Inspection on 09/09/05 for Gardenia House

This inspection was carried out on 9th September 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Gardenia House 19/06/06

Gardenia House 14/02/06

Gardenia House 10/01/05

Gardenia House 07/09/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Gardenia House 19 Pilgrims Court Farnol Road Dartford Kent DA1 5LZ Lead Inspector Eamonn Kelly Unannounced 9 September 2005 10:00 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 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. Gardenia House H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Gardenia House Address 19 Pilgrims Court Farnol Road Dartford Kent DA1 5LZ 01322 290837 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Heritage Care Limited PC Care Home 25 Category(ies) of Older Age (23 registration, with number Physical disability (1) of places Physical disability over 65 (1) Gardenia House H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Care for people with physical disabilities is restricted to one resident whose date of birth is 11/06/1936 Care for 1 older person with physical disabilites is restricted to a person whose date of birth is 21/06/1934 Date of last inspection 10 January 2005 Brief Description of the Service: The home is owned by Heritage Care Ltd. and provides residential care for up to 25 people. All bedrooms are single (each has en-suite facilities, some with showers). Bedroom accommodation is situated over 3 levels: ground, first and second floors are served by a shaft lift. The home is situated on the outskirts of Dartford, relatively close to bus and train services and local amenities. The home has parking facilities at the front. There are gardens available to residents and visitors at the rear of the premises and at the side. Gardenia House H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit (unannounced) comprised a review of some of the home’s records and policy statements, meeting some service users and members of staff, and visiting parts of the premises. A further visit was made on the evening of September 10th to see procedures surrounding the evening meal and when service users retired to their bedrooms. A visit was also made on September 12th to further assess the levels of compliance with the substantial number of requirements contained in the previous inspection report. At the end of the inspection visit, a note was provided to the manager outlining the general issues to be contained in the report. What the service does well: What has improved since the last inspection? The new manager has identified the need for many improvements and has begun these to help improve the lives of service users. Medication procedures have been reviewed and improved. The working patterns of care team leaders were revised. Staffing levels (and staff “mix”) are subject to review as well as implementation of required core training and qualification training. The manager is implementing a new maintenance schedule. He is committed to sorting out the perimeters of the home so that service users and members Gardenia House H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Version 1.40 Page 6 of staff know what land, garden area and car-parking spaces belong to the home and have a better level of day-to-day security. He is also committed to improving support systems (care plans, reviews, and access by service users to appropriate health services) at the home so that these have a more positive effect on the way good care is provided to service users. Individual care team leaders now have responsibility for supervising specific procedures (eg. medication, care plans, health and safety, training): the purpose is to continuously monitor effectiveness and advise the manager where improvements are possible (as part of quality assurance measures). What they could do better: This report outlines issues identified as needing attention, as follows: • • • • • • • • • • Better and more accurate pre-admission written information for prospective service users and their supporters. Substantial improvements to service user’s care plans and reviews of care. Evidence in the service user’s guide (supported by training records) that staff have received appropriate core training and qualification training. Changes in the way meals are provided so that service users do not have intervals of more than 12 hours between meals and have supper each day. Better procedures to enable service users to obtain sufficient mental and physical stimulation. Improved intervention techniques to encourage service users not to immediately return to their bedrooms after breakfast, lunch and tea. Improvements to the premises (replacement carpets, redecoration, maintenance schedule with the support of an in-house maintenance person). Identification of the actual perimeters of the premises (including the home’s gardens) so that service users and staff have sufficient safety and security. Review of the home’s registration certificate so that it reflects the current position. Better administrative arrangements and positioning of facilities for the manager and care team leader on duty. Gardenia House H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Version 1.40 Page 7 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. Gardenia House H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Gardenia House H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3 and 6 Prospective service users and their supporters do not have the benefit of suitable pre-admission written information. EVIDENCE: The current pre-admission written information presented to potential service users is misleading and out-of-date. The manager is currently re-writing this material so that a suitably presented and accurate information pack is given to all prospective service users or their supporters. The purpose is to enable them to make an objective assessment of the quality of care and accommodation before they make a decision to take up residence. A personal contract is given to all service users at admission stage. The manager is updating this contract so that all the rights and responsibilities of both parties (the home and the service user) are clearly outlined. These modifications are likely to make the personal contract a useful document for both parties. Previously there were significant shortfalls in the process for assessing the care and accommodation needs of prospective service users. The manager and care Gardenia House H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Version 1.40 Page 10 team leaders have addressed this issue in the case of recent referrals for admission and detailed assessments are now made. The current evidence is that service users and their