Inspection on 21/02/07 for Garland House

This inspection was carried out on 21st February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

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

CARE HOMES FOR OLDER PEOPLE Garland House 2 Garlinge Road Southborough Tunbridge Wells Kent TN4 0NR Lead Inspector Justine Williams Key Unannounced Inspection 21st February 2007 09:30 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 Garland House DS0000068655.V325012.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. Garland House DS0000068655.V325012.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Garland House Address 2 Garlinge Road Southborough Tunbridge Wells Kent TN4 0NR 01892 532707 01892 532707 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) Davis Care Limited Mrs Tracey Ann Allcorn Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Garland House DS0000068655.V325012.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd November 2006 Brief Description of the Service: Garland House is registered to provide personal care and accommodation for 20 older people. The home has recently been taken over by Davis Care, and is currently the only care home owned by the company. The responsible indivdual, who is also the owner of the home, visits frequently and has undertaken redecoration of parts of the home and plans further improvments. Garland House is located in a residential area of Southborough, close to a variety of local shops and public transport. The main town of Tunbridge Wells is approximately 4 miles away and offers the usual town amenities. The home was first registered on 16th February 1984. It consists of an attractive property and gardens with car parking facilities to the side of the building. Accommodation is over three floors, with access to all floors by a shaft lift. Disabled access is to the rear of the building. Garland House has nineteen single rooms, four of which have en-suite facilities. There are telephone points and staff call points in every bedroom. The home is run by the registered manager and deputy manager, in the manager’s absence. The home employs care staff working a roster, which gives 24-hour cover. The home also employs other staff for catering and domestic duties. The current fees are £316.00 to £420.00 per week, this information was given to the inspector in writing in the pre inspection questionnaire. Garland House DS0000068655.V325012.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was carried out on 21st February 2007 between 09.50 am and 2.30 pm by regulatory inspector Justine Williams. During that time the inspector spoke with residents individually and in small groups. The registered manager was on the premises throughout the inspection and feedback was given to the manager during and at the end of the inspection. This was the first visit to the home by the inspector. All of the key standards and some additional standards were inspected on this occasion. This report contains assessments made from observation, conversation, inspecting records and a tour of the premises. As part of the inspection process comment cards were sent to service users, to GP’s, health care professionals, care managers and relatives of residents. Whilst specific comments were not made by those completing the comment cards, they indicated satisfaction with how relatives are welcomed to the home, and being kept informed of the residents’ progress. Most said there were sufficient staff on duty and that they had been made aware of the complaints policy. Some specific comments from residents were: “I feel lucky to be here” “some residents feel the dining room (newly decorated) is a bit modern but I like it” “the manager is wonderful and does anything she can for us….well all the girls do” “I would like more warm cups of tea, by the time it gets to me its not very hot” “we always have fresh flowers, and plenty of fresh fruit” “since the new owner took over we have biscuits in the morning with coffee so that’s good” The food is very good, and we have home baked cakes” What the service does well: Residents continue to be very happy at Garland House and feel glad and lucky to live there. The residents speak very highly of the staff and feel well cared for. Residents said they feel listened to and that within reason changes are Garland House DS0000068655.V325012.R01.S.doc Version 5.2 Page 6 made to suit them and if they ask for something every effort is made to provide it. Many of the residents are physically quite able and they appreciate that staff just like to know when they go out but allow them the freedom to come and go as they please. Garland House continues to be a sociable home with residents who have forged strong friendships. Residents like the level and range of activities offered. The staff receive the support and encouragement to attain NVQ qualifications. The physical environment is pleasant, light, airy, and decorated to a good standard. The home enjoys good relationships with the local GP, and other health care professionals and with relatives and advocates of the residents. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Garland House DS0000068655.V325012.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Garland House DS0000068655.V325012.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have confidence that the home is right for them through good admission processes. EVIDENCE: The inspector spoke with a resident who has recently moved into the home. The resident described how the manager visited her in hospital and discussed with her what help she needed and what her likes and dislikes were, as well as her medical history, interests etc. The resident was not able to visit the home prior to moving in due to her medical condition at the time but her family had visited on her behalf and the home provided her family with written information about the home. The manager confirmed that a visit to the home to meet staff, look around etc is offered to all prospective residents. The manager uses an assessment pro-forma, which broadly covers the items in the standard, but could be more detailed. The manager said the assessment paperwork is likely to be changed and improved in the near future. Copies of joint assessments undertaken by social services were seen, which is another good source of information for the home. Garland House DS0000068655.V325012.R01.S.doc Version 5.2 Page 9 Every effort is made to accommodate a resident through all the stages of older age, but where this becomes impossible, the resident will be supported to move to a more suitable environment. Intermediate care is not provided by the home. Garland House DS0000068655.V325012.