Inspection on 02/07/08 for Gadlas Hall Nursing And Residential Home

This inspection was carried out on 2nd July 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Gadlas Hall Nursing And... 25/01/08

Gadlas Hall Nursing And... 28/08/07

Gadlas Hall Nursing And... 11/09/06

Gadlas Hall Nursing And... 27/09/05

Gadlas Hall Nursing And... 18/11/04

Gadlas Hall Nursing And... 23/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Gadlas Hall Nursing And Residential Home Gadlas Hall Dudleston Heath Ellesmere Shropshire SY12 9DY Lead Inspector Joy Hoelzel Key Unannounced Inspection 2nd July 2008 10:00 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 Gadlas Hall Nursing And Residential Home DS0000022246.V367824.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. Gadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gadlas Hall Nursing And Residential Home Address Gadlas Hall Dudleston Heath Ellesmere Shropshire SY12 9DY 01691 690281 01691 690790 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) Mrs Michelle Roberts Mrs Michelle Roberts Care Home 29 Category(ies) of Dementia (10), Learning disability (1), Old age, registration, with number not falling within any other category (18) of places Gadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home must comply with the Staffing Notice issued by the Shropshire Area Health Authority dated 12 October 1999. The home is registered to care for one person, aged under 65, with Dementia, who is named in the attached Schedule (not to be displayed). 25th January 2008 Date of last inspection Brief Description of the Service: Gadlas Hall is owned and managed by Mrs Michelle Roberts, and is situated in the village of Dudleston Heath, just outside the town of Ellesmere, on the North Shropshire/Welsh border. The Home provides accommodation, residential and nursing care for up to 29 older people, some people require specialist care for dementia. The building is purpose built with spacious communal areas and wide corridors to accommodate wheelchair users, and people with mobility difficulties. Three bedrooms are designed for double occupancy, the remainder being single occupancy. Bathing and toilet facilities are shared but all of the bedrooms have hand wash basins. The surrounding garden, with views of the countryside, provides a pleasant external environment. Information of the home and the provision of the service are available in the statement of purpose and service user guide. The service user guide includes information on the current level of fees for the service and range from £310.85 - £479.80 per week. Commission for Social Care Inspection reports for this service are available from the provider or can be obtained from www.csci.org.uk. Gadlas Hall Nursing And Residential Home DS0000022246.V367824.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 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection took place over five hours on Wednesday 2nd July 2008. Twenty three of the thirty eight National Minimum Standards for Care Homes for Older People were inspected as they are viewed as key standards for services. Twenty nine people are currently living at the home and during the inspection were observed to be accessing all areas of the home. The proprietor/manager was on the premises and in charge of the home, supported by four care staff and ancillary personnel. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of a number of people using the service were viewed including care plans, daily records and risk assessments. Other documents seen included medication records, service records, some policies and procedures and staffing records. Discussions were held with people living and working at the home. Some people were unable to fully comment about their experience of life at the home, observations were made of how they spent the day and of the interactions offered by staff in an attempt to obtain an overview of how they may be feeling. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a selfassessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to us within a given timescale. The proprietor/manager and deputy manager completed this document and returned it to us. It gave us limited information and their point of view on how the service is currently operating. It describes the plans for improvements within the next twelve months. Comments from the AQAA are included within this inspection report. Gadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The care plans should be in sufficient detail to inform staff of the actions needed to fully meet peoples assessed needs. They should be accurate, concise, comprehensive, person centred and seen used as a working document. Gadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 7 When ever possible care plans should be developed, agreed and reviewed with the individual person and/or representative. People should at all times be offered choices and encouraged to make decisions about their life. More attention should be given to increasing the variety, frequency and range of social and leisure activities to meet the needs and personal preferences of all the people living at the home. The dining arrangements are very routine and functional with people given little to no choice. Meals and mealtimes are not viewed as an opportunity for socialising. 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. Gadlas Hall Nursing And Residential Home DS0000022246.V367824.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 Gadlas Hall Nursing And Residential Home DS0000022246.V367824.