Inspection on 20/08/07 for Garsewednack Residential Home

This inspection was carried out on 20th August 2007.

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

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

Other inspections for this house

Garsewednack Residential Home 25/11/08

Garsewednack Residential Home 30/05/08

Garsewednack Residential Home 20/06/06

Garsewednack Residential Home 15/11/05

Garsewednack Residential Home 16/05/05

Garsewednack Residential Home 25/02/05

Garsewednack Residential Home 13/12/04

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

CARE HOMES FOR OLDER PEOPLE Garsewednack Residential Home 132 Albany Road Redruth Cornwall TR15 2HZ Lead Inspector Ian Wright Unannounced Inspection 20th August 2007 08:45 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 Garsewednack Residential Home DS0000054567.V343898.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. Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Garsewednack Residential Home Address 132 Albany Road Redruth Cornwall TR15 2HZ 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) 01209 215798 01209 215798 Mrs Anne Brazier Mr Neil Edward Brazier, Mrs Nicola Carla Brazier N/A Care Home 21 Category(ies) of Dementia - 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 Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Service users to include up to 21 adults of old age (OP) Service users to include up to 4 adults over 65 years with Dementia (DE) [E] Service users to include up to 4 adults over 65 years with a mental disorder (MD) [E] Total number of service users not to exceed a maximum of 21 Date of last inspection 20th June 2006 Brief Description of the Service: Garsewednack provides personal care for twenty-one older people. Four people living in the home may have dementia, and four other service users may have other mental health needs. The home also provides day care for some people. The registered providers are Mrs Anne Brazier, and Mr Neil and Mrs Nicola Brazier. The providers purchased the home in August 2003. Mr N and Mrs N Brazier also own another residential care home in Newquay. The manager Ms Alison Smith supervises care and the staff team on a day-to-day basis, although she is not registered with the commission as the manager. The accommodation is on two floors. There is a staircase and stair lift, which allows access to the first floor. There are 19 single bedrooms and 2 shared bedrooms. No rooms have en suite facilities but there are sufficient shared toilet and bathroom facilities. There are two lounges, a dining room and garden area accessible to people living in the home. A copy of the inspection report is available in the hallway, and it is suggested a copy is requested from management if required. The range of fees at the time of the inspection is £335-£400 per week. There are additional charges e.g. for hairdressing, chiropody, and newspapers etc. Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Unannounced Key Inspection took place in eight hours in a day. All of the key standards were inspected. The methodology used for this inspection was: • To case track four people who use the service. This included interviewing the people who use the service about their experiences and inspecting their records. • Interviewing four staff about their experiences working in the home. • Informal discussion with staff and other people who use the service. • Observing care practices. • Discussing care practices with management. • Inspecting records and the care environment. Other evidence gathered since the previous inspection such as notifications received from the home (e.g. regarding any incidents which occurred) were used to help form the judgements made in the report. What the service does well: What has improved since the last inspection? What they could do better: This inspection has resulted in the issuing of eight statutory requirements. Action regarding these is required by law within the timescales set. In brief improvement is required to: • Ensuring all people living or staying in the home for respite have a satisfactory care plan. • The residents’ monies accounting system. • Ensuring bathrooms, toilets and bedrooms have a lockable door. Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 6 • • • • • Staff employment checks. Staff training. Ensuring the home has a registered manager. Quality assurance systems. Health and safety precautions. The Commission will monitor suitable action is taken in these areas, and complete a further inspection to check compliance if this is deemed necessary. 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. Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered provider has developed a statement of purpose and service user guide. The service user guide is available to people who use the service and their representatives. People who use the service are issued with a contract either via the social services department or the registered provider, depending fee arrangements. The provision of suitable information ensures people who use the service are aware of the services the registered provider offers. This information also helps ensure people who use the service are made aware of their rights and responsibilities. The registered provider’s assessment procedure is satisfactory, and there is evidence that people who use the service are assessed before they are admitted to the home. Suitable assessment procedures ensure the registered provider only accommodates people for whom the provider can suitably meet their needs. EVIDENCE: Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 9 Copies of the statement of purpose and service user