Inspection on 08/02/06 for Ganarew House

This inspection was carried out on 8th February 2006.

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 05/12/07

Ganarew House 23/01/07

Ganarew House 05/09/06

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 Wendy Barrett Unannounced Inspection 8th February 2006 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.V282962.R01.S.doc Version 5.1 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.V282962.R01.S.doc Version 5.1 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) 01630 890273 Milkwood Care Limited 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.V282962.R01.S.doc Version 5.1 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. 25th October 2005 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 have obtained planning consent for an extension to the premises that will increase the number of people that can be accommodated. Ganarew House DS0000065335.V282962.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was pre-arranged. The Provider organisation has only been registered since October 2005 and it was important to give management personnel an opportunity to be present. There is a condition of registration requiring the Provider’s representative and a Group Manager to be present at the home for a minimum of 30hours per week until the Commission has approved a separate Care Manager for registration. There is a Care Manager designate in post. She participated in the inspection and will be presenting her application for registration with the Commission in the near future. The presence of senior management staff during the inspection helped the Inspector to find out what work has been done to develop the service overall since last October. Comment cards for residents and relatives had been given to the home at the last inspection. Six cards have been completed and returned to the Commission. Responses are referred to in this report. Some time was spent sitting with a group of residents in one of the communal lounges. The cook, Deputy Manager and a Senior Care Assistant were interviewed. There was a tour of the accommodation. Some records and documentation were inspected. The focus of this inspection was on key National Minimum Standards that were not covered during the last inspection. The report of the last inspection should also be read to obtain a more comprehensive picture of the service. What the service does well: There is a professional and organised approach to the running of the home. This means that resources are used to best effect and staff know what is expected of them. Residents feel well informed and consulted about everyday life at the home so that they can influence their experience at the home. They express considerable confidence in the staff. The accommodation has received considerable investment since the new Providers took over the home last October. This has resulted in a much safer and higher quality standard of accommodation for the residents to enjoy. The open attitude of managers and staff give the home a welcoming and warm atmosphere. Ganarew House DS0000065335.V282962.R01.S.doc Version 5.1 Page 6 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. Ganarew House DS0000065335.V282962.R01.S.doc Version 5.1 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.V282962.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: The service offered at Ganarew does not include intermediate care so National Minimum Standard No. 6 is not relevant. Ganarew House DS0000065335.V282962.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 Medication is safely managed on behalf of residents, and staff who handle medication receive training for this responsibility. There is a policy and associated procedures to guide staff with this work although staff need to be sure that they are reflecting this guidance in their everyday practice. EVIDENCE: The provider has completed a considerable amount of work to improve medication procedures at the home. There are also proposals to introduce a new medication room when the accommodation is extended in the near future. The Deputy Manager and Senior Care Assistant had recently received training from a Boots pharmacist on the new arrangements for using blister packs. Although they both knew where to find copies of the home’s policies and procedures it was less evident that those relating to medication management had recently been read. A recommendation is made for all staff who handle medication to check that they are following the relevant written guidance. There were indicators of safe management of residents’ medication e.g. checking of prescriptions before sending to pharmacy for dispensing, storage of data sheets that provide information about possible side effects, storage requirements etc. Risk assessments and care plans are in place to guide staff Ganarew House DS0000065335.V282962.R01.S.doc Version 5.1 Page 10 in their administration of medication prescribed ‘as required’. The way that this type of medication is managed shows clearly that staff try to avoid using chemical interventions until they have tried diversions, additional reassurances etc. This is good practice, and helps to avoid unwanted side effects, particularly for those residents who may sometimes become anxious and restless due to dementia related conditions. No residents were self-medicating at the point of this inspection. Two requirements are made to further strengthen the management of medication. Ganarew House DS0000065335.V282962.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15 Residents’ ideas are listened to, and acted upon, so that their life at the home matches their expectations and preferences. An experienced and qualified cook prepares meals in a clean, well-organised kitchen. The residents are happy with their diet. EVIDENCE: All the resident feedback responses confirmed that the home provides suitable activities. Residents meetings are held so that ideas and opinions about life at the home can be discussed. When the new Providers arrived at the home residents were pleased that they were asked for their views and given information about future plans for the service. The cook had been employed in January 2006. She has worked in catering for a number of years and holds relevant qualifications e.g. Diploma in Catering. She was aware of plans to renew her current food hygiene certificate to keep her up to date. The menu for the day was displayed in the main entrance area. The standard menus rotate over a five-week period so there is plenty of variety. The cook explained how she meets residents each day and showed awareness of individual dietary needs and preferences. Written records reflected flexibility in accommodating special requirements or requests. Residents are very happy Ganarew House DS0000065335.V282962.R01.S.doc Version 5.1 Page 12 with the meals and feel able to make requests. They also mentioned that they were offered fresh fruit. Copies of food orders included a good range of fresh meats and vegetables for meals preparation. Stock was tidily stored and fridge and freezer temperatures were being regularly checked. There was some literature in the kitchen to provide additional information and ideas for the cook. It may be helpful to obtain further guidance on the particular nutritional needs of elderly people because although the cook has general experience and qualification she has not worked specifically with older people in the past. Ganarew House DS0000065335.V282962.