Inspection on 27/08/08 for Garrett House Residential Home

This inspection was carried out on 27th August 2008.

CSCI found this care home to be providing an Adequate service.

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

Other inspections for this house

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 25/08/05

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 23/11/2008.

CARE HOMES FOR OLDER PEOPLE Garrett House Residential Home 43 Park Road Aldeburgh Suffolk IP15 5EN Lead Inspector Kevin Dally Unannounced Inspection 27th August 2008 09:00 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 Garrett House Residential Home DS0000024394.V370650.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. Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Garrett House Residential Home Address 43 Park Road Aldeburgh Suffolk IP15 5EN 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) 01728 453249 01728 451730 garretthouse@btinternet.com Mrs W Stedman Mr B Stedman Mrs W Stedman Care Home 45 Category(ies) of Dementia (6), Old age, not falling within any registration, with number other category (39) of places Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th December 2007 Brief Description of the Service: Garrett House is a large Georgian house, which has been registered with the current providers 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 Alde. There is a parking area and the garden has a number of decorative marble statues in place. 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, seventeen of which provide very spacious accommodation, with two larger bedrooms available should couples wish to share. Within these numbers the home offers four suites incorporating adjoining rooms and exceeding the standards for accommodation. All the bedrooms in the extension have en suite facilities, as do all except one in the main house. The fees for the home range between £355.00 and £620.00 and may vary depending on the accommodation occupied or the level of support required. Fees do not include the cost of private telephone lines, newspapers, toiletries, hairdressing and chiropody. Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a key unannounced inspection of Garrett House, which took place on the 27th August 2008. Mrs. Winifred Stedman, the manager and owner, was present for the inspection and provided us with information that was relevant to the inspection. A tour the premises was completed and we were able to spend time with some of the residents and staff, and talk with visiting relatives. This gave us information about the home including what people thought about the quality of the service provided. We also observed staff serving the lunch and followed a medicines round. A selection of residents’ care plans and medicine records; staff records, maintenance and training records were also checked, as were a selection of other documents, including the staff duty rotas and the menus. Surveys were sent to the home to distribute to residents, relatives and staff before the inspection took place. Eleven residents, one relative and four staff members responded to our questions. A selection of their views and opinions about the home are included within this report. The manager also completed the CSCI Annual Quality Assurance Assessment form (AQAA), which provides key information about the home, and allows them to say what they do well, what they could do better and any plans to improve the service. The report has been written using some of the information gathered before, or during the inspection. On the day of inspection the residents were seen relaxing in various parts of the home including one of the main lounges or in their own bedrooms, as they chose. Staff were seen supporting the residents and undertaking their care duties throughout the day in a calm and respectful way. What the service does well: Garrett House offers a comfortable and attractive environment with spacious rooms and very good décor. The communal rooms are well furnished and give a choice of seating areas so people may choose to sit alone or with others. Residents can receive visitors privately in their own rooms or in one of the home’s communal rooms. The grounds are extensive and have a variety of areas of interest including stocked ponds and statue lined walks. Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 Page 6 The residents told us they are provided with good information about the home before they move in. They also told us that the level of care the home provides is good, and that this met their particular care needs. All residents said the meals were very good, and there was evidence of a wholesome and varied diet. Residents at the home are able to choose a lifestyle that suits them. This included undertaking activities like reading, a walk in the garden, games or simple exercises. Peoples’ complaints would be treated seriously. There would be sufficient staff to meet the residents care needs, and staff would be appropriately recruited, trained and supervised, to ensure they can meet the needs of the people living at the home. The manager would ensure that the home is properly run in the best interests of the residents. The safety and the welfare of the residents and staff is promoted. One resident told us, ‘My care and support is very good’, and a relative said, ‘We have nothing but praise for the home’. What has improved since the last inspection? Since the last inspection, the home has shown us that they have maintained the previous improvements made. This included providing new assessments for new residents, and ensuring that care plans are drawn up to identify particular care needs. The guidance for medicine administration had been updated, and there was adequate provision for staff hand washing to ensure the prevention of infection. The information provided by the home (AQAA) was detailed and showed us that the management team take the running of the service very seriously. They told us about the areas where the home had improved. In summary these included investing in a new lift, completely renovating the main kitchen and laundry, and re-allocation of the control of substances hazardous to health cupboard. A new outbuilding provides improved storage facilities, and they have increased the on site parking. Two public corridors have been recarpeted. The home has accessed external training companies for some staff training, and ongoing training for staff is actively encouraged. The home has improved communication with the residents through more regular meetings and has provided a ‘comments and suggestions book’. Suggestions received via the residents’ quality assurance surveys have been implemented around improvements to some of the entertainment provided. Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 Page 7 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. Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, and standard 6 does not apply. Quality in this outcome area is good. People can be confident they will receive good information about the service, and have their support needs assessed prior to entering the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides detailed information about the services offered in the home’s statement of purpose, which is made available to the residents or any people who enquire about the home. New residents and their families can visit the home to view the premises, and if all parties are satisfied, a 6-week trial period can be offered. Ten of eleven CSCI residents’ surveys returned said they had received enough information about the home before moving in. One did not say. The care records for three residents were checked and each included a needs assessment, which the home had adequately completed to provide key background information about each resident. The assessment information Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 Page 10 included sections around the person’s past medical history, any current medicines, any disabilities, areas of personal care needed, mobility issues including any falls, and any nutritional problems. The assessment also provided a section on a resident’s social background, which included their place of birth, their previous occupations and work locations, their hobbies and interests, and their family history. This gave staff a more holistic picture of that person’s life background. The home was able to show us that they usually provided an adequately trained staff group that could meet the care and support needs of the people who lived at the home. For example, staff training records checked included fire, moving and handling training, food hygiene, medicines training, and infection control training, although two staff members’ records checked did not include a record of any safeguarding training. Some specialised training included challenging behaviour training had been provided for some staff. Feedback received from staff (4) informed us that they had received training which they considered was ‘relevant to their role’ and which ‘helped them understand and meet the individual needs of the residents’. The home recorded that around 61 of their care staff (11 of 18) had achieved a national vocational care qualification (NVQ) level 2 or above, with a further 1 staff member currently working towards this award. This informed us that over half of the staff group had achieved a formal care qualification, and of the home’s ongoing commitment in ensuring a competent and qualified workforce. The following is a selection of feedback received from residents and relatives about the care provided by the home. ‘This is a very homely place to be in’. ‘My care and support is very good’. ‘We have nothing but praise for the home’. Feedback from the staff group included the following comments. ‘The home provides a lovely atmosphere, with happy friendly staff. We give good care and support to our residents’. ‘This is a nice working atmosphere with happy residents, and a nice home’. The service does not offer intermediate care. Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is adequate. People who use this service can expect to have their health needs met but their plan of care may not always provide sufficient detail, of the care required. People cannot be assured that all the medicine practices will protect them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents’ ‘individual care plans’ and records were checked, which included documents relating to an admission assessment and a form that covered the level of support required for activities of daily living (ADL). The assessment covered personal hygiene, mobility, diet, continence and the medication regime, and is further described under standard 3. Each individual care plan checked had a health profile for the resident which looked at oral hygiene, hearing, sight, foot care and weight on admission. A section was provided for information about the resident’s medical history. Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 Page 12 Care was linked to 14 areas of ADL’s and included sections on orientation, personal hygiene, continence, mobility, eating and drinking, likes and dislikes, communication, spiritual needs and night needs. Some areas of the plans checked provided good detail around their care needs, for example one care plan checked clearly listed their complete medicine needs, and provided a detailed medicine risk assessment. This would ensure that staff could administer these safely to the resident. However other areas lacked sufficient detail. For example, the home had identified in one resident’s admission assessment that they had experienced ‘many falls’. However their care plan said, ‘Uses trolley or sticks, as can be a little unsteady at times’, while the moving and handling risk assessment stated ‘no falls’. The resident’s accident records checked showed they had experienced 5 falls during the last 3 months, so these were still a concern. The moving and handling risk assessment for the resident had not been reviewed in the last 17 months so may not reflect their current condition and needs. Another resident identified at high risk of falls, their risk assessment was checked which showed that the risk of falls had been fully assessed and recorded, and recently updated to show that the home were fully aware of the key concerns. Additional measures had been undertaken including falls monitoring, involving the falls prevention team from the local hospital to suggest strategies of care, the use of hip protectors, and the use of a pressure mat to inform staff when the resident is moving away from their chair or bed. Other records checked provided separate basic moving and handling assessments, weight charts and a medicine risk assessment. Daily records recorded the changing needs of the individual resident. One resident’s weight records checked showed good evidence of monthly monitoring by the home until the beginning of 2007, after which these stopped without any explanation if weighing was still necessary. The files checked contained records of visits by health care professionals involved with the resident, and recorded any treatment given. Feedback from eleven residents said they ‘always or usually’ received the ‘care and support’ they needed, or ‘medical support’ required. One CSCI survey received from a relative said that the home ‘always’ met the needs of their relative, and that they give their relative the support and care they expected. One resident spoken with said ‘I think the care and support is very good’. Feedback from one relative raised some concerns about the care provided for their relative. They said, ‘I think my relative does not get much attention from the staff’. This point of view was unable to be substantiated during the inspection. Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 Page 13 The medication administration policy was checked and this provided guidance around the storage, administration, recording, the use of covert medicines, self-administration, controlled drugs, over the counter remedies, and how to re-order the resident’s medicines. Guidance stated that all staff deemed competent to administer medicines, would have to undertake medication training. Staff records checked confirmed that they had received medicines training. One resident’s care plan checked showed the home had completed a medicine risk assessment, and provided details of the medicines they used. The lunchtime medication round was observed and the medication administration records (MAR) sheets were seen and checked. The carer signed the MAR sheets appropriately after medicines were administered and no signature gaps were noted on the MAR sheets. Records also included ‘refusal codes’ being used to identify when a resident refused any medicines. During the medicine round, the carer left the medicine trolley open in one corner of the dining room, and a number of dossett boxes were left stacked on the open shelf, while they handed each resident their medicines. Although the carer was always present in the room, this is not considered best practise. On checking the medicine trolley, four medicine cassettes belonging to the home were noted being used for new individual residents. The senior carer on duty said this system was used to cover the period between a new resident entering the home, and the local pharmacy providing medicines in dossett boxes. The carer told us that the cassette boxes were prepared by staff from residents’ prescribed medicines, that had been brought to the home on their admission. This practice is secondary dispensing and could lead to possible errors, and residents’ safety being compromised. Staff were observed to be hardworking throughout the inspection, and were polite and caring towards the residents. Residents’ dignity was maintained during care sessions. One resident told me, ‘The staff are extremely patient’. Staff were seen to knock on doors, and to ask residents what they wanted. One relative said, ‘I have nothing but praise for the home’. Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 Page 14 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. People can be confident that the home will offer a choice of lifestyle opportunities that will meet their individual needs. People would be offered appetising and well balanced diets. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The information provided by the home (AQAA) said, ‘We provide a wide range of activities on the premises, based on the preferences of our residents. We promote constant contact with family and friends and our residents are welcome to have guests for lunch or supper.’ Further, ‘We have internet facilities including online shopping and email. We invite residents to parties for musical nights and karaoke. We celebrate St Patrick’s day, St George’s day, American independence day, Halloween and Christmas’. The activities records show that during the month of June, events programmed included films, a theatre company visit, Communion, books on wheels, and exercise classes. Feedback from several residents confirmed that there were a Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 Page 15 variety of leisure opportunities they could attend at the home. These included singing groups 2-3 times a year, exercise groups, crosswords, games, and daily newspapers. One resident said they had been to Snape Maltings for coffee. Feedback from staff said the home provides a limousine service for residents who do not have their own transport, and who wish to go shopping. Further, there were regular films, a church service each month, and a weekly visit from the local vicar. Staff said that when the weather is fine, residents could access the garden, and one resident told me they enjoyed walking in the garden. During the inspection, the hairdresser was seen providing hair care for several residents. During the day we saw a number of families and friends visiting with their relatives, and some told us they were able to visit the home whenever they wanted. The visitors were made to feel welcome by the staff, and they could visit with their relatives in one of the lounges or the privacy of their relative’s room. One resident told me they ‘preferred their own company’, so chose to stay in their own room. They said they could rise in the morning when they wanted, and could take meals in their room. Some of the residents had their own private telephones to keep in touch with their family and friends. A selection of menus was seen and this showed us that there was a wide choice of main dishes for each meal for example, toad in the hole, or sea bass, roast supreme of chicken or pan fried salmon, garlic and rosemary roasted leg of lamb, or pan fried cod, pan fried escallop of turkey or lemon crusted rainbow trout, or braised steak and kidney pie or sautéed fillet of seabass. Lunch on the day of inspection was very well presented, looked and smelt appetising, and residents told us that the meals were very good. Feedback from residents when asked ‘do you like the meals at the home 10 of 11 said, ‘always’, one did not say. Comments from the residents included, ‘The meals are excellent’, or ‘I cannot fault the meals’, or ‘I think the meals are exceptionally good’. Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 Page 16 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. People who use this service can usually expect to have their complaints taken seriously and be protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure that is available to the residents with the statement of purpose, or in the home’s brochure, ‘A guide to making a complaint’. The home has a four-step complaint process, which includes talking with a staff member about the problem or making a formal complaint. The complaints log was seen and showed that the home has not had a recent complaint, although the CSCI received some general concerns about the home. These were unable to be substantiated at the inspection. Eleven residents’ survey forms were returned to the CSCI and all said that the residents were aware of how to complain, and that they, ‘always or usually’ know who to speak with, if they were not happy. One resident told me that the manager often visits the residents, and was very approachable if there were any problems. The resident said that they had raised a concern on one occasion and that the home had ‘done their best’ to resolve this. Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 Page 17 The home showed us their safeguarding policy, which contained information on protection of vulnerable adults policy (POVA) that covered the key areas for recognising abuse and the different types of abuse. The information provided by the home (AQAA) said that they had made amendments to their procedures to reflect local and national guidelines around safeguarding adults. Further the senior management team had attended training around the ‘mental capacity act, and depravation of liberties’. Staff records checked included criminal record bureau (CRB) and protection of vulnerable adult (POVA 1st) checks and reference checking to ensure that staff were suitably checked and cleared to work with vulnerable adults. Discussion with the management and staff records checked confirmed that adult safeguarding training was provided for staff, although 2 staff members’ records checked, did not provide evidence that they had received safeguarding training. Eleven of eighteen staff members had achieved their national vocational training level 2, which does cover safeguarding training. This would ensure that these staff members would know what to do in the event of any allegations of abuse being made. Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 Page 18 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, 20, 24, and 26. Quality in this outcome area is excellent. People who use this service can expect to live in a very comfortable, hygienic and well-maintained home and gardens. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Garrett House is a large Georgian house, set in around four acres of wellmaintained landscaped gardens, which incorporate a croquet lawn, tropical themed courtyard, a summerhouse and a fenced pond. The house has views to the river Alde. There is a parking area and the garden has a number of decorative marble statues in place. 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 Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 Page 19 single, seventeen of which provide very spacious accommodation, with two larger bedrooms available should couples wish to share. Within these numbers the home offers four suites incorporating adjoining rooms and exceeding the standards for accommodation. All the bedrooms in the extension have en suite facilities, as do all except one in the main house. The internal décor is very attractive with soft furnishings and furniture in keeping with the style of the home. The rooms are spacious and the outlooks from the windows are appealing. On the day of inspection the home was clean and well maintained, with no unpleasant odours detected. There were large attractive informal seating areas evident throughout the home with small tables for cups available and fresh flowers and plants displayed. During a tour of the home a number of individual rooms were checked and some residents told me they had brought some of their own personal items of furniture and belongings. The hallways, corridors and the communal rooms were all clean and tidy. Feedback from eleven residents said that the home was ‘always or usually’ kept fresh and clean. The information provided by the home said that they provide hygiene gel around the house with comprehensive hand wash facilities. Liquid soap and paper hand towels were noted at various places throughout the home for staff use. Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 Page 20 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. People who use this service can expect to be supported by adequate numbers of correctly recruited and trained staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The information provided by the home said, ‘We recruit staff with our residents’ best interest and above all, their safety in mind. We have a skilled task force who work with confidence. We have ample staff and we ensure that they are trained to a very high standard’. The duty rotas were checked and these showed that there was a senior carer on duty at all times. They were supported during the day by two or three junior staff and at night by one carer. In addition there was a chef daily between 8.00 and 16.00, a domestic morning and afternoon, an administrator and a maintenance person. A further member of staff was rostered during the evening to help with supper delivery and assist with evening baths. The management team was supernumerary but readily available at all times. The home employs eighteen care staff and actively encourages personal development and education for staff to reach their potential. Eleven staff hold Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 Page 21 a National Vocational Qualification (NVQ) at level 2 or above with a further one working towards the qualification, so around 60 of staff have achieved this award. Surveys received by the CSCI from staff said that they were updated with training which was ‘relevant to their role’. The staff training records showed that staff had attended courses within the last year about dementia awareness, moving and handling, effective communication, and managing challenging behaviour and medication administration. The carer who administered the lunchtime medicines confirmed that they had received training in medication administration. Staff employment records checked showed that the home had undertaken criminal bureau records (CRB) and protection of vulnerable adult (POVA 1st) checks, and 2 reference checks for both employees. Records also contained a photograph of the person, and an application form including a previous work history. One staff file included a record of their identity, one did not, and which was required. The information provided by the home (AQAA) said that training over the last 12 months had included first aid, manual handling, terminal care, Parkinson’s care, fire training, aggressive behaviour training, food hygiene, disability access, infection control, medicines training, and mental capacity. Records checked and feedback from the staff group confirmed this. All new staff follow an induction programme that covers personnel, staffing and human resource issues as well as training relevant to the job they are to perform. These areas include the aging process, fire awareness, health and safety, communication, infection control, moving and handling, food hygiene and control of substances hazardous to health (COSHH) regulations. Staff surveys confirmed that induction training covered everything they needed to know to do their job, and that training undertaken was ‘relevant to their role’. Two staff members’ records checked did not provide evidence that they had received safeguarding training, however eleven of eighteen staff had completed their NVQ 2 training, which does incorporate this. Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 Page 22 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, and 38. Quality in this outcome area is good. Residents will benefit from an appropriately run home that seeks their views about the service provided. This judgement has been made using all the available evidence including a visit to this service. EVIDENCE: Mr. and Mrs. Stedman have owned Garrett House for twenty-seven years. Mrs. Stedman is the registered manager. The deputy manager and the property and services manager are family members. All the management team have relevant professional qualifications. Residents and staff spoken with said the management team were approachable, and in a crisis provided good support. Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 Page 23 The home had a quality assurance process in place and surveys had been given to residents and relatives during the last year, and 24 responses had been returned. Seven responses checked showed that those who replied were happy with the environment, cleaning, food and care offered by Garrett House. Some residents suggested different types of activities to be included with the activity programme. A sample of some comments included the following points of views. ‘We are well cared for’, and ‘all seems satisfactory at the moment. Thank you’. ‘The general cleanliness and tidiness is fine, but I think we need more activities and entertainment’, and ‘I am very fortunate to sit with friends. I am very happy here’. The information provided by the home said, ‘We maintain records with regards to residents personal monies held. We have an efficient administrator and bookkeeper’. The home has a system for managing residents’ personal monies and records and receipts were maintained. These records were not checked on this occasion. The home maintains maintenance and service records and the fire records were checked. The home had undertaken a fire risk assessment in accordance with the local fire service requirements. Fire training was provided for new staff members. The information provided by the home (AQAA) showed that home continued to maintain equipment including hoists, fire detection equipment, call bells, the heating system, soiled waste and gas appliances. The home confirmed they have a written assessment around the control of substances hazardous to health. The information provided by the service (AQAA) confirmed that the home has a range of policies and procedures for staff, which includes health and safety, and financial procedures, which are regularly reviewed. Staff records show that they have received health and safety training including moving and handling, fire procedures, infection control and food hygiene training. This was confirmed by feedback received from staff. The tour of the premises showed that the building was very well maintained. The home maintained fire check records and undertook checks of hot water temperature checks to ensure that these remained safe for the residents. A sample of hot water tap temperatures taken during the inspection showed all temperature controlled at around 38 to 41 degrees Celsius Feedback from staff said that they were ‘regularly’ supported by their manager who would meet with them to discuss how they were working. However two staff members’ records checked did not provide detailed evidence of recent supervisions. Records checked for one staff member showed evidence of an annual appraisal completed in June 2007, and another in February 2007. Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 Page 24 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 3 x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 4 4 x x x 3 x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 2 x 3 Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(2)(c) Requirement Care plans must provide sufficient details of the care required, for staff guidance and to keep the residents’ safe. Moving and handling risk assessments but be regularly reviewed to ensure they reflect the current needs of the resident, and to keep them safe. Timescale for action 24/11/08 2. OP7 13(4)(b) (c) 24/10/08 3. OP9 13(2) 4. OP29 19(1) Sch 2(1) The home must ensure that 24/09/08 medicines are prepared by persons qualified to do so, to prevent errors and ensure the safe delivery of medicines to the residents. This requirement is immediate. A record of all identity checks 24/10/08 must be maintained on staff files to ensure the home can evidence that staff members are suitable to work with vulnerable adults. Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 Page 26 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 OP9 OP8 Good Practice Recommendations The manager should ensure that suitable arrangements are in place to ensure dossett box medicines are always secure during the medicines round. One resident’s monthly weight chart had been discontinued without reason. The manager should review the need for continuing these, and provide clear guidance for staff, on what they must do. This is to ensure that any residents with nutritional concerns are closely monitored. The home should ensure that all staff members’ have received safeguarding training, to ensure they know what to do in the event of any allegations of abuse being disclosed by a resident. Staff supervision records should be kept up to date to ensure the home can evidence support of the staff group. 3. OP18 4. OP36 Garrett House Residential Home DS0000024394.V370650.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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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