Inspection on 04/09/08 for Greetwell House Nursing Home

This inspection was carried out on 4th September 2008.

CSCI found this care home to be providing an Adequate service.

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 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 13/10/05

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 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Greetwell House Nursing Home 70 Greetwell Close Lincoln Lincs LN2 4BA Lead Inspector Julie Western Unannounced Inspection 4th September 2008 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.V371234.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. Greetwell House Nursing Home DS0000002600.V371234.R01.S.doc Version 5.2 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 F/P 01522 521830 Dr Sharaf Abd El Monem Salem 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.V371234.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only:Care Home with nursing - Code N To people of the following gender: Either Whose primary needs on admission to the home are within the following categories:Old age, not falling within any other category - Code OP 2. Physical disability - Code PD - maximum number of places 1 The maximum number of people who can be accommodated within the home is: 25 5th September 2007 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. Residents are accommodated in sixteen single rooms and six shared rooms. 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 garden to the side of the property and a limited car parking area to the side and rear of the property; in addition there is on-street parking. The nurse in charge confirmed that charges made by the home for care on ranged from: £348.00 - £431.00 p.w. Information about the service including a copy of the previous inspection report, fees and the home’s facilities is available from the manager’s office. Greetwell House Nursing Home DS0000002600.V371234.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced visit and it formed part of a key inspection, focusing on key standards, which have the potential to affect the health, safety and welfare of people who use the service. Throughout this report the terms ‘we’ and ‘us’ refer to The Commission for Social Care Inspection (CSCI). The visit lasted approximately two and a half hours and we took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since the last inspection. Before we made our visit the provider had returned the Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans to improve aspects of the service. We sent out surveys to people before we visited the service. The main method used to carry out the inspection is called ‘case tracking’, this includes following the care of a sample of four people through their records and assessing their care. We spoke to four people who use the service and saw rooms of those people who said we could and to three staff members. The manager has resigned and the nurse in charge was acting as manager; she was present throughout the visit and the general outcomes of the visit were discussed with her. What the service does well: Greetwell House delivers a good standard of medical care; it does this by maintaining competent health care practices. Staff members are well trained and have a sound knowledge of residents needs. People are happy to be living at the home; comments made were ‘I like it here; I don’t have any complaints’ and ‘It’s very nice – we’re well looked after’. Another compared it favourably with a previous home they had lived in. Greetwell House Nursing Home DS0000002600.V371234.R01.S.doc Version 5.2 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Greetwell House Nursing Home DS0000002600.V371234.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 Greetwell House Nursing Home DS0000002600.V371234.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 [Standard 6 N/A]. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The information provided is available to residents and sets out what is available for them. An initial assessment ensures that the needs of residents can be met. Prospective residents are encouraged to take time before making the decision to move into the home on a permanent basis. EVIDENCE: The nurse in charge confirmed that she always visited prospective residents at home or in a care setting such as a hospital to undertake a thorough assessment of all their care needs. Records confirmed this. Written admission documentation gave staff the information they needed to meet the residents’ needs. During our visit it was confirmed that the statement of purpose and the service user guide are being updated. The statement of purpose contained all of the Greetwell House Nursing Home DS0000002600.V371234.R01.S.doc Version 5.2 Page 9 information needed for prospective residents to make a decision. The service user guide was in a format that was easy to read by older people. A resident described how he had visited for the day before he was sure she wanted to move in permanently. Another resident said ‘I came here a long time ago, with my friend’. A staff member described the admission process and the importance of making new residents and their families welcomed. The home does not provide intermediate care. Greetwell House Nursing Home DS0000002600.V371234.