Inspection on 23/01/07 for Ganarew House

This inspection was carried out on 23rd January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Ganarew House 18/12/08

Ganarew House 05/12/07

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Ganarew House Ganarew Near Monmouth Monmouthshire NP25 3SS Lead Inspector Philippa Jarvis Unannounced Inspection 23rd January 2007 10:00 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 Ganarew House DS0000065335.V330068.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. Ganarew House DS0000065335.V330068.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ganarew House Address Ganarew Near Monmouth Monmouthshire NP25 3SS 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) 01600 890273 Milkwood Care Limited *** Post Vacant *** Care Home 17 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (17) of places Ganarew House DS0000065335.V330068.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Until a manager is appointed by Milkwood Care Ltd and registered by CSCI, Janet Lloyd-Leech (Responsible Individual) and Marion Flett (Group Manager) will between them spend a minimum of 30 hours a week at Ganarew House. 5th September 2006 Date of last inspection Brief Description of the Service: 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 large gardens. The Provider, Milkwood Care Ltd took over the Home on 4th October 2005 from the previous owners who had run the Home for over 15 years. The Provider is registered in respect of the Home to provide care for up to 17 people with care needs relating to the ageing process or the effects of having a dementia illness. The new Providers are currently having an extension to the premises built. When finished, this will increase the number of people that can be accommodated. Information provided in the pre inspection questionnaire states that the current range of fees for Ganarew House is from £350 to £500 per week. Additional charges are made for hairdressing, chiropody and newspapers. Ganarew House DS0000065335.V330068.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over a day and a half, the first was unannounced and the second was pre- arranged with staff. During the two days records and some policies and procedures were inspected, residents, visitors and staff were spoken to and general observations were made of the premises and life in the home. There were also discussions with the acting manager and the service providers who attended the home to be present for the inspection. An application has been received by the commission for the acting manager to be formally registered as the manager and this is being considered. The home has not had a registered manager for over a year. A Pre Inspection Questionnaire and service user and relatives written comments were obtained for the inspection that took place in September. They were not requested again on this occasion. What the service does well: The atmosphere in the home is relaxed and friendly. The residents feel well looked after and relatives are satisfied with the quality of the care. The residents were all well groomed. Residents feel safe and they and their relatives are confident that they can raise concerns if they have any. They said that they like the staff and they find them very helpful and caring. Staff were observed to speak pleasantly to the residents and to involve them and to explain to them what they were doing. A range of activities is provided and residents enjoy taking part in these. A couple of residents said that they had enjoyed the entertainments over the Christmas period and the music man who had recently been to the home. Visitors are welcomed in the Home at any time and they appreciate the relaxed and welcoming atmosphere. The residents all said that they like the food and mealtimes were observed to be pleasant social occasions. Residents chose where to eat their meal, in the dining room, stay in the lounge or to remain in their own room. Indeed people chose where to pass the day at all times. Staff training is promoted and the staff have completed a good range of appropriate training. The home is also encouraging them to take a course in national vocational qualifications (NVQs) and a number are enrolled on this Ganarew House DS0000065335.V330068.R01.S.doc Version 5.2 Page 6 form of training. The approach to training helps ensure that the staff have the knowledge and skills to carry out their role effectively. What has improved since the last inspection? 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. Ganarew House DS0000065335.V330068.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 Ganarew House DS0000065335.V330068.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. Intermediate care is not provided. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home gathers information about prospective service users before offering them a place at the home. This means that there is information for the Home to make a decision about whether it can meet the care needs of service users before offering them a place. EVIDENCE: The files for three service users, including the person most recently admitted, were examined. These each contained copies of information that was obtained before the person was admitted. For the most recently admitted person the assessment covered the areas detailed in the standard. There was also evidence that the home had liaised with the referring social services department and a copy of their care plan was on file. These had formed the basis of the initial plan of care. Ganarew House DS0000065335.V330068.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 and 10. Quality in this outcome area is, adequate. This judgement has been made using available evidence including a visit to this service. The residents feel well looked after and relatives are satisfied with the quality of the care. The care plans are developing to provide staff with a framework to make sure that residents get care that is safe and meets their needs. The management of medication is safe. EVIDENCE: There was a plan of care on each file that was examined. This listed the service users capabilities, care needed and action to take. The section about action to take would benefit from further detail so that the staff would be fully aware about the nature of the assistance that each individual service user needs. For example “Needs help with washing and dressing” is not precise about the level of assistance needed. The home has also started to introduce individual plans to address service users care needs arising from their dementia illnesses. These are in the early stages of development and