Inspection on 02/06/06 for The Green Nursing Home

This inspection was carried out on 2nd June 2006.

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 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 Green Nursing Home 01/06/10

The Green Nursing Home 09/03/10

The Green Nursing Home 07/12/09

The Green Nursing Home 31/07/09

The Green Nursing Home 08/08/08

The Green Nursing Home 09/08/07

The Green Nursing Home 07/11/06

The Green Nursing Home 15/12/05

The Green Nursing Home 16/06/05

The Green Nursing Home 15/11/04

The Green Nursing Home 23/06/04

The Green Nursing Home 19/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Green Nursing Home, The Wharf Road Kings Norton Birmingham West Midlands B30 3LN Lead Inspector Lisa Evitts Unannounced Inspection 08:15 2nd June 2006 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.V298374.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 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 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 Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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. 15th December 2005 2. 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. The current scale of charges for the home is £480 for private funding residents. Further rooms are charged from £430 - £497 depending on the assessed banding and type of room chosen. Previous inspection reports are available inside the reception area of the home, for anyone who wishes to read them. Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced fieldwork was undertaken by two inspectors over ten hours and was assisted throughout by the Manager. There were 50 residents living at the home on the day of the inspection, two residents were receiving hospital care. Information was gathered from speaking with the residents and interviewing staff, from observing care staff perform their duties and from examining care and health and safety records. Medication procedures were reviewed. Staff personnel files were sampled and a partial tour of the building and garden was undertaken. The pre inspection questionnaire was not returned to CSCI. Since the last inspection, the suspension of placements by Social Care and Health has been lifted and the home has been taking new admissions. An additional visit has taken place to monitor the progress of the home in meeting a number of previous requirements generated. It is recognised that the recently appointed manager has inherited a number of previous requirements made. Two immediate requirements were made on the day of the inspection. What the service does well: Comprehensive pre admission assessments are undertaken and this ensures that the home can meet the assessed needs of the resident prior to admission. The home provides a range of activities and outings and residents are encouraged to maintain activities outside of the home, maintaining their independence. Varied and well balanced meals are available and residents are offered choices in menus and alternatives. Snacks are available. The manager holds a monthly surgery where anyone can make an appointment to see her to discuss any concerns or issues but stresses “her door is always open” The home provides a homely, safe and comfortable environment with spacious lounges and corridors. Residents can personalise their bedrooms with personal effects to ensure they are as comfortable as possible. Comments from residents included: Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 Page 6 “My daughter and son visit and are welcome at anytime” “Food is alright” “I have no complaints at all” That the “bedroom was to his liking” “Staff will respond to requests” “Staff are nice” “I’m happy here” “The home is nice” What has improved since the last inspection? What they could do better: The home must ensure that it provides prospective residents with up to date information about the home and provide residents with terms and conditions of stay so that they have the information to make an informed choice about living at the home. Care planning needs improving to ensure that personal likes and dislikes are recorded to ensure staff have the knowledge to deliver individualised care. Staff training requires improving to ensure that all staff have the knowledge and skills to work competently within their roles and have the knowledge to safeguard residents. Protection of Vulnerable Adults checks must be made on all staff prior to employment in order to safeguard the residents. The home must work towards a formal quality assurance system that takes into account views of relatives, representatives and stakeholders. This will Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 Page 7 ensure that views are listened to and acted upon appropriately and will ensure a consistently improving service. Staff must receive formal supervision sessions to ensure that they are supported in their role and training needs are identified, in order to fill any gaps in knowledge. 