Inspection on 25/07/05 for Galsworthy House 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 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 19/12/05

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 25 July 2005 1000 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. Galsworthy House Nursing Home G53 G53 S26245 galsworthyhouse V196538 250705 stage 4.doc Version 1.40 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 Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8547 2640 020 8547 3175 South London Nursing Homes Limited Mrs Catherine Mary Robertson Care Home 72 Category(ies) of Old age registration, with number Physical disability of places Dementia Terminally ill Galsworthy House Nursing Home G53 G53 S26245 galsworthyhouse V196538 250705 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25/1/05 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. Galsworthy House Nursing Home G53 G53 S26245 galsworthyhouse V196538 250705 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced, and was conducted over one day. During that time a number of records were examined, a brief tour was made of the premises and time was spent talking with service users, a relative and staff. All but one of the previously made requirements had been met. The one outstanding requirement had been partially met and related to one aspect of record keeping. This visit resulted in a further four requirements being made. With one exception (extending the fire detection system) these are relatively minor issues and 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: The most notable failure to meet Standards/Regulations concerned the medication administration, where a number of errors were found in the documentation. This must be improved. Galsworthy House Nursing Home G53 G53 S26245 galsworthyhouse V196538 250705 stage 4.doc Version 1.40 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 G53 G53 S26245 galsworthyhouse V196538 250705 stage 4.doc Version 1.40 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 Galsworthy House Nursing Home G53 G53 S26245 galsworthyhouse V196538 250705 stage 4.doc Version 1.40 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) 3 Paperwork relating to four new service users 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: Of the four files mentioned above, one contained a detailed assessment from the placing hospital, while another contained a less detailed but nevertheless satisfactory assessment from the Local Authority. The other 2 contained notes of discussions with the service users by staff at the home. While both of these service users were actually self-referred, it is still important to gather as much information as possible, so that it can be determined that the home will be able to meet all of their needs. One of the sets of notes was informative, the other much less so. The home does have a Galsworthy House Nursing Home G53 G53 S26245 galsworthyhouse V196538 250705 stage 4.doc Version 1.40 Page 9 specific in-house pre-admission proforma, and it is strongly recommended that this be used in all cases (unless an assessment is provided by a placing Authority), even if self-referred. The previously made requirement regarding the need for the home to apply for a variation so that the registration certificate accurately reflected the various client groups resident in the home, has been met. Galsworthy House Nursing Home G53 G53 S26245 galsworthyhouse V196538 250705 stage 4.doc Version 1.40 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 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 a number of errors were noted. Clearly this is unacceptable, as any mistakes made in giving out medication can have serious consequences for the service users. From observation and discussion, service users were treated with respect, and their right to privacy was upheld. While improvements have been made, the Inspector felt that more work was needed to establish the wishes of each service user in the event of their death. Galsworthy House Nursing Home G53 G53 S26245 galsworthyhouse V196538 250705 stage 4.doc Version 1.40 Page 11 EVIDENCE: There was good documentation in each of the service user files inspected. Supplementing the care plans were a number of assessments, including those for risk, nutrition, pressure areas, moving and handling, dependency and social activities. Not all of the plans see were being reviewed on a monthly basis – this was drawn to the attention of the manager. The medication administration records for one of the floors were selected for inspection. A number of errors were found – staff had failed in some instances to sign the charts; tippex had been used, staff had failed to record why some prescribed medication had not been given, and there were two gaps in the testing of blood sugar levels for one service user. From observing the interaction between the staff and the service users, and having also talked to a number of service users and their relatives, it was evident that they felt that they were being treated with respect and that their privacy was upheld as much as was possible. At the last inspection a requirement was made for staff to seek the views of service users as to their wishes in the event