provide the basis of useful information to guide the staff about the management of individual behaviours. Ganarew House DS0000065335.V330068.R01.S.doc Version 5.2 Page 10 The care plans are reviewed each month by the manager and her deputy, or more frequently if needed. Changes in the care plan are drawn to the attention of the staff. Care staff confirmed that the care plans were working tools but that they did not have any input into their preparation or review. On all the files examined the service user or their representative had signed a sheet indicating that they did not wish to be involved in the care planning process. Formal reviews with the service user and/or their family had not been held. Records kept on the files indicated that there had been appropriate monitoring of health issues with referrals made to health care professionals if needed. There were daily notes for each service user where matters relating to their health were recorded. Care needs to be taken to ensure that outcomes are always recorded. The optician visited during the course of the inspection. The eye tests were undertaken in the ground floor communal rooms. This is not appropriate but the provider said that there would be a designated room for health care activities in the new extension. The residents all looked well groomed. Their clothes and hair were clean and suited their individual preference. Those spoken with confirmed that the staff assisted them as much as they needed. They also said that they were able to have a bath at a time to suit them. One relative spoken with confirmed that her mother always appeared well presented. She said she was happy with the way that the staff were able to encourage her gently but firmly to do what she needed to and to join in activities. Most aspects of medication practice were carried out to a satisfactory standard, for example, • Medication was seen being given to people one by one with the record signed straight away. • The staff talked with them about what they were doing. • The medication trolley was tidy. Most medication was in monitored dosage systems. • The box or bottle for those that were not, had the date of opening recorded on them. However there were a few gaps in the recording or alterations that were not initialled. In the CD register there were also some gaps or lack of clarity about what was recorded. Senior staff have completed training in medication and they lead the administration of medication in the home. Ganarew House DS0000065335.V330068.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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A range of activities is provided and residents enjoy taking part in these. Visitors are welcomed in the Home at any time and they appreciate the relaxed and welcoming atmosphere. Residents enjoy the quality of the food provided. EVIDENCE: Ganarew has a friendly and welcoming atmosphere. The visitors’ book showed that a number of people visit the home throughout the week and the residents confirmed that they are always made welcome. A list on the wall in the entrance hall showed the activities being arranged for that week. These included a range of activities in line with those indicated in the pre inspection questionnaire submitted in September such as: • Music and movement • Video afternoons • Bingo • Knitting • Manicures • Sing-alongs Ganarew House DS0000065335.V330068.R01.S.doc Version 5.2 Page 12 • Jigsaws • Flower arranging A record was kept when each person joined in. Families had provided the home with information about what each person had enjoyed doing in their earlier lives. The information read provided little evidence of how this was promoted with the residents whilst at Ganarew. Their individual files detailed their spiritual needs. The acting manager reported that no one wished to go to church, although communion was provided monthly for those that chose to participate. Residents were able to spend the day in the communal rooms or in the privacy of their own rooms if they preferred. A new kitchen has been brought into use since the last inspection as part of the new extension being built. The cook confirmed that it provided a good working environment and that it was easy to maintain hygienically. The residents all said that they enjoyed the meals that were provided for them. Examples of menus were seen and these showed that the meals were all in the style of traditional home cooking. The home does not routinely provide service users with a choice for their main meal. There were no service users with specific dietary requirements at the time of the inspection. The manager said that they would contact their district nurse for guidance if required. There were plentiful supplies of fresh fruit in the lounge for the residents to help themselves. Ganarew House DS0000065335.V330068.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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents feel safe and they and their relatives are confident that they can raise concerns. Residents are protected from abuse by staff, most of whom know how to identify and deal with concerns. EVIDENCE: There was a poster displayed in the hall informing people how to make a complaint. At the inspection the acting manager said that there had been no complaints since the last inspection and the commission has not received any directly. There was a complaints log in the Home in which to record receipt of complaints and write about action taken to investigate what had happened. One relative spoken with thought she had probably had a copy of the complaints procedure. She said that any small matters could readily be raised during visits to the home and that they would be dealt with before they became a matter for complaint. The residents spoken to said they feel safe at the Home and would happily speak to the acting manager or owners if they had concerns. The home provided training in the protection of vulnerable adults and most, but not all, staff at Ganarew have now undertaken this training. Those staff spoken with were clear about what action they would take if they were concerned that a resident was being abused. Ganarew House DS0000065335.V330068.