Inspection on 25/01/08 for Gadlas Hall Nursing And Residential Home

This inspection was carried out on 25th January 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Gadlas Hall Nursing And... 02/07/08

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 08/07/2008.

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 25th January 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.V358626.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.V358626.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 vacant post 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.V358626.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). 28th August 2007 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 of who 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 with privacy screening, the remainder being single occupancy. Bathing and toilet facilities are shared but all of the bedrooms have hand wash basins. Internal decoration is light and bright, and there is a courtyard accessible to Residents and their visitors. 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 does not include information on the current level of fees for the service. The reader may wish to obtain more up to date information from the care service. 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.V358626.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 seven hours on Friday 25th January 2008. In addition a follow up visit to the home was made on Friday 1st February 2008. It was conducted by two Commission for Social Care Inspection personnel, a regulation inspection and a pharmacy inspector. Twenty five 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 five people are currently living at the home and during the inspection were observed to be accessing all areas of the home. The registered manager was on the premises 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. Following the key inspection in August 2007 several requirements were made in relation to care planning, social and leisure activities, recruitment procedures and staff training. The registered manager was requested to submit an improvement plan to us detailing how the requirements were to be met and what improvements were to be made. The improvement plan was received in December 2007; the stated improvements were inspected on this occasion and are detailed in the main body of the report. What the service does well: The accommodation provided is of a high standard with the premises being warm, comfortable and homely. Gadlas Hall Nursing And Residential Home DS0000022246.V358626.R01.S.doc Version 5.2 Page 6 People living, working and visiting the home offered positive comments on their experience of the service – ‘Lovely place to work I am very happy here and we work as a team’. ‘Reasonably content it’s not like home but they [staff] do their best’ ‘ They look after my relative pretty well it is an ok place’ ‘Never a problem with visiting times can visit whenever it suits, look after my relative very well, no complaints’ What has improved since the last inspection? What they could do better: The statement of purpose and service user guide detailing the service provision should be reviewed and amended accordingly to provide accurate and up to date information of the home. Whenever possible people and/or their representative should be involved in the care planning and review processes. 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. For ease of reference both for the person allocated the responsibility of organising and arranging training opportunities for staff and for the purpose of inspection a matrix should be developed to indicate the training needs of each Gadlas Hall Nursing And Residential Home DS0000022246.V358626.R01.S.doc Version 5.2 Page 7 staff member, the date of the proposed training and when the person completed the course. The training and development needs of all staff must now be identified and urgent action taken to ensure that training and updates in all core/mandatory and specialist topics relating to the service provision are accessed accordingly. Sufficient time should be available for Mrs Roberts to be able to fully discharge the responsibilities of being a registered manager. For the safe use of bedrails, regular checks should be conducted to ensure the rails are correctly fitted and compatible with the beds and that the rails are fit for the purpose. Records of these checks should be maintained and available for inspection. Regular monitoring must be carried out for the fire alarm system, emergency lighting, hot water temperatures, legionella, use of chemicals, gas and electricity supplies and all equipment in use at the home. Records should be maintained in order to demonstrate that systems are safe and reduce the risk of harm to people living, working and visiting the home 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.V358626.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.V358626.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 needs assessment has been undertaken by a senior member of the staff team, this ensures that the home is confident that all assessed care needs of the individual can be fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A statement of purpose or service user guide was not requested from the home on this occasion but should be available upon request. A service user guide was obtained from the home at the last inspection and although not inspected in depth, on general observation it does not include information on the current level of fees for the service. To comply with the regulations the service user guide must include information about the fee levels and what is and is not included in the fees. Gadlas Hall Nursing And Residential Home DS0000022246.V358626.R01.S.doc Version 5.2 Page 10 The case file of the person most recently moving into the home contains an assessment of care needs from which details of this person basic care needs had been recorded at the point of admission to the home. The improvement plan submitted by the registered manager (10/12/07) stated that ‘on admission a basic care plan is completed by the qualified nurse on duty to identify the immediate needs of the client and a full plan of care is completed within two weeks of admission’. During the follow up visit on 1st February 2008, a full plan of care for this person had been developed with the relevant details of the care needs and interventions required by staff, fully documented. This information will ensure that the care needs can be fully met. Other case files inspected included pre admission information from the Primary Care Trust, social workers and previous social care placements. The home does not provide an intermediate care service. Gadlas Hall Nursing And Residential Home DS0000022246.V358626.