guide were inspected and are satisfactory. A copy of the service user guide is kept in the hallway and the registered provider said a copy is given to the person who uses the service, or their representative, when admission is arranged. The registered provider said each person using the service receives either a contract issued by the registered provider (if their care is funded privately) or receives a contract issued by the Department of Adult Social Care (DASCsocial services) if they fund them. This provides information about the service offered and the person’s fees. A copy of this documentation is contained within each person’s file. The registered provider outlined a suitable approach to the assessment of potential residents. For example, one of the senior staff will visit the person before admission is arranged. Copies of pre admission assessments are contained on individual files. A copy of the social services or NHS assessment is obtained, where possible, before admission is arranged. Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good, although some improvement is required to care planning arrangements. This judgement has been made using available evidence including a visit to this service. Most people who use the service have a satisfactory care plan, although these were absent for some people who were staying at the home for respite (short stay). There is satisfactory evidence of regular review of care plans. Suitable care plans help to ensure people who use the service receive all the care they need, for example in a consistent manner. There is evidence that staff ensure health care needs are met. However some improvement is required to the medication system. People who use the service said they felt staff worked with them in a manner, which respects their privacy and dignity, and this was also evident from the inspector’s observations. EVIDENCE: Care plans for some people who use the service were inspected. These appeared to be generally satisfactory, and contained suitable information to assist staff to provide care. However there was not a care plan for two people who were staying in the home for respite. These should be developed for the Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 11 person when they are admitted to the home. All care plans need to have a photograph attached to them. This helps staff or agency staff, who for example are new to the service, to be able to identify the individual. Some care plans contained satisfactory risk assessments e.g. regarding manual handling. However these were absent for some people living in the home. There was satisfactory evidence care plans are reviewed. Although people who use the service, who the inspector spoke to, did not appear to be aware of their care plans, these people all said the care they received was appropriate and carried out in a manner according to their wishes and needs. However one person said they wished they could have had more baths during their short stay. The registered provider said people had one bath a week and a strip wash each day. The matter should be discussed when people move in to ascertain people’s wishes and expectations. All people living in the home looked clean, well dressed and well cared for. Health care support appears to be to a good standard. People who use the service said they could see a doctor or other medical practitioner when this is necessary. There is satisfactory evidence of links with medical professionals such as district nurses/ dentists/ GP’s /optician’s etc, and any appointments are recorded in care files. The registered provider said one person had a small pressure sore, but the person is receiving medical support from the district nurse regarding this matter. A previous requirement was made in the report dated 20th June 2006 regarding the provision of epilepsy training, because at least one person living in the home has this condition. The registered provider said she has obtained literature regarding the condition which staff are required to read when they start employment. The registered provider said the person who has the condition seldom has seizures, and does not require assistance, support or medication when seizures occur. If the registered provider is satisfied the induction training in place is satisfactory, no further action is required. It should also be recorded in a risk assessment what action has been taken to minimise any health and safety risk to the person living in the home. However it should be recorded when staff receive induction regarding these matters, and regular refreshers should be considered. Further training and information can also be obtained from organisations such as the British Epilepsy Association at: http:/www.epilepsy.org.uk/ The medication system was inspected. Medication is stored in locked cupboards and administered via a monitored dosage system. The operation of the system is generally satisfactory, although some dosages for three people using the service were signed for but did not appear to be given. Otherwise stock levels, storage and records were satisfactory. Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 12 Staff have received training regarding the handling of medication. This was delivered via a distance learning training course. The manager from the registered provider’s other home verifies individual staff performance handling medication is satisfactory. The training given appears to be satisfactory, although the registered provider is advised to consult the CSCI guidelines regarding medication training: http:/www.csci.org.uk/professional/default.aspx?page=7328&key= It is recommended that a risk assessment be completed regarding the administration of any PRN (as required medication) particularly related to mental health. This should, for example, include under what circumstances the medication is administered. When this medication is administered, the reasons for administration should be recorded, for example, within the daily notes and / or on the back of the medication sheet. It should also be clearly recorded how many tablets are administered when the prescription allows some discretion regarding its administration. Such measures could protect staff and the registered provider from allegations of abuse. People who use the service spoke positively regarding the attitude of staff, and said staff respected their privacy and dignity. People said staff encourage them to make choices, for example when they can get up and go to bed. Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Routines are flexible to meet the needs of people who use the service. Some activities are available to people living in the home. This ensures people who use the service can have a daily routine that suits their needs and some opportunity for social activity. People who use the service have opportunity to receive visitors. People who use the service are encouraged to make choices regarding how they live their lives. Arrangements for meals are good and ensure that people who use the service have a varied and wholesome diet. EVIDENCE: The inspector observed some of the morning routine. This was relaxed, but organised. It was clear people who use the service could get up when they wanted to, and staff support was professional, relaxed and unhurried. The inspector was able to speak to many of the people who use the service and all said they could get up and go to bed when they wanted to. Some activities are available. The activities book stated there have recently been bingo sessions, a musician visiting, quizzes, and a visit from the church singers. Board game and nail care sessions have also been held. People living in the home also enjoy sitting in the garden, and some new garden furniture has been purchased. The minister from the local church visits once a month. Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 14 People who use the service said they felt they could exercise choice over their lives for example how to spend their time, what they could wear etc. People can look after their own money, although there is some need for improvement in this area as outlined later in the report. It was evident people who use the service could bring their own furniture and belongings into the home. For example bedrooms are individualised with peoples’ personal belongings such as photographs and ornaments. The inspector shared a meal with some people who use the service. Food served was of good quality. People who use the service all said they were happy with the food provided. They said there was always enough food and meals were well cooked. A choice of a hot or cold snack for evening tea is available each evening. There were satisfactory levels of food supplies available in the home and supplies were of satisfactory quality. Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered provider has suitable policies and procedures regarding complaints and adult protection. Policies in place should assist in ensuring people who use the service can be assured any concerns, complaints or allegations are taken seriously and dealt with effectively. Staff should have the opportunity to receive training regarding recognising abuse. EVIDENCE: Policies and procedures regarding complaints and adult protection were inspected. The registered provider received one complaint from the relative of a person living in the home in July 2006, and this seems to be have been investigated to a satisfactory standard. The Commission for Social Care Inspection has not received any complaints regarding this service since the last key inspection in June 2006. The registered provider needs to update the CSCI address in the Complaints Procedure now the CSCI office is based in Devon. Many people who use the service were positive about staff practices and said they were not aware of any poor or abusive practice. Staff the inspector spoke to also said practices within the team were to a good standard. It would be beneficial if more staff that work in the home received training regarding recognising abuse, and what to do if they thought people living in the home had been the victim of abuse. Although some of the staff the inspector spoke to say they would report any concerns to management, staff should receive training in this area as outlined in the regulations. Such training Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 16 is available from Cornwall County Council (Department of Adult Social Care). Information regarding this can be found at: http:/www.cornwall.gov.uk/index.cfm?articleid=37718 Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 17 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, 21, 26 Quality in this outcome area is generally good although improvements are required to ensure privacy in bathroom and toilet facilities. This judgement has been made using available evidence including a visit to this service. The registered provider has continued to bring improvements to the physical environment at Garsewednack, and the home provides clean, pleasant and homely accommodation for the people who live there. EVIDENCE: The building was inspected. The building was light, warm and clean on the day of the inspection. The registered provider has made a number of improvements to the building since the last inspection. For example the outside of the home has been painted and looks very nice. The front garden has been redesigned and looks very pleasant. The second lounge has been enlarged and one of the bedrooms, which had little natural light, has been moved. The registered provider has further plans for improvement including new carpets on the stairs and landing, and further redecoration. Satisfactory kitchen and laundry facilities are available. Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 18 All bedrooms are of a satisfactory size; all are decorated and furnished to a good standard. There are two lounges where people living in the home can choose to spend time, and there is a separate dining room. Bathrooms and toilets are satisfactory. For example there is a chair lift on baths to assist people with disabilities. The previous requirement to fit locks to toilet and bathroom doors have not been complied with, and this is renotified. The registered provider said there is an ‘engaged’/‘vacant’ sign on toilet and bathroom doors, but these clearly are not effective. For example the inspector went to the toilet marked ‘engaged’ although this was not actually being used. It is disappointing action has not been taken regarding this requirement, particularly considering the excellent developments elsewhere to improve facilities. One of the toilet doors (near room 11) is difficult to shut, particularly by someone who is frail. This needs attention. The registered provider said she would attend to the matter. Most of the bedroom doors do not have locks. There is a ‘break bolt’ system on bedroom doors, but many of these are broken. There should be a lock (with an overriding facility if necessary) on each door. People who use the service should be issued with a key if they are suitable to have one (e.g. in terms of cognitive ability). As a minimum people moving into the home should be offered a lock on their bedroom doors, and their decision should be recorded. Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are to a satisfactory standard and should ensure people who use the service receive appropriate levels of support when they need it. Recruitment procedures need improvement so people who use the service can be assured they are in safe hands and protected at all times. Staff training, although improved since the last key inspection, still requires further improvement so staff have appropriate knowledge and skills to support people who use the service. It must be a priority to ensure there is always one first aider on duty at any one time and all staff receive moving and handling training. It is essential the registered provider ensures all staff receive the training they need to meet the needs of people living in the home, and training required by law. EVIDENCE: On the first day of the inspection the following staffing was provided: • • • • Two members of staff on duty from 08:00 to 15:00 One member of staff from 08:00 to 13:00 Three members of staff on duty from 15:00 to 22:00 Two waking night staff from 22:00 to 08:00 Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 20 In addition all three of the registered providers were working in the home for all or part of the day. The manager was working from 08:00 until 16:00. The cook and a cleaner were on duty. People who use the service were positive regarding the support they receive from staff. Comments were made that staff were approachable and worked well as a team. The registered provider has a suitable approach to enabling staff to have the opportunity to obtain a national vocational qualification (NVQ) in care. The home’s Annual Quality Assurance Assessment (AQAA) [An annual return which registered provider’s are required to return to CSCI], states 38 (6 out of 16) have an NVQ with 3 working towards this qualification. Copies of an NVQ certificate were on three of the eleven personnel files inspected. Recruitment checks completed when staff are employed have improved since the last inspection but are still only adequate. The records of eleven staff were inspected. Records show most staff have a record of their employment history, although in some cases these need improvement, for example, they were patchy or absent in some cases. All staff records have two written references, and records regarding training received. One staff member has little documented employment history and only two character references. It is strongly advised the registered provider always obtains a reference from the person’s last employer, and also (if different) when the person last worked in a caring capacity. There needs to be evidence that staff have, as required by the regulations proof of identityalthough this must be seen in order for the person to apply for a CRB. A statement by the person as to their mental and physical health is also required, for example at the application stage. Some of these matters were reported in the last key inspection report in June 2006. All staff have a Criminal Records Bureau (CRB) check, although one member of staff only had a check from a previous employer. These checks are not transferable between employers. There is no evidence this person had a POVA First check. The registered provider said she was sure a full CRB check had been recompleted for the person, but was not able to produce evidence of this. There is very limited evidence a Protection of Vulnerable Adults ‘First’ (POVA First) check is completed for other staff before they commence employment. The registered provider said staff do not commence employment until a full CRB disclosure is received. The registered provider is reminded it is illegal not to check employees against the list of people who should not work with vulnerable