Inspection on 14/09/05 for The Glen Nursing & Residential Home

This inspection was carried out on 14th September 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 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

The Glen Nursing & Residential... 21/10/08

The Glen Nursing & Residential... 24/10/07

The Glen Nursing & Residential... 20/09/06

The Glen Nursing & Residential... 01/02/06

The Glen Nursing & Residential... 02/02/05

The Glen Nursing & Residential... 13/07/04

The Glen Nursing & Residential... 22/01/04

The Glen Nursing & Residential... 09/10/02

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Glen Nursing & Residential Home Shapway Lane Evercreech Shepton Mallett BA4 6JS Lead Inspector Barbara Ludlow Unannounced 14 September 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Glen Nursing & Residential Home Address Shapway Lane Evercreech Shepton Mallett Somerset BA4 6JS 01749 830369 01749 831390 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes (CFC) Ltd. No 2006738 Ms Gale Lesley Smith Care Home 58 Category(ies) of 1. Old age (OP) - 58. registration, with number of places The Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Number of persons for whom nursing care is provided shall not exceed 35. 2. Up to 26 places for personal care, 23 of which must be sited within the original building. 3. Up to three persons of either sex, in the age range 18-64, who require general nursing care. 4. Maximum overall number 58. Date of last inspection 2 February 2005 Brief Description of the Service: The Glen is a service that supports up to 60 older people. The Glen is part of the BUPA Care Homes group. The service is situated in the village of Evercreech, which is a few miles from the town of Shepton Mallet. The home is situated within pleasant grounds in a country setting. The service is split into two wings with those service users who require nursing support in one and those who require personal care only in the other. There is a common kitchen and offices in the centre of the two wings. The bedrooms are distributed over three floors and there are two passenger lifts that allow easy access to all floors. Service users are able to visit all areas of the service even if their bedroom is on the opposite wing. The Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors for CSCI conducted this unannounced inspection. The Manager was on duty and was available to assist throughout the inspection day. The inspectors met with the Manager at the start of the inspection to discuss the last inspection and current issues and at the conclusion of the inspection to give feedback on the day. A tour of the premises was made and service users were seen and spoken with some in the privacy of their own rooms and others in the communal areas of the home. Lunch was observed served in the dining rooms in both the Nursing and Residential wings and on the first floor where it was served to service users in their own rooms. Records were sampled these included, care plans, financial records, staff recruitment records, maintenance and medication administration charts. This was a very positive inspection and some areas were highlighted for improvement. What the service does well: The Glen is in a very pleasant rural setting and the grounds are well managed providing a very pleasant outlook for service users and level access for those service users wishing to go outside. The communal areas of the home are very well and comfortably appointed. The dining rooms are attractively presented and add to the social occasion of meal times. Bedrooms are comfortable and can be personalised to make them homely. Service users confirmed to the inspectors that they are treated kindly and respectfully by staff. The home is well managed; the Manager is approachable and is an experienced professional nurse. There is a good level of administrative support. The Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 Page 6 Social activities are supported and there is community involvement. Families were welcomed and a good rapport was evident between visitors and staff at the home. 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 Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,4,5, NMS 6 is not applicable. The home provides a good level of information for prospective service users to make an informed choice of care home. Visits to view the home are welcomed. EVIDENCE: The CSCI registration certificate was displayed. The Glen has a Statement of Purpose and offers information to prospective service users and their families/carers. Visits to the home are welcomed and the home offers respite care. Information is displayed in a file in the foyer at the home. The home has four beds that are contracted with Somerset Social Services. Individual service user contracts were not sampled at this inspection. The homes current fee rates range from £550 per week for residential/personal care only to £700 per week for Nursing Care. Respite is charged per night and The Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 Page 9 is currently £85 per night for residential care to £100 per night for nursing care. Care plans contained the information gathered for pre-admission assessment and care plans had been written to meet the needs of service users. The Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 The care plans were generally well recorded and demonstrated that needs are assessed and care is planned to meet the identified needs of the service users and is regularly reviewed. Requirements are made for record keeping and the labelling of creams. Other actions have been required as identified under NMS 26. EVIDENCE: The care plans seen at this inspection provided a good level of information for nurses and care staff to deliver care. Care plans were read that recorded fears and anxieties and suggested how best to meet the persons needs. Risk assessments are documented for nutritional needs, pressure area risk, falls and bedrails. Input from the homes physiotherapist was recorded where chest percussion and breathing exercises had been carried out to relieve symptoms. The home uses the Gold Standard Framework for Care Homes, advanced care planning. This allows a the service users wishes for treatment to be recorded The Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 Page 11 in advance and therefore be available for consultation in the event of their health deteriorating. Service users commented that there are not enough staff and that sometimes they would have to wait, it was identified that this was particularly around meal times. This should be reviewed. Service users who were spoken with confirmed that they felt well cared for and that they are treated with dignity. Medication administration records were examined, gaps on the administration sections were identified and not all hand transcribed entries had signatures to verify who made the entry and who checked the entry. Skin creams for individual service users did not have opened on, nor discard by, dates on them; this is recommended at this inspection. Blood sugar monitoring practice was measured against recent guidance from the Medical Devices Agency (MHRA), the manager is required to review current practice to ensure best and safe practice. The Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 The Glen offers a good range of activities for service users. Service user can choose whether or not to join in with the events/activities offered. Visitors are welcome and the home is involved in the wider community. Service users comments included that ‘there is a lot going on’. EVIDENCE: All activities and event at the home are well advertised; service users were seen to have an activities sheet for the summer and a newsletter, which is issued monthly. This newsletter contains activity information, notice of forthcoming events, welcomes new service users and informs of staff news. The hairdresser visits weekly and Holy Communion is held monthly. On the inspection day, activities included flexercise and stroke club. The Glen hosts the community stroke club to enable service users to access the club and participate if they wish. The Art group is a popular activity and pictures are displayed at the home. Service users from the BUPA home, Clare Hall, are invited and attend. The Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 Page 13 Visitors coming to the home were seen to be welcomed by the staff and management. Service users confirmed that their visitors are welcomed. Lunch was observed being served in three dining rooms and on the first floor to people choosing to eat in their rooms. The dining rooms were attractively presented and meal was served in an organised manner. Lunch served on the first floor was disorganised and should be reviewed. Service users were seen to have sat and waited for some time before being served, others were being carefully assisted and all were at different stages in their meals. This could be more organised and could be an improved experience for the service users who eat in their rooms. The needs of service users and staffing level at such times should form part of the review. The Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17. The home has a complaints procedure which is made available to service users. Service users are protected from abuse with the homes policies and procedures and practice. EVIDENCE: The home has a corporate adult protection and Whistle blowing policies. These policies were reviewed on 07/01/05. The home has a complaints policy and procedure. All complaints are investigated and a record is kept. One complaint per month had been recorded and investigated for June/July. One more recent complaint investigation was in progress. Staff files were checked and these demonstrated good recruitment practice. The records showed a good level of information and that staff had two references taken up and CRB POVA First checks before commencing work at the home. The Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26 The Glen is well maintained and provides a comfortable environment for service users. One bathroom was identified that was accessible and yet cluttered with equipment and furniture and therefore unusable. The Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 Page 16 EVIDENCE: The Glen is suitable for its stated purpose with well-maintained buildings and gardens. The service is split into two wings with those service users who require nursing support in one and those with personal care needs in the other. The bedrooms are distributed over three floors and there are two passenger lifts that allow easy access to all floors. Service users are able to visit all communal areas of the home, even if their bedroom is on the opposite wing. In addition to the 49 bedrooms with en-suite facilities the Glen has a further 11 toilets and 4 bathroom facilities. One bathroom was seen that was being used for storing spare pieces of furniture and equipment, the inspectors were informed that this bathroom is not used. This room must be kept safe and tidy if accessible. Otherwise all shared facilities are accessible to the current service user group and contained a range of adaptations. There are gardens, which are accessible by wheelchair and provide pleasant places to sit or walk, in warm weather. Service users were seen using the garden. The Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 Page 17 All communal areas are nicely furnished and decorated. All were seen to be clean and well presented an exception was a corridor carpet in a heavy use area which was identified for sufficient cleaning. Two ceilings were seen to have some staining to the decoration possibly caused by water leaking from above, one was in a service users room another a corridor, these should be redecorated. The Glen has in place a range of equipment and adaptations. A nurse call bell is available in all areas. Various hoists and moving and handling equipment are provided to meet the needs of service users. There are grab rails and specialist bathing hoists. The Glen provides aids used for pressure relief and the prevention and treatment of pressure ulcers, equipment was seen in use. Not all beds are adjustable and bed type assessment must be part of the assessment process to ensure that service user needs can be met. The Manager has stated previously that new beds are purchased within the capital expenditure budget. A number of waste bins were identified for attention to best practice, bins containing staff hand wash waste should be covered. Where staff only wash