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 practice of involving residents and/or their representatives in the development and review of the plan is variable. Some improvements have recently been made to the plans, the effectiveness of the changes will be determined over time, when the health, personal and social care needs of people are fully met. 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 the plan is then reviewed on a regular basis. There was no evidence in the case files selected to suggest that people or their representatives were being fully involved with the care planning process. Gadlas Hall Nursing And Residential Home DS0000022246.V358626.R01.S.doc Version 5.2 Page 12 One relative confirmed that he was aware of his mother having a plan of care but that he had never been asked to participate in this process he thought that it would be a good idea to know what was ‘happening’ to his mum but he had no concerns about the care she is receiving. It is acknowledged that some people may not wish to or are unable to contribute to the process but efforts should be made to ensure that the plan of care is discussed and agreed with the individual. The care plans are based on assessments of risk and the activities of daily living and where a potential risk has been identified, the action to be taken to reduce the risk was recorded. One care plan looked at identified a person at risk of developing pressure areas due to a reduction in mobility, a plan had been implemented for the use of specialist equipment, continence care and personal hygiene. The content of the plans looked at was generally of a good standard with improvements made since the last inspection in August 2007, the effectiveness of the changes will be determined over a period of time. The people living and working at the home appear to have developed good relationships with each other there was lots of chatter and discussions occurring. Staff were observed to be offering many choices and carrying out interventions in a calm, efficient and competent manner. The pharmacist inspector also visited the home as part of the inspection to assess what progress the home had made in meeting the requirements made at an inspection on the 2nd November 2007. At that inspection a number of immediate requirements were issued to instigate improvements in the handling of medicines within the home. We found that the handling and recording of the Controlled Drugs had greatly improved. We found that all of the residents had their own supply of their respective Controlled Drugs and that the receipt, administration and disposal of the Controlled Drugs were being recorded on an individual basis, although the quality of the information recorded needed to be improved. With the improvements it could be seen that the residents were having their Controlled Drugs administered as required by their doctor. The medication records had improved but not sufficiently enough to ensure the safety and welfare of the people who use the service. There had been improvements in the recording of the receipt of the medication. However, the audit sampling process showed that some people were not receiving their medication as prescribed by their doctor. The audit process showed that the Medicine Administration Record (MAR) charts had been signed when the medication had not been administered. We also found that there was signature Gadlas Hall Nursing And Residential Home DS0000022246.V358626.R01.S.doc Version 5.2 Page 13 gaps, undefined and inappropriately used abbreviations on the MAR charts. The handwritten entries on the MAR charts were also being written out poorly and were not being checked for accuracy by other suitably trained members of staff. Changes made to the administration records were not support by information in the care plans. Where variable doses had been prescribed the records did not show what quantity had been given. We also found that the practice of sharing prescribed medicines between residents was also still taking place. We also found that some when required medication was not available in the home and therefore if a resident required some of this medication the home would not be able to meet the residents needs. An immediate requirement notice was issued asking for these issues to be addressed. We found that the waste management system for the disposing of waste medication was now in place and records of the disposals were being recorded. It was disappointing to find that some medication that, at the last inspection, had been identified for disposal had not been disposed of. We found that the storage area where the residents’ medication was kept had been cleaned. We also found that the excess stock had been significantly reduced and the organisation of medicines in the trolley was much better. Both of these factors would mean that there was less risk of picking errors and consequently less risk of residents receiving the wrong medicines. We found that the nursing staff had still not been assessed for their competency to handle and administer medication safely. Gadlas Hall Nursing And Residential Home DS0000022246.V358626.