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Inspection on 08/08/08 for The Green Nursing Home

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

This inspection was carried out on 8th August 2008.

CSCI found this care home to be providing an Adequate service.

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.

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

What the care home does well

Prior to coming to stay at the home people are encouraged to make informed decisions about whether they would like to live there. Pre admission assessments are undertaken so that the home and prospective resident know that their individual needs can be met. People have access to a range of Health and Social care professionals and this ensures that health care needs are met. Choices of meals are offered and food is well presented. The home can cater for special diets, including individual preferences, dietary and cultural needs. There are a variety of activities on offer should people choose to participate and people are encouraged to take part in activities outside of the home. Meetings are held so that people are given the opportunity to voice concerns or make suggestions about how improvements could be made. There is a robust system in place for the safekeeping of small amounts of personal money should people choose to use this facility. People told us: "I have been made very welcome and am well taken care of" "I like it here" "The staff give a good level of care and support" "One of the staff painted my nails, they look lovely" "The food is good" "I am aware of the complaints procedure" "I have no concerns" "Staff are marvellous, very nice people" "Staff are always there to help and support me"

What has improved since the last inspection?

The home has worked towards meeting the previous requirements, which suggests that the providers and manager are keen to ensure that people live in a home that complies with regulations. Care plans have improved and provide staff with details about individual personal choices and preferences. This should mean that people receive the care that they require in a way that they prefer. The management of medication means that people receive their medication safely and as prescribed. A second activities coordinator has been employed so that more activities and 1-1 time can take place. This means that people`s individual needs should be met. External managers undertake Regulation 26 visits (unannounced visits) to the home and write reports regarding the quality of service provided.

What the care home could do better:

Staff should ensure that the privacy and dignity of people living at the home is maintained at all times. Call bells must be within reach so that people can call for assistance, as they require. Any `grumbles` received by the home should be recorded so that any trends can be monitored and addressed to meet the needs of the people living at the home. Maintenance hours could be improved so that the home maintains a consistently safe and pleasant environment. The recruitment procedure must be robust to ensure that people are safeguarded from harm.