people (POVA list) before the person commences employment. Training records were also inspected for the same sample of employees. By law all staff must have: Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 21 • • • • • • Regular fire training in accordance with the requirements of the fire authority. There must always be at least one first aider on duty (at appointed person level). All staff must have manual handling training. All staff must have basic training in infection control. If staff handle food they must receive training regarding food hygiene. All new staff must have an induction and there should be a record of this. Records show some improvement regarding the delivery of staff training since the last inspection. However there are still some gaps in the evidence of training required by regulation. A sample of eleven staff files was inspected. Record show: • Fire Training. The registered provider said senior staff had trained to become fire wardens, and now were responsible for training staff in this area. There should be evidence on individual files of what training has been received and when this was completed. For example a dated checklist. • First Aid. Only three staff in the sample had a first aid certificate. No night staff on duty of the night of the inspection had a copy of a first aid training certificate. Lack of formal training in this area could put residents at significant risk, and the matter needs to be addressed as a priority. • Manual handling. Five staff in the sample had received some manual handling training in the last year (as is necessary), and one person had a certificate stating they received this training in 2004. All staff need to receive this training as a priority. • Infection control. Six people in the sample had received training in this area. • Food hygiene. Four members of staff in the sample had training in this area. The provider said the manager had recently completed a manual handling ‘training the trainers’ course and would now be training the staff in this area. It is important manual handling training is comprehensive, a copy of the outline of training programme people will complete is available, and there is evidence the training programme has been completed by staff. Many of the staff have training regarding the needs of people with dementia. Six of the eleven staff had a certificate of completion of a correspondence course regarding this matter. Staff however still need to receive training regarding people with mental health needs and all care staff need to receive training regarding the needs of people with dementia. It is essential a training programme is in place for all staff to receive appropriate training, for example training required by law, within six months of commencing employment. Previous reports have detailed what training is Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 22 required, and shortfalls in training provided to staff. Failure of the registered provider to ensure staff receive suitable training could result in enforcement action being be taken, if satisfactory progress is not made in this area. Of the sample most staff had written records regarding staff induction. The inspector spoke to one member of staff who had commenced employment in 2007. This person confirmed she had received an induction. For example she said she shadowed an experienced member of staff for several days when she first commenced employment. Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered provider must put in an application for a registered manager for this service, and for the other care home they carry on. Having an approved registered manager in charge of the home will ensure there is a legally accountable person managing the home on a day-to-day basis. Some improvement is required to the registered provider’s approach to managing quality. This will assure people who use the service that there are suitable mechanisms in place for improving areas of the service where this is required. The management of residents’ monies needs some improvement. This will ensure people who use the service can be assured staff look after their money appropriately. The management of health and safety needs some improvement so people who use the service can be assured they live in a safe environment. Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 24 EVIDENCE: The Commission has reassessed the management arrangements, as part of a review of registration arrangements. At the inspection the current management arrangements were discussed. Mrs N. Brazier said Mr and Mrs N Brazier work at the home on Monday and Thursdays. They work at the sister home in Newquay Tuesdays and Fridays. They complete maintenance and other duties at either home on Saturday and Sundays. Mrs Anne Brazier works at the home on Tuesdays and Friday. A manager is employed who works at Garsewednack five days a week. The manager has delegated authority to manage the home on a day to day basis. The manager is currently not registered with the Commission for Social Care Inspection. A Senior Carer is also employed at Garsewednack. The Commission has sought legal advice from its legal department regarding these arrangements. The legal advice is that it is necessary for the registered providers to employ a registered manager at both of their homes. For example, this is because regulation 8 of the Care Homes Regulations 2001 states the appointment of a registered manager is required: • When the registered provider is an organisation or a partnership • Where the registered provider is not, or does not intend to be, in fulltime day to day charge of the care home. An application for a registered