supporters are assured that their needs will be effectively met. The home does not admit people for recuperative care following discharge from hospital but respite care in some circumstances is considered. The revised service user’s guide will fully describe admission procedures and criteria for admission. Gardenia House H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 Service users written plans of care are not sufficiently accurate so as to be a reliable guide to the effectiveness of the care being provided. EVIDENCE: In the examples of care plans seen, the evidence was that the current system is exceptionally poor: the process is not effective enough to enable care staff to accurately record service user’s identified care needs, the care allocated to each need and information following reviews. The manager is addressing this shortfall in recording initial assessment and subsequent upkeep of service user’s care plan records. Initial thoughts about an effective system involve the probability that a more simple and straightforward record will be devised: this will be an improvement on what is currently a confused procedure [based partially on numerical allocations of scores (ie. Barthel/Waterlow indices)] and other records which, on the evidence seen, bore little relationship to the needs of service users and goals of care expected to be in place. It was difficult to confirm that service user’s health and personal care needs were being adequately addressed. The home has difficulty in, for example, Gardenia House H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Version 1.40 Page 12 ensuring that appropriate measures were taken to ensure that people who previously had a history of self-neglect were kept clean and well presented. It was unclear whether service users with hearing and sight difficulties had immediate and appropriate access to health care provision. There was some tendency for staff to express exasperation and indicate that it was the “choice” of service users to remain alone and isolated in their bedrooms for very long periods. Service users are conditioned from admission stage to go to their bedrooms after breakfast, dinner and tea. The previous report outlined serious problems with the medication system. There was evidence that the problems identified have been addressed. A care team leader now has a general responsibility for overseeing procedures and identifying shortfalls. There is a need for all members of staff who administer medication to receive appropriate training: the manager is arranging this. A CSCI pharmacy inspector will make an assessment of progress achieved in due course. Service users expressed general satisfaction with the care they received. However, some said that there were constant pressures on the low numbers of staff on duty and, as a result, they did not like to be a nuisance to them. Whilst the evidence was that staff treated service users with respect, the time constraints (and possibly the issue of conditioning from admission stage) on staff and dispersal of accommodation over 3 floors meant that relatively low levels of attention were available to service users (for example, many service users went directly to bed at 06.30 pm without a bath or wash and without a process in place for providing supper). Gardenia House H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Version 1.40 Page 13 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 standard(s) 12, 13 & 15 Service users do not receive adequate encouragement and support in remaining mentally and physically active. EVIDENCE: The previous inspection report indicated that there were 2 planned activities during a seven-day period and one of those was hairdressing. The manager has identified relevant shortfalls in this context and is addressing them. Most service users tend to return to their bedrooms after breakfast, dinner and tea. It is stated that it is their choice to do so. Some may indeed follow this path because there is no alternative. There was evidence of extreme loneliness in some cases: isolation is unlikely to help. Constant leadership is needed throughout the day and evening to ensure that service users are encouraged to come out of their rooms and be attracted to a better life at the home. The activities organiser provides 19 hours service a week (3 of these hours are spent on gardening). The activities organiser maintains detailed records relating to the improvement of service users as can be seen from participation in activities: such improvements should be recorded as part of service user care plan records. Gardenia House H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Version 1.40 Page 14 The lounge is on the 1st floor: there is no central focus for staff/service users to be together in a communal area such as a shared dining room/lounge area. This may be partially addressed when a kitchenette is installed in the lounge area. Service users can meet their visitors at any reasonable time in private. The home has a minibus which the manager plans to use more frequently than previously. Service users have a longer than 12 hour gap between their tea and breakfast (ie. 06.30 pm to 08.30 am). Supper is not provided. Gardenia House H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Version 1.40 Page 15 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 standard(s) x These Standards were not assessed on this occasion. EVIDENCE: Gardenia House H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Version 1.40 Page 16 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 standard(s) 19 and 26 Whilst bedroom accommodation and facilities on 3 floors served by a modern shaft lift offers a good standard of accommodation, there are a number of factors which adversely affect the safety of service users, members of staff and visitors. EVIDENCE: Service users have single bedrooms. A lift serves each of the 3 floors and the home has a successful tradition of enabling wheelchair users to live there with success and independence. The rear garden has no defined perimeters and is shared by many families renting houses from a housing organisation. This presents a potential security and privacy problem for service users. In addition, there is no physical separation from the church next door (previously the home was owned by the church): church users have direct access to the home via a door from the dining room and a church storage shed as located outside the back-door of the home. The adjoining garage is not under the control of the home and families renting nearby homes use parking spaces at the front (through apparent Gardenia House H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Version 1.40 Page 17 formal arrangement with