of their death, and to ensure that these wished were recorded. While this had now been done for a number of residents, there were still gaps in the recording. It is, of course, quite feasible that some service users will say that either they do not have any particular wishes, or that they do not want to discuss the issue. In such instances staff should simply record these comments. Galsworthy House Nursing Home G53 G53 S26245 galsworthyhouse V196538 250705 stage 4.doc Version 1.40 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 standard(s) 12, 13, 14 and 15 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, and can join their loved one for a meal if they so wish. The lunchtime meal was observed and appeared to be well prepared and appetising. Service users said that generally they found the food to be good, although several commented that it was not always hot. EVIDENCE: The home is fortunate in its location as it overlooks Richmond Park and its many attractions. Service users were asked if they felt that they had enough to stimulate them during the day, and all said that there were enough activities should they wish to partake in them. One relative was present during the inspection and praised the home for the quality of its care. The service users spoken with felt that their independence Galsworthy House Nursing Home G53 G53 S26245 galsworthyhouse V196538 250705 stage 4.doc Version 1.40 Page 13 and choice was being upheld as much as was possible given the circumstances they were in. While all of the service users (who were asked) commented that the food was generally good, several did make the comment that it was usually cold by the time it reached them. One also made a request for more beef dishes. This request was passed on to the manager, while a recommendation has been made with regard to the temperature of the food. Galsworthy House Nursing Home G53 G53 S26245 galsworthyhouse V196538 250705 stage 4.doc Version 1.40 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 standard(s) 16 and 18 The home had a satisfactory complaints procedure in place, within the Service User Guide, which is accessible to service users. There was an adult protection policy in place however the Inspector 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. Similarly, the Inspector felt that service users were not adequately protected by the restraint procedure. EVIDENCE: The complaints procedure within the Service User Guide was satisfactory, and clearly stated that a complainant could, if they so wished, contact the Commission directly, and at any stage. For some reason, the complaints procedure within the policy and procedure manual differed, and stated that a complaint would be dealt with within 7 days, and after that time, if unsatisfied, a complainant could contact the Commission. Clearly this latter procedure is incorrect, and needs to be amended. There was a Vulnerable Adults policy in place and while the content of it was satisfactory, the Inspector did not feel that it gave any specific guidance as to the steps staff should follow if they had concerns re possible or witnessed abuse. The procedure needs to be expanded, and should also make reference to the Local Authority’s procedure. There was a restraint policy in place however it needs to be amended so that it clearly states that restraint would be used as a last resort, usually in a situation that demands immediate action, and therefore its duration cannot be predetermined. Galsworthy House Nursing Home G53 G53 S26245 galsworthyhouse V196538 250705 stage 4.doc Version 1.40 Page 15 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 and 26 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. Not all of the bedrooms are en-suite but there are a sufficient number of toilets in the communal areas. There are ample bathing facilities, with specialist equipment where needed. EVIDENCE: A tour was made of the communal areas and a number of the bedrooms. These areas were well maintained, well furnished and pleasantly decorated. 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. All of the service users spoken with commented that they were comfortable in their rooms. Galsworthy House Nursing Home G53 G53 S26245 galsworthyhouse V196538 250705 stage 4.doc Version 1.40 Page 16 Two requirements were made at the time of the last inspection. One concerned the need to install restrictors on the windows above ground floor level. The manager has risk assessed the bedrooms in question and restrictors have been fitted where there is an identified need. Further restrictors may need to be fitted as and when the occupants of the rooms in question change. The second requirement was made with regard to the blocking of a fire exit. On this visit, the exit in question – adjacent to the laundry was clear. It was little surprising to find that in a home of this size, there was not a full time handy person. One is available, but they have to share their time between this home and another in the group. Consideration should be given to allocating a full time post to Galsworthy House. Galsworthy House Nursing Home G53 G53 S26245 galsworthyhouse V196538 250705 stage 4.doc Version 1.40 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 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 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. Before making a requirement however, further discussion will be had with the manager. 