Care Home: Greenways

What the care home does well The staff are caring, friendly and approachable whilst encouraging people to be as independent as possible. The home is maintained to a good standard and has been subject to ongoing improvements by the owners so that people live in a pleasant and homely environment. What the care home could do better: Risks associated with people`s care need to be fully assessed and systems put in place to ensure they are effectively managed. Effective systems need to be in place for reviewing and revising care plans to ensure people are cared for in accordance with an agreed plan that meets their assessed needs. Random inspection report Care homes for older people Name: Address: Greenways Marton Road Long Itchington Nr Southam Warwickshire CV47 9PZ zero star poor service 01/12/2009 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. 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: Sandra Wade Date: 2 8 0 6 2 0 1 0 Information about the care home Name of care home: Address: Greenways Marton Road Long Itchington Nr Southam Warwickshire CV47 9PZ 01926633294 F/P01926633294 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Carole Mary Webb Type of registration: Number of places registered: Conditions of registration: Category(ies) : Kirkley Limited care home 27 Number of places (if applicable): Under 65 Over 65 27 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is: 27 The registered person may provide the following category of service only: Care Home Only (Code PC); 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 (OP) 27 Date of last inspection Brief description of the care home Greenways was originally a domestic dwelling and has been converted into a residential care home. It is situated in the quiet village of Long Itchington and can accommodate up to 27 elderly people. The home offers personal care to people over Care Homes for Older People Page 2 of 9 2 3 0 3 2 0 1 0 Brief description of the care home the age of 65 years. The home is not registered to take people in any other categories. People needing nursing care receive this from the visiting community nurses. An extension has recently taken place to add another three bedrooms to the home. There are local shops which are around a 15 minute walk from the home and there are public transport links to Leamington Spa, Rugby and Southam within a five minute walk from the home. The bus stop being located by the village pond. There is a door into the home which has level access for wheelchairs and people with mobility problems although this is not the main entrance. Accommodation for people is provided over two floors and all bedrooms are for single occupation, several of the rooms have ensuite facilities. There is a communal dining room and one large lounge with two small quiet areas in the home. There is also a relatives room where people can meet in private. There is one shower/wet room and four bathrooms with assisted facilities such as bath chairs to support people into the bath. There is a garden and patio area where people and parking to both the front of the home and in a car park which is accessed down the side of the garden area. The owners are involved in running the home and there is a full time manager and a team of carers and ancillary staff. At the time of this inspection the fees for the home were up to £364 to £485. These are published in the Service User Guide. Extra charges are made for hairdressing and chiropody. Fees are subject to change and should therefore be confirmed with the service. Care Homes for Older People Page 3 of 9 What we found: This random unannounced inspection was undertaken to check compliance with outstanding requirements including those issued within Statutory Requirement Notices in relation to continued breaches of Regulation 12, 13 and 15. These are explained in more detail below. We last visited the home on 22 March 2010 to check compliance with these requirements and found they had not been met. The service were therefore advised that this would result in enforcement action being pursued against the home. Enforcement action in respect of ongoing non-compliance with Regulation 15 is still under consideration by the Commission. We visited the home on Monday 28 June 2010 between 10am and 3pm. The service did not know we were coming. The manager was not on duty so the inspection was carried out with the assistance of the Senior Carer on duty. We discussed actions taken by the home to comply with the requirements issued during our previous inspections including those requirements issued in the three Statutory Requirement Notices. We also viewed the care records for three people living in the home to determine whether the actions stated in the Statutory Requirement Notice relating to care plans had been completed. Regulation 12, the registered persons were required by 9 February 2010 to:Put in place systems to ensure proper provision for the care of people who use the service. Ensure that the particular care needs of individuals with multiple disabilities and confusion are addressed to minimize the potential for harm while in bed. At the compliance inspection visit which had taken place on 22 March 2010, non compliance with Regulation 12 had been found. During this visit on 28 June 2010 we checked compliance with this Regulation again. We looked at the care plan file for a person whose care records had been checked on 22 March 2010 to check whether the records accurately reflected how the persons healthcare needs were to be met and that these were being met. We also spoke to staff to determine if there had been any changes in practice on how this persons care was to be managed. A new risk assessment had been completed since the 22 March 2010 inspection showing that the person continued to have bedrails on their bed. The risk assessment was more detailed and was being regularly reviewed. This showed that padded bumpers were also in use which can help to prevent injuries to the person when in bed. There was a GP record sheet in the file showing that the episodes of confusion had been discussed with the GP and a new medicine had been prescribed to manage