Inspection on 07/11/06 for The Green Nursing Home

This inspection was carried out on 7th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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.

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 02/06/06

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 Key Unannounced Inspection 7th November 2006 09:20 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.V318036.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 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 Vacant 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.V318036.R01.S.doc Version 5.2 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. 2nd June 2006 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 needs. 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 are the dining rooms. The home has off road parking to the front of the property, which is sufficient for the home, 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 £343 - £373 depending on the assessed banding and type of room chosen and a “top up” fee is payable. Hairdressing, chiropody, opticians and dentists visit the home, and are available for additional fees. Previous inspection reports and leaflets of interest are available inside the reception area of the home, for anyone who wishes to read them. Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced fieldwork was undertaken by two inspectors over eight hours and was assisted throughout by the Manager. There were 49 residents living at the home on the day of the inspection, one resident was receiving hospital care. Information was gathered from speaking with the staff, observing care staff perform their duties and from examining care and health and safety records. Staff personnel files were sampled and a partial tour of the building was undertaken. CSCI Pharmacy inspector had been to the home on the 31st October 2006 to complete an inspection and the findings from that visit are incorporated into this report. This is the second key inspection of the home for the 2006 - 2007 year and it is recommended that this report is read in conjunction with the previous report of the home. Prior to the inspection the manager had completed a pre inspection questionnaire and returned it to CSCI, and this gave some information about the home, staff and residents that was taken into consideration. No immediate requirements were made on the day of the visit to the home. What the service does well: The home provides a range of activities and outings and residents are encouraged to maintain activities outside of the home, maintaining their independence. 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” and residents meetings are held to give the residents the opportunity to raise concerns or to make suggestions as to how improvements could be made. The home provides a homely and comfortable environment in which to live. Dining rooms, corridors and assisted baths are spacious and allow the residents freedom to move around the home. There are pressure relieving mattresses, hoists and handrails available in the home and this assists residents who have decreased mobility to keep safe. Resident’s personal monies can be safely held by the home if required. Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Pre admission assessments must be available and signed and dated by the person completing the assessment to ensure that the home can meet the needs of prospective residents, prior to their admission. Care planning needs improving to ensure that personal likes and dislikes are recorded to ensure staff have the knowledge to deliver individualised care. Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 Page 7 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. Improvements are required to Infection Control practices to minimise the potential risk of cross infection. The manager must ensure that two complete written references are available for all staff prior to commencing employment at the home, to ensure that residents are safeguarded. The providers must ensure that Regulation 26 visit monthly reports are written and are available to the manager and for CSCI to review as requested. The home must work towards a formal quality assurance system that takes into account views of relatives, representatives and stakeholders. This will ensure that views are listened to and acted upon appropriately and will ensure a consistently improving service. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 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.V318036.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 & 4 The quality outcome of this area is adequate. This judgement has been made using available evidence including a visit to the service. Prospective residents have all the information they need to make an informed choice about where to live. Some residents have contracts issued to inform them of terms and conditions of stay at the home. Improvements are required to documentation of pre admission information to enable the home to ensure that residents can be confident that their needs can be met upon admission. EVIDENCE: Since the last fieldwork visit to the home, the Statement of Purpose and Service User Guide have been updated and contain all information as required to enable prospective residents to make an informed decision about moving into the home. These documents are not available in any other formats and it is recommended that they are made available in other formats such as large print and audiotape to enable people with sensory impairments to access the information. Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 Page 10 Residents who are privately funded are now issued with terms and conditions of stay at the home, and the contracts specify a trial period of one month, room to be occupied and the fee. This ensures that prospective residents are informed about conditions of residency at the home and gives them the opportunity to sample life at the home before making a decision to become a permanent resident. Three way agreements are in place for residents who are assisted by social services, however the home must still provide residents with terms and conditions of stay at the home. Three files were reviewed and pre admission assessments were inconsistent. One file had a very comprehensive assessment on file, which enabled the home to determine if they could meet the assessed needs of the resident. A second file had an assessment but it had not been signed or dated by the person completing it and it did not state where the assessment had taken place. One file did not have any evidence of a pre admission assessment. The manager must ensure that assessments are available, signed and dated by the person assessing the resident’s needs to ensure that the home can meet the needs. A service users information pack is provided to the residents upon admission, and this provides various information about the home. Letters of confirmation that the home can meet the assessed needs following pre admission assessment are not sent to residents or their representatives and this is required to ensure that prospective residents or their representatives know that the home can meet the assessed needs prior to admission to the home. The home does not offer intermediate care. Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 The quality outcome of this area is adequate. This judgement has been made using available evidence including a visit to the service. Resident’s health and personal care needs are generally met by the care staff. Medication is well managed and this ensures residents receive their prescribed medication. EVIDENCE: Each resident has a written care plan. This is an individualised plan about what the person is able to do independently and states what assistance is required from staff in order for the resident to maintain their needs. As at the last fieldwork visit, care plans reviewed did not consistently detail personal likes and dislikes and many of the care plans were pre printed resulting in them not been individualised and this does not ensure that staff have information to follow to meet the personal preferences and assessed needs of the individual residents. The manager stated that care plans were the next area to be improved with the assistance of the new Deputy Manager. Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 Page 12 Some specific details were recorded such as “can wash hands and face if flannel is given” “prefers to use the shower”, and this needs to be further developed across all care files so that personal preferences are maintained and residents are assisted to maintain their independence for as long as possible. Staff must ensure that care prescribed is actioned and documented as one file stated that a resident should be weighed weekly and be commenced on a food diary, however the weight had not been recorded weekly and there had been no food diary implemented and this does not enable staff to monitor the progress of residents and take appropriate action. On two further files all identified actions had been implemented. A manual handling assessment had not been completed for one resident and this does not ensure that the resident had been assessed and that staff had instructions to follow to support the resident safely. On the mobility care plan it was not clear if the resident required the assistance of one or two staff and this does not ensure the safety of residents or staff. There was good documentation in the daily records for the day of admission of a recent admission and this provides staff with baseline information about the resident. Staff had recorded a skin tear which had steristrips applied, however there was no further mention of this in the records so it was not clear if the wound had healed or if the sterisrips were still in place. One resident had had a body map completed on admission to the home and this gave good details about skin sores, including location, size and colour of wound. Type of pressure relieving mattress and cushion was documented along with the dressing to be used and this ensures that staff know what equipment and dressing to use to meet the residents assessed needs and improve skin condition. There was some evidence that representatives of residents had been involved in the care planning process. There was evidence that external healthcare professionals such as opticians, social workers, GPs, dentists, audiologists and speech and language therapists visit the residents as required. Residents appeared well kempt and were dressed appropriately for the time of year, and to reflect individual preferences. The home has a dedicated medication room for the storage of medicines. Random audits undertaken demonstrated that the medicines are administered as prescribed by the doctor and records reflected this. Nursing staff interviewed had a good understanding of the medicines they administer and medication reviews are sought with the doctor on a regular basis and for all new service users who come to live in the home. Robust systems have been Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 Page 13 installed to check the medicines into the home. Two registered nurses now undertake this. Staff levels have increased and this is reflected in the quality of the medicine management seen. The manager regularly undertakes audits to confirm staff administer and record medicines correctly. An active programme is in place to reduce the amount of service users being prescribed food supplements and menus have improved to aid this process. Service users are encouraged to self-administer their own medicines but no risk assessments or compliance checks were seen to ensure they do so safely. All Controlled Drugs were documented and stored correctly. There is a residents post tray located in the corridor and it was recommended that this is removed to a more secure area, as post is accessible to other residents and visitors to the home. On one residents file reviewed there was an unopened letter that had not been given to the resident and this was brought to the attention of the manager and the resident was assisted to read the mail. Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 The quality outcome of this area is good. 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 choices are available. EVIDENCE: On the day of the fieldwork visit residents were seen engaging in various activities such as watching TV, playing games and knitting. There was pleasant music playing in some lounges and there was a pleasant atmosphere in the home. The activity coordinator works full time and has arranged various activities such as external entertainers, coffee mornings, bingo, arts and crafts, hand massage, puzzles and exercises. Residents were observed participating in activities and appeared to be enjoying them. The home had held a Halloween party, which had also been attended by some relatives. There were plans for a Remembrance Sunday, carol singers and a Christmas party. Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 Page 15 The hairdresser visits once a week and a church service is held once a month, as is Holy Communion, and this enables residents to continue to follow their religion if they wish. The home does not currently have residents with any other religious needs but could assist residents to meet these needs if required. Newspapers are delivered to the home for residents as required and one activity is a discussion about what is in the news. Residents are able to go out with family and friends if they choose to and attend local day centres. The activity coordinator was in the process of devising personal histories and this will provide further information for staff, which will assist in care planning and provide topics of interest for staff to discuss with the residents. Good activity records were kept and these evidenced activities that residents had participated in. The home has an open visiting policy, which means that residents can have visitors at any time, and visitors were seen throughout the visit. The morning routine had been reorganised and residents are able to have breakfast in bed if they choose, this allows staff to spend more time with residents assisting them with personal care needs as they will have had their breakfast. Both the Manager or Deputy Manager serve the lunchtime meals to oversee what residents are eating and that staff are supervising and assisting residents appropriately. Three dining rooms are now utilised and this enables staff to supervise a smaller group of residents to ensure their nutritional needs are met. The CSCI pharmacist had raised a concern that a high number of residents were receiving supplement drinks. This was discussed with the manager and the number of these is being reduced. A new 28-day menu has been devised, which is nutritious and varied and the cook undertakes home baking. New equipment had been purchased for the kitchen, which assists the staff to meet the nutritional needs of the residents. The dining room is large and has good access for residents who use wheelchairs, dining tables were attractively laid and an alternative menu board is on display. This offers choices for residents who do not choose the main meal option of the day. Snacks are available throughout the day and include, cakes, biscuits, sandwiches and fresh fruit. Soft and pureed diets are available for residents with swallowing difficulties, the home did not require any special diets for cultural reasons at the time of the fieldwork visit, but these could be catered for if required. Both inspectors sampled the main option of the day, which was quiche, potato croquets and beans and apricots and custard for the sweet. The meal was well presented, hot and appetising. Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this 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 as is on display in the corridor of the home and in each resident’s bedroom. The complaints form was reviewed and has appropriate sections for the recording of investigations and actions taken which would provide evidence of outcomes for residents and actions to improve the service provided by the home. CSCI have not received any complaints pertaining to the home since the last visit and this is seen as positive, as previously the home had generated a number of complaints. The home had received one complaint regarding staff attitude and there was good documentation about investigations undertaken and the outcome. As at the previous inspection, 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” Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 Page 17 There are a number of “thank you” cards on display in the entrance of the home, which indicate satisfaction with the service provided. The home has a whistle blowing policy, which ensures that staff at the home have the knowledge to protect residents without the fear of reprisals. The home has a missing persons policy, which has been reviewed this year, to ensure it has the correct details for staff to follow in the event of a resident noted missing from the home. The home had a copy of the Birmingham Multi Agency guidelines and an adult protection policy in line with the Department of Health’s “No secrets” and this ensures that staff have guidelines to follow to respond to any allegations of abuse appropriately. As at the previous inspection there are 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.V318036.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides residents with a homely and comfortable environment in which to live, where they appeared to feel relaxed and secure. Improvements are required to infection control at the home to ensure residents are protected from potential cross infection risks. EVIDENCE: On the day of the visit to the home, the home was found to be clean and fresh with no offensive odours. The corridors around the home are spacious and allow the residents freedom to move around the home with any assessed equipment needs. On the ground floor perspex had been fitted to walls to protect them from damage however it was seen that condensation had built up behind the perspex and black mould Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 Page 19 was present. It is required that the perspex is removed and the walls are cleaned to prevent any occurrence of infection. 