Care Home: Greenslades Nursing Home

What the care home does well The anonymous caller told us that people living at Greenslades were being bathed in cold water. We talked to the manager and staff about the normal practice throughout the home when staff assist people with bathing, showering and washing. We heard that approximately 3 months ago there was a short period of just a couple of days when some parts of the home were affected by boiler problems. While the heating in the home had not been affected, the water temperature from the hot water taps in a few bedrooms had been affected. The problem was quickly resolved by plumbers. The care staff we talked to said it had not been a problem as they were able to fetch hot water in a bowl from another sink nearby. We were told that almost everyone who lives in the home prefers to have a shower rather than a bath. The showers are electrically heated and thermostatically controlled and therefore the showers have always worked efficiently and have not been affected by hot water problems at any time. One person on Belvedere always liked to have a bath and two people on Isca. We talked to one of these people and they were told us their baths have always been the correct temperature and they have always been warm enough when having a bath. The care staff showed us the procedures they always follow before a person takes a shower. There is a thermometer tied to each shower rail and the staff showed us how they check the temperatures to ensure they are correct. We looked at the way the home has recorded the temperatures of the water in the showers and baths. We saw a bath and shower recording book that had been completed regularly until October 2008. The staff were unsure why the recording had suddenly ceased, but thought it was possibly due to a new system or recording that had been brought in around that time. We talked to the manager about the recording systems and she assured us they will resume hot water temperature recording immediately. Despite the lack of temperature records we were reassured by the staff we talked to, and by checking the showers and observing the procedures the staff follow when assisting people with a bath, shower or wash, that the water has always been comfortably warm. The baths and showers have temperature regulators to prevent scalding. We found no evidence to support this part of the complaint. The anonymous caller told us that there were too few staff to help people who needed one to one assistance with their meals. On the day of our inspection there were 30 people accommodated in Belvedere (15 people on the upper floor and 15 people on the lower floor) and 35 people accommodated on Isca (18 people on Lower Isca and 17 people on Upper Isca). Each unit had 1 trained nurse in charge and 3 care assistants. We talked to each of the trained nurses in charge of each wing about the staffing levels, and about the staffing needs of each unit particularly at meal times. We were told how the staff organise themselves so that the meals are dished up, medicines are administered, and people are given the assistance they need. Each of the nurses we talked to said they felt the staffing levels were sufficient and that they were able to help each person who needed one to one help to eat their meals without anyone feeling rushed, and without the need for staff to help more than one person at a time, or by leaving people to wait for their meal. We watched at lunchtime as staff dished up meals in each dining room and we saw staff helping people calmly, sensitively, and carefully. In each dining room we saw staff dishing up one meal at a time and when they took the meal to the person they asked the person if they needed help to cut the food up. At the time of our visit there were four people on each unit who could not feed themselves and needed total assistance from staff with all aspects of the meal. The staff organised themselves efficiently with one member of staff sitting down with one person to give them their meal while the other staff members dished up and helped other people. The first person who needed one to one assistance had finished their meal by the time the other staff had finished dishing up the meals. The staff were then able to sit down with the other three people who needed individual attention. In this way everyone was given help in a timely way, and no one was left to wait for a long time without food. The meal time lasted approximately 45 minutes. We saw staff talking to the person they were assisiting, encouraging them to eat, and making the meal time a pleasant occasion. One member of staff was concerned when one person did not appear to want much food, and so they quietly spoke to the nurse in charge and then went back and encouraged the person again. The person then ate some more. Another member of staff recognised when the meal had cooled down and went and warmed the meal up again in the microwave. We looked at the records the home has maintained on the diet and nutrition of each person. We found that the home had kept detailed records of the actual foods eaten and the amounts of food and fluids. Each person has been weighed at least once a month, and those people who have lost or gained weight have been weighed either fortnightly or monthly. Where the staff have been concerned about weight gain or loss they have sought advice from the person`s GP, and where necessary supplements or treatment has been provided. The home has recorded peoples weights in several ways including a graph which gave very clear evidence of any fluctuations in weight. The records also included assessments of the risk of pressure sores or malnutrition. The