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 adequate. Generally staff are aware of the need to support residents with daily life and social activities. Some residents are consulted or listened to regarding the choice of daily activity, but this process could be improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home does not employ a person for arranging and facilitating social, leisure and recreational activities; two members of staff have been allocated joint responsibility for this in addition to their care duties. The improvement plan submitted by the registered manager in December 2007 states ‘ Clients activities are held on a weekly basis 1-5pm, All activities are documented with staff arranging entertainment by outside bodies. This is arranged on a regular basis’. Gadlas Hall Nursing And Residential Home DS0000022246.V358626.R01.S.doc Version 5.2 Page 15 During the morning of the inspection people were either in their own rooms or in the lounge areas. The television was on in both lounges, some people were reading the papers, some watching the happenings of the day and others were dozing in their chairs. During the afternoon staff put on some music for a short while, and two people went out for a walk in the grounds accompanied by staff, one stated ‘ it was lovely and blew the cobwebs away’. One person stated that they preferred to stay in their own room as they were ‘more comfortable in my own chair’ and passed the time of day with reading, listening to music and watching the television. This person has regular visitors and is able to get out into the gardens ‘weather permitting’. People living, working and visiting the home appeared to be at ease with one another, it was evident that good relationships had been developed. Visitors at the home during the morning stated that they were generally satisfied with the home and had no concerns. The home operates a rotational menu for all meals served; the catering staff prepare the meals with care staff serving the food from a heated trolley in the dining areas. The meal on the day of the first inspection looked appetising and nutritious and people appeared to be enjoying it. The dining tables had not been prepared in advance of the midday meal, only one table had a cloth on, no serviettes, there were no drinks provided (hot or cold), and no condiments or sauces readily available. The continuation of not paying sufficient attention to the quality and style of the presentation of dining was further discussed with the registered manager. An explanation was offered but the importance of providing a good standard of presentation, choice and preferences of all people was emphasized. At the follow up visit (1st February) improvements had been made to the dining areas with these being prepared in advance of the midday meal with table linen, condiments and drinks are now provided on the tables. This improvement to the previous very functional aspect of dining will go a long way to enhancing the social feature of this significant part of a person’s life. Gadlas Hall Nursing And Residential Home DS0000022246.V358626.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): OP 16,18 Quality in this outcome area is adequate. The service has a complaints procedure that is displayed on a notice board in the home; some amendments are required to ensure that people have the correct contact details of other agencies should they wish to contact them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is displayed at the entrance to the home, details of this procedure are included in the service user guide. The statement of purpose and service user guide should be amended to ensure that our details are correct should anyone wish to contact us. The registered manger confirmed that no complaints or safeguarding adult referrals had been made since the inspection in August 2007 and that a satisfactory conclusion had been reached for all of the previous three referrals made. We have not directly received any concerns or complaints regarding the service since August 2007. Gadlas Hall Nursing And Residential Home DS0000022246.V358626.R01.S.doc Version 5.2 Page 17 One person living at the home stated that he didn’t have any complaints at the moment but if he did he would speak with his son who would then ‘sort it out’. The registered 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.V358626.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): OP 19,22,24, 26 Quality in this outcome area is adequate. Generally the home provides a physical environment that meets the specific needs of the people who live there. Some action has been taken with a review of the equipment in use that may reduce the potential risk of injury to people; time will determine the effectiveness of these changes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides well-furnished, comfortable and homely private and communal accommodation and has an ongoing programme of redecoration and refurbishment. Gadlas Hall Nursing And Residential Home DS0000022246.V358626.R01.S.doc Version 5.2 Page 19 The bedrooms are highly personalised with the furniture provided by the home of good quality. Contrary to the recommendations previously made, wooden wedges are still in use for keeping doors open, during the tour of the premises the office and kitchen door were wedged open. If there is a need or a personal preference for doors to be kept open then suitable door closures should be fitted, linked in with the fire alarm system so as to close automatically in the event of an emergency. Some bedrails in use were unsuitable and not compatible with the type of bed, some were not stable and moved very easily up and down the bed, and some were not of an effective height to prevent people from falling over the rail. The manager explained that following the inspection in August 2007 an attempt had been made to ensure that all rails in use were of the correct type, fit for the purpose and compatible with the bed. It was again emphasized of the requirement for all equipment in use at the home to be safe and fit for the purpose and an immediate requirement was issued for all bedrails to be assessed and either removed or replaced. The manager spoke with the supplier and a visit was arranged. At the follow up visit on 1st February a full assessment had been conducted of the need for bedrails, a risk assessment had been completed and where necessary the rails had been changed or removed. The home has three twin occupancy bedrooms, it was noted that privacy curtains were not available either between the beds or at the wash hand basin. The manager explained that a portable screen is used when personal care interventions are carried out. Staff working practice was observed and did not evidence this. The need to maintain a person’s privacy and dignity was discussed with the registered manager and during the follow up visit (1st February) privacy curtains had been placed in the three bedrooms. Hand wash facilities have been provided at the point of the delivery of care and in communal toilets and bathrooms. Gadlas Hall Nursing And Residential Home DS0000022246.V358626.