CARE HOMES FOR OLDER PEOPLE
The Green Nursing Home 45 The Green Hasland Chesterfield Derbyshire, S41 0LW Lead Inspector
Ivan Barker Unannounced 19th July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Green Nursing Home C02 C52 S2084 The Green V239769 190705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Green Nursing Home Address 45 The Green Hasland Chesterfield Derbyshire S41 0LW 01246 556321 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Green Nursing Homes Limited Christine Innes Care Home with Nursing 40 Category(ies) of 40 - OP - Older People registration, with number of places The Green Nursing Home C02 C52 S2084 The Green V239769 190705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28/02/05 Brief Description of the Service: The Green Care Home is situated within the village of Hasland, close to the centre of Hasland, which has numerous shops, park and a church. The home provides nursing and residential care for 40 service users. The home is purpose built and is fully accessible. There are two lounges, the smaller of which is designated as a quiet lounge. There is also a separate dining room. Outside there is a well maintained garden with a seating area for residents. The Green Nursing Home C02 C52 S2084 The Green V239769 190705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The person present at the inspection was: Mrs C Innes, manager. Within this inspection, which occurred over a four-hour period, the inspector toured the building, spoke to service users, relatives and staff and examined the care plans and other documentation. He spoke with 8 service users and 4 during the inspection. What the service does well: What has improved since the last inspection? What they could do better:
The registered person should ensure that service users have a choice of meal. The registered person should ensure that the repairs and redecoration are acted upon, prior to an inspection, rather than the issues being raised by the
The Green Nursing Home C02 C52 S2084 The Green V239769 190705 Stage 4.doc Version 1.40 Page 6 inspector. Although he appreciated that the registered person’s wife advised the inspector that the redecoration was booked for August. The registered person should comply with all requirements within the specified timescale. 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 Green Nursing Home C02 C52 S2084 The Green V239769 190705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Green Nursing Home C02 C52 S2084 The Green V239769 190705 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 No intermediate care was provided. EVIDENCE: The manager informed the inspector that the home did not provide intermediate care. The Green Nursing Home C02 C52 S2084 The Green V239769 190705 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10 Accurate care plans contribute to the delivery of care. The relatives and service users were satisfied with the care and service provision. EVIDENCE: On examination of 4 care plans the inspector established that the plans identified the service user’s needs, were up to date and evaluated on a monthly basis. The relative or service user had signed the plans to record that they had been consulted on the documentation. Archiving of documents was undertaken on a regular basis. There were systems in place to facilitate the retrieval of archived documents. This practice allowed the care plans to be maintained as ’working’ documents, which were easy to access, obtain information from, and up date, to maintain accurate information.
The Green Nursing Home C02 C52 S2084 The Green V239769 190705 Stage 4.doc Version 1.40 Page 10 On discussing the care with service users and relatives. They informed the inspector that they were satisfied with the care and service provision, and he received such comments as: ‘The care is good’. ‘The staff are kind’. ‘They cannot do enough for you’. The Green Nursing Home C02 C52 S2084 The Green V239769 190705 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 The service users, who spoke to the inspector, were satisfied with the quality of their meals. The registered person was unable to evidence that an alternative choice of meal was available to the service users. EVIDENCE: The inspector recognised that the main meal and dessert were displayed on the menu board. The kitchen staff advised the inspector that they were aware of the service users likes and dislikes, and would cater accordingly. An example given was that ‘if it was fish and the resident did not like fish, we would do her something else’. On raising the question of what would be ‘something else’ the inspector was advised by the kitchen staff that this ‘would depend on what was taken from the freezer, as some things had to defrost. The inspector raised the issue that pork steaks was the main meal at the time of the visit, and questioned what would occur if the service user decided that he/ she did not want pork. There was no alternative. The kitchen staff advised the inspector that an alternative meal would be quickly produced. The inspector then raised the issue that whilst other service users were eating that
The Green Nursing Home C02 C52 S2084 The Green V239769 190705 Stage 4.doc Version 1.40 Page 12 particular service user would then have to wait for the meal to be cooked. The staff accepted this comment. The inspector identified that there were several options available to improve the catering practice to offer the service users an alternative choice of meal. On discussing the meals with the service users, the inspector was informed of the following. ‘The food is good, but not sure what we are getting until I check the menu board’. ‘Don’t know what’s for dinner, but whatever they put in front of me, it will be nice’. ‘No idea what’s for dinner’. ‘Lovely meals, but I don’t like the hotpots that I am given’. The inspector concluded that the service users were not always offered a choice of meal. This conclusion was supported by the lack of menu showing an alternative, the observations by the inspector, the information received from the staff and service users. The manager identified that she took on board the inspectors comments and would review the catering practices. The Green Nursing Home C02 C52 S2084 The Green V239769 190705 Stage 4.doc Version 1.40 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 0 These standards were not assessed, at this inspection. EVIDENCE: The Green Nursing Home C02 C52 S2084 The Green V239769 190705 Stage 4.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 23, 24, 26 The environment, monitored at this inspection, had not been maintained to the required standard to provide a safe, well-maintained environment for services users. EVIDENCE: The inspector monitored the previous requirements from the last inspection, and established the following: The bedroom door locks to enable the service users to have privacy and security, if they wished had not been fitted. This matter had been discussed at previous inspections and the registered person had informed the inspector that he had decided to offer the service users a choice whether they wished to have a lock on the bedroom door, and to record this decision in the care plan. On examination of the care plans, the inspector established that there was a recorded entry elating to this matter. The lockable storage had been provided for every room.