their hands foot operated flip top bins are recommended. Where staff and/or service users share a waste bin a flip top bin may be preferred. The Manager should review what bins are in use in each area and adopt the best practice and practical solution for that area. The sluice rooms are small, but contain a wash and disinfection cycle machines. The laundry room is small for the size of the home; one washing machine was reported to be out of order at this inspection. The laundry bags are now being collected by the laundry staff. This is done to ensure they can manage to store the washing ready for immediate processing only and not have the congestion of all the washing to be processed brought in at once. No issues were raised with the laundry process at this inspection. The domestic staff informed the inspector that they have a rota for spring cleaning bedrooms and one staff member identified the room due for deep cleaning on the inspection day. No cleaning issues were raised at this inspection. The Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 The home has sufficient staff employed in all departments and maintains a satisfactory number of staff on duty. Recruitment practice was good. Staff training is provided. EVIDENCE: There was sufficient staff on duty during the inspection. The homes Manager stated that the home has not used agency staff since December 2004. At the announced inspection it was confirmed that the schedule for nurses and care staff used was as set by the former registering body, Somerset Health Authority and for the personal care unit, the minimum care hours as set by Somerset County Council are provided. In addition there are dedicated administration, catering, domestic and laundry staff. There are staff vacancies (kitchen, laundry and night carer), which are currently being covered by current staff working overtime. No impact from this situation was reported. Staff recruitment files for the three new starters were sampled; these files demonstrated good recruitment practice. Application and interview records were seen. CRB POVA First checks and two references were taken up before their employment commenced. The Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 Page 19 Care staff spoken with confirmed having had induction, manual handling training and job specific training in aspects of care delivery such as assisting with feeding and assisting service users with bathing/showering. The Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,37,38 The home has a CSCI Registered Manager and the home is well managed. Records are appropriately stored and systems are in place to protect the best interests of service users. Staff are supervised and receive training to meet the needs of service users. EVIDENCE: Mrs Gale Smith was appointed by BUPA and was approved for the post as Registered Manager with CSCI on 26/01/05; the certificate was issued after the last inspection. Mrs Smith is managing the home well, is friendly and efficient and has an open, approachable management style. The Manager is supported by the newly deputy manager, the administrator and by the corporate management The Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 Page 21 teams input. Regulation 26 monthly management visits are made and are recorded. All records sampled for staff and service users were seen to be well managed and appropriately and safely stored. Maintenance records were sampled and included, Fire equipment: Fire extinguishers had been serviced in April 2005. Fire alarm weekly tests and escape routes were confirmed. Monthly in house fire fighting equipment was last tested 19/08/05. This included the emergency lights testing. PAT: labels on equipment indicated checks in December 2004. Water temperature records are made for the monitoring of storage and flow temperatures. Outlet temperatures were in the safe range 42 to 44 degrees Celsius. Showerheads were cleaned on 12/08/05. Hoists had been visually inspected on 05/09/05 and the 6 monthly sticker tests on hoists and assisted baths indicated they were serviced 06/05. The home displayed current Employers Liability Insurance. Care staff spoken with confirmed having had induction, manual handling training and job specific training in aspects of care delivery. Domestic staff spoken with confirmed having received training in Health and Safety, which included COSHH. Two catering staff had undertaken hazard analysis in July 05. Seventeen staff have received first aid training. The Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 1 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 Standard No 16 17 18 Score 3 3 x 3 3 3 3 3 3 3 3 The Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 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 OP 9/26 Regulation 13(2) Requirement The method and equipment used for blood sugar monitoring requires a prompt review of current practice to ensure adherrance to BUPA, MHRA and Health Protection Agency guidance for safe practice. Timescale for action Prompt Action was taken at the time of the inspection but the review and action taken must be completed by 09.11.05. 09.11.05 2. OP26 13(4) 3. OP 26 23(2)(d) Waste bins must be reviewed situations risk assessed. Foot operated flip top bins must be placed where required in communal and en-suite areas where staff hand wash waste is created. Carpet as identified must be cleaned. 9.11.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. The Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 Page 24 No. 1. Refer to Standard OP 15 Good Practice Recommendations Lunch served to service users in their own rooms should be managed in a more organised way. The availability of staff at lunch times and the needs of service users should form part of this review. Fluid charts should be in place where service users are dependent upon staff for assistance with fluid intake. Bathrooms must be kept tidy and be safe to access. Ceilings which were stained should be redecorated. 2. 3. OP 19 OP 19 The Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier, Taunton TA1 4AL 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 The Glen Nursing & Residential Home D53_D02 S03298 The Glen V244140 140905 Stage 4.doc Version 1.40 Page 26 - 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!