CARE HOMES FOR OLDER PEOPLE The Green Nursing Home Wharf Road Kings Norton Birmingham West Midlands B30 3LN Lead Inspector Lisa Evitts Unannounced Inspection 8th August 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Green Nursing Home DS0000024842.V369596.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. The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Green Nursing Home Address Wharf Road Kings Norton Birmingham West Midlands B30 3LN 0121 451 3002 0121 486 3360 flintvaleltd@btconnect.com 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) Flintvale Limited Andrea Hinton Care Home 59 Category(ies) of Dementia (59), Old age, not falling within any registration, with number other category (59) of places The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 59 Dementia (DE) 59 The maximum number of service users who can be accommodated is: 59 9th August 2007 2. Date of last inspection Brief Description of the Service: The Green is a purpose built facility, which offers nursing care for up to 59 older adults, and can accommodate people 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 people 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 has wheelchair access. Laundry and kitchen services are located on the ground floor, as are the dining rooms. There is 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 £500 - £650 per week. This depends if the person is privately funded or funded by Social Care and Health. Charges vary, 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. The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 5 Previous inspection reports and leaflets of interest are available inside the reception area of the home, for anyone who wishes to read them. The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The visit to the home was undertaken by two inspectors over ten hours and was assisted throughout by the registered manager. The home did not know that we were visiting on that day, when there were 54 people living there. Two people were receiving hospital treatment. Information was gathered from speaking to and observing people who lived at the home. Three people were “case tracked” and this involves discovering their experiences of living at the home by meeting or observing them, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. One further file was partly reviewed. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety files were also reviewed. Random questionnaires were sent out to five staff and to fifteen people who live at the home in order to gain their views about the service. Seven people who live at the home and four staff returned the questionnaires and their comments about the service provided and are included within this report. It is difficult to get peoples views about the home due to differing levels of dementia however eight people who live at the home and two relatives were spoken to. Prior to the inspection the Registered Manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This tells us how well the home think they are performing and gives us some information about the home, staff and people who live there, improvements and plans for further improvements, which were taken into consideration. Regulation 37 reports about accidents and incidents in the home were reviewed in the planning of this visit. One immediate requirement was made on the day of the visit to the home to ensure that people are safeguarded. The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? The home has worked towards meeting the previous requirements, which suggests that the providers and manager are keen to ensure that people live in a home that complies with regulations. Care plans have improved and provide staff with details about individual personal choices and preferences. This should mean that people receive the care that they require in a way that they prefer. The management of medication means that people receive their medication safely and as prescribed. A second activities coordinator has been employed so that more activities and 1-1 time can take place. This means that people’s individual needs should be met. The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 8 External managers undertake Regulation 26 visits (unannounced visits) to the home and write reports regarding the quality of service provided. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 9 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 The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 10 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): 1,3 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have sufficient information about the home to enable them to make an informed decision about whether they would like to live there. Pre admission assessments ensure that people know their needs can be met prior to moving in. EVIDENCE: The certificate of registration was clearly displayed in the reception area of the home and a copy of the previous inspection report is displayed so that people have access to this information if they wish to read it. The manager showed us a new service user guide and statement of purpose which had been designed to include more information about the home and included pictures so that the information was made easily available to people. The document was in large print format so that people with visual impairments could access the information. Information about charges for the home were The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 11 included in the documents so that people knew what they would need to pay for if they chose to live at the home. Comprehensive pre admission assessments are undertaken prior to people coming to live at the home and this should ensure that peoples individual needs can be met when moving in. People are able to visit the home prior to moving in so that they can sample what it would be like to live there. This enables them to make an informed decision about whether they would like to live there. People told us: “I visited the home on several occasions and so did my family” “I have been made very welcome and am well taken care of” “I like it here” “Its a very good home” The home does not offer intermediate care services. The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans provide sufficient information for staff to assist people to meet individual needs. The management of medication ensures that people receive their medication as prescribed. People’s privacy and dignity is not always maintained. EVIDENCE: Each person had 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 