Inspection on 29/04/08 for Gallimore Lodge

This inspection was carried out on 29th April 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gallimore Lodge 08/06/07

Gallimore Lodge 29/11/06

Gallimore Lodge 31/12/05

Gallimore Lodge 26/08/05

Gallimore Lodge 02/11/04

Gallimore Lodge 17/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Gallimore Lodge Meesons Lane Grays Essex RM17 5HR Lead Inspector Mrs Bernadette Little Unannounced Inspection 29th April 2008 09:00 Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 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 Gallimore Lodge DS0000015534.V363442.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 Adults 18-65. 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. Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gallimore Lodge Address Meesons Lane Grays Essex RM17 5HR 01375 396174 01375 396174 gallimore.lodge@familymosaic.co.uk www.familymosaic.co.uk Family Mosaic 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 Evelyn Thomson Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Excluding any person who is liable to be detained under the provisions of the mental Health Act 1983 8th June 2007 Date of last inspection Brief Description of the Service: Gallimore Lodge is a purpose built double bungalow situated on a private residential road in Grays. Public transport by both rail and bus is available approximately one mile away. The home has its own minibus. The accommodation consists of single bedrooms with lounge, dining room and kitchen facilities. Appropriate bathroom and toilet facilities are also available. The home has its own car parking facilities and a garden area is also made available for the use of residents. The home provides nursing and personal care for 8 adults with learning disabilities. Services provided include personal, psychological, social, emotional and educational care by a multidisciplinary team and enabling residents to remain as independent as possible. Residents are actively encouraged to participate in leisure pursuits within the local community but formal day care placements which were provided by the local Social Services Department, are no longer available. The Service User Guide and Statement of Purpose are available for residents or their representatives. The current range of fees are between £63.95 and £98. 60 per week for rent charges and a block payment arrangement is in place with the local funding authority which covers the remaining fees. The Registered Provider also contributes £250 a year, (per resident) towards holiday expenses. Residents are responsible for extra charges to cover items such as hairdressing, newspapers/magazines and toiletries. Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The site visit was undertaken over a seven and a half hour period as part of the routine key inspection of Gallimore Lodge. Time was spent with the residents at various times during the day in the communal rooms or when they joined us in the office. Due to the residents’ complex needs including communication, verbal comments received from residents were limited. Observations of interactions and non-verbal communications were noted during the day and these are reflected as part of the report. The manager submitted an Annual Quality Assurance Assessment, received immediately following the site visit. This details their assessment of what they do well, what could be done better and what needs improving. This information was considered as part of the inspection process and reflected as part of the report. Prior to the site visit, the manager was sent a variety of surveys to distribute and that asked questions that were relevant for each group, such as for residents, relatives, care managers and healthcare professionals. Unfortunately these were not distributed to, and so answered by, the relevant people but we have tried to include any relevant information they did include. The manager did provide the relevant survey to care managers/social workers but no responses were received. Six staff, including permanent and agency staff, and the acting manager were spoken with. A tour of the premises was undertaken and records, policies and procedures were sampled. The service manager was also present for part of the afternoon and contributed to the inspection. The outcomes of the site visit were discussed with the manager throughout the day and opportunity was given for clarification where necessary. The assistance provided by all of those involved in this inspection was greatly appreciated. What the service does well: In a survey sent to the Commission a relative commented we feel my relative is well looked after and cared for. Another relative confirmed that Gallimore Lodge support people to live the life they choose. Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 6 Residents were offered choices and people’s individuality and diversity were acknowledged and respected. Pictorial menus were available so that residents could indicate their preferences and there were ample stocks of food and drinks available to support this. Staff on engaged well with residents and residents gave the impression that they were at ease in their company. A picture board was being developed in the main entrance hall that showed photographs of staff with their names to make it easier for people to know the staff on duty and recognise familiar faces. This will also include regular bank and agency staff so that they will valued and feel part of the team. The home was warm, comfortable and friendly and the refurbishment means that residents live in a well furnished and decorated home. What has improved since the last inspection? What they could do better: Some parts of the care plans need to be developed or be clearer and risk assessment tools need to be used effectively to promote residents well-being. There needs to be better evidence of induction of permanent staff and safe recruitment of agency staff to show that staff have initial training to help them to understand all areas of peoples’ care needs and that residents are safeguarded. Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 7 The registered provider needs to show that they visit and report on the home regularly as required to ensure it is running effectively for the well-being of the residents, and keep the commission informed of events that we need to be notified about to be reassured of affective management 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. Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment system would help to ensure that the team at the home could meet the needs of the residents they admit. EVIDENCE: A survey received from one resident indicated that they were asked if they wanted to move into the home and they had been given enough information to decide if it was the right place for them. Surveys completed by two parents also confirmed that they and the resident were asked if they wanted to move into the home and had been given enough information to base a decision on. The manager advised that they did not believe the service user guide had recently been updated. It is recommended that this be amended to show the changes to the management and also up-to-date contact details for the Commission, so that people have access to accurate information. There had been no new admissions to Gallimore Lodge for some time. The manager was clear that there would be a careful and lengthy transition process for any proposed admission. The manager was able to provide a written policy and procedure on admission that had very recently been updated. This showed a clear assessment process with the involvement of the prospective resident and their family. Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 10 Others involved would include social services/care manager to undertake a community care needs assessment and confirm funding. This would ensure that all aspects of the person’s needs would be identified to ensure that they could be met at Gallimore Lodge. Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ have care plans to support staff to meet their individual needs, however some shortfalls in relation to care planning and management could adversely affect their care outcomes. EVIDENCE: Care plans reviewed were written from a person centred approach, for example ‘I need’ or ‘I like’ showing that the persons needs, abilities and preferences had been taken into account, as far as these were able to be determined. A personal history and pictorial ‘who am I’ showing other relevant people in the person’s life were also included, giving more information to staff that would help them to communicate with residents and plan care in the way that residents need and prefer. Support plans were informative and covered relevant issues including physical needs, health needs, communication, occupational/leisure and finance. There was some good information identifying the way people communicate, and what Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 12 communications such as facial expressions might indicate, so helping staff and others to better understand residents and meet their needs. Staff were observed to use different methods of communication with residents, including signing. While a wealth of information on people’s care needs was available in the care files sampled, it was discussed with staff that much of it was not easy to find, for example when people liked to go to bed or get up, whether they preferred a bath or shower or when this should be offered, and that care plans did not provide clear details on all aspects of the person’s assessed needs that staff can use as working documents and follow in a consistent way. It was noted positively that agency staff advised that they had been able to read care plans so they were aware of each person’s individual needs. They also confirmed that they completed daily care notes as an equal member of the care team so that all information relating to residents well being was recorded. Daily care records were routinely completed to show how people spend their day so providing a resource for monitoring the effectiveness of the care plans. A monthly support plan review had been undertaken by the person’s key worker, which is a noted improvement from the last inspection. This helps to ensure that the care plan is still right for that resident and gives an opportunity to assess and make any amendments. Residents were unable to comment on their care. From observation during the day, residents were able to make their wishes and preferences made known to staff on duty and related well to all staff at all times. The staff we spoke with demonstrated to us a good understanding of residents needs. As stated by the manager in the AQQA, there was evidence that the funding authority had undertaken a review of peoples placement at Gallimore Lodge. This is to ensure that it was still the right place at the person and was meeting their needs. Risk assessments seen were detailed and recently reviewed. They area such as moving and handling, bathing, choking, use of equipment, going out in the minibus, maintaining safety and preventing falls that was also referenced in the care plan. Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to receive a balanced and varied diet and a developing leisure activity programme to meet their individual needs. EVIDENCE: Information in the AQQA and as well as discussion with the manager and staff indicated that there had been a review of the activities available to residents and steps put in place to improve this. This includes increased staffing levels, better management of the staff roster to use drivers most effectively, the use of activity monitoring sheets, using other transport facilities to access the community and the redecoration and equipping of the sensory room. There was awareness from both the manager and staff that this continues to need development, particularly in relation to community presence and participation, with enthusiastic commitment to achieve this to benefit the residents and to support equality and diversity. A staff survey said we can improve by “more outdoor activities although this is currently being addressed”. Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 14 Activities that residents currently participate include going shopping, iceskating, to the cinema, the hairdressers, bowling and attending church services. A planned imminent wheelchair assessment for one resident is expected to make them more comfortable and mobile to be able to participate. A list of at home activities was also available. A chart had been prepared to ensure residents had routine and planned access to the sensory facilities. An outside musical entertainer was in the home on the day of the site visit. The manager has plans to book a hall once a month for people at home to meet their friends including those from other care facilities to encourage and foster positive social contacts. Visitors were said to be welcomed and encouraged at Gallimore Lodge and some residents also go out with their family and friends. The manager had introduced food celebration days where foods from different places were home cooked by the staff to reflect diversity and provide residents with new experiences and choices. Records, along with observation show that residents are encouraged to make choices about what they want to wear, their daily routines and choice of food according to individual ability. During the day, we observed staff asking residents about various preferences and residents were seen to make decisions about where they wanted to be in the home. Records showed that residents weight is monitored regularly. Specific needs in relation to food were identified in care plans to help support good nutrition. Staff sat at the dining-room table with residents at lunchtime, offering encouragement for independence and also providing support in a sensitive and unhurried way so that residents could get the best from real-time. Residents have their evening meal between 5pm and 5:30pm. It was recommended that the nutrition record demonstrate that residents are offered an evening snack to evidence that they are not going without food for excessive periods of time. Staff confirmed that residents are supported to make choices about food by using pictorial menus, which were readily available. Support plans had information about people’s specific dietary needs. The record of food served to residents showed that they made choices and were offered variety, including a cooked breakfast at weekends. This also showed that residents went out to lunch sometimes. Staff were aware of residents’ individual preferences, for example while one person preferred fish in sauce, and other preferred it in batter with chips. Ample food stocks and drinks were available in the home as were bowls of fresh fruit. One resident confirmed by signing that they helped themselves to snacks from the kitchen. Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall residents can expect to receive good health and personal care that meets their needs and to have their medication managed safely. EVIDENCE: Staff spoken with were aware of promoting residents’ privacy and dignity while offering them personal support and residents were offered care by a same gender staff member. A relative survey confirmed that they feel that their relative is usually given the support and care expected, and while they did not feel they were always kept up-to-date in the past about important issues affecting the resident, things are improving gradually. The AQQA identifies that two staff are always used for all moving and handling transfers to promote the safety of all involved. Staff spoken with confirmed this and that they now have sufficient staff on duty each shift to achieve it. New personalised individuals slings are also advised as having been introduced for residents as a further improvement to ensuring residents wellGallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 16 being and safety, along with additional training. Information on use of the equipment was seen in individual residents’ bedrooms so that staff had immediate information at the point of care delivery. In the AQQA, the manager states that residents have keyworkers and named nurses who work together with them to achieve optimum healthcare choices. This was confirmed in discussion with staff and review of the care plans. New forms have been introduced to record the input of outside health professionals. Care plans included information on the persons needs and timescales in relation to accessing the dentist, chiropodist, optician and showed that residents’ need for routine screenings had also been considered with the support of the community nurse. The manager stated that none of the current residents have pressure sores. Tissue viability assessments were available on resident files as a way of identifying any resident that might be at risk of developing a pressure sore, so that a preventative plan of care could be developed. One assessment was noted not to include scores for all the relevant criteria, which gave an inaccurate assessment. When reviewed and reassessed with the manager, it identified that the resident was at risk. The manager was advised that where there is an identified risk to tissue viability maintenance, a care plan must be in place to meet the person’s assessed need. A monitored dosage system for medication