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.V298374.R01.S.doc Version 5.1 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.V298374.R01.S.doc Version 5.1 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 quality outcome of this area is adequate. This judgement has been made using available evidence including a visit to the service. Prospective residents do not have all the information they need to make an informed choice about where to live. Not all residents have contracts issued to inform them of terms and conditions of stay at the home. The home completes assessments and gathers pre admission information and this enables the home to ensure that they can meet the needs of the residents. EVIDENCE: A copy of the statement of purpose was taken for review and this requires updating as it does not contain all the information required by the Regulations, and therefore does not ensure that the residents have all the information they need to make a decision about living at the home. Files reviewed did not have any evidence of contracts being issued to residents to inform them of terms and conditions of stay at the home. It is required that all residents are issued with contracts. A blank copy of a contract was reviewed and this has space to include the room number to be occupied and the fee. Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 Page 10 Residents come to live at the home on a trial period of one month, and this enables them the option to trial the home to see if they would like to live there on a permanent basis. Pre admission assessments were reviewed and were found to be comprehensive and this ensures that the home can meet the assessed needs of the residents prior to admission. The home does not offer intermediate care. Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 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): 7,8,9 & 10 The quality outcome of this area is poor. This judgement has been made using available evidence including a visit to the service. 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 they have sufficient detail and up to date information for staff to follow to meet the assessed needs of individual residents. Medication is generally well managed. EVIDENCE: Care plans reviewed did not detail personal likes and dislikes and many of the care plans were pre printed resulting in them not been individualised to assessed needs. Care plans for privacy and dignity and socialising were not personalised and therefore does not provide staff with the information to ensure individual needs are met. Information was fragmented throughout the files and did not allow for ease of access to the information; the files structure was not consistent. Weights were recorded, however it was noted there was some inconsistency in the recording of weights throughout one file, and this does not provide Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 Page 12 accurate information to use as a baseline recording. Recording of weekly weights were being kept separate and this does not allow ease of monitoring the information. This information should be recorded alongside the care plan. A resident who had been identified of being at risk due to a poor appetite did not have any food likes or dislikes recorded. Evaluation of the plan stated that the GP wanted monitoring of dietary intake before prescribing any supplements, however no food records had been maintained for the resident. Therefore no information was available on this resident’s dietary intake. Where supplements had been prescribed, there was no record of this on the care plan and it was difficult to determine when they had been commenced as the record of visits by external professionals had not been completed. This does not enable staff to monitor the progress of residents. One bedrail risk assessment was not evaluated and another plan reviewed stated that bedrails were not used, however were in place and a permission to use form had been signed by the next of kin. This does not ensure that the use of bed rails is still appropriate for the individual resident and does not give staff clear instructions to follow as to their use. The manual handling risk assessment is not an actual assessment but an opinion as to the risk. Instructions for manual handling procedures were good. It is required that a more detailed risk assessment is devised so that residents are safeguarded from harm. One file showed that the staff had monitored a resident for several days following a raised blood glucose level on admission, and this is good practice. A short-term care plan had been written for a chest infection and this is good practice. Another resident had been seen by the GP but had no short-term care plan in place and the outcome of the treatment had not been recorded. This does not allow for monitoring of the problem to ensure that it has been appropriately treated. One resident who was nursed in bed required position changes every two – three hours. While daily records indicated that “turns maintained” there was no turn chart in place to evidence that the turns were being done and recorded. This was brought to the attention of the manager. One plan of care was found to have good details regarding a resident’s life history and this should be rolled out to all the other residents at the home to better enable the home to meet resident’s individual needs, preferences and expectations. Care plans for residents who display difficult to manage behaviour should have details of likely triggers and how staff should respond to the behaviour to minimise the risk of these behaviours occurring. Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 Page 13 Two wound charts were reviewed and one had no description as to the size, appearance odour or exudates of the wound, therefore staff would be unable to monitor its progress. A recent admission into the home arrived without the dressing reported to have been applied by the hospital staff and staff must ensure that prescriptions are requested prior to running out of stock, if dressings have been changed following assessment of the wound then the rationale for this must be documented. The management of medication was good with drugs received being audited onto Medication Administration Records. No gaps were found in the documentation and refusals were entered into a non-compliance form, copies of prescriptions were kept alongside the chart. The supply of Controlled Drugs was satisfactory, however one Controlled Drug was found in the medication trolley rather than in the Controlled Drug cupboard and an immediate requirement was made to rectify this error. The treatment room contained oxygen cylinders and a sign is required on the door to alert people that oxygen is stored, so appropriate safety controls are adhered to. Residents appeared well kempt and were dressed appropriately for the time of year. One resident was noted to be wearing nail polish, which she stated had been applied by the staff. Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 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): 12,13,14 & 15 The quality outcome of this area is adequate. This judgement has been made using available evidence including a visit to the service. Residents are able to exercise their choice over their daily lives and the activities they choose to participate in which promotes independence and individuality. The meals offered were varied and nutritious and appeared to meet the needs of the residents. EVIDENCE: On the day of the inspection, residents were seen to be participating in a film day and care staff were giving residents hand massages. The radio was playing pleasant music and painting was organised for the afternoon. The smaller lounge is used as an activities room and the notice board indicated a number of organised events including a barbeque and a stroll around Cannon Hill Park, there is a variety of activities available depending on the resident’s choice. The activities file was reviewed and this contained information about individual preferences and resident’s participation in activities was recorded. One resident’s file stated, “likes to go to the pub” and this is commended as encourages residents to maintain contact with the local community. Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 Page 15 However some care plans did not contain information about particular interests and this must be further developed to include all residents. The activity coordinator holds monthly meetings and the minutes of these were available for review. The meetings give the opportunity to discuss further events and ideas for activities, and encourage residents to voice their opinions. The home has an open visiting policy, which means that residents can have visitors at any time. There is a four-week rolling menu in place, which states choices of meals and alternatives are always available. Cooked breakfasts are available for residents who choose this. Snacks are available on request and two residents were noted to have supper trays. Special diets can be catered for and pureed meals were available for residents with swallowing difficulties. The lunchtime meal was observed and a wholesome and balanced diet is offered. The dining room is large and has good access for residents who use wheelchairs. Residents were observed to request alternative choices and the staff attended to these requests. The cook serves the meals and they were well presented and appetising, generous portions were served. Generally the staff assisted the residents discreetly, however one member of staff was observed to mash all a residents food together in the bowl before assisting them to eat. This does not allow for residents to experience the flavour and texture of the meal and does not promote their dignity. This was brought to the manager’s attention and an immediate requirement was left at the home for this practice to cease. Comments from residents included: “Food is alright” “Food is average” “My daughters visit and are able to come at anytime” “My daughter and son visit and are welcome at anytime” Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 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 & 18 The quality outcome of this area is adequate. This judgement has been made using available evidence including a visit to the service. The complaints procedure is comprehensive and is accessible to residents and their representatives should they wish to make a complaint. Gaps in staff training in respect of adult protection may potentially put residents at risk. EVIDENCE: The home has a comprehensive complaints procedure in place and this is accessible to residents and their representatives. The complaints form requires amending to include sections to record details of investigations and post monitoring, this will provide evidence of outcomes and future actions to improve the service in order to achieve better outcomes for residents and their representatives. The home had not received any complaints since the last inspection. CSCI had received one complaint and this had been investigated during an additional visit, the elements of the complaint were not upheld. The manager holds a monthly surgery where anyone can make an appointment to see her to discuss any concerns or issues but stresses “her door is always open” One resident stated “I have no complaints” and other said “I have no complaints at all” Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 Page 17 Missing person, restraint, and whistle blowing policies were reviewed and had all the required information. These should be signed and dated with a review date, as were dated 2003 and this does not ensure that they are regularly reviewed to ensure they contain up to date information and guidance for staff to follow. There were some significant gaps in staff training in relation to abuse and challenging behaviour and this does not ensure that staff have the knowledge and skills to deal with these situations should they arise and therefore does not safeguard the residents. The manager must make provision for staff training in these areas. Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 Page 18 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): 19,20,21,24,25 & 26 The quality outcome of this area is good. This judgement has been made using available evidence including a visit to the service. The home provides residents with a homely, safe and comfortable environment in which to live, where they appeared to feel relaxed and secure. EVIDENCE: On the day of the inspection the home was found to be clean and fresh, with no offensive odours. Equipment in use was also found to be clean. Wheelchairs were clean and footrests were in place. The corridors around the home are spacious and allow the residents freedom to move around the home with any assessed equipment needs. The home has a number of assisted bathing and showering facilities available, and toilets have handrails in place, which meet the needs of residents living at the home and enable them to maximise their independence. Where residents require assistance from staff there is a range of equipment available. Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 Page 19 Flooring had been replaced in one resident’s bedroom to ensure a level surface for the resident to walk on and to remove potential trip hazards. A further bedroom was identified during the inspection as requiring repair to the flooring as the floor had ‘bubbled’ and was a trip hazard. Communal areas had a variety of chairs to suit the needs of the residents and these had been arranged to promote social interaction with residents who were participating in a film day. Bedrooms seen were personalised and all rooms have a lockable facility, this ensures residents are comfortable in their environment. One resident commented that the “bedroom was to his liking”. A gazebo had recently been purchased so that residents could enjoy the garden area in the warmer weather and there was evidence that activities had taken place in the garden area. A storeroom had been converted into a training room/meeting room, which was accessible to anyone who wished to use it, and offered a further area where residents could meet their visitors in private. The kitchen and laundry areas were clean and tidy. The laundry room has a sewing machine for labelling of clothes were relatives are unable to achieve this, to ensure that all residents had their own clothing returned to them. Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 Page 20 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): 27,28,29 & 30 The quality outcome of this area is poor. This judgement has been made using available evidence including a visit to the service. Residents are supported by an appropriate number of staff to ensure that their identified needs are met. There is generally a robust system for the recruitment of staff. Improvements are required to staff training to ensure that staff have the knowledge and skills to meet the individual and collective needs of the residents. EVIDENCE: Laundry, domestic, kitchen and maintenance staff are employed in addition to the nursing and care staff. The manager has increased staffing levels since taking up her post and there is now an extra carer on the early and late day shift. Bank and agency staff are used to ensure that staffing levels are maintained and the home tries to use the same members of agency for consistency. Staff have been organised into three teams in order to identify which staff delivered care to particular residents, and this ensures that there are adequate staff to support individual residents with their care needs. Comments from residents included: “Staff are nice” “She is marvellous” “Staff will respond to requests” Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 Page 21 There are currently seven staff that hold an NVQ, with four more staff working towards a qualification. The home must continue to train staff in order to meet the recommended 50 of staff who hold this qualification in order to ensure that residents receive care from well-trained and competent staff. Five staff files were reviewed and held all the required information with the exception of one file where there was no evidence of a POVA or CRB being returned and the manager must ensure that this is in place for all staff to safeguard the residents from potential harm. One member of staff had transferred from another home but there was no evidence of supervisory sessions in order to assist the manager in making an informed decision as to the ability of the staff member. The transfer had taken place prior to the current manager being in post. An induction booklet for a staff member was reviewed and there was no space for the employee to sign or any evidence of the member of staff’s knowledge base. The inspectors could not determine if the booklet covered all the information listed in the skills for care guidance, and the manager is required to review this, to ensure that staff have basic instruction upon commencing employment at the home. A training matrix is required to be implemented, as staff training was confusing and it was difficult to obtain a clear understanding of training supplied and that which was outstanding. Staff training was sampled and found some gaps in training and some staff where no training could be evidenced. The manager is required to complete a review of training for all staff and implement a training programme. Staff had recently received training in Fire and Moving and Handling and this ensures the staff have the knowledge and skills to safely handle residents and to safeguard them from any potential harm. Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 Page 22 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): 31,33,35,36, 37 & 38 The quality outcome of this area is adequate. This judgement has been made using available evidence including a visit to the service. The management of the home needed strengthening and continuity to ensure sustainable improvement. A formal quality assurance system needs to be implemented to ensure a consistent improving standard and to empower residents. The home regularly undertakes health and safety checks and this safeguards residents and staff. EVIDENCE: Since the last inspection there have been two further managers in post. The present manager has been in post for approximately two months, is a Registered General Nurse and has previous experience of working with older people and within management roles. She is also an accredited Moving and Handling trainer. Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 Page 23 Staff spoken to were very complimentary about the new manager and included comments such as: ”Manager is very approachable and very co operative” “She gets things done properly” “The manager cares about the staff as well as the residents” The manager has support from a manager of another home within the company. While there is evidence of improvements within the home, the manager requires continued support to make and to sustain improvements already in place, whilst being assisted with the overall running of the home. The providers visit regularly to undertake quality of service inspections and inform CSCI of their findings as per Regulation 26. There is no formal quality assurance system in place and the home must work towards implementing a system taking into account views of residents, representatives and external visiting professionals, and a report and action plan must be made available to ensure there is continuous development of the service. Staff meetings take place and the minutes from these meetings were available for review. The manager has undertaken night spot checks to determine staff competence and compliance and that standards of care are maintained. Minutes of these checks were also available for review. The system for the management of resident’s personal money had improved. Balances were checked and correct. Two signatures are now in place for money going into and out of the account, and receipts were available. This ensures that resident’s money is safe. No staff have had supervision so that they have the support they require to meet the residents needs. The manager plans to complete appraisals with all members of staff prior to commencing supervision. This now requires urgent attention, as has been a requirement of the home since November 2004. Policies and procedures of the home require a review and should be signed and dated following review, to ensure that they are up to date and reflect current practice. Maintenance records were reviewed and servicing had taken place for the passenger lift, nurse call bells, bath hoists and hoists, legionella, portable appliances, gas appliances, fire alarms and emergency lighting. The handyman checks water temperatures and a record of these were available. This contributes to maintaining a safe environment for residents to live in. The fire officer from West Midlands Fire Service had recently visited the home and had made two recommendations; the home was in the process of completing work to meet these. All staff had recently had fire training and a Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 Page 24 drill had taken place. There was no fire plan available for the home and it is required that the home has a plan for staff to follow in the event of fire. COSHH files had not been reviewed as previously required, and the manager must review the products being used in the home and ensure that risk assessments are in place and that staff have instructions to follow if harm is caused by a COSHH product. The files must be available to staff. Accidents and incidents were recorded appropriately and CSCI are informed as per Regulation 37. The manager has written a protocol for staff to follow in the event of any incident and audits are undertaken. The accident book is compliant with the data protection act, however it was noted that one page had been completely torn out of the book and no explanation could be provided for this. Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 Page 25 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 3 X X 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 1 2 2 Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4(1c) Requirement The Statement of purpose requires a review as does not contain all the information as required by the regulations. Residents must be issued with terms and conditions of stay at the home. The care planning system must be further developed to include the following: Care plans must be individualised to include the residents likes and dislikes. (Some evidence, although not consistent) The Manager must review the current system in respect of the frequency of residents receiving baths and showers at the home, and preferences must be recorded on care plans. 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. Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 Page 27 Timescale for action 29/09/06 2. 3. OP2 OP7 5(1)(c) 12(2) 15(1)(2) 31/08/06 31/08/06 The information within the care plan evaluations must reflect the residents current care needs. (Previous timescales of 15/03/05, 31/08/05, 20/03/06 & 26/05/06 not met) Short-term care plans must be devised and outcomes recorded. Wound care plans must detail descriptions of the wound in order to be able to monitor progress. Moving and handling risk assessments must detail the action to be taken should a resident fall. (Previous timescale of 31/07/05, 30/11/05 & 27/02/06 not met) 4. OP7 13(5) 14/08/06 5. OP7 13(4)(c) 6. OP8 12(1)(a) The document should be revised to include a full assessment as currently indicates high/medium/low risk. Personal risk assessments must 14/08/06 be written separately and clear guidelines for the actions to be taken recorded. (Previous timescale of 27/02/06 not met) Documentation is not individualised and is fragmented in the filing system. 16/06/06 Residents must be weighed at least monthly or more regularly if instructed to do so by a Health Care Professional. Documentation of this is fragmented and a system to ensure that information is readily available must be implemented. Food records must be maintained for residents who are assessed as being at risk. Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 Page 28 7. 8. OP8 OP9 9. OP9 10. OP12 11. OP15 12. 13. 14. 15. OP16 OP18 OP19 OP19 16. 17. OP29 OP30 Visits from external professionals must be recorded along with any outcomes. 13(2)(4)( A sign must be placed on the a)(c) treatment room door to ensure that people are aware that oxygen is being stored in the room. 13(2) Controlled Drugs must be stored in Controlled Drug Cabinet not in the medicine trolley. (The manager received this as an immediate requirement) 15,16(2)( Activities care plans must be n) 17 further developed with the 3)(b) activities coordinator. Limited information available on some files. (Previous timescale of 25/05/06 not met 16(2)(i) Staff must not mix pureed foods together as this does not promote dignity of residents or allow them to experience the flavour and texture of the food. (The manager received this as an immediate requirement) 22 The complaint form requires amending to include sections for post monitoring and outcomes. 18(1)(c)(i All staff must receive training in ) POVA and challenging behaviour. 13(4)(a)(c An identified bedroom requires )23(2)(b) the flooring to be stretched or replaced to reduce the ‘bubbling’ 23(2)(b) A rolling maintenance programme must be developed to identify work to be completed throughout the next year. A copy of this is to be forwarded to CSCI. (Previous timescale of 31/03/06 not met)) 19(1)(a) The manager must ensure that a Sch 2 POVA 1st check is available on all staff files. 18(1c,i) The care assistant induction (2) must be in line with the DS0000024842.V298374.R01.S.doc 13(1)(b) 16/06/06 30/06/06 02/06/06 31/08/06 02/06/06 04/08/06 06/10/06 11/08/06 25/08/06 30/06/06 25/08/06 Page 29 Green Nursing Home, The Version 5.1 guidelines and timescales specified by Skills for Care. (Previous timescale of 10/03/06 not met) Document must include a section for the staff member to sign. A written report of the findings of the quality assurance questionnaires must be completed annually and made available for review. (Previous timescale of 31/03/06 not met) A system for formal staff supervision and appraisal must be implemented at the home. (Previous timescales of 22/11/04, 31/08/05 & 28/02/06 not met) Policies and procedures must be reviewed and signed and dated. Risk assessments of the premises, food, staffing and COSHH items must be must be reviewed regularly. (Previous timescale of 15/03/05, 31/08/05 & 31/03/06 not met) Staff statutory training records must include detail of the content and duration of training sessions and approved trainers must provide moving and handling training. (Not assessed on this occasion) The manager must ensure that a fire plan is available for the home. 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. DS0000024842.V298374.R01.S.doc 18. OP33 24 13/10/06 19. OP36 18(2) 02/10/06 20. 21. OP37 OP37 24(1) 13(4) 01/09/06 01/09/06 22. OP38 18(1c,i) 31/08/06 23. OP38 23(4) 31/07/06 24. OP38 23(4)(a) 30/06/06 Green Nursing Home, The Version 5.1 Page 30 (Previous timescale of 16/06/05 & 26/05/06 not met) 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. Refer to Standard OP28 OP30 Good Practice Recommendations The home must work towards achieving 50 of care staff who are trained to NVQ Level 2. An individual staff-training matrix should be undertaken for each staff member. Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 Page 31 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. Extracts may not be used or reproduced without the express permission of CSCI Green Nursing Home, The DS0000024842.V298374.R01.S.doc Version 5.1 Page 32 - 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!