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 rotas for three weeks were assessed. They showed somewhat erratic staffing levels, with the number of qualified nurses on duty in the morning varying between 3 and 6, and in the afternoon between 2 and 4. The number of carers also varied, although not as noticeably. At night there are usually 2 trained staff on duty with between 4 and 5 carers. For a home of this size, the lower numbers given above do not appear to be sufficient to cater for upwards of 60 residents. Further discussion will therefore be had with the manager. Staff are fortunate to be able to access a number of training courses, and these are put on at regular intervals so that all staff have the opportunity to attend. Some courses are mandatory, and staff are reminded when they are due to attend refresher courses. Until recently the home had its own designated part-time training officer. The post is currently vacant, however it is Galsworthy House Nursing Home G53 G53 S26245 galsworthyhouse V196538 250705 stage 4.doc Version 1.40 Page 18 being covered by a training officer from another home in the group. The previously made requirement regarding staff training has been met. It was not possible to review recruitment procedures as, contrary to Regulations, staff documentation is not kept on site. Galsworthy House Nursing Home G53 G53 S26245 galsworthyhouse V196538 250705 stage 4.doc Version 1.40 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 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, 37 and 38 The registered manager, a qualified nurse, is shortly due to commence a course which once completed will ensure that she fully meets the legislative requirements. Mention has been made of gaps in medication records and the need to revise several policies/procedures. The Inspector was not satisfied therefore, that service users’ rights and best interests were fully safeguarded. No action had been taken with regard to recommendations made by the Fire Authority towards the end of last year. This means that the health, safety and welfare of both service users and staff is not as protected as it could be. EVIDENCE: At the previous inspection a requirement was made with regard to the need for the registered manager to undertake an NVQ level IV course in management, so as to bring her qualifications into line with the demands of the Regulations. Galsworthy House Nursing Home G53 G53 S26245 galsworthyhouse V196538 250705 stage 4.doc Version 1.40 Page 20 A place has now been identified for her to commence a relevant course in September. A visit by the London Fire and Emergency Planning Authority (LFEPA) to the home last November, resulted in a number of recommendations being made. Not all of these have been adhered to yet, and it is beholden on the home to ensure that it complies with all of the LFEPA’s recommendations. Galsworthy House Nursing Home G53 G53 S26245 galsworthyhouse V196538 250705 stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x 3 x 3 STAFFING Standard No Score 27 x 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 3 x 2 3 x x x x x 2 2 Galsworthy House Nursing Home G53 G53 S26245 galsworthyhouse V196538 250705 stage 4.doc Version 1.40 Page 22 yes 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 9 Regulation 13 Requirement The manager must ensure that staff accurately maintain the medication adminstration records at all times. Staff must ensure that the determine and record the wishes of service users in the event of their death. The previously set timescale for this requirements has not been fully met. Both the POVA and the restraint procedures must be revised as outlined in this report. The proprietors must ensure that staff recruitment documentation is available for inspection in the home. The proprietors must ensure that they comply with the recommendations of the LFEPA. Timescale for action 25/7/05 2. 11 12 25/7/05 3. 4. 18 29 13 19 30/9/05 30/9/05 5. 38 13 30/10/05 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 3 Good Practice Recommendations It would be good practice to ensure that the in-house preG53 G53 S26245 galsworthyhouse V196538 250705 stage 4.doc Version 1.40 Page 23 Galsworthy House Nursing Home 2. 3. 4. 7 15 16 admission proforma was used in every case where an assessment is not provided by the placing authority. Staff should endeavour to review service user plans on a monthly basis, as outlined in the Standards. Steps should be taken to improve the serving of meals which are hot at the point of delivery. It would be good practice to ensure that the copy of the complaints procedure in the policy and procedure manual is the most up to date version. Galsworthy House Nursing Home G53 G53 S26245 galsworthyhouse V196538 250705 stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection 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 G53 G53 S26245 galsworthyhouse V196538 250705 stage 4.doc Version 1.40 Page 25 - 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. 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