Inspection on 25/07/05 for Gallions View Nursing Home

This inspection was carried out on 25th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Gallions View Nursing Home 19/08/08

Gallions View Nursing Home 25/06/07

Gallions View Nursing Home 24/07/06

Gallions View Nursing Home 13/02/06

Gallions View Nursing Home 21/12/04

Gallions View Nursing Home 05/08/04

Gallions View Nursing Home 10/02/04

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

CARE HOMES FOR OLDER PEOPLE Gallions View 20 Pier Way Thamesmead London SE28 0EU Lead Inspector Sue Grindlay Announced 25 July 2005 10:00am 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 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. Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Gallions View Address 20 Pier Way Thamesmead London SE28 0EU 0208 316 1079 020 854 5531 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Post Vacant CRH with Nursing 120 Category(ies) of OP 90 registration, with number DE 30 of places Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. 90 beds for general nursing care of people aged 50 years plus 2. 30 beds for people with dementia aged 50 years plus Date of last inspection 21st December 2004 Brief Description of the Service: Gallions View is a Nursing Home for 120 residents, run by BUPA Care Homes. It is situated in spacious grounds in West Thamesmead, but is within striking distance of the town centres of Plumstead and Woolwich with their thriving and multi-ethnic shops and markets. The Home consists of four purpose built bungalows, each accommodating thirty residents, and a central two-storey building housing the administrative staff, the laundry, kitchen and hairdressing salon. The Bevan Unit, an NHS Intermediate Care Unit, shares the site and the service functions with the Home, but staff are separate. Each unit has its own Statement of Purpose, and one unit offers specialist care for people suffering from dementia. All the rooms are single occupancy, with wash handbasins and shared bathroom and toilet facilities. The site is attractively landscaped, with gardens adjacent to each unit, and secure fencing around the perimeter, including gates that are locked at night. There is car parking to the front of the building. Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection by two inspectors, Sue Grindlay and Pauline Lambe over the course of eight hours. Information received prior to the inspection included a pre-inspection questionnaire completed by the manager of the Home, information in respect of several complaints in the previous months and three telephone calls from relatives of residents. Three comment cards were returned to the Commission, but two of these were incorrectly attributed, for example, one General Practitioner’s Comment card was returned from the wife of a resident. A number of service users, staff and relatives were spoken to in Duncan House, Benn House and Squires House, and records relating to health and safety were perused. Some bedrooms were seen and tours were made of all the communal areas in these three units. What the service does well: What has improved since the last inspection? What they could do better: Staff morale in parts of the Home could be affecting patient care, and a culture of grievance appears to be developing. Requirements have been made around medication, complaints and health and safety. Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 6 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. Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3 and 5 Information is available to prospective residents to enable them to make an informed choice about moving into the Home. Some amendments are required to the Statement of Purpose. EVIDENCE: Standard 1 – In the light of the different client groups, it was suggested at the last announced inspection that each House devised their own Statement of Purpose. This was in progress at the time of the last inspection. Squires House caters for people with dementia, and this component has been addressed in their particular statement. It states that the head of the team has specialised in this area of care, but does not inform relatives or care managers of the expertise of other staff members, nor how the environment is designed with the care of patients with dementia in mind. This was something that was queried by relatives spoken to in the course of the inspection. It is required that the Statement of Purpose includes information about staff training and expertise. Standards 3 and 5 – New admissions are assessed by the sister of Hutton House prior to admission. A staff member said that sometimes the resident or Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 9 a member of their family comes in to choose the room, and can set the room up with items such as a television or personal artefacts before the resident arrives. This is good practice. Three care plans in Duncan House were reviewed. Two included pre-admission assessments and a care manager’s assessment and one had an assessment completed at the time of admission. There was no evidence to show that residents received written confirmation that the home could meet their assessed needs and this is a requirement. Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 and 11 Care plans varied in how comprehensive they were. Some health needs were unmet, and some residents complained that they were not treated respectfully. Improvements are required to the management of medication in Duncan House. EVIDENCE: Standard 7 – A nursing assessment is commenced on admission and completed within 24-48 hours. From this a care plan is drawn up covering all aspects of the resident’s care. A form for the service user or their relative to sign, agreeing to the care plan was seen on all files looked at. The three care plans reviewed on Duncan House included risk assessments. Care plans varied in the detail included as to how assessed needs were being met. For example the care plan for one resident at risk of developing pressure sores did not state what equipment was provided to reduce the risk and did not have any evidence as to how the risk was to be managed. Another care plan did not state that the resident was to be moved using a hoist even though this was the outcome of the risk assessment. Otherwise care plans were satisfactory. Care plans were reviewed monthly. It was evident on one of the care plans viewed that efforts were made to involve the resident and relative in care Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 11 planning. However this was not the case in the other two despite the residents having the ability to make decisions for themselves. The staff spoken with said care plans were not formally prepared or reviewed with the resident/relative and key worker present. This is subject to a requirement. Standard 8 – An assessment is made for the use of cot sides, and a relative signs a consent form for the use of restraint. In one case it was deemed inappropriate because the resident would have trapped her legs. In her case there had been discussion with the husband and agreement sought for the use of a mattress on the floor beside the bed. Accident records showed that one resident sustained an injury when being assisted to transfer but there was no follow-up to this to show what action was taken to prevent a recurrence. Residents were supported to access NHS services routinely or through G.P referral. Another relative said that her father, an insulin-dependent diabetic, had not had any chiropody treatment for three months, and she had been unaware of this until recently. In the pre-inspection questionnaire the manager stated that a chiropodist was “to be appointed”. In the light of this man’s condition, alternative arrangements should have been put in place. This is now subject to a requirement. Residents’ weight was recorded monthly unless it was not practical to do so. Staff said that all beds had the minimum low-grade mattresses provided for the prevention of pressure sores and higher grade equipment was provided when identified through risk assessments. There was evidence of other professional involvement, for example the G.P. and the tissue viability nurse specialist visited the Home. Standard 9 – Consent for a photograph to place on the medication records was seen on all files. A record of the doctor’s visits was found on the care plans. The medicine storage area in Duncan House was satisfactory. It felt cool, had a washbasin, controlled medication was properly stored and recorded, and a medicine fridge was provided with daily temperatures recorded. A medicine trolley was used to administer medication to residents. Medication administration charts were used and the NOMAD system was used. Residents were identified using photos, date of birth and room numbers. Receipts were kept for medicines brought into the home and for the disposal of unused medicines. Medicine administration charts were well kept. Medication records for two residents were reviewed. One was correct and one had one inaccuracy, which was referred to the manager and the nurse in charge. Staff had access to up to date information on medications and said if they needed specific advice they would get this from the chemist or the G.P. Hand written entries on the MAR charts had only one signature. It is a requirement for two signatures unless signed by the G.P. Training was not assessed but staff explained how they received medication management induction and supervision when first employed. Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 12 The home had a stock of homely remedies and each resident had a list of these agreed by the G.P. The list included topical applications, which is not acceptable because they should be individually prescribed. One resident had two bottles of medications in the room. Relatives had purchased these and the resident self-administered them. There was no evidence to show that a risk assessment had been completed in relation to this and the resident was of the opinion that someone took one of the medications and filled the bottle with water. The medicines were not locked away and the resident’s bedroom was not locked. Standard 10 – Residents seen on the day of the inspection looked clean and well–presented. Relatives confirmed that their husbands or wives were bathed and washed regularly. One lady of nearly a hundred returned from the hairdressers in the afternoon, was changed into a pretty dressing gown and given a late lunch. A recent meeting for residents, relatives and staff on one unit praised staff for knocking on doors prior to entering. Many of the bedrooms are overlooked