Inspection on 03/11/08 for Gairloch

This inspection was carried out on 3rd November 2008.

CSCI found this care home to be providing an Good 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

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Gairloch 11-15 Russell Rd Clacton-on- Sea Essex CO15 6BE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Tina Burns     Date: 0 3 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Gairloch 11-15 Russell Rd Clacton-on- Sea Essex CO15 6BE 01255422788 Telephone number: Fax number: Email address: Provider web address: gairloch11@aol.com Name of registered provider(s): Name of registered manager (if applicable) Kay Beverley Wigfall Type of registration: Number of places registered: Gairloch Care Homes care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Gairloch is a care home for twenty-four older people with or without dementia. It is situated in a quiet residential area of Clacton-on-Sea, near the sea front and within walking distance of the town centre. The home is close to bus and rail links. The premises consists of two properties that have been converted into one with additional extensions added. There is a parking area to the front of the property and there are gardens to the front and rear. Accomodation is provided in two double rooms and twenty single rooms, most of which have en-suite facilities. Rooms are provided on the ground and first floor and their is a lift to the first floor. The home is decorated and furnished to a good standard. Since the last inspection the home has been sold to new owners. Their application for a change of provider was approved by the Commission in 0 0 Over 65 24 24 Care Homes for Older People Page 4 of 27 Brief description of the care home March 2008. The home is now owned by Gairloch Care Ltd but it continues to be managed by the previous Registered Manager Mrs Kay Wigfall. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection which focused on the core standards relating to older people and was undertaken by regulatory inspector Tina Burns. The report has been written using accumulated evidence gained prior to and during the inspection. The homes manager Mrs Kay Wigfall was present during the inspection and provided the requested information promptly and in an open manner. People living at the home were referred to as residents and this term will be used throughout this report. The inspection process included a tour of the building and grounds and observations throughout the day. The inspector also spoke with the owners Mr Ray Hunt and Mrs Caroline Hunt, residents, staff members and a visiting relative. Records examined included three residents care plans, three staff files, health and safety and Care Homes for Older People Page 6 of 27 maintenance records and incident and accident records. Further records viewed are detailed in the main body of this report. Information was also provided in the homes Annual Quality Assurance Assessment that was completed by the registered manager and submitted to us in September 2008. We also received completed survey forms from five residents, two members of staff, three residents relatives and two health care professionals. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can expect to be provided with the information they need to make an informed choice about where they live. They can also expect to have their needs assessed prior to moving into the home. The home does not provide an intermediate care service. Evidence: Since the last inspection the homes Statement of Purpose and Service User Guide has been amended to reflect the changes in registration and the fact that the home has new owners. All five of the residents that completed surveys told us that they had received enough information about the home before they moved in so that they could make a decision about whether it was the right place for them. The Annual Quality Assurance Assessment confirmed that people interested in the home are invited to visit. If they think that it may be suitable an assessment is Care Homes for Older People Page 10 of 27 Evidence: undertaken and they are offered a trial stay. Records examined and discussion with the manager confirmed that prospective residents have an assessment of their needs completed prior to moving into the home. Since the last inspection the manager had begun to use a new assessment tool that covered a wide range of needs. The assessment included areas such as communication, lifestyle, maintaining a safe environment, mental state and cognition, breathing, eating and drinking, eliminating, personal cleansing and dressing, controlling body temp, sleeping, pain and medication. Consequently assessments were becoming more thorough and this will enable the home to have a clearer picture of whether and how they can meet peoples needs. The home does not provide intermediate care. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to have their health and personal care needs met and their privacy and dignity respected. Evidence: Information provided in the AQAA, records examined and discussion with the manager confirmed that everyone had an individual care plan in place. Some peoples care plans were in a different format to others and the manager explained that this was due to the fact that they had introduced a new style of care plan. Care plans completed in the new style were more detailed than the previous ones and better reflected peoples needs and preferences. The home was in the process of transferring everyones care plans to the new format. Consequently we looked closely at one residents care plan that had been completed in the new style. Overall, the care plan that was fully examined reflected the needs identified by the home in their assessment. It covered areas such as skin care and pressure sore Care Homes for Older People Page 12 of 27 Evidence: prevention, falls prevention, mobility and moving and handling, communication, orientation, nutrition and weight, mouth care, continence, washing and dressing, foot care, sleeping and medication. Information about the residents needs with regard to dementia care could have been more detailed particularly with regard to managing their episodes of distress but the manager agreed to develop the care plan in this area. Observations made and feedback from staff, residents and relatives tells us that staff have a good understanding of residents needs and residents feel that their needs are met. Records seen during the inspection confirmed that the home works in partnership with a range of health care providers so that residents health care needs are met, for example GPS and district nurses. One resident said You just have to tell them (if you feel unwell) and they get them straight out for you and a visitor told us that their relatives health had improved significantly since they had moved into the home. The home had appropriate policies and procedures in place for the safe administration and handling of medication. One member of staff was observed administering lunch time medication. They used a monitored dosage system and medication was