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Inspection on 15/12/05 for The Green Nursing Home

Also see our care home review for The Green Nursing Home for more information

This inspection was carried out on 15th December 2005.

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

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

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

What the care home does well

Residents are well supported by the care staff to meet their health, welfare and personal needs. The Green provides a homely and attractive environment in which to live where resident can personalise their rooms to ensure there environment is as comfortable as possible. Comments from residents include: "My room is alright I go up there with my daughter for some privacy" "I like to stay in my room for quiet and comfort" "I have cornflakes, two eggs and two toast for breakfast" "The food is nice"Residents are encouraged to maintain activities outside of the home, which promotes independence.

What has improved since the last inspection?

The management structure has improved and the Acting Manager has now become the Registered Manager. A Deputy Manager has been appointed and she will assist the Registered Manager in the overall running of the home while working alongside the staff. The management have worked hard to address many of the requirements that had been made at previous inspections. The manager now audits accidents/incidents in the home, and this will ensure that any trends are identified in order that appropriate action can be taken to resolve or minimise the risk of a reoccurrence. Agency staff complete an induction checklist on their first shift at the home to ensure they are aware of policies and procedures at The Green. The manager has devised a re-assessment form to review residents who have been sent into hospital prior to them being discharged back to the home, and this will ensure that the home can continue to meet their identified needs. Quality Assurance Questionnaires have been implemented to assist with the monitoring of the service provided at the home. The director`s visit the home regularly to monitor the standards of service provided at the home and sent reports to CSCI. Some new windows have been fitted to ensure that the environment is homely and warm. New equipment has been purchased, including a new hoist to assist staff with moving and handling. A hot trolley and soup kettle, to ensure that meals are served hot to residents when they choose. The garden pond has had fencing erected to ensure that it is safe for the residents to enjoy.

What the care home could do better:

Care planning needs significant improvements to ensure that staff are aware of the individual needs of the residents and any changes in their care requirements. Care planning must include details of their likes and dislikes of the residents.The management of resident`s personal monies must be reviewed and auditing must take place to ensure that there are no discrepancies and money is safely held for the residents at the home.

CARE HOMES FOR OLDER PEOPLE Green Nursing Home, The Wharf Road Kings Norton Birmingham West Midlands B30 3LN Lead Inspector Lisa Evitts Unannounced Inspection 15th December 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Green Nursing Home, The Address Wharf Road Kings Norton Birmingham West Midlands B30 3LN 0121 451 3002 0121 486 3360 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) Flintvaleltd@btconnect.com Flintvale Limited Ms Lynn O`Reilly Care Home 59 Category(ies) of Dementia - over 65 years of age (59), Old age, registration, with number not falling within any other category (59), of places Terminally ill over 65 years of age (59) Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That the home is registered to accommodate 59 people over 65 years of age who are in need of nursing care for reasons of old age or dementia. Registration Category 59 OP DE(E) TI(E) Due to the layout of the building, in particular the distance from the main lounge to the rest of the home, a member of staff must be supervising the service users in the main lounge at all times. 16th June 2005 Date of last inspection Brief Description of the Service: The Green is a purpose built facility, which offers nursing care to up to 59 older adults, and can accommodate residents with Dementia care requirements. The home has a mixture of shared and single bedrooms, some of which have en-suite facilities, spread over the ground and first floors of the building. There are communal bathing, shower and toilet facilities on both floors. The building has basic adaptations for residents with limited mobility, including two passenger lifts. Communal lounges are situated on the ground floor and the lounge doors open onto an enclosed garden with a water feature, which is accessible to residents and visitors. Laundry and kitchen services are located on the ground floor, as is the dining room. The home has recently completed a new extension to the building, and an increase in occupancy. The home has off road parking to the front of the property and is situated close to bus links to the centre of Birmingham. There are a range of local shops and community facilities nearby. Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was undertaken by two inspectors over a full day in December and were assisted throughout by the Registered Manager. There were 41 residents living at the home on the day of the inspection. Information was gathered from speaking with the residents, observing care staff perform their duties and from examining care and health and safety records. A partial tour of the building was undertaken. A complaint had been received by CSCI pertaining to health and care issues and this was investigated during the inspection. The elements of the complaint were not upheld, with the exception of one element, further information can be found in the main body of the report, in relation to this. Since the last inspection, there had been an adult protection issue, which had led to further concerns being raised regarding the frequency of residents being admitted into hospital. A suspension on placements at The Green by Health and Social Care was implemented, as a result of this. This inspection was predominantly to assess progress made on the requirements, which had previously been made, and to assess if the suspension on placements could be lifted. It is pleasing to note that the management had put structures in place to address the areas of concern and were monitoring the service provided. Not all of the remaining requirements were assessed at this time. This is the second statutory inspection for the 2005/2006-year and it is recommended that this report is read in conjunction with the previous inspection report. What the service does well: Residents are well supported by the care staff to meet their health, welfare and personal needs. The Green provides a homely and attractive environment in which to live where resident can personalise their rooms to ensure there environment is as comfortable as possible. Comments from residents include: “My room is alright I go up there with my daughter for some privacy” “I like to stay in my room for quiet and comfort” “I have cornflakes, two eggs and two toast for breakfast” “The food is nice” Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 6 Residents are encouraged to maintain activities outside of the home, which promotes independence. What has improved since the last inspection? What they could do better: Care planning needs significant improvements to ensure that staff are aware of the individual needs of the residents and any changes in their care requirements. Care planning must include details of their likes and dislikes of the residents. Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 7 The management of resident’s personal monies must be reviewed and auditing must take place to ensure that there are no discrepancies and money is safely held for the residents at the home. 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. Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 8 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 Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 The admission and assessment processes and information available for prospective residents are generally comprehensive. Residents are issued with a contract to ensure that they are informed of the terms and conditions of their stay at the home. EVIDENCE: The home has produced a service user guide and a statement of purpose, however these require amendments to the complaints procedure as it currently states that CSCI should be informed if the complainant is not satisfied with the outcome of an investigation. This should state that CSCI can be informed at any stage of the process. Pre admission assessments are undertaken for all prospective residents using a comprehensive document, however the most recent admission into the home did not have an assessment fully completed and this does not ensure that staff are able to meet the needs of the residents prior to admission into the home. Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 10 Residents come to live at the home on a 28-day trial period, and are issued with terms and conditions of stay, which includes the room number to be occupied, and the fee. The manager has devised a new document to re-assess residents who have been admitted into hospital, prior to their discharge back to the home, to ensure that the home can continue to meet their needs. Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 Resident’s health and personal care needs are generally well met by the care staff. Improvements are required in respect of care planning to ensure that they include sufficient detail for staff to follow in order to meet the identified needs of the residents. EVIDENCE: Three resident files were reviewed. An audit of care plans had recently taken place and shortfalls had been identified, however the named nurses had not rectified these at the time of the inspection. The manager must ensure that the staff address any shortfalls and provide the information required. Care plans had been written in respect of short-term needs and discontinued as appropriate. Care plans did not detail likes and dislikes, core care plans had been implemented for personal hygiene but these had not been individualised, for example preferences as to bath or shower. Continence care plans did not state what aids the resident would require in order to maintain continence and no assessments were on file. Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 12 Of the care plans reviewed, not all had been evaluated on a monthly basis and the manager must ensure that evaluation takes place to ensure that the plans of care are still relevant to the needs of the resident. There was no evidence that residents or their families had been involved in the care planning process. Care plans which were no longer being used had been stored at the back of the folders away from the currently used care plans in order to avoid confusion. Residents were observed to be appropriately dressed for the time of the year. Moving and handling assessments did not always include sufficient information such as the type of hoist or the size of sling to be used and this could result in staff using inappropriate equipment for the resident. Bed rail risk assessments were in place but these were not always reviewed and consent for use was not always obtained. The manager stated that new tools were in place for these and would be implemented. Some personal risk assessments were confusing as they incorporated two risks together. It is required that risk assessments should be separate to ensure that clear instructions are provided on how to minimise the risk. Daily records were detailed and described visits from healthcare professionals and family, visits out and any changes to healthcare needs. There is a separate sheet for monitoring the visits from external healthcare providers and this included Dietician, GP, Optician and Social workers. Nutritional screening risk tools were not always completed; pressure sore risk assessments had been evaluated and recorded monthly. The manager has recently held a meeting with tissue viability specialist nurses to set up link nurses, teaching sessions and generally to improve wound care management at the home. Weights were not always monitored correctly, one resident had been seen by a GP and it was requested that the resident was weighed every two weeks, however this had not been done for a month. On the weight chart staff had written that the resident didn’t like to be weighed and in this instance it would be recommended that an alternative method be used to monitor weight loss such as arm circumference recordings. A further example was a care plan, which stated a resident, should be weighed weekly; the resident had been weighed monthly and while there was no significant change to the resident’s weight, staff must ensure that care plans reflect the current needs of the resident. A new system of working had been implemented, and the staff have been allocated to one of three groups, a accountability record is in place, and this will help staff to know what they are responsible for doing throughout their duty. Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 13 At the time of the last inspection there was a concern raised that residents were not able to wash their hands when they used the bathroom. The manager has devised a declaration form for all staff to sign to say that they have been informed of the good practice recommendation of assisting residents to wash their hands when they have used the bathroom. The manager will continue to monitor this. Medication was not reviewed on this occasion. Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15 On the day of the inspection activities were available for residents who wished to take part. The menus evidenced a varied diet with some choices available. EVIDENCE: On the day of the inspection, residents were seen to be engaging in a number of activities such as knitting, drawing, painting, reading newspapers and completing a jigsaw. One resident was outside painting the fencing around the pond. Later, in the afternoon, a visiting company performed a pantomime. The small lounge is now used as an activities room and there were many photographs on display, including line dancers and trips out to Cannon Hill Park. On the notice board, there were details of clothing parties, Christmas card making, Irish dancers, the Christmas party and a visit from a school choir. There had been outings to Touchwood and Merry Hill Centre and some residents had been out to see the Christmas lights and enjoy a fish and chip supper. One resident informed the inspectors that she goes out once a week using the ring and ride service, and this is commended as this ensures residents maintain their independence. Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 15 The activities coordinator has produced a newsletter, which provides residents with details of entertainment, resident and relatives meetings, a quiz and a feedback form, for anyone to provide feedback about the newsletter and its contents and to allow people to express what they would like to see in the next edition. The coordinator keeps a written record of activities participated in. In the Dining room, there is a menu board, which states the choices of meals for the day. There is a four-week rotating menu in place, cooked breakfasts are available and two choices are available at lunchtime. At tea time there is only one meal available on the menu, and the menu should include the alternative options. Snacks are available on request. One resident said “the food is nice” and another resident said, “I have cornflakes, two eggs and two toast for breakfast” Some food records were in place but these were for the main meal only and records should be kept of all meals, including vegetables. The soft option was not always detailed and was very repetitive. A new hot trolley and a soup kettle has been purchased to ensure that food is hot for residents whenever they choose to take their meals. In the lounge, trolleys with cold drinks were available for the residents. Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The complaints procedure is generally comprehensive and is accessible to residents and their representatives should they need to make a complaint. EVIDENCE: The complaints procedure is on display in the main entrance to the home and the manager has placed a copy of the complaints procedure on all the bedroom doors to ensure that residents have access to it, should the need arise. The procedure needed to include the time scale within which a response to the complainant would be made. Complaints had been recorded appropriately and included details of any investigations, which had taken place. CSCI had received a complaint pertaining to healthcare needs and staff training. One element of the complaint was upheld, but other elements of the complaint were not upheld. There was evidence that the manager had previously tried to resolve the issues with the complainant. An anonymous complaint regarding a staff member using a mobile telephone when with residents had also been received and the homes management team investigated this. Actions have been taken and no staff members are allowed to use mobile phones whilst on duty. An adult protection issue had been raised and this had led to further training for staff regarding moving and handling procedures. There were a number of thank you letters and cards on display on the notice board. Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 The home provides residents with a homely and comfortable environment in which to live where they appeared to feel relaxed and secure. EVIDENCE: A number of areas in the home are well decorated and are homely in style. The carpet area in the lounge was very stained and action must be taken to clean this. The carpet in the upstairs corridor is also stained and worn and requires replacing. A piece of the vinyl flooring outside the lounge (which was not being used at the time of the inspection) had lifted and an immediate requirement was made for this to be fixed as it posed a potential trip hazard. The garden pond had had been fenced off and a risk assessment had been written in respect of this. A resident was outside painting the fencing that had been put in place. Two lounge and two bedroom windows had been replaced since the last inspection. A rolling programme of maintenance should be devised which identifies work to be carried out over the following year. Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 18 Communal lounge areas had a variety of chairs to suit the needs of the residents and these had been arranged to promote social interaction between the residents. There are a number of assisted bathing and showering facilities available at the home. One of the toilets had had a handrail pulled off and some of the plaster had come away from the wall. In one of the shower rooms, some of the tiles were broken and cracked and others had lifted from the wall. These must be repaired or replaced as currently pose a hazard. Cupboards had been installed for the storage of pads to prevent the risk of cross infection. Plastic curtaining has been installed to the external covered area where the wheelchairs are stored in order to ensure that they are not exposed to the weather conditions. An element of a complaint received by CSCI was that residents own wheelchair was often dirty and this element of the complaint was upheld, the manager is to ensure that the wheelchairs are cleaned as required. Some bedrooms were reviewed and these were found to contain many personal possessions to ensure that the residents were in a comfortable environment. Pillows had been replaced since the last inspection. Comments from residents included: “My room is alright I go up there with my daughter for some privacy” “I like to stay in my room for quiet and comfort” It was noted during the inspection, that a residents bed had been moved into the centre of the room so that staff could monitor them throughout the night, however the resident could no longer reach the call bell. The manager must ensure that residents who are able to use the call bell have it within reach when in rooms on their own. A number of bed rails were noted not to be fitted correctly to the bed frame or did not fit the length of the bed appropriately. Some were not of the correct height when in use with pressure relieving mattresses, an immediate requirement was made that the manager was to audit all bed rails to ensure that they were correct height, length and correctly fitted to the bed frames. A new hoist and a selection of slings had been purchased to ensure equipment is available for staff to use with residents as the assessment states. Care staff are no longer able to enter the kitchen, without appropriate clothing. Staff are able to enter the kitchen to make drinks only, and this is reinforced with a notice on the door. This should be included on the risk assessment also. The home was clean and fresh on the day of the inspection. Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 Residents are supported by an appropriate number of staff to ensure their identified needs are met. There is a robust recruitment process in place and this ensures that the residents are protected. The induction training for care staff needs to be further developed to ensure new staff are equipped with the necessary skills and knowledge to fulfil their roles. EVIDENCE: Kitchen, laundry, maintenance and cleaning staff are employed in addition to the nursing and care staff. Staffing rotas were reviewed and found to have appropriate numbers of staff on duty. Agency staff that work are also recorded on the rotas to ensure an accurate reflection of the number of staff on duty. A new Deputy Manager has been appointed since the last inspection and she will work clinically, providing support to the care staff, whilst assisting the manager with the overall running of the home. The rota did not indicate the on call support for the person in charge of the shift and a system for the management of this should be devised to include all senior staff and the detail of this should be recorded on the rota. The rota does state which nurse is in charge for the shift. Shift times allow for a 15-minute handover, morning and night and half an hour handover at the afternoon shift. Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 20 The home uses agency staff and since the last inspection, the manager has devised an induction checklist for agency staff to undertake on their first shift at the home. The induction covers fire procedures, health and safety, manual handling and types of equipment, receiving of messages and confidentiality. There is also a further induction for care staff, which covers aspects of care requirements such as personal hygiene and food hygiene. There was evidence that this checklist had been completed for an agency carer on the day of the inspection. The manager has undertaken visits to the home during the night in order to ensure that the standards of service are maintained during the night, as they would be expected throughout the day. Three staff files were reviewed and were very well organised. All files had had the relevant checks made prior to commencing employment and two references had been obtained. It was noted that one member of staff had had an induction programme signed and completed in one day and this covers a vast amount of information. The induction training for care assistants must cover all the topics by Skills for Care and be completed over the first 12 weeks of employment. Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 The Registered Providers have implemented a structured managerial system in order to address the concerns previously identified. The management of resident’s personal finances was poor. EVIDENCE: Since the last inspection the Acting Manager has successfully completed the CSCI fit person’s interview to become the Registered Manager for the home. She is a General Nurse who has had a lot of experience of working with older people and within management roles. A new Deputy Manager has been appointed since the last inspection and she will work clinically, providing support to the care staff, whilst assisting the manager with the overall running of the home. Support has been provided to the manager, from a care home consultant and from a manager of another home owned by the company. Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 22 The Registered providers visit the home regularly and undertake quality of service inspections and inform CSCI of their findings as per regulation 26. Trained staff and care staff meetings are held at the home and these indicate that morale at the home is improving. The home has devised a quality assurance questionnaire, which was available in different places throughout the home. Residents or their representatives can complete the questionnaire and the manager plans to summarise the responses periodically and make the summaries available. This will be reviewed at the next statutory inspection. The system for the management of resident’s personal money was poor. Since the last inspection, the home had installed a safe. The majority of balances examined were found to be incorrect, money was unaccounted for on some records but there was extra money on other records. Audits had taken place on the accounts but these were not consistent in time or by the same person checking all accounts. Discrepancies found on the audits had not been reported to the manager and the discrepancies had not been investigated. Receipts were not always available. Immediate requirements were made that the manager must audit all records for personal monies belonging to residents, highlight and investigate any discrepancies and that two signatures must be obtained for any expenditure on behalf of residents and receipts obtained. Supervision and staff appraisal documentation had been set up, however this is to be further implemented once the deputy has settled into her post and this will be reviewed at the next statutory inspection. Maintenance records were reviewed and servicing had been completed for hoists, gas appliances, nurse call system, fire alarm system, other equipment being used and the passenger lift. The water system had been checked for the prevention of legionella. Weekly checks were made on self-closures and the fire alarm system. Staff had received fire training and fire drills had taken place. During the tour of the building it was noted that there were some gaps under the bedroom doors and the manager must liaise with the fire officer in respect of this and implement any action required. The fire risk assessment was out of date and required review. The COSHH files require review, to ensure that all the products were still being used in the home and a copy of this must also be available in the COSHH cupboard so it is available to staff in the event of an emergency. Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 23 The premises risk assessments also needed to be reviewed and further developed to include all areas of risk, for example, slips, trips and falls and hot surfaces. Accidents were recorded appropriately and the manager now undertakes audits of any accidents. Records seen had comments recorded on them by the manager. CSCI are informed of incidents as per regulation 37. Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 3 2 3 2 3 3 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 1 1 X 2 Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4(1c) 14 5(1)(e) 14(1) Requirement Timescale for action 10/03/06 2. OP3 The statement of purpose and service user guide must be amended to include the correct complaints procedure. Pre admission assessment 03/02/06 documents must be completed in full. (Previous timescale of 31/07/05 not met) The care planning system must be further developed to include the following: Care plans must be agreed and reviewed with the involvement of the resident and/or their representative. Care plans must be individualised to include the residents likes and dislikes. Care plans must detail the actual care to be afforded to the individual by the care and nursing staff and this includes the management of mental health care needs. The information within the care 3. OP7 12(2) 15(1)(2) 20/03/06 Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 26 plan evaluations must reflect the residents current care needs. (Previous timescales of 15/03/05 & 31/08/05 not met) Bed safety rail risk assessments: consent and disclaimers must be undertaken for all residents that use this type of equipment. (Previous timescale of 31/07/05 not met) Moving and handling risk assessments must detail the actual assistance required from the care staff, type of equipment to be used and the action to be taken should a resident fall. 4. OP7 13(4)(b) 27/02/06 5. OP7 13(5) 27/02/06 6. OP7 13(4)(c) 7. OP7 12(1) (Previous timescale of 31/07/05 & 30/11/05 not met) Personal risk assessments must 27/02/06 be written separately and clear guidelines for the actions to be taken recorded. Continence assessments must be 20/03/06 undertaken and a record of this kept for all residents that use continence aids. (Previous timescale of 31/08/05 not met) Residents must be weighed at least monthly or more regularly if instructed to do so by a Health Care Professional. (Previous timescale of 31/08/05 not met) Nutritional risk assessments must be completed for all residents. The Manager must review the current system in respect of the frequency of residents receiving baths and showers at the home. (This requirement was not DS0000024842.V273940.R01.S.doc 8. OP8 12(1)(a) 10/02/06 9. OP8 12(1)(2)( 3) 15/08/05 Green Nursing Home, The Version 5.0 Page 27 10. OP9 13(2) assessed on this occasion) All prescription creams must be labelled for individual use with the directions for use and stored securely at all times. (This requirement was not assessed on this occasion) Multi disciplinary guidance must be sought about the covert administration of medication. 17/06/05 11. OP9 13(2) 31/07/05 12. OP9 13(2) (This requirement was not assessed on this occasion) All staff must adhere to the 17/06/05 policies and procedures for medicine management within the home. (This requirement was not assessed on this occasion) The quantities of all medicines received or balances carried over must be recorded on the MAR chart referred to prior to administration and signed directly after the transaction. (This requirement was not assessed on this occasion) All medicines must be stored in accordance with their product licences. (This requirement was not assessed on this occasion) All prescriptions must be seen and the system installed to check the dispensed medicines received into the home must be implemented at all times. (This requirement was not assessed on this occasion) A daily record of food provided for each resident must be kept, this must include all meals. The complaints procedure must DS0000024842.V273940.R01.S.doc 13. OP9 13(2) 16/06/05 14. OP9 13(2) 16/06/05 15. OP9 13(2) 16/06/05 16. 17. OP15 OP16 16(2)(i) 4(13) 22(1)(4) 31/07/05 10/03/06 Page 28 Green Nursing Home, The Version 5.0 18. OP18 13(6) include timescales for completion. An adult protection procedure must be written to include Birmingham Multi Agency guidelines and the contact details of all relevant people to be notified in the event of actual or alleged abuse and staff must ensure that they adhere to this procedure. 