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): OP 27,28,29,30 Quality in this outcome area is adequate. Improvements have been made to the recruitment of staff, with procedures in place to ensure the protection of people living at the home. The manager is aware that there are some gaps in the training programme and plans to deal with this. Currently there is no comprehensive training plan and no reliable records of staff training that has been undertaken. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing rotas maintained on a weekly basis and indicate the numbers of staff on the premises at any given time. At the time of this inspection there were twenty five people in residence with a staffing complement of the manager (working in a clinical capacity) supported by four care staff with catering and domestic staff additional. The registered manager stated that recruitment for staff, both trained nurses and care staff is ongoing. The registered manager confirmed that currently there are twenty one permanent care staff of which ten have gained accreditation at National Gadlas Hall Nursing And Residential Home DS0000022246.V358626.R01.S.doc Version 5.2 Page 21 Vocational Qualification in care level 2, with four staff either completing or starting the course. Three staff personnel files were selected for inspection each contained the required documentation to ensure a suitability to work with vulnerable people. Separate files are kept of each subject area for staff training, with certificates and accreditations of training kept in this file. It was not possible to establish the training identified or completed by each individual as no matrix is maintained. It was suggested that for ease of reference both for the person allocated the responsibility of organising and arranging training opportunities for staff and for the purpose of inspection that a matrix be developed. Members of staff discussed the limited training opportunities that they had received and stated they had fire safety training and ‘the nurses are very good at showing us how to do things’. A requirement was made following the key inspection in Aug 2007 – ‘Staff must receive training and regular updates in the core topic areas and any specialist areas relating to the service provision’ There is no documentary evidence to suggest that this requirement has been complied with. The improvement plan submitted by the registered manager (December 2007) states that the home is ‘ registered with SPIC (Shropshire Partners in Care) and other outside bodies, all staff attend the mandatory study days’. During the follow up visit (1st February) the registered manager confirmed that SPIC have been contacted, a programme for training has been received and includes courses in the protection of vulnerable adults, recording and documentation, moving and handling and first aid. Fire safety awareness has been arranged through the local fire office. It is imperative that staff are adequately skilled, trained and competent to do their job. All staff must receive training and regular updates in all core topics e.g. fire safety, first aid, health and safety, moving and handling and specialist topics e.g. dementia care and awareness etc, to ensure that residents needs are fully met and they are in safe hands. Gadlas Hall Nursing And Residential Home DS0000022246.V358626.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): 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 there are many areas that would benefit from having dedicated management time to ensure that systems are in place for the ensuring the health, safety and welfare of people living, working and visiting the home are fully upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager/owner Michelle Roberts has been at the home for a number of years. She is a first level nurse and has completed National Gadlas Hall Nursing And Residential Home DS0000022246.V358626.R01.S.doc Version 5.2 Page 23 Vocational Qualification Level 4 in management and is currently awaiting receipt of the certificate. Mrs Roberts continues to work mainly in a clinical capacity and has very limited supernumery time to attend to managerial responsibilities. It is commendable that Mrs Roberts feels the need to ‘work on the floor’ and to oversee the care staff team, however sufficient time should be available to be able to fully discharge the responsibilities of being a registered manager. There are many areas within the home that would benefit from additional time, effort and managerial expertise to ensure the effectiveness of the service. A limited quality assurance and monitoring system is in operation with the last quality in care audit conducted in March 2007. No satisfaction surveys or questionnaires have since been distributed to people living, working, visiting or otherwise involved with the home to aid the continuation of monitoring the service provision. Staff meetings takes place approximately every three months; the registered manager stated that service user and family meeting are not arranged. The policies and procedures relating to the home were last updated and reviewed in March 2007. 