Inspection on 05/09/07 for Greetwell House Nursing Home

This inspection was carried out on 5th September 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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 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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Greetwell House Nursing Home 70 Greetwell Close Lincoln Lincs LN2 4BA Lead Inspector Roger Harrison Key Unannounced Inspection 09:00 5 September 2007 th 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.V336057.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.V336057.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 Dr Sharaf Abd El Monem Salem Post Vacant 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.V336057.R01.S.doc Version 5.2 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. 7th November 2006 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, of which are ensuite and six shared rooms, of which are en-suite. 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. The manager confirmed that charges made by the home for care on 05/09/07 currently range from: £348.00 - £431.00 p.w. Greetwell House Nursing Home DS0000002600.V336057.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken by an inspector reviewing all the previous inspection records available, looking at written information that we asked the manager to provide about Greetwell House, and by undertaking a visit to the home, with the inspector using a method of inspection called “case tracking”. This involved identifying individual residents who currently live at the home and tracking the experience of the care and support they have received during the time they have lived there. The inspection was also used to check that information provided by the manager matched the individual experiences of residents. This was done by talking to the acting manager, and talking to residents and care staff whilst observing day-to-day care practice within the home. What the service does well: What has improved since the last inspection? The acting manager has developed a range of policies and procedures for use by the staff team. A statement of purpose and residents guide is now available for all residents and visitors so that people know what to expect from the service. All residents have an individual care plan, which shows their personal care needs and how these should be met. The laundry area has been improved through the purchase of new equipment. A range of activities are available, which residents said they enjoy. The acting manager has made a formal application to be the registered manager for the home and an interview date has been arranged. Greetwell House Nursing Home DS0000002600.V336057.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Greetwell House Nursing Home DS0000002600.V336057.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.V336057.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): Standard 3 [Standard 6 N/A]. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are assured that their needs can be met before any admission to the home takes place. EVIDENCE: Before the inspection visit took place the acting manager provided information to show that there had been no new long-term admissions since the last inspection. The Service user guide produced by the acting manager was available in resident’s rooms and in the manager’s office. Residents said that they were aware of the service user guide and that they had copies. Other information about how the home is run was available in the reception area of the home and the manager’s office. This information included a copy of the homes Statement of Purpose. Greetwell House Nursing Home DS0000002600.V336057.R01.S.doc Version 5.2 Page 9 Previous admission information included pre admission paperwork both in house assessment information and information from other professionals to confirm that a basic assessment had been completed before admission to the home took place. Residents made positive comments about their experience of moving into the home and one resident said, “I moved here from another home. I was made to feel welcome straight away and they talked to me about my needs and how they would be met and I haven’t been disappointed since I came here”. The information available regarding assessments completed was brief but did show that communication had taken place with new residents, family members and other professionals about how needs should be met. During the inspection visit the acting manager confirmed she is developing a full pre-admission form, which she said she will be using to make sure that all assessment information about needs and wishes is gathered together in one place and used to ensure the needs of any new resident can be fully met. Greetwell House does not provide an intermediate care service. Greetwell House Nursing Home DS0000002600.V336057.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): Standards 7,8,9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s health and personal care needs are set out in an individual care plan and their health needs are met. But residents would benefit from more detailed plans in order to improve the quality of the direct support given. The acting manager has policies and procedures in place, which staff follow in order to support residents with their medication needs. Residents are treated with respect and supported to maintain their dignity. EVIDENCE: Since the last inspection the manager said that she had reviewed how care plans are put together and as a result had developed a format for individual plans to make sure that residents had their own health care needs information kept separately to show how each individual should be supported. Information included a separate section about risks along with details and how any risk is managed. For example, one resident, who liked to go out into town Greetwell House Nursing Home DS0000002600.V336057.R01.S.doc Version 5.2 Page 11 on his own had been supported to do this more safely with a basic risk assessment, which was signed by the resident. Care plans contained some information about social histories and personal preferences including likes and dislikes and religious needs. Residents said that they felt they received support to make choices and that they were supported with their religious needs. One resident said, “Some people go to out to churches and we have services here”. However this information was not recorded on all care plans. The acting manager said she would be working to ensure all care plans contain this information to ensure that any needs not already identified could be met. Whilst one staff member was providing support with the mobility needs of resident’s one resident fell out of a chair. This incident was managed in an effective and professional manner using safe moving and handling