Inspection on 14/08/06 for Galsworthy House Nursing Home

This inspection was carried out on 14th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Galsworthy House Nursing Home 21/08/07

Galsworthy House Nursing Home 19/12/05

Galsworthy House Nursing Home 25/07/05

Galsworthy House Nursing Home 25/01/05

Galsworthy House Nursing Home 10/08/04

Galsworthy House Nursing Home 27/02/04

Galsworthy House Nursing Home 02/12/03

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

CARE HOMES FOR OLDER PEOPLE Galsworthy House Nursing Home 177 Kingston Hill Kingston Surrey KT2 7LX Lead Inspector Margaret Lynes Key Unannounced Inspection 10:45a 14th August 2006 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Galsworthy House Nursing Home DS0000026245.V307659.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Galsworthy House Nursing Home DS0000026245.V307659.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Galsworthy House Nursing Home Address 177 Kingston Hill Kingston Surrey KT2 7LX 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) 0208 547 2640 0208 547 3175 South London Nursing Homes Limited Mrs Catherine Mary Robertson Care Home 72 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0), of places Physical disability over 65 years of age (0), Terminally ill over 65 years of age (0) Galsworthy House Nursing Home DS0000026245.V307659.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th December 2005 Brief Description of the Service: Galsworthy House is situated in a residential area of Kingston, and provides for older people who require nursing care. It is also registered to provide nursing care to elderly terminally ill clients, elderly clients with dementia, and elderly clients with a physical disability. The home provides accommodation over three floors in a listed building that has been thoughtfully extended. The home has two lifts. There are seven rooms within the home, which can be used as doubles, the remainder are single, and these rooms are en-suite. Many rooms have the attraction of overlooking the pleasant vista of Richmond Park, and the home also has very attractive walled gardens that provide seating areas. The home has an ongoing redecoration programme and is maintained to high standards. The home has four resident pet cats, who provide an added attraction for service users and visitors. Galsworthy House Nursing Home DS0000026245.V307659.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over the course of 81/2 hours, and consisted of examination of records, meeting residents and staff, and a brief tour of the communal areas. All of those who contributed to the inspection are thanked for their assistance. The last inspection had resulted in four requirements. Of these three had been met, and while improvements had been made with regard to the fourth, the expected Standard had still not been achieved. This visit has resulted in a further four requirements and six recommendations. Evidence to support the comments below was gathered from a range of sources – the service users themselves, relatives, members of staff and inspection records. What the service does well: What has improved since the last inspection? What they could do better: Examination of the medication administration records for one of the three floors in the home found that, while much improved, there were still errors being made. The previously made requirement has, therefore, been repeated. Requirements have also been made regarding recording the action taken when a complaint is received; staff recruitment and staffing levels, and quality assurance recording. It is anticipated that the home will take prompt action to resolve these issues. Galsworthy House Nursing Home DS0000026245.V307659.R01.S.doc Version 5.2 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. Galsworthy House Nursing Home DS0000026245.V307659.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Galsworthy House Nursing Home DS0000026245.V307659.R01.S.doc Version 5.2 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 the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All of the files (with the exceptions mentioned below) included a pre-admission assessment, albeit the contents varied in the depth of information provided. Generally, however, this means that the service user and their relatives can be reassured that the home has taken into account their individual needs, and feels that it can meet them; and the staff in the home can be as familiar as possible with new service users, and have an understanding of what specific service they will need to provide. EVIDENCE: It was previously required that the home ensure that it obtained or conducted detailed pre-admission assessments before agreeing to a placement. On this visit some eight service user files were inspected. Four contained assessments conducted by the home and recorded on the (relatively new) Standex system. Two others contained relevant information pertaining to each client albeit it Galsworthy House Nursing Home DS0000026245.V307659.R01.S.doc Version 5.2 Page 9 was not recorded on the aforementioned system. One of the remaining two files seen belonged to a client who was admitted quite some time ago, when the sort of assessments now expected were not required. The final file inspected was that of a client who had transferred from a sister home to Galsworthy, and staff had not felt that it was necessary to repeat the assessment. Galsworthy House Nursing Home DS0000026245.V307659.