Care Home: The Green Nursing Home

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What the care home does well This is a random inspection and therefore not all of the core standards were assessed. The management team have made significant improvements at the home in order to improve the outcomes for the people who live there. These improvements are detailed in this report. They are keen to address any areas of concerns to ensure that the home is run in the best interests of the people who live there. The management team have put systems in place to monitor the quality of the service. This should mean that the service can identify and act upon concerns before they are identified by other agencies. The management team have kept people informed of changes both at the home and externally, to ensure that people know what is happening there. What the care home could do better: This is a random inspection and therefore not all of the core standards were assessed. Care plans could be further developed to include more specific details about people`s needs. Systems should be reviewed to ensure that people are weighed as often as they should be, so that staff can monitor any changes. Systems for recording the application of creams and dressings must be developed, so that records are an accurate reflection of products administered. Accessibility of the bathing facilities should be reviewed so that people can access the baths with any equipment they may require. Random inspection report Care homes for older people Name: Address: The Green Nursing Home Wharf Road Kings Norton Birmingham West Midlands B30 3LN zero star poor service 09/03/2010 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: Lisa Evitts Date: 0 9 0 7 2 0 1 0 Information about the care home Name of care home: Address: The Green Nursing Home Wharf Road Kings Norton Birmingham West Midlands B30 3LN 01214513002 01214863360 flintvaleltd@btconnect.com Flintvaleltd@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Flintvale Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 59 Number of places (if applicable): Under 65 Over 65 0 59 dementia old age, not falling within any other category Conditions of registration: 59 0 The maximum number of service users who can be accommodated is: 59 The registered person may provide the following category of service only: Care Home with Nursing (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 (OP) 59 Dementia (DE) 59 Date of last inspection 0 9 0 3 2 0 1 0 Care Homes for Older People Page 2 of 13 Brief description of the care home The Green is a purpose built facility, which offers nursing care for up to 59 older adults, who may also have dementia care needs. There is off road parking to the front of the property, which is sufficient for the home. The home is situated close to bus links to the centre of Birmingham. There are a range of local shops and community facilities nearby. The home has a mixture of shared and single bedrooms, some of which have en-suite facilities, spread over the ground and first floors of the building. There are communal bathing, shower and toilet facilities on both floors to meet the needs of the people who live there. The building has basic adaptations for people with limited mobility, including two passenger lifts. Communal lounges are situated on the ground floor and the lounge doors open onto an enclosed garden with a water feature, which has wheelchair access. Laundry and kitchen services are located on the ground floor, as are the dining rooms. Fee rates for the home vary depending if the person is privately funded or funded by Adults and Communities. Charges vary, on the assessed banding and type of room chosen and a top up fee is payable. Current fee rates are available on request from the home. Hairdressing, chiropody, opticians and dentists visit the home, and are available for additional fees. Previous inspection reports and articles of interest are available inside the reception area of the home, for anyone who wishes to read them. Care Homes for Older People Page 3 of 13 What we found: The focus of this inspection undertaken by the Care Quality Commission (CQC) is upon outcomes for the people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. The last key inspection of the home was undertaken on the 9th March 2010. In April 2010 Adults and Communities had placed a suspension upon on the home, which meant that they would not pay for anyone else to live there until improvements had been made. This was due to a number of concerns. This suspension was lifted in July 2010 and new people can now go and live at the home. Following our visit in March 2010, we issued the home with a Statutory Requirement Notice, to make them improve the management of peoples medication. On the 1st June 2010 a pharmacist inspector visited the home to see if the improvements had been made. We found that the requirements of the notice had not been fully met; however a new manager had started working at the home that day. She was aware of the problems and was keen to address them. We decided to undertake a further visit so that the manager could implement the new systems which had been identified to improve medicine management. This random visit was undertaken by two inspectors over seven hours. There were 48 people living at the home and they did not know we would be visiting. The reason for this visit was to monitor the homes progress in meeting the requirements made at previous visits to the home. We looked at two peoples care plans in detail. We looked around some areas of the home. We spoke to people who live at the home, two relatives and four staff. We looked at the complaints records and discussed staff training. A pharmacist inspector also visited on the same day to review the management of peoples medication. Theses are our findings: A new manager had started working at the home on the 1st June 2010 and was on holiday on the day of our visit. We were assisted by the deputy manager who had only been in post for approximately two weeks. Despite being at the home for a short time she was very helpful. She demonstrated that she was aware of the previous concerns at the home, had a good understanding of the current performance of the home and had a clear insight into how the home would move further forward in the future. The new management team have kept us informed with changes through improvement plans and weekly updates. During this visit we found that there had been a number of significant improvements at the home to improve the outcomes for the people who live there. The home have further plans to improve the quality of the service. With the number of improvements already made we are confident that the home will continue to improve with the current management team. Care Homes for Older People Page 4 of 13 Peoples relatives told us: Staff seem more aware of things There are plans for a lot of changes I was so concerned but not anymore things are 100 Im very