because of the design of the building, but staff said that the curtains are always drawn before a resident is given personal care. Net curtains have been put in place in the lounge of Squires House at the request of the residents, and it is recommended that this be a consideration for bedrooms windows for those who wish to have them. Similarly it has been a recommendation in the past to offer door locks to those residents who wish to have them. Locks and the option of net curtains could be made available as part of the admissions procedure. A number of residents in Duncan House were unhappy with the quality of care provided. Comments made to the inspector in that house included “you get carers what care and carers what don’t”, and “Staff do not even talk to some people”. When a resident asked a member of staff to smile the response was, “I have to do a job not to pander to you” and when using the bell at night was asked, “What do you want now?” Residents who made these comments were obviously upset as to how it made them feel about themselves and their situation. Some residents said that the day staff were gentler than the night staff. One resident said, “I prefer to be put to bed by the day staff as the night staff are rough and often only one person hoists me to bed which make me feel unsafe and it does hurt”. These matters are subject to a recommendation. Standard 11 – The Home has a sensitive but pragmatic attitude to death and dying, and this was amply illustrated. One lady had recently died and her relatives had asked that she remain in the Home rather than be transported to hospital. Relatives are asked to put this in writing. A specially designed form called an End of Life Plan is on every file to record the wishes of the service user and his or her family in respect of death and dying, though these were not completed in all cases. Staff say that they approach the subject when it is clear relatives would be receptive to discussing it. One staff member was heard offering condolences on the telephone to the relative of a resident who had Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 13 died, and asking to be kept informed of the funeral arrangements. A number of staff attended Funeral Awareness Training in October. A Remembrance service had been arranged for later that week, when friends and relatives of all the residents who had died in the last eighteen months were to be invited to the Home for a ceremony and to light a candle in memory of their loved one. This standard is exceeded. Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15 Social and recreational activities are limited and there is little evidence of individual social care plans. EVIDENCE: Standard 12 – The Home celebrates topical events such as commemorating VE Day and centenarian birthdays. For every day activities the Activities Coordinator said that she had introduced some craft activities, including painting, stencilling and seasonal crafts such as making Christmas cards or Easter baskets. Photographs were available on one House showing residents with their artwork. Bingo is enjoyed by many of the residents, and the activities coordinator is hoping to acquire another numbers drum. One House had a book corner with a comfy chair and a good overhead light. There was range of books, which are usually donated, some in large print. In one House a resident was reading a newspaper and another had a book of word search games. The Sister on Squires said that particular activities for her residents would involve touch or smell, and spoke of music therapy, reminiscence work and dressing up. For these residents this could be most effective on a one to one basis, to maintain attention span and to stimulate conversation, but it was unclear how often this occurred for the individual although records are kept of all activities undertaken. The new sensory garden had a range of herbs and scented flowers in a raised bed, so that residents could reach them from their wheelchairs. Photographs were available of a day trip to Herne Bay enjoyed by some of the Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 15 residents, although staff admitted that residents do not get out “as often as we’d like”. Relatives endorsed this. A few residents on Duncan unit said they were confused as they were playing Bingo today when they normally play on Fridays. Social histories seen on file varied with little information available for some residents. Life mapping was seen in some care plans but there were no social care plans prepared. A tick-list of activities was kept to show resident involvement. These showed that some activities had been provided but had no detail to show whether this was resident choice or preference. A requirement and a recommendation have been made in respect of social care plans. Standard 13 – Several relatives were visiting the Home at the time of the inspection and all said that they could visit at any time, and that staff were friendly and approachable. Only four comment cards were returned to the Commission, and analysis of these was not possible, as two had been designed for other purposes, one for a General Practitioner and one for a Health and Social Care Professional. These had clearly been sent out to relatives erroneously by the Home, and this mirrors an error last year when the