CARE HOMES FOR OLDER PEOPLE
Garsewednack 132 Albany road Redruth Cornwall TR15 2HZ Lead Inspector
Lynda Kirtland Unannounced 16 May 2005 0930 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. Garsewednack D52-D04 S54567 Garsewednack V215916 160505 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Garsewednack Address 132 Albany Road Redruth Cornwall TR15 2HZ 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) 01209 215798 01209 611924 Mr Neil Edward Brazier, Mrs Nicola Carla Brazier & Mrs Anne Brazier Care Home 21 Category(ies) of Demetnia - over 65 years of age (4), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (4), Old age, not falling within any other category (21) Garsewednack D52-D04 S54567 Garsewednack V215916 160505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: Service users to include up to Service users to include up to Service users to include up to (MD(E)) Total number of service users 21 adults of old age (OP) 4 adults over 65 years with Dementia (DE(E)) 4 adults over 65 years with a mental disorder not to exceed a maximum of 21 Date of last inspection 25 February 2005 Brief Description of the Service: Garsewednack is a private residential care home accommodating twenty-one older people requiring personal care and accommodation, of which four older people may have dementia or other forms of mental ill health. The registered providers are Mrs Anne Brazier and Mr Neil and Mrs Nicola Brazier who have been registered under the Care Standards Act 2000 since 5th February 2004. The providers purchased the home in August 2003 and own another residential care home in Newquay.The home provides day care facilities for a maximum of two service users attending on the same day. Since purchasing the home the management team have been investing in the building and training the new staff team that they have recruited, reviewing the homes records, policies and operational systems, plus getting to know the service users, families and representatives. The accommodation is on two floors and due to a lift it allows access to all parts of the building for service users resident in the home. The premises are clean, decorated attractively and is comfortably furnished. There are 19 single bedrooms and 2 shared rooms. No rooms have en suite facilities but there are sufficient toilet and bathroom facilities within the home. There is a main lounge, quiet room, smoking room, dining room and garden area accessible for all service users. Management stated that it is their intention to provide a quality residential experience for those service users living at the home whilst respecting their dignity and rights Garsewednack D52-D04 S54567 Garsewednack V215916 160505 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Garsewednack on the 16 May 2005 and spent the day at the home. This was an unannounced visit. On the day of inspection 21 service users were resident in the home. The inspector met with 13 service users and 2 representatives, a number of staff and the registered providers to gain their views on the service that Garsewednack provide. In addition the inspector examined records, policies and procedures and toured the building. This report summarises the findings of this inspection. What the service does well: What has improved since the last inspection?
The commitment to improving the physical standards in the home has been evidenced throughout this inspection. Some examples of the improvements are: new windows fitted throughout the home, redecoration, and new carpets/ lino and updated equipment in the kitchen area. Service users commented that they are pleased with the improvements made to the home. Service users and their representatives commented that staff are skilled to be able to meet their care needs in a sensitive and professional manner. They commented that the staff team is now a consistent group and this means that the same individuals are now meeting their care needs. Staff commented that they are ‘happier’ with the consistent staff team and feels that this allows them to know service users personal needs in more
Garsewednack D52-D04 S54567 Garsewednack V215916 160505 Stage 4.doc Version 1.20 Page 6 detail. Additionally this helps them in developing a feeling of a ‘team approach’ and support’ within the home. The registered providers have implemented a review process that allows service users and their representatives to participate in if they wish. This process reviews the individuals care plan and records if any changes need to be made and how this will be achieved. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Garsewednack D52-D04 S54567 Garsewednack V215916 160505 Stage 4.doc Version 1.20 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 Garsewednack D52-D04 S54567 Garsewednack V215916 160505 Stage 4.doc Version 1.20 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 Garsewednack have a pre admission procedure. Information form referring agencies must be gained prior to or on admission to the home. Garsewednack are encouraging staff to update their skills in the care for older people. EVIDENCE: From inspection of three service users files, this evidenced that Garsewednack have a pre admission process. However it was noted and confirmed by the registered provider that for the latest admissions this was completed on the day following admission. The registered provider stated this was an emergency placement however information from referring agencies must be followed up. The inspector found minimal or no pre admission assessments on the other files inspected. In addition the inspector advised that the home consider how they can evidence that service users and their representative’s views and participation at the point of assessment where incorporated. Requirements to this effect have been identified. A requirement was identified at the previous inspection to ensure that all staff attends relevant training in older persons care especially in the areas of dementia and memory loss. The registered provider stated that some staff is
