Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 16/01/06 for Greetwell House Nursing Home

Also see our care home review for Greetwell House Nursing Home for more information

This inspection was carried out on 16th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

All residents and the visitors spoken with all rated the care of the staff highly and said the food is excellent. The visiting health care person said, "whatever the home is asked to do in relation to the medical care of the residents, the staff willingly do without delay".

What has improved since the last inspection?

Some re-decoration of residents` rooms has taken place and the rooms seen were pleasantly decorated and personally furnished. The visiting health care person stated, "the home has improved over the past two years. There is better documentation and the staff are more knowledgeable of the care procedures".

What the care home could do better:

Activities are not provided in sufficient quantity or variety to ensure they meet with the residents` wishes and needs. Until all staff have received training in the awareness and prevention of Adult Abuse, the residents will remain at risk of harm. Hot water temperatures should be monitored regularly, with written records kept, and maintained at a temperature which is safe for all residents to prevent the risk of scalding. The manager does not have sufficient time for administration, monitoring and supervision of staff to ensure that the quality of care is good enough to keep the residents comfortable and safe. Nor does the Provider carry out the regular monthly monitoring visits to the home to make sure that the comfort and safety of the residents, the quality of the premises and care provided by the staff is adequate. There is no quality assurance or monitoring system in place to learn what the views of the residents are and whether the home is successfully caring for the residents in the way they want.

