Care Home: Greengables Nursing Centre

What the care home does well Greengables is a well run and managed home. A relative commented, "Greengables is the best nursing home in the Congleton area. The residents are very well cared for. Staff are helpful, kind and caring. The management is very good and effective." A staff member wrote, "the home provides a really homely environment for residents - it does really feel like one big family". People have their needs assessed before they move into the home to make sure that their needs can be met at Greengables. Staff at Greengables have good working relationships with health professionals and makes sure that people living in the home receive support and advice when they need it. This helps to make sure they stay as healthy as possible. The home provides a wide range of activities both on a one to one and group basis so that people are stimulated and have the chance to join in social activities. The standard of catering is good and visitors are made very welcome at the home and invited to join in activities and meals so they feel part of the home. The home receives very few complaints and these are well managed so people living at Greengables can be confident that their concerns will be listened to and acted upon. Greengables offers a homely, safe and comfortable living environment that suits the needs of the people who live there. There are thorough recruitment procedures and good staffing levels at the home. Staff are trained to carry out their role. They enjoy working at the home and there is a low turnover of staff. One staff member wrote, "creates a warm, friendly, caring, pleasant atmosphere for all our residents, families and friends. We are more like a big family who enjoy all our residents and love them as individuals". What has improved since the last inspection? A sensory garden and raised flowerbeds have been completed, enhancing the outside of the home and providing enjoyment for people living in the home. The management of medication has improved so people living in the home receive their prescribed medication in a safe manner. The complaints procedure is included within the information pack so people living at Greengables and their relatives know what to do if they have a concern or complaint about the home. There is always someone on duty who is competent to deliver first aid so people living in the home are protected. What the care home could do better: Care plans should be written within at least five days of admission so that staff are fully aware of the care needs of the person and what actions need to be taken to meetthose needs. Staff should undertake periodic refresher training in safeguarding adults so they are aware of their responsibilities and what to do if they suspect someone is being abused. All staff should do refresher training in safe moving and handling techniques so they know the correct processes to use to make sure they and the people who live at the home are safe. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Greengables Nursing Centre 54 Sandbach Road Congleton Cheshire CW12 4LW     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: June Shimmin     Date: 2 1 0 5 2 0 0 9 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. that people have said are important to them: They reflect the things 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 26 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Greengables Nursing Centre 54 Sandbach Road Congleton Cheshire CW12 4LW 01260270030 01260297848 robeanne@bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : BUPA Care Homes (ANS) Ltd care home 31 Number of places (if applicable): Under 65 Over 65 31 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following category of service only: Care home with nursing - Code 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 - Code OP. The maximum number of service users who can be accommodated is: 31. Date of last inspection Brief description of the care home Greengables Nursing Centre is a detached, two storey Victorian house standing in its own grounds. It is on the outskirts of Congleton, approximately one mile from the town centre. The accommodation for the people who live at the home is on two floors. Access between them is by a passenger lift or one of the staircases. There are three lounges and a dining room on the ground floor. There is an enclosed patio that can be reached through the dining room. Bedrooms are single rooms, 18 of which have en-suite facilities. The rest of the bedrooms have wash hand basins in them. There is easy access for wheelchairs through the main entrance and to all parts of the home. Care Homes for Older People Page 4 of 26 Brief description of the care home There is always at least one first level registered nurse on duty. The weekly fees are 450 to 700 pounds, which includes the nursing contribution. There are additional charges for hairdressing, toiletries, newspapers and chiropody. Care Homes for Older People Page 5 of 26 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: The last inspection on this service was completed on 30 May, 2007. The overall quality rating for this service is two stars. This means that the people who use the service experience good quality outcomes. This unannounced inspection visit took place over nearly six hours. One regulatory inspector carried out the visit. The report will refer to we and us as it is written on behalf of the Care Quality Commission. This visit was just one part of the inspection. Other information received was also looked at. Before the visit the manager was asked to provide information about the Care Homes for Older People Page 6 of 26 home as part of this inspection process. We sent questionnaires to people living in the home and staff members to find out their views about Greengables. We also spoke to a number of people living in the home, several relatives, staff members and a visiting health professional during our visit to the home. Their views are incorporated into the findings of this report. During our visit we looked at various records and the premises. Records of care plans, medication and staff training records were also examined. What the care home does well: What has improved since the last inspection? What they could do better: Care plans should be written within at least five days of admission so that staff are fully aware of the care needs of the person and what actions need to be taken to meet Care Homes for Older People Page 8 of 26 those needs. Staff should undertake periodic refresher training in safeguarding adults so they are aware of their responsibilities and what to do if they suspect someone is being abused. All staff should do refresher training in safe moving and handling techniques so they know the correct processes to use to make sure they and the people who live at the home are safe. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 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 10 of 26 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. People have their needs assessed before they move into Greengables so they know their needs can be met at the home. Evidence: We looked at the assessments of two people who had recently been admitted to Greengables. The homes manager or a senior nurse do the assessments so they are done by people who are skilled and competent. The assessment document is a BUPA form and includes a ticklist format so that the manager ticks a box which best describes the persons ability in carrying out activities of daily living. There is also space for further comments to be made. The content of the assessments was satisfactory and included sufficient information regarding the persons care needs and any identified risks so that staff could draw up a care plan to meet that persons needs. During the process of moving into the home, care staff ask family members complete a form about the person and their life, education, family, career, interests Care Homes for Older People Page 11 of 26 Evidence: and hobbies so that staff have a good understanding of the person as an individual. This enables them to provide care that is person centred and is good practice. It also shows that people and their relatives are involved in the assessment and care planning process so they are able to give information about their preferences in relation to how care is provided. One person living in the home said that, she was settling in well. Care Homes for Older People Page 12 of 26 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. Peoples care plans contained the information needed so their health and personal care needs were being met by staff who respected their privacy and dignity. Evidence: We looked at the care plans of two people, one person who had recently moved into the home and another person who had been living there for some time. This was to see what care they needed and how this was being provided. Although risk assessments were in place for the person recently admitted to the home, staff had not yet drawn up care plans as the manager told us that the home needs time to compete a full assessment. The second care plan for someone living in the home had been written within five days of them moving in so that staff knew what actions to take as these had been fully documented. The home has introduced a new care planning format, which is written in a way that is intended to be person centred and so that people living in the home are regarded and treated as individuals. Some of the documentation was difficult to follow as there Care Homes for Older People Page 13 of 26 Evidence: seemed to be some duplication of records. This made it difficult to track what was happening for one person in relation to the prevention of pressure sores. This care plan had been kept under monthly review so that any changing needs were recorded. The home staff try to involve the person, or where this is not possible the nearest relative, in the care planning process. People living in the home have a keyworker who takes responsibility for ensuring that there is good communication with the family. This helps to make sure that people living in the home have all that they need, for instance personal toiletries. Greengables staff maintain good and effective contact with health professionals. A health professional who was visiting the home for the first time when we were there was very complimentary about the home and said, patients feet are well kept. We spoke to a relative during the visit and three relatives completed comment cards whilst we were at the home. All were very happy with the care provided for their relatives at Greengables. One wrote, looks after residents very well and another said, very good - especially now as shes deteriorated a lot - coping with her very well. We looked at how medication was being managed and this was of a good standard so that people received their medication as prescribed. Care Homes for Older People Page 14 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities and meals are both well managed so they provide daily variation and interest for people living in the home. Evidence: Many people living at Greengables are able to enjoy a good lifestyle with a variety of options to choose from. Routines are made as flexible as possible so people living in the home can make choices in major areas of their life wherever practicable. People are able to take part in activities arranged by the home or if they prefer follow their own interests. One person living in the home said, can join if you wish, get up and go to bed when I want. Staff knock on door. During our visit a flower demonstration was organised for the afternoon which was attended by a number of people living in the home and several relatives. Other people were observed reading or talking in small groups. Greengables has very good relationships with family members who are made to feel welcome both at events taking place in the home and for Sunday lunch, which are freely available. Staff at the home also arrange events such as a world cruise with themed meals and events designed to stimulate people living in the home. Greengables employs an activities organiser who draws up a weekly programme of Care Homes for Older People Page 15 of 26 Evidence: events so people are aware of what is available if they wish to join in. An event had been organised involving people from a nearby care home and staff at Greengables had designed their own invitations to this event. One relative wrote, look after the needs of visitors well, ie by communication and making them feel welcome when visiting and Greengables entertainments are fun and welcoming to visitors. The standard of catering at Greengables is good. People living in the home told us that they enjoyed the food provided and there was evidence that much of the food is home baked and uses mostly fresh produce. A small garden area in the central courtyard of the home has been set aside to grow vegetables such as cress, tomatoes and runner beans that are then used in meals for the people living at Greengables. The dining room offers people a relaxing and pleasant environment in which to eat meals and menus are provided on tables so people know what food is available. The main meal of the day is served in the evening and people can eat their meal in their own room if they wish. Care Homes for Older People Page 16 of 26 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. There are clear procedures for dealing with complaints and