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service user plans seen adequately covered the health, personal and social care needs of the service users. This means that the staff team are aware of the differing needs of their residents, and know what specific care needs to be given. Staff ensure that each resident is able to access community based health facilities as and when required. The service user plan was supplemented by a number of health assessments, which means that the staff team are aware of the health needs of each individual service user and can plan their care accordingly. The medication administration records for one of the floors were examined. Unfortunately several errors were noted. Clearly this is unacceptable, as any mistakes made in giving out medication can have serious consequences for the service users. Galsworthy House Nursing Home DS0000026245.V307659.R01.S.doc Version 5.2 Page 11 From observation and discussion, service users were treated with respect, and their right to privacy was upheld. EVIDENCE: Each of the files inspected contained a care plan. These were detailed and, in the main, reviewed monthly. In line with the requirement made at the last inspection the health care records had been improved. It was noted, however, that although each of the files contained a lot of information, a number of assessments had not been reviewed for over a year. These included assessments for manual handling, nutrition and pressure sores. The steps the home has taken to try to reduce the number of falls suffered by service users were examined. This examination was partly due to a number of reported incidents over the past year which had resulted in residents fracturing bones, and partly as a result of inspecting the home’s accident book, which indicated that there had been 12 falls in August alone. It was reassuring to see that the staff had accessed information on falls risk assessments, and were maintaining a running audit of falls and the action that could be taken to reduce the likelihood of them re-occurring. The medication administration records for one of the three floors were examined. Unfortunately, several errors were noted, and the requirement that has been made in the last two reports has again been repeated. A number of service users were spoken with. They all expressed their satisfaction with the care being provided and felt that their privacy and dignity was maintained. Galsworthy House Nursing Home DS0000026245.V307659.R01.S.doc Version 5.2 Page 12 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 the following standard(s): 12-15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a designated activities co-ordinator who provides a sufficient amount of stimulation to satisfy the service users social and recreational interests. A number of service users met with the Inspector and they all felt that they were enabled to exercise choice and control over their lives to the extent that it was possible. Visitors are encouraged to call. The menus were examined and appeared to offer a good selection of meals. Service users said that generally they found the food to be good, although there was one dissenting voice. EVIDENCE: Time was spent talking with the activities co-ordinator with regard to the variety of activities that were available. There appeared to be a good range, including tabletop games, quizzes, reminiscence, ball games, outings and an external entertainer was engaged on a weekly basis. The home caters for a Galsworthy House Nursing Home DS0000026245.V307659.R01.S.doc Version 5.2 Page 13 number of service users who are not of English origin. Although more by fault than design, the home is fortunate to have amongst its staff team carers with a variety of languages. Enough variety, indeed, to cover all of the nationalities currently resident. This enables service users to make their wishes known, and for the staff team to have a much fuller understanding of their needs, including any dietary preferences. Although a meal was not observed, the menus were provided and they indicated that there was a choice of meal each day. One of the service users commented that they were not keen on the food, but the remainder spoken with were all satisfied. Relatives are made welcome, and a number were seen to be coming and going during the day. Although informed that the Inspector was present, none chose to have a discussion. Galsworthy House Nursing Home DS0000026245.V307659.R01.S.doc Version 5.2 Page 14 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 the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has an adequate complaints procedure however it must ensure that it clearly documents all responses to complaints. In this way service users and their relatives/friends can be assured that any concerns will be taken seriously and acted upon promptly. The adult protection procedure has been amended so that it now gives clear and accurate guidance as to the action staff need to take in the event of any allegations or suspicions, thereby offering sufficient protection to service users. EVIDENCE: The information provided by the manager on the pre-inspection questionnaire indicated that there had been 13 complaints during the course of the past year, eight of which were substantiated. On examination of the complaints