Inspection on 05/12/07 for Ganarew House

This inspection was carried out on 5th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Ganarew House Ganarew Near Monmouth Monmouthshire NP25 3SS Lead Inspector Philippa Jarvis Key Unannounced Inspection 5th December 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 Ganarew House DS0000065335.V352392.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.V352392.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 Sylvia Williams Care Home 37 Category(ies) of Dementia (37), Old age, not falling within any registration, with number other category (37) of places Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is 37. The registered person may provide the following category/is 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 23rd January 2007 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 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 illness. An extension to the premises has recently been opened and the old rooms are being upgraded. The home is in the process of admitting new residents to the vacancies created. At the time of inspection there were 32 people living in the home. The premises are on two floors. The ground floor has space for people who like to walk around a lot 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. Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a full inspection of the Home to look at how it is performing in respect of the core national minimum standards (the report states which these standards are). We call this type of inspection a key inspection. There were two visits to the home; the first was unannounced and the second arranged when the manager was planned to be available. An Expert By Experience assisted the inspector. This is someone with personal experience of a relative in using a care service who has been trained to accompany inspectors during inspections. Experts By Experience observe what happens in the home and try to get a view of what the home is like by doing this and speaking with the people who live there. The Expert who came on this inspection sent us a written account of her of her findings, which we have integrated into our report. The home completed an Annual Quality Assurance Assessment (AQAA) and the information provided in this was taken into account. We also sent some survey forms to some people who live in the home, to some relatives and to some staff. We had a good response with 10 residents and 11 staff returning them. Only one came back from a relative although some had helped the resident to complete them. During the two visits we spoke to the care manager, the area business manager, some service users and some staff. We looked round the building and spent time observing how people pass their time and the arrangements in place at lunchtime. Throughout the inspection there were opportunities to observe and overhear staff contacts with the residents. We checked some documentation, including care records of some people living in Ganarew and records of some staff working in there. Copies of policies and procedures, maintenance and health and safety records were also examined. The Service User Guide does not include information about fees charged although it does indicate that additional charges are made for hairdressing, chiropody, telephone, eye tests, dentist and newspapers. What the service does well: All people who are thinking of living in the home are assessed by a senior member of staff to ensure that they can be provided with the care that they Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 6 need. People are encouraged to look round the home before they are admitted and all visitors are welcome to the home at any reasonable time. Staff are caring and respectful towards the resident. They understand the importance of treating them as individuals. We saw and heard examples of sensitive care practice during the inspection. We also received complimentary comments about staff from relatives who were visiting. Care is taken to employ the right people to work in the home and there are thorough recruitment procedures in place. After staff are appointed there is a programme of training that equips them to provide care in the right way. People’s health care needs are identified and dealt with appropriately. The home has good working relationships with local health care professionals who visit their clients there regularly. Medication is well managed and residents can be sure that they receive the right medication at the correct time. Residents told us that they enjoyed the food that was provided and although a choice was not routinely provided for the main meal of the day they could request an alternative to the meal provided. People felt secure living in Ganarew. They knew how to tell the home about any concerns they might have related to the provision of their care. The approach to the management of health and safety is sound. Care is taken to make sure that all routine servicing and maintenance is carried out and that all necessary checks and tests are done with the appropriate frequency. What has improved since the last inspection? What they could do better: Care plans should always be compiled promptly for people moving into Ganarew so that information about their individual needs is set out clearly for staff. Care plans should also be reviewed regularly to ensure that the information is up to date. Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 7 Guidance should be made available about how to manage the difficult behaviours that are associated with people’s dementia illness. This will ensure that they receive an appropriate and consistent approach from the care staff. As part of the new building a small secure patio area has been created at the rear. The space within this is limited for the number of people living in the home. A senior member of staff has recently been allocated responsibility for developing the activities within the home. She has no training in this area or knowledge of specialist provision of activities for people with dementia illnesses. 