staff we talked to were able to give examples of the people they had monitored closely and the actions they had taken. Comments from some of care assistants we talked to said they felt able to go to senior staff. `They`re always around the wings`, `They have an open door policy`, `You could ring across and ask to speak with them`. We talked to one person who lives in the home about staffing levels. She said she felt the staff were often rushed and thought that there were not enough staff to give people the right amount of help they needed at mealtimes. We also talked to each of the four nurses in charge of each unit. They told us that if more people needed assistance than they were able to cope with they could ask for assistance from other areas of the home. The manager or assitant manager also told us they will always help out at mealtimes What the care home could do better: Whenever people are assisted by staff to have a bath or shower a record should be made of the water temperature. This will provide evidence to show that people are not being placed at risk of scalding, or of being bathed in cold water. When staff give people their medication they should observe the person actually taking the medication unless a risk assessment shows the person can be safely left to take their medication without observation. The risk assessment should also determine if other people may be at risk if the medication is left in a place where another person might accidentally pick it up and take it. The bathrooms would benefit from upgrading or redecoration to make them appear more welcoming. The manager told us that they had plans to upgrade these rooms but no definite dates for the work. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Greenslades Nursing Home Willeys Avenue Exeter Devon EX2 8BE two star good service The quality rating for this care home is: The rating was made on: 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. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Vivien Stephens Date: 2 6 0 3 2 0 0 9 Information about the care home Name of care home: Address: Greenslades Nursing Home Willeys Avenue Exeter Devon EX2 8BE 01392274029 01392279089 alison.robertson@sanctuary-housing.co.uk 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) : Sanctuary Housing Association (trading as Sanctuary Care) care home 67 Number of places (if applicable): Under 65 Over 65 36 36 31 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: Date of last inspection Brief description of the care home 0 0 0 Greenslades Nursing Home is a modern three-storey red brick building. Access is via a side road off one of the main routes into the city near the centre of Exeter. There are local shops and amenities close by, the city centre being approximately one mile away. ISCA wing is primarily for 36 older people with mental health/dementia related needs. Belvedere wing is for 31 older people with more general health care needs. Nursing care is provided for 67 service users in all areas of the home, by nursing care assistants who are supervised by Registered Nurses. There is one double room, which is currently being used as a single room. All residents accommodation is en-suite. The Care Homes for Older People Page 2 of 12 Brief description of the care home average cost of care is £503 per week at the time of inspection. Additional costs, not covered in the fees, include hairdressing and personal items such as toiletries, newspapers and magazines and private chiropody and taxis. Current information about the service, including CSCI reports, which are accessible at the Home, is given to prospective residents/their representatives. Care Homes for Older People Page 3 of 12 What we found: This unannounced visit was carried out following an anonymous telephone complaint received by the Commission relating to staffing levels, medication, and low temperature bathing. Two inspectors visited the home, arriving at approximately 10.30am and finishing at approximately 3pm. During our visit we talked to the manager, Alison Robertson. We also talked to five members of staff in depth about the specific issues relating to the complaint, and we also spoke more briefly to, and observed, other staff who were on duty during our visit. We also talked to one person living in the home. There are 2 separate units in the home - Belvedere and Isca. Each unit is arranged over 2 floors - Upper Belvedere and Lower Belvedere, and Upper Isca and Lower Isca. During our visit one inspector looked at the care provided in Isca and one inspector looked at the care provided in Belvedere. During this inspection we did not look at the requirements or recommendations made at the last key inspection. They will be checked for compliance at our next key inspection. What the care home does well: The anonymous caller told us that people living at Greenslades were being bathed in cold water. We talked to the manager and staff about the normal practice throughout the home when staff assist people with bathing, showering and washing. We heard that approximately 3 months ago there was a short period of just a couple of days when some parts of the home were affected by boiler problems. While the heating in the home had not been affected, the water temperature from the hot water taps in a few bedrooms had been affected. The problem was quickly resolved by plumbers. The care staff we talked to said it had not been a problem as they were able to fetch hot water in a bowl from another sink nearby. We were told that almost everyone who lives in the home prefers to have a shower rather than a bath. The showers are electrically heated and thermostatically controlled and