Care Home: Greenwell House Nursing Home

What the care home does well People live in a clean comfortable home. Staff are kind and helpful and make every effort to provide the service in the way that people want. The manager from the home visits people before they move in, she finds out about the kind of support the person might need. This helps the home decide whether they have the right knowledge and experience to be able to care for the person properly and safely. The information kept about people is good and is the right kind of information needed; this helps staff support properly all of the time. A good choice of food and drinks are available. This ensures that people receive a varied and nutritious diet. Comments about the meals provided included "The meals have always been very good" and "The Cook is an excellent cook"The relationships witnessed between staff and the people who live at the home appeared relaxed, warm and genuine. Comments from surveys include: "Provides excellent nursing care- caring environment, small and friendly home. Good personal assessment, communication skills and standard of care". "The care home has a very warm and friendly atmosphere and you can see the residents are very well cared for. Any issues I have raised have been dealt with in a caring, dignified and respectful manner". What has improved since the last inspection? Parts of the home have been refurbished, in particular the re-location of the laundry which means there is now space to install a shower/wet room which will make bathing much more comfortable for people. The dining room and communal lounge have new furniture this makes these rooms pleasant and comfortable to use. CARE HOMES FOR OLDER PEOPLE Greenwell House Nursing Home Wycar Bedale North Yorkshire DL8 1ER Lead Inspector Chris Taylor Key Unannounced Inspection 29th April 2008 09:00 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenwell House Nursing Home Address Wycar Bedale North Yorkshire DL8 1ER Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01677 424012 F/P 01677 424012 greenwellhouse@fisherpartnership.com John.fisher@fisherpartnership.com The Fisher Partnership Mrs Liza Mufti Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 60 years plus Date of last inspection 1st May 2007 Brief Description of the Service: Greenwell House is a Care Home registered to care for up to 21 people over 65 years of age who require nursing care. The service is provided in a detached stone built building on three floors; the upper floors are serviced by a vertical lift. The home is located near the centre of the market town of Bedale overlooking the local bowling green. The fees charged at 29/04/08 are £400 - £610 per week. Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This is what was used to write this report. • • • Information about the home kept by the Commission for Social Care Inspection. Information asked for before the inspection, this is called an Annual Quality Assurance Assessment. A visit to the home that was unannounced. This lasted five hours and included talking to staff about their jobs and the training they have completed. Also spending time with people and checking some of the records, polices and procedures the home has to keep. Seven surveys were received completed by relatives. Looking at four peoples’ care files in detail. • • What the service does well: People live in a clean comfortable home. Staff are kind and helpful and make every effort to provide the service in the way that people want. The manager from the home visits people before they move in, she finds out about the kind of support the person might need. This helps the home decide whether they have the right knowledge and experience to be able to care for the person properly and safely. The information kept about people is good and is the right kind of information needed; this helps staff support properly all of the time. A good choice of food and drinks are available. This ensures that people receive a varied and nutritious diet. Comments about the meals provided included “The meals have always been very good” and “The Cook is an excellent cook” Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 6 The relationships witnessed between staff and the people who live at the home appeared relaxed, warm and genuine. Comments from surveys include: “Provides excellent nursing care- caring environment, small and friendly home. Good personal assessment, communication skills and standard of care”. “The care home has a very warm and friendly atmosphere and you can see the residents are very well cared for. Any issues I have raised have been dealt with in a caring, dignified and respectful manner”. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3. People who use this service experience good quality outcomes in this area. Peoples’ needs are properly assessed prior to admission this helps make sure that staff know they will be able to meet their needs before the person moves in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Most people are admitted to the home from a stay in hospital. Others come via Care managers from the local authority with an assessment of the persons needs and from members of the public who contact the home directly. Regardless of where the referral comes from the manager would visit people either at their own home or in hospital and complete the home’s assessment to make sure that the home would be suitable. A return visit by the person in order for them to get a feel for the home is encouraged but can’t always be possible. Sometimes relatives visit instead. Two people said that they had been Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 9 provided with information about the home before they moved in and this had been useful. Information provided to people is currently being reviewed and revised into a more comprehensive “welcome pack”. The format for the pre admission assessment is good and has appropriate headings to determine what support people need. Four people’s files were looked at to establish whether this process had been followed. Two had assessments forms completed by the local health authority and all had the home’s own assessment completed thoroughly. This provides staff with the right kind of information to support people safely and in a way that they want. Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 People who use this service experience good quality outcomes in this area. Peoples’ health and personal care needs are assessed and are met promoting independence, choice and respect for individuals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four peoples’ case records were looked at in order to check that a plan had been formulated which helps staff provide support to people according to their needs and wishes. There were forms completed which contained information about the person, such as date of birth, GP and next of kin. This was followed with specific documents to record information about all aspects of the person’s life, what support is needed and how the person wants that support to be provided. Information recorded not only covers where people need help and assistance but also information about social interests and personal preferences about how Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 11 they wish to spend their day; times for getting up and going to bed. The care plan format also records information about areas of risk, specifically with regard to moving and handling, falls and pressure areas. There were some inconsistencies in dating and signing information. Ensuring documents are dated and signed make sure staff provide the most up to date support needed. There were also inconsistencies in the regularity and recording of reviewing care plans. Even if there has been no change it important to record this. There is no place for people to sign their care plan. The Registered Manager said that there are few people who want to be included in the care planning process. Regardless of this it would be prudent to include this information on the document as evidence that some effort had been made to include and consult people. People are registered with a GP of their choice and staff confirmed good working relationships with health care professionals. The delivery of personal care is individual and flexible. Discussions with people confirmed this. They said that staff always treat them with respect and ensure their privacy and dignity. Comments heard include “anything you ask them to do they do it” and “ The staff have always been most helpful and kind” Staff were observed delivering care in a kind and helpful manner. Comments from surveys include: “Greenwell house has provided care and support which exceeded our expectations”. “The support and care is excellent” “The staff are warm and friendly and are well qualified at meeting the needs of x”. Medication is stored in a locked trolley. A monitored dosage system is in use with proper procedures in place for the receipt, storage, administration, recording and return of medicines. It is usual that only nursing staff administer medication. Lunchtime medication administration was observed and this was carried out safely and in a way that ensured peoples’ dignity was maintained. Daily records provided a good picture of how people spend their day and would provide essential information to track any changes people may experience, with ill health or involvement in social activities. Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. People who use this service experience good quality outcomes in this area. People can choose how they spend their day and have the opportunity to pursue their own interests. Meals provided are nutritious, are of good quality and freshly prepared. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People choose their own daily routines and are encouraged to remain independent and have as much control over their lives as is possible. People can sit in communal lounges or spend time in their rooms and can rise and retire as they wish. Although there isn’t a designated activates organiser there are a number of regular visitors to the home to provide activities such as hairdressing, aromatherapy, clothes parties and musical entertainers. The local pre school group have started visiting every fortnight and provided an Easter Bonnet parade. They are plans for them to be involved in potting tubs up with flowers Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 13 together with the people who live at the home. The Church of England Vicar visits every month to provide Holy Communion and the Priest form the local Catholic Church also visits. The atmosphere at the home was very relaxed. Warm and genuine relationships were witnessed between staff and service users and there was a lot of good-hearted banter. There are three main meals per day, although there isn’t a choice provided the chef speaks to people about the daily menu and prepares alternatives if people don’t want what is on offer. Special dietary needs such as low sugar diets are catered for and special requests can usually be met. Where appropriate nutritional assessments are carried out and these were seen in case records. People spoke positively about the quality of meals provided and people clearly enjoyed their lunch. Staff supported those people who needed assistance respectfully and discreetly. Menus were looked at and these were varied. Hot and cold drinks are available throughout the day with a hot drink and snack provided prior to bed. Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. People who use this service experience good quality outcomes in this area. People can be confident that concerns are listened to and appropriate action is taken. Staff training and relevant polices and procedures to safe guard people from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints procedure is provided to people and is included in the Statement of Purpose. People said that they felt able to talk to staff and the manager of the home if they had complaints and that these would be dealt with properly. There have been no formal complaints made to the home or to the Commission for Social Care Inspection. Comments in surveys include: “ x has never had to complain about the care he receives”. “ I have always had a prompt reply”. Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 15 There is a comprehensive policy and procedure with regard to adult protection and staff have a good awareness of this. Staff receive training in adult protection issues as part of NVQ (National Vocational Qualification) level 2 and 3 in care. Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26. People who use this service experience good outcomes in this area. People live in a clean, comfortable and safe home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The environment in the home has improved and requirements made at previous inspections met. The laundry has now been relocated to a cottage adjacent to home and has sufficient room and ventilation. The change of location also improves the standard of infection control. The old laundry is to be refurbished into a wet room with shower. This work is due to commence next week and will vastly improve the bathing facilities for people. The kitchen has been refurbished with new flooring, tiles and units. Other areas in the home have been redecorated and refurbished including new Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 17 curtains, blinds and furniture in the lounge and dining room. Some of bedrooms were looked at and these were comfortable and personalised. The home is welcoming and is furnished in a way which is appropriate to the age and needs of the people who live there. The home was spotlessly clean, not only does this present a pleasant environment but reduces the risk of people becoming ill from poor hygiene. Hand wash scrub, gloves and aprons are available throughout the home. This helps to minimise the risk of cross infection. The fault with the sluice disinfector had been rectified and is now working effectively. The home has a variety of equipment available to assist with maintaining people’s independence. This is serviced at the required intervals to ensure the safety of people. Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. People who use this service experience good outcomes in this area. Recruitment procedures help ensure that suitable people are employed. Staff receive appropriate training that ensures people receive the care and support they need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The recruitment records of the six staff were checked, two had been recruited very recently. All had a completed application form and had attended formal interview where any gaps in employment had been explored. Written references and checks for professional registration were checked. All had appropriate CRB ( Criminal Records Bureau) checks apart from the two most recently recruited. The manager explained that they had recently changed the provider the home uses to process to CRBs and this was why there had been a delay. The manager said that those staff were not working unsupervised. She was advised to carry out POVA first checks (Protection of Vulnerable Adults). Staff complete Skills For Care Common Induction Standards as well as a home specific induction which includes health and safety training such as moving and handling, first aid and infection control. There have been difficulties in facilitating NVQ level 2 (National Vocational Qualifications) but this has Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 19 recently improved with the appointment of a new provider. Staff complete other training which provides them with essential skills and knowledge to support people competently. Staff spoken to say the training is good and helped them with their role. During the inspection there appeared to be enough staff on duty to meet people’s needs. One person said “ there’s always a member of staff around when I need them” and another said, “ the staff are wonderful, kind and attentive, always enough staff around”. There is always a qualified nurse on duty with the addition of three care assistance during the day, two during the late afternoon and evening and one waking night. There are two cooks, one laundress and two cleaners. Holidays and sickness are covered by part time staff working additional hours or agency staff. The manager was pleased to report a reduction in the use of agency staff. The manager and senior staff work alongside staff and as such monitor their practice. At every shift change there is a handover where specific issues relating to service users are discussed. There are regular staff meetings. There is no formal supervision system where by staff meet with their manager to discuss their work and areas of development. Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38. People who use this service experience good outcomes in this area. The home is managed in such a way that promotes the best interests of people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home is organised, competent and runs the home to meet the needs of the people who live there. Service users, staff and families know who to go to if there is a problem and are very happy with the way in which the home is run. The manager keeps up to date with her own training and is knowledgeable about current ways of working. Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 21 A comment from a survey said: “Matron is excellent, with great leadership qualities”. There is always a senior member of on duty to take responsibility for the smooth, safe running of the shift. Tasks are appropriately delegated so that the safety of people, and the safe running of the home is shared out among staff. Regular, internal audits make sure that all the necessary health and safety checks are being carried out. The home’s line manager visits monthly and allows time for people to talk about their satisfaction with the service. Improvements have been made with regard to quality assurance and surveys have been collated from service users and their relatives about their views of the home. Issues raised have been actioned. This information needs to be collated into a report and development plan which should be shared with services users, their relatives and staff. The fire procedure is prominently displayed throughout the home and fire detection and fire-fighting equipment is tested and maintained regularly. Records were seen which confirmed that other equipment in the home is maintained and serviced appropriately. Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care plans must be date and signed to ensure staff are aware of the most up to date information. Care plans must be reviewed at least once a month to ensure current support is relevant to the person’s needs. Criminal Records Bureau and Protection of vulnerable adults checks must be completed prior to new members of staff commencing work in the home to reduce the risk of unsuitable people being employed. Timescale for action 13/06/08 2. OP18 OP29 19 (1) (b) 13/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP28 Good Practice Recommendations The provider should endeavour to have 50 of the care staff trained to NVQ Level 2 Standard. DS0000028028.V363494.R01.S.doc Version 5.2 Page 24 Greenwell House Nursing Home 2. OP31 The manager should acquire NVQ Level in Management award. An identified space in the documentation for the resident or their representative to sign to evidence their involvement in the care plan process should be provided. . 3. OP8 4. OP33 The results of any quality assurance surveys should be collated into a development plan and be made available to service users, relatives and professionals. Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greenwell House Nursing Home DS0000028028.V363494.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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