was used. Medication administration records were well completed and those audited tallied with the medication remaining in the blister packs. Photographs were available on each resident’s profile so that staff could be sure they were giving the medication to the right person. Qualified nursing staff have had updated medication training since the last inspection to ensure their knowledge and competence is up to date. The manager stated in the AQQA that protocols had been rewritten for medications used on an ‘as required basis’ to show that these were used consistently and to monitor their effectiveness and these were seen on the files reviewed. Individual care plans on medication were not in place, although the manager responded positively to the advice on providing these. Records show that residents have a six monthly review of their medication with their consultant to ensure that it remains appropriate to their needs. Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be assured that satisfactory arrangements are in place to promote their protection from abuse. EVIDENCE: The manager’s AQQA shows that no complaints have been received since the last inspection. The commission have not received any complaints about the service. A detailed complaints procedure was available that explained to people the steps and timescales involved to help them with the process. A format for recording any concerns had been introduced since the last inspection, which will help with managing information more effectively. Surveys received showed that relatives would know how to make a complaint. One survey advises that the service is now more responsive to concerns they raise. A one page pictorial sheet for residents shows things people might want to complain about. It is recommended that this be reviewed to look at informing residents that they can raise any dissatisfactions and how to do it, so that they are fully informed. A book to record suggestions, comments and complements was available in the main hallway and contained a number of cards of thanks. The AQQA shows that two referrals relating to residents of Gallimore Lodge have been made since the last inspection and are being investigated under safeguarding procedures. The Commission had been notified of the events, but had not been notified, particularly in one instance, that this had been referred on. The manager stated that this was prior to her appointment. The service Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 18 manager was able to explain to us the actions that had been taken to protect residents and to work positively with the safeguarding team and other involved professionals. The service manager confirmed that they keep the Commission updated so that we can monitor the outcomes for residents. The manager stated that they had not had training in protecting vulnerable people for a number of years and it is recommended that this be addressed. Discussion however showed that they were able to clearly identify types of abuse and appropriate procedures for reporting this and protecting residents. Detailed policies and procedures that refer to working with local protocols were readily available to provide information for staff. A copy of Thurrock Councils safeguarding adults protocol was not available in home. It is recommended that a copy of the local protocol for any authority funding residents at the home should be obtained to ensure that the manager and staff have all the required information. The AQQA stated that all staff had had updated training on protecting vulnerable people in December 2007. Five staff, both permanent and agency, were spoken with and confirmed that they had had recent training. All were able to show that they were aware of how people can be abused and tell us the appropriate steps they would feel able to take to safeguard residents. The manager confirmed in the AQQA that there have been no instances of restraint of residents at the home. In discussion at the site visit, she advised that residents at Gallimore Lodge do not present behaviour that challenges, either verbally or physically and therefore staff do not require training in this area. The manager provided evidence that they had undertaken behavioural approaches training. Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in an environment that meets their needs and are benefiting from the ongoing redecoration and refurbishment of the home. EVIDENCE: At each end of Gallimore Lodge residents have a lounge, separate dining room and kitchen giving them ample communal space. The sensory room was in the process of being redecorated and the manager confirmed that the bathroom/ shower rooms will also be updated. It was recommended that a risk assessment be undertaken on the outward opening toilet doors, to ensure the safety of residents. The communal areas at one end had recently been redecorated. The manager stated that this will be carried through to the areas at the other end, to ensure that all residents benefited from a pleasant and well-decorated environment. All residents have a single bedroom giving them privacy and some personal space. These were decorated in individual colours and styles and with the Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 20 manager’s support, one resident confirmed that they had been involved in choosing the colour scheme. One survey received from a staff member advised that they would like to see residents have a more opportunity to choose colour schemes and make choices about what money was spent on. The manager advised that there is a plan to continue to replace the wardrobes/units in residents’ bedrooms to ensure they have enough space to hang their clothes comfortably. People living at Gallimore Lodge have the use of a pleasant garden, which has level patio areas and garden furniture, offering an alternative communal area in good weather. Wheelchair access to the garden is through the patio doors in the lounge. The manager stated that, while this does not present a major difficulty, they have plans as stated in their AQAA, to have the small step ramped to make access easier. All areas of the home were inspected and found to be clean and odour free. Laundry facilities were appropriate and staff confirmed good infection control procedures to ensure residents well being. The cupboards where hazardous items were stored were locked promoting resident safety. Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be expect to be cared for by a team of staff that are adequate in numbers to meet their needs, but who would benefit from better induction, updated/training and safe recruitment to promote residents well being. EVIDENCE: Staff rotas and discussion with staff confirmed the information in the AQQA that there has been an increase in staffing levels at Gallimore Lodge, following the safeguarding referrals. These are now set at a minimum of one qualified and three care staff all day, with either the manager or an extra member of staff on duty each day. This gives residents more opportunity for individual care and attention and also for greater interaction and social activities either at home or in the community. The manager and staff spoke positively about the increased staffing levels and were clear that this had benefited residents. Observations on the day of the inspection confirmed information in the AQQA that there is regular use of bank and agency staff at Gallimore Lodge. Those spoken with on the day of inspection advised of working at the home for between one week and four years. Observations and discussions on the day of Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 22 the site visit showed that permanent and agency staff were knowledgeable about residents needs and that residents responded positively to them. There has been some recent recruitment to the permanent staff team that will enable greater consistency of care for the residents. The files of two recently recruited staff were viewed on computer. These showed that all appropriate checks to protect people living at the home were carried out before staff started to work there and is a noted improvement from the last inspection. Profiles were not available for any the regular agency staff working at the home. The service manager told us that there was a general letter confirming any staff supplied would have been checked. They were advised that individual profiles need to be available to the person in charge of the home prior to the agency staffs first shift working in the home and would include photograph, confirmation of appropriate references and checks having been undertaken as well as induction training and evidence of mandatory training. . When staff start working at the home they should have a comprehensive induction within the first few weeks, based on Skills for Care standards to assist them to understand all areas of peoples’ care needs and other aspects that will enable them to care well and safely for people. While the service manager confirmed that the organisation do have an induction programme based on Skills for Care Standards, it had not been properly implemented at Gallimore Lodge for the two staff whose files were reviewed. The service manager advised that this was due to the manager and deputy manager leaving about that time and so had been missed. First-day induction records were seen for agency staff, which is good practice. Agency staff spoken with confirmed that they were introduced properly to the residents and staff and were advised on health and safety issues and the care needs of the residents. The manager confirmed the information in the AQQA that three support staff have achieved NVQ level 3 and one staff member has now applied to attend NVQ level 2 training. Discussion with staff and observation of some certificates showed that staff had a good range of basic training to support them to provide best care outcomes for residents. The training matrix showed that the majority of staff had current training in moving and handling, protecting vulnerable adults, medication, fire, first aid and food hygiene. However some areas were identified where updates are required, for example two staff and the manager have not had training in moving and handling in the past three years. This does not best protect residents and staff. Certificates were seen relating to continence promotion and two staff were on assertiveness training. Records sampled for agency staff showed up-to-date training in the basic areas. The AQQA advises that diversity training is to be added to the organisation’s annual training schedule in the coming year. Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a home where the registered provider’s support to, and the commitment of, the current in-house management have a positive impact of the day-to-day care outcomes for residents. EVIDENCE: The Commission had been informed that the registered manager had left and that cover was to be provided by the manager of another home. At this site visit it was identified that an acting manager had been appointed but the commission had not been formally notified as required by regulation. The acting manager told us that they manage the home three days a week on a temporary basis while the registered provider recruits a suitable manager. The acting manager is a qualified registered mental health nurse and has many years experience managing a health service facility. Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 24 The service manager confirmed that the advertisement to recruit a permanent manager had been reissued, following a review of the salary, to ensure that it attracted candidates of a suitable calibre. This report has indicated continuing improvements to the management of the home, and particularly by the current manager. In a survey, a staff member said that the home has improved so much recently and that they feel they can speak to this manager about any concerns within the home or the staff group, and that they will listen and take appropriate action. A survey had been undertaken of residents’ views since the last inspection. The registered provider had identified that these had been completed on behalf of residents by staff and so could not be considered completely independent. Some residents had access to independent advocacy services but these resources were limited and not available to all residents, particularly those who had family/friends to advocate on their behalf. Regular residents meetings take place at the home, supported by the manager and staff, who advised they involve residents as much as possible and review how suggestions from the previous meetings have worked out. Records available showed that the registered provider has inconsistantly undertaken the required monthly checks and report on the home to show that they are satisfied that the home is running properly and all aspects of the residents needs are being met to a satisfactory level. Reports available show that they have visited/reported in February, November, August and May. This does not comply with the requirement to visit/report monthly and improvement is needed particularly in view of the ongoing investigation of the concerns that have been raised regarding the service. The service manager advised they believed that more visits and reports had been undertaken but these were not available for inspection in the home as required. It has been identified in the report that the registered provider has not always ensured that the Commission has been notified of events as required by regulation, such as the appointment of the acting manager or a referral to the safeguarding team. This is an area for monitoring which the service manager advised they will address and feed back to home managers. At the last inspection safety and maintenance records were sampled and noted to be in good order. These were not viewed again at this inspection as the manager is still in the process of waiting for clear instruction on managing these. A ‘log book’ has been introduced by the registered provider that identifies and prompts when specific aspects of health and safety and service agreements needed to be inspected or checked and provides a clear recording system, that would ensure good practice. Gallimore Lodge DS0000015534.V363442.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 Adults 18-65 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 2 3 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 X 12 3 13 2 14 x 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 x 3 3 2 x x 3 x Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 26 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. 1. Standard YA6 YA19 Regulation 15 13(4)c Requirement So that residents are cared for consistently and safely, care plans must identify all current assessed needs, and supported by risk assessment, provide staff with sufficient information and instructions to offer residents proper care and assistance, including in relation to preventative pressure area care. To safeguard residents, records must be maintained in the care home, as required by regulation and schedule to show that all appropriate references and checks on staff have been obtained, including in relation to agency staff. Timescale for action 01/07/08 2. YA34 17(2) Schedule 4(6) 01/05/08 3. YA35 18(1)c To benefit residents and the 01/06/08 quality of support offered to them all staff must be provided with training and regular updates appropriate to the work they are to perform including induction training. Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 27 4 YA39 26 & 37 To ensure the safety and wellbeing of residents the registered provider must demonstrate that they are carrying on the home with sufficient care, competence and skill including undertaking the required monthly visits and reports promptly as required by regulation 26and having them available in the home for inspection and notifying the commission of events required by regulation 37. 01/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations So that interested people have access to accurate information the service user guide should provide information on the current management arrangements at the home as well as current contact details for the Commission. Records of individual meals provided to residents should include all snacks and drinks, especially in the evening to show that residents do not go for long periods without being offered food. So that people using the service have clearer information, it is recommended the pictorial complaints procedure be reviewed. So that best information is available, and in line with the organisation’s own policies and procedures, it is recommended that a copy of the local protocol for any authority funding residents at the home should be obtained. It is recommended that the manager attend updated safeguarding training. DS0000015534.V363442.R01.S.doc Version 5.2 Page 28 2. YA17 3. YA22 4. YA23 5. YA23 Gallimore Lodge 6. YA24 To promote the safety of residents and staff, a risk assessment should be undertaken on the outward opening toilet doors. Following completion of the quality assurance exercise, an action plan should be drawn up for the home setting out how improvements are to be met with timescales for implementation. 7. YA39 Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Gallimore Lodge DS0000015534.V363442.R01.S.doc Version 5.2 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!