person to maintain their needs. We looked at three peoples care plans in detail and partially looked at one other file. The plans provided details of peoples individual needs, likes and dislikes such as “prefers a shower and likes to have hair done on Wednesdays”, “prefers to lie down after dinner” and “wears blue pads in the day and green at night”. People are asked if they would like male or female carers to assist them and this means that people should receive care in a way that they prefer. The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 13 One file did not have a risk assessment in place for the use of bed rails and this was brought to the attention of the manager at the time. Risk assessments are undertaken for sore skin, risk of falls, nutrition and moving and handling and this means that staff can act appropriately to any changes in peoples health needs. There were some plans and assessments in place, which referred to “cot sides”, and this does not promote the dignity of the people living at the home. This was a previous recommendation of the home. There were good plans in place for staff to manage people who sometimes displayed difficult to manage behaviour and this should assist them to minimise this behaviour. There were good details of the type of moving and handling equipment that each person should use so that staff and the person were safe. One care plan for diabetes did not give staff details of what symptoms they should look for if the person were experiencing high or low blood sugars. A care plan for high blood pressure stated, “observe for hypertension” and “monitor BP regularly”. This does not provide staff with specific instructions or guidance and should be included in the plan of care. There was evidence that external healthcare professionals such as the general practitioner, practice nurse and tissue viability nurse see people who live at the home. This ensures that all care needs are met and that specialist advice is sought. People appeared to be well supported by staff to choose clothing appropriate for the time of year which reflected individual cultural, gender and personal preferences. People told us: “The staff give a good level of care and support” “One of the staff painted my nails, they look lovely” “I have a shower weekly” “I feel his overall health has improved since he moved to this home” The management of medication was reviewed and was found to be robust so that people received their medication safely and as prescribed. Staff were observed to interact well with people living at the home and were observed talking to people about what they were doing and why, so that people were informed. It was disappointing that one member of staff took us into a shared room, where one person was sleeping and one person was waiting for staff to assist with personal care. The dividing curtains were not drawn and the member of staff put on the light and opened the window curtains, which did not provide either person with any privacy. Infection The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 14 control measures, which were being followed by the home, did not promote peoples privacy and we discussed with the manager how they might be able to continue the good infection control practices whilst being discreet and promoting peoples privacy. It was of concern that during a walk around the home, a number of people who were in their rooms did not have access to a call bell as they were out of reach. This was brought to the attention of the manager and an immediate requirement was made to ensure that people had access to call bells so that they could call for assistance as required. The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to choose the activities that they participate in which promotes their individuality and independence. People are offered a choice of meals to meet their dietary, cultural needs or preferences. EVIDENCE: Since our last visit to the home a second activities coordinator has been employed and this means that more activities and 1-1 time can be provided. There are a number of activities on offer in the home including, games, quizzes, arts and crafts, singing, reading of newspapers and gardening. The home has external entertainers and a monthly keep fit session. There had recently been a Barbeque held at the home and one person said “we had a lovely barbeque the other day and enjoyed a singsong”. An outside activity had been planned but unfortunately had to be cancelled as the home was let down by the transport arranged at short notice. The manager was however very keen to develop this area. During the day we observed numerous activities being undertaken including newspaper reading, crafts and a film show. We observed good interactions The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 16 from the staff and two people were encouraged to assist with folding the paper napkins. Church services are held so that people can continue to follow their chosen religion and the hairdresser visits weekly so that people can have their hair dressed as they choose. The home has a monthly newsletter, which tells people about events, activities and entertainment. There is an open visiting policy, which means that people can see their visitors as they choose and maintain relationships that are important to them. People were seen to visit throughout the day. One visitor told us “I visit nearly everyday, the home has lots of activities”. We had received some questionnaires from people who live at the home prior to the inspection and comments about meals were mixed. Since we had sent out the questionnaires the home had started a four-week rolling ‘summer’ menu and people living at the home were involved in devising this menu. On the day of the visit people were complimentary about the meals. Menu cards have been devised so that people will be able to see the menu offered. People are given the choice of having breakfast in bed. The home can cater for people who need specific diets for reasons of medical, cultural or personal preferences. Purred meals were served in separate portions so that people can experience the taste and texture of different foods. There is a range of alternative options available for people to choose from if they do not want what is on the menu and individual requests can also be catered for. The inspectors sampled the main meal of the day, fish, and this was well presented, hot and appetising. One person had requested sausage and beans and this was catered for. People told us: “Food is excellent except for the pasta yesterday but I had a sandwich instead” “The food is good” The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is comprehensive and is accessible to people should they need to make a complaint. Policies and procedures should ensure that people are safe from harm. EVIDENCE: There is a comprehensive complaints procedure which is on display in the reception area of the home, making it accessible to people who live there and their representatives should they need to make a complaint. The procedure is also included in large print in the service users guide. We have not received any complaints pertaining to the home since the last visit and the home had not received any formal complaints. People told us: “I am aware of the complaints procedure” “I have no concerns” The home had received two letters, one regarding fee rates and the other regarding the type of quilt of one person’s bed. These were not formal complaints however it is recommended that a ‘grumbles’ book is implemented to record low level concerns so that any trends can be monitored and acted upon. The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 18 The home has a copy of the Birmingham Multi Agency Guidelines and an adult protection policy in line with the Departments of Health’s “No secrets” and this should ensure that staff have guidelines to follow in the event of any allegations of abuse. There have been two adult protections opened since our last visit. These had all appropriate actions taken and the cases have all been closed. Staff spoken to were able to give satisfactory responses to questions about adult protection and this should ensure that staff would act appropriately in the event of an allegation being made. The training matrix was not up to date and it was not possible to determine if staff had received training, however staff spoken to confirmed that they had received training in the protection of vulnerable adults. It is recommended that this information is included in the training matrix so that information is easy to track and so the manager knows when training is due for updating. The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 19 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): 19,20,21,24,25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are provided with a clean and comfortable environment in which to live. Remedial work should be undertaken to ensure that the environment is safe to live in. EVIDENCE: Entry to the home is via a bell and this means that staff know who is entering the building in order to safeguard the people who live there. The home was clean and fresh with no offensive odours and there was a friendly and relaxed atmosphere. The corridors are wide and spacious and allow people at the home freedom to move around with any equipment they are assessed as needing. The home has a number of hoists available for use with people who need this assistance and a range of pressure relieving equipment to prevent skin sores. Staff told us The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 20 that they needed another hoist as one was faulty and they had a high number of residents who needed to use a hoist. This was discussed at the time of our visit and the manager stated that she would arrange for another hoist to be loaned to the home. There are three assisted baths, two non-assisted baths and four showers to meet the needs of the people living at the home. Bathrooms and toilets required some remedial work for example one had a broken toilet seat, one had a broken bath panel, tiles required deep cleaning and door locks were not all working. This may place people at risk of injury and means that they cannot lock the toilet door if they choose to to maintain their privacy. There are no mirrors in any of the bathrooms or toilets and this is recommended so that people can see themselves positively. There are three lounges in the home and one of these is used as the activities room, a range of comfortable seating is available and social interaction is promoted. We looked at the bedrooms of the people we case tracked and found that these were personalised with items that reflected individual choices and preferences. People had the equipment that they had been assessed as needing. Some of the protective bed rails bumpers required replacing as were no longer fit for purpose. There is an attractive garden area with a gazebo and a pond and people who were living at the home used this. A variety of seating and tables gives people a choice of where they may like to sit. There is a ramp so that people in wheelchairs can access the garden independently. It was of concern that the door to the shed was open as this contained access to tools and hazardous substances, which may cause accidental harm to people. We asked for this to be secured immediately and the maintanance person did this. There was lots of furniture, which was waiting to be disposed of, and this should be completed so that people have a pleasant and safe environment in which to live. At the last visit to the home we recommended that consideration was given to increasing the number of hours available to the maintenance person as he is fully utilised and the home is large in size. Due to the number of remedial works that we found in limited area of the home seen, we strongly recommend that this be further reviewed so that maintenance is proactive rather than reactive. This should ensure a safe and well-maintained environment for people to live in. The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 21 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. The home maintains adequate staffing levels to meet the individual needs of people who live at the home. Lapses in the recruitment procedure do not fully protect people from harm. EVIDENCE: There are nine care and three trained staff on duty throughout the morning, seven care and two trained staff throughout the afternoon/evening and four care and two trained staff during the night. The home maintains a core group of staff and currently had no vacancies and this means that people at the home know who will be assisting them to meet their care needs. In addition to the nursing and care staff the home also have laundry, domestic, kitchen, maintenance and administrative staff to meet all the needs of the people who live in the home. People told us: “Staff are marvellous, very nice people” “Staff are really good to me” “Staff are good” “Staff are always there to help and support me” The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 