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): OP 1,3,6 Quality in this outcome area is good. Admissions are not made to the home until a full needs assessment has been undertaken. This tells the home all about them, what they hope for and want to achieve, and the support they need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information of the service provision are detailed in the statement of purpose and service user guide and are available upon request at the home. The service user guide has recently been reviewed to include the current levels of the weekly fees. This ensures that prospective residents have full information available to assist with making a choice of whether or not to move into the home. Pre-admission assessments are undertaken prior to people coming to live at the home. This should ensure that people’s needs can be met when moving Gadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 10 into the home. The examination of a sample of people’s case file’s that had recently moved into the home contained assessment of needs, which clearly indicated their needs. A member of the homes nursing staff carried out an assessment where the person had been in hospital. A social workers assessment was also in the case file. The persons individual preferences were recorded, such as; sleep patterns, likes and dislikes. This reduces the risks posed when relying on verbal communication between staff. One person who lives in the home, shared with us, “Me and my family came to look at the home and we liked it very much so I moved in”. Other case files looked at included social worker reviews, assessments from Primary Care Trusts and community care services. The home does not provide an intermediate care service Gadlas Hall Nursing And Residential Home DS0000022246.V367824.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): OP 7,8,9,10 Quality in this outcome area is adequate. Each individual has a care plan but the current practice of involving residents and/or their representative in the development and review of the plan is variable. The plan includes basic information necessary to deliver the person’s care but is not always accurate, reliable or person centred. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All people living at the home have a plan of care that is based on the information gained prior to admission, and an assessment of daily living activities. The plan is then reviewed on a regular basis. There was little evidence in the selection viewed that people or their representatives/relatives are involved in the planning and review process. Four case files were selected for inspection and generally contained the information required to ensure staff have the specific details for successfully meeting a persons needs. However, in the selection viewed there appeared to Gadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 12 be omissions of information and some discrepancies and inconsistencies when discussing care needs with individuals and observing staff working practice. One person required a particular daily intervention by the senior staff, there appeared to be differences in the actual treatment prescribed and what the staff were giving. This was discussed with the owner/proprietor at the time who offered an assurance that the care plan would be amended to show the correct information and instructions. Another case file indicated a particular religious persuasion, there was no recording of how this persons preferences could be adequately met. This person stated that although religious services are arranged at the home, and they participate in this service, there was ‘ little opportunity’ for their particular denomination. Other case files recorded details and personal preferences such as the assistance needed to prepare for bed and undertaking personal care tasks. Staff were able to provide a verbal update of the care of people who use the service and described the individual and diverse care needs. They appeared to have a good idea and knowledge of each persons likes and dislikes. Improvements were noted in the content of the care plans at the key inspection in January 2008. There appears in the selection viewed on this occasion that no further improvements have been made to the content, accuracy and effectiveness of the plan. The Annual Quality Assurance Assessment completed by the proprietor/manager and deputy manager states that during the past twelve months improvements have been made to care planning by – ‘Ensure that individual care plans are evaluated each month to include individual activities’. The home operates a twenty eight day prescribing regime for the administration of medication using a monitored dosage system with the additional use of boxes and bottles of medicines. The registered nurses or senior care staff administer the medications, the Medication Administration Record appears to be fully completed, and no gaps in the recording sheet were seen in the selection viewed. Some medications were stored in the medication cupboard without a prescribing label and name of the person they were originally prescribed for. The proprietor/ manager stated that these were no longer needed and would return them to the supplying pharmacist for disposal. Other external preparations were not dated upon opening this has the potential for people to be at risk with using out of date medications. Gadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 13 The manager stated that a monthly audit of the medication system and procedure is carried out, any omissions or concerns found are discussed with the staff responsible for administering the medications. During the tour of the premises the shared bedrooms had been provided with one privacy curtain between the beds. However, the curtain was not sufficient to completely offer full privacy and dignity when a person was being assisted with personal care interventions. People commented that the ‘staff were very good’ and many expressed a satisfaction with life in the home. The people who were unable or did not wish to express comment looked comfortable, at ease and relaxed. Gadlas Hall Nursing And Residential Home DS0000022246.V367824.