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans have information to ensure that residents’ care needs can be met, but this information is not always dated. Pharmacist visits are not in enough frequency to ensure that medicines are checked thoroughly by an outside agency. Staff members ensure that the dignity and privacy of residents is maintained. EVIDENCE: Of the four care plans looked at in depth, two contained information about individual health and personal care needs, but the information was not always dated. They were reviewed regularly and signed where possible by the service user or relatives/advocates. They contained risk assessments. Social histories ensured that there was information to meet residents’ social needs, but were not always dated. Greetwell House Nursing Home DS0000002600.V371234.R01.S.doc Version 5.2 Page 11 A third care plan for a person receiving respite care did not have a photograph of the resident, even though she had regular periods of respite care every six weeks. Her care plan was not signed. The fourth care plan mentioned the use of bedrails but there was no signed evidence of relatives’ permission for this. There was no indication that the pharmacist visited regularly; the most recent visit from the pharmacist was in 2004, although the nurse in charge said she was sure he had visited more recently than that. One person we spoke with said ‘They’re all good here’ and another described how his medication was given to him and said ‘I don’t have to worry about it – they make sure I get my pills’. The staff team were observed carrying out their duties with kindness and sensitivity towards the residents, especially when attending to their personal needs. Greetwell House Nursing Home DS0000002600.V371234.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Social activities are not regular and varied and do not currently meet individual peoples needs. People have a choice of meals from a balanced and varied menu. EVIDENCE: The senior nurse in charge confirmed the home has no designated activities co-ordinator. It was also confirmed that the previous manager used to carry out activities herself, but that since her departure, social activities have been on an ‘ad-hoc’ basis, with staff fitting them in when they have the time. She said staff sat and chatted to residents in the evenings. On the day of the inspection some people were in the main lounge, watching television, and others resting in the quiet lounge. People we spoke with did not know what activities they were doing that day. Staff members spoken with said that there were two escorted hospital visits that day so it was unlikely that there would be time for activities. One person Greetwell House Nursing Home DS0000002600.V371234.R01.S.doc Version 5.2 Page 13 said ‘I always look forward to the games, when we have them’. In the main lounge, there was a shelf full of games and puzzles. People were observed eating breakfast and the mid-day meal. All said they enjoyed the meals served; one said ‘They’ve improved recently’ and another said ‘If I don’t like it, I can have something else’. Menus seen were balanced and varied. The acting manager said she had compiled them with the help of residents. The cook, who had been in post for two months, was knowledgeable about the nutritional needs of service users and described cooking for diabetics and people needing pureed food. She confirmed that the home was now using fresh fruit and vegetables and that she made all meals herself, including pies and cakes. Greetwell House Nursing Home DS0000002600.V371234.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s procedures for addressing complaints and for protection from abuse are clear. Residents and their families are confident that their comments and concerns will be listened to. EVIDENCE: People spoken with said they did not wish to complain but knew how to make a complaint. One resident said ‘I’ve no complaints – if I did have I’d go to the office’. The home had an up to date copy of the Local Authority adult protection procedures; staff members said they had read it. The training programme showed that there was a staff had received on safeguarding adults in the last year. Staff members spoken with knew what to do in the event of a serious concern. Since the last inspection there had been one complaint and this had been resolved with the complainants. Greetwell House Nursing Home DS0000002600.V371234.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a generally safe environment that is suitable for their needs. However, toilet and bathroom areas in particular are worn and in need of upgrading EVIDENCE: Externally, the paint was flaking off the walls in places, but the building itself appeared sound. The building has large corridor spaces and rooms with high ceilings and efforts have been made to prevent communal areas from looking institutional, with the exception of the bathrooms and toilets. These had bare walls. One bathroom was used to store commodes and the senior nurse said this was because there was little storage space in the building. Greetwell House Nursing Home DS0000002600.V371234.R01.S.doc Version 5.2 Page 16 The bathroom most used was in need of redecoration. The bath had old fittings and had been re-enamelled and this had worn in places. The gardens and courtyard areas were well maintained and offered seating for residents to sit out on. Staff members described how the maintenance worker, who shared his time between this home and the sister home in Lincoln, carried out any repairs needing attention. Recent improvements to the home had included the complete refurbishment of the dining-room, including tables and chairs, new furniture in the front lounge, 2 bedrooms redecorated, new carpets on the ground floor and two main staircases, a new hoist, refurbishment of the kitchen and the patio re-laid. There was a refurbishment plan in place and this showed clearly what had been achieved and what was still to be carried out. It did not include replacement of the bath with worn enamel. People’s individual rooms were well decorated, although an armchair in one room had worn arms. There were safety notices and hand-washing equipment around the building to prevent the spread of infection. The entrance hall smelled of urine on arrival, and a cleaner was dispatched immediately to clean the area; the nurse in charge said it was probably from a chair in the living room adjacent to the hall that had not yet been cleaned. Greetwell House Nursing Home DS0000002600.V371234.