Inspection on 03/09/08 for Garden Hill Care Home

This inspection was carried out on 3rd September 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Garden Hill Care Home 04/02/10

Garden Hill Care Home 05/08/09

Garden Hill Care Home 23/10/07

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Garden Hill Care Home 32 St Michaels Avenue South Shields Tyne & Wear NE33 3AN Lead Inspector Irene Bowater Key Unannounced Inspection 3rd September 2008 09:45 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 Garden Hill Care Home DS0000070307.V371500.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. Garden Hill Care Home DS0000070307.V371500.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Garden Hill Care Home Address 32 St Michaels Avenue South Shields Tyne & Wear NE33 3AN 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) 0191 4975255 0191 4975269 gardenhill@schealthcare.co.uk Southern Cross OPCO Ltd Mrs Marilyn Jackman Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Garden Hill Care Home DS0000070307.V371500.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Old age, not falling within any other category - Code OP, maximum number of places 40 The maximum number of service users who can be accommodated is: 40 23rd October 2007 2. Date of last inspection Brief Description of the Service: Garden Hill is a large detached three storeys building in South Shields set in its own grounds. The home can provide general nursing and social care for up to forty people. The home does not provide intermediate care services. There are lounges on each floor and the main dining room is on the ground floor. Bedrooms are on each floor and all are en-suite. Throughout the home are specialist bathing and toilet facilities and there is easy access to the gardens and car park. The gardens are to the front and side of the property with a car park to the front. There is a lift provided which enables people to get to the different floors. An emergency call system is provided in all bedrooms. It is situated in a residential area and convenient for the town centre of South Shields. It is close to local train and bus transport. The seaside, shopping outlets, local theatres and social amenities are close by. The local shops and a post office are within easy walking distance of the care home. Fee rates vary in the home: Social and Personal Care £408, Private £475. General nursing care £509, Private £570:50. Continuing nursing care £534. The free nursing care element is set nationally. Personal items such as clothing, toiletries, newspapers and outings are not included in the fee rates. Garden Hill Care Home DS0000070307.V371500.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. Before the visit: We looked at: • Information we have received since the home was last visited on the 14 November 2007 and 25 April 2008. • How the service dealt with any complaints and concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people • The views of people who use the service and their relatives, staff and other professionals. • • We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken.” • The Visit: An unannounced visit was made on the 3 September 2008.This visit was carried out by one Inspector and took seven and a half hours to complete. The Pharmacy Inspector completed a separate visit. During the visit we: • Talked with people who use the service, relatives, staff, the support managers and visitors. • Looked at information about the people who use the service and how well their needs are met. • Looked at other records, which must be kept. • Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. • Looked around the building to make sure it was clean, safe and comfortable. Garden Hill Care Home DS0000070307.V371500.R01.S.doc Version 5.2 Page 6 • Checked what improvements had been made since the last visit. We told the project manager and the regional manager what we found. What the service does well: What has improved since the last inspection? What they could do better: Garden Hill Care Home DS0000070307.V371500.R01.S.doc Version 5.2 Page 7 Further work is needed with care planning so that they clearly detail the wishes of people using the service, and the care and support needed to meet people’s needs. People and their representatives need to be involved in planning their own care with staff. People’s nutritional health status must be monitored and any changes recorded and updated in care plans. Fluid balance and food charts must be completed in detail to evidence practice. Staff need to follow medication policies at all times so that people receive their medication properly. Information about peoples lifestyles and choices before they moved in need to be written down so that staff can continue to support them or, help them access help from others. The menus and food provision need to be looked at again and so that people can have a choice of food at the point of service. Staff must always give assistance in a sensitive discreet manner. Redecoration is needed especially in bathrooms toilets. The staffing levels, training and skills of the staff team need to be reviewed so that the staff are confident they have the skills to do the job. Visitors and people living in the home said: “Staff always come from the other home to help out.” “People have to wait for help.” “There is never anyone about especially at weekends.” The staff need constant support so that they can feel confident that they will be able to meet people’s needs in a professional manner, taking the principles of a person centred approach to care into account The Company’s quality assurance system needs to be followed so that people receive consistent quality of care and their views are taken into account. 