22 Over 50 of staff have the National Vocational Qualification (NVQ) Level 2. This should ensure that a knowledgeable and skilled workforce can meet people’s needs individually and collectively. Staff were observed to interact well with the people living at the home and the atmosphere was calm, friendly and relaxed. We looked at the recruitment files of three staff and found that all staff had had a Criminal records Bureau check. One file had only one reference and this was discussed with the manager at the time of the visit. The manager confirmed that the reference had been obtained prior to employment starting but was unable to find the reference. One qualified member of staff did not have a Personal Identification Number (PIN), which was checked with the Nursing and Midwifery Council (NMC) confirmation service. This confirmation ensures that the nurse is currently registered and fit to practice. One file did not have a risk assessment in place for a medical condition and this was discussed with the manager. These lapses in recruitment procedure do not fully protect people from harm. The training matrix was being updated but had not been completed and this meant that information was difficult to track. There was evidence that some staff had received training in fire, manual handling, infection control, health and safety, dementia care, first aid, continence, Parkinson’s disease, wound care and nutrition. There were some gaps in the training however due to the matrix not being complete it was unclear how many gaps there were in the training. It is recommended that the matrix is completed so that gaps in training can be addressed. There was evidence that staff receive an induction into the home before completing the skills for care package. One induction booklet seen however had all areas of the induction signed on the same day and this was discussed with the manager, as it would be a lot of information to be given at one time. The manager stated that this would have been done over a period of time but staff had signed it all on one day. This does not show a gradual induction into the home. The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 23 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 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager strives to run a home, which is run in the best interests of the people who live there. EVIDENCE: Since our last visit to the home the manager has successfully completed the Registered Managers Award and become the Registered Manager of the home. She has completed study days and this shows that she is keen to keep her knowledge and skills updated in order to lead the staff team. The home needs to ensure that there is a robust recruitment procedure and programme of staff training so that a knowledgeable workforce cares for people safely. The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 24 Resident and relatives meetings have taken place and the minutes from these were available. These meetings enable people who live at the home and their relatives the opportunity to raise concerns or ideas about the home and how it can be improved. The minutes from these meetings showed that people were involved in decisions about the home. A Responsible Individual has recently been employed at the home and this person will undertake unannounced visits to the home in order to monitor the quality of service provided and complete a report. The home has recently purchased a quality assurance programme, which will assist them in formulating their audits into an annual report. The home has sent out some satisfaction questionnaires and the manager completes some audits to monitor quality of the service. Both the manager and the Responsible Individual are committed to improving this and progress will be reviewed at the next visit to the home. There is a robust system in place for recording personal money, which should ensure that it can be held safely at the home, on behalf of the people who live there. Records of servicing, tests and maintenance in respect of health and safety for utilities, appliances and equipment such as electricity, fire; emergency lighting and hoists are well maintained and this should ensure they are safe to use. Staff receive fire training and complete fire drills to ensure they have the knowledge to act appropriately to safeguard people in the event of a fire. Accident and incidents were well recorded. The manager completes a monthly audit to ensure that any follow up is undertaken and to monitor any trends. The Green Nursing Home DS0000024842.V369596.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 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 3 2 X X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 X X 3 The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 13(4)(c) Requirement Measures must be in place so that people can call for help to ensure they are safe. This was an immediate requirement. Robust recruitment procedures must be followed to ensure that people are protected from harm. Timescale for action 08/08/08 2. OP29 19 Sch 2 12/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP2 OP7 OP8 Good Practice Recommendations Room numbers should be identified on terms and conditions of residency. (Previous recommendation, not assessed on this occasion) Care plans should provide details so that staff know how to recognise and monitor any changes in conditions. The use of terminology of cot sides should be reconsidered to promote the dignity of people at the home. (Previous recommendation) DS0000024842.V369596.R01.S.doc Version 5.2 Page 27 The Green Nursing Home 4. 5. 6. OP10 OP16 OP19 7. 8. 9. OP21 OP30 OP33 People’s privacy and dignity should be maintained at all times. A ‘grumbles’ book should be implemented so that concerns can be monitored and acted upon. The number of hours available for maintenance staff should be reviewed so that the home is safe and attractive to live in. (Previous recommendation) Mirrors should be available in bathrooms so that people can see a positive image of themselves. A staff-training matrix should be devised so that information is accessible and future training needs can be planned. An annual report based on the quality of service should be written and available to people living in the home. The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 The Green Nursing Home DS0000024842.V369596.R01.S.doc Version 5.2 Page 29 - 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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