therefore the showers have always worked efficiently and have not been affected by hot water problems at any time. One person on Belvedere always liked to have a bath and two people on Isca. We talked to one of these people and they were told us their baths have always been the correct temperature and they have always been warm enough when having a bath. The care staff showed us the procedures they always follow before a person takes a shower. There is a thermometer tied to each shower rail and the staff showed us how they check the temperatures to ensure they are correct. We looked at the way the home has recorded the temperatures of the water in the showers and baths. We saw a bath and shower recording book that had been completed regularly until October 2008. The staff were unsure why the recording had suddenly ceased, but thought it was possibly due to a new system or recording that had been brought in around that time. We talked to the manager about the recording systems and she assured us they will resume hot water temperature recording Care Homes for Older People Page 4 of 12 immediately. Despite the lack of temperature records we were reassured by the staff we talked to, and by checking the showers and observing the procedures the staff follow when assisting people with a bath, shower or wash, that the water has always been comfortably warm. The baths and showers have temperature regulators to prevent scalding. We found no evidence to support this part of the complaint. The anonymous caller told us that there were too few staff to help people who needed one to one assistance with their meals. On the day of our inspection there were 30 people accommodated in Belvedere (15 people on the upper floor and 15 people on the lower floor) and 35 people accommodated on Isca (18 people on Lower Isca and 17 people on Upper Isca). Each unit had 1 trained nurse in charge and 3 care assistants. We talked to each of the trained nurses in charge of each wing about the staffing levels, and about the staffing needs of each unit particularly at meal times. We were told how the staff organise themselves so that the meals are dished up, medicines are administered, and people are given the assistance they need. Each of the nurses we talked to said they felt the staffing levels were sufficient and that they were able to help each person who needed one to one help to eat their meals without anyone feeling rushed, and without the need for staff to help more than one person at a time, or by leaving people to wait for their meal. We watched at lunchtime as staff dished up meals in each dining room and we saw staff helping people calmly, sensitively, and carefully. In each dining room we saw staff dishing up one meal at a time and when they took the meal to the person they asked the person if they needed help to cut the food up. At the time of our visit there were four people on each unit who could not feed themselves and needed total assistance from staff with all aspects of the meal. The staff organised themselves efficiently with one member of staff sitting down with one person to give them their meal while the other staff members dished up and helped other people. The first person who needed one to one assistance had finished their meal by the time the other staff had finished dishing up the meals. The staff were then able to sit down with the other three people who needed individual attention. In this way everyone was given help in a timely way, and no one was left to wait for a long time without food. The meal time lasted approximately 45 minutes. We saw staff talking to the person they were assisiting, encouraging them to eat, and making the meal time a pleasant occasion. One member of staff was concerned when one person did not appear to want much food, and so they quietly spoke to the nurse in charge and then went back and encouraged the person again. The person then ate some more. Another member of staff recognised when the meal had cooled down and went and warmed the meal up again in the microwave. We looked at the records the home has maintained on the diet and nutrition of each person. We found that the home had kept detailed records of the actual foods eaten and the amounts of food and fluids. Each person has been weighed at least once a Care Homes for Older People Page 5 of 12 month, and those people who have lost or gained weight have been weighed either fortnightly or monthly. Where the staff have been concerned about weight gain or loss they have sought advice from the persons GP, and where necessary supplements or treatment has been provided. The home has recorded peoples weights in several ways including a graph which gave very clear evidence of any fluctuations in weight. The records also included assessments of the risk of pressure sores or malnutrition. The staff we talked to were able to give examples of the people they had monitored closely and the actions they had taken. Comments from some of care assistants we talked to said they felt able to go to senior staff. Theyre always around the wings, They have an open door policy, You could ring across and ask to speak with them. We talked to one person who lives in the home about staffing levels. She said she felt the staff were often rushed and thought that there were not enough staff to give people the right amount of help they needed at mealtimes. We also talked to each of the four nurses in charge of each unit. They told us that if more people needed assistance than they were able to cope with they could ask for assistance from other areas of the home. The manager or assitant manager also told us they will always help out at mealtimes if needed. Our