Inspection on 18/12/08 for Ganarew House

This inspection was carried out on 18th December 2008.

CSCI found this care home to be providing an Good service.

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

Ganarew House 05/12/07

Ganarew House 23/01/07

Ganarew House 05/09/06

Ganarew House 08/02/06

Ganarew House 25/10/05

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ganarew House Ganarew House Ganarew Near Monmouth Monmouthshire NP25 3SS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Philippa Jarvis     Date: 1 8 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Ganarew House Ganarew House Ganarew Near Monmouth Monmouthshire NP25 3SS 01600890273 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Sylvia Williams Type of registration: Number of places registered: Milkwood Care Limited care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 37. The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Ganarew House is a converted country house in a rural hamlet between the towns of Ross on Wye and Monmouth. The setting is very attractive with views over open countryside and gardens to the front. There is a small-enclosed courtyard to the rear. The Provider is registered in respect of the Home to provide care for up to 37 people with care needs relating to the ageing process or the effects of having a dementia Care Homes for Older People Page 4 of 27 Over 65 0 37 37 0 Brief description of the care home illness. An extension to the premises was opened in 2007 and the old rooms have been upgraded. There are bedrooms on both the ground and first floors, four of which are available for shared occupancy. There are a range of communal rooms on the ground floor. The ground floor has space for people who like to walk around during the day. The Provider is Milkwood Care Ltd who took over the Home on 4th October 2005. The Responsible Individual for the company is Ms Janet Lloyd-Leech and the registered Care Manager is Mrs Sylvia Williams. Information about fees is available on request from the home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We spent a day at Ganarew House where we talked to people who use the service, their visitors, staff, the manager and the area manager. We also looked at some records, including some that relate to the care of people who use the service. These must be kept by the home to show that it is being run properly. The service completed an Annual Quality Assurance Assessment (AQAA) form. This is a self assessment that focusses on how well the service is meeting good outcomes for the people who live there. We used this information in planning the inspection and some of the managers comments are included in this report. We also received completed survey forms from people who live in the home and from Care Homes for Older People Page 6 of 27 staff working in he home. The information from these helps us to understand how well the home is meeting the needs of people using the service. The last inspection for this service was completed on 5th December 2007. What the care home does well: What has improved since the last inspection? The home is developing the care planning system and this provides more information for carers to use to guide them in providing the right care for people living in the home. They have introduced an additional carer in the mornings to help at this busy time of the day. There is also an activities organiser who works each afternoon to provide the residents with a range of activities if they choose to join in. These include trips outside the home in the homes minibus. It would help the home to assess each persons involvement in activities if a more detailed record were to be kept of their involvement. The main lounge has been refurbished and has new furniture and decor. Care Homes for Older People Page 8 of 27 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is written information available to help people decide if they wish to move into Ganarew House. They are welcome to visit the home to help them make up their minds about whether it is the right home for them to live in. Evidence: We received ten surveys from people who use the service. Eight of these told us that they had been given enough information to help them decide whether they wished to live in Ganarew House. The home has a Statement of Purpose and Service User Guide that provide detailed information about the facilities in the home. Currently people living in the home do not have a personal copy in their room because they tend to be removed. A new Service User Guide is in the process of being developed and the manager stated her intention of providing a representative of each person living in the home with a copy of this. Care Homes for Older People Page 11 of 27 Evidence: The home has a pre-admission assessment form that is usually completed before people are admitted to the Ganarew. This helps the home to understand peoples care needs and to make an assessment as to whether they can meet them. It also helps staff to know what care needs to be provided as soon as people move into the home. The day before our inspection a new resident had been admitted on an emergency basis. The normal documentation had not been completed and there was some lack of knowledge over the persons care needs. The management team were actively pursuing this information on the day of the inspection. Visitors to the home told us that they had been able to look round before their relative was admitted. They told us that they had been made very welcome and that they had found the environment friendly. In the AQAA the home told us that every new resident has a trial period of one month during which time their needs are assessed and a decision made about whether the needs of the client can be met. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are developing to include comprehensive information about how peoples care needs should be met. Evidence: We looked at the care plans for two people who use the service and at the information available for the person admitted the previous day. The home is in the process of changing the format for the care plans. The new format will help to make the care plans more accessible for the staff to use. We found that there was information in the care plans to inform staff about peoples preferred daily and night time routine. There were also separate care plans to draw their attention to peoples specialist needs. The home has risk assessments in place where appropriate such as moving and handling, pressure area care and management of behaviours that challenge the service. In the AQAA the home indicated that it carries out monthly reviews of peoples care plans. We could not find evidence that all risk assessments had been reviewed regularly. For one person there was no evidence that her nutritional risk assessment