Care Home: Green Gates Nursing Home

What the care home does well The service provides a friendly, well- maintained environment that the people who live there appear to enjoy. The healthcare need`s of the individual is planned for, provided, and external support obtained when required. What has improved since the last inspection? Areas of the home have been redecorated to keep the home a pleasant environment to live in. There is a continual programme of training to improve the knowledge of staff to be able to meet the needs of the people living in the home. What the care home could do better: The staff could look at making the daily records reflect the outcomes of the person`s day as to give a better holistic view of the individual. If they have to use agency staff occasionally, ensure that they have sufficient information about the key policies, procedures, and routines of the home before they commence working. The care and nursing staff should get more involved in supporting activities and personal interests of the people living in the home. This is in order to offer assistance at other times to when the Activities Coordinator is not in the home. The nursing and care staff should maintain good practices by ensuring that the `slings` used with the hoists are changed between residents. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Green Gates Nursing Home 2 Hernes Road Summertown Oxford Oxfordshire OX2 7PT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ruth Lough     Date: 1 2 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Green Gates Nursing Home 2 Hernes Road Summertown Oxford Oxfordshire OX2 7PT 01865558815 01865514090 wilcockm@bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: BUPA Care Homes (CFC Homes) Ltd care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: On admission persons should be aged 60 years and over. Date of last inspection Brief description of the care home Green Gates is a nursing home in Summertown in the outskirts of Oxford city and is part of the BUPA care home group. The home provides 24-hour care for older people who require nursing. Other services that can be arranged on request include private physiotherapy, chiropody and hairdressing. The home organises a range of activities for residents to enjoy. General practitioners from local medical practices provide medical care to residents, and other NHS services are available. The original building is a traditional Edwardian style town house, that has had several extensions and purpose-built additions made since its original registration as a nursing home in the 1980s. Although the home is registered to accommodate 40 residents, BUPA has chosen to accommodate all the residents in single rooms, with en-suite toilet and wash hand basin facilities, and therefore is able to accommodate 36 residents. There are Care Homes for Older People Page 4 of 28 Over 65 40 0 Brief description of the care home three ground floor lounges, a dining room, and a first floor sitting room. There are attractive accessible gardens to the rear of the home. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection process generated from the planned inspection programme for a service rated as a good provision. This inspection process included reviewing information provided by the service before a one-day visit to the home. During the day the records for care planning, recruitment, and administration of the service were assessed. The people who use the service were consulted about their opinion of what is provided. We also spoke to relatives and staff. From this visit it was found that they continue to provide a good quality service that is Care Homes for Older People Page 6 of 28 in the interests of the people who live there. A small number of good practice recommendations were given at the time of the inspection and can be found in the body of this report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective users of the service can be confident that their needs will be thoroughly assessed before a decision is made that the home will be able to meet them. Evidence: We looked at the processes the home carries out to assess the individuals needs before they are admitted. This was see, if the process is thorough and identifies the key physical, mental, and social needs of the person concerned. We reviewed the records of two residents who had been admitted to the home in the last few weeks to sample the quality of the process carried out. From the records seen there is formal process that ensures the person carrying out the assessment looks at the holistic needs of the individual. The document tool used, Care Homes for Older People Page 10 of 28 Evidence: QUEST, forms the basis to the care planning that is developed after the person is admitted to the home. Information from hospital discharge letters, other health professionals, and significant people involved with the individuals care and support, are included in the assessment process. The records reviewed showed that all the necessary questions are asked. However, some areas of information could be improved to give a better explanation and therefore assist with the development of the care plan. The involvement by the person concerned in the decision to move to the home is noted in the initial assessment process. We were informed that the, assessment of need process, is usually undertaken by the manager or deputy manager. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal care, physical and mental health needs of the people living in the home will be met. Evidence: The people we spoke to did confirm that they thought they were supported well and that they got the help that they needed. The records of three residents, were reviewed to see what information staff are provided with to ensure that the individuals needs will be met. Two of the records were those who we looked at in the assessment process, the other was of a resident who had complex needs. The documents were detailed and gave staff good information of how to achieve the best outcomes for the person concerned. Risk assessments are completed and reviewed for the key areas of personal safety and mobility. Monitoring tools are in place to assist staff to identify any significant changes, such as weight, dependency, Care Homes for Older People Page 12 of 28 Evidence: and nutrition. Additional records were in place for continence, and any specialist nursing tasks, such as wound care. As part of the policy in the home to keep information as open and available to the people receiving the support, the care plans are kept in the individuals rooms. We looked at the information included in the daily records, which showed that the registered nurses take the lead in noting the outcomes for the person concerned. Some of the records reviewed did indicate that the staff note the care tasks that had been achieved with the person concerned, but didnt reflect their personal wellbeing during that period. The current medication needs are recorded in the persons care plans and within central medication administration records kept in the home. We reviewed a sample of the records to see if this area of medication administration was carried out safely. From the