manager must be submitted to the Commission’s Regional Registration Team within three months. The registered provider’s approach to quality assurance is only adequate. A satisfactory quality assurance policy is in place. A quality assurance survey was last completed in July 2006. The registered provider said this was currently being undertaken again, however Mrs N Brazier said it was difficult to get a satisfactory response to surveys. A copy of the homes Annual Quality Assurance Assessment has been submitted to the Commission, which has been completed to a satisfactory standard. There is some evidence that staff meetings take place. The last recorded staff meeting on file was in November 2006. The last recorded resident meeting on file was in March 2007. The last recorded management meeting on file took place in March 2007. Discussion took place between the inspector and the registered provider regarding other possible measures to improve quality assurance systems, which could be implemented to develop the service. Evidence from this, and previous inspections, show people living in the home are happy with the support they receive, their lifestyles and the food provided. The provider’s are also clearly taking action to improve some aspects of the service such as improving the environment. However some matters such as some of the Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 25 statutory requirements from the last key inspection, still need attention. Improved management systems may ensure these issues get addressed within the timescales set. One example to address this matter could be to develop an annual development plan. This would outline what needs to happen, by who and within what timescales. Management look after some money on behalf of people who use the service. Staff do not act as appointee for government financial benefits, for any of the people who use the service. Records are kept of fees paid to the registered provider. The registered provider can look after valuables on behalf of people who use the service. Records of cash looked after on behalf of people who use the service is generally satisfactory, however the records for at least one person were inaccurate. Clearer records need to be kept so they are easier to audit, and to pick up when any errors occur. For example there should be ‘money in’, ‘money out’, ‘money spent’ and ‘ balance’ columns. Money received or taken out should be signed for. People who use the service said they felt their personal belongings were safe, and said nothing that belonged to them had disappeared. The registered provider has a health and safety policy. The fire prevention system was last serviced in May 2007. The registered provider has developed a fire risk assessment, which was last reviewed in October 2006. The fire brigade visited the home in July 2007, and now require the registered provider to upgrade fire doors. The registered provider has until July 2008 to make these changes, and has said to CSCI that they will comply with the requirement. According to records, staff appear to regularly test the fire alarms and emergency lighting system. Health and safety risk assessments were completed in June 2007. These appear to be to a satisfactory standard and include a risk assessment regarding the prevention of legionella. The Health and Safety Officer from Kerrier District Council has said this is satisfactory. The hoists and stair lift have records to state they have been serviced in the last year. Gas appliances were serviced in July 2007, and a gas safety certificate was available for inspection. The registered provider said the electrical hardwire circuit was recently tested, and deemed to be satisfactory. The registered provider is awaiting a copy of the certificate. A copy this needs to be forwarded to the Commission. The registered provider completes testing of portable electrical appliances. These were tested in July 2007 and were satisfactory. However the records need to be more explicit as to what they are. Currently the records appear to Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 26 be an inventory. It should state when an item passes or fails the test, and what remedial action is taken when necessary. Suitable records of servicing bath hoists and mobile hoists are maintained. This equipment was last serviced in July 2007. The registered provider said the emergency call bell system is serviced by the company which maintains the fire prevention system. There is a notebook in one of the bathrooms to record bath temperatures. However there were no records in the book. Records need to be maintained, and the temperature checked before residents have a bath. Otherwise thermostatic temperature valves need to be fitted to baths. The Environmental Health Officer also visited the home to inspect health and safety standards on the same day as this inspection. The registered provider said standards were seen as generally satisfactory although some legal requirements were made. For example a policy regarding slips, trips and falls. Training in various aspects of health and safety need to take place so the registered provider meets legislative requirements (e.g. moving and handling training, fire training). This is outlined in the previous section of the report. Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 27 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 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Timescale for action The registered person shall, after 01/10/07 consultation with the service user, or representative, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of his health and welfare are to be met. Care plans should be made available to the service user, and kept under review. (For example all people living or staying in the home must have a care plan. The care plan should also include suitable risk assessments [including for manual handling], and a photograph of the person as required by the regulations. The registered person shall 01/09/07 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. (For example accurate and auditable records of monies maintained on behalf of service users must be kept) The registered person shall make 01/10/07 suitable arrangements to ensure that the care home is conducted DS0000054567.V343898.R01.S.doc Version 5.2 Page 29 Requirement 2. OP14 OP35 12(1) 13(6) 3. OP21 OP10 12(4)(a) 23(j) Garsewednack Residential Home in a manner which respects the privacy and dignity of service users. ( For example the registered provider needs to provide a lockable door on each bathroom and toilet (with an override facility if necessary) Previous timescale of 01/04/07 not met. 3rd Notification There should also be a lock in each bedroom door The registered provider must confirm in writing what action has been taken regarding this statutory requirement within the timescale set. ) 4. OP29 19(1) Schedule 2 The registered provider shall not 01/10/07 employ a person to work at the care home unless: (a) The person is fit to work at the care home (for example a POVA First and subsequent CRB check is completed as outlined in the guidance). (b) The registered provider has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2 (for example a full employment history, proof of identity and a statement by the person as to their mental and physical health.) The registered person shall 01/03/08 ensure that persons employed to work at the care home receive training appropriate to the work they are to perform. This must include suitable assistance, DS0000054567.V343898.R01.S.doc Version 5.2 Page 30 5. OP29 OP28 18. 19 Garsewednack Residential Home including time off, for the purpose of obtaining further qualifications appropriate to such work. (For example: (a)This must include training required by regulation such as infection control, food hygiene, Fire training, manual handling training and first aid. (b) Training regarding people with dementia and mental health needs.) Timescale of 01/06/07 not met. Third Notification. (c)Suitable records of training e.g. NVQ and other training certificates need to be maintained and available for inspection. (d)The registered provider must provide the Commission with an update regarding what training staff have received, and an action plan regarding how it is intended to meet the requirement within the timescale, by no later than 01/10/07. 6 OP31 8 (1) The registered provider shall appoint an individual to manage the care home where(a) There is no registered manager in respect of the care home; and (b) The registered provider— (i) Is an organisation or partnership; (ii) is not a fit person to manage a care home; or (iii) is not, or does not Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 31 01/11/07 intend to be, in full-time day to day charge of the care home. (2) Where the registered provider appoints a person to manage the care home he shall forthwith give notice to the Commission of: (a) the name of the person so appointed; and (b) the date on which the appointment is to take effect. (Therefore, for example, the registered provider must provide the Commission, in writing, with the name and information regarding the person, who it intends to employ as the registered manager as soon as this information is available. They must provide for example a copy of the person’s CV. A completed application for the person must be submitted to the CSCI Regional Registration Team within the timescale set. An application pack should be obtained as soon as possible. ) 7. OP33 24(1) The registered person shall establish and maintain a system for evaluating the quality of the services provided at the care home. The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. Any unnecessary risks to the health or safety of service users are identified and so far DS0000054567.V343898.R01.S.doc 01/12/07 8. OP38 12, 13(4) 23(2)(c) 01/12/07 Garsewednack Residential Home Version 5.2 Page 32 as possible eliminated. Any equipment provided at the care home for use by service users or persons who work at the care home is maintained in good working order (For example: • Ensure an electrical hardwire certificate is obtained. This must be forwarded to the Commission within the timescale set. • Improve records of portable electrical appliance testing. • Maintain a record of the temperature of hot water (for baths and shower facilities). RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations Regarding PRN medication: • Complete a risk assessment for any medication related to mental health e.g. when it should be administered. • Ensure clear records are maintained regarding how many tablets are administered and why • Maintain an ongoing stock count. Staff should receive training regarding recognising, and responding to allegations of abuse. The registered provider always obtains a reference from the person’s last employer, and also (if different) when the person last worked in a caring capacity 2. 3. OP18 OP29 Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP (Covering Cornwall, Devon and The Isles of Scilly) 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. Extracts may not be used or reproduced without the express permission of CSCI Garsewednack Residential Home DS0000054567.V343898.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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