The Green Nursing Home C02 C52 S2084 The Green V239769 190705 Stage 4.doc Version 1.40 Page 15 On touring the building, at this inspection, the following was found: Room 31 had a carpet, which had frayed where two pieces of carpet had been fitted together, so much so that the carpet edges were loose and were a serious tripping hazard. The manager acted promptly and secured the two edges together with adhesive tape, as an interim measure. This action alleviated the tripping hazard. The manager advised the inspector that a new carpet would be ordered. Rooms 12, 12a, 35, and the corridors walls between rooms 4 and 5 and the bathroom and the sluice room were in need of repair and redecoration. The bathroom opposite room 2 required repair to the wall and redecoration and the replacement of 3 tiles. Some of the rooms to the rear of the building have very reduced natural light, because of large trees outside the building. This issue had been previously discussed with the registered person, who had increased the wattage of the electrical light bulb, to improve the artificial light. Whilst the inspector accepted that this had increased the light lux within the room and that most service user were only in the their rooms during the evening, he did find one lady who was being nursed in bed 24 hours a day, with constant artificial light, and the window view obscured by the foliage of the trees. The registered person contacted the inspector, by telephone during the inspection. The inspector discussed the lack of natural light with the registered person. The registered person agreed to re-look at the problem created by the trees. The registered person’s wife, was on site at the time of inspection, she informed the inspector that the areas identified as requiring redecoration were already ‘booked in’ to be redecorated in August 2005. The Green Nursing Home C02 C52 S2084 The Green V239769 190705 Stage 4.doc Version 1.40 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Current staffing levels in place would appear to meet the current dependency needs of service users, accommodated within the home. EVIDENCE: On examination of the duty rotas and discussion with the manager the inspector established the following; On the am shifts, there were I qualified nurse and 6 care assistants. On the pm shifts, there were I qualified nurse and 5 care assistants. On the night shifts, there were I qualified nurse and 3 care assistants. In addition there was the manager, who was supernumerary, Caring for 34 service users (17 receiving nursing care, and 17 receiving personal care.) The Green Nursing Home C02 C52 S2084 The Green V239769 190705 Stage 4.doc Version 1.40 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The manager had acted on the requirements to ensure the safety of the service users and visitor. EVIDENCE: These standards were not monitored at this inspection. However a previous requirement was monitored. At the previous inspection, the inspector observed cleaning substances that were not locked away. The manager advised the inspector that since the last inspection, she had raised the need to ensure that the service users and visitors safety was not compromised, and that cleaning substances should be locked away. The Green Nursing Home C02 C52 S2084 The Green V239769 190705 Stage 4.doc Version 1.40 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 2
COMPLAINTS AND PROTECTION 2 x x x 2 2 x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x x The Green Nursing Home C02 C52 S2084 The Green V239769 190705 Stage 4.doc Version 1.40 Page 19 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. 2. Standard 24 15 Regulation 23 12 Requirement Timescale for action 03/05/04 3. 19,23,24, 26. 16 The registered person must provide locks that must be fitted to bedroom doors. The registered person must 19/08/05 ensure there is an alternative choice of meal and service users are aware of the choice, prior to mealtime. The registered person must 19/10/05 ensure that the service users live in a safe, clean, pleasant, well maintained environment. Therefore action is required to the rooms and facilities as listed in the body of the report. 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. Refer to Standard Good Practice Recommendations The Green Nursing Home C02 C52 S2084 The Green V239769 190705 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection South Point Cardinal Square Nottingham Road, Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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