removed from the blister pack directly into a small pot which was given to the resident. The exception was where one resident was unable to put their tablets in their mouth independently so in this case they were asked consent before the carer put them in their mouth. One tablet dropped from their mouth to the floor so the carer had to find it and replace it. It was agreed in discussion with the manager afterwords that in the future the resident would be offered their tablets one by one and not all at once. This approach would seem more dignified and make it easier for the resident to swallow them. The Medication Administration Records (MAR charts) that were looked at had been appropriately completed, there were no gaps identified and staff administering the medication had signed with their initials. One resident that was responsible for their own medication was appropriately supported to store them safely and self administer. Their care plan included a thorough risk assessment signed and agreed by the resident and the manager. Observations were that staff interacted positively with residents and were polite and respectful at all times. All personal care was given in the privacy of residents rooms. Comments received included She is always treated as a person and not just another resident and I cannot thank them enough for their kindness and expertise. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to maintain contact with their families and friends, participate in recreational activities of their choice and enjoy healthy and appetising meals. Evidence: Observations made and people spoken with confirmed that visitors are made welcome at the home and residents are supported to maintain contact with their friends and family. Residents could meet with their visitors in communal areas of the home or in the privacy of their own bedrooms. There was also a small area at the rear of the home, that people could use for private visits. Bedrooms seen were very personalised and confirmed that residents were able to bring some of their own possessions and personal effects with them when they moved into the home. On the day of inspection people who live at the home were seen coming and going as they pleased, choosing to sit in the lounge areas or spending time in their own rooms. Residents spoken with confirmed that there was a new activities co-ordinator who had Care Homes for Older People Page 14 of 27 Evidence: introduced a range of activities such as gentle exercise, crafts, games and quizzes. They also said that they occasionally managed to get out to the local shops with assistance from staff and were hopeful that in time there would be opportunities to go out on day trips and organised outings. People could take their meals in their rooms or eat in the lounge or dining area. The main dining area was particularly pleasant and meal times were found to be relaxed and cheerful with residents chatting and enjoying their meal. Dining tables were attractively set with tablecloths, napkins and place mats and the lunch provided looked wholesome and appetising. Staff and residents confirmed that there is always a choice of meals and firm favourites were shepherds pie and sunday roasts. Meals were generally home cooked using fresh meat and vegetables. One resident said that meals could be better but feedback from others was more positive with comments such as Very nice meals and Very good, no complaints. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect their complaints to be listened to, taken seriously and acted upon. Further more they can expect to be safeguarded from abuse. Evidence: Since the last inspection there had been nine minor complaints recorded. The records confirmed that they had been taken seriously by the manager and were dealt with within the timescale set out in the homes complaints procedure. All five residents that returned surveys told us that they knew how to make a complaint and confirmed that staff listened to them and acted on what they had to say. One resident spoken with said that they had made a complaint a long time ago that had not been taken seriously, however five other residents told us that they felt confident that they could raise issues with the manager who they found approachable and helpful. The homes AQAA tells us that there were no safeguarding referrals made in the previous twelve months. Care workers spoken with felt confident that they could recognise symptoms of abuse and knew how to report concerns. Training records examined evidenced that they had undertaken appropriate safeguarding adults training. The home had a copy of the local authority safeguarding adults guidelines in the office and available for staff reference. Examination of the homes complaints procedure and adult protection procedures Care Homes for Older People Page 16 of 27 Evidence: identified some outstanding issues from the last inspection particularly about the detail of documents with regard to the role of the commission and appropriate contact details. However, the provider took these findings seriously and took immediate action to address the issues and provided us with amended versions of the documents. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to live in a comfortable, clean and well maintained environment. Evidence: At the time of inspection the home was warm, clean and tidy and in a good state of repair. Five out of the five residents surveys returned said that the home was always clean. During a tour of the premises the home smelled pleasant through out with the exception of a faint odour detected in or around the entrance of the home which was immediately dealt with. The furniture, decor and facilities provided were comfortable and pleasant and created a homely and relaxing environment. Observations made, information provided in the AQAA and discussion with the manager confirmed that the home has an ongoing redecoration and maintenance plan in place. Since the last inspection improvements had been made to the communal lounge and dining areas. The laundry area was appropriately equipped with commercial washing machines and tumble dryers. Procedures were in place to ensure that soiled linen was handled safely. There was a stock of disposable aprons and gloves for staff use as well as liquid hand wash and disposable towels. Care Homes for Older People Page 18 of 27 Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to have their needs met by a trained and competent team of staff. They can also expect to be safeguarded by the homes recruitment procedures. Evidence: Discussion with the manager and staff records examined confirmed that the home undertakes all required recruitment checks. Documentation included photographs, evidence of ID, CRB checks, application forms, references and health checks. Although a new care worker had started work before their CRB check had been completed a POVA first check had been undertaken and the manager confirmed that in these circumstances they work under full supervision. Feedback from staff and records examined confirmed that the home provides induction programmes that reflect