techniques and sensitive communication to ensure the situation was managed without distress for the resident involved. During the inspection visit an optician visited the home to provide support for some residents by checking their vision. Residents said that this was helpful. Individual medication is kept in separate containers in a locked cupboard in the manager’s office. Residents said they were happy to have help with their medicines and that if they wanted to take their own medication they felt the acting manager would support them to do this. All residents said that they needed help to remember to take their medicines. Medicine records were checked during the inspection with nursing staff signatures showing when support had been given. The acting manager said that she had noted some gaps in the records recently and showed how she had taken action to address this issue together with the staff team. The acting manager provided information to confirm that senior staff members have received training to enable them to provide support for residents when taking medication. During the inspection visit a senior agency care worker responsible for medication demonstrated how she carried out the role in a safe way by using daily records and care plan information to get a good understanding of each individual need. The agency worker said, “This is the first time I have been here and can say that the records helped to me to understand exactly what was needed to support each resident”. Greetwell House Nursing Home DS0000002600.V336057.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): Standards 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents make choices to take part in individual and group activities within the home and community and feel that they have control over their own lives. Residents receive a varied, balanced and nutritious diet. EVIDENCE: The acting manager said that the whole team takes responsibility for supporting residents with activities and that this helps the staff to get to know about all residents social interests and how they want them to be met. Since the last inspection the manager has taken action to start adding personal profiles to care plans, which describe residents personal and social interests. Both the manager and some residents said that these were completed together and one resident said, “They have started to talk to us a lot more about what we like to do and the meetings we have with the manager help us to make choices about the things that go on”. Greetwell House Nursing Home DS0000002600.V336057.R01.S.doc Version 5.2 Page 13 Residents were observed listening to music, talking together, watching television either in the lounge or their rooms and going out with friends into the community. Some other residents were enjoying playing games with staff members. One resident was being supported to have a hair done and said, “This has made me feel much better”. The acting manager showed that she keeps a file to show all the events that she has organised since she joined the home. These included evening discos, clothes parties, a St Patrick’s day lunch, a barbecue, fish and chips supper and an August fair. Both the manager and residents said that the residents meetings were being used to discuss activities and that this had helped residents to talk about what they liked to do. Meals are organised by the acting manager and an established cook using care plan information, talking to residents daily and using a menu plan, which was available in the reception area of the home. The kitchen area of the home contained written information about the special dietary needs of residents. The manager also said that residents are encouraged to make different choices to the daily menu, including breakfast and that any requests for an alternative to the menu were acted upon on the day. During the inspection visit the food stores contained a variety of foods to suit the tastes of residents and an appetising lunch was being prepared, which residents said they were looking forward to eating. Residents said that they enjoyed all the meals provided at the home. Comments ranged from “We can have what we like here, the food isn’t just what is on the menus and we can ask for something different whenever we want” to “The food is great. There is always lots to eat and I don’t like leaving food but I would rather have too much than not enough”. Greetwell House Nursing Home DS0000002600.V336057.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): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The acting manager and care team take complaints seriously and wherever possible involve residents and carers in resolving issues as soon as they are raised. The care team receive training and support to enable them to act in order to protect residents from abuse. EVIDENCE: Information provided by the acting manager before and during the inspection visit confirmed that a complaints policy and procedure is in place. This procedure was on display in the entrance at the home and residents said they felt happy to raise any concerns that they have direct with the staff team. One resident said, “I know exactly who to refer to if I have any worries or complaints” and a visiting family carer said “I would raise any issues directly with the manager and I have seen the complaints information in reception, which is easy to use”. The acting manager confirmed that no formal complaints have been recorded in the complaints log at the home since the last inspection. The acting manager said she would always provide a written response to any complaint and always attempts to meet with individuals to try to resolve concerns informally whenever they are raised. Greetwell House Nursing Home DS0000002600.V336057.R01.S.doc Version 5.2 Page 15 It was also confirmed that copies of the adult protection policy and procedure for Lincolnshire are available in the home for staff use, and training records produced by the deputy manager show that staff members have had access to abuse training either direct or through nationally recognised training courses. Since the last inspection visit the acting manager has needed to take action to protect residents from harm. The action taken by the acting manager helped to ensure residents were supported safely and the procedures followed. Greetwell House Nursing Home DS0000002600.V336057.R01.S.doc Version 5.2 Page 16 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): Standards 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is clean and the environment is set out to ensure residents can access all areas safely. The home is in need of a decorative update. Parts of the building and grounds are in need of appropriate maintenance to ensure that the needs of all residents can be met. EVIDENCE: Before making this inspection visit the manager provided some