Inspection on 05/08/09 for Garden Hill Care Home

This inspection was carried out on 5th August 2009.

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

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

Other inspections for this house

Garden Hill Care Home 04/02/10

Garden Hill Care Home 03/09/08

Garden Hill Care Home 23/10/07

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Garden Hill Care Home 32 St Michaels Avenue South Shields Tyne & Wear NE33 3AN Lead Inspector Clifford Renwick Key Unannounced Inspection 5th August 2009 09:00 DS0000070307.V375976.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Garden Hill Care Home DS0000070307.V375976.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 June McKenzie (not yet registered) 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.V375976.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 3rd September 2008 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 dependent upon whether you are receiving nursing or social care and range from £427.53 - £650.00. Personal items such as clothing, toiletries, newspapers and outings are not included in the fee rates. Garden Hill Care Home DS0000070307.V375976.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 two stars good service. This means that the people who use this service experience good quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspections 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 last key inspection of this service was carried out on 3rd September 2008. In line with current CQC policy on ‘Proportionality’ the inspection focused upon a number of key standard outcomes for service users. And also what actions had been taken with regards to the requirements and recommendations that were made at this last key inspection in September 2008. Before the Visit. We looked at. Information we have received since our last visit. How the service has dealt with any complaints or concerns. Any safeguarding issues. Any changes to how the service is run. The providers view of how well they care for people from information they provided in the annual quality assurance document (AQQA) that they sent to us. The Visit. An unannounced visit was made on the 5th August 2009 followed by an announced visit on 7th August 2009. Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 6 During the visits we. Met with the people who live in the home and also their relatives who were visiting the home while we were there. Spoke with the staff that was on duty. Held discussion with the newly appointed manager who was present during our visits and who is currently responsible for the day to day management of the service. Observed staff working practices. Looked at information about the people who are receiving support and how well their needs are met. Looked at other records which must be kept in relation to health and safety and staffing. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the home to make sure it was accessible, well maintained, safe and free of any hazards. We also gathered information from looking at, care records to assess how staff supports people with their assessed needs. We also focused upon looking at the records for 3 people who live in the home we refer to this as case tracking. And this involves looking at all of the records for a named individual. We told the manager and staff what we had found. What the service does well: The home ensure that every persons needs are assessed and from this implement a written plan of care to confirm how staff will support people. Good progress has been made and is continuing to be made in providing a range of activities that residents can take part in. Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 7 Decoration and refurbishment has taken place in the building and the building is in good decorative order. The people who live in the home said that they are very satisfied with the services being provided. Families of the residents stated that the appointment of a permanent manager has been a positive step by the company. The staff team are committed to providing a good consistent service. Good arrangements are in place for dining and a wide variety of nutritious meals are made available. Staff have good opportunities for training and receive support though personal supervision from the manager. What has improved since the last inspection? New pull call cords to the light fittings in all bathrooms have been replaced and also provided with a plastic covering. This enables them to be kept clean and also reduces the risk of cross infections. All bathrooms have been provided with a thermometer so that staff can check the temperature of the hot water is safe when bathing people. The coffee lounge and the main dining room have been decorated. And the dining room tables are nicely set out. A new shower facility has been provided on the second floor and this enables good disabled access. A system of formal supervision is now in place so that all staff receive structured formal supervisions. The training matrix that lists all staff training is much improved and available to confirm what training has taken place and also what is planned. Activities have improved and a fuller programme of activity is now available for residents to take part in. A permanent manager has now been appointed and the home have also appointed a deputy manager. Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 8 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 9 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.V375976.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 & 6. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A full pre-admission assessment of needs ensures that new residents are offered the right type of care at the home. Furthermore, residents are aware of what service they will receive, through the issuing of a written contract/statement of terms and conditions. Intermediate care is not provided in this home so this standard was not looked at. EVIDENCE: The manager stated that she could only comment on the provision of care since she took up her position in April, 09. She confirmed that all enquiries to Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 11 the home are dealt with in a professional manner, where potential residents and their relatives are invited to look around the home and indicate their choice of room from those rooms that are available. Prior to admission every potential Service User has a pre-assessment carried out by a competent person, whereby all needs at the time of assessment are identified. Once the assessment is complete and Garden Hill has confirmed they can meet the individual persons needs. A place is offered in the home. The home ensures that the relevant equipment if required is in place before the service user takes up residency. The manager also ensures that the prospective service user has been informed about their rights and responsibilities. So that they are clear about what kind of service they can expect when they move into the home. We looked at files for those people who have been admitted since the last inspection and this confirmed that the appropriate assessments had been completed. In discussion with the manager and also the staff it was confirmed that following admission the assessment tool in use continues to be used as part of the ongoing assessment process. An individual plan of care is implemented based upon the assessment and this is discussed more fully in sections 7 – 11 of this report. Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Though care plans are in place the care planning process needs further development to ensure that people receive care in a way that they prefer. Nevertheless, health care needs are effectively met to ensure that residents’ general health and wellbeing are safeguarded and promoted. However medication records on the residential unit are not always completed in line with good practice and this could potentially compromise residents well being. EVIDENCE: Every service user has a written care plan in place that sets out how their assessed needs are to be met. Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 13 We looked at four care plans as part of a case tracking exercise and this involves us looking at all records that relate to a persons health and social care needs. The care plan process in place uses standardised documents and though these contained good information as to how a persons health needs would be met. There was limited and mixed information as to how person’s social needs were to be met. In their current format the care plans did not contain a lot of information that related to the persons background, personal interests or previous lifestyle. Discussion held with the staff about the care plans confirmed that they were aware of how the care plans needed to be developed and also what additional information needed to be included. As part of the care plan process a number of standard charts are used particularly if supporting people with their food and fluid intake. Discussion was held with staff about this and they demonstrated that they had built up a good standard of knowledge of people who had needs in this area. Charts were in place to record the actions taken by staff and in turn records were available to confirm appropriate actions were taken if there was a change in a persons needs. Staff were advised when completing the fluid balance charts to ensure that they are kept up to date on a daily basis and also to make sure that recordings made by staff are consistent. For example to make sure the volume of fluids taken is recorded as opposed to “fluids taken well” which was being recorded in some records. A daily record system is also in use and this is completed on a daily basis by staff and ensures that the communication about peoples needs is shared with staff on each shift change. The daily records are detailed and serve as a good record of day to day life in the home. And it was good to see that these also cross reference with other records that are kept, for example visits by health professionals. Good records were available to confirm that good use is made of G.P’s and advice was sought on a regular basis as part of the process of meeting peoples health needs. The staff have made good use of visiting health professionals and have worked with the tissue viability nurse, continence advisor and other people who are Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 14 part of the community health support services such as speech and language therapists. The manager stated that in order to provide the highest standard of care in relation to pressure damage, the provision of equipment is, provided by the home and the expertise of the Tissue Viability Nurse is sought for guidance. In addition to this the home does monitor the progress of this by carrying out monthly updates. The manager confirmed that referals are always made to relevant professionals in the first instance if there are any concerns about a persons health. And a visit is requested from the GP during early signs of residents ill health. Observations made during our visit confirmed that staff deal with intimate care tasks in the privacy of service users rooms and this ensured that their dignity was maintained at all times. Staff were respectful in their mannner towards people and it was evident that some residents have their “favourites” among the staff team. Each service user has a named nurse and key worker. Care plans are reviewed monthly or earlier should there be a change in needs and similarly all health needs are reviewed as part of this. The care plan is then amended if required. The home uses a standardised monitored dosage system for the receipt, recording, administration and disposal of prescribed medicines. And records were looked at on both the nursing and residential unit. The practices for issuing prescribed medicines in the home are that the nurses are responsible for issuing medicines to people receiving nursing care and senior care staff take responsibility for issuing medicines to people who are receiving residential care. The records of administration on the residential until are generally well maintained however there were a number of gaps for several people. It could not be determined if medicines had been given for this period of time as staff had not signed to confirm this. A check of the cassette that holds the individual dose of medication confirmed that the medicines were not there. Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 15 In discussion with a senior carer it was established that medicines had been dispensed but staff had omitted to sign. The senior carer had noted this and was in the process of informing the manager about the administrative errors so that these could be discussed with staff. The administrative records on the nursing unit were better maintained and confirmed that these were being completed correctly. Each administrative record had a photograph of the service user and the divider contained information about allergies and the type of medicines they had been prescribed. One person has been supported by staff to manage their own insulin and another person has been supported to manage their own inhalers and this was noted on the administrative records. In respect of the person who manages their own insulin there is a need to ensure that this is supported by a risk assessment and this should be linked into their care plan. One person on a regular basis declines to take their prescribed medicines over a period of time. And though staff are aware of this and have sought the advice of the G.P. This needs to be kept under review. The records that are used to record those medicines referred to as “controlled drugs” were looked at. An audit of the “controlled drugs which are currently only in use on the nursing unit was carried out. This confirmed records were in good order and confirmed that good practices were in place by nursing staff. In discussion with staff it was confirmed that they have received appropriate training on the safe handling of medicines. The manager confirmed that she is currently carrying out a monthly audit and in addition to this the company carry out monthly audits of the medication systems and records. In discussion with the manager about the gaps on the administrative records on the residential unit. It was agreed that immediate actions would be carried out to rectify this. As this had been a requirement of the previous inspection report. Other area that related to medicines within the home that we looked at and that we discussed with the manager. Related to the storage and the temperature within the room. As during our previous visit high temperature readings were taken in excess of 25 degrees centigrade. Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 16 Temperature readings were taken during this visit and at times the temperature was 31 degrees centigrade. And though a fridge was available for those medicines that needed to be stored there the rest were stored in cupboards or in the locked medicines trolley. Most of the medicines in use require storage at a temperature below this according to the instructions on their packaging. And steps need to be taken by the manager to ensure that a suitable temperature is achieved. Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents lead fulfilling lifestyles through exercising choice and control over how they spend their day. People’s lifestyle is good with regular contact being maintained with relatives and friends and the residents receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. EVIDENCE: Routines within the home are as flexible as possible and take into account the service users choices. For example two people who are related like to spend most of their time in their room watching television. Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 18 And though this is supported staff also make sure that they pop in and out throughout the day to see if they are alright. And they also keep them informed of any activities that are taking place should they wish to join in. An activities coordinator is employed in the home and takes responsibility for organising a wide range of activities and also fund raising events. In addition to working 35 hours per week the activity coordinator will also work extra hours and this includes weekends. A recent fund raising event had been a bungee jump whereby staff and friends of Garden Hill took part in a sponsored bungee jump from Middlesbrough transporter bridge. This was a success with close to £1.000 being raised for the resident’s funds. The home was also selected for a person from a local college to come into the home to carry out a musical reminiscence programme. This course is mainly designed to support people with dementia with the aim of jogging memories through song, armchair exercise and reminiscence. An activity programme is in place and this confirmed what activities had been carried out or were arranged for a future date. These included bingo, cream teas, a pie and pea supper, Burns night celebration, aromatherapy club, history club, sing-along sessions and armchair exercises. Lists are kept of the numbers of people who attend the activities and this assists the activities coordinator in planning activities that people like to take part in. In discussion with the activities coordinator it was confirmed that they had met with service users and their relatives to discuss activities and any ideas that they had so that these could be included in the activities programme. The home had plans in place to research more places of interest that the residents could visit. And the activities coordinator was continuing to discuss previous past times with residents and to find ways of implementing them. The manager also identified improvements that they wished to make and this included making every effort to have more relative involvement in planned outings. And to ensure old time menus are available regularly as part of the themed entertainment nights. Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 19 There were a range of photographs throughout the home particularly in the lobby showing activities that residents had taken part in. The activities coordinator has recently concluded NVQ Level 2 training in customer care and is about to commence NVQ Level 3 training in the same area. On the day of our visits it was a pleasant warm day and a number of the residents chose to spend the afternoon sitting outside. They were joined by relatives who were visiting them. This provided a good opportunity to talk with them about the services being provided. All of the relatives with the exception of one were complimentary about the home stating that they had seen a number of improvements being made. They spoke highly of the staff stating that they worked hard for a long term and in a period where there had been no stability of management. They went on to say now that a permanent manager had been appointed the staff were being supported in their work. And they said that the new manager was making a difference in the home. They also confirmed that there are no restrictions on visiting the home and staff always made them feel welcome when they visited. Lunch was taken with the service users and this too was a good opportunity to observe staff practices and also have discussion with service users. The company uses the “Nutmeg” system, which analyses the content of the menus to make sure people receive a nutritional balanced diet. Though the menus do not show how service users have a choice of more cultural meals such as fish and chips in batter. Meal times are set in a relaxed atmosphere and although governed by the Company Nutmeg system there are 4 weekly menus with two choices for each course and if a resident does change their mind, where possible every effort is made to comply with their request for an alternatived meal It was evident that a range of choices are made available to the service users in other ways and the introduction of the pie and pea supper was one example. And at the meal time service users were asked what they would like to eat from the choices available on the menu. Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 20 The meal on the day was nicely presented, hot and tasty and of sufficient quantity. Tables were well set out with tablecloths, placemats, condiments and serviettes. Appropriate arrangements are also in place for those people who required a pureed or softened diet. And this ensured that food was presented in a way that looked appetising. And where people required support to eat their meal this was provided by staff. Some people chose to eat in what is known as the coffee lounge. They said there were fewer distractions for them in this room indicating that at times in the dining room it can be disruptive and noisy due to the particular illnesses of some service users. The mealtime was unhurried and it was good to see that where people needed specialised implements to assist them with eating their meal that these were provided. In discussion with service users they confirmed that they get plenty to eat and that the food is always nice. Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A clear accessible complaints procedure gives residents and their relative’s confidence that they will be listened to and taken seriously. Furthermore it provides information that is effectively used to improve the service. The manager and staff have a good understanding of local adult protection procedures, which helps to ensure the protection of residents from abuse. EVIDENCE: The home have polices and procedures in place that deal with complaints. Evidence available confirmed that when complaints have been made the company have addressed these quickly. And records are available to confirm what actions have been taken. A previous anonymous complaint that had been made related to a member of the nursing staff working excessive hours and there also being a shortage of skilled nursing staff. The Care Quality Commission (CQC) instructed the company to investigate these concerns. And this was dealt with satisfactorily. Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 22 In discussion with people who live in the home they confiremd that they had no complaints but if they did would raise them with the manager. Similarly when we spoke to service users relatives who were visiting the home they too said that they had no concerns. They went on to say that they would be happy to raise any concerns with either the staff or the manager knowing that this would be dealt with to their satisfaction. The relatives described the new manager as being approachable and they stated that it was positive that the home had now employed a permanent manager. Relatives stated that they had received assurances from the manager that a number of improvements were to take place in the home. And this would include looking at how service users can continue to be supported to raise any cocnerns that they have. In discussion with the manager it was confirmed that individual residents can also access appropriate advocacy services to support them should they wish to make a complaint. Polives and procedures are in place that deal with safeguarding adults. And confirmation was received from the manager that a high percentage of staff have either completed or are near completion of appropriate safeguarding training. In discussion with staff they said they knew what actions to take if they had any concerns about a service users well being and safety. All staff are aware of the Companys Whistle Blowing Policy. And some staff said that if they had any concerns they would inform the manager immediately. Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, well maintained and has a good range of facilities. This promotes a positive image for residents and furthermore ensures that they remain safe and well. EVIDENCE: During our visit we looked at all communal areas of the home and also a number of bedrooms on each floor. A number of requirements made during our previous visit had all been addressed and this ensured that the building was being maintained to a good standard. Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 24 Decoration has been carried out to a number of the communal areas. And the area referred to as the coffee lounge can also be used by service users to eat their meals should they prefer not to sit in the main dining room. A number of matters that potentially contravened the fire safety in the home were noted. And this related to bedroom doors on the first floor being wedged open with a variety of objects that ranged from a chair to a wheelchair. This was brought to the attention of the manager who dealt with this immediately. On our second visit to the service doors were not being wedged open. Overall the building is well maintained, clean, and free of unpleasant odours and with a good standard of hygiene evident. The manager confirmed that she would be looking at making improvements in the home and this included updating some of the communal bathrooms and wet room. Ordering of soft furnishings to make the home more personalised. And touching up paintwork when it is damaged by wheelchairs. Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27. 28, 29 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are sufficient to ensure that residents’ needs are met. Furthermore the staff receives sufficient training to support them in their work, to ensure residents receive good quality care. Robust recruitment procedures are in place to prevent unsuitable people being employed. EVIDENCE: A permanent manager has now been recruited to work in the home and also a deputy manager has been appointed. This is discussed more fully in sections 31 – 38 of this report. Staffing rotas confirmed that sufficient staffing was on duty to meet the needs of the people living in the home. On duty at the time of our visit was 1 qualified nurse, 1 senior carer and 5 care staff. And due to the layout and design of the building staff were allocated to work on different floors of the building. Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 26 Discussion held with the manager confirmed that the staffing levels are kept under review and adjusted accordingly. In addition to this there were also housekeeping and catering staff working in the home and also the manager, an administrator and the activities coordinator. In discussion with the manager it was confirmed that sixteen staff have completed NVQ Level 2 training and three staff are currently undergoing NVQ Level 3 training. This has ensured that staff have received training that is appropriate to their work. Records were available to confirm other training that staff have undertaken and this included. Fire training for all staff, Food Awareness for all but 2 of the staff with health and safety training being an ongoing process. Training had been booked for August for staff to receive updated training in moving and handling. The manager also confirmed that 60 of the staff had received training in safeguarding adults and 40 were currently undergoing this training. Once completed staff would be undertaking training in Infection control. It was also confirmed that staff who are responsible for administering prescribed medication have received training in safe handling of medicines. A training matrix was available and this confirmed what training had been achieved and also what was planned. Since our last visit four new staff have been appointed. Records available in their staff file confirmed that records of recruitment were satisfactory. Discussions held with staff during our visit confirmed that morale was good and staff were positive about the changes and the appointment of a permanent manager. Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An experienced and qualified manager is in post, and this ensures that the service is effectively run in the best interests of the residents; that they are safe and well cared for and their rights are safeguarded. EVIDENCE: Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 28 Since our last visit a new permanent manager has been appointed and has been in post since April 2009. This person has appropriate experience and qualifications to carry out the job as manager. As part of the ongoing development the manager has recently appointed a deputy manager who is a qualified nurse and who will deputise in her absence. The appointment of the manager and the deputy manager has ensured that staff receive consistent support and supervision to do their work. In discussion with the manager it was confirmed that all staff are now receiving formal supervision and all staff have had at least 2 periods of supervision since the new manager took up post. Records of supervision were available but these were not viewed during our visit. Since taking up post the manager stated that she had been looking at staff practices and also what developments were needed in the home. Staff were being supported to work in a way that was required by the manager and support was being offered to them. The manager stated that she has an open door policy whereby any staff member, service user or their relative can approach her to discuss any matters about the home. And in addition to this she holds a once weekly surgery (on a Wednesday) where she stays in the home up until 10pm. This enables service users, their relatives or anyone who wishes to, to have the opportunity to meet with the manager. The manager has also used a monthly newsletter which is circulated to all service users and their relatives to inform them of developments in the home. A range of documentation is available and up to date to demonstrate the company and the home carry out regular audits as part of the quality assurance procedures. The operations Manager visits the home on a monthly basis to carry out regular audits. All safety equipment is assessed on a regular basis and certificates of approval are obtained. Policies and procedures are updated by head office and all hazardous substances are stored as stated in health and safety regulations and staff are encouraged to report areas of concern that would be acted upon in the first instance. Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 29 Records are kept to confirm that staff have undertaken regular fire drills and received fire instruction. Monies that are held on behalf of service users are maintained in accordance with the company’s policies and procedures. A computerised system is in use and this demonstartes that a record is kept of all transactions. Money that is banked on behalf of a servcie user is paid into a combined account. The records show what interest a service user has accrued when money is held on their behalf in this combined bank account. The Homes Administrator is responsible for maintaining the records or service users monies and ensures that these are in good order and up to date. Appropriate records are in place to record all accidents in the home and also what actions have been taken by staff in respect of any accident. As part of the ongoing improvements within the home the manager has identified areas of improvement that will be developed over the next 12 months. And these relate to ensuring that all staff are issued with specific guidelines on the actions to follow during fire drills and what to do in the event of a fire. These guidelines will be specific to Garden Hill and will take into acocunt the design and layout of the building. Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 30 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 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 31 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 OP38 Regulation 23 Requirement The manager must ensure that fire safety and the means of escape are not compromised at any time. And ensure that all fire doors are kept free of any obstructions. Timescale for action 31/08/09 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 OP7 Good Practice Recommendations The social history for each resident should continue to be developed so that this information can be used as part of the care plan. And care plans should continue to be developed as advised during the inspection. Staff should ensure that fluid balance charts are updated to include sufficient detail to demonstrate that people are receiving the correct amount of fluids as part of the plan of care. The registered person should ensure that: Medication is always signed for at the time of administration so that people are protected from the Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 32 2. OP8 3. OP9 potential of medication errors. Action should be taken to ensure medication is stored at the appropriate temperatures. For those people who decline their medicines on a regular basis, this should be kept under review with advice being sought from the G.P. Garden Hill Care Home DS0000070307.V375976.R01.S.doc Version 5.2 Page 33 Care Quality Commission North East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northeastern@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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