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. Garden Hill Care Home DS0000070307.V371500.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 Garden Hill Care Home DS0000070307.V371500.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): 3. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive clear information about the service and a comprehensive assessment of need before admission. This helps them make the right decision about using the service. EVIDENCE: The home sets out the aims and objectives of the service in a Statement of Purpose, which is readily available. There is also a Service Users Guide that sets out the values of the home. This makes references to supporting the diversity of needs, cultures, and beliefs of all those involved in the home. Garden Hill Care Home DS0000070307.V371500.R01.S.doc Version 5.2 Page 10 Before anyone is admitted to the home a full needs assessment is undertaken by a Care Manager, senior nursing staff and where necessary the nurse assessor. From this information the staff complete a care plan based on individual needs. Before coming to live in the home people can come and visit and spend some time getting to know the home. Also the home confirms in writing to each individual that they can meet their needs and everyone has a contract that sets out the terms and conditions while living in the home. Garden Hill Care Home DS0000070307.V371500.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): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Access to health care is satisfactory, but lack of detailed care planning does not demonstrate that peoples’ needs are being fully met. EVIDENCE: Each person has a plan of care based on the admission assessment carried out by care managers, the home manager and where necessary nurse assessors. Staff completes pressure ulcer risk using the Braden scoring system, dependency, moving and handling, nutritional assessments using the Malnutrition Universal Screening Tool (MUST), continence and fall risk assessments. These tools help the staff understand the level of risk each person and helps them complete a care plan. Garden Hill Care Home DS0000070307.V371500.R01.S.doc Version 5.2 Page 12 Care plans and risk assessments are reviewed and generally updated on a monthly basis. Staff have contacted the Speech and Language Therapists (SALT) when there have been concerns about people having difficulty swallowing and being at risk of choking. Detailed information from the SALT team is available in the care plans but staff have not updated the plans to show what diet and fluids those people need. Food and fluid charts are completed but do not show what people are offered should they refuse or mot eat their meal. For example “¼ eaten or refused all.” There was no evidence that additional calorific snacks and drinks are given and accepted between meals. Ongoing day and night reports are recorded. These showed some links to care plans but again were not detailed about daily care delivery. Staff need to develop care plans to show how peoples previous history and lifestyle affects their current needs and aspirations. Decisions on how care is given are based on health care needs and not on a person centred approach. Plans around pressure ulcer prevention were often bland and unspecific. Appropriate pressure relieving devices are available. Several people have air cell mattresses and cushions to prevent pressure damage. And several have profiling nursing beds. Staff do not always detail preventative pressure ulcer care nor do they record the type of mattress in use with peoples weight and pressure of mattress. This would make sure that the proper care was being given. Medicine storage facilities are of adequate size but both first and second floor storage rooms are hot and the temperature recorded is regularly over 25c but no action has been taken. Some medicines were inappropriately stored in the fridge. On the first floor not all medication in use had date of opening recorded. There was a bottle of lactulose and indigestion mixture in the cupboard with the pharmacy label removed. The home is in the process of updating the homely remedies policy. Standard Southern Cross Policies are kept with the medicine trolley. Some people were self-administering inhalers and creams but no selfmedication assessment had been completed. Medication round started at 9.30am, finished 10.30am. Two members of staff completed the medicine round. There was a no touch process used and clean Garden Hill Care Home DS0000070307.V371500.R01.S.doc Version 5.2 Page 13 medicine pots and drinks were available. Encouragement was given to people taking medication. Some Medicine Administration Records (MAR) dividers did not have photographs of the person and some dividers had been reused. This may lead to confusion as the previous person information was on the back. Reminder cards were found between the medidose packs for discontinued medication. There were very few gaps on the MAR charts but not all MAR records accurately reflect what has given. Not all handwritten entries were countersigned by a second person or had starting quantities thus making audit of medication difficult. The care plans of one diabetic person and one person taking Warfarin were looked at and the records were up to date and accurately recorded changes to dosage. The Controlled Drug cupboard appears to meet requirements. Records of administration match with MAR charts and entries are double signed. The Controlled Drug book still recorded had 95ml of Oramorph 10mg/5ml solution that was not in the cupboard. (An investigation showed it had been returned to person on discharge but had not been booked out.) Temazepam 20mg had been incorrectly recorded because of supply in halves by pharmacy. Everyone has access to all NHS facilities to ensure their healthcare needs can be met. There are regular visits from GP’s and other health professionals including, dentists, opticians and chiropody services. All of the care staff worked very hard to make sure everyone was treated with respect and their rights to privacy and dignity maintained. Garden Hill Care Home DS0000070307.V371500.