pleased, I can see things happening and improving around the home and staff are so much happier We looked at two peoples care files. These are individualised care plans about what the person is able to do independently and what support is required from staff in order for the person to meet their needs. We found that the care plans contained information about peoples likes and dislikes so that staff could meet peoples needs in a way that they preferred. Risk assessments had been completed for falls, moving and handling, sore skin, wheelchair use and weight loss. Night time care plans were very detailed about how to help a person prepare for a restful night. Moving and handling assessments gave details about the type of equipment to use and sling size. The home has employed a physiotherapist for three and a half hours a week. She will assist in moving and handling assessments and also provide staff training so that people are moved safely. People had been seen by external professionals including the GP, dietician, speech and language therapist and tissue viability nurse (sore skin). This means that people are seen by people who have the expertise to give advice so that healthcare needs are met. We acknowledge that there have been improvements with the care plans to provide staff with information. These could now be further developed. One persons plan had some conflicting information about how often they should be weighed. In some places it said weekly, in others every other week. When we looked at weight records we found that the person had not been weighed every week. We discussed this with the deputy manager during feedback and it appears that there were different systems in place for monitoring and recording peoples weight. This should be reviewed so that people are weighed as required. While some plans identified peoples needs, they could be further developed with more information for staff. For example, one person had a care plan for depression but it did not state how the person may present symptoms of this so that staff know what to look for. One persons plan said they sometimes cried but the plan didnt tell staff how to alleviate or manage this. One persons plan said they had unpredictable mood changes, the plan said for staff to take avoidance action, but the plan didnt expand on this and tell staff what they should do. One person had different care plans for drinking, risk of aspiration and nutrition. These did not cross reference with the information following a recent swallowing assessment. It was not clear that the person should have a soft diet from the plans however staff were able to tell us this. Daily records were detailed with how the person had spent their day, any changes in their conditions and any visitors they had received. Food and fluid charts were completed and showed what people had had to eat and drink, including the amounts. Care Homes for Older People Page 5 of 13 People told us: I get plenty of drinks Lunch was good I like sitting by the door with the sun shining in Im happy with everything Staff are okay The new manager seems really good, just hope she stays, there have been too many changes The pharmacist inspector carried out an assessment of how the home was managing the medicines that had been entrusted to them by the people who were using the service. We found that medicines were being kept in dedicated medicines room which was being maintained at the correct temperature to store medicines in. With this room we found the fridge which was being used to store medicines that required cold storage conditions. We found that the fridge temperatures were being measured and record but the temperature was not always being kept within the accepted temperature range. We found that Controlled Drugs were also stored in this room within a cabinet that was used specifically to store these drugs. We found that the Controlled Drugs cabinet had not been attached to the wall correctly and therefore did not meet with the Misuse of Drugs (Safe Custody) Regulations. We examined a sample of the medication administration records (MAR) along with the medicines present in the home in order to determine whether the home had systems in place to demonstrate that medicines were being administered as prescribed. Overall we found with the oral medicines that the records were able to demonstrate that people were receiving their medicines as prescribed. We found that the home needed to ensure that when medicines were refused and disposed of this practice was recorded in the disposal register and the disposal was witnessed by another member of staff. We raised concern about the administration of an inhaler to one of the people using the service. This particular inhaler had an indicator that showed the user how many doses were left before it ran out. The inhaler would have had 124 doses upon opening and the MAR chart showed that since opening a quantity of 44 doses had been administered. We would have expected therefore that the indicator on the inhaler would be showing that there were 80 doses available for the user. We found that the indicator was showing that there was 89 doses still available indicating that only 35 doses had actually been administered. The deputy manager confirmed that the use of inhalers had not been examined during the regularly audits carried out by the home. Another concern was raised with the application of some antibiotic eye drops. Normally antibiotic eye drops only need to be applied for a short period of time for example seven days. In this case we had found that the eye drops had been applied for 18 days and there was still a problem with the eye indicating that the eye drops were not working in clearing the infection. What was concerning was that none of the nursing staff had picked up on this or requested a review from the persons doctor. Care Homes for Older People Page 6 of 13 We found that the management team was carrying out regular audits of the medicines and were taking effective and appropriate action when errors were discovered. The previous inspection had found that the management of creams and ointments was poorly handled. The previous inspection found that some creams were unlabelled and were left in communal areas therefore increasing the possibility that the creams would be applied to people who they had not been prescribed for. We found at this inspection that this issue had been resolved. However when discussing the application of some creams for one of the people using the service, we were told that the care staff were applying the non medicated creams but the nursing staff were signing the MAR charts confirming administration had taken place. We informed the home that they must introduce a system that allows the care staff to record what they have administered themselves. We found when looking at the MAR chart for this person that both creams had instructions to apply twice a day but the MAR chart showed that both creams were