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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, well-maintained environment. EVIDENCE: A number of communal rooms, bedrooms and bathrooms were inspected. These were all clean and well presented. Everywhere was warm and tidy. The number of hours allocated to domestic tasks have increased since the last inspection and cleaning rotas have been implemented. The service providers commented that it has been particularly difficult to maintain cleanliness because of the building works being undertaken. A number of additional staff were on duty to prepare the new rooms and carry out extra cleaning. It was noted that an additional call bell for personal use had been provided for residents who had a pressure pad outside their room. Ganarew House DS0000065335.V330068.R01.S.doc Version 5.2 Page 15 Attention to hygiene practices was being appropriately addressed. The laundry was maintained in an organised manner. Potentially hazardous cleaning materials were locked away and risk analysis sheets were available. Ganarew House DS0000065335.V330068.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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff recruitment procedures ensure that only suitable staff are considered for employment at the home. The homes arrangements for the training and deployment of staff ensure that there are usually enough suitably competent staff to meet the needs of the service users. EVIDENCE: There was a rota available to indicate the staffing arrangements for the day of the inspection and the rostered staff were on duty. There were enough staff on duty to meet the care needs of the residents and to attend to the ancillary functions. Staff confirmed that the rotas are always covered. Relatives have confirmed their confidence in the staff in the home. There are some limited times when there are only two carers on duty in the home with no ancillary support. The commission has previously indicated to the service providers that this level of staffing is not adequate for this number of residents. Three staff files were examined. These showed that appropriate recruitment and selection procedures were followed. The files contained appropriate evidence of the staff identification and training certificates. Following their appointment new staff undertake a period of induction training. One member of staff who had started in September was not recorded as having completed her induction. Ganarew House DS0000065335.V330068.R01.S.doc Version 5.2 Page 17 Records showed that Milkwood Care Ltd have ensured that a significant amount of training has taken place since they took over proprietorship of the home in October 2005. They have provided training courses in required health and safety areas such as first aid, moving and handling and POVA. Most but not all staff have completed these. Attention needs to be paid to ensure that all staff complete relevant training. There is no record of staff having received training in infection control. In addition there has been some training in specialist areas such as stoma care and working with people with dementia illnesses. The service providers need to ensure that only staff who have appropriate knowledge provide care. An example was identified in care records of a member of care staff not having adequate knowledge of a condition that she was dealing with. The acting manager reported that she intends to complete a First Aid at Work qualification. She is taking the Registered Managers Award, a qualification in care service management. The acting manager has completed initial training in dementia care. To lead a service where a significant number of service users have dementia illnesses she needs to consider taking further training in this aspect of care practice. The home is actively promoting training in national vocational qualifications (NVQ). Eight carers are currently taking this form of training and two have already achieved an award. The files read indicated that the home has a system of supervision and appraisal for staff that occurs on a regular basis. A record is kept of the content of the meetings that is confidential to the participants. Ganarew House DS0000065335.V330068.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 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service providers are supporting the acting manager whilst consideration is given to her application for registration. They visit the home regularly and monitor the management processes to make sure that they are appropriate. EVIDENCE: An application for the management of the home has been submitted and is being considered by the commission. The service providers have supported the acting manager in her role. They have devised a form that they complete on a monthly basis to audit a wide range of activity within the home. In addition they also complete a written report on the conduct of the home (Regulation 26) that they provide to the acting manager. Ganarew House DS0000065335.V330068.R01.S.doc Version 5.2 Page 19 Milkwood Care Ltd have a quality assurance document that they use in all the services in the group. They have carried out an annual quality audit following which they set goals for the service. Milkwood Care Ltd provides the policies and procedures for the service. They are reviewed by the organisation. The records for one service user whom the home supports with personal monies were examined. An expense sheet showed that due care was taken with this area of responsibility. There was evidence that the home was being kept safe and well maintained. The maintenance book indicated when tasks had been completed. The fire log showed that all tests and checks had been carried out at appropriate intervals. All records of checks and testing of equipment for health and safety that were viewed as part of the inspection were fully recorded and indicated a robust approach to health and safety matters. There was some lack of clarity over responsibility for ensuring that the first aid boxes were fully stocked with appropriate items. This needs attention. Ganarew House DS0000065335.V330068.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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 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 3 Ganarew House DS0000065335.V330068.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. Standard Regulation Requirement Timescale for action 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 OP31 Good Practice Recommendations The manager of the service should ensure that they have a good knowledge base of the conditions and illnesses of the residents to so that they can lead the care appropriately. Ganarew House DS0000065335.V330068.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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. Extracts may not be used or reproduced without the express permission of CSCI Ganarew House DS0000065335.V330068.R01.S.doc Version 5.2 Page 23 - 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. 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