Care Home: The Green Nursing Home (Hasland)

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What the care home does well Residents told us that the manager of the home was approachable and was the person they would speak to about any worries they had. People told us that staff were kind and responded in good time when people used the buzzers. A grant has been used to provide a decked seating area in the garden for residents to use in good weather. This was attractive and was accessible to wheelchair users. The care plans in place were personalised and reflective of the people we spoke to. Where people told us about their preferences they were recorded so that staff were aware of them.Most people and one survey told us that the food at the home was good. A choice was offered routinely to people and staff told us that plates were typically emptied. The home was well presented and residents and relatives told us that it was usually fresh and clean. A relative told us that `there is a pleasant, warm friendly feeling about the home`. `It is the attentions to details which make all the difference to comfort and most of the staff do this`. What has improved since the last inspection? Work has been done to improve the personalisation of care plans and the ones looked at There has been an Activities coordinator employed since our last visit and this has meant that residents are invited to take part in a variety of activities. People told us they knew the Activities person by name and enjoyed the activities that were offered. On the day of the visit some people took part in skittles and seemed to enjoy this and engaged in banter with each other during the game. Contracted specialists have been into the home to undertake legionella and fire risk assessments to examine and limit any risks to people. What the care home could do better: Some terms and conditions contracts were in place where residents were selffunding but were not given to residents funded by local authorities to inform them about what to expect from their stay at the home. The electrical installation serving was overdue having last been checked in 2000. The Manager was aware of this and was planning to address this in June after new regulations came into place. The Provider was doing some quality assurance checks which involved speaking to staff and residents but the frequency of this was typically two monthly not monthly as is required by regulations CARE HOMES FOR OLDER PEOPLE The Green Nursing Home (Hasland) 45 The Green Hasland Chesterfield Derbyshire S41 0LW Lead Inspector Bridgette Hill Unannounced Inspection 11th June 2008 09:15a 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 The Green Nursing Home (Hasland) DS0000002084.V366176.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. The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Green Nursing Home (Hasland) Address 45 The Green Hasland Chesterfield Derbyshire S41 0LW 01246 556321 01246 551561 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) The Green Nursing Homes Limited Christine Eluned Innes Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th July 2007 Brief Description of the Service: The Green Care Home is situated within the village of Hasland, close to shops, park and a church. The home provides nursing and residential care for up to 40 service users. The home is purpose built and is fully accessible for wheelchair users. There are two lounges, the smaller of which is designated as a quiet lounge. There is also a separate dining room. Outside there is a well maintained garden with a seating area for service users. The fees charged at the home range from £345.52 - £531.00. There are additional costs for hairdressing, chiropody, and personal newspapers. The Manager gave this information by telephone after the visit. The Manager said the Inspection report and other information such as the Statement of Purpose was available in the home to anyone who wished to see it. The Green Nursing Home (Hasland) DS0000002084.V366176.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 the service receive good quality outcomes. The inspection visit was unannounced and took place over 6 ½ hours. Additionally, time was spent in preparation for the visit, looking at previous reports and other relevant documents and preparing a plan for the inspection. The Annual Quality Assurance Assessment which the home completes was not available prior to the visit but was available prior to completion of this report. Some information was available at the home as a rough copy of this document was available. Surveys were sent out prior to the visit to residents, staff and relatives and where these were returned to us the information received has been included in this report. There were 35 people living at the home on the day of the inspection which included people who had nursing needs. 3 residents, 2 staff and 1 visitor were spoken with during the visit. We talked to people who had different needs including where there were some communication difficulties. As part of the inspection a sample of service users care files and a range of documents were examined. The communal areas were viewed and some residents were happy to show us their bedrooms. Information sent since the last inspection told us that any incidents that have to be reported to us such as events that affect the well being of residents appear to have been sent. The Manager was on duty throughout the visit. What the service does well: Residents told us that the manager of the home was approachable and was the person they would speak to about any worries they had. People told us that staff were kind and responded in good time when people used the buzzers. A grant has been used to provide a decked seating area in the garden for residents to use in good weather. This was attractive and was accessible to wheelchair users. The care plans in place were personalised and reflective of the people we spoke to. Where people told us about their preferences they were recorded so that staff were aware of them. The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 6 Most people and one survey told us that the food at the home was good. A choice was offered routinely to people and staff told us that plates were typically emptied. The home was well presented and residents and relatives told us that it was usually fresh and clean. A relative told us that ‘there is a pleasant, warm friendly feeling about the home’. ‘It is the attentions to details which make all the difference to comfort and most of the staff do this’. 