Heritage Care Ltd). Staff cars have been damaged when parking in front of the home (signs have been placed at the home warning about this problem but staff and visitor’s vehicles remain vulnerable). The Commission was not advised at the time of these incidents. Some service users stated that bedroom chairs (which have wood armrests) are uncomfortable. Bedroom door-locks are unsuitable for easy use by frail older people. The lack of an on-site maintenance person could be a contributing factor to the poor record of routine maintenance (and implementation of a maintenance schedule) at the home. Previously, a thermostatic valve was found to be unreliable: the lack of a maintenance person means that safety issues may not be fully in place. Redecoration is also being carried out in a piece-meal fashion. The manager stated that he was addressing this issue. Cleaning equipment and materials (when not in use) were not stored in the (locked) COSHH cupboard. Individuals entered the kitchen from the front and secondary entrances without putting on a clean white coat that should be available for that purpose. Gardenia House H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Version 1.40 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) x These standards were not assessed on this occasion. EVIDENCE: Gardenia House H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 The home has the benefit of a new manager and management structure and changes are being put into place to improve the safety and wellbeing of service users. EVIDENCE: The manager has identified a range of problems (referred to in this report) and is taking steps to address them. The conclusion reached by the manager was that the home was not being run in the best interests of service users: procedures were adopted over time which served to condition service users to act in ways which covered over staffing shortages and poor practices. The revised management structure has placed responsibility on 3 care team leaders to put new procedures into effect. The outcome of this review is a commitment to improved quality assurance measures. The focus is on adopting procedures that lead to better lifestyles for all service users and ensures that the individual challenges faced by service users are effectively addressed. This Gardenia House H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Version 1.40 Page 20 includes measures for ensuring, for example, that people who previously neglected themselves have the type of attention that alleviates their concerns (by use of intervention and diversion techniques) and maintains their good appearance at all times. It also includes commitment to resolving safety and privacy issues connected with site boundaries, parking and garden access and usage. The manager was aware of the need to seek a new certificate of registration because the conditions of registration currently shown are no longer relevant. He also is assessing the need for a number of household issues to be addressed (ie. whether the current door-locks are suitable for use by frail older people, improvement of office facilities and storage of records). Gardenia House H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 2 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 x 15 1 COMPLAINTS AND PROTECTION 1 x x x x x x 2 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 x x x x x x x Gardenia House H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Version 1.40 Page 22 Yes 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 1 Regulation 5 Requirement The registered person shall produce a written guide to the care home... The intention of the manager to produce an accurate service users guide (and provide a copy to existing and new service users) is acknowledged. ..the registered person..shall prepare a written care plan..as to how the service users needs in respect of his health and welfare are met. The current care plan records should be reviewed and updated. The registered person.. shall promote and make proper provision for the health and welfare of service users. The shortfalls agreed with the manager as adversely affecting the well-being of service users should be addressed (ie. prompt referral to GPs, more accomplished methods for preventing service users continuing self-neglect, reasons for isolation of some service users (and appropriate actions recorded in service users care plans). H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Timescale for action 30/11/05 2. 7 15 30/11/05 3. 8 12 30/11/05 Gardenia House Version 1.40 Page 23 4. 12 16 5. 15 16 6. 19 23 The registered 30/11/05 person..shall..enable service users to engage in social and community activities..and provide facilities for recreation... Whilst it is acknowledged that 19 hours per week (less 3 for garden maintenence) is allocated by an activities organiser, the manager has undertaken to review the reasons why service users spend much of their time in their bedrooms: this review will involve an assessment of the level of success in providing encouragement for service users to take part in a programme of social activities. The registered person 30/11/05 shall..provide..food which is varies and properly prepared and available at such time as may reasonably be required by service users. The proposed addition of a kitchenette in the 1st floor lounge area is likely to address this requirement in part. The premises are suitable for 01/02/06 the purpose of achieving the aims and objectives set out in the statement of purpose. The issues agreed with the manager as necessary are the availability of an in-house person and the preparation of a maintenence schedule, and the identification of the homes perimeters and subsequent maintenence of these). RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Gardenia House H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Version 1.40 Page 24 No. 1. 2. 3. Refer to Standard 9 26 2 Good Practice Recommendations The new procedures adopted by the home for medication administration should be supported by appropriate training for each member of staff involved in the process. Revised procedures for the prevention of infection should be adopted. The review by the manager of the personal contract given to service users is acknowledged and the revised contract should reflect the issues as required under this standard (including a variation in particular contracts if specific requirements pertain to the service user). Gardenia House H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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 Gardenia House H56-H06 S23943 Gardenia House V246576 090905 Stage 4.doc Version 1.40 Page 26 - 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!