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.V352392.R01.S.doc Version 5.2 Page 8 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.V352392.R01.S.doc Version 5.2 Page 9 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): 1, 2 and 3. (Ganarew does not provide intermediate care). Quality in this outcome area is good. The service provides some written information to help people decide if Ganarew is the right place for them to live. The home obtains information during the assessment of prospective residents and relevant people are asked to provide information so that the staff have the information they need to decide if they can provide the right care for people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provides written information called a Service User Guide to help people and their relatives decide if Ganarew is the right place to live. This does need some development to form a cohesive document that contains all the information required by the national minimum standards. In the comment Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 10 cards people confirmed that they had received information and one person said that when they visited, “We were given a warm welcome and a cup of tea with biscuits.” People are provided with contracts about their stay in the home. We saw copies on their files. This sets out what is included in their fee, the ole and responsibility of the provider, and the rights and responsibilities of the resident. Staff from the home obtain information about people before they offer a place to live in Ganarew. When the local authority is assisting someone they also obtain a copy of the assessment carried out by the local authority care staff. This is so they can be sure that they are likely to be able to meet their needs. Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 11 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. Staff are respectful and caring towards people living in the home and work hard to provide them with a good quality of care. People feel that they or their relative receive good attention from the staff most of the time. There are written care records that need some attention so that staff always have reliable and up to date information to guide them in giving each person the care that they need. There are arrangements in place to make sure that medicines are administered safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We observed that the staff were had a good approach to the residents and were patient, kind and flexible in the way that they assisted them. One relative that we spoke to said the residents “Were spoken to with affection and respect.” Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 12 We observed that the people living in the home all looked clean and their clothes were well presented. The view of the Expert By Experience also confirmed this. She said in her report, “Each resident appeared clean, tidy and well presented in their own freshly laundered clothes.” The hairdresser was in the home on the first day of our inspection and many residents chose to have their hair done. When we walked round the building we noticed that some peoples soap, toothpaste and toothbrushes looked as though they might not have been used that day and this was drawn to the attention of the manager at the time. We looked at the files for a sample of residents. These were the people we case tracked. Most of those selected had lived in the home for four months or less, which was a reflection of the number of new people coming to live there since the opening of the extension. They each had information about the assessment of their needs before they had been admitted. Two files did not have a care plan, although one for a person admitted about ten days previously, was on the computer and had not been transferred to their file. For another person admitted three days previously a plan of care had not yet been written. Staff said that they were told at the handover between shifts, of information that they needed to know to provide care for people. The care plans contained basic information about peoples care needs. The manager reported that they also had a specialist care plan that related to peoples dementia care needs for some people, but none had been written for those who were case tracked. The information in the care plans was basic but did cover most areas of care provision. There were also risk assessments in place that identified areas where residents were particularly vulnerable. We read one file where the resident had times of using behaviour that challenged the service. There was no guidance to the care staff about how to manage this type of behaviour. We found that the care plans and risk assessments had not been reviewed for two months and the information in one plan was not accurate. In their comment card one member of staff said, “During the period of time from one update to the next they are not always exact enough.” The home keeps daily notes about each resident. These were recorded in good detail and changes to care needs were identified in these notes. This information needs to be transferred to the care plans. There is a handover of information between shifts and in their survey one resident said: “Information is not always passed on about me when there is a change of staff shift. There is a record book which is not always looked at if staff are busy.” This view was further confirmed by care staff in their surveys where some indicated that there were times when information needed to passed on more Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 13 effectively, for example, one staff said the home should “provide better communication support and information to staff.” In their surveys, the residents said that they were confident about the medical support that they received in the home. We spoke to two health care professionals who were visiting residents. They both said that they thought the health care given to residents was good. They said that referrals were made to them appropriately and that the staff in the home carried out their instructions correctly. Each person’s file contained a sheet that recorded when the resident had seen a health care professional. The home also recorded their weight on a monthly basis to monitor their progress in this area. One person who had been underweight at the point of admission had been weighed every few days to monitor progress. This was good practice. We looked at the storage, administration and record keeping for medication for those residents that we case tracked. This was generally all carried out carefully. We did see that the carer administering the medication signed the record of administration before actually giving the medication to the residents. This is not good practice. We also checked a random sample of medication and found that the stock counts were accurate. All staff who administer medication have taken training in this area of practice. Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 14 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, 1 3, 14 and 15. Quality in this outcome area is adequate. The home does not have a range of pastimes and activities available for people to take part in to provide occupation during the day. Visitors are always welcomed to he home so residents are able to maintain outside community links. The importance of good food is recognised and promoted as an element of good care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People are able to decide their own daily routine within Ganarew; including the time they get up, where they sit and where they eat their meals. Recently one of the senior staff has been allocated responsibility for organising social activities. She has no specialist knowledge in providing activities for people with dementia illnesses. We were told about certain activities that were planned in preparation for Christmas. It was however evident that there has Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 15 not been much attention to provision in this area for some time. Comments were received from staff such as, “I do feel that more time could be spent with service users to help and support to keep them active in ways of supporting the service user to keep up certain hobbies, doing activities that they enjoy which will benefit the service user their families also the staff to build a closer relationship.” Relatives who made comments such as; “It would greatly enhance the residents lives if there were more activities.” “They don’t seem to do much.” Of the 10 residents who sent back comment cards only 2 said that activities were always provided. The Expert By Experience also reflected on the lack of activities in her report, “These clients could benefit from an activity such as armchair aerobics. Maybe an occasional film, some music and some one to one activities. Perhaps a diversional therapist could be employed on a part time basis. The more able residents go out to social activities but alas two thirds of the residents are confined to the home.” The information on people’s files about their individual interests and preferences was limited. The manager showed us a form that is going to be brought into use that will inform the home about residents’ backgrounds and interests when completed. This will help the home to plan for individual preferences when organising activities. Some people living in the home like space to walk about and were using the area outside the main lounge regularly to do this. At times this area felt very busy. The gardens at the front of the house are not available for residents with dementia illnesses to use unless they are escorted. The Expert By Experience also commented on the garden space. “On further inspection I noticed a small terraced area which seems ill thought out and very cramped for a home housing in excess of thirty clients.” Visitors said that they were always made welcome in the home. The menus show that meals are on a rolling three-week rota and comprise mainly traditional home cooked food. A choice is not routinely available for the main meal but residents are able to request an alternative if they do not wish to eat the meal. The provision of breakfast is flexible and people are able to eat in their room or in the dining room at any time in the morning. One person was observed having their third breakfast of the day having insisted that previously none had been provided. The chef knows all the residents and Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 16 is aware of the dietary needs and preferences. Fresh fruit was available in the lounges and drinks were provided throughout the day. Most people eat in the dining room, which is a large airy atrium type room. Those needing assistance tend to eat in their own rooms or in the lounge. Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 17 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. The service has suitable complaints, whistle blowing and adult protection policies and procedures in place and staff are aware of the importance of reporting abuse. Staff work hard to meet the varied care needs of people living in the home but there are times when they find this difficult. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure and we saw this displayed in the entrance hall. Everyone who responded to the comment cards said that they knew how to make a complaint. The manager said that the home has not received any complaints since the last inspection and there were none recorded in the complaints log. In addition to the complaints log there is also a book in the entrance hall where people can write down any comments they have about developing the service. The home also has a policy and procedure for safeguarding people from abuse. The records indicate that staff have received training in this area of practice. Staff we spoke to said they would not hesitate to report to the manager if they Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 18 thought someone was being abused or neglected. There is also a whistle blowing procedure. Due to their dementia related illnesses, many of the people who live in the home spend much of their time walking around the building and can be restless and occasionally confrontational. These are issues that can have an effect on other people living in the home. Staff indicated in their questionnaires that they would like more training in how to manage the more difficult behaviours associated with dementia. One person said, “I feel that training associated with anger, aggression and violence would be something the care team would benefit from.” During our time in the home we observed numerous examples of sensitive and effective communication, where staff were working hard to relate to each person as an individual. Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 19 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. The accommodation provides attractive surroundings for people to live in and is comfortable and well maintained. There are a number of different communal areas and spacious corridors so people who are restless can move about. The home is clean and tidy and smells fresh and care is taken to make sure that people are not at risk from infection. There are limited secure external facilities although residents can use large gardens in the front when a member of staff accompanies them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Ganarew is situated in a beautiful rural location, between Ross and Monmouth, although this does mean that visitors must have transport. Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 20 The building has been extended over the last two years and the service providers are now in the process of redecorating rooms in the original part of the home. The home is well presented throughout. There is a choice of communal areas for residents to use throughout the day; two lounges and a third area with seating at the end of the dining room that is very popular. The dining room has a large atrium type roof and is very light and airy. All bedrooms have an en suite toilet and washbasin. The bedrooms are nicely decorated and residents are able to bring their own belongings to personalise them if they wish to. The view of the Expert By Experience was that “All bedrooms are clean and bright and residents are allowed to individualise them to their own liking. Personal mementoes eg. Pictures, ornaments, flowers and in some cases pot plants abound and in some cases items of furniture are also accommodated.” We spoke to people in their rooms and they said that they found them comfortable. Shared rooms are equipped with a screen to help with issues of privacy for those sharing. Some consideration has been given to assisting people with orientation in the home but this needs some further consideration. Residents’ names are put on the doors to their rooms, but other residents moving around the home had removed some. Consideration should be given to finding a way of providing a more permanent solution where peoples’ names are on their doors in print that is large enough to be easily read and recognisable. The numbers on doors are raised to assist people with a visual impairment to feel them; the door handles also have a black surround to make them easier to identify. The décor in the corridors is not varied to assist with breaking them into smaller areas to aid orientation. The shared bathrooms and toilets have been completed to a high standard. These rooms are spacious to allow for disabled access and people needing assistance. There is a newly fitted laundry that is well equipped including a sluice washing machine. Systems are in place throughout the home, such as hand washing facilities, alcohol gel and clinical waste bags to help with control of infection. We saw a range of information about infection control displayed on the staff notice board and we were told that this was to remind staff about how to make sure they had good practice in this area. The manager said that they change the information sheets from time to time as a training aid for staff. We found the home was clean throughout and there was little evidence of offensive odours. The Expert By Experience reported that “The home appears well kept and clean with all public areas and individual bathrooms cleaned once a day.” All the residents who sent back a comment card said that the home was always or usually clean and fresh. Heating and lighting arrangements comply with requirements, and emergency lighting is fitted throughout the Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 21 premises. All radiators are guarded. Water temperatures are controlled and regular checks undertaken to make sure that water temperatures are safe at point of supply and also at storage to prevent risks from legionella. There are systems in place to make sure that the home is maintained appropriately. Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 22 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 good. The staff group is hardworking and committed to their work and provide people living in the home with caring and respectful contact. Staffing levels are sufficient to ensure that staff and managers have the time they need to deal with peoples care needs. Care is taken to ensure that the right people are employed to work with vulnerable residents. They generally receive the training they need to provide them with appropriate knowledge to carry out their role. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information from the surveys gave a positive picture of the approach of the care staff to the residents: “We are very satisfied with the care being given to --- and thankful for all the compassion shown by all of the staff.” In the surveys the residents all indicated that they always or usually received all the care and support that they needed. They said how caring and understanding the staff were. Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 23 The staffing levels have been increased since the last inspection to reflect the increase in the numbers of people living in the home. In the surveys and in conversation with staff they said that generally there are enough staff working in the home to meet the care needs of the residents although there were occasions when there were considerable pressures on staff time. One resident commented that “the needs of the EMI patients have taken up time of staff.” We sat in the main lounge on the first day for two hours. This is the area where most of the residents with needs relating to their dementia tend to sit. We observed that there were times when there were no staff in this room and there were confrontations occurring between the residents that needed the intervention of a staff member to diffuse. We observed that staff in all roles were busy throughout both of our inspection days. There appeared to be good team working between the staff working in different roles in the home. All staff related to the residents, including kitchen and domestic staff. We were given a copy of the staff rota for two weeks and this showed that the staffing arrangements were sufficient to meet the care needs of the people currently living in the home. The manager expressed her confidence that she could employ additional staff should a particular need arise to do so. The home does not use agency staff and is able to fill all shifts from within its own staff group. We examined the files for four members of staff. These showed that suitable recruitment procedures had been used. Following recruitment they undertook a period of induction training although this had not been reliably completed and signed off for some staff. The home does not have a training policy that identifies the training that staff are expected to complete. However the training matrix displayed on the wall in the office showed that there had been a conscientious approach to ensuring that staff