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 The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 8 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 The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 9 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): 2,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are arrangements in place prior to admission to ensure that people are assessed and the home has information to ensure peoples needs will be met. Not all people have contracts to tell them about what to expect from their stay at the home. EVIDENCE: In the entrance hall there was a range of information available this included the last inspection report, the Statement of Purpose and Service User Guide. One relative told us they had never looked at this. Surveys told us that most people had enough information about the home before they moved in. The people we spoke to said that their relatives had usually visited the home before they moved in to help them make the decision. The people we spoke to told us that it was a decision they had been happy with. The Manager The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 10 confirmed that this was often what happened but that visits to stay and have a meal at the home were offered. The Manager told us that they always visited prospective new people and recorded an assessment; these were in the care files along with other information such as care management and nursing assessments which told the home about peoples needs. This confirmed that the preadmission steps described to us in the Annual Quality Assurance Assessment were being followed. The surveys we received told us that not all people had terms and conditions contracts in place to tell them what to expect from their stay at the home. This was discussed with the manager who said that there were contracts in place for people who funded themselves but for other people funded by local authorities there were no contracts in place between the provider and people who use the service. Social Services contracts between the Provider and Social Services were available where local authorities funded people. The Manager told us that the home does not offer intermediate care. The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 11 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): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care that people told us they received was consistent with that described in care records and was appropriate to meet their needs. Medicines are competently handled to ensure residents receive prescribed treatment. EVIDENCE: We looked at 3 care files to assess how staff were recording peoples care needs and spoke to people to see if their care needs were those that were described. The Annual Quality Assurance Assessment told us that 3 nurses had attended person centred planning training. It was easy to see people’s needs reflected in the care plans written. They contained preferences regarding bathing, choice of drinks and the way people were helped to move was as people had talked to us about. The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 12 There were records that staff wrote on a shift by shift basis which told us how people had been and recorded any progress or concerns that had arisen. Only one aspect relating to continence needs was not as clearly described in the care plan as it should have been although accurate information was in another part of the care file. A system for ensuring care plans and other aspects of care were reviewed monthly was in place with an overview of this available in the front of care files. There was no evidence of residents being involved in the care planning process and this was acknowledged on the Annual Quality Assurance Assessment as an area in which improvements could be made. In each care file were a range of risk assessments including tissue viability, falls and Moving and handling. The people we talked to described how they moved and we looked at what equipment was in place in their rooms. Equipment in place was as described and people told us that they felt safe when staff were helping them move using the hoist. We looked at the storage and administration of medicines and found that there was good storage available which was secure. The Annual Quality Assurance Assessment told us a new trolley and cupboard had been obtained to ensure storage was suitable. The nurses in the home took responsibility for giving medication and a reference book, which was up to date, was available. There were clearly documented systems for recording medication received, administered and disposed of. The medication administration records indicated that residents received their medication regularly and as prescribed. One balance check on the medication administration records was confusing as it appeared to be a signature that could be construed as an administration but it wasn’t. People told us that staff explained to them what the tablets were for. Healthcare needs were met by visiting chiropodists, optician and dentist. Where residents had received input from these it was recorded in their records. Other specialist services such as Speech and Language Therapists were occasionally consulted and where residents were funded for personal care only the District