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Residents are confident that the staff will listen and deal sensitively with their concerns and there is written guidance that explains the Providers’ commitment to investigating complaints thoroughly. Residents are protected from abuse by staff who understand how to raise any concerns relating to abuse issues. The Care Manager demonstrates an open approach through her expressed intention to invite the local co-ordinator for adult protection into the home to further strengthen staff awareness. EVIDENCE: There is a complaints procedure advertised at the home to advise people how to express any concerns they have. The Commission has not received any complaints since the new Provider was registered. Residents’ feedback confirmed that they feel safe. The confidence they have in the staff was illustrated in their comments – ‘they are good staff. We were worried we’d lose them (as a result of a change of Provider) and we’re glad they stayed’. The Deputy Manager and Senior Care Assistant were familiar with a copy of the local protocol for adult protection. This information was seen at the home. They had not yet met the Co-ordinator of this scheme and it is recommended that she be invited to the home to meet the staff. The Care Manager requested contact details so this could be followed up. The two interviewed staff were also aware of an Adult Protection policy and Whistle blowing procedure. This information is included in a staff handbook. Ganarew House DS0000065335.V282962.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: There has been a considerable amount of work completed to maintain and improve the accommodation since the new Providers arrived e.g. new furniture and carpets, decoration of several bedrooms, covering of heating radiators. A maintenance worker has been employed and a routine maintenance plan implemented. There had been attention to a requirement arising from the last inspection regarding risk assessment of windows. Window restrictors are now fitted to those windows assessed as potentially hazardous. A new fire alarm system and call bell system have been installed. A satisfactory electrical safety certificate had been obtained in January 2006. The Provider has recently introduced an additional bedroom facility. This has been furnished and fitted to a satisfactory standard. A protective radiator cover was due to be fitted before the room is occupied. Ganarew House DS0000065335.V282962.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 Potential staff are carefully selected to be sure they will be safe to work with vulnerable adults. EVIDENCE: There are normally two care assistants on duty during the day. The Care Manager supports them during the weekdays. Two care assistants are on duty during weekends. A cook is on duty seven days each week and a cleaner works four hours on Mondays, Tuesdays, Thursdays and Saturdays. Staff were concerned about their ability to respond adequately to residents care needs, particularly at weekends. They described most residents as needing assistance with washing and dressing, many requiring support with continence management, and one or two residents who need two staff to attend to them safely. The staff were aware that occupancy would soon rise to 17 residents and this was increasing their concern about current staffing levels. They were happy for the matter to be raised with the Provider, and it was discussed. It is difficult for the Commission to assess staffing needs as these will change according to the overall dependency levels at any particular time. The current indicators from inspections indicate that residents are receiving the attention they need and feel they should be receiving. A requirement is, however, made for the Provider to undertake further consultation with staff and review of care demands and working patterns. Ganarew House DS0000065335.V282962.R01.S.doc Version 5.1 Page 16 The cook described a thorough recruitment process when she was employed earlier this year. Her personal file contained all the required documentation to reflect compliance with regulatory requirements and good practice. Ganarew House DS0000065335.V282962.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 and 38 The home is run by experienced managers who understand and respond well to their responsibilities for the health, safety and welfare of residents and staff. EVIDENCE: The Care Manager designate has considerable experience and will soon be applying for registration with the Commission. Until this has been approved there is an additional condition of registration that requires the Provider’s Responsible Individual and a Group Manager to spend between them a minimum of 30 hours each week at the home. These are also experienced personnel who understand their responsibilities as care home operators. Staff feel they have easy daily access to management staff and they are already being offered regular one-to-one supervision sessions. Staff meetings are also held to encourage good communication between staff and management. Ganarew House DS0000065335.V282962.R01.S.doc Version 5.1 Page 18 The home does not handle any personal monies or valuables for residents. This approach is in line with currently recognised good practice. Relatives or other representatives support residents who need help with this. There has been considerable financial investment in improving the safety of the premises since the arrival of the new Provider (see Environment section of this report). Indicators of attention to hygiene were seen during a tour of the accommodation e.g. anti-bacterial soaps, paper towels, colour coded laundry and cleaning equipment, cleaning rotas, attention to staff training. An existing matrix record of each staff member’s receipt of training would be more informative if dates of last training and target dates for initial or refresher training were listed. The information available on the day indicated a structured approach to the provision of health and safety training. Relevant health and safety policies and procedures have been implemented and staff know where to find this guidance in the home. Ganarew House DS0000065335.V282962.R01.S.doc Version 5.1 Page 19 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 x x x x x x x STAFFING Standard No Score 27 x 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x 3 x x 3 Ganarew House DS0000065335.V282962.R01.S.doc Version 5.1 Page 20 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 OP9 Regulation 13(2) Requirement Timescale for action 15/03/06 2 OP27 18(a) All staff who handle medication must be familiarised with the home’s related policy and procedures in order to ensure this guidance is always followed. The views of some staff that care 31/03/06 staffing levels are not always adequate must be further explored. 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 OP9 Good Practice Recommendations Medication records would be strengthened if the following practices were introduced: i) All allergy boxes completed ii) A sample list of staff initials used on administration records iii) Initials of the two staff who check transcribed instructions to be shown on the relevant administration record iv) Re-write, rather than alter existing instructions on DS0000065335.V282962.R01.S.doc Version 5.1 Page 21 Ganarew House 2 3 OP15 OP30 administration records. The cook may benefit from additional information on the particular dietary needs of older people. The existing matrix record of individual staff training would be more useful if dates of last training and intended frequency of refresher training was listed. Ganarew House DS0000065335.V282962.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ganarew House DS0000065335.V282962.R01.S.doc Version 5.1 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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