Inspection on 17/07/07 for Galtres Care Home

This inspection was carried out on 17th July 2007.

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

Galtres Care Home 22/02/07

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

CARE HOMES FOR OLDER PEOPLE Galtres Care Home Ox Carr Lane Strensall York YO32 5TD Lead Inspector Jo Bell Key Unannounced Inspection 17th July 2007 09:30 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 Galtres Care Home DS0000068222.V333721.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. Galtres Care Home DS0000068222.V333721.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Galtres Care Home Address Ox Carr Lane Strensall York YO32 5TD 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) 01904 491300 01904 491300 galtresch@yahoo.co.uk Mrs Gillian Mary Conroy Mr John Anthony Conroy vacant post Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (20) of places Galtres Care Home DS0000068222.V333721.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 20 (OP) and up to 20(DE(E) up to a maximum of 20 service users. 22nd February 2007 Date of last inspection Brief Description of the Service: Galtres is a home offering personal care for up to twenty older people who may have dementia. The home is situated in the village of Strensall and has two gardened area and an area for visitors and staff to park. Service users have access to local shops and amenities within walking distance. The fees per week are £410 (from April 2007), additional charges are made for hairdressing and chiropody. Information regarding the service is available from the statement of purpose, inspection reports and through verbal discussions with the manager of the service. Galtres Care Home DS0000068222.V333721.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key inspection of the home took place on Tuesday 17th July 2007. Prior to the visit an Annual Quality Assurance Assessment was completed and surveys were sent to relatives, healthcare professionals and people using the service. Two relative’s surveys were returned along with five service user surveys. One inspector spent six hours at the home conducting the site visit. During this time discussions took place with people using the service (three in detail), two relatives, three care staff, the cook, domestic staff, the manager and the owner of the home. Observations of care practices including interactions between staff and people using the service took place. The lunchtime meal was observed, moving and handling techniques and participation in activities were examined and discussed. Documentation relating to care plans, risk assessments, medication, accidents and finances were checked. Issues regarding staff including training, raising concerns, recruitment, competencies and meeting individual needs were discussed on a one to one basis. The manager was available to assist throughout the day and the owner during a feedback session highlighted the progress made since February 2007 and the plans to refurbish the home which will improve the outcomes for people using the service. The home have worked hard to improve the staffing levels, care plans and environment for people. Good progress has been made since the last visit with previous requirements been actioned effectively. What the service does well: What has improved since the last inspection? Galtres Care Home DS0000068222.V333721.R01.S.doc Version 5.2 Page 6 People are now consistently cared for by staff in sufficient numbers. This ensures that individual needs can be met. People have their needs recorded more effectively. A range of up to date risk assessments are in place and people have their needs reviewed and evaluated on a regular basis. Individual bedrooms have started to be refurbished to a good standard. This was evident through observations. People in conjunction with the manager and owner have discussed their colour and décor preferences to suit their individual tastes. An overall plan of improvements to the environment has been submitted and discussed with CSCI, this area has a huge impact on the outcomes for people and the owner is fully aware of the improvements to quality of life for people once the environment has been improved. Medications are stored safely and recorded more effectively, this helps to prevent errors occurring. A fire risk assessment has been undertaken which ensures that the correct action is taken in the event of a fire. All staff have relevant police and protection of vulnerable adults checks, this has improved and helps to protect people using the service. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Galtres Care Home DS0000068222.V333721.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 Galtres Care Home DS0000068222.V333721.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 is not applicable) People using this service experience good quality outcomes in this area. Service users have their needs assessed in a detailed manner which helps ensure their needs can be met. We have made this judgement using available evidence including a visit to this service. EVIDENCE: The manager is responsible for carrying out assessments prior to individuals being admitted to the service. Three assessments were examined and these all contained detailed information regarding personal and social care needs. One new person has been admitted and the file was user friendly and easy to understand with all needs been discussed and recorded. The manager was observed discussing the rationale for not accepting a person whose needs could not be met (due to the room availability). This showed the manager had an awareness of the importance of correctly assessing and placing a person in the home. The home is registered for older people with dementia care needs and the manager has a good understanding of this. Galtres Care Home DS0000068222.V333721.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 People using this service experience adequate quality outcomes in this area. Generally personal care needs are met and people are treated with respect and dignity. We have made this judgement using available evidence including a visit to this service. EVIDENCE: People looked well cared for and needs due to progress in the staffing levels are been met more consistently. Four care plans were inspected, one was in the process of being completed. All the information about each person was quick to find and set out in a methodical way. This made it easy to follow the needs of each person and the interventions needed to meet both personal and social care needs. Care plan audits now take place and these were evident in the records. Senior staff have taken responsibility for reviewing and evaluating care plans and progress with risk assessments has been made. Each person needs to have a nutritional assessment, and whilst many of these were in place it should be part of the admission process to complete this assessment, rather