Inspection on 25/08/05 for Garrett House Residential Home

This inspection was carried out on 25th August 2005.

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

Other inspections for this house

Garrett House Residential Home 27/08/08

Garrett House Residential Home 19/12/07

Garrett House Residential Home 23/03/07

Garrett House Residential Home 08/02/06

Garrett House Residential Home 18/02/05

Garrett House Residential Home 01/07/04

Garrett House Residential Home 09/10/03

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

CARE HOMES FOR OLDER PEOPLE Garrett House Residential Home 43 Park Road Aldeburgh Suffolk IP15 5EN Lead Inspector Joe Staines Unannounced 25 August 2005 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. Garrett House Residential Home I54-I04 S24394 Garrett House V218340 050825 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Garrett House Address 43 Park Road Aldeburgh Suffolk IP15 5EN 01728 453249 01728 453249 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) Mrs W Stedman Mrs W Stedman Care Home 45 Category(ies) of Old Age (OP)39, Dementia (DE)6 registration, with number of places Garrett House Residential Home I54-I04 S24394 Garrett House V218340 050825 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 18/02/05 Brief Description of the Service: Garrett House is a large Georgian house, which has been in use as a care home for older people since 1982. The Home is located on a private road within a residential setting in the costal town of Aldeburgh. It is situated in grounds of approximately four acres of landscaped gardens, which incorporate a croquet lawn, tropical themed courtyard, a summerhouse and a fenced pond. The House has views to the river Ald. The main house and extension offer accommodation on two floors. There is a passenger lift serving both sides of the Home. Most of the bedrooms are single however two large bedrooms are available should couples wish to share. All the bedrooms in the extension have en suite facilities, as do many in the main house. As a result of recent developments, the home now has four new rooms, and has increased its capacity from 41 to 45 service users. Further developments to create additional space are currently being considered by the owners. Garrett House is registered under the Care standards Act 2000 as a Care Home to accommodate up to 45 older persons, including 6 individuals with dementia. Garrett House Residential Home I54-I04 S24394 Garrett House V218340 050825 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the first of the two statutory inspections for the year 1st April 2005 - 31st March 2006. The inspection was undertaken by Joe Staines (Regulation Inspector) and Jessica Scotford (Regulation Inspector). The registered manager of the home was present, although Mrs StedmanKeeble (deputy manager) and Mr Stedman-Keeble (Property and Services Manager) acted as representatives for the registered manager. This inspection focused on a number of standards identified by the Commission for Social Care Inspection as key standards for inspection over the two statutory inspections each service receives per year. In addition to a number of these key standards, additional standards were inspected relating to issues drawn to the attention of the inspectors by service users, relatives, and informed by the last inspection report. The inspectors looked at a total of four service users files, and spoke with four service users as part of the inspection, some in their rooms, and some during the course of the day in communal areas. Staff files, and policies and procedures were examined. A visiting health care professional was interviewed, who made consistently positive comments about the home. The inspection took place between 10am and 4pm on a weekday. What the service does well: The quality of care provided was reported by all of the service users, staff and visiting professionals as of an extremely high standard. The environment is of the highest calibre, and beautifully maintained both internally and externally. Examples of the comments made by service users include: “It’s a wonderful place”, “I couldn’t be anywhere better” and “”I’m well cared for here”. A visiting health care professional also reported positively on the care arrangements in the home, stating that, “I think it is a very good standard of care here, the best compared with other known homes”, and that there was good liaison with staff, who were very co-operative. The home evidenced that it had good arrangements in place for ensuring new staff received appropriate induction training. Garrett House Residential Home I54-I04 S24394 Garrett House V218340 050825 Stage 4.doc Version 1.40 Page 6 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. Garrett House Residential Home I54-I04 S24394 Garrett House V218340 050825 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Garrett House Residential Home I54-I04 S24394 Garrett House V218340 050825 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4 & 6 Prospective service users and their representatives can be confident that the home will meet their needs. The home must expand its pre admission assessment procedures before the relevant standard is fully met. Standard 6 does not apply to this service, as it does not provide intermediate care. EVIDENCE: The inspectors examined a sample of service users files, including pre admission assessments. These assessments were completed using a questionnaire, and the level of detail in relation to some of the areas identified in the National Minimum Standards was lacking in detail. For example, the personal backgrounds of service users in relation to social interests and hobbies were not always present. The feedback from service users, staff and visiting professionals was consistently positive about the home’s ability to meet the needs of service users. The home’s training programme, staffing levels, organisational structure, induction procedures and a comprehensive set of policies and procedures demonstrate that the home is capable of meeting the needs of the service users it is