Nurses visited to provide any nursing care required. Some care files we looked at had information recorded where people had made decisions about their post death wishes. A relative survey told us that their relative was always kept looking nice which is how they always have looked. We observed that people were well dressed in clean clothing that appeared well laundered and pressed. People told us they chose their clothes each day but did not wear their ‘Sunday best’. The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 13 Some people were cared for in bed on a permanent basis. Relatives told us that residents always appeared to be clean and comfortable. Charts were available to record where staff had helped people to move position. One persons privacy and dignity was found to be potentially compromised by them sitting in a chair covered by a large plastic sheet. The manager said this was placed there due to incontinence. The sheet was removed during the visit. The Annual Quality Assurance Assessment told us that there were some people for whom English was not their first language but on discussion with the manager it was confirmed that they had a good command of English and this did not pose communication difficulties. Where there were communication difficulties people told us that generally staff were patient in giving time to ensure they were understood but ‘some staff were better than others’. A loop system has been available at the home but this was currently broken. The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 14 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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an improvement in the range and structure of activities offered to residents in the home and there is now more choices offered to residents. EVIDENCE: There was recorded evidence of a wide range of activities that people could be involved with. An activities coordinator worked for 4 hours per day MondayFriday they had commenced in post in April 2008 and were offering a range of activities. Records were kept of activities offered and included the names of people that had been involved. The care records for each person also had some recorded preferences of social and leisure activities. The range of activities offered currently included board games, skittles, bingo, movement to music and external entertainers. On occasions the activities coordinator had taken people out to the local town. The Annual Quality Assurance Assessment completed by the manager told us that there were plans to develop the role of the activities coordinator. The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 15 Some people preferred to spend time in their rooms rather than communal areas. The activities coordinator said in addition to group activities they also spend some time chatting to these people. One person told us that they did not like the activities offered but knew the activities coordinator by name as they had spent time conversing with them. There was a notice board in the reception hallway that gave people details of the next movement to music session, entertainer or chiropody visit. A Minister from a local church visited the home on a monthly basis to give communion. A hairdresser visited the home regularly and this seemed to be greatly appreciated. One resident told us they could continue to have their hair done weekly as they did when they lived at home. Observations during the day were that the home received a number of visitors. Some spent time in communal areas to see their relatives others used the privacy of bedrooms. There was a choice of food at mealtimes. On the day of the inspection we observed the lunchtime meal. The options were gammon or white fish with potatoes and vegetables. Apple pie or ice cream was offered as dessert. We observed different portion sizes being offered with food being served on plates or large dishes dependant on peoples needs. Some people were using specialist cutlery to help them eat independently. Where people needed help staff sat with them individually and helped them to eat. Where residents had restrictions on the foods they could eat due to special diets being needed for health reasons some people were not as happy with the food partly as choice was limited due to health and safety reasons and preferred foods could no longer be eaten. The Annual Quality Assurance Assessment told us there was scope to improve the teatime meal and some changes have been made including fish and chip suppers. One relative told us that the home always celebrated birthdays with a cake and that staff were pleasant, good and kind. The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 16 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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to safeguard resident’s welfare and ensure that their concerns are listened to and acted upon. EVIDENCE: The Manager told us that the complaints procedure was available in the reception area. People spoken with and the surveys we received told us that people generally knew how to raise any worries and could name staff they would speak to usually the manager. There had been two complaints recorded on the Annual Quality Assurance Assessment. These were discussed with the Manager. For one complaint the paperwork was reported to be archived and not available. The handling of the other complaint indicated that a timely acknowledgement was sent to the complainant. There was a range of documents and notes where the manager had reviewed the information available before responding to the complaint. A suggestions/complaints book was available in the reception but this was not being used as the last entry was dated 2003. The surveys we received told us that people knew how to complain if they had worries. There was a Safeguarding Adults policy in place along with a copy of Derbyshire County Councils adult protection policy. Staff we spoke with