Garsewednack D52-D04 S54567 Garsewednack V215916 160505 Stage 4.doc Version 1.20 Page 9 attending NVQ level 2 training, after which they will then attend moving and handling and dementia courses. Therefore this requirement remains in place. Garsewednack D52-D04 S54567 Garsewednack V215916 160505 Stage 4.doc Version 1.20 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) 7,8,10. Care plans must be expanded to ensure that they identify service users physical, emotional, social, educational and leisure pursuits and the interventions expected of staff to approach the care need in a consistent manner must be recorded. Health needs are met in a satisfactory manner. The registered provider must audit the number of falls in the home and ensure appropriate actions are taken to minimise further falls. Service users commented that the majority of staff at the home approaches them with dignity and privacy. EVIDENCE: The inspector noted that the registered provider and senior carer have commenced work on the development of service users care plans. However further work continues to be needed to ensure that all physical, emotional and social care needs are included in the care plan. The care plan must specify what staff interventions are needed. It was evident that the registered provider and senior carer have gained service users and their representatives’ views in the monthly review process of their individual care plans. Documentation evidenced who participated in the review and what changes, if any were made to the care plan.
Garsewednack D52-D04 S54567 Garsewednack V215916 160505 Stage 4.doc Version 1.20 Page 11 From discussion with service users and their representatives they all said their health needs are met and that they see health professionals in private. The registered provider stated Garsewednack has a positive relationship with health professionals in the surrounding area. Service users files evidenced that advice received from health colleagues are recorded as is the actions staffs have taken. Some areas of health care need to be developed further; nutritional assessments must be undertaken; moving and handling policy must be reviewed; and ensure that all staffs attend annual moving and handling training; a review of moving and handling equipment in the home must occur and purchased where appropriate. It is of concern that Garsewednack does not have access to a hoist especially as some care needs have deteriorated. The registered provider is liaising with the district nurses to try and resolve this. The registered provider confirmed that the previous requirement in respect of recording medication after it has been administered has been complied with. The other requirements remain in progress and therefore are re notified to the home and not inspected. The accident book was inspected and showed that all accidents are now being recorded. The inspector advised at the last inspection that the registered provider audits the number of accidents and if the home can take actions to minimise future accidents, this has not occurred. Service users and their representatives stated that they felt that all their care needs were met. Service users did not have any issues in respect of personal care and made comment such as ‘staff are kind’ and ‘wonderful’. The inspector observed during the inspection staff that approached service users in a sensitive manner. Garsewednack D52-D04 S54567 Garsewednack V215916 160505 Stage 4.doc Version 1.20 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) 12,13,14,15 Garsewednack provides a programme of activities to promote and encourage the pursuit of service users social, educational and leisure needs. Service users visitors are encouraged to visit their relative. Service users are encouraged to retain links with the local community Garsewednack must consult with service users about the provisions of meals in the home. EVIDENCE: Service users confirmed that there is flexibility in their daily routines. From discussion with service users, staff and observations it was evident that there is a number of activities that service users can participate in if they wish. Some service users recalled monthly church services at the home, entertainers, fortnightly craft shops, knitting and reading. The registered provider stated that there is an activity book, which records the level of activities in the home, but this was not inspected. Service users did state that the area of improvement that they would like is to have a ‘keep fit’ session; this was relayed to the registered provider. Service users and their representatives confirmed that visitors felt welcomed to the home and that they can visit their relative in private or in communal areas. The home has an open and flexible policy to visitors and there are no visiting restrictions.