CARE HOMES FOR OLDER PEOPLE Greetwell House Nursing Home 70 Greetwell Close Lincoln Lincs LN2 4BA Lead Inspector Vanessa Gent Unannounced Inspection 16th January 2006 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.V276831.R01.S.doc Version 5.1 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.V276831.R01.S.doc Version 5.1 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.V276831.R01.S.doc Version 5.1 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. 13/10/05 Date of last inspection Brief Description of the Service: Greetwell House Nursing Home is a privately-run, twenty-five bedded, Gothicstyle property situated in a quiet residential area in the centre of Lincoln, opposite Lincoln County Hospital. There is a regular bus service into the city and a shopping centre within half a mile. 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. The home is currently accommodating one resident over the age of 60 years with a physical disability. The residents are accommodated in sixteen single rooms, of which are ensuite and six shared rooms, of which are ensuite. Two staircases and a passenger lift give access to the upper floor. Communally, there are three bathrooms, a shower room and three toilets. There is a small garden to the side of the property and a limited car parking area to the side and rear of the property. Greetwell House Nursing Home DS0000002600.V276831.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over 6½ hours. The main method of inspection used is called ‘case-tracking’; this involved selecting three residents and tracking the care they receive through the checking of their records, discussions with residents and care staff and observation of practices. The inspector spoke with several residents, three staff, the manager, two relatives and a visiting healthcare professional. Some policies and procedures were examined and records concerning the safety of the home were also seen. The home’s philosophy of care is “to minimise the trauma [of going into a care home] and ensure the moving in the home and adapting to a new way of life is as stress-free as possible”. What the service does well: What has improved since the last inspection? Some re-decoration of residents’ rooms has taken place and the rooms seen were pleasantly decorated and personally furnished. The visiting health care person stated, “the home has improved over the past two years. There is better documentation and the staff are more knowledgeable of the care procedures”. Greetwell House Nursing Home DS0000002600.V276831.R01.S.doc Version 5.1 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. Greetwell House Nursing Home DS0000002600.V276831.R01.S.doc Version 5.1 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.V276831.R01.S.doc Version 5.1 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, 4 Although the initial documentation is adequate, there are not enough means in place to ensure that new residents are informed of how the home can meet their needs once they are admitted to the home. EVIDENCE: The statement of purpose has been upgraded to now contain the information necessary to give prospective residents an insight into what the home can provide to meet their needs. The service user guide is basic but adequate to inform residents of what they might expect to be provided with at the home. However, when the pre-admission assessments have been completed by the home’s representative, no written confirmation is sent to assure the new resident that the home can meet their needs. Greetwell House Nursing Home DS0000002600.V276831.R01.S.doc Version 5.1 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 The care plans contain enough detail to ensure staff can provide adequate care for the residents. EVIDENCE: The care plans examined contain the risk assessments and care plan issues that inform staff how to care appropriately and safely for all the residents. It was recorded in one resident’s care plans that the family of a resident had requested involvement in the reviews of the care plans but no further mention has been made of this to date that this has taken place. Greetwell House Nursing Home DS0000002600.V276831.R01.S.doc Version 5.1 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 Activities are not well-promoted or provided in sufficient variety or quantity to meet the residents’ needs and wishes but they do have choice and variety in their menus and meals. EVIDENCE: The home does not have an activities co-ordinator and staff say they do not have the time to do any activities. Residents spoken with say that there is usually a monthly ‘sing-a-long’ and very few other activities. No activities were undertaken on the day of the inspection and there was no notice of activities advertised as available. Funds for activities are not available and money from the ‘Comfort Fund’, collected by voluntary contributions, is used to pay for monthly entertainment, when provided. All residents said the meals are excellent and the chef “does a good job”. Fresh fruit and vegetables are used daily, for which the chef said he was not limited on budget. Greetwell House Nursing Home DS0000002600.V276831.R01.S.doc Version 5.1 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): 18 The home’s training programme is not robust enough to safeguard the residents from harm. EVIDENCE: Not all staff have undertaken the adult abuse awareness training to protect residents from the risk of harm and no date has been booked for this to be accomplished. Greetwell House Nursing Home DS0000002600.V276831.R01.S.doc Version 5.1 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, 24, 25, 26 The residents live in a generally comfortable and pleasant environment, which suits their tastes, although it could be improved by a re-decoration and refurbishment programme particularly in the communal areas. Some areas, however, are not adequately maintained to ensure that the residents are kept safe at all times. EVIDENCE: Although the rooms of the residents case-tracked were seen to be pleasantly decorated, many communal areas of the home are in need of re-decoration and refurbishment to make the residents feel comfortable and ‘at home’. Outside, the small, enclosed garden and the patio leading from the dining room offer a safe area where residents can sit in good weather. Residents spoken with say that the home is comfortable and homely; one resident said “It’s a nice home; I’ve been here since October last year and I like living here”. One relative said that “in the five years [the resident] has Greetwell House Nursing Home DS0000002600.V276831.R01.S.doc Version 5.1 Page 13 lived at the home, I have never had to make a complaint. [The resident] is happy with the room, the care is excellent and everything is comfortable”. Health and safety rules apply to any room in which oxygen is stored to safeguard the residents and staff. However, there is no sign to ensure people are aware that oxygen is stored in the office. Two bathrooms were inspected; one had not been cleaned after use and personal toiletry and medicated items were not kept in a locked cupboard or in the resident’s room. The water temperatures of the sink in this room and other hot water outlets in residents’ rooms were found to be higher than the approved level for safe use by residents. The other bathroom seen is used for storage, although staff said the toilet in this room is used by residents and therefore is inappropriate to be used as a storage room. Greetwell House