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): OP 12,13,14,15 Quality in this outcome area is poor. The service is not person centred in its approach to supporting people that use the service with little consideration given to people’s individuality or social preferences. Eating and food in the home is not considered to be an enjoyable event. Menus are not available and residents are not asked what they like or dislike. Individuals have very little choice of what they eat, and are not given the choice of where and when they eat. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of social and leisure activities provided at the home are organised and arranged by the care staff. The frequency and content of the activities is limited by time and workload constraints of the care staff on duty. A member of the care staff commented that – ‘A person comes in 2 afternoons a week for activities, at other times if we have the time we do skittles, throwing the ball, connect 4, dancing and the occasional outside entertainers are arranged’. Gadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 15 One person living at the home commented – “I would like more going on, it’s very boring”. Other people spoken with stated that they preferred to stay for the majority of the time in their own bedrooms and had the television and radio ‘to pass the time of day’. The service user guide has a section on social activities and describes – ‘These are provided by our activities coordinators. They include bingo, skittles, singing, crafts, cooking and our annual pantomime performed by staff. We have a weekly visit from our beauty therapist who visits to do manicures and pedicures’. The Annual Quality Assurance Assessment completed by the proprietor/manager and the deputy manager identifies that it could do better by providing – ‘More social activities and outings’. And plan to do this by – ‘Regular activities and increase one to one socialisation’. Throughout the duration of the inspection there was little activity happening, most people sitting in the lounge areas were either asleep or watching television. A music CD was playing in the large lounge, one person was singing along. People appeared to be disengaging due to the lack of social stimulus and activities. There was very little interaction between residents or staff, except when people were being assisted with daily living tasks and personal care interventions. Visitors at the home were generally satisfied with the care provided – ‘Never a problem with anything everything is fine- staff try their best’. The main entrance door is locked at all times for security purposes with entry and exit being gained by push button at the top of the door. Other external doors are kept locked and are alarmed. No doors inside the home are kept locked with the exception of a few private bedrooms. Gadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 16 Staff were observed to be restricting a persons choice of where to sit in the large lounge and assisited them to an armchair where they said they did not wish to sit. When asked about this staff replied ‘she always sits here’. Meals and mealtimes were again observed to be very basic and functional with very little attention to detail to making dining a social and pleasing occasion. The dining areas were not prepared in advance of the midday meal. Cutlery was provided as each meal was served. There is insufficient seating available should all people wish to have their meals at the dining tables. Four people had their midday meal on tables in front of them while they were sitting in armchairs. When asked, staff stated that these people preferred not to go to the dining area but we did not hear people being asked their preference. The meals are served from a heated trolley where the food had been plated up in the main kitchen by the catering staff. The care staff then serves the meal. One lady was given an incorrect meal, when they had recently been assessed as requiring a soft diet. When asked staff stated that this information had not been passed on. One person stated that they were generally satisfied with the food given but stated that they were not offered a choice of meals. Other people were unaware what was the meal for the day, they had what was given but it is ‘usually ok’. Gadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 17 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): OP 16,18 Quality in this outcome area is adequate. The service has a complaints procedure that meets the national minimum standards and regulations. The procedure is up to date and is displayed on a notice board in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaint procedure that is available upon request. Details of the procedure are included in the statement of purpose and a copy is displayed at the entrance to the home. The proprietor/manager confirmed that no concerns or complaints have been received and no referrals have been made to the safe guarding adults multi agency team. We, the commission, have received one anonymous concern regarding staffing levels and registered nurse cover. We phoned the home on the day of the possible shortage and spoke with the nurse in charge who confirmed that registered nurses are on the premises over the twenty-four hour period. The proprietor/manager confirmed that their own bank staff cover any shortfalls in staffing as and when the need arises. Two people living at the home stated that they would speak with their family if they had any concerns and were hopeful that they would sort it out. Gadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 18 Care staff confirmed their recent attendance on protection of vulnerable adults training and described