told us The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 17 that they would report any concerns to the nurse in charge or manager. A whistle blowing policy was also in place. A record of training examined indicated that some staff had not yet received training. The manager was aware of this and gave us some planned dates where the in house trainer was going to address this. The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 18 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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well presented and maintained and offers a clean and comfortable environment for the people who live there. EVIDENCE: The home is well presented with attractive gardens and is easy walking distance to the centre of Hasland, which has a range of shops. The home has one dining room and two lounges with a range of different chairs to suit people’s different needs. Since the last visit a grant had been secured which has been used to improve the garden area by building a raised decked area with seating so the people can enjoy the garden in summer. This was accessed by a ramp that made it accessible to all. The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 19 People we talked with and the surveys we received told us that the home was fresh and clean as it was on the day of the visit. A handyman was employed and a maintenance book was available to record any works that needed doing. It appeared that works were rectified quickly. The home appeared to be generally well maintained with good décor. Only one bedroom viewed seemed to have some damage to plaster where the bed had pushed against the wall. Some people showed us their bedrooms, which had personal photographs, ornaments and collections in them. Generally people had their own television and one person had a video and DVD with a wide range of films to watch whenever they wished. The laundry area was tidy with all equipment functioning. There was no backlog of laundry and staff was seen busily returning clean items to rooms. One resident told us that their clothes were well cared for and they were happy with the laundry service. The fire records told us that there was checking and servicing of the fire system to ensure all precautions were being taken and a fire alarm check took place on the day of the visit. The fire risk assessment has been drawn up since the last visit but a company who was competent to do this. The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 20 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitment practices are robustly followed and regular training is offered to ensure staff have the skills to meet residents needs. EVIDENCE: There were 35 people in the home on the day we visited of these 17 required nursing care. The usual staffing levels on the current rota were one nurse for all shifts and 6 care staff each morning, 5 each afternoon and 3 at night. In addition to this the manager typically worked office hours each weekday. There generally appeared to be staff around to ensure they were available to respond to requests for assistance and there was observation of people. People told us that if they asked for help or used the staff call system staff were generally prompt in responding. Staff told us there were occasions where staff rang in sick where shifts were short staffed. The Manager told us that where there was sufficient notice there had been odd occasions where agencies had supplied staff to the home but there were occasions where last minute sickness did cause problems. The Annual Quality Assurance Assessment told us that there were some bank staff the home could call on as well as the agencies the home was registered with. The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 21 A sample of three staff files we looked at confirmed to us that all checks were in place to ensure that staff were suitably recruited with vulnerable adults. Some staff commenced employment prior to the full Criminal records Bureau was received but the pova first check was always in place. For these staff it was not clearly documented that they should be working in a wholly supervised capacity until full Criminal records Bureau clearance was confirmed. One staff member told us they had to wait for the pova first check to be returned before they could start. The surveys from staff also said checks were completed, some were not happy at the length of time checks took to complete. There was also evidence of good practice in recruitment procedures, such as keeping interview notes A skill-based induction was available and a completed recent copy was seen to indicate that staff were completing these. Staff spoken to described to us that they had been informed about fire and Health and Safety issues when they commenced employment. A training file was in place which gave information on each individual staff member and an overview of what training staff had received. Some newer staff had yet to be included in this file. A range of training had been completed since the last year. This included Health and Safety, Safeguarding Adults, basic food hygiene, Moving and handling infection control, and fire safety. First aid training was planned for 16.6.08 and further dates for Safeguarding Adults training were due shortly. There appeared to be a planned approach to providing ongoing training to staff to ensure they had the required skills to meet resident’s needs. The home had some qualified in house trainers in Moving and handling and Safeguarding Adults to ensure that staff received training when it was required. The home has a team of 26 staff of whom 13 had achieved at least National Vocational Qualification level 2. This met the national minimum standard of 50 of care staff. A further 5 staff were working towards National Vocational Qualifications to enhance further the skill level of the staff team to ensure they were able to meet the needs of residents. People