safeguarding so that people living at Greengables can be confident their concerns will be listened to and acted upon. Evidence: Greengables has a complaints procedure, which is displayed in the foyer of the home and is also available in the information leaflet (service user guide) given to people when they move into the home. People we spoke with and those people who returned comment cards said they would know who to speak to if they had any concerns. Greengables has received very few complaints and has fully investigated these and taken appropriate action to put any issues right. The home has a policy about safeguarding adults, which was last reviewed in December 2006. The manager told us that staff undertake training in this subject during the induction process and as part of their NVQ training. However, a number of staff have not undertaken refresher training in safeguarding adults since 2007 so may not be fully aware of their responsibilities in this regard. We spoke to one staff member who told us that she would know what to do if she suspected someone was being abused. The manager told us that she had attended a training day in safeguarding adults so the home has its own trainer to do this training. Care Homes for Older People Page 17 of 26 Care Homes for Older People Page 18 of 26 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. Greengables is well maintained so that it provides a safe, homely and pleasant living environment. Evidence: We walked around the home and found it to be clean, tidy and well maintained. Greengables offers people homely, comfortable and relaxing surroundings in which to live. The standard of decor, fixtures and fittings is good and there is an ongoing redecoration programme to upgrade the premises. During our visit we noted that a shower room was being improved. Outside the home, maintenance staff have made a sensory garden and raised flower beds for the enjoyment of people living in the home. A relative commented, the home is very clean. There are effective measures used in the home to protect the people living there from possible infections. Care Homes for Older People Page 19 of 26 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. Staffing arrangements, recruitment and training ensure that people are cared for and supported safely. Evidence: We looked at staffing levels at Greengables and these seemed to be sufficient to meet the needs of people living in the home. Staff who returned comment cards about the home considered that there were usually enough staff to meet the individual needs of all the people who use the service. People living in the home who returned comment cards also said that there were usually staff available when they needed them. The manager told us, we have a good level of retention so that there is a low turnover of staff at the home, which means there is good continuity of care. We observed staff carrying out their duties and they appeared happy in this role. They made the following comments, Greengables employees do their utmost to treat their residents with respect, dignity and individuality also holistically and communication is always well understood and there is generally a good aura. Relatives also spoke favourably about the staff in the home saying it provides a homely and caring environment. We looked at the records of two new staff to check on how they had been recruited. Care Homes for Older People Page 20 of 26 Evidence: The files contained all the necessary information including security checks from the Criminal Records Bureau (CRB) and two references. New staff are given an induction booklet and we saw one that had been completed by a staff member to show they had done everything required. The home uses the standards linked to Skills for Care, which is a nationally recognised organisation in relation to care standards, so is of a good standard. Staff are encouraged to do training which is relevant to their role and the manager told us that more than 50 percent of staff have achieved a national vocational qualification at level 2 in care. The home is also recognised as a suitable placement for student nurses from Keele University. Care Homes for Older People Page 21 of 26 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. Greengables is well managed so that it is run in the best interest of the people living in the home. Evidence: The manager of Greengables has 13 years management experience and has completed a national vocational qualification at level 4 in management. She has a degree in Health Education and is a moving and handling and safeguarding adults trainer. The manager told us that she has done training in equality and diversity but has not yet provided this training for staff in the home. The manager told us that all staff are supervised and that staff meetings are held monthly so that staff receive feedback about training and care issues and are able to say what they think about how the home is managed. The manager told us that various methods are used to find out how well the home is Care Homes for Older People Page 22 of 26 Evidence: performing as a care service. These include monthly visits by a senior manager of BUPA to check how the home is running and a report is made of the findings each month. The manager also carries out her own regular checks on aspects of management of the home such as medication, care plans, complaints, recruitment and training so that she is aware of any areas for improvement. We looked at the way in any money being held on behalf of people living at Greengables is managed and found this was satisfactory, with full information to show correct balances. We also reviewed training in mandatory subjects such as fire safety and moving and handling. Fire safety training was up to date but six staff had not done moving and handling training since 2007 so might not be fully up to date in terms of safe practice. Care Homes for Older People Page 23 of 26 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 24 of 26 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 7 Care plans should be drawn up within five days of the person moving into the home so their care needs are identified promptly and guidance for staff on how to meet those needs is recorded. All staff should undertake periodic refresher training in safeguarding adults so they know what to do if they suspect someone is being abused. All staff who have not received up to date training in moving and handling should do so to make sure they know the correct techniques for moving and handling so they and the people who live in the home are safe. 2 18 3 38 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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). 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