Nursing Home DS0000002600.V276831.R01.S.doc Version 5.1 Page 14 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, 29, 30 The number of staff on duty is not always sufficient to give the residents all the care and activities they require, need or would like and staff are insufficiently trained to ensure that residents are kept safe at all times. EVIDENCE: Residents say they do not have any activities provided and staff say they are too busy to do this as well as their caring and other roles. An inspection of the staff duty rota shows that at times, there are only two staff, including a trained nurse, on duty to care for sixteen residents, some of whom have high dependency needs. This occurs every evening for one hour and has happened for the whole shift on several occasions over the past few months. The care staff also do the laundry, both at night and in the daytime and cater for the teatime meal. However, residents state that “the staff are lovely”, “very caring” and that their needs are met. Relatives spoken with say “the staff are wonderful and very friendly. They always welcome us and talk to us and we visit every day”. Staff files examined show that not all the required documentation is in place in each record to help to ensure that all staff employed will safeguard the residents from harm. Greetwell House Nursing Home DS0000002600.V276831.R01.S.doc Version 5.1 Page 15 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): 33, 35, 36, 37, 38 Insufficient monitoring, training and health and safety measures are in place to protect the residents and ensure that staff provide an efficient and competent service at all times. EVIDENCE: Previous inspection reports have identified that the responsible person has not made monthly, unannounced visits to the home to monitor and check the standards of management, care, hygiene and maintenance and whether the residents, relatives and staff are happy with the conditions and environment of the home, as required. This has still not been accomplished. Resident questionnaires have been used in the past to ascertain their tastes, wishes and needs, but these still have not been collated into a quality assurance format that could be used to improve the service provided. Greetwell House Nursing Home DS0000002600.V276831.R01.S.doc Version 5.1 Page 16 The finances of some residents are overseen by the manager and banked in a communal account. The annual interest gained must be given to those residents and not retained by the home. Because the manager has only six supernumery hours out of the total hours she works per week and has no business administration support, she feels she does not have time to complete all the administration records, fully monitor the service provided and the staff practices, efficiently oversee the staff training, supervision and meetings or complete the review of all the policies and procedures in place. Staff say they feel inadequately supported in their work and that the manager is sometimes not available when they need her, although all staff spoken with said that the manager is a kind, understanding person. The maintenance person does not keep up-to-date or ongoing records to show that fire tests and drills, water temperatures and tests for the prevention of Legionella disease are completed on a regular basis. An Environmental Health Officer had visited and inspected the premises recently and identified that although there was a general standard of cleanliness in the kitchen, not enough time was given to producing a cleaning schedule to evidence that it is cleaned as well or as often as required for hygiene purposes. Not all staff have received essential training to ensure that residents are protected at all times. Where outlets are ‘fire doors’, these are not kept closed, especially from the exit to the kitchen. Doors that are propped open need to have approved doorclosing fire sensitive fixtures fitted. Residents are allowed into the kitchen area to use the hot water urn and go into the fridge (for the milk) to make hot drinks. Risk assessments are necessary for the safe use of this facility. Greetwell House Nursing Home DS0000002600.V276831.R01.S.doc Version 5.1 Page 17 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 3 X X 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 1 3 X X X X 3 2 3 STAFFING Standard No Score 27 2 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X 2 2 2 2 Greetwell House Nursing Home DS0000002600.V276831.R01.S.doc Version 5.1 Page 18 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 OP4 Regulation 14.1 Requirement Written confirmation that the home can meet the needs of prospective residents must be given when offering admission to the home. The registered person must ensure that a programme of activities and events for residents, based on their individual needs, is produced and available. (Timescales not met at previous inspections and 12/12/05.) The registered person must ensure that all staff receive adult protection training. Commencement of staff training for this must be arranged by the timescale for action date indicated. (Timescale not met at previous inspections and 12/12/05. An Immediate requirement was set. ) Water temperatures must be maintained at a temperature which will prevent scalding and must be recorded regularly to evidence their maintenance. The staff numbers and skill mix DS0000002600.V276831.R01.S.doc Timescale for action 16/03/06 2 OP12 16.2 30/04/06 3 OP18 13.6 15/02/06 4 OP25 13.3 28/02/06 5 OP27 18.1 28/02/06 Page 19 Greetwell House Nursing Home Version 5.1 6 7 OP29 OP33 19 24.1, 26.1,3,4 8 OP35 20 9 OP36 18.2 10 OP37 17 11 OP38 23.4 must be adequate to meet the needs of the residents at all times. Staff records must contain the items as required in Schedule 2.1-7. The registered person must make monthly, unannounced visits to the home, and must ensure that a quality assurance system is developed to monitor the service provided and the residents’, relatives’ and staff opinions, wishes and needs are met. (Timescale not met at previous inspections and 12/12/05. An Immediate requirement was set. ) Residents whose finances are overseen by the manager and kept in a communal bank account must be given their annual, earned interest on the savings. Regular staff supervision must be in place to support staff to safeguard the residents. (Timescale not met at previous inspections and 12/12/05.) The policies and procedures of the home must be updated and all other records, including maintenance, must be kept upto-date as required in Schedule 4. (Timescale not met at previous inspections and 12/12/05.) The registered person must ensure that fire safety procedures are in place, including the propping open of fire doors. 28/02/06 28/02/06 28/02/06 30/04/06 30/04/06 28/02/06 Greetwell House Nursing Home DS0000002600.V276831.R01.S.doc Version 5.1 Page 20 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 OP12 Good Practice Recommendations It is recommended that the registered person pay for all entertainments provided and that funds for activities should not come from the fund, collected by voluntary contributions. It is recommended that staff supervision should take place six times per year. The registered person should seek the advice of the Fire Department. 2 3 OP36 OP38 Greetwell House Nursing Home DS0000002600.V276831.R01.S.doc Version 5.1 Page 21 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.V276831.R01.S.doc Version 5.1 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!