only being applied daily. We also found that the use of this persons dressings were not being adequately recorded on the MAR charts. In order to establish whether the dressings were being applied correctly we had to undertake a lengthy review of the care records. At the same time we also looked for information about changes made to the creams prescribed and although we found the information was scattered amongst different sections of the care records. We examined the Controlled Drugs record and found that an analgesic patch that required changing after seven days had been changed after six days. We examined the handwritten administration record and on this it showed that the patch had been changed after seven days. On closer examination we discovered that the member of staff writing out this record had included a date of the 31st June 2010 and therefore this record showed a period of seven days between the patch changes. We also found that the new supply of these patches had arrived at the home with instructions to change the patches after 72 hours. We were shown a copy of the prescription which also showed that the patches should be changed after 72 hours. What again was concerning was that none of the nursing staff had checked with the prescriber that the directions he had written on the prescription were correct. The home has employed two new activity coordinators, who were both very new into their roles at the home. They were getting to know the people who live there and their interests. On the day of our visit a company had come to the home with some small animals and it was pleasing to see the people who live at the home interacting and enjoying touching them. The management have told us about external entertainers that have come into the home. We did not fully review provision of activities during this visit and this will be reviewed at our next visit to the home. Following our visit in March and prior to the new manager starting, there had been a number of safeguarding concerns raised. Many of these had been identified by external professionals who had visited the home and a number of them related to one persons behaviour. The management have now put systems in place to address this and staff have received training in the Safeguarding Of Vulnerable Adults (SOVA) so that they have the knowledge to keep people safe. This has resulted in the number of safeguarding referrals being reduced. Since the new manager had been in post, there had been two complaints received by the Care Homes for Older People Page 7 of 13 home. Both of these complaints were detailed in the complaints records and included what actions had been taken to resolve the concerns. We had received one complaint since March, which was looked into under the safeguarding procedures. The atmosphere in the home was welcoming, friendly and relaxed. The home was clean and odour free. We reviewed the bathroom, sluice and toileting facilities. Infection control practice had improved and we found these areas were clean and free from clutter so that people could use these as they needed to. The area around the sink in the kitchen had been retiled so that staff could keep this clean. Some staff told us that it was difficult to get people into the baths as the hoists did not easily fit around them. This was brought to the attention of the deputy during feedback for consideration. Staffing numbers have increased and staff morale appeared to have improved greatly since our last visit. Staff told us: Im really happy now, the new manager is great We ask for things and we see action, you feel you are listened to Staffing levels have improved so we get time to sit and talk to residents The home is more relaxed Things have really improved, its more organised The manager has given us a lot of advice Staff have received training in health and safety, principles of care, fire and moving and handling. Further training was booked for these topics to ensure that all staff received this and there were plans for dementia training and Deprivation Of Liberty Safeguarding training. These topics are relevant to the people who live at the home and will increase staffs knowledge so that they can meet peoples needs. What the care home does well: This is a random inspection and therefore not all of the core standards were assessed. The management team have made significant improvements at the home in order to improve the outcomes for the people who live there. These improvements are detailed in this report. They are keen to address any areas of concerns to ensure that the home is run in the best interests of the people who live there. The management team have put systems in place to monitor the quality of the service. This should mean that the service can identify and act upon concerns before they are identified by other agencies. The management team have kept people informed of changes both at the home and externally, to ensure that people know what is happening there. Care Homes for Older People Page 8 of 13 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 9 of 13 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 12 16 Provision of indoor and oudoor activities must be reviewed. So that people can continue to have an interesting and stuimulating lifestyle. 31/05/2010 Care Homes for Older People Page 10 of 13 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 9 13 The fridge used to store medicines is maintained at between 2 and 8 degrees Celsius. To ensure that peoples medication is stored in line with its product licence. 20/08/2010 2 9 13 The use of external products 20/08/2010 such as creams and dressings must be recorded by the person who administers the products. An audit of the recording tool must take place on a regular basis. To ensure that these products are used in accordance with the prescribers directions. Care Homes for Older People Page 11 of 13 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 2 7 8 Care plans should be further developed to include more specific details about individuals needs. Systems should be reviewed to ensure that people are weighed as often as they should be so that staff can monitor any changes. The disposal of medicines should take place in the presence of a second member of staff and the records reflects this. The use of inhalers is included in the audit tool to ensure that they are administered as prescribed. A second member of staff checks all handwritten administration charts for accuracy and the records reflect this. Medicines that are refused and destroyed are recorded in the disposal register. Consideration should be given to the style of bathing facilillities in the home so that people can access these with any equipment they may need and the assistance of staff. 3 4 5 9 9 9 6 7 9 21 Care Homes for Older People Page 12 of 13 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. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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