Garsewednack D52-D04 S54567 Garsewednack V215916 160505 Stage 4.doc Version 1.20 Page 13 In respect of food, the majority of service users stated that the quality, quantity and presentation of food are to a ‘good’ standard. Service users confirmed they have a choice of food. The home offers a 4-week rotational menu; service users said lunch that day was ‘nice’. Service users felt that the kitchen staff in the main knew their likes and dislikes and would provide an alternative if necessary. Some said they would like more variation in their meals. The registered provider and kitchen staff stated that they have met with service users to discuss menus and a menu plan was seen which stated this. However service users were unable to recall this. Due to service users ability to vocalise their views the inspector recommended to the registered provider that a residents meeting be held to address the provision of meals and activities in the home. The registered provider stated that the staff team had recently considered this and are aiming to organise such a meeting within the next month. Since the previous inspection kitchen staff has complied with requirements and recommendations identified: they now record if an alternative meal be provided and have ensured that suitable light coverings in the kitchen are installed. Kitchen staff now ensures the temperature of food is probed and recorded. The kitchen does need to have a fly screen installed. Garsewednack D52-D04 S54567 Garsewednack V215916 160505 Stage 4.doc Version 1.20 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) 16,17,18 Garsewednack has an appropriate complaints and whistle blowing policy. The management team encourage service users, their representatives and staff to voice any concerns so that they can be addressed. The registered provider ensures that service users are protected from all forms of abuse. The policy must be expanded. EVIDENCE: The homes policies and procedures in respect of complaints and accessibility to advocacy service are satisfactory. There has been one expression of concern relayed to the home. The registered provider responded to this concern and the service user and representative commented to the inspector that they were satisfied with the homes response. CSCI have not received any complaints. Service users told the inspector that they had ‘no grumbles’ about the care or facilities provided at Garsewednack. Some service users confirmed that they had participated in the local general election. Service users stated that they are aware of local advocacy services or can request if they wish, for family or solicitors to act on their behalf. The home has an adult protection policy; it was required at the previous inspection that this needs to be expanded to include the POVA process. The registered provider stated that this had not occurred and has been re notified to the home Garsewednack D52-D04 S54567 Garsewednack V215916 160505 Stage 4.doc Version 1.20 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) 19,20,21,22,23,24,25,26 Garsewednack provide a good standard of décor and furnishings creating a comfortable and safe environment for those living there and visiting. Garsewednack have invested in the homes furnishing and décor to improve the facilities in the home. The home is clean. EVIDENCE: From inspection of the premises it was evident that Garsewednack is maintained, decorated and furnished to a good standard throughout the home. Since the last inspection it was evident that all the windows in the home have been replaced, some rooms have been redecorated, new carpets fitted in bedrooms and new lino flooring in the bathrooms, some new beds purchased and some kitchen equipment has also been updated. The registered provider stated that their aim to continue redecorating parts of the home and are asking service users to be involved in choosing the colour scheme for their rooms. Service users stated they were ‘pleased’ with their ‘comfortable rooms’ and ‘pleasant’ surroundings. The home was clean and odour free throughout. There
Garsewednack D52-D04 S54567 Garsewednack V215916 160505 Stage 4.doc Version 1.20 Page 16 is a secure garden area for service users and their representatives’ use. It was evident that Garsewednack continue to update the home, as there is a planned maintenance programme of works in situ. Following review of the location of the call bells, this has been monitored and it was observed that they are now accessible to service users. Garsewednack D52-D04 S54567 Garsewednack V215916 160505 Stage 4.doc Version 1.20 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) 27,28 Garsewednack ensure that suitable trained staffs are employed in sufficient numbers at all times. EVIDENCE: On the day of inspection three carers, senior carer plus domestics, kitchen staffs and registered providers were on duty. Staffing ratio during waking hours is aimed to be around 1:7. At night there are two waking night staff plus a manager on call. The registered provider stated that there are currently no staffing vacancies in the home. The inspector would comment on the day of inspection there were sufficient staffs on duty and observed staff to be communicating with service users in a caring, friendly and relaxed manner. The inspector would comment that service users spoke positively about staff. One recommendation was identified to ensure that 50 of care staff obtains NVQ level 2 status, the registered