train in mandatory areas such as moving and handling and fire safety. The manager is taking further training in dementia care and there are plans that the two deputies should also do so. Staff at the home receive dementia training from a DVD. This has not been completed by all care staff. In their comment cards the staff clearly identified a need for further training in this specialist area. “The only training I have had with dementia patients was watching a DVD which I felt only touched the surface, it didn’t give me a full understanding.” There are some areas of care practice where staff have not received training such as diabetes and skin care. The AQAA indicated that over half of the care staff have completed or are taking an NVQ in care. Staff files indicate that care staff have received personal supervision but staff spoken with were not aware that they had taken part in this process. This would indicate that it is not a robust and meaningful process. We were told Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 24 that additional training is planned for the manager and her deputies in the New Year in this area of practice. In their surveys staff indicated that generally they felt well supported by the management of the home and that help and guidance was available if they wanted it. Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 25 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, 36 and 38. Quality in this outcome area is adequate. The registered manager has the experience and qualifications relevant to the management of a care home, but needs to continue to develop her knowledge of specialist dementia care provision. She is working hard to develop a level of service that provides good outcomes for the people who live in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager of the home, Mrs Sylvia Williams, has many years experience in the care industry. She has worked at Ganarew for nearly two years and was registered as the manager in the summer of 2007. She has Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 26 taken training relevant to the management role and is continuing to take training to develop her knowledge and skills, for example in dementia care and in supervisory management. She is working to establish a good service for the increasing number of people who live in the home. This is a complex task bearing in mind the changes to the staff group and resident dynamics that are involved in this situation. There were some aspects of the management task where there was still work to be done to achieve full compliance with the legislative requirements that underpin good care, such as frequency of reviews and changing care plans when there are changes to peoples care needs. The information in the AQAA, which was completed by the manager, needed development. In this document we ask the home to carry out a selfassessment of the quality of the service they are providing. A number of sections were not completed and the quality and depth of some responses was limited, for example there was no information about what the service could do better. Insurance cover is in place and the certificate and the certificate of registration are displayed in the home. The home surveys the residents and their families annually. This has not been done for 2007 because the timing would have coincided with our request for surveys for the inspection. The file with the results for 2006 could not be found at the time of the inspection. One of the service providers visits monthly and prepares a report as required by regulation. The information in this is limited. It is complemented by a monthly review carried out by the area manager who provides the home manager with support and guidance. The AQAA indicated that all expected policies and procedures are available at the home. We saw copies of some of these as requested. The service provider has made a decision that the home will not look after the spending money for anyone living there. Monthly invoices are sent out to a family member/responsible person for them to deal with any additional expenses incurred. There are systems in place to make sure that the health and safety of the residents and staff are promoted. We saw information about regular checks and servicing of equipment in the home. This included the fire log, fridge and freezer temperatures and information about regulation of water temperatures. We saw the accident book where a number of accidents had been recorded. The staff training information showed that staff have received training in health and safety, moving and handling and where relevant in food hygiene. Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 27 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 2 3 3 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 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 Requirement Guidance should be written and provided to care staff about how to deal with behaviours that are difficult to manage. Staff will then have clear guidance about what to do and will provide a consistent approach. Timescale for action 31/01/08 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 OP1 Good Practice Recommendations Consideration should be given to revising the Service User Guide so that it is a cohesive document that provides all the information required by regulation to people who are thinking of moving into the home. Care plans should be reviewed each month, or more frequently if required, and a new plan written as necessary to ensure that staff have the information they need to meet peoples care needs in the right way. The home should keep under review the system it has in place for providing residents with a suitable range of DS0000065335.V352392.R01.S.doc Version 5.2 Page 29 2 OP7 3 OP12 Ganarew House 4 OP27 activities that are suited to their individual and specialist needs. This will help to ensure that there arrangements in place to provide each resident with some form of activity. Consideration should be given to ensuring that one member of staff is deployed into the area by the main lounge so that there is someone available in that area at all times in the event of needing to help distract residents who are confrontational. Ganarew House DS0000065335.V352392.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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.V352392.R01.S.doc Version 5.2 Page 31 - 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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