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff numbers are in sufficient quantity for them to be able to support people safely, but staffing does not allow for quality time to be spent with residents. Staff members are suitably trained, qualified and competent to meet the needs of people. Staff employment records were unavailable for inspection on the day of the inspection. EVIDENCE: The daily staff rota showed that in addition to the nurse in charge there were two carers for 12 residents. The nurse in charge said this decreased to one carer in the afternoons. The home owner also employs a cook, 2 cleaners, and a handyman and a gardener who shared their time between this home and the sister home. Night staff members did laundry tasks and day staff did the ironing. Staff members said that there were enough staff available to complete their tasks in time, but that there was rarely time during the day to spend any quality time with residents. One person said ‘they’ll help you when they can, but sometimes they’re busy’. Greetwell House Nursing Home DS0000002600.V371234.R01.S.doc Version 5.2 Page 18 The nurse in charge said that, in addition to the manager leaving, in the past two months a nurse, a carer and a housekeeper had left and one carer was on long-term sick leave. This meant that although the home was kept adequately staffed, they were at full stretch. There were currently vacancies for an assistant cook and two carers, in addition to the manager. The nurse in charge said that four staff members have completed the National Vocational Qualification [a nationally recognised qualification], with one working towards it. One staff member has NVQ level 3, with one working towards it. The training records showed that recent training had included challenging behaviour, abuse and an update on diabetes. Training was usually shared with the sister home. Staff employment records were not available for inspection, being in a locked cabinet that the nurse in charge had no access to. The nurse in charge described how staff members are recruited and we have since asked the home owner to provide information for us to review. The nurse in charge said that staff supervision had not recently been carried out and staff members confirmed this; neither had there been staff meetings, but the nurse in charge said one was planned for mid-September. Residents meetings were not formally held, but the nurse in charge spoke informally with residents regularly, the most recent occasion being when residents’ opinions of the content of the menus were sought. There was no record of this. Greetwell House Nursing Home DS0000002600.V371234.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is not currently being managed in a way that promotes the health and safety of residents, since senior staff members lack support to carry out their tasks and to give adequate support to staff. The views of people are listened to and they are involved in decisions affecting them, but this is not always recorded. EVIDENCE: There is currently no manager at the home and it is being managed temporarily with senior nurses acting as managers on shift. The nurse in charge on the day of the inspection said that her hours had been increased to include some management hours, but that there was no computer at the home and any paperwork had to be taken home. Greetwell House Nursing Home DS0000002600.V371234.R01.S.doc Version 5.2 Page 20 There is now an administration assistant whose base is at the sister home; she visits the home on Fridays and is responsible for wages and finances. The owner visits weekly; however, despite a requirement being made to complete regulation 26 visit reports at the previous inspection, these reports could not be located. A staff member said ‘I’ve seen him but I’ve never spoken to him’. Residents said ‘He doesn’t usually say much to us’. Policies and procedures were well organised and were generally up to date. Health and safety policies were well documented and demonstrate a clear commitment to ensuring the wellbeing of residents. There is a quality assurance system in place; this consists of sending questionnaires to residents and their families/advocates. On return, these are discussed with the manager and owners and any issues from the returned forms are addressed. No survey forms sent to selected residents were returned in time to be included in this report. Comments from residents spoken with included ‘I like it here – we can do what we want to do’, ‘They’re good girls and help us out’ and ‘It’s alright here’. Greetwell House Nursing Home DS0000002600.V371234.R01.S.doc Version 5.2 Page 21 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 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 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 Greetwell House Nursing Home DS0000002600.V371234.R01.S.doc Version 5.2 Page 22 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 OP33 Regulation Requirement Timescale for action 24/10/08 2 3 OP7 OP12 4 OP19 5 OP33 6 OP36 OP26(a)(b The registered person must visit )(c) the home each month, unannounced, to get and record the views of residents and staff on the standard of care provided. STILL OUTSTANDING 15[1] Care plans must be updated to 15[2][c] reflect the current needs of the resident. 16[2][mn] A regular programme of activities must be arranged after consulting each service user about their social interests. Individual needs must be taken into account. 23[2][b] The bathroom on the ground floor must be kept in a good state of repair. The bath surface is worn, tiles and taps have not been replaced or upgraded for some years and water pipes are exposed and show corrosion. 24[1,2,3] An effective quality monitoring system must be in place, based on seeking the views of service users. 18[2] Staff must receive regular supervision DS0000002600.V371234.R01.S.doc 24/10/08 24/10/08 24/10/08 24/10/08 24/10/08 Greetwell House Nursing Home Version 5.2 Page 23 7 OP37 17[1,2,3] The person in charge of the home must have access to records identified in Schedules 3 and 4 within the home, including staff records. 24/10/08 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 OP9 Good Practice Recommendations The registered person should seek regular advice and information from a pharmacist regarding medicines policies and medicines dispensed for individuals in the home. Greetwell House Nursing Home DS0000002600.V371234.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greetwell House Nursing Home DS0000002600.V371234.R01.S.doc Version 5.2 Page 25 - 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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