Care Home: Green Pastures Christian Nursing Home

What the care home does well The home provides a comfortable, clean and homely place for people to live in. Good health care is provided, and people are able to make complaints when they need to, and know they will be listened to. A variety of appropriate equipment is available to help people manage their personal needs, and new pieces of equipment have been provided recently. The home is able to meet the needs of people from different backgrounds, race, ability and culture. Christian religious services are held in the home two or three times a week, for those who want to attend. Two individuals said that the staff team were `very nice` and people who responded to our survey said that staff members were available when they were needed. One relative commented that it was the `great care` of the staff team that helped one individual recover from illness, and another said that `all aspects of the home and care are excellent`. Staff training is good, and the registered manager provides good clinical leadership to the team. What has improved since the last inspection? There have been several improvements to the environment of the home. There is a new conservatory, and new wood flooring to several bedrooms. New equipment has been purchased, including new hoists and a different type of chair to improve life for individuals. The staff training programme has continued, and the home is now part of the Liverpool Care Pathway programme, about improving care at the end of life. The variety of choice for the evening meal has improved, and people told us that they enjoyed the improvements, especially the hot dish provided in the evenings. What the care home could do better: The social activities provided at the home need to be shown on a form separate from the religious service details, so that people living in the home know what social activities are provided. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Green Pastures Christian Nursing Home The Hawthorns Banbury Oxfordshire OX16 9FA     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: Kate Harrison     Date: 0 3 1 0 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 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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 24 Information about the care home Name of care home: Address: Green Pastures Christian Nursing Home The Hawthorns Banbury Oxfordshire OX16 9FA 01295279963 01295701501 belinda@green-pastures-christian-nursinghome.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Belinda Victoria Woodward Type of registration: Number of places registered: Green Pastures Limited care home 30 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 Pastures Christian Nursing Home is a purpose built care home located on the outskirts of the market town of Banbury. The home is operated as a `not for profit Christian organisation through Green Pastures Ltd, and is a registered charity. The board of directors has responsibility for the home, which is overseen by the home manager, who is the registered Responsible Individual. The home has a registered manager who is in day-to-day charge of the service, and responsible for the care of residents and staff deployment and management. The home is registered to provide nursing care for 30 older people aged 60 and over. Accommodation is provided on ground and first floors, and a passenger lift is provided. The home has various adaptations to meet the needs of residents and the ground floor is fully wheelchair Care Homes for Older People Page 4 of 24 Over 65 30 0 Brief description of the care home accessible. There is a choice between three main lounge/dining rooms, and a further small lounge is also available. The home has an attractive, enclosed rear garden, with areas of shade and a range of seating available. A conservatory has recently been added. The home has a strong Christian ethos, but this does not preclude residence by people who belong to other denominations and have different religious beliefs. Care Homes for Older People Page 5 of 24 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 inspection of the service was an unannounced Key Inspection. We arrived at the home at 11am and the inspection lasted for 5 hours. This inspection was a thorough look at how well the service is doing. It took into account detailed information provided by the service through the Annual Quality Assurance Assessment (the AQAA) and any information that we received about the home since the last inspection. The general manager is in charge of the home, assisted by the registered manager and the deputy manager. The registered manager (the manager in this report) and the deputy manager are nurses, and the registered manager is responsible for the quality of care provided. We saw most areas of the home, including all the shared areas and looked at records and documents relating to the care of the people living there. We asked the views of the people who live in the home and other people seen during the inspection Care Homes for Older People Page 6 of 24 or who responded to questionnaires we sent out, and their views are included in this report. We observed how lunchtime was managed and how people spent their time during the day. We checked the recruitment process and the homes staff training, and saw other documents relating to the running of the home. We looked at how the home was meeting the standards set by the government and in this report make judgements about the outcomes for people living at the home. The fees for this service range from GB pounds 625 to 677 per week, and our last inspection was in December 2006. 