CARE HOMES FOR OLDER PEOPLE
Garden House Priestlands Sherborne Dorset DT9 4HN Lead Inspector
Debra Jones Unannounced Inspection 14th June 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Garden House DS0000026807.V300014.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 House DS0000026807.V300014.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Garden House Address Priestlands Sherborne Dorset DT9 4HN 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) 01935 813188 NO FAX Garden House Rest Home Limited Mrs Gillian Houghton Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th January 2006 Brief Description of the Service: Garden House is a residential home registered to accommodate 15 older persons. It is situated in a quiet residential area of Sherborne and within walking distance of the town centre. Mr Calder purchased the home in 1992 and continues to take an active role in the management of the home. He lives in private accommodation within the grounds of Garden House. In August 2005 a new registration certificate was issued to reflect the fact that the home is under the ownership of Garden House Ltd (the change to a limited company occurred in 1999). Mr Calder is the responsible individual and Mrs Houghton is the registered manager. The home is established in the main house and an extension to the property named Trudys Cottage and is set in landscaped grounds. The front garden is set to lawns and herbaceous borders with mature trees and shrubs and a parking area for visitors convenience. A series of steps lead to the front entrance and a large sliding glass door/window at the front of the house allows access to a raised patio area with garden furniture. The back garden has mature fruit trees, lawns and seasonal flower borders. Once inside the home there is level access to residents rooms and communal facilities. The accommodation is furnished and decorated to a high standard. Fees currently range from £300 - £550 per week. Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 5 hours on 14th June 2006 and was the home’s key inspection for the year. The requirements and recommendations made at the last inspection were followed up to see how the home was progressing. The Inspector looked around some of the building and a number of records were inspected. The manager, staff and 5 of the residents were spoken to. During the visit residents were very positive about the home and the care that they received there. Comments included:‘It is so very good here’ ‘The staff are very kind – excellent!’ ‘This is a very friendly home.’ Prior to the inspection the home gave out comment cards on behalf of the Commission to people living in the home so that they could give feedback about their experience. 13 were returned. Comments included; ‘You couldn’t better it’ ‘Very satisfied’ ‘If only all homes were run to the high standard of Garden House.’ What the service does well:
Garden House is fortunate in having both a stable resident and staff group, both of which help to foster a family atmosphere where residents take an interest in each other’s welfare. The emphasis from the management is on encouraging an informal atmosphere and on promoting the comfort of service users. There is a procedure in place for the assessment of prospective residents to ensure that only people whose care needs can be met are admitted. Care plans are written for all residents that are clear about what the residents can do for themselves and what they need help with. Daily notes are kept about what care is given to the individual residents along with other things that happen at the home. Having good care plans in place ensures that staff have all the information they need to fully meet residents’ care needs. Residents are appreciative of the efforts of the staff and say that they are well looked after. Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 6 Residents’ health needs are well met by the home working with community health professionals. Medication is generally well handled at the home promoting the health and well being of residents. Residents confirm that they are well cared for and treated with respect and dignity. There is a varied programme of activities, which suit residents. Provision is also made to enable residents to have their spiritual needs met through visiting clergy from different denominations. Residents are encouraged to retain control over their own lives. They can receive visitors whenever they wish and their visitors are always made welcome by the staff. Residents and staff enjoy the meals at Garden House. Meals are prepared from fresh ingredients and are prepared in the style of “home cooking”. The complaints procedure reassures residents that their views are important to the home and that any complaints they, or their supporters raise will be properly investigated. The accommodation is generally well maintained. The bedrooms and communal areas are light, clean and odour-free, providing a pleasant and comfortable environment for residents. Residents are happy with the laundry arrangements. The home is suitably staffed with a well-motivated group of workers. Staff members enjoy working at the home and consider that they are well supported by the management. The majority of the staff members have attained a nationally recognised qualification, either NVQ level 2 or 3. Staff have access to the basic training that they need to do their jobs well. The manager has years of experience caring for people and has achieved the registered manager’s award, equivalent to NVQ level 4. A formal survey of residents’ views is conducted each year and the results confirm that there is a high level of contentment with the provision of services. The home respects residents’ rights to look after their own finances. Systems, regular checks and staff training are all in place to ensure that Garden House is a safe place to live. What has improved since the last inspection?