the skills for care induction standards and training is provided in areas such as safeguarding adults, manual handling, first aid, dementia, medication, fire, food hygiene, health and safety, infection control, risk assessment, care planning, bereavement, falls prevention, continence and diabetes. It was identified that ten care staff were overdue their manual handling refresher training, however evidence was provided to confirm that this was because a training course that they were booked on was postponed. Consequently they had been re Care Homes for Older People Page 20 of 27 Evidence: booked to undertake the training later in the month. The dementia training provided to care staff was a three hour training session which seemed very limited bearing in mind the home is registered to provide care for up to twenty four people with dementia. The manager also confirmed that they had not personally undertaken any training in this area for some years. It was acknowledged that although the home currently provides very little care to people with dementia this was likely to increase and the manager and provider advised that they were committed to improving staff training in this area so that they had a good standard of expertise in dementia care. Information provided on the day of inspection and in the homes Annual Quality Assurance Assessment tells us that ninety five percent of care workers hold or are undertaking NVQ level 2 in care or above. The manager had also just completed their Registered Managers Award and NVQ level 4 in care. Observations made and feedback from staff and residents confirmed that the home is suitably staffed to meet the residents needs. Four out of five residents that completed surveys said that staff are always available when they need them and one said that they are usually available when they needed them. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from the management approach of the home and overall their health, safety and welfare is promoted and protected. Evidence: Kay Wigfall is the registered manager and has worked at the care home for many years. She confirmed that she has recently completed the Registered Managers Award and NVQ level 4 in care although she was still waiting for her certificate to arrive. The manager and the provider, who was also at the home on the day of inspection, were receptive to the inspection process and welcomed discussions about how the home could improve. Feedback received indicated that the manager is well respected and approachable. Discussion with the manager and documentation seen confirmed that initially the home had continued to work within existing policies and procedures following the change of ownership but they were gradually being reviewed and replaced. The AQAA tells us Care Homes for Older People Page 22 of 27 Evidence: that since the last inspection the policies and procedures have been indexed so that staff can reference them more easily, they also sign to confirm that they have read and understood the documents. There were appropriate procedures and equipment in place to safeguard staff and residents with regard to fire safety, food hygiene and infection control. There was also the required gas and electrical certificates in place and portable electrical equipment had been safety checked. Since our last visit inspections carried out by the fire service and the environmental health agency had not identified any contraventions and there had been no requirements or recommendations made. The home had a no smoking policy but facilities were provided in the grounds for anyone wishing to smoke. The exception was that two residents had agreements that they could smoke in their own bedrooms. Although risk assessments had been carried out with regard to fire safety the home had not considered their responsibilities to care workers providing personal care in those rooms. The manager and owner agreed to ensure that the policy was suitably amended and they have since confirmed that this has been addressed. Records examined confirmed that the home undertakes weekly hot water temperature checks. The purpose of these checks is to ensure hot water is maintained close to 43 degrees centigrade to prevent scalds or burns to residents, staff and visitors. Unfortunately, three temperatures that exceeded acceptable levels had not been reported to the manager so no action was taken until we pointed out the temperatures recorded. The manager and provider understood that this was a serious shortfall and took immediate action to address the issue. They called a contractor who came out straight away and adjusted the temperature. They advised that in they future they would personally ensure hot water temperatures are monitored and addressed as appropriate. Consequently no requirement has been made as the matter was fully addressed before the end of the inspection. Staff training records viewed evidenced that staff undertake training in areas such as manual handling, first aid, fire, food hygiene, health and safety, infection control, risk assessment and falls prevention. Incident and accidents are recorded and reported as required although records do not evidence that they are analysed for a trend or pattern or show how they are addressed. The homes quality assurance procedures include quarterly satisfaction surveys and a full annual review is scheduled to take place in February 2009. Residents also told us that they attend a residents meeting once or twice a year.The homes Annual Quality Assurance Assessment that was submitted to the Commission in September 2008 Care Homes for Older People Page 23 of 27 Evidence: provided some useful information but overall it did not fully evidence what the home does well and how it intends to improve. This was discussed with the manager who advised that they would complete it more fully in the future. Regulation 26 visit reports were viewed and confirmed that the new owners visit regularly and talk to the manager, the staff and residents. The manager confirmed that she did not act as agent or appointee for any of the residents bank accounts or benefits. However small amounts of money were held for safe keeping for some residents. Records relating to money held were maintained and checked by the owners during their visits.Residents were also provided with lockable drawers in their rooms. Records seen and feedback from staff evidenced that staff are appropriately supervised. They have one to one formal supervision sessions and the manager also undertakes on the job supervision through direct observation. They also advised that the manager is very approachable and has an open door policy that ensures that issues are dealt with quickly and not left for supervisions. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 38 The home should evidence that they routinely analyse accident and incident records to identify and address recurrent incidents. Accident and incident reports should also include a record of the action taken by the home. Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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