this. Staff reported that this was being regularly given and as a result there were less episodes of confusion at night and the person was now sleeping well most of the time. This requirement in respect of Regulation 12 was found to be met at this inspection (28 Care Homes for Older People Page 4 of 9 June 2010). Regulation 15, the service was required by 12 February 2010 to:Put in place effective arrangements to keep under review the service users written plan as to how the service users needs in respect of his health and welfare are to be met and revise it as appropriate. Ensure the service users plans are kept up-to-date to address the health and welfare needs of residents in their beds. At the compliance inspection visit which had taken place on 22 March 2010, non compliance with Regulation 15 had been found. During this inspection visit on 28 June 2010 we checked compliance with this regulation again. We looked at the care plan file for a person whose care records had been checked during our visit on 22 March 2010 to determine whether it accurately reflected how their care needs were to be met. We also looked at two other peoples care records to determine compliance. During this visit on 28 June 2010, we found that whilst records in one file had been updated to show how a persons care was being managed, records in another care plan file were not accurate and it was not clear how the persons care was being managed. For example, a Resting and Sleeping care plan showed that the person had been assessed for bedrails and a decision had been made for them not to be used because this could place the person more at risk of falls or harm. The care plan stated that the person was to have a mattress by the side of their bed instead. We viewed the room for this person and found that bedrails were on the bed. Staff spoken to confirmed that they were in use both during the day and at night if the person was in bed. Staff explained that the bed the person was using was new and they understood that the bedrails came as part of the bed. They stated that the new bed had been arranged by the District Nurse. The Resting and Sleeping care plan had not been updated to show that the person had been assessed as requiring a new bed with bedrails. Staff stated that the Resting and Sleeping care plan and risk assessment had not been updated either prior to or following the arrival of the bed to take into account the use of bedrails. It was therefore not clear what, if any, risks were considered when making a decision for this person to have a new bed with bedrails to make sure they would be safe when in bed. This requirement under Regulation 15 was not met and remains under consideration for enforcement action. Regulation 13, the registered providers were required by 1 February 2010 to:Put in place effective arrangements to make sure that people who use the service receive where necessary, treatment, advice and other services from any health care professional. At the compliance visit which took place on 22 March 2010, non compliance with Regulation 13(1)(b) had been found. Care Homes for Older People Page 5 of 9 During this visit on 28.6.2010 we checked compliance with Regulation 13(1)(b). We looked at the care records for the person whose care records we checked on 22 March 2010 to determine compliance. We found that the care records demonstrated advice had been sought from the GP. It was also evident from discussions with staff and records viewed that the advice of the GP was being followed. This had resulted in less episodes of confusion for the person. This requirement under Regulation 13(1)(b) was therefore met. Whilst complaince with Regulation 13(1)(b) was determined, we identified during the process of viewing care files, concerns relating to the management of risks relating to compliance with Regulation 13(4). There were two different types of risk assessments for bedrails being used. Staff spoken to were not aware of why this was. Staff suggested that one person may have a different type as they had been involved in an accident involving bedrails. This means the home are not taking a consistent approach to managing risks. We observed that there were different types of protective padding in use for the bedrails. Some were thicker than others. We noted that the padding in use on one bed was thin and worn and would offer limited protection to the person. This person had previously had an accident involving the use of bedrails. The risk assessment in place asked staff if the persons bed rails had been inspected regularly and were in proven good order. This had been ticked as yes. It was not clear from the risk assessment that the checks being carried out included the good order of the bumpers when making this judgement. In view of our findings around risk assessment management, a new requirement has been issued. What the care home does well: 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 6 of 9 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 7 15 The service must put in place 12/02/2010 effective arrangements to keep under review the service users written plan as to how the service users needs in respect of his health and welfare are to be met and revise it as appropriate. In addition the service must ensure that service users plans are kept up-to-date to address the health and welfare needs of residents in their beds. This is to ensure the needs of people are clearly identified and any staff support needed can be provided to meet these needs. Statutory Requirement Notice not met. Care Homes for Older People Page 7 of 9 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 1 7 13 Risks associated with a 31/07/2010 persons health condition must be promptly assessed and a clear risk management plan put in place. This is so that staff are clear on what action they must take to meet the persons needs safely and effectively. 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 8 of 9 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission 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 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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