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): 12,13,14,15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Opportunities to take part in meaningful activities and keep control of everyday decisions are limited, and mealtimes are not well organised. This prevents people from leading full and active lives. EVIDENCE: There is a designated activity organiser who plans events for the people living in the home. Photographic evidence shows people enjoying Lady Ascot Day, games afternoons and Fourth of July celebrations. The summer fete was successful with a good amount of money raised to support the activities and leisure funds. People also have access to various board games, books and daily newspapers. A monthly newsletter is produced and this is used to record events that are happening in the home. It is readily available so that everyone can see what is going on. Garden Hill Care Home DS0000070307.V371500.R01.S.doc Version 5.2 Page 15 Visitors are welcome at any time and are able to use the lounges or their relatives’ bedrooms for visits. It was confirmed that there are no restrictions regarding visiting times. Information about advocacy is available in the home. Many people have brought small items with them making their rooms homely and reflective of their previous lifestyles, religious beliefs or cultural backgrounds. The dining room is on the ground floor of the home. Next to it is a small “coffee room” where people and their visitors have a drink or a meal with their relative. Fruit, hot and cold drinks are readily available in the coffee area and main lounge. And staff served drinks and biscuits mid morning. The main dining room is small and compact at mealtimes. Should anyone want to eat their meals in their own rooms this service is readily provided. Tables were set with tablecloths and knives and forks but no condiments or napkins were readily available. Drinking glasses and cups and saucers were not provided until halfway through the meal. The Company uses the “Nutmeg” system, which analyses the content of the menus and makes sure people nutritional status is met. The choices for the lunchtime meal were fish pie or sausages with mashed potatoes, carrots, peas and sweet corn. Dessert choices were spotted dick and custard, yoghurts. Although this was displayed on a chalkboard in the corner of the dining room, no one, including staff knew what was for lunch. Choices were not given at the point of service. The meal was ready-plated which meant no one had any control over what was on his or her plate, portion size, and type of vegetable or amount of gravy. No one was able to self-serve drinks with no milk sugar and pots of tea on the tables. Meals were served and then some people had to wait for help and it was difficult for staff to make sure everyone had sufficient hot food at this time. Staff had to help more than one person at a time. This means people did not receive individualised care and the mealtime experience would not be enjoyable. Garden Hill Care Home DS0000070307.V371500.R01.S.doc Version 5.2 Page 16 The soft meals were nicely presented but then staff processed to “mash” everything together on the plate so the meal looked like a plate of brown mush, which was not appetising. One relative asked for a plate guard so that X could eat the meal independently and was told, “there is none left”. No other help was offered and X found it very hard to put the food on to the cutlery without spillage on to her clothing, which upset her and her relative. Staff were disorganised and other people had to wait for help or did not eat all of their meal. Some people had their meals in their own rooms or in the “coffee” area. The main meal and dessert were served at the same time, which meant the dessert was left to go cold. A project manager has been employed at the home and she confirmed that there are plans in place to have two sittings at mealtimes, which will reduce the congestion and make sure mealtimes become a more pleasurable experience. Garden Hill Care Home DS0000070307.V371500.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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good complaints and protection procedures are in place and effectively followed to ensure that people and their relatives are listened to and protected from abuse. EVIDENCE: The Company have a detailed complaints procedure, which is easy to understand, and it is readily available in the home. The home keeps a full record of all complaints including detail of any investigation and actions taken. Five complaints have been investigated since the last inspection. One of these complaints resulted in the Commission for Social Care Inspection (CSCI) carrying out a Random Inspection of the service. Concerns raised on the day of the visit all related to staffing levels, activities, meals and lack of stable management. The Provider is aware that these concerns have a recurring theme and they are working with everyone including care managers to put things right. One complaint continues to be investigated by the Provider. Garden Hill Care Home DS0000070307.V371500.R01.S.doc Version 5.2 Page 18 Staff have had training in Safeguarding Adults. Both the Local Authority and the Provider have investigated four alerts. These have related to care practices, pressure ulcer prevention and record keeping. The Provider is working with the Local Authority and CSCI to make sure the issues are put right. There are currently no safeguarding referrals reported to CSCI or Local Authority Garden Hill Care Home DS0000070307.V371500.