 3 3 2 Greetwell House Nursing Home DS0000002600.V257616.R01.S.doc Version 5.0 Page 16 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 OP1 Regulation 4[1][2] 5[1][2] Requirement The registered person must update the statement of purpose. The service user guide must be in a format, which is clear and easy to understand. OUTSTANDING FROM PREVIOUS INSPECTION The registered person must develop risk assessments for each resident The registered person must develop a programme of activities and events for residents, based on their individual needs The registered person must ensure that all staff receive external training on adult protection issues The registered person must ensure that all bedrooms have mirrors and a lockable facility. The registered person must ensure that Room 14 is free from odours The registered person must develop a quality assurance system based on the views of residents DS0000002600.V257616.R01.S.doc Timescale for action 12/12/05 2 3 OP7 OP12 13[4] 16[2] 12[2][3] 12/12/05 12/12/05 4 OP18 13[6] 12/12/05 5 6 7 OP19 OP26 OP33 16[1] 23[2] 13[3] 16[2](j) 24 12/12/05 12/12/05 12/12/05 Greetwell House Nursing Home Version 5.0 Page 17 8 OP37 8 OP38 OUTSTANDING FROM PREVIOUS INSPECTION Regulation The registered person must 26 make a visit at least once a month to the establishment and forward a report of the visit to CSCI in accordance with Regulation 26. 17 The registered person must ensure that all policies and procedures are updated. 12/12/05 12/12/05 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 15 Good Practice Recommendations It is a recommendation that the day’s menu is clearly displayed in the dining room, so that residents could anticipate the day’s meals and decide whether they want to make a different choice. Greetwell House Nursing Home DS0000002600.V257616.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Greetwell House Nursing Home DS0000002600.V257616.R01.S.doc Version 5.0 Page 19 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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