16/06/05 19. OP19 23(2)(b) 20. OP19 23(2b,d) 16(2c) (This requirement was not assessed on this occasion) A rolling maintenance 31/03/06 programme must be developed to identify work to be completed throughout the next year. A copy of this is to be forwarded to CSCI by The lounge carpet requires a 24/02/06 deep clean as is stained in places. The carpet to the upstairs corridor requires replacing and must be included in the annual maintenance plan. The raised flooring outside the lounge requires resealing, as is a potential trip hazard. (The manager received this as an immediate requirement) The tiles in the shower rooms must be repaired or replaced as some are broken and cracked. The broken toilet handrails must be repaired. Bed rails are to be audited to ensure that they are fitted correctly to the bed frame and are of the correct length and height for the bed frame. (The manager received this as an immediate requirement) 21. OP19 23(2b) 13(4a,c) 16/12/05 22. OP21 23(2b) 13(4a,c) 10/03/06 23. OP22 13(4)(b) 23/12/05 Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 29 24. OP22 23(2)(c) All wheelchairs must be thoroughly cleansed. 03/02/06 25. OP22 12(1)(a) 13(4)(c) 12(4)(a) 26. OP24 (Previous requirement of 23/06/05 not met) The manager must ensure that 31/01/06 staff ensure that residents are provided with their call bells and that the facility can be reached. A written record of the reasons 27/03/06 why individual residents are not able to hold the key for their bedroom doors must be available on file. (Documentation has been written, needs to be reviewed with residents) A lockable storage facility must be available in each residents bedroom. (This requirement was not assessed on this occasion) A system for the management of on call support to the person in charge of the shift should be devised to include designated senior staff and the detail of this must be included on the staffing rota. The care assistant induction must be in line with the guidelines and timescales specified by Skills for Care. Resident consultation meetings must be held at the home regularly. (This requirement was not assessed on this occasion) A written report of the findings of the quality assurance questionnaires must be completed annually and made available for review. The Manager must develop and implement a safe system for the DS0000024842.V273940.R01.S.doc 27. OP24 23(2)(m) 31/03/06 28. OP27 18(1a)(2) 28/02/06 29. OP30 18(1c,i) (2) 12(2)(3) 24 10/03/06 30. OP32 31/08/05 31. OP33 24 31/03/06 32. OP35 16(2)(l) 31/01/06 Page 30 Green Nursing Home, The Version 5.0 management of residents personal allowances. (Previous timescale of 23/06/05 not met) All records for personal monies 20/12/05 must be audited, discrepancies highlighted and investigated. (The manager received this as an immediate requirement) Two signatures must be obtained 16/12/05 for any expenditure on behalf of residents and receipts obtained. (The manager received this as an immediate requirement) A system for formal staff supervision and appraisal must be implemented at the home. (Previous timescales of 22/11/04 & 31/08/05 not met) (Documentation is in place, now needs implementing) Policies and procedures must 30/09/05 include issue and review dates and the missing persons policy must include information about notifying CSCI should an incident occur. (This requirement was not assessed on this occasion) Risk assessments of the 31/03/06 premises, food, staffing and COSHH items must be further developed to include details of hazards and safety measures specific to the home and must be reviewed regularly. (Previous timescale of 15/03/05 & 31/08/05 not met) All records in respect of food safety must be available for inspection. DS0000024842.V273940.R01.S.doc 33. OP35 16(2)(l) 34. OP35 16(2)(l) 35. OP36 18(2) 28/02/06 36. OP37 37 37. OP38 13(4) 38. OP38 16(2)(j) 31/07/05 Green Nursing Home, The Version 5.0 Page 31 39. OP38 18(1c,i) (This requirement was not assessed on this occasion) Staff statutory training records must include detail of the content and duration of training sessions and moving and handling training must be provided by approved trainers. (This requirement was not assessed in full on this occasion) Fire doors must be kept shut unless suitable magnetic closures that are linked into the fire alarm system are installed. Risk assessments must be undertaken in the interim for all residents who choose to keep their bedroom doors open. 31/08/05 40. OP38 23(4)(a) 16/06/05 41. OP38 23(4)(a) (This requirement was not assessed on this occasion) The manager must liaise with the 24/02/06 fire officer regarding the gaps under the bedroom doors and implement any action required. 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. 2. 3. Refer to Standard OP8 OP24 OP30 Good Practice Recommendations It is recommended that arm circumference is recorded for residents who refuse or are unable to be weighed. Where bedrooms do not contain all of the items of furniture listed in this standard, the residents agreement to this should be recorded. An individual staff-training matrix should be undertaken for each staff member. Green Nursing Home, The DS0000024842.V273940.R01.S.doc Version 5.0 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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. 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