inspection posters were all returned to the Commission! In one House the inspection report available was not the most recent. The Commission expects that Homes will co-operate with inspection protocol, including sending out questionnaires appropriately. Relatives spoken to were content with the overall care, but sometimes felt that information was lacking, or, as one relative put it, “someone to explain things to you”. One relative was approached by a staff member after the inspection and told that they had been “reprimanded” by the Inspector for the care of her mother at lunchtime. This was not true, and caused the relative some needless distress. Standard 15 – Tables in one House were nicely laid for lunch with a clean tablecloth, mats, cruets and a flower posy in a vase. Laminated menus were on each table, as had been recommended at the two previous inspections, and these were easy to read, and enabled the residents to have some anticipation of the choices they would be offered at lunchtime. The meal was beef cobbler, gammon or spicy bean stew. There was a range of eating styles, from those who were able to use a knife and fork to those who used a plate guard and those who had food pureed. All the meals were presented nicely and according to individual choice and capacity. One relative said that the chef had come to see her parent who was a diabetic, to find out what food he liked to eat. Lunch was observed in the dining area off the lounge in Duncan House. The meal was brought to the unit from the main kitchen in a hot food trolley. Tables again were nicely laid with tablecloths, napkins, the daily menu and condiments. However a number of residents said this was unusual, as normally they did not have tablecloths, napkins or condiments and some said it was the first time they had seen a daily menu! Staff were attentive to residents during lunch and items such as plate guards were provided. Pureed foods were served Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 16 separately. Residents were generally satisfied with the meal but a number said the portions given were too large and this put them off eating. The portions served were large and there was a lot of waste from the meal. Residents were served their dessert while they were still eating their dinner. The inspector was told that often vegetables were tasteless and overcooked. Some food was sampled. The carrots were tasteless and watery and the topping on the apple pudding was not fully cooked. Recommendations are made under this standard. Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Complaints have not been recorded fully and transparently. EVIDENCE: Standard 16 - Four complaints only have been logged in the complaints book, but this is not a reflection of the true picture. Two anonymous complaints relating to staff dissatisfaction were received at the Commission and the Operational Manager has addressed these. Another complaint from the London Ambulance Service is being looked into. Several relatives took the opportunity before, after and during the inspection to contact the Commission with complaints about the Home and were advised to speak to the manager about their concerns. The current manager has been particularly targeted by the anonymous complaints and this is further addressed under standard 31. Information on the complaints procedure was available beside the visitor signing in book in the front entrance of Duncan unit. Two residents said things “went missing” from their rooms. In both cases it was sherry, books and other small items. Although the residents reported this to staff, they did not get any feedback as to what was done about it, nor was it recorded as a formal complaint. Residents said they did not have, nor were they offered keys to their bedrooms and felt their privacy was compromised, as they had no control over who entered their rooms. All complaints raised during the inspection should be added to the log and duly investigated. The manager is asked to provide the Commission with a statement containing a summary of the complaints received at the Home in the last six months and the action taken to resolve them. Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 18 Standard 18 – The Home has a whistle blowing policy. This was seen laminated on the wall of the office of one House. Staff displayed an awareness of adult abuse and how to handle allegations or suspicions of this. Training records showed that since the last inspection 22 staff received POVA training. Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24, 25 and 26 The Home appeared clean and well maintained. Individual bedrooms were spacious and were personalised with residents’ own items. EVIDENCE: Standard 19 – The Houses seen were all clean, bright and well maintained, and are suitable for their purpose. Squires House has benefited from the corridors being painted, a parquet floor in the dining area and a new sensory garden, opened recently by the Mayor of Greenwich. The lounge/dining area space in Duncan House was well laid out. The room had separate areas designated for smoking, listening to music or reading, watching TV or for dining and activities. The room was clean, tidy and well ventilated. Residents were seen in the various sections of the room. Clocks were provided and some residents were reading