written information showing areas of the home environment, which had been improved. For example; more waste bins have been provided, some doors now have sound activated closure mechanisms, some new kitchen equipment has been purchased and toilet facilities have been decorated. The laundry area has also been improved through the purchase of a new washing machine facility. Greetwell House Nursing Home DS0000002600.V336057.R01.S.doc Version 5.2 Page 17 During the inspection visit the building was observed to be clean and tidy. A no smoking policy has been introduced to the home and residents who do smoke are being supported to do so with appropriate outside cover. The residents who use this facility said that they agreed with the arrangements in place. The acting manager did recognise that some parts of the home are in need of ongoing decoration and maintenance to make sure that the upkeep of the home environment is maintained. For example parts of the communal areas of the home are in need of redecoration and parts of the outside of the building, including the garden areas are in need of appropriate maintenance. The acting manager said that she would undertake an audit of the environment and share this with the home-owner so that they could set timescales for the work identified to be completed. Greetwell House Nursing Home DS0000002600.V336057.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are currently sufficient numbers of safely recruited care staff available at the home with appropriate training and skills to meet the needs of residents. EVIDENCE: Before carrying out this inspection visit the acting manager provided information, which included staff rotas, which showed that staffing levels are balanced using a shift system. This includes a night care team for the home. During the inspection visit staff files were provided, which showed that references and checks are completed to make sure recruitment is carried out safely. The acting manager also provided a basic training plan with training records on individual staff files to show that staff members are supported to undertake a range of training courses to help them to provide care for residents as highlighted in their care plans, this includes nationally recognised qualifications. The training plan showed that training has been provided in abuse awareness, moving and handling, fire safety, care planning and risk assessments since the last inspection. Greetwell House Nursing Home DS0000002600.V336057.R01.S.doc Version 5.2 Page 19 Staff members said that they felt the acting manager had worked to develop a structure for supporting them in their roles and that they worked together well as a team to make sure sufficient staff are available to support residents with their needs. Residents said they trusted the staff team and one resident said “They always seem to know what they are doing and they are very gentle in the way they care for us”. Greetwell House Nursing Home DS0000002600.V336057.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The acting manager supports the staff team and encourages feedback from residents and carers and there is a system in place for consulting people about the quality of care provided. However, The home-owner does not provide enough structured support for the manager in order to plan, agree and record the future development needs of the home and how they will be met together. The manager safeguards residents’ financial interests. Greetwell House Nursing Home DS0000002600.V336057.R01.S.doc Version 5.2 Page 21 EVIDENCE: The acting manager has applied to be registered to manage the home on a formal basis and is soon to be interviewed for the position she currently has. Residents and family carers said they trusted the manager and felt able to speak with her whenever they needed to. Comments made by residents ranged from “The managers door is always open for us” to “She is very good to us all and takes the time to listen if we need to talk” One family visitor said “I visit the home every day and it feels like a family here, I have my meals here and the manager always feel very welcome”. The acting manager provided records to show that since taking up her role she has set up regular residents meetings, which residents said are used to make comments about how they would like to see the home develop. One resident said, “At the last residents meeting we got to pick the new furniture for the dining room. The manager was thinking of one colour but we all thought blue was the best and she supported us with our decision”. The acting manager said that the home-owner could be contacted if there are any concerns that she needs to discuss and that the home-owner does visit the home. However, records available in the managers office showed that the home-owner does not use the time that he spends at the home monitor and provide regular written reports on the quality of the care being provided by the manager and care team overall. Some records were available to show that visits had been made but did not show that residents and staff had been given an opportunity to meet and talk to the owners about how things are and how they might be further improved. Residents said that they are able to manage their own financial arrangements either individually or with support from family members. The manager confirmed that when requested she does have arrangements in place to help support residents to make sure that they have access to their own day-to-day money. The acting manager said that whenever she is asked for support with managing daily finances she keeps a detailed record to make sure she knows how much money each resident has. A check made during the inspection visit showed these records were accurate. Greetwell House Nursing Home DS0000002600.V336057.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X 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 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Greetwell House Nursing Home DS0000002600.V336057.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO. 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 OP19 Regulation OP23(B)( O) Requirement An internal environmental audit must be completed in order to provide a clear action plan with timescales, which fully identify and address all the environmental needs of the home. The registered person must visit the home each month, unannounced, to get and record the views of residents and staff on the standard of care provided. Timescale for action 05/11/07 2. OP33 OP26(a) (b)(c) 05/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Greetwell House Nursing Home DS0000002600.V336057.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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.V336057.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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