provider aims for this to be achieved by June 2005. This remains in progress. Garsewednack D52-D04 S54567 Garsewednack V215916 160505 Stage 4.doc Version 1.20 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, 34,37 The registered providers are promoting a management structure, which creates an open, positive and inclusive atmosphere. The home is developing quality assurance systems involving service users to monitor the quality of the home. The home is financially viable. EVIDENCE: There are three registered providers who jointly own Garsewednack and are accountable for its operational aspects of the service. The inspector met with one of the registered provider during this inspection. As two registered providers also own another home they divide their time between the two homes. The registered providers are in discussion with CSCI regarding consideration of a registered manager being employed at both homes. Garsewednack D52-D04 S54567 Garsewednack V215916 160505 Stage 4.doc Version 1.20 Page 19 Service users and staff stated that the management team are approachable and skilled to carry out the tasks of managing the home. Due to comments made by some service users the registered provider has agreed to initiate residents meetings so that there is opportunity for service users to express their views on the service that the home provides. The registered provider acknowledged some of the homes processes and policies need to be reviewed for example implementing a quality assurance survey, implementing a policy on the management of service users monies and developing the care planning processes further. The registered providers have ensured that health and safety of service users and staff is met. Regular monitoring of the condition of the home and appropriate inspections from Fire authority and the Environmental Health department take place. The registered provider stated that Garsewednack is financially viable, appropriate insurances are in place. Garsewednack D52-D04 S54567 Garsewednack V215916 160505 Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 2 x 3 2 3 x x 3 x Garsewednack D52-D04 S54567 Garsewednack V215916 160505 Stage 4.doc Version 1.20 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1)(a)( b)(c)(d) Requirement Service users must have a pre admission assessment to ensure that the home can meet their social, educational and leisure needs prior to admission to the home, as detailed in the homes statement of purpose In addition service users and their representatives views should be incorporated in the pre admission documentation/ processes. the registerd provider musr ensure yhat all staff recieves training in older persons care especially in the area of dementia and memory loss. (2nd notification) The registerrd provider must review the care plans to ensure that they record all identified care needs, aims and objectives and specify staff interventions to ensure that care is provided in a consistent manner. (timescale for complainace extended 1st time ) nutritional assessments for all service users must be undertaken with apporaite interventions and actions Timescale for action 30/09/05 2. OP4 18(1)(a) 19(5)(b) 30/10/05 3. OP7 15 (1)(2)(a) 30/06/05 4. OP8 sch 3(m) 30/06/05 Garsewednack D52-D04 S54567 Garsewednack V215916 160505 Stage 4.doc Version 1.20 Page 22 5. OP8 12(1)(b)2 3 (2)(n) 6. OP18 12 (5)(a)(b) 24 7. OP33 8. OP33 16(2)(m)( n) 20, 16 (2)(i) 17 (2) Sch 4(9)9a)(b ) 13(2) sch 3(k) 12(3)(4)( 5) 9. OP35 10. Op9 recorded and included in care plan. A review must occur to ensure that sufficient equipment to enable the safe moving and handling of service users must be undertaken and equipment purchased. the adult protection policy must be expanded to indlude the process of POVA and appropriate training given a qualtiy assurance process must be implemented. The findings of the quality assurance process must be forwarded to CSCI annually the registerd providers must consult with service users to gain views on the service that the home provides. the registerd provider must write a policy in the administration, management and auditing of service users monies. This policy must be implemented. The medication policy must be expanded to cover all elements of the storage, receipt, administration and disposal of medication. This policy must be available to staff at all times 30/11/05 30/10/05 30/08/05 30/08/05 30/07/05 30/07/05 11. 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 OP8 OP28 Good Practice Recommendations the registerd provider should undertake an audit of all falls within the home and take appropariate actions to minise future falls. Service users and representatives views in respect of
D52-D04 S54567 Garsewednack V215916 160505 Stage 4.doc Version 1.20 Page 23 Garsewednack 3. 4. 5. 6. OP28 OP15 OP9 OP9 health deteriorating or in the event of death should be gained and incorporated in care plan (3rd notification) A minimum of 50 trained memebrs of care staff with NVQ level 2 should be achieved (4th notification) A flyscreen should be installed at the kitchen window. the storage of creams/liquid medication should be monitored in a room at the correct storage temperature the receiveing pharmacist should sigh tne returns book of medicationto evidence they have received the medication. Garsewednack D52-D04 S54567 Garsewednack V215916 160505 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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