than identifying a need then completing the risk form. Galtres Care Home DS0000068222.V333721.R01.S.doc Version 5.2 Page 10 Observations in the lounge showed people who had visited the hairdresser, one lady had received a manicure and other people confirmed that visits from the doctors and dentist had taken place. People’s privacy and dignity was maintained, although when the environment is refurbished this will help to ensure people are aware of where the bathroom, toilet and own bedroom is. Currently some bathrooms do not have vacant/engaged signs, therefore it would be easy to enter this room without realising a person was using it. It may be difficult to identify individual rooms, currently these doors are dark brown though plans are in place to alter this. Surveys returned were generally positive about the standard of care. One person said ‘the staff are lovely and really friendly’, another person visiting the home said ‘the staff know what they are doing’. One person did comment that clothes are not always clean or well ironed. The manager was aware of this. The medication system was examined, improvements to the storage of medication had taken place. Three charts were checked and found to be satisfactory. Monthly stock balances take place. On one occasion medication had been carried forward from the previous month but no record of the amount of tablets was recorded. On one chart a tablet has been removed from the blister pack but had not been given to the person, and whilst no signature was recorded this tablet had been left in a pot in the trolley. A member of staff confirmed that she was waiting until later. The white tablet in the pot had no name or label which could have led to an error. The fridge was checked and medication was stored correctly with the temperature been taken on a regular basis. The book for recording controlled drugs was checked, two signatures were evident when administering and witnessing a drug been given, though the page checked did not give the name of the medication, though this was evident on the previous page. These issues were discussed with the manager and can be easily resolved. Galtres Care Home DS0000068222.V333721.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 People using the service experience adequate quality outcomes in this area. People can participate in some activities, with visitors been welcomed and autonomy encouraged. The standard of food and drink provided is good, though the dining environment needs improving. We have made this judgement using available evidence including a visit to this service. EVIDENCE: People have access to a range of activities. At the site visit some people were enjoying a quiz, trips out had been planned but due to the poor weather this had not been possible. One relative said there use to be more activities. Television, magazines, games and entertainers are available, these are planned on a daily basis, and this is recorded in the activities book. Staff encourage people to go out to the shops and into the garden. Some people were sat in one place for a long time, because currently there is not a suitable dining room and many people had lunch on a table infront of them. Staff do encourage autonomy and choice though this can be limited because of the poor environment. Church services are available and visitors are welcomed into the home at anytime. This was confirmed by two people and details of visitors was available in the visitors book. Galtres Care Home DS0000068222.V333721.R01.S.doc Version 5.2 Page 12 The lunchtime meal was observed. The cook is very experienced and is currently undertaking a nutrition course. Home-made food is always available and the portion size and presentation is to a high standard. People were observed enjoying lunch (chicken casserole and fresh vegetables, with sultana sponge and custard). A hot meal is also served in the evening and a cooked breakfast is available as requested. Staff discuss the menu with people during the morning prior to the meal being served. Some new chairs have been obtained in the conservatory though this area is not used very much. The cook is aware of how to puree food and present it in an appealing manner. The kitchen area will alter when the refurbishment is undertaken as currently the kitchen store can only be accessed through the laundry area. Galtres Care Home DS0000068222.V333721.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. Service users are confident that their concerns will be listened to and acted upon and they feel protected in the home. We have made this judgement using available evidence including a visit to this service. EVIDENCE: People spoken with confirmed that they are aware of the complaints procedure and are confident that the staff and the manager of the home would deal with any concerns effectively. The home have a complaints procedure and since the last visit there has been a vulnerable adults issue and a complaint made. The owner took the correct action and both issues were investigated and discussed. Staff spoken with felt that the new owner was approachable and would deal with any issues arising. Two relatives confirmed that they would be happy to raise issues with the manager, and in discussions with the manager and owner of the home it was evident that they are keen to deal with any concerns people bring to them. Three care staff spoken with confirmed the action they would take if they witnessed abuse taking place. Staff were aware of different types of abuse and the vulnerable policy and procedures which are in the home. The manager is aware of the whistle blowing procedure and training has taken place in this area. Though it is not mandatory. No concerns were raised regarding the safety of people in the home. Galtres Care Home DS0000068222.V333721.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using this service experience poor quality outcomes in this area. People generally live in an unsuitable environment for people with dementia. Whilst some individual rooms have been refurbished to a good standard, many improvements are needed to enhance the quality of life for people. We have made this judgement using available evidence including a visit to this service. EVIDENCE: Aspects of the environment have improved since the last visit in February 2007. A plan of refurbishment is in place and work will start shortly to improve the communal areas, kitchen, laundry and office. Some bedrooms have been redecorated and input from people using the service has been included in the decision making regarding the décor of the room. These rooms were inspected and were found to be welcoming, fresh smelling and homely. This will have a positive effect on the people using these rooms. Areas of the home inspected were all found to be free from unpleasant smells, one relative said ‘this room is always really clean’. Currently care staff have to undertake washing and ironing duties, some staff spoken with were unhappy about this as they felt this took them away from caring duties. This was discussed with the owner Galtres Care Home DS0000068222.V333721.R01.S.doc Version 5.2 Page 15 who felt this was not the case. Staff do need to undertake infection control training and staff could not confirm when they had last attended this course, and the training records were not fully completed. Galtres Care Home DS0000068222.V333721.