the action they would take if they had suspicion of any wrong doings. The proprietor/manager stated that no money is held for safekeeping on behalf of any people living at the home, any sundry expenses incurred are invoiced to the person’s family or representative for payment. Gadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 19 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): OP 19, 26 Quality in this outcome area is adequate. The home provides a physical environment that meets the specific needs of the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides a good standard of accommodation, fixtures and fittings and is suitable for the current resident group. All accommodation is on the ground floor, corridors are wide and very accessible for people who use a wheelchair to aid mobility. Routine maintenance and renewal of the fabric and decoration continue on an ‘as needed’ basis. The Annual Quality Assurance Assessment completed by the deputy manager and proprietor describes what has improved over the last twelve monthsGadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 20 ‘Shower installed, decoration and carpeting, new bedroom furniture and bedding’ Plans for further improving include – ‘Dining area to be redecorated, new furniture, new signs’. The service user guide describes ‘future aims’ for the service – ‘Interior decorating is ongoing to maintain a high standard. Our gardens have access for wheelchairs but we would like to extend this and add more seating’. Wooden wedges were being used to keep open the office and main kitchen door on our arrival to the home. The danger of propping doors open in highrisk areas, notably the kitchen, was discussed with the catering staff who were directed to remove the wedges. This has been discussed with the manager/proprietor on previous occasions. For the safety of people living, working and visiting the home the manager/proprietor must now ensure that if doors are required to be open then the appropriate door closures are fitted without delay. During the tour of the premises some of the communal and private areas around the home were malodorous with carpets in need of a deep clean and/or replacement. This was discussed with the proprietor/manager. Not all communal and private areas have been supplied with suitable hand wash facilities for the effective control of the spread of infections and for general hygiene purposes. Gadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 21 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): OP 27,28,29,30 Quality in this outcome area is adequate. People are generally satisfied that the care they receive to meet their needs, and the service has a recruitment procedure that meets statutory requirements. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A duty rota is maintained on a weekly basis to identify the people working in the home at any one time. The proprietor/manager confirmed the staffing levels maintained during the twenty four hour period as • • • Mornings, one registered nurse and five care staff, Afternoons, one registered nurse and three care staff, reducing to One registered nurse and two care staff for night cover. Catering and domestic staff are additional to these levels. The proprietor/manager confirmed that currently they are fully staffed with all grades of workers. The service has sufficient bank staff to cover any shortfalls in maintaining the staffing levels due to annual leave or sickness of the Gadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 22 permanent staff. With the proprietor/manager confirming that agency staff are never used. General observation of daily activity suggested that there are sufficient staff to provide the basic care but little opportunity to pay attention to detail and improve the outcomes for people living at the home. Those people who were able and wished to offer an opinion indicated a satisfaction with the staff and offered comments such as – ‘“The staff are very caring’. The Annual Quality Assurance Assessment completed by the manager/proprietor states that of the twenty-three staff, ten have been accredited with National Vocational Qualification in care at levels 2 or 3, with another four staff working towards the qualification. Care staff at the time of the inspection confirmed their attendance on the course. Three staff personnel files were selected for inspection and indicated that suitable recruitment procedures are in place. Each file contained references, criminal record bureau disclosures and confirmation of identity. A training matrix has been developed as a check document to ensure that all staff are up to date with their training and development requirements. The manager/proprietor spoke of the difficulties encountered with accessing some training agencies to facilitate the courses. Staff members completed an on site survey and stated that during the past six months things had improved by – ‘Staff training/being asked what other course we would like apart from the mandatory ones’. Gadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 23 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): OP 31,33,35,38 Quality in this outcome area is adequate. The manager is qualified and has the necessary experience to run the home. However, some areas of the service would benefit from having dedicated management time to improve the outcomes for people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mrs Michelle Roberts is the proprietor/manager of the home and is supported by a deputy manager. Mrs Roberts has recently gained accreditation at National Vocational Qualification level 4 with the deputy manager nearing completion of the same course. Gadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 24 Mrs Roberts states that sufficient supernumery time is taken to allow for