observations of mealtimes in all parts of the home was that the staffing levels were satisfactory and that staff had sufficient time to help people in a calm and unhurried manner. We were satisfied that people receive good care to ensure they receive the support they need with meals and drinks. This part of the complaint was not upheld. The anonymous caller told us that they had witnessed staff not checking that the people they had given medication to had taken the medication. They said they had seen people giving the medication to another person. At lunchtime we watched the senior nurse on each floor giving the midday medicines out on each floor. The home uses a monitored dosage system supplied in monthly blister packs from a local pharmacy. Each floor has its own medicine trolley. The trained nurse in charge of each floor was observed checking the medicines against the medicines administration record for each person, before placing the tablets for that person in a clean pill pot and giving the pot to the person. They then returned to the medicines trolley and recorded that they had given the tablets to that person. They were calm, unhurried and took care when checking and signing to ensure the medications were correct. While some people took their tablets immediately, in a few instances people were given their tablets at the dining table and they did not take them immediately. The nurse did not wait to observe these people taking their tablets. We talked to the home manager about this practice. We agreed that some people may not want to take their tablets while they were eating their meal, and instead may prefer to wait until after their meal. However, there may be a risk of people either forgetting to take the tablets, or another person may accidentally take them. The manager agreed to carry out a risk assessment on each person and to determine which people should be observed taking their tablets, and which people will be safe to be left. We concluded that the procedures followed by staff were satisfactory but further Care Homes for Older People Page 6 of 12 safeguards could be put in place to ensure people who may be at risk of forgetting to take their medications are observed to make sure the medicines have been taken safely. 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 2. Care Homes for Older People Page 7 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 8 13 (4) (c) You must ensure that 13/02/2007 unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. (This relates to the need to ensure that actions are taken to protect those residents identified as being at risk from falls.) This remains to ensure that if a resident continues to fall then the issue of staff supervision or other aids are considered. 2 8 12 (1) (a) (b) You must ensure that the 13/03/2007 care home is conducted so as to promote and make proper provision for the health, care and welfare of service users. (This relates to the need to ensure that the psychological health is monitored and preventative and restorative care provided.) This remains but there have been improvements. 13 (2) You must make arrangements for the safekeeping and handling of medicines received into the home. (This relates to the need to record when and why `as needed? 13/02/2007 3 9 Care Homes for Older People Page 8 of 12 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action medications should be given and to ensuring that creams are not out of date.) This area has improved. 4 12 16 (2) (m) You must consult service 13/03/2007 users about their social interests and make arrangements to enable them to engage in social activities. This remains but it is noted that some improvement has been made and that staff have undergone training. You must, for the purpose of 13/03/2007 making proper provision for their health and welfare, so far as practicable ascertain and take into account service users? wishes and feelings. (This relates to the need to ensure that residents are offered choices and their capacity to exercise personal autonomy is maximised.) This remains but has improved. You must ensure that at all 13/03/2007 times there are suitably qualified, competent and experienced persons working at the Home that are appropriate for the health and welfare of residents. (This refers to staff on Isca relating to specialist training and competency monitoring). This remains but more in 5 14 12(3) 6 30 18 (1) Care Homes for Older People Page 9 of 12 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action relation to the implementation of knowledge gained and monitoring. Care Homes for Older People Page 10 of 12 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, 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 9 When staff give people their medication they should observe the person actually taking the medication unless a risk assessment shows the person can be safely left to take their medication without observation. The risk assessment should also determine if other people may be at risk if the medication is left in a place where another person might accidentally pick it up and take it. The bathrooms would benefit from upgrading or redecoration to make them appear more welcoming. Whenever people are assisted by staff to have a bath or shower a record should be made of the water temperature. This will provide evidence to show that people are not being placed at risk of scalding, or of being bathed in cold water. 2 3 21 38 Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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). 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. 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