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. A number of toilets and bathrooms were cluttered with equipment and this requires removing as prevents residents from accessing the facilities, as they require them. Two toilet doors did not have locks and this does not promote resident’s dignity or independence. One bathroom was out of order due to a water leak and the home were waiting for maintenance services to come into the home to carry out repairs and ensure it was fit for purpose. A number of bathrooms and toilets had residents toiletries left in them and bars of soap were in the majority of toilet areas and this poses a potential cross infection risk. Clean incontinence pads were left on top of clinical waste bins posing a potential cross infection risk and staff must ensure that the pads are stored in the cupboards provided. The downstairs sluice machine was in a toilet area and requires locking to prevent residents accessing the sluice and sustaining any injury. The first floor sluice room requires racks to store commode pots appropriately. Linen trolleys were left stacked in corridors; clean linen should be stored in linen rooms. It was recommended that the Infection Control Nurse from the Health Protection Agency is invited in to complete an audit of the home. Where residents require assistance from staff there is a range of equipment available. The home has a number of hoists available for use with residents who are assessed as needing this assistance, however some hoists and slings required cleaning as were soiled. Bedrooms seen were personalised and all rooms have a lockable facility, this ensures residents are comfortable in their environment. Communal areas had a variety of chairs to suit the needs of the residents and these had been arranged to promote social interaction. The dining room was clean and tables were set with tablecloths and plastic flowers. There were books available from bookshelves in the corridor for residents who choose to read. The home had arranged for new carpets in the corridors upstairs and new flooring in a residents bedroom, identified at the previous inspection. The manager telephoned the company during the visit and stated that this work was to be completed in the next ten days. Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported by an appropriate number of staff to ensure that their identified needs are met. There is a robust system for the recruitment of staff so that residents are safeguarded. 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. Three trained staff are on duty throughout the day, eight care staff in the morning and seven care staff in the afternoon. During the night four care staff and two trained nurses are on duty. The Manager and Deputy Manager are supernumery. Currently the home has only 4 of staff who have completed a NVQ and the home must work towards meeting the recommended 50 of staff who hold this qualification in order to ensure that residents receive care from welltrained and competent staff. Four staff files were reviewed and were found to contain all the information as required by the regulations and this assists in safeguarding residents from harm, with the exception of one file where only one reference was available Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 Page 21 and one file, which had two references, but the second page of one reference was missing. The manager must ensure that two completed written references are received prior to employing staff at the home. There were no identity photographs available for staff and these are required. Two new staff at the home were currently receiving induction and were supernumery, in order to allow them time to work with staff and familiarise themselves with the home and the residents. An induction to the home had been completed and the staff were now following the Skills for Care workbook. This will ensure that staff have basic skills when commencing employment at the home. There has been no staff training provided since the last inspection of the home. The Manager and Deputy Manager have attended a Nutrition In Care study day. The manager has compiled a staff-training file, which gives individual staff records, however a training matrix for all staff is required to be devised to give an overview of the training and to assist the manager to plan and implement a training programme. Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recruitment of new managers of the home should provide continuity to ensure sustainable improvement. A formal quality assurance system needs to be implemented to ensure a consistently improving standard and to empower residents. The home regularly undertakes health and safety checks and this safeguards residents and staff. EVIDENCE: The manager has been in post for approximately seven months, is a Registered Nurse and has previous experience of working with older people and within management roles. She is an accredited Moving and Handling trainer, which would enable her to train staff at the home. The manager has commenced the Registered Managers Award at a local college and it is anticipated that this will Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 Page 23 take a year to complete; this will ensure that the manager continues to update her knowledge in order to lead the staff team. It is required that the manager submits an application to CSCI to become the Registered Manager of the home. A new Deputy Manager had recently commenced employment at the home and she is also a Registered Nurse and has experience of working with older people and within management roles. Both managers were receptive to ideas and were keen to make changes to improve the service offered by the home. The Deputy manager should provide continued support to the manager to make and sustain improvements already in place, whilst assisting with the overall running of the home. It was pleasing to see that the Manager had identified priority areas to improve in the home and was concentrating on bringing these areas up to the required standards. The providers of the home regularly visit the home to undertake quality of service inspections as per Regulation 26, however CSCI have not received any written reports and the last one available in the home was for February 2006. It is required that a monthly report is written and is available to the manager and for CSCI to review as requested. Staff and relatives meetings have taken place and the minutes from these were available and these meetings enable residents, relatives and staff the opportunity to raise concerns or ideas about the home and how it can be improved. A quality assurance questionnaire has been devised however no further progress has been made towards a formal quality assurance system, 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. The system for the management of resident’s personal money is robust. Nine residents personal monies were audited and balances were correct. Only the two managers have access to the safe. Receipts were available for transactions and two signatures were obtained for the records. It is recommended that two staff audit all personal monies each month in order to identify any errors and allow for them to be corrected. Supervision was not fully reviewed at this visit to the home but evidence was seen on two files reviewed, that work on this has now commenced. This will ensure that staff are supervised and any areas for development are identified to ensure a skilled and competent workforce care for residents at the home. Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 Page 24 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. There was no evidence of a five yearly electrical wiring certificate and it is requested that a copy of this is forwarded to CSCI. A new boiler had been installed on the first floor, mixer taps had been replaced and water pressures had been reviewed. The maintenance person had previously checked water temperatures every month but there was no evidence of any checks being completed since July. While the thermostats have been set at 38 degrees, it is still required that checks are made to ensure they are regulated and that residents are protected from being scalded. The fire officer had recently visited the home and stated that self-closing devises needed to be fitted to doors, there are 32 doors that require these to be installed and the home has purchased these. A fire drill was undertaken in August but the names of staff attending had not been recorded and this is required to ensure that staff receive two fire drills per year. 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, which provide good detail of the incident, if it was witnessed and the time and place of incident. This will assist in the identification of any trends or reoccurrences. COSHH (Control Of Substances Hazardous to Health) files have been reviewed and information is available on both trolleys for staff to follow if harm is caused by a COSHH product. Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 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 3 2 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 2 X X 3 3 2 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 2 3 2 X 2 2 X 2 Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 Page 26 YES 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 OP2 Regulation 5(1)(c) Requirement Residents must be issued with terms and conditions of stay at the home. (Including residents with three way agreements) (Previous timescale of 31/08/06 partly met) Pre admission assessments must be undertaken, signed and dated by the person completing. Letters of confirmation that the home can meet needs must be sent to residents. 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. Timescale for action 16/01/07 2. 3. 4. OP3 OP4 OP7 14(1)(a) 14(1)(d) 12(2)15(1 )(2) 19/12/06 31/12/06 31/01/07 Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 Page 27 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 plan evaluations must reflect the residents current care needs. (Previous timescales of 15/03/05, 31/08/05, 20/03/06, 26/05/06 & 31/08/06 not met) Short-term care plans must be devised and outcomes recorded. 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) The document should be revised to include a full assessment as currently indicates high/medium/low risk. (Previous timescale of 14/08/06 not met) Food records must be maintained for residents who are assessed as being at risk. 5. OP7 13(5) 22/12/06 6. OP8 12(1)(a) 08/12/06 7. OP18 8. 9. OP19 OP19 Weekly weights must be recorded if this is identified in care plans. 18(1)(c)(i All staff must receive training in ) POVA and challenging behaviour. (Previous timescale of 06/10/06 not met) 13(4)(c) Perspex to corridor walls 16(2)(j) requires removal and cleaning. 13(4)(a)(c An identified bedroom requires )23(2)(b) the flooring to be stretched or replaced to reduce the ‘bubbling’ (Previous timescale of 11/08/06 DS0000024842.V318036.R01.S.doc 31/01/07 15/12/06 30/11/06 Green Nursing Home, The Version 5.2 Page 28 10. 11. OP21 OP21 13(4)(a) 12(4)(a) 13(4)(a,c) not met) (CSCI Informed work is planned to be completed) Equipment must not be stored in bathrooms and requires removing. Toilet doors must have suitable working locks. Sluice rooms require a suitable lock to prevent resident access. Racks are required to store commode pots appropriately. Personal toiletries must not be left in communal areas. Bars of soap must not be left in communal areas. Incontinence pads must be stored in packets or cupboards. Hoists and slings require cleaning. Two complete written references must be available for all staff. Staff photographs must be available on file. A staff-training matrix must be devised and a training programme implemented. The manager must submit an application to CSCI for registration. Regulation 26 visit reports must be written monthly and available to the manager and CSCI. 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 and 13/10/06 not met) A system for formal staff supervision and appraisal must be implemented at the home. DS0000024842.V318036.R01.S.doc 18/12/06 25/12/06 12. OP26 16(2)(j) 11/12/06 13. 14. OP26 OP29 16(2)(j) 19 Sch 2 11/12/06 31/12/06 15. 16. 17. 18. OP30 OP31 OP33 OP33 18(1)(c)(i ) 8 26(5) 24 05/01/07 31/12/06 31/12/06 28/02/07 19. OP36 18(2) 31/01/07 Green Nursing Home, The Version 5.2 Page 29 20. OP38 23(4)(a) 21. 22. OP38 OP38 13(4)(a, c) 13(4)(c) 23(2)(c) (Previous timescales of 22/11/04, 31/08/05, 28/02/06 & 02/10/06 not met) (Work has now commenced to meet this requirement) 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. (Previous timescale of 16/06/05 ,26/05/06 & 30/06/06 not met) (Magnetic closures have been purchased) Random water temperature checks must be maintained. A copy of the five yearly wiring certificates must be available for inspection. 31/12/06 08/12/06 22/12/06 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. 4. 5. Refer to Standard OP1 OP10 OP26 OP28 OP35 Good Practice Recommendations It is recommended that the statement of purpose and service user guides is available in other formats. It is recommended that the residents post tray is moved to a more secure area. It is recommended that the Infection Control Nurse is invited in to the home to complete an audit. The home must work towards achieving 50 of care staff who are trained to NVQ Level 2. It is recommended that two staff audit resident’s personal monies monthly. Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Green Nursing Home, The DS0000024842.V318036.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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