log there was clear audit trail of complaint and response – in all but one case. Staff must ensure that all complaints are responded to and this response is documented. It was previously required that the in-house Adult Protection procedure be revised so that it accurately reflected the action that staff should take should Galsworthy House Nursing Home DS0000026245.V307659.R01.S.doc Version 5.2 Page 15 abuse be suspected or alleged. Within the main policy and procedure file there had been added an ‘action card’, which clearly states that both the Local Authority and the Commission must be informed of any concerns. It was surprising, however, that the procedure itself still made no mention of the Local Authority multi-agency procedures, even though it had a copy. It was also surprising that the new ‘action card’ had not been inserted into the key policy/procedure manual. It would also be helpful if a copy of the whistleblowing procedure could be added to the aforementioned key manual, particularly as the in-house adult protection procedure refers to it. It will be recommended that the whistleblowing procedure is amended so that it makes it clear that staff can, if they so wish, ‘whistle blow’ to organisations external to the home. Since the last main inspection there has been one adult protection investigation carried out in the home. The allegation could not be substantiated. Galsworthy House Nursing Home DS0000026245.V307659.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The parts of the home seen were in a good state of repair, and it was felt that the home provided a safe and well-maintained environment. The communal areas were clean, pleasant and hygienic, as were the bedrooms that were visited. EVIDENCE: A walk was taken around the home, with a number of the communal areas and some of the bedrooms visited. All of these areas were clean and in a good state of decoration and furnishing. The house itself is a listed building and has many original, attractive features. Although large, the home does not feel institutionalised. Service users are able to bring in their own personal possessions, and it was nice to see rooms outfitted with furniture brought in by the residents. Galsworthy House Nursing Home DS0000026245.V307659.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 – 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The number of staff on duty, both qualified nurses and care assistants, did not always appear to be sufficient to meet service users needs. This means that it is possible that service users cannot always be attended to promptly. Recruitment procedures were not robust enough to adequately support and protect service users. Staff are able to access a variety of in-house training courses, and these are put on at regular intervals. This means that the staff team should be competent to do their jobs. EVIDENCE: The staff rota indicated that on the morning shift there were usually between 3 and 6 qualified staff and 8-13 carers on duty. In the afternoons and evening, this dropped to between 2 and 5 qualified staff and 5-8 carers. On duty overnight were 2 qualified staff and 5 carers. Overall this means that on the morning shift there are usually between 13 and 17 care staff on duty, while in the afternoon evening 9 – 10. There needs to be a more even distribution of staff so that between 8 and 8, with 60 residents, the home should be providing approximately 1 carer to every 5 service users (in this case [on current occupancy levels] 12, and then approximately 1/3 of that figure again Galsworthy House Nursing Home DS0000026245.V307659.R01.S.doc Version 5.2 Page 18 as qualified staff, which would equate to 4. There does not appear to be a problem with the actual number of staff generally available, but rather that they are not evenly rostered. In spite of previous requirements the staff recruitment files were not available in the home for inspection. It has to be acknowledged, however, that after a call to the head office, the requested files were brought to the home so that they could be inspected. Generally the documentation was well presented. There were, however, a number of gaps, including exploration and explanation of gaps in employment histories; the provision of a recent photograph of each staff member; a health declaration for each staff member; and, evidence, for all staff, that the company had waited for a CRB (or at least a POVA 1st) before they commenced work. Staff are able to access a variety of training courses, including dementia care, mentorship and NVQ level II and level III. ‘Mandatory’ training in areas such as health and safety, manual handling, adult protection is ongoing. It was pleasing to note that all staff, not only the carers, were being enabled to undertake NVQ courses – for example one had completed an NVQ in Patisserie, while another was currently working towards an award in kitchen/larder practice. While none of the staff team currently has a first aid certificate, the newly appointed trainer is undergoing the course, and all staff are given a brief first aid refresher every year. It is anticipated that once the trainer has been trained, she will be able to carry out courses in-house. Galsworthy House Nursing Home DS0000026245.V307659.