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal care and health needs of residents are managed well. Residents are treated with respect and regard for their privacy and dignity. EVIDENCE: Each resident has a comprehensive and detailed plan of care, which guides staff in how to care for each individual residents, and documents their likes and dislikes, what time they like to get up, go to bed, etc. Most of the care plans seen had been reviewed on a monthly basis, none of the care plans had been signed by the resident, and residents spoken with were unsure about what the care plan was for. It is recommended that residents be involved in drawing up their care plans and be asked to sign them to agree the content. Risk assessments seen included moving and handling and a brief and partial assessment for preventing falls, this should be expanded upon. The staff do not carry out written risk assessments for nutrition the inspector and manager discussed the various nutritional screening tools available. Staff do not carry out risk assessments for the development of pressure sores but report any worries to the district nursing service, who carry out the assessment and provide any equipment needed. Garland House DS0000068655.V325012.R01.S.doc Version 5.2 Page 11 The health needs of residents are well met, and any visits to and from healthcare professionals are clearly recorded, with any instructions documented and put into the care plan. Resident’s continence needs are also assessed by district nurses. Residents are encouraged to go for walks, participate if they are able to in physical activity, such as the music and movement class held weekly. The home’s practices around storage, administration, record keeping and training in medication are robust, however the home does not currently have a medication policy but uses the Kent social services’ document. The home should develop its own policy reflecting its own practices and to include homely remedies, although these are seldom used. Risk assessment for residents selfmedicating were detailed and comprehensive. Residents said staff always treat them with courtesy and call them by the name they prefer. Residents spoke very highly of all the care staff and particularly of the manager. Staff were observed caring for residents sensitively and politely. Toilet and bathroom doors are lockable, residents can ask for a bedroom door lock if they would like one. Garland House DS0000068655.V325012.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents enjoy the lifestyle and recreational activities at the home, and are encouraged to maintain contact with relatives, friends and the local community. Residents are encouraged to make choices and maintain control over their lives. EVIDENCE: The home does not employ a staff member dedicated to organising and running activities but care staff run activities daily, these include bingo, music and movement and card games. Outings are also organised periodically and recent events include an outdoor entertainment show and buffet, a strawberry tea, guest speakers, and many of the residents also go out to the shops, and library. Church services are also held regularly at the home. The home purchases a range of newspapers including local papers for residents to read, and also have papers delivered to individual residents if they wish. Some of the residents knew of the home and had visited family or friends who were residents, prior to moving in themselves. Residents said their visitors are made to feel welcome and are offered drinks, when they visit. Fresh fruit and flowers were on the tables and residents said there is always a variety of fresh fruit for them to snack on. Garland House DS0000068655.V325012.R01.S.doc Version 5.2 Page 13 The majority of residents were very satisfied with the food, including the menus, presentation and how meals are cooked. The residents complimented the cook on her home baking, and in particular the cakes. Residents said that visitors were welcome to stay for a meal; a hospice charity box was available if the visitor wanted to contribute. One resident said the cook could not be expected to please all the residents but that an appealing alternative was always offered. The majority of residents spoken with said the hot drinks and meals if they have them in their rooms are plenty hot enough, but one resident who spends most of the time in her room said the tea was often not very hot by the time it got to her, the manager said she would look into this. Menus are planned in advance with the day’s menu on display in the hallway. A resident said ‘if we look at the menu and don’t like the main option, providing we ask before coffee time we can have the alternative’ Garland House DS0000068655.V325012.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confident that any complaints would be listened to and acted upon. Residents are protected from abuse by the home’s policies and practices. EVIDENCE: The home has a clear complaints policy, which is displayed and contained within the service users guide. The home has not received any formal complaints. Residents spoken with said they had no cause for complaint as the home and staff were so good. The home has set up a comments book where minor dissatisfaction and staffs actions to remedy them is recorded. The manager has a good understanding of the adult protection and recognising abuse and of the procedure for reporting abuse. A flow chart for reporting has been written up and a copy of the Kent and Medway adult protection policy is available. Adult protection training was taking place at the home the afternoon of the inspection. Garland House DS0000068655.V325012.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, pleasant, well maintained environment. Development of an infection control policy will better protect residents. EVIDENCE: Garland House is a large domestic property in a road of similar properties on the northern outskirts of Tunbridge Wells. Adaptations to make it suitable for older people include a shaft lift, a call system and assisted bathrooms. The home has ample communal space including 2 lounges, 1 dining room and a conservatory. The home is very well decorated with residents’ rooms redecorated when they become vacant. Security is monitored through restricted access at night and external CCTV cameras. The dining room has recently been redecorated and plans are in place to refurbish bathrooms and some other areas. The manager has recently received confirmation of an adequate fire risk assessment from the local fire service, and the building complies with Garland House DS0000068655.V325012.R01.S.doc Version 5.2 Page 16 requirements of the environmental health department. Despite the time of year the gardens were attractive and are accessible for residents. Residents who have rooms on the 1st floor commented that when the home’s main bathroom is in use they do not have use of the toilet, the manager said the new owner hopes to review and address this. One residents said her room was very hot and that the window was difficult to secure half open due to the window’s design, the manager confirmed that part of the refurbishment plan included replacing these windows. As planned, radiators and pipe work should have safe surface temperatures or covers. The premises were clean and hygienic and pleasant smelling. The laundry is a good size and is located in the basement, the washing machines do not have a sluicing facility for the safe laundering of foul or infected laundry, but the manager understands that the owner will replace these in due course. 