registered to care for. Garrett House Residential Home I54-I04 S24394 Garrett House V218340 050825 Stage 4.doc Version 1.40 Page 9 Garrett House Residential Home I54-I04 S24394 Garrett House V218340 050825 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 10 & 11 The home works well in ensuring that the privacy and dignity of service users is respected and promoted, particularly in situations where service users have a terminal illness, or are in the latter stages of life. The evidence obtained at this inspection identified that the care plans used by the home need to be expanded, and contain evidence of service user involvement and regular review, before the relevant standard could be said to be fully met. EVIDENCE: The inspectors examined a sample of care plans, and found them to contain some useful information about how the home intended to meet the assessed needs of individuals. However, some gaps were noted, particularly in relation to health profiles, and detail of services to be received e.g. chiropody. Preferences in relation to the provision of personal care were not routinely recorded, and the involvement of service users, or their representatives, was not evidenced in the records. Service users also fed back to the inspector that the staff at the home were very respectful of the privacy of service users, not intruding unless they had a genuine reason, and always waiting for a response to knocking before entering service users rooms. All of the rooms had en suite facilities. One service user, who needed help with personal care stated that the Garrett House Residential Home I54-I04 S24394 Garrett House V218340 050825 Stage 4.doc Version 1.40 Page 11 staff respected their dignity when helping them. Other comments made included “Staff always knock before entering my room”. A visiting health professional also stated that staff always maintain the privacy of service users by ensuring all treatments are carried out in private bedrooms. A visiting health professional also stated that the home used the full range of support services to care for individuals who were close to the end of their lives, liaising well with health services, and maintaining positive care. A member of staff was able to confirm that the arrangements for service users with terminal illness included regular and continuing visits, extra staff, close monitoring of pain relief, and that staff always attended funerals of service users who had died. The home’s training records confirmed that staff had been given access to training on the care of the terminally ill. The inspectors saw personal phones set up in each of the five rooms seen. Garrett House Residential Home I54-I04 S24394 Garrett House V218340 050825 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 14 The home provides a wide range of activities on site, and helps service users engage in these, along with maintaining regular contact with friends and family, although some additional work can be done in relation to facilitating group trips for those who wish to attend. The home provides care based on the expressed preferences of service users, and allows choice and selfdetermination wherever possible. EVIDENCE: The inspectors received unanimously positive comments from service users about the opportunities for leisure in the home. One service user confirmed that the home always arranged for a small celebration on birthdays. Some service users were enjoying watching cricket on television, whilst others were observed enjoying music and sharing conversation with each other in the lounge. There was a summerhouse at the end of the garden, routinely stocked with fresh cold drinks for service users to enjoy. The deputy manager reported that activities programme identified on the home’s website identified the range of activities available, these included dinner parties, barbeques, film showings, variety shows, flower arranging sessions, cocktail parties, buffet evenings, open days, themed evenings and monthly exercise classes, massage and reflexology therapy for those who wish to partake. Other activities provided by the home, and routinely enjoyed included chess, and access to books. All of the service users interviewed confirmed that they received frequent visits from Garrett House Residential Home I54-I04 S24394 Garrett House V218340 050825 Stage 4.doc Version 1.40 Page 13 members of their family, and went on trips out with them on occasions. The home has several areas where private visits can be undertaken, including some small lounges, offices, and service users own bedrooms. Service users rooms contained many personal items belonging to the occupant. Choice in relation to meals was also confirmed, service users stating that the chef came each day to ascertain the choice of each service users in relation to the next day’s meal. A minor shortfall was identified in relation to the lack of clear information, available to service users, about how to contact external agents (advocacy services) who could act on their behalf if requested. Garrett House Residential Home I54-I04 S24394 Garrett House V218340 050825 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 Service uses can expect their rights to be protected through the accessibility of the complaints procedure, and staff’s knowledge of adult protection procedures. EVIDENCE: The home had a robust complaints policy, displayed in the home, and incorporated into the statement of purpose and service user guide. All of the service users who spoke to the inspectors confirmed that they had no reason to complain, but were confident that they could access the procedure if necessary. The examination of the home’s adult protection procedure confirmed that the home had identified the appropriate agency as having the lead responsibility for investigation allegations/suspicions of abuse. The feedback from staff during interview confirmed that they had received training on, and were fully aware of, the principles of adult protection, including the process for reporting concerns, and responding to allegations of possible abuse. Garrett House Residential Home