told us that the staff were kind and gave them a ‘thumbs up’ the manager got a double ‘thumbs up’. The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 22 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): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was found to be well managed with a manager and staff who were well regarded by everyone we spoke to. EVIDENCE: The Manager of the home has been in post for many years and was positively regarded by everyone we spoke with. Staff told us they could and would approach the Manager if they had any concerns or worries. All people in the home knew the Manager by name and said they had confidence that she would address any worries they had. The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 23 The Annual Quality Assurance Assessment told us that there was stable management at the home with the manager and senior staff and a core of care and ancillary staff having worked at the home for a number of years. The Annual Quality Assurance Assessment told us what action has been taken to previously listed requirements and wherever it has been possible for the manager to address these work has been completed. In November 2007 some surveys were sent out by the home. Out of 36 surveys 17 were returned. The findings were summarised and made available to people and visitors in the reception area. There was a range of positive comments included on this such as: ‘Mum seems happy and well cared for’ ‘Staff are excellent – very approachable, and have a sense of humour’ ’I cant thank you enough for the way you care for my relative’ Suggestions were also recorded and a response given by the manager. The suggestions included drinks being given to visitors, the manager responded by saying visitors were welcome to have drinks at the times they were offered to residents and visitors who had travelled distances or were staying long periods with poorly residents were offered drinks. There were staff and residents/relatives meeting held albeit on a sporadic basis. The minutes of these were examined. One concern identified was that due to a shortage of kitchen staff there had been occasions where paper plates had been used to save staff from washing up. Accident records seems consistent to what was recorded in care notes and the frequency of some accidents had been discussed with staff at meetings. The Provider had recorded some visits to the home which contained brief details of discussions with staff and residents however the frequency of the recorded visits was not the minimum of monthly. The manager said the provider was a frequent visitor to the home although the visits were not always recorded. There was a good system to ensure the safety of residents’ money. This included clear records of any money that was held on behalf of the person by the service. There was evidence that these records were regularly checked. Some monies are paid into the Providers account and transferred to the home typically on a 3 monthly basis and monies were always found to be available for any purchases the resident made. We looked at some staff supervision records and the manager described to us a cascaded system where nursing staff undertook staff supervision. The records we looked told at there had been periods where most staff had The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 24 received supervision but the last times recorded were in March 2008 and there was not a planner in place to ensure that supervisions were regularly completed. One staff survey told us that Regular health and safety checks were being done. This included testing water temperatures and the fire alarm. Some water temperatures recorded indicated that bedrooms had a pattern of lower or higher temperatures than is expected. A legionella risk assessment has been completed since the last by a private contractor an invoice for this was available but a copy of the actual risk assessment was not available and therefore staff would not be able to know where there potential risks evident. The Annual Quality Assurance Assessment completed by the home indicated that all service checks were up to date apart from the electrical installation; this was last checked in 2000. The Manager said they were aware of this and was arranging for it to be checked In July after new regulations had come into force. The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 25 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 2 3 x x N/A 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 2 x 2 The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 OP2 Regulation 5(1)(b) Requirement Timescale for action 31/08/08 2 OP33 26 Terms and conditions contracts must be issued to all residents to inform them about the conditions of their stay There must be a quality 31/07/08 assurance process in place which meets the requirements of regulation 26 with the Provider monitoring the quality of the service At visit 11.6.08 these were intermittently being completed Previous timescale 31/08/07 3 OP38 23(2) The electrical wiring in the home must be checked and any fault rectified 31/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000002084.V366176.R01.S.doc Version 5.2 Page 27 The Green Nursing Home (Hasland) 1 Standard OP9 2 3 4 OP10 OP29 OP38 Where medication administration records are audited to check balances this should be completed in a manner where it cannot be confused with an administration signature The loop system should be repaired or replaced Where staff commence employment with a pova first check in place clear arrangements must be in place to ensure they work in a fully supervised capacity at all times A copy of the legionella risk assessment should be available to ensure staff are aware of and can limit any risks The Green Nursing Home (Hasland) DS0000002084.V366176.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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