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 People using this service experience adequate quality in this outcome area. Staffing levels have improved and people are recruited safely which reduces the risk of harm to people, though some improvements to training are needed. We have made this judgement using available evidence including a visit to this service. EVIDENCE: Staffing levels have improved, and there are consistently three care staff working on a morning for seventeen people with dementia care needs. There is a cook and housekeeper and the manager tries to be supernumerary. This level of staff needs to be sustained. At the visit there was one night staff expected to work that night, and the manager was trying to access another person to cover. Recruitment for this position is taking place. People feel their needs are being met. Call bells were answered promptly and staff had a good rapport with people using the service and their relatives. Many staff have completed an NVQ Level 2 or 3 and induction training takes place which is equivalent to skills for care. Observations of care practices confirmed that staff know how to move and handle people using specialised equipment. Though further training is needed (see next outcome group). The home have good recruitment practices in place, staff have two written references, a police check and a protection of vulnerable adults check completed prior to commencing employment. Three files were examined and found to contain relevant information. A discussion took place regarding Galtres Care Home DS0000068222.V333721.R01.S.doc Version 5.2 Page 17 information discussed at the interview. Any specific disclosures regarding references should be documented for future reference by the interviewer. Galtres Care Home DS0000068222.V333721.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 People using this service experience adequate quality in this area. The way the home is managed has improved and people are able to air their views and opinions, further improvements to health and safety training are needed to ensure people living in the home are safe. We have made this judgement using available evidence including a visit to this service. EVIDENCE: Overall the management of the home has improved during the past five months. The manager is experienced and has completed her Manager’s award, although she still needs to be registered with the CSCI. This has been outstanding for some time. The manager has undertaken a range of audits, improvements in care plans, and in risk assessments were evident and previous requirements have been actioned. This is good progress in a short space of time. Staff feel supported by the manager but some felt she needs to be more assertive and give clearer direction to the staff. There are a range of management responsibilities which need fulfilling and sustaining to improve Galtres Care Home DS0000068222.V333721.R01.S.doc Version 5.2 Page 19 the service for people. The quality assurance system includes sending out surveys and discussing the care on an informal basis. One relative said she would like to have a relatives meeting, though the owner has previously tried this and feels it works better on an individual basis. As more audits are taking place for example medication audits, and accident audits this ensures that people like living in the home and their needs are being met, and this can be clearly evidenced. Finances were discussed and three files were examined. Records are available for hairdressing, chiropody and toiletries and the home is aware of the amount of money that can be kept in the home in line with their insurance. Individual ‘purses’ are kept and these are well maintained. One relative confirmed that she brings a certain amount of money in each money which is available for small purchases. The home may send a letter to people to remind them if more money is needed. Health and safety was discussed. A fire risk assessment has been completed and weekly fire alarm testing takes place on different days of the week. It was initially unclear as to whether all staff have received fire training as the training plan had not been correctly updated. One person’s record showed no fire training had taken place since 2002, this was evident with other staff. Speaking to staff they were uncertain as to when they had been updated. A discussion with the owner has taken place and it is evident that the training officer has a strong commitment to ensuring all courses are completed by November 2007, this includes both mandatory and specialist training for example dementia care and alzheimers awareness. People said they felt safe in the home, water temperatures are regularly recorded and five were checked and found to be within expected parameters. Door closures for some people have been ordered and this area will be assessed in more detail when the environmental issues have been actioned. The owner is in discussions with the fire officer and building control to ensure any refurbishments and alterations to the building are done within the correct guidelines. Galtres Care Home DS0000068222.V333721.R01.S.doc Version 5.2 Page 20 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 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 1 x x x x x x 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 2 Galtres Care Home DS0000068222.V333721.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP19 OP26 Regulation 23 Requirement Improvements to the environment must take place in line with the improvement plan. This will enhance the quality of life for people. An up to date training plan must be forwarded to CSCI detailing evidence of mandatory training taking place. To include fire/moving and handling/infection control/health and safety. Any outstanding mandatory training must be completed to ensure people are not put at risk (within 3 months) Timescale for action 17/07/08 2. OP38 18 17/08/07 Galtres Care Home DS0000068222.V333721.R01.S.doc Version 5.2 Page 22 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 2. Refer to Standard OP9 OP12 Good Practice Recommendations Regular stock balances of medication would be beneficial. More activities should be made available to ensure people have regular stimulation. The manager needs to complete the process to become registered with the CSCI. OP31 Galtres Care Home DS0000068222.V333721.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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