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. The registered manager stated that the monitoring of the health and safety systems at the home take place on a regular basis, there were no records available to support that this is happening. The manager stated that the maintenance person attends to this routine work and that they hold the records. The records for the control of substances hazardous to health have not been reviewed since 2005. There are no records for the regular testing of the hot water accessible to residents; people are therefore at risk of scalding if the water is at an extreme temperature. A care plan looked at indicated that the bedrails have been monitored on a monthly basis and have been checked for safety, with a recording made in November 2006 as ‘checked and safe’. This was not the case during the tour of the premises when this set of bedrails was found to be incompatible with the bed. At the follow up visit 1st February 2008, the manager stated that outside contractors have been contacted to attend to some maintenance checks, the suppliers of bedrails have visited the premises and have checked and fitted the rails required and that the homes handyman has been instructed on the weekly, monthly and annual checks that are required. Gadlas Hall Nursing And Residential Home DS0000022246.V358626.R01.S.doc Version 5.2 Page 24 There was no evidence in the three staff personnel files to suggest that staff receive induction and foundation training on safe working topics to meet the Skills for Care specifications. Gadlas Hall Nursing And Residential Home DS0000022246.V358626.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 2 X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X 2 X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 1 Gadlas Hall Nursing And Residential Home DS0000022246.V358626.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 OP9 Regulation 13(2) Requirement The records of the receipt, administration and disposal of medicines for the people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. Previous timescale of 07/11/07 not met. 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. Previous timescale of 09/11/07 not met. Staff who administer medication must be trained and competent and their practice must follow written policy and procedures to ensure that residents receive their medication safely and correctly. Previous timescale of 31/12/07 not met. Appropriate information relating to medication must be kept, for example, in risk assessments DS0000022246.V358626.R01.S.doc Timescale for action 27/01/08 2. OP9 13(2) 30/01/08 3. OP9 13(2) 31/03/08 4. OP9 13(2) 15/03/08 Gadlas Hall Nursing And Residential Home Version 5.2 Page 27 5 OP22 23(2)(a) 5 OP22 23(2)(a) 6. OP30 18(1) and care plans to ensure that staff know how to use and monitor all medication including when required, as directed and self administered medication to ensure that all medication is administered safely, correctly and as intended by the prescriber to meet individual health needs. Previous timescale of 07/11/07 not met. Bed rails must be assessed, 25/01/08 fitted and maintained by a competent person in accordance with MHRA/HSE guidance. This is to protect the person from the risk of harm and promote their safety All equipment provided and in 01/02/08 use at the home should be safe, checked regularly and fit for the purpose. Accurate records should be maintained. Staff must receive training and 01/02/08 regular updates in the core topic areas and any specialist areas relating to the service provision. Previous requirement – timescale 02/11/07 Not met. Effective systems must be in place for all safe working practices to ensure that the health, safety and welfare of people living, working and visiting the home are promoted and protected. 01/02/08 7 OP38 13(4) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Gadlas Hall Nursing And Residential Home DS0000022246.V358626.R01.S.doc Version 5.2 Page 28 No. 1 Refer to Standard OP1 Good Practice Recommendations The statement of purpose and service user guide must be reviewed and updated to contain current and accurate information of the service provision, so people can make informed choices about the home’s service and understand what is offered. The service user guide should include information on the current level of fees. When ever possible care plans should be developed, agreed and reviewed with the individual person and/or representative. All people should be offered opportunities to engage in leisure and recreational activities to suit their personal preferences. The improvements made to the presentation and social aspect of dining should continue, further developments in this area should enhance the lives of people. The complaint procedure should be amended to include the contact details of Commission for Social Care Inspection should a person wish to contact us. The practice of propping open doors within the home should cease. To maintain a person’s privacy and dignity at all times privacy curtains should be in use and staff working practice amended. Sufficient supernumery management time should be allocated to ensure that all managerial tasks are fully carried out. An effective quality assurance and monitoring system should be implemented to ensure the home is run in the best interests of people living at the home. All staff must receive training and updates in all safe working practice topics. The policy and procedures document for the handling of medicines is updated and amended and nursing staff are made aware of its contents. The receipt, administration and disposal of each Controlled Drug is recorded separately in the Controlled Drugs register. Products that have a short shelf life when opened is dated upon opening and discarded at the appropriate time. Daily monitoring of the environmental temperatures is carried out to ensure that all medication is stored in accordance with the manufacturers storage requirements. DS0000022246.V358626.R01.S.doc Version 5.2 Page 29 2 OP7 3 OP12 4 5 6 7 8 9 10 11. 12. 13. 14. OP15 OP16 OP19 OP24 OP31 OP33 OP38 OP9 OP9 OP9 OP9 Gadlas Hall Nursing And Residential Home 15. OP9 Medicines to be disposed of are accurately recorded and are discarded into properly authorized bins. Gadlas Hall Nursing And Residential Home DS0000022246.V358626.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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.V358626.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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