the daily paper. A portable pay phone was provided. The well-maintained garden was accessible through three sets of French doors off the large lounge/dining area. The bath in one bathroom was stained and needed cleaning. Hoists seen had last service dates as 9/11/04. The manager Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 20 said that they had been serviced recently and agreed to provide a copy of the certificate when it arrived. The certificate sent to the Commission confirms that hoists and baths were serviced in November last year and were due a service. This is a further requirement. Residents said that bathrooms were normally very cluttered with items such as hoists and linen bins. That was not the case on the day of the inspection. Standard 24 – A number of bedrooms were seen in all three houses. All were spacious, adequately furnished and included personal items such as TV, photos, ornaments, own phone lines and clocks. In Duncan House the walls were quite bare. Call bells tested were working. No rooms are lockable, but the manager confirmed that locks could be provided if requested. One sheet was seen with a tear, and residents’ meeting notes, and discussion with relatives and the manager confirmed that new linen is on order and was a late submission at the end of the budget year. Several relatives mentioned the need for new beds in Squires House, and a training session in Squires House noted, “Beds are too low; not adjustable”. The sister said that she hoped some of the promised high/low beds would be delivered to Squires House. Standard 25 – It was recommended at the last announced inspection that lighting and hot water checks be done on a monthly basis. The manager reported that they are now done but no records were looked at. Hot water was tested in one bathroom at 43 degrees. One relative had commented that there had been insufficient fans to keep residents cool during one particularly hot day. The day of the inspection was mild, and the temperature in the houses inspected was comfortable. There was no shortage of fans and floor standing fans and cooling units were in evidence throughout. Standard 26 – The Houses seen were clean and tidy on the day of the inspection, and at least two relatives commented that the Home was “very clean”. Hand washing facilities were available in every toilet and bathroom seen. The laundry was not inspected on this visit, but clothing continues to be marked with the house and room number, although relatives can mark clothing with a name if they wish. Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 The Home is operating at acceptable staffing levels, and staff receive training appropriate to the work they do. EVIDENCE: Standard 27 – Some tensions within the staff group have arisen due to a management decision to transfer staff across the site. A residents’ meeting on one House records, “concern expressed about continuity of care as staff are being transferred indiscriminately”. One staff member who did move to another House said that she still has contact with her former residents as, “I go and see them all the time”. Relatives spoken to expressed praise for staff who “tend to work well together”. Comments about their personal qualities were common, with generalised remarks such as, “the girls are terrific”. Residents in one House said that a lot of staff had been on duty for the past week getting the Home ready for the inspection. Increased staffing levels were seen on one House according to the rotas. They also said that, “the best staff are on today”! The worked rotas showed that the Home is operating according to its staffing notice. Standard 29 – The Home holds a recruitment day every three months. A sister and a deputy conduct interviews. The files of four newer staff members were looked at briefly. A new starter checklist on the front of each was incomplete in every case, and therefore could give no immediate corroboration that the necessary checks had been made. This standard was not fully assessed. Staff files will be looked at on the next inspection. Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 22 Standard 30 – Some relatives queried the level of expertise of some carers, especially those caring for people with dementia. The sister in charge of Squires House aims to have all staff trained in the care of people with dementia. She has put together a resource pack that can be used by staff to further their knowledge. She knew that some criticism has been levelled, and is taking appropriate action to deal with it, whilst supporting her staff. One staff member said that she learned through her work colleagues, and expressed her approach as, “to treat people the way you would like your mum and dad to be treated”. Another staff member described a three-day course she had undertaken on Quality Care in Dementia, accredited through Sunderland University. She felt that the training had enabled her to be more understanding and to see that the person “had a life”. Staff said they kept training certificates at home and were unsure if the home kept copies. It was evident that the manager kept central records of training provided. Since the last inspection, training has been provided in Moving and Handling, Dementia care, POVA, Fire safety and Palliative Care. The records seen, however, did not show the content of the training. Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 and 38 The manager has been in conflict with some staff members over how she wishes to manage the service. EVIDENCE: Standard 31 - The current manager has been in post for over a year, and the Commission is currently processing her registration. Changes that the manager has put in place have not been popular with all the staff and some conflicts have arisen in the last few months because of this. This has led to anonymous complaints, copies of which were sent to the Commission. The Operational Manager has investigated these complaints and deemed them unfounded. Standard 33 – Relatives’ surveys take place from time to time, and meetings for relatives to express their views are held on each House. Standard 38 – Some regulation 37 notifications have been sent to the Commission without sufficient detail, and this was brought to the attention of Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 24 the Home sister on the day of the inspection. Also it came to light through a complaint that the death of a resident late last year had not been reported to the Commission and this is a requirement. In one bedroom in Duncan House, the resident had a ‘monkey pole’ to help her sit up in bed, but this was not fixed to the floor or the bed and could pose a risk to the resident as it could be pulled down when in use. This is a further requirement. Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 3 x x x x 3 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x 3 3 x 3 x x x x 2 Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 26 NO Are there any outstanding requirements from the last inspection? 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 1 Regulation 4(1) Requirement The Statement of Purpose for each House should include the relevant qualifications and experience of staff. The manager must confirm in writing to every prospective resident that his needs can be met. Service users must be involved in care planning and review of all care plans. The Home must make proper provision for health and welfare, specifically residents identified as at risk of developing pressure sores must have care plans in place to show how the risk will be managed. The Home must make arrangements for service users to receive treatment, advice or other health services as required, specifically chiropody services in respect of residents suffering from diabetes. Handwritten entries in MAR charts must be supported by two signatures unless signed by the G.P. A record must be kept of all medication received into the Timescale for action 30 Sept 2005 Immediate 2. 3 14(1)(d) 3. 4. 7 7 15 12(1)(a) Immediate 30 Sept 2005 5. 8 13(1)(b) Immediate 6. 9 13(2) 30 SEpt 2005 Immediate Page 27 7. 9 13(2) Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Home. 8. 9. 9 8 13(2) 13 A risk assessment must be made of all residents who selfmedicate. The Home must have a system in place to follow injuries sutained by residents when being assisted to transfer to prevent a recurrence. Individual social care plans should be drawn up in consultation with residents. All complaints, from whatever source, must be logged and be subject to investigation within the appropriate timescale. A statement containing a summary of the complaints for the preceding six months and action taken should be sent to the Commission. The Home must notify the Commission without delay of the death of any service user, including the circumstances of his death. The manager must ensure that unnecessary risks to the health and safety of residents are identified, and, so far as possible eliminated. Specifically the use of the monkey pole in Room 33 of Duncan House should be reviewed. Equipment in use in the Home must be maintained in good order. Specifically a copy of the certificate in respect of the hoist maintenance should be sent to the Commission when received. Immediate 30 Sept 2005 10. 11. 12 16 16(2)(m) 22(1) 30 SEpt 2005 Immediate 12. 16 22(8) 30 Sept 2005 13. 38 37(1)(a) Immediate 14. 38 13(4) 30 Sept 2005 15. 38 23(2) Immediate Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 10 10 12 15 Good Practice Recommendations It is recommended that net curtains and door locks are available for those residents who wish to have them and that these are offered as part of the admission procedure. It is recommended that staff receive refresher training in delivering personal care in a sensitive and respectful way. It is recommended that activities be developed with reference to individual social care plans. It is recommended that tables are laid with tablecloths, condiments and a menu every day, portion size is varied according to individual capacity and dessert is only served once the main course plates have been cleared away. It is recommended that vegetables are cooked with more care to retain their taste and crispness, and residents are consulted regularly about their preferences in this area. 5. 15 Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 Page 29 Commission for Social Care Inspection Riverhouse 1 Maidstone Road Sidcup Kent DA14 5RH National Enquiry Line: 0845 015 0120 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 Gallions View G51G01s6761GallionsViewv225690.25.7.05stage4.doc Version 1.30 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!