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 24 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 24 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. An assessment of individual needs is carried out before people are admitted to the home, to make sure that the home can meet their needs. Evidence: The home does not provide intermediate care, so this standard does not apply. The manager usually carries out the pre admission assessments at home or in hospital, to make sure that the home can meet the needs of the individual. The home receives the assessment documentation for individuals funded by the local authority before the pre admission assessment is carried out. We saw the pre admission assessment of two individuals, and these were appropriate and detailed, so that a decision could be made about admission to the home. The results of our survey showed that people said they received enough information about the home before moving in. Care Homes for Older People Page 10 of 24 Care Homes for Older People Page 11 of 24 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 health and personal care needs of the people in the home are recognised and met. Evidence: We saw the detail of two individuals care plans, showing that their personal and social needs, and their physical, psychological and emotional health needs were recognised. We noted that the documentation takes into account the individuals choice regarding how care is received, and that personal preferences are recorded, although individuals have not signed their care plans. We noted that one care plan was not updated to reflect the individuals current needs, although it was clear from the daily record that the needs were met. The manager has plans to improve the way the care plans are updated, and is discussing the best way forward with the senior staff. Risk assessments were carried out to determine how the staff team should look after key aspects of their care, including how to manage moving about, their nutrition and personal care. The manager is planning to implement the nationally evidenced based nutritional assessment tool, and to record the Body Mass Index (BMI) for each individual, as this will improve how nutritional needs are managed. A recommendation Care Homes for Older People Page 12 of 24 Evidence: was made at our last inspection that the records of any accidents should be kept in individual care records, but this is not being implemented. Each person has an individual emergency evacuation plan, and can see their general practitioner as necessary. Daily records are completed showing the outcome of how the individual spent the day, and details of any significant event. As the care plans seen were not signed by the individual or his/her representative, the manager discussed how she intended to address this at annual reviews or at discussions with the families. No one at the home manages their own medication, and there are good systems in place to keep medication appropriately and securely. The deputy manager is responsible for the management of the homes medication, and the staff team have access to the homes policies and procedures about medication. We checked how medication was managed for two individuals, and we saw that their medication was given as prescribed. The record for one cream was not completed at the time it was given, as the carers usually administer the medication and the deputy manager said she would address this so that carers kept a record at the time it was administered. Medication audits are carried out regularly, and these have proved useful in improving practice. People responding to our survey said that they always or usually received the care they need. We observed the care practice of some of the staff team, and noted that people are treated with care and respect, and that attention to detail is seen as important. The manager said she was considering how to signify in the care plans that the staff team are mindful of the Mental Capacity Act 2005, when they make decisions on behalf of individuals who do not have capacity to do so for themselves. Care Homes for Older People Page 13 of 24 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. People living in the home are encouraged to choose their daily routines as far as they can, and are supported to do so by the homes policies. Evidence: At our last inspection a recommendation was made that the home should consider how the activities programme could be extended throughout the week. We saw the activities programme for the week of 5th October, the Monthly Diary, and noted that Christian religious services are included with the activities schedule. There were several days when there were no social activities organised for people. People who responded to our survey gave a variety of replies to our question about the availablity of activities they could take part in, the majority saying that they were arranged usually or sometimes, and others saying always. The homes AQAA states that the activities programme is good and varied, but the October schedule shows that religious services make up a large part of the schedule. We recommend that a separate social activities diary is produced, so that it is clear to the people living in the home what are social activities and what are religious services. We understood that not all the activities provided are on the programme, as the manager mentioned a weekly event at Monday lunchtime including a glass of sherrry for those who want it, and all the Care Homes for Older People Page 14 of 24 Evidence: activities provided need to be on the programme, so that everyone is aware of what is available to them. People we spoke to said they enjoyed the food provided, especially the improved choices in the evening including a hot dish. Visitors are welcome at the home and several were in the home on the day of our visit. People can bring personal possessions with them and are encouraged to manage their own affairs for as long as they are able to. Care Homes for Older People Page 15 of 24 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. People in the home can make a complaint and know it will be addressed, and they are protected from harm by the homes procedures. Evidence: The homes complaints procedure and complaint forms are available for people to complete if they want to in the entrance hall. We saw the complaints record, and the manager encourages people to discuss any concerns or complaints with her. We have received no information about complaints since out last inspection visit. People who responded to our survey said that they knew how to make a complaint if they wanted to. We saw the homes safeguarding procedure, and it contains the information the staff need to report any concerns about the safety of the people living in the