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): 19,20,21,22,24,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is being well maintained and a pleasant, clean and comfortable place for people to live. EVIDENCE: The home has lounges; bedrooms, toilets and bathing facilities spread over three floors. On the ground floor there is a dining room and a coffee lounge. The communal areas are pleasantly decorated and furnished. There has been some water damage to some ceiling tiles, which are going to be replaced. The majority of the people living in the home use the lounge on the ground floor. This makes this area quite cramped with everyone “huddled together”. Garden Hill Care Home DS0000070307.V371500.R01.S.doc Version 5.2 Page 20 Some may like to spend some time in the upstairs lounges, which are very pleasant and spacious. This would mean they had more room to have visitors and have a little more privacy. Any changes would have to be with individuals consent. The home provides sufficient specialist equipment. This includes walk in showers, adapted baths, grab rails and raised toilets. The home also has sufficient hoists and moving and assisting equipment. There are bathrooms and toilets in each floor, close to the communal areas and bedrooms. In addition all bedrooms have an en-suite facility. Not all bathrooms had a bath thermometer so that staff could make sure the water was not to hot for people to use safely. Another bathroom was being used to store continence aids. Also being stored were a set of sitting scales, a hoist and bed table. The bathrooms and toilets are looking worn, mainly from damage from wheelchairs and trolleys. The light cords in all areas are dirty and need to be replaced. This is so they can be cleaned easily and reduces any risk of cross infection. There are bedrooms on each floor and all have an en-suite facility. There are a number of modern, adjustable, beds with built in rails available. Alternative strategies would be employed to avoid the use of rails whenever possible. People have brought small items with them making their rooms homely and reflective of their lifestyles. The laundry is compact but is clean and organised. Liquid soap and paper towels are readily available for staff to use. Most of the areas have footoperated bins with lids to prevent spread of infection. On the day of the visit the home was clean and odour free. Garden Hill Care Home DS0000070307.V371500.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems around recruitment and selection of staff are satisfactory but staffing levels and training of staff only adequately meets the range of needs of the people using the service. This means that people’s lifestyles are restricted and overall affects their quality of life. EVIDENCE: The registered manager has been off sick for some considerable time. During this time several managers have come into the home to manage the day-today running of the home. During the last moth the Company has allocated manager to the home to temporarily manage the home in the short term. On the day of the visit fifteen people required nursing care and nineteen have social and personal health care needs. During the day there are two qualified nurses and four carers on duty and overnight there is one qualified nurse and four carers. Garden Hill Care Home DS0000070307.V371500.R01.S.doc Version 5.2 Page 22 In addition to the nursing and care staff the home employs domestics, laundry, cook, kitchen assistants, a maintenance and activities person and an administrator. As there are facilities on three floors it is sometimes difficult to immediately find a member of staff, as they are busy in someone’s room. During the visit there were times when there was no one about as staff were busy helping individuals in the privacy of their bedrooms, bathrooms and toilets. The staffing levels and dependency of people living in the home need to be regularly reviewed to make sure peoples needs are being met. The allocation of staff to certain areas may help to make sure they are available to help people all of the time. Both visitors and people living in the home said: “There is never enough staff especially at weekends” “They need more staff” “Staff always come from the other home to help out” “People have to wait for help” “There is never anyone about especially at weekends” The records for recruitment were satisfactory. There was evidence of Criminal Record Bureau checks, Protection of Vulnerable Adult checks, two written references, proof of identity and professional identity numbers for registered nurses. A training matrix is now in place and it shows what training is to be provided in the near future. This will make sure all mandatory training is up to date. Care staff are to complete Safe handling of Medicines so that the role of senior carer can be introduced. Safeguarding Adults training is to continue so that everyone knows what to do should there be a suspicion of abuse. Other training to be completed includes Palliative Care, Flu vaccinations, and continence care. Garden Hill Care Home DS0000070307.V371500.