I54-I04 S24394 Garrett House V218340 050825 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 23 & 26 Current and prospective service users can be confident that the home provides excellent standards of accommodation, including personal and communal facilities, suitable to individuals, and maintained to high standards of cleanliness and hygiene. EVIDENCE: The environment at the home is of the highest quality. Internally, all of the communal areas were furnished with good quality furniture and fittings. The lounges and hallway areas were all decorated to a high standard, and included several side tables, chairs lamps and a number of fresh flower arrangements. The home provides en suite facilities in all bedrooms. The home also provides eight assisted bath/shower rooms in shared areas, and toilet facilities close to dining areas. All of the bedrooms seen at this inspection were spacious, warm and well ventilated. The home meets all of the national minimum standards for space requirements in relation to bedrooms and communal space. The property services manager reported that the laundry facilities had been earmarked for refurbishment, and were identified as needing decorating by the Garrett House Residential Home I54-I04 S24394 Garrett House V218340 050825 Stage 4.doc Version 1.40 Page 16 inspectors. The washing facilities included machines capable of washing at over 65 degrees, hand washing facilities and protective garment were available. On the day of this unannounced inspection, the home was clean and tidy throughout, with no evidence of any unpleasant odours. Garrett House Residential Home I54-I04 S24394 Garrett House V218340 050825 Stage 4.doc Version 1.40 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 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) 29 & 30 Current and prospective service users can be confident that the home recruits staff with service users safety and best interests in mind, and that staff are trained to the levels required in order to meet the needs of service users. EVIDENCE: The inspector examined the files of four members of staff. All the records required by the Care Homes Regulations 2001 were present in the files. This included a completed application form providing an employment history, references, interview notes and certificates of training. Training records confirmed that staff had received training in fire safety, health and safety, care of substances hazardous to health, manual handling and continence care. Garrett House Residential Home I54-I04 S24394 Garrett House V218340 050825 Stage 4.doc Version 1.40 Page 18 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) 32, 33 & 38 Current and prospective service users can be confident that the home is well run by the management team, and is also run in the best interests of service users. The home maintains the health & safety of service users and staff through its policies and practices, along with the staff training programme. EVIDENCE: The home’s quality assurance policy refers to seeking the views of service users by way of questionnaires and other means. The home had produced two different questionnaires, one specifically relating to activities, whilst the other facilitated comments on catering and food, personal care & support, daily living, premises and management. One example of good practice was the introduction of routine meals with the manager, a system whereby the manager would dine with small groups of service users, and discuss their views of the home in a relaxed, informal setting. Feedback from service users and staff was positive about the management of the home. Service users stated Garrett House Residential Home I54-I04 S24394 Garrett House V218340 050825 Stage 4.doc Version 1.40 Page 19 that senior staff were always available to discuss how service users were getting on. A visiting professional stated that the deputy manager was always available to discuss any concerns, and that communication with the home, via senior staff was very good. The examination of records confirmed that Health and safety issues are addressed through appropriate maintenance of equipment and procedures. First floor windows are fitted with chains to limit the extent of opening. Garrett House Residential Home I54-I04 S24394 Garrett House V218340 050825 Stage 4.doc Version 1.40 Page 20 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 x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION 4 x 3 x 3 x x 3 STAFFING Standard No Score 27 x 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 3 x x x x 3 Garrett House Residential Home I54-I04 S24394 Garrett House V218340 050825 Stage 4.doc Version 1.40 Page 21 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 3 Regulation 14 Requirement The registered persons must ensure that pre admission assessments cover all the needs of prospective service users. The National Minimum Standards identify the specific areas that should be covered. Timescale for action 20th October 2005 2. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 7 7 7 Good Practice Recommendations The registered persons should ensure that all service users care plans contain evidence of consultation with the service user, or their representative. The registered persons should ensure that care plans are reveiwed at least every month. The registered persons should ensure that care plans identify how the home will meet the assessed needs of service users in relation to all the areas identified in the national minimum Standards. The registered persons should ensure that service users, and their representatives, are provided with information that enables them to access independent advocacy services if they wish. I54-I04 S24394 Garrett House V218340 050825 Stage 4.doc Version 1.40 Page 22 4. 17 Garrett House Residential Home Garrett House Residential Home I54-I04 S24394 Garrett House V218340 050825 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 5th Floor, St Vincent House Cutler Street Ipswich IP1 1UQ 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. 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