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are enabled to live in a home which is run and managed well. Although some improvement in the recording of quality assurance checks is needed, it was felt, nevertheless, that the home was being run in the best interests of the service users. Service users finances are safeguarded by the accounting and financial procedures in place in the home. Further improvement is needed in the frequency of staff supervision, however it is noted that progress has been made. It was felt, from examination of the relevant documentation, that the health, safety and welfare of services users and staff was being promoted and protected. Galsworthy House Nursing Home DS0000026245.V307659.R01.S.doc Version 5.2 Page 20 EVIDENCE: The manager continues to undertake a management course, to supplement her nursing qualifications. From observation and comments received from staff and service users the home was well run and well managed. It reflects well on the manager that in her absence the deputy has the confidence and competence to more than adequately cover. Periodic surveys are made of the service users to obtain their views as to how good, or bad, the service is. One such survey has been conducted this year and the results collated. They showed that overall the residents were more than satisfied with almost every aspect of life in the home. One area that scored less highly than others was activities. This was surprising, given the amount of activities on offer, and it must be said that the dissenting voices were in the minority. It will be recommended that the results of this survey are made available, in an easily understood format, to service users and their relatives/friends. From discussions with the deputy it was clear that a number of quality checks are carried out by the senior staff on a regular basis – and usually discussed in the (approximately) three-monthly meetings. While the company carries out its own audit annually, it will be required that the home better evidences these quality assurance checks. Inspection of the policies and procedures showed that while most had been reviewed within the last year, there were some that were overdue for an annual review. Only two service users have their finances looked after by the home. In both cases monies are paid into the Company’s accounts and then either given in cash to the service user or passed on to their family. Should any service user purchase items additional to those covered in the fees, the home will cover the initial cost and subsequently invoice the service user/their family. Staff supervision has been revised since the appointment of a new in-house trainer. While the frequency has not yet reached the level recommended in the Standards, progress has been made. Examination of health and safety documentation indicated that all of the periodic maintenance checks were up to date. These included maintenance of the lift, fire detection and fighting systems; hoists and wheelchairs; gas and electrical installation and appliances and the water system. Both fire and general health and safety risk assessments were available and up to date. Galsworthy House Nursing Home DS0000026245.V307659.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Galsworthy House Nursing Home DS0000026245.V307659.R01.S.doc Version 5.2 Page 22 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 OP9 Regulation 13 Requirement The manager must ensure that staff accurately maintain the medication administration records at all times. The previously set timescale has not been met. The manager must ensure that the investigation and outcome of all complaints is recorded. The manager must ensure that there is an even distribution in the numbers of qualified staff and care staff on each shift. The manager must ensure that all new staff provided the required documentation before commencing work in the home. The manager must ensure that there are adequate quality assurance systems in the home and that these can be evidenced. Timescale for action 14/08/06 2. 3. OP16 OP27 22 18 14/08/06 14/08/06 4. OP29 19 14/08/06 5. OP33 24 01/10/06 Galsworthy House Nursing Home DS0000026245.V307659.R01.S.doc Version 5.2 Page 23 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 Refer to Standard OP8 OP18 OP18 Good Practice Recommendations It is strongly recommended that assessments such as those for manual handling, nutrition and pressure sores are reviewed on a regular basis. It would be good practice if the in-house whistleblowing procedure gave staff the option of reporting concerns to bodies outside of the home as well as internally. It would be helpful if the in-house adult protection procedure made reference to the Local Authority multiagency procedure, and that the key policy and procedure manual contained the most up to date version of the aforementioned in-house procedure. It would be good practice to ensure that all policies and procedures are reviewed annually and this is recorded. It would be good practice if the outcome of the periodic service user satisfaction surveys were published/made available to service users. The recent efforts made re staff supervision need to be sustained and expanded so as to ensure that care staff receive supervision at the frequency recommended in the Standards. 4 5 6 OP33 OP33 OP36 Galsworthy House Nursing Home DS0000026245.V307659.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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. 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