The registered manager has submitted the new medicines policy to the Commission Pharmacist. Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 7 The policies in place demonstrate the home’s commitment to providing a safe environment for residents that is free from abuse. These are no in line with the local ‘No Secrets’ guidelines. The home manager has all the information she needs to ensure that the next time she recruits any new staff this is done in accordance with the law and that all pre employment checks are carried out to ensure that residents are not put at risk of potentially unsuitable people working at the home. All staff have had training in moving and handling. The fire assessment at the home has been reviewed and updated. Also visual checks to fire fighting equipment are now carried out monthly at the home. What they could do better:
The home’s Statement of Purpose must be amended to comply with regulations. Prospective residents would benefit from having the outcome of their pre admission assessment in writing e.g. being given written assurance that the home can meet their needs. The home could do with introducing a system whereby they review all care plans on a monthly basis to ensure that that they are taking any changing needs of residents into account. The home must tighten up their medication administration system through self auditing e.g. looking at what medicines they have in the home and what is recorded as being there. Where staff are having to make entries on the medication administration records or note changes to the medicines that are to be administered to residents they should always get a second person to check what they are doing and sign the record to confirm this check. Sample ‘initials’ that staff use to sign the medicines records should be kept on file. It would be also be good if the home could get their pharmacist to always note on medication administration records whether someone has a known allergy or not. The home should replace the metal box that they use to keep medicines in the fridge with a plastic one. All staff must have training in abuse awareness to ensure that they have a real understanding of the issue and thereby fully protect residents. The risk assessments conducted in respect of radiators, pipe work and hot water temperatures must be sufficiently comprehensive and regularly updated to take into account the individual circumstances of residents and cover all the areas they have access to. Where deemed appropriate timely action must be taken to minimise risk. Records must be kept of both the assessment the action taken.
Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 8 The home’s policies/procedures should be reviewed on at least an annual basis to ensure that the information contained within them is up-to-date. The views of residents’ representatives and external professionals who have contact with the home should be ascertained through the use of periodic surveys (e.g. once a year). 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. Garden House DS0000026807.V300014.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 House DS0000026807.V300014.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. 6 is not applicable to this home. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The statement of purposes gives useful information to prospective residents and their supporters but does not include all the information required by law. The home carries out pre-admission assessments to ensure that no one is offered a place at the home whose needs can’t be met. Prospective residents and their supporters are able to visit Garden House before making a decision about whether it is right for them or not. EVIDENCE: The statement of purpose was last reviewed in January 2005. Whilst giving a wealth of useful information it lacks some that is required by law. The care files for 2 residents demonstrated pre-admission assessments were completed before they moved into the home. The manager conducts an assessment of prospective residents by visiting them and consulting with other people who have relevant information, e.g. relatives and/or health or social care professionals.
Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 11 Whilst the home informs prospective residents in writing what the outcome of their pre admission assessment has been if the home cannot meet their needs, confirmation in writing is not given to those that the home can accept. One new resident talked of how impressed she had been by the homely atmosphere in the home when she came to look around. Thirteen residents returned comment cards prior to the inspection. All but one who commented said that they had received a contract and that they had had enough information before they moved in so they could decide if it was the right place for them. Comments included:‘XX was too ill to decide for himself so was decided by family and social services’ ‘Her sister chose this home because she was in another home.’ ‘XX came for a weeks respite and never left!’ Garden House DS0000026807.V300014.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual plans of care show what the person’s health, personal and social care needs are and how they will be met whilst living in the home. The health needs of the residents are well met with evidence of good support from community health professionals. The medication at this home is generally well managed promoting the good health and well being of residents. Residents are treated with respect and their right to privacy is upheld. EVIDENCE: Some care files were reviewed at the inspection visit. Each service user has a care plan, which is agreed with them. Residents confirmed that they were very happy with the care they received at the home from the staff. There was evidence to show that plans are updated when needs change but not that all plans are reviewed regularly. Daily notes support and evidence the delivery of care to residents. Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 13 When asked ‘do you get the care and support you need?’ eleven of the thirteen residents who returned comment cards replied ‘always’, one ‘usually’ and the other ‘sometimes.’ Each resident is registered with a general practitioner. The staff monitor the well-being of residents and contact the primary care team when necessary. Residents confirmed at the inspection that the home got their GPs to see them when they asked. Records demonstrated that residents have their health needs met by community professionals e.g. GPs, district nurses, chiropodists, opticians and dentists. A range of equipment is evident in the home including bathing equipment, raised toilet seats and walking aids. Eleven residents who returned comment cards said that they ‘always’ received the medical support they needed and 2 said they ‘usually’ did. Only staff who have been trained in handling medication safely dispense medicines to residents. At the time of the inspection no residents were managing their own medication. Medicines are appropriately stored / locked away. Most medicines are dispensed from a monitored dosage system filled by a local pharmacy. Samples of medication administered from boxes and bottles were checked. Boxes were marked with the date that they were brought into use but the total number of tablets that should be in the home was not immediately obvious. Evidence of the home undertaking their own medication audits was not available. Where there were handwritten changes to / entries on the medication administration records these were not signed by two people to show that they had been checked with the direction of the GP. Sample signatures of staff giving medicines are held in the file but not sample initials (as used by staff in the records.) A system for returning medicines not used by residents is in place. In the ‘any allergies known’ section of the medication administration records (MAR) printed by the pharmacist where ‘none were known’ this was not being routinely noted. At a previous inspection the home was asked by the Commission’s pharmacist to amend their medication policy. This has been done and has been submitted to the Commission for approval. The home is awaiting the delivery of an inner box for their medicines cupboard to use for the storage of some medicines. Some eye drops are being stored in the fridge. These are being kept in a metal lockable box. Residents spoken to confirmed that they had confidence in the medication administration at the home and that they got their medicines when they were supposed to. Residents said that staff were very good and treated them well.
Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 14 Service users are able to pursue their preferred lifestyle and interests and their privacy is respected. All residents have their own bedrooms and receive all personal care and health interventions in private. Every room has a telephone point so residents can choose if they have their own phone or not. Staff members were observed to approach service users in a courteous and friendly manner whilst retaining a pleasant and informal atmosphere in the home. Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 15 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, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers a varied programme of activities, thus providing a stimulating environment for residents. The home makes arrangements which enable residents to have their spiritual needs met. The home makes visitors welcome and thereby helps, residents maintain contact with the local community. The home serves nutritious and well cooked meals which meet the expectations and dietary needs of residents. EVIDENCE: The regular programme of activities includes the following: a quiz and use of the “memory box” library on alternate weeks, a bingo session once a week and a daily crossword puzzle and game of cards. The sessions are well attended. There are also some outings arranged, the next being to Stourhead. Two residents recently went on a cruise. Local school children also visit the home regularly to talk with residents and engage in activities. Three arrived on the afternoon of the inspection visit. A summer party is planned for residents and their friends and families. Residents spoken to talked of the things they liked to do with their time. These included knitting, reading and playing cards.
Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 16 In respect of spiritual needs a Holy Communion service takes place regularly and a Roman Catholic priest visits. Of the thirteen residents who returned comment cards seven said that they it was ‘always’ the case that there are activities arranged by the home that they could can take part in; five said that this was true ‘usually’ and three said ‘sometimes.’ Residents receive visitors whenever they wish – either in their rooms or in the communal areas - and their visitors are always made welcome by the staff. One resident said how good it was that their visitors were offered tea when they arrived ‘in the way that you would offer a drink to a visitor in your own home.’ A visitor spoken to praised the home and the service his aunt got. Friends and relatives of residents are encouraged to participate in the life of the home and to maintain contact. Information regarding visiting arrangements is contained in the statement of purpose. The visitors’ book confirmed the number and range of visitors to the home. Residents at this home are well able to make their choices and opinions known to staff. They are very much in control of how they live their lives at the home and most have the support of families or supporters / solicitors to help them with their affairs. Information regarding accessing external advocates is available. There is information in the home’s statement of purpose about residents accessing their personal records if they wish. Residents can spend the day where they like, in the lounges / dining area or their rooms. Some are able to come and go from the home as it suits them whilst others need staff or family members / friends to accompany them. Residents are able to personalise their bedroom by bringing in items of furniture and other personal possessions. Residents said that they enjoyed the meals at Garden House. One service user commented at lunch that “the food is always like this, always a good choice of fresh vegetables”. Lunch on the day of the visit was roast pork and gravy served with fresh swede, brussel sprouts, carrots, cauliflower and roast and / or boiled potatoes. Dessert was mandarin cheesecake with double cream or stewed apple. Fruit juices and water are served with meals. Most residents are able to help themselves to what they want. Those that aren’t are assisted by staff who encourage them to make choices about what and how much they want put on their plates. Meals are prepared from fresh ingredients and in the style of “home cooking”. There were good supplies of fresh fruit and vegetables in the storeroom. All residents spoken to said that the standard of food was very good or excellent. Account is taken of residents’ likes and dislikes and of any specific dietary needs. Some residents choose to have their meals in their bedrooms or in one Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 17 of the two pleasant and light communal rooms. All are encouraged to eat with others at lunchtime, but their wishes are respected if they don’t want to. A record of meals is maintained. Comment cards returned from residents confirmed that nine people ‘always’ liked the meals and four ‘usually’ liked them. Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 18 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The procedure in place reassures potential complainants that they will be listened to, taken seriously and their complaints acted upon. The home has policies and procedures to protect residents; telling staff what to do if they are concerned about abuse. EVIDENCE: There have been no complaints to the home or the Commission since the last inspection. The home has a straightforward complaints procedure in place that meets the Care Home Regulations and the National Minimum Standards. Residents confirmed at the inspection visit that they would know who to speak to if they were unhappy with anything in the home and would have confidence in things being sorted out for them. The comment cards sent to residents ask the question ‘Do you know who to speak to when you are not happy?’ Thirteen residents sent back cards. Ten residents answered ‘always’ to this question and three said ‘usually.’ In respect of knowing how to make a complaint seven said ‘always’, two said ‘usually’ and two said ‘sometimes.’ There have been no allegations of abuse at the home. Garden House has adult protection, “whistle blowing” and responding to aggression/restraint policies/procedures. The wording of the adult protection procedure has been amended to make it clear that no investigation of an alleged abuse incident is
Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 19 investigated by the management prior to obtaining the approval of an officer from Social Care and Health. Training for all staff in abuse awareness is planned for later in the year. Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 20 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): 19, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Ongoing attention to the daily maintenance of the home ensures the comfortable environment for the residents living there and anyone visiting. The home is kept clean and hygienic and smells fresh, making it a pleasant place to live. EVIDENCE: The inspector visited all communal rooms / areas and a sample of bedrooms. The home is homely, comfortable and well maintained. The communal rooms are light and comfortably furnished. Bedrooms are personalised to the resident and it was clear that people are able to bring items into the home. Residents have the specialist equipment and items of furniture that they need to maintain their independence. There are patio areas and a garden for residents to enjoy. Bathrooms and WCs have the necessary aids to enable service users to use facilities safely
Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 21 The home is centrally heated with radiators in all areas accessed by service users. Radiators do not have covers or low heat surfaces. A risk assessment has been undertaken and the outcome written down. At present it has been assessed by the home that the risk to residents does not merit the covering of radiators or pipework or the further limiting of the temperature of the hot water coming out of taps. This assessment is based on the physical abilities of residents and their understanding and appreciation of risk. Some measures are put in place e.g. The home’s policy is for staff members to always run baths and check the temperature before residents get in. Some radiators have furniture placed in front of them to minimise risk. The building complies with the requirements of the fire service who are next due to visit in June 2008. All areas of the home were found to be clean and free of unpleasant odours. Residents expressed satisfaction with the cleanliness of the home and the way that the staff managed their laundry. The laundry area was in good order and houses appropriate washing machines. It is not ideally situated, adjoining the kitchen, but staff are clear about the precautions they need to take to safeguard hygiene standards. Of the thirteen residents that returned comment cards twelve said that the home is ‘always’ fresh and clean and one said it was ‘sometimes.’ Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 22 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The stable and well-motivated staff group carry out all duties needed to meet the needs of the residents at the home. The home promotes the achievement of nationally recognised care qualifications. Residents are protected from potentially unsuitable people working at the home by the checks that the home have carried out on their staff. The home enables staff to access the training the need to do look after residents. EVIDENCE: Staff members are employed in sufficient numbers by day and night to carry out the care, domestic and catering duties in the home. A roster is in place which records staff cover each day and a record of the hours worked by staff members is kept in the diary. Only the first names of staff are listed on the roster. Residents said that they were happy with the staffing arrangements that are in place. Residents were asked in the comment cards are the staff available when you need them? Eleven said ‘always’ and two said ‘usually’.
Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 23 When asked ‘do they listen to and act on what you say? Eight said ‘always’ three said ‘usually’ and two ‘sometimes.’ The manager encourages staff to gain a nationally recognised qualification following completion of a probationary period. Seven of the ten staff members have achieved either NVQ level 2 or 3. As noted throughout the report, residents have a high opinion of the competence of the staff. No new members of staff have been recruited since the last inspection and the home does not have any staff vacancies. The manager has all the up to date information needed to properly recruit the next member of staff they appoint including • getting full employment histories from staff, • statements in respect of their fitness to do the job • getting a POVA check, all before the staff member begins working at the home. No staff are going through an induction programme at present. The manager is aware of the new induction programme devised by Skills for Care that can be used at the home when there is next a new member of staff. Records are kept of training courses that staff have attended. These included moving and handling training, which all staff completed in April 2006. Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 24 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, 33, 15 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager of the home understands the needs of the people living there and works hard to ensure that Garden House is well run. Residents’ views indicate a high level of satisfaction with the home; further work is needed to produce a comprehensive quality assurance system. The home has the necessary arrangements in place to safeguard residents’ financial interests. Policies and practices promote the health, welfare and safety of the residents and staff at Garden House. EVIDENCE: Mrs Houghton, the registered manager, has many years experience of managing a care home. She undertakes day-to-day responsibility for the running of the home, supported by Mr Calder, the registered Responsible
Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 25 Individual for the Company. Her role is clearly understood by the residents and the staff. Mrs Houghton has achieved the registered manager’s award at NVQ level 4 and keeps herself up to date with care practice by attending the relevant courses that all staff at the home undertake. The manager conducted a survey of residents’ views about the home in August 2005, the results of which indicated a high level of contentment and no areas of concern. The annual survey did not show that representatives of residents and external professionals, who have contact with the home, had been included. Staff have the opportunity to share their ideas as to how the home might be improved at staff meetings. Minutes are taken of these meetings. A range of policies/procedures underpin practice at the home. Not all had been reviewed in the last year to ensure that they are in accordance with guidance and expected practice. The home has no involvement with residents’ finances or money, in accordance with its own stated policy. Residents are given the option of having a lockable facility for the safe keeping of valuables if they so wish. The home has a health and safety policy. All accidents are documented. Accident records are analysed regularly and trends looked for to help prevent future accidents. Accident records could be clearer about whether accidents are actually witnessed by the person writing the report or if the information about the accident has been told to them. There is a rolling programme of staff training in respect of matters relating to health and safety e.g. moving and handling, first aid, food hygiene and infection control and what to do in the event of a fire. It is clear in the fire book who trains the staff and the content of that training. Fire fighting equipment is checked regularly by the home and by an external contractor. Appropriate records are kept. The homes own fire risk assessment was last reviewed and updated in May 2006. Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X 2 3 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 4&5 Requirement The statement of purpose and service user guide must be amended to comply with regulations. A copy of the revised documents must be sent to the Commission and be supplied to each service user and/or their representative. Previous timescales not met 1/10/05. 2. OP3 14 The registered person shall not 01/10/06 provide accommodation to a resident at the home unless they have confirmed in writing to the resident that having regard to the assessment the care home is suitable for the purpose of meeting the resident’s needs in respect of his health and welfare. There must be evidence of 01/10/06 regular audits of the records of administration of medicines to ensure that they are given as prescribed and accurately recorded. Previous timescales not met 28/02/06.
Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 28 Timescale for action 01/10/06 3. OP9 13 4. OP18 13 The registered person shall make 01/10/06 arrangements, by training staff or by other measures, to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. Risk assessments conducted in respect of radiators, pipe work and hot water temperatures must be sufficiently comprehensive and regularly updated to take into account the circumstances of residents and all areas to which they have access. The roster of who is to work at the home must contain the full names of members of staff. The views of residents’ representatives who have contact with the home should be ascertained through the use of periodic surveys (e.g. once a year) at the home as part of the quality assurance system. 01/10/06 5. OP25 13 6. OP27 17 01/07/06 7. OP33 24 01/10/06 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. Refer to Standard OP7 OP9 Good Practice Recommendations The resident’s plan should be reviewed at least once a month. Evidence of this review should be available. • Where there are handwritten changes / entries to the medication records these should be countersigned by another competent person to show
DS0000026807.V300014.R01.S.doc Version 5.2 Page 29 Garden House • • • 3. OP33 that the changes accord with the GP’s direction. All medication administration records should record if there are any allergies known or if there are not. Sample ‘initials’ should be kept with the sample signatures of staff. The metal box used to keep medicines in the fridge should be replaced with a lockable plastic one. The home’s policies/procedures should be reviewed on at least an annual basis to ensure that the information contained within them is up-to-date. The views of external professionals who have contact with the home should be ascertained through the use of periodic surveys (e.g. once a year). 4. OP33 Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Garden House DS0000026807.V300014.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
