Inspection on 19/12/05 for Galsworthy House Nursing Home

This inspection was carried out on 19th December 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Galsworthy House Nursing Home 21/08/07

Galsworthy House Nursing Home 14/08/06

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 Unannounced Inspection 19th December 2005 11:10 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.V273511.R01.S.doc Version 5.0 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.V273511.R01.S.doc Version 5.0 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.V273511.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th July 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 a number of 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.V273511.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was conducted over the course of several hours and was aimed at determining if the home had taken action to meet the five requirements that were made following the last inspection visit. Of these aforementioned five requirements, the home has now met two, and taken action to partially meet one more. One remains unmet, while it was not possible to assess one. Two new requirements have been made. These should not be difficult to meet. In meeting them the home will improve the overall quality of the service being provided, and improve the well-being of the service users. What the service does well: What has improved since the last inspection? What they could do better: As mentioned above, one requirement remains outstanding while one has only been partially met. The former concerns the medication administration records. In spite of a previous requirement, a number of gaps were again found. The latter relates to the requirement to amend the POVA and restraint procedures. The restraint procedure has been updated however the POVA procedure still, wrongly, states that the manager will investigate any allegations of abuse. The two new requirements concern the need to ensure that all potential residents are assessed prior to a placement being agreed (this assessment (be it by the home or the placing authority, or both) should be kept on the service user file), and the need to ensure that any changes to health care needs are recorded on the service user plan. Galsworthy House Nursing Home DS0000026245.V273511.R01.S.doc Version 5.0 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.V273511.R01.S.doc Version 5.0 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.V273511.R01.S.doc Version 5.0 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 Pre admission assessments were not in evidence in all of the files inspected. This means that the service user and their relatives cannot be certain that the home has taken into account their individual needs, or that it can meet them; and the staff in the home may not be as familiar as they could be with new service users, or have a full understanding of what specific service they will need to provide. EVIDENCE: The home has changed its recording proforma to the Standex system. While it may well be that staff are still familiarising themselves with this system, the need for all new referrals to receive a thorough pre-admission assessment should remain of paramount importance. Such an assessment was not in evidence in all of the files that were inspected. Galsworthy House Nursing Home DS0000026245.V273511.R01.S.doc Version 5.0 Page 9 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 11 While most care plans were being reviewed monthly, this good practice was not universal. This means that it is possible that the care being given may not be as specific as it could be. Examination of a number of care plans and the records re dressings indicated that the two were not being cross-referenced. This means that it is possible that specific wound care information may be overlooked by staff, which could have a detrimental effect on the service user. In spite of a previous requirement, a number of errors were noted in the medication records. This is unacceptable, as any mistakes made in giving out medication can have serious consequences for the service users. Better recording of service users wishes in the event of their serious illness and death means that residents and their families can be reassured that they will be treated with sensitivity, care and respect at this difficult time. Galsworthy House Nursing Home DS0000026245.V273511.R01.S.doc Version 5.0 Page 10 EVIDENCE: The majority of the care plans examined were being reviewed on a monthly basis. This is in line with the Standards and this good practice is to be commended. There were, however several plans that had not been so reviewed. A recommendation has been made in this regard. It was surprising to find that a number of care plans had not been updated to include the care being given for wounds. While reference to dressings could be found in the daily notes, it would be normal practice to update a care plan so as to make specific reference to the wound, the treatment to be given and the dressings to be used and the frequency of changes of dressing. The medication administration records for one of the floors were inspected. It was both surprising and disappointing to find a large number of gaps in the records, particularly in view of the previously made requirement. It was previously required that the records relating to each service users’ wishes in the event of their illness/death be improved, so that essential information was not overlooked. From examination of a number of service user files it was evident that steps had been taken to improve matters in this area. Galsworthy House Nursing Home DS0000026245.V273511.R01.S.doc Version 5.0 Page 11 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): 15 It was previously recommended that the manager look at ways to improve the way in which hot food was transported around the building as some residents commented that it was often cold by the time it reached them. Steps have been taken to remedy this and on this visit the service users were much more positive, and confirmed that matters had improved. EVIDENCE: To enable the food to be kept at an acceptable temperature, a number of hot trolleys have been purchased. Service users commented that this had made a noticeable difference to the meals, and they were now usually served hot. Galsworthy House Nursing Home DS0000026245.V273511.R01.S.doc Version 5.0 Page 12 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 The home has an adequate complaints procedure in place, thus reassuring service users and their relatives that complaints will be listened to and acted upon. Although some amendments had been made to the POVA procedure, the Inspector still felt that it did not give sufficient guidance to staff in the event that they had to make a referral, thereby not offering sufficient protection to service users. EVIDENCE: It was previously recommended that the main policy and procedure manual contain the most up to date complaints procedure (the same one as had been reviewed and replaced in the service user guide). This had not been done prior to this visit, but it was done during it. A requirement was previously made re the need for both the restraint and the POVA procedures to be revised. The former has been amended and while some changes have been made to the latter it still states that allegations will be investigated by the home manager. This is not in line with the accepted multiagency procedures and indeed has recently led to some discussion between the Commission, the home and the Local Authority regarding these procedures not being followed. Galsworthy House Nursing Home DS0000026245.V273511.R01.S.doc Version 5.0 Page 13 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): Not assessed on this visit. EVIDENCE: Galsworthy House Nursing Home DS0000026245.V273511.R01.S.doc Version 5.0 Page 14 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): 29 Recent changes to Commission procedures means that in specific circumstances it may not be necessary for homes to maintain certain staff files in the home. This home is part of a group that has not made its records available in the homes themselves, and as such they have yet to be inspected. The home can undertake to keep them centrally and make them available at any time for inspection. It is understood that they are in the process of seeking the Commission’s agreement to this. This means that on this visit, the records were again unavailable for inspection, and thus remain unexamined. EVIDENCE: Galsworthy House Nursing Home DS0000026245.V273511.R01.S.doc Version 5.0 Page 15 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): 38 Steps have been taken to comply with the recommendations made by the London Fire and Emergency Planning Authority. This means that in this respect, the health, welfare and safety of service users and staff was being protected. EVIDENCE: The fire officer, on their visit to the home recently, recommended that a fire detection device be fitted in the main entrance lobby. This had now been done. Galsworthy House Nursing Home DS0000026245.V273511.R01.S.doc Version 5.0 Page 16 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Galsworthy House Nursing Home DS0000026245.V273511.R01.S.doc Version 5.0 Page 17 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 Requirement Timescale for action 19/12/05 2 OP18 13 3 OP3 14 4 OP8 15 The manager must ensure that staff accurately maintain the medication administration records at all times. The previously set timescale has not been met. The POVA procedure must be 31/01/06 revised as outlined in this report. The previously met timescale has not been fully met. Staff must ensure that pre19/12/05 admission assessments are carried out and recorded, prior to placements being agreed. Any health care changes should 19/12/05 be recorded on the individual service user plans. 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 OP7 Good Practice Recommendations It would be good practice to ensure that all service user DS0000026245.V273511.R01.S.doc Version 5.0 Page 18 Galsworthy House Nursing Home plans are reviewed on a monthly basis, as outlined in the Standards. Galsworthy House Nursing Home DS0000026245.V273511.R01.S.doc Version 5.0 Page 19 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. Extracts may not be used or reproduced without the express permission of CSCI Galsworthy House Nursing Home DS0000026245.V273511.R01.S.doc Version 5.0 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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