small number of records seen, staff are suitably recording any administration process carried out. They are supported with a photograph of the individual and any significant information about allergies that all assist with ensuring safe practices. The safe practices of the storage of medication, was of concern during the day of this inspection visit. The clinical room where some of the medication is kept was unlocked and at least two of the cupboards were again unlocked. This was against the instruction in the medication policy and procedure and could of put residents at risk. The manager sought the agency registered nurse responsible who was on duty at the time to secure the facilities. The manager and deputy manager were advised to look at what instruction and guidance agency staff are provided with in regard to the homes policies and procedures. The manager did provide information that the home is looking at providing a more focussed approach to caring for people at the end of their lives. The deputy manager has attended the necessary training to implement the Liverpool Care Pathway, with the involvement of individuals GP, as to improve the quality of support for people before their death. Some of the personal choices and wishes that people have about how they wish to be cared for at this particular point in their lives is recorded in the care planning documents. However, most of this information was mainly in regard to choices for care Care Homes for Older People Page 13 of 28 Evidence: after their death. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal choices of how people want to live and continue with their interests are supported. Meals and menu planning meets the needs of the people living in the home and appears to be enjoyed. Evidence: The people, we spoke to, stated that there was a varied activities programme that they could join in if they wished to, but they were equally supported to decline. From the records we reviewed and from what they told us they are able to conduct their lives as much as they are able and as they choose. Personal choices of daily routines are listened to and acted upon by staff, unless the person is seen to be at risk from harm. Several of the residents are enabled to continue with their interests outside of the home. Some of these activities include, visiting their friends and family, shopping, and walking their pet dog. The information about personal interests and activities that they enjoy is taken during Care Homes for Older People Page 15 of 28 Evidence: the assessment process and passed to the activities coordinator who takes the lead in creating or sourcing different pastimes for them. At present the main records of personal choices, an individual plan, and the outcomes for them are kept by the activities coordinator, and not in the central care records. Therefore, if the coordinator is not in the home, other staff are not continuing with providing this much valued support. The records we saw were comprehensive in identifying personal needs and the planning carried out by the activities organiser did focus on finding both communal activities and those that could be provided on a one to one basis. However, it was evident that it was difficult to deliver what was intended on the current twenty hours per week that she was in the home. From what we observed the nursing and care staff do not have much involvement in the activities going on. During the day a local college visited and provided a musical interlude for those residents who wanted to attend. From what we observed the music and the company of the young people, was enjoyed by all. The care planning records we reviewed did identify if someone had any religious or cultural needs. However, the strategies or how they met these needs were not recorded in depth. The manager and some of the staff who we spoke to did provide further information that indicated that support was provided. They now need to ensure that their record keeping matches what they actually do. The people we spoke to confirmed that they enjoyed the meals provided and this was evident from what we observed of the midday meal during the day of the visit. The home has a separate dining room that appears pleasant, fairly spacious, and presented well. Residents are enabled to eat their meals where they wish but are encouraged to join the others in the dining room for the main meal of the day. The staff have introduced two meal sittings as to provide the extra focussed time for people who need added support to eat their food. This means that the staff can spend the required time to make the process unhurried and at the pace of the person concerned. The dietary needs and personal preferences for food are noted in the care plans and significant information is passed to the chef. The menu is planned in a four-week rotational programme and it offers a variety of choices for people to have, at each mealtime. Choices are obtained the day before, but there is a flexible approach should they change at the time of the meal. Care Homes for Older People Page 16 of 28 Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the service can have confidence that their concerns will be listened to and acted upon. They can also be confident that staff are trained and enabled to make sure that they are protected from possible harm or abuse. Evidence: The residents of the home are provided with the information of how to make a complaint or comment about the service in the Statement of Purpose and Service User Guide that they given on arrival to the home. Additionally the complaints procedure is on display in a central part of the home. Residents also make an opportunity to speak to the receptionist who is stationed in the inner hallway of the home as they pass by. From what we observed all of the staff on duty during the day of the inspection, appeared friendly, responsive and communicate well with the residents and visitors to the home. This was reflected in some of the comments made by the residents we spoke to. We looked at the documented information the manager had about the complaints they have received since the last inspection process. The home have had a number of complaints made to it about the service from one individual who visits on a regular basis. The commission has also been contacted by the same individual in regard to their worries about support provided in the home. The matters raised, could be seen by the copies of the comprehensive communications between the complainant, the Care Homes for Older People Page 18 of 28 Evidence: home, the organisation, and other relevant bodies, to have been listened to, investigated, and any action if required put in place. The manager of the home has also instigated strategies to ensure that communication is maintained and that to prevent the concerns being raised again. No other complaints have been received about the home. They do have a method of recording the investigation of a complaint made and have a process of ensuring that the provided is kept informed of any concerns raised. However, they do not at present have a system of logging or monitoring concerns or complaints made in the home for quality assurance processes. If they had this in place it would assist them to assess trends or common factors that may help to identify and help in implementing improvements to the service. The home has the required information available to staff to support them recognise and manage any concerns of possible abuse. The organisations policy and procedure directs staff to the local inter- agency procedure and is left accessible to staff. Protection of Vulnerable Adults training is incorporated in the ongoing training plan that ensures that all levels of staff, including the maintenance, gardening and catering staff, have the knowledge to seek help if concerns are raised. The manager has had a situation of concern in the recent months, and appropriately sourced support and advice to manage the situation. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment of the home is kept maintained, pleasant to live in and meets the needs of the people who live there. Evidence: The home was not purpose built but has been adapted sympathetically to provide good communal and private spaces for the residents living there. There is a good standard of maintenance, renewal, and continual programme of redecoration carried out. Residents are provided with a secure and sheltered garden that gives them a pleasant area to enjoy the outdoors in the warmer months. Care is taken to ensure that the garden is maintained and can still be enjoyed from the windows of the home in the winter. The storage facilities for some of the equipment, such as hoists, weighing scales and linen trolleys, is limited. Care should be taken not to leave in corridors or at the base of stairways as to ensure that fire and personal safety is not put at risk. Residents are provided with reasonably sized bedrooms, all with en suites of toilets Care Homes for Older People Page 20 of 28 Evidence: and hand basins. Throughout the bedrooms there is plenty of storage space for personal possession. They should think about possibly providing a little more storage or shelving in the en suites as to accommodate personal toiletries, tooth brushes, etc. as some residents are using the cisterns of the toilets for this purpose. Through discussion it was identified that staff are not changing slings for the hoists between residents as routine. The home does have a good supply of disposable hoists slings for this purpose but staff have not got into regular practice using these. This is an area of good practice that they must implement as to minimise the risk of cross infection between residents. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The number of staff, qualifications, and training provided to them meets the needs of the people living in the home. Evidence: We observed very positive relationships between the residents and staff during the day of the inspection visit. From information available there appears to be sufficient staff on duty at all times of the day. Agency staff are only used when the regular bank staff are not able to support the home at short notice. A sample of recruitment and employment records were reviewed as to see if sufficient numbers of qualified, experienced staff are working in the home. The two recruitment records of staff employed in the recent months showed that the required information and checks are carried out before they commence employment. However, better care should be taken to check the gaps in the persons work history and ensuring that an explanation is recorded in the records why a reference from the last employer has not been obtained. The manager does not routinely keep the records of any interview or selection process with the employment records and this would help to evidence the discussion about Care Homes for Older People Page 22 of 28 Evidence: work history and referees. Copies of the terms and conditions, job descriptions are kept in these records. Also qualifications and training certificates seen and copies are retained. Any registration with a professional body, such as the Nursing and Midwifery Council is checked and copies of the relevant documents are kept. The manager also provided evidence that the registration status, of the nurses is re- checked on a regular basis. There is a structured induction programme for all staff that includes the key health and safety topics. Additionally the trained staff are given a revisit to the medication practices before they are allowed to carry out any administration process. From the observation and the discussion with the deputy manager it was apparent there is no formal documented induction process for agency staff only a practical orientation to the home when they arrive on shift. They were advised to look in conjunction with their agency staff provider how they can improve this so that those employed have sufficient knowledge to ensure they carry out their responsibilities in accordance to the home own procedures. This would prevent any lapses in practices and provide better continuity of service. Training provided by the provider organisation includes NVQ s and safe working practices. Additionally, there has been training specific to the provision of care and residents medical conditions. The recent training programme has included the Mental Capacity Act, prevention of cross infection, care of the dying, and basic dressing technique. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is run in the best interests of the people living there, and is managed effectively by a knowledgeable experienced manager and provider. Evidence: The manager is an experienced registered nurse and has been in her role for a considerable length of time. She has obtained an RMA (Registered Managers Award) and continues on a regular basis to attend training through the provider to maintain her knowledge and skills for her role. They have a rolling programme of quality assurance that includes consulting with the people living in the home every six months through surveys. They also encourage the relatives and residents to meetings to give them the opportunity to comment. Regular reviews of care provide the opportunity to obtain formal comments from the resident concerned. Care Homes for Older People Page 24 of 28 Evidence: Regular quality monitoring visits from the providers senior management look at key areas of care and service provision and include sampling the relevant documents. The home does manage small amounts of residents money to be used for the purchase of hairdressing, toiletries, newspapers, and other expenditures. The have a system in place whereby items purchased are invoiced and managed through an account held on their behalf. All transactions are audited regularly both within the home and by the accounts department of the provider. Residents are enabled to hold small amounts of money should they wish or be able and a lockable space can be provided in their rooms for this. We looked at what the home has in place for safe working practices as to ensure the safety and wellbeing of the residents, staff, and visitors to the home. Staff are provided with the necessary policies, procedures, and training for safe working practices. There is also a regular programme of checks fire safety. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!