home. All the staff team have attended safeguarding training, and we have received no information about safeguarding concerns since our last inspection visit. Care Homes for Older People Page 16 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home have a safe, well-maintained and clean place to live in, and benefit from the new conservatory. Evidence: We saw all of the shared areas of the home, and the living and dining areas were comfortable, clean and hygienic. Improvements include more new flooring, new equipment including seating and a new conservatory. People told us that they appreciate the conservatory as it offers an improved outlook onto the garden. There is a separate room for use of the visiting hairdresser, so that people can have privacy while having their hair done. All communal areas are accessible by wheelchair, including the garden and the garden offers a delightful area to meet the needs of the people in the home. The home has a routine maintenance programme, and during our visit a new carpet was being laid on the stairway. The laundry is well managed and staff follow the infection procedures to minimise the spread of infection. New flooring has been fitted to help minimise the spread of infection, and all the care staff have atended infection control training. Care Homes for Older People Page 17 of 24 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. People at the home are cared for by a staff team who are well trained and responsive, but the home needs to act on our recommendation about keeping records of Criminal Record Burea Checks. Evidence: The home has a rota showing the numbers of staff at the home over the twenty four hours and at least one registered nurse is always available. People who responded to our survey said that there are always staff available when they are needed, and that they listen and act on what they say. The manager said she uses the homes staff to fill shifts when carers are unexpectedly away, and this arrangement suits the people living in the home. The deputy manager manages the staff training, and the homes induction programme is to the appropriate standards. The home is making good progress towards meeting the national minimum standard of 50 trained carers, as 12 of the 25 care staff now hold the National Vocational Qualification (NVQ) Level 2 in Care, and 5 more are doing the course. We saw records showing that several of the registered nurses had taken update and further training in the past year, and all the registered nurses hold current first aid certificates. All the carers have update training on key health and safety topics regularly. We saw the recruitment records for 2 staff showing the recruitment process. The process was thorough, but we saw no evidence that one individual had a clear CRB, as Care Homes for Older People Page 18 of 24 Evidence: there was no record kept. At our last inspection it was recommended that a record of the Criminal Record Bureau (CRB) certificate number be kept if the certificate is destroyed, so that evidence is available that the person is safe to work at the home. We received confirmation following our inspection visit that the CRB checks had been carried out and were satisfactory. Care Homes for Older People Page 19 of 24 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 home works in the best interests of the people living there. Evidence: The home is managed by the responsible individual and the registered manager on a daily basis. The registered manager is experienced and skilled at managing the home, and gained her NVQ Level 4 Registered Managers Award this year. She provides clear leadership to the staff team about good practice and is approachable and welcoming to visitors and to people living in the home. She has an interest in end of life care, and has arranged for the home to be part of a national programme so that the home can develop best practice to benefit the people in the home. The home has met the three requirements made at the last inspection visit, and has continued to improve the environment of the home. Meetings are held regularly with people living in the home chaired by a member of staff. An annual quality assurance assessment is carried out annually, including surveys to relatives, and following the inspection visit we received information that the 2008 assessment was recently conducted. A letter about the Care Homes for Older People Page 20 of 24 Evidence: homes annual quality assurance assessment results is sent to people who return questionaires. The home manages some petty cash on behalf of some of the people living in the home who cannot manage it themselves, and keeps these securely. The manager explained that individual accounts are kept with receipts and balances, and that the individuals can have access when they want. At our last inspection a recommendation was made that the record of accidents to individuals living in the home be kept in their individual files. This has not yet been addressed, but the home is planning to do this soon. The home has a health and safety policy statement, but the AQAA shows that some policies are not yet in place to help the home meet its obligations. Following our inspection visit the registered manager informed us that these policies are now available. The AQAA shows that the homes equipment is serviced or tested regularly, and the annual testing of portable electrical appliances has been carried out. All the nurses working in the home have updated first aid certificates. The home has a risk assessment in place for fire safety, and training is provided regularly for staff. Care Homes for Older People Page 21 of 24 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 22 of 24 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 1 12 That the home considers providing a separate social activities schedule from the religious services schedule, to make sure that people understand what social activities are provided by the home. Care Homes for Older People Page 23 of 24 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 © (2009) 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 24 of 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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