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Without consistent management there is a lack of leadership and guidance, which means there is only adequate quality assurance systems in place and people may be placed at risk. EVIDENCE: The registered manager has been off sick for some considerable time. In the meantime there have been several managers in the home. Since then managers from different homes have been coming to work at the home for short spells. Garden Hill Care Home DS0000070307.V371500.R01.S.doc Version 5.2 Page 24 The constant changes in senior staff result in staff being unsure what is expected of them and then doing what they think is right. This means the focus is on the task, getting the job done without looking at the individual needs of those using the service. Recently a “project” manager has been allocated to the home until the registered manager returns. She has only been in post for about four weeks and is starting to carry out full audits of the service. The regional manager visits on a monthly basis and completes a separate report. These reports are to make sure the quality of the home continually improves. An action plan has been produced to identify shortfalls and show how things are going to be put right. Staff meetings have been re introduced. They have been made aware of their responsibilities, a work schedule has been introduced and formal supervision of all grades of staff has started. Relative meetings have been organised but only three people turned up. The concerns from this meeting were about the staffing numbers, which are being looked at. The manager holds regular “surgeries” so that everyone has the chance to discuss anything that concerns them. The personal allowance records demonstrate that receipts and double signatures are maintained for all transactions. These could be cross-referenced and weekly checks are carried out to make sure there are no discrepancies. Accidents are recorded and best practice guidance is used to track trends, which prevents as far as possible the same accidents occurring. Mandatory training is now being brought up to date. Internal maintenance checks are up to date and external service certificates are available and up to date. Garden Hill Care Home DS0000070307.V371500.R01.S.doc Version 5.2 Page 25 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 3 3 X X N/A 3 2 2 3 X 3 X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 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 2 X 3 2 X 2 Garden Hill Care Home DS0000070307.V371500.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? 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 The registered persons must ensure that the care plans are reviewed at least monthly, are person centred and reflect how current and changing needs will be met. The registered persons must ensure that they maintain people’s health. People’s skin integrity and nutritional health status must be monitored and any changes recorded and updated in care plans. Fluid balance and food charts must be completed in detail to evidence practice. The registered person must ensure that: • Medication is always signed for at the time of administration so that people are protected from medication errors: Handwritten entries on medication charts are always signed, dated and witnessed to reduce the risk of mistakes when Version 5.2 Page 27 Timescale for action 01/11/08 2 OP8 12,14 01/11/08 3 OP9 12,13,17 01/11/08 • Garden Hill Care Home DS0000070307.V371500.R01.S.doc copying complex information: • All drugs including controlled drugs must be are stored according to current relevant regulations and they must be accurately recorded and checked. There must be individualized identification on all MAR to reduce the possibility of medication error. Action must be taken to ensure medication is stored at the appropriate temperatures. 01/11/08 01/11/08 01/12/08 01/12/08 01/12/08 • • 4 5 6 7 8 OP15 OP20 OP26 OP27 OP30 12,14,15 23 23 18 18 9 OP38 23 The registered persons must review the organisation of mealtimes. The registered persons must replace the damaged ceiling tiles. The registered persons must replace all of the dirty light cords in all bathrooms and toilets. The registered persons must ensure that there are enough staff deployed at mealtimes The registered persons must ensure that all staff receives suitable training to enable them to do their jobs effectively. A planned training and development plan must be produced and implemented with records kept. The registered persons must ensure that there are bath thermometers in each bathroom. The registered persons must 01/12/08 Garden Hill Care Home DS0000070307.V371500.R01.S.doc Version 5.2 Page 28 ensure all mandatory training is brought up to date with records kept. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP14 OP20 OP21 OP33 Good Practice Recommendations The registered persons should make sure that people living in the home can make their own decisions about where they spend their day. The registered persons should start a redecoration programme of the communal areas. The registered persons should make sure that the redecoration of bathrooms continues. The registered persons should maintain systems of evaluating all aspects of the service and take the views of people using the service into account. Garden Hill Care Home DS0000070307.V371500.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Garden Hill Care Home DS0000070307.V371500.R01.S.doc Version 5.2 Page 30 - 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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