the managerial duties to be fully executed, at the time of this inspection Mrs Roberts was working in a clinical capacity. There are clear lines of accountability with care staff offering positive comments regarding the management team. The deputy manager and proprietor/manager completed all sections of the Annual Quality Assurance Assessment and the information gives a reasonable picture of the current situation within the service. The Annual Quality Assurance Assessment gives us some limited detail about the areas where they still need to improve. The ways that they are planning to achieve this are briefly explained. Limited quality assurance and monitoring of the service continues with general satisfaction surveys being distributed to people living at the home and their representatives. The Annual Quality Assurance Assessment comments that it provides a good service by – ‘Qualified and experienced staff, promote a comfortable home and atmosphere, good assurance and monitoring, aims and objectives met, policies and procedures and up to date and accurate records’. And could do better and improve with – ‘More frequent staff meetings’ The proprietor/manager stated that no money is held for safekeeping on behalf of any people living at the home, any sundry expenses incurred are invoiced to the person’s family or representative for payment. Records are maintained for the weekly, monthly and annual health and safety checks. These checks ensure that people living, working and visiting the home are in a safe environment. General risk assessments have been carried out for the environment, equipment and aids in use. Safe working practices are being compromised in two areas observed during the course of this inspection• Two care staff were observed to be transferring a person from a wheelchair to an arm chair in the lounge using the underarm method. This moving and handling technique was condemned many years ago as it is considered a dangerous manoeuvre. Due to the lack of suitable hand wash facilities in all areas of the home, effective hand washing and the prevention of the spread of infections is being compromised. • Gadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 25 Care staff appeared to be unaware of potentially dangerous practices and stated that they had received training in moving and handling and infection control. In many areas of the Annual Quality Assurance Assessment there is reference to an improvement in staff training with a comment of – ‘Staff training is much more in depth and frequent’. The proprietor/manager discussed the current problems she is experiencing with accessing appropriate and suitable training organisations. Gadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 26 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 3 X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 2 Gadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement Timescale for action 1 OP8 12(1)(a) The service must make proper 31/07/08 provision for the health and welfare of people who live at Gadlas Hall to ensure that they receive the nursing, personal care and monitoring that their conditions require. 2 OP10 12(2)(3) Suitable arrangements must be 31/07/08 (4)(a)(b) made to ensure that people living at the home are treated in a way that respects their privacy, dignity, wishes and feelings. 3 OP12 16(2)(m) All people must be offered 31/07/08 (n) opportunities to engage in leisure and recreational activities to suit their personal preferences. 4 OP14 12(1)(a) People should be supported and 31/07/08 helped to exercise choice in daily living to ensure that whenever possible they are in control of their own lives. 5 OP15 12(2) People must be offered a choice 31/07/08 of food and when and where they wish to eat 6 OP19 23(4)(a) The practice of propping open 31/07/08 doors within the home should cease to ensure the safety of people within the home. 7 OP33 24(1)(a) An effective quality assurance 31/07/08 (b) and monitoring system should be implemented to ensure the home Gadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 28 8 OP38 13(4) is run in the best interests of people living at the home. Staff working practices must ensure that the health, safety and welfare of people living, working and visiting the home are promoted and protected. 31/07/08 Gadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 29 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. 2 3 4 5 6 Refer to Standard OP7 OP9 OP10 OP26 OP26 OP27 Good Practice Recommendations When ever possible care plans should be developed, agreed and reviewed with the individual person and/or representative. Medication must only be administered to the person it has been prescribed, dispensed and labelled for to ensure that medication is given safely and correctly. To maintain a person’s privacy and dignity at all times privacy curtains should be in use and staff working practice amended. Arrangements should be made to ensure that all areas in the home are free from any offensive odour, clean and hygienic. Suitable hand wash facilities should be available in all areas for effective hand washing purposes and for the control of the spread of infections. Staffing numbers should continue to be reviewed and increased in line with the dependency needs of the people and taking into account the lay out and purpose of the home. Sufficient supernumery management time should be allocated to ensure that all managerial tasks are fully carried out. All staff must continue to receive training and updates in all safe working practice topics. 7 8 OP31 OP38 Gadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Gadlas Hall Nursing And Residential Home DS0000022246.V367824.R01.S.doc Version 5.2 Page 31 - 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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