2 toilets do not have hand-washing facilities and the risk assessment should include actions taken to minimise risk of infection. The manager must also develop an infection control policy in line with professional guidance and legislation. Garland House DS0000068655.V325012.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and qualifications of staff meet the residents needs and the staff are safely recruited. Residents needs will be better met when all staff have received the training updates they need. EVIDENCE: Staff and residents said there are sufficient staff on duty to care for residents and to run activities. In addition there are cleaners, cooks, laundry and maintenance staff. Residents said they never have to wait long for assistance when they ring. The staffing roster should include the surnames and the designation of staff. The home has one waking and one sleeping staff at night, but this is changed to two waking should the residents needs warrant it. The manager, the deputy and 4 care staff were on duty the morning of the inspection, and in addition the cook and cleaner were also working. 58 of the care staff have attained NVQ qualifications and the new owner has already agreed to continue to support staff to attain further NVQ training. The home does not use agency staff currently. The recruitment files for staff contained all the necessary information including 3 references, evidence of CRB checks, proof of identification etc. the manager demonstrated a good understanding of the need for robust recruitment processes. It is recommended that the manager review asking for applicant’s date of birth on the application form following new anti age discrimination legislation. It is also recommended that a brief transcript of the interviews be kept in order to Garland House DS0000068655.V325012.R01.S.doc Version 5.2 Page 18 demonstrate equal opportunities. The manager is aware of the amended regulations and the need to check gaps in employment history and to verify references. Some staff training has lapsed and updates are needed as soon as possible, the new owner has made funds available to ensure this takes place as a matter of urgency and the manager is in the process of organising the updates. Staff were being trained in adult protection that day and fire and medication training has already been undertaken. The manager is organising other mandatory and core training and all staff should have completed the programme and be fully updated within 6 months. New staff receive induction training. Garland House DS0000068655.V325012.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a well managed home, which is run with their best interests in mind. Residents will be better safe guarded when the training update programme is fully completed, although the home’s policies and working practices maintain safety. EVIDENCE: The manager is newly registered and was the deputy manager for the previous owners, but took responsibility for the day-to-day management of the home. The manager and new owner have already forged a good, productive working relationship which continues to put the residents needs and wants at the forefront. The manager has worked at the home for 8 years and has an HND in managing care and a BSc (hons) degree in health, she is also an NVQ assessor. Garland House DS0000068655.V325012.R01.S.doc Version 5.2 Page 20 The amount for which insurance cover is provided for residents own belongings should be made clearer. The new owner has yet to undertake visits and reports under regulation 26, and the manager has now obtained a copy of the amended regulations, which require further quality assurance work. The home already has some quality assurance systems in place and the manager has begun work to meet the new regulations. The home does not manager or look after resident’s monies and residents are encouraged to look after their financial affairs for as long as they are able. Residents are provided with lockable space so they can keep their valuables safe. The manager ensures safe working practices and environment through the home’s policies, and regular supervision, the training update programme has commenced and once completed will better protect service users. The manager has recently reviewed the fire and environmental risk assessments and has had confirmation from the fire service. Hazardous substances were safely stored and regular servicing and maintenance of equipment ensures safety. Garland House DS0000068655.V325012.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 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 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Garland House DS0000068655.V325012.R01.S.doc Version 5.2 Page 22 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 Regulation Requirement All staff must receive training appropriate for the work they are to perform, this will include that all staff receive moving and handling, health and safety and first aid training and update any such training within recommended timescales. Timescale for action 01/08/07 OP38 18 (1) (c) 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 OP3 Good Practice Recommendations It is recommended that the assessment form be reviewed to include prompts for all the performance indicators in standard 3.3. It is recommended that care plans be signed by the residents to indicate their involvement and agreement. 2 OP7 Garland House DS0000068655.V325012.R01.S.doc Version 5.2 Page 23 3 OP7 It is recommended that falls risk assessments be reviewed, and expanded upon, and that the manager look into training staff to use a nutrition risk assessment tool. It is strongly recommended that the manager and staff compile their own medication policy to include the homes individual practises but with reference to good practice guidance and legislation. The medication policy must include the homes use of homely remedies. It is recommended that the manager and owner carry out the review of the bathroom and look into the possibility of providing a separate toilet for the 1st floor, and to the possibility of providing different opening mechanisms or different windows. As planned, radiators and pipe work should have safe surface temperatures or covers. The infection control policy should be reviewed to include the toilets without hand washbasins, and the management of foul or infected laundry. It is recommended that the manager and owner ensure the review of quality assurance systems takes place to ensure compliance with changes in regulations. The amount for which insurance cover is provided for residents own belongings should be made clearer. 4 OP9 5 OP19 6 OP25 7 OP26 8 OP33 9 OP34 Garland House DS0000068655.V325012.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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