Care Homes for Older People Page 13 of 27 Evidence: had been reviewed since she came out of hospital with identified swallowing problems. We talked with staff about the management of this issue and they were aware of how to work in the correct way. The home has close working relationships with local GP surgeries both of whom make routine visits to the home as well as visiting in the event of need. We were able to speak with a visiting district nurse who told us that she has confidence that the home manages peoples health care needs well and that it makes appropriate referrals to the surgery. In their survey one relative told us that the residents health had fluctuated over the last year but that the home had identified problems quickly, involved health care professionals and had also kept them informed. We looked at some aspects of the administration of medication. Generally this was managed in an appropriate way. Medicines are stored in a suitable trolley which itself is safely stored in a locked cupboard when not in use. We watched part of a round of the administration of medication and this was done in a way that was safe and accountable. The record of administration was signed after people had been given their medicine. Controlled drugs are stored in a special locked cupboard and the home uses a proper register to record their use. The home were uncertain about whether the cupboard had been fixed to a load bearing wall. We counted one of the medicines stored in this cupboard and found that the count was incorrect. We looked at the medication policy for the home and found that it was in need of review. The residents were all well presented. Their clothes and personal appearance was clean and suitable. One resident told us how her clothes were always well cared for in the laundry and that they were always returned to her promptly. The home needs to take more care to ensure that it records information about the personal care provided for the residents, for example it was not possible to determine when people had last had or been offered a bath. We saw that the all staff treated residents with kindness and respect throughout the day of the inspection. We spoke with visitors to the home and they told us that they thought the approach of the staff was brilliant. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a range of activities for people to take part in. There is a varied menu of nutritious food provided for the residents. Evidence: The home has employed an activities organiser who works with people during the afternoon. There have been a number of organised activities such as a Christmas bazaar and a visit to a local school play. The home now has a minibus available to take the residents out and there were plans to take some residents to a carol concert the following day. There are regular music and movement sessions in the home and people told us that they enjoy these. In the care plan there is a section where the staff can record peoples interests and hobbies. There is also a sheet to record any activities that they have taken part in. This would benefit from continued development. Since the last inspection the home has set up some displays of reminiscence materials in the hall. These have proved of interest to the residents. Care Homes for Older People Page 15 of 27 Evidence: There were a number of visitors to the home on the day of the inspection. They were all made welcome. One of those we spoke to said that they never felt as though they caught the home out at whatever time they visited. We arrived as breakfast was being served and saw that people were able to choose from a range of breakfast foods. Indeed those who thought they had not been served with breakfast ate more than one meal. Lunch was liver and sausage with fresh vegetables followed by apple crumble and custard. The manager said that the main meal was usually popular but several people did not eat well. Those who did not like liver were provided with an alternative. One person needed a soft diet and the cook served this in separate elements. Unfortunately the carer mixed it all together before serving it to the resident so they were not able to distinguish the different components of the meal. The dining room is light and airy and a pleasant place to eat. Residents can choose to eat in there or in their own rooms. Visitors to the home told us that they were impressed with the food that they saw served. In their surveys five residents told us that they always liked the meals and another four said they usually did. The food is excellent and varied. The menus showed a varied selection of meals, which are rotated three weekly. The home does not have a system for monitoring the nutritional content of the food, but the menus appeared well balanced and included fresh fruit and vegetables. There was also a bowl of fresh fruit on a table in the main lounge that was available for residents to help themselves if they wished. Cold drinks were also available on this table and hot drinks were offered at regular intervals. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to a complaints procedure if they wish to raise concerns about the home. The home has a safeguarding policy in place but staff need training in this area to help protect the residents from risk of harm or abuse. Evidence: There is a copy of the homes complaints procedure in the hall and nearly everyone who replied to the survey said that they knew how to make a complaint. The manager told us that she had not received any formal complaints since the last inspection. She said that she operated an open door policy to the office and hoped that people raised any concerns with her before they became a problem. There is a log in which the home could record a complaint if they received one. When the home employs new staff there are checks that must be carried out to ensure that unsuitable people are not employed. These include a Criminal Records Bureau (CRB) check and two written references. We looked at the files for three new members of staff appointed since the last inspection. These checks were in place but one person had been employed through an agency and we raised some queries about the quality of the references that the agency had supplied. The home has a policy in place about safeguarding vulnerable people from abuse or harm. Whilst the staff we spoke with were able to tell us what they would do if they Care Homes for Older People Page 17 of 27 Evidence: had suspicions of abuse, there were a number of staff who had not received training in this area. The home has identified that that this is an area that needs addressing and has plans in place for training over the next few months. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe and comfortable environment for the people who live there. It is kept clean, tidy and well maintained. Evidence: Ganarew House was originally a country vicarage and is situated in a rural village in the Wye Valley. It has been adapted to the needs of the people who use the service, but has not lost some of its original character. We looked round some of the communal rooms, bathroom facilities and some bedrooms. There are two lounges, both are comfortable and well furnished with armchairs and tables. One of these has recently been refurbished. A new dining room was created just over a year ago and is a pleasant light and airy room, which is well equipped with a number of dining tables and armchairs. There is also a small seating area at one end of this room. The bedrooms we visited were well furnished and people had brought in some personal items to help make their room look homely. The bathrooms and toilets that we saw were all clean and well maintained. The home is clean and tidy throughout. We spoke with the housekeeping staff who Care Homes for Older People Page 19 of 27 Evidence: confirmed that there were domestic staff working in the home each day, including Christmas day. They said that they have appropriate equipment to keep the house in clean condition. One survey said It is a lovely home kept spotlessly clean. There is a maintenance man employed in the home five days a week to deal with routine maintenance issues and decoration. There is a small enclosed area to the rear of the home which residents can access at will. The main gardens are to the front. They are not secure and residents can only use these when accompanied by staff or visitors. Some residents like to walk around the home and the main corridor allows them space to do this internally. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff to meet the needs of the people who live in Ganarew House. Staff do not receive an adequate level of training which means that people cannot be fully confident that staff will be able to carry out care tasks properly because they have not been adequately trained to do so. People who use the service can be confident that the staff are kind and caring. Evidence: The staff rota showed that on the day of inspection there was one member of senior staff and five care staff on duty all day from 8am to 8pm. There was also a cleaner, a laundry assistant and cook and kitchen assistant duuring the main part of the day. The maintenance man also works each day from 8am to 4pm. Overnight there are three members of care staff awake and on duty. In the surveys most staff told us that there were usually enough staff on duty to meet the needs of the people living in the home. One person said that in the mornings they could need extra assistance. We talked to members of the staff team in addition to receiving the surveys. They were all positive about working in the home and told us that they enjoyed working with the residents. Residents and visitors also told us that they liked the staff. They made many positive comments like, The staff are always cheerful. Care Homes for Older People Page 21 of 27 Evidence: We looked at the recruitment for new staff working in the home. We also looked at the training provided. New staff undertake an induction programme. This was not to the standard set down by Skills for Care, the sector training agency. We also found that new staff have not reliably received training in mandatory areas, such as moving and handling, health and safety, fire safety and safeguarding, even though they have been working in the home for several months. The manager said that the home is due to start using a new training organisation who will provide regular training inputs in appropriate areas. The home has promoted NVQ training amongst its staff and in the AQAA the manager reported that 17 staff have achieved a qualification in this area. It also encourages all staff to train in Dementia Care and twelve staff have completed this training. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in a way that promotes the health and well being of the people who use the service. Evidence: The manager has been in post for two years and has achieved qualifications for the management of a care home. She continues to take relevant training. She is well supported by the service provider and is visited regularly by the area manager for Milkwood Care. The staff and residents told us that she is approachable and confirmed that the home has an open door policy to the managers office. Information in the AQAA tells us about how the home assesses its performance against the national minimum standards. The analysis has improved since last year but the quality of detail still needs to improve to show that the manager is making a careful analysis. In addition to the AQAA the home also carries out an internal quality monitoring process and sends questionnaires to residents, their relatives, staff and Care Homes for Older People Page 23 of 27 Evidence: health professionals once a year. Whilst the completed forms are read the home does not undertake an analysis of the information. There is a quality assurance policy. This is limited in content and needs to be reviewed. There are quality monitoring elements that are carried out by the home that are not detailed in this document such as the managers monthly checks and the Regulation 26 visits carried out by the service provider. The home does not encourage residents to keep money on the premises and their representatives are invoiced for items purchased on their behalf. The manager confirmed that the home is not currently holding any money or valuables on residents behalf. Equipment in the home is regularly serviced and the home employs a maintenance man to carry out minor repairs. In the AQAA the manager told us that there have been checks and tests carried out in the home. We saw a sample of documents which confirmed that water temperatures have been checked and fire safety equipment tested. We saw the accident record. This showed that any accidents in the home are recorded appropriately. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 The home should review the systems it has in place for recording the personal care received by the people living in the home. This will help them to ensure that people reliably receive this care on a regular basis. The home should ensure that the control drug cabinet is fixed to a suitable load bearing wall to ensure the safe storage of this medication. There should be a system in place so that the training programme ensures that each member of staff receives the training they need to ensure their competence, their understanding of their role and that they are able to deliver appropriate care. This should include all mandatory health and safety and safeguarding training. This should be updated with suitable frequency. 2 9 3 30 Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!