Inspection on 20/06/06 for Garsewednack Residential Home

This inspection was carried out on 20th June 2006.

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

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

Other inspections for this house

Garsewednack Residential Home 25/11/08

Garsewednack Residential Home 30/05/08

Garsewednack Residential Home 20/08/07

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 Key Unannounced Inspection 20th June 2006 9:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Garsewednack Residential Home DS0000054567.V296273.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.V296273.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 611924 Mr Neil Edward Brazier Mrs Nicola Carla Brazier, Mrs Anne Brazier 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.V296273.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 15th November 2005 Brief Description of the Service: Garsewednack provides personal care for twenty-one older people. Four service users may have dementia, and four other service users may have other mental health needs. The home also provides day care for some service users. The registered providers are Mrs Anne Brazier and Mr Neil and Mrs Nicola Brazier. The providers purchased the home in August 2003, and Mr N and Mrs N Brazier also own another residential care home in Newquay. The assistant 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 is a main lounge, quiet room, smoking room, dining room and garden area accessible to service users. 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 £295-£360 per week. There are additional charges e.g. for hairdressing, chiropody, and newspapers etc. Garsewednack Residential Home DS0000054567.V296273.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key Inspection took place in fifteen and three quarter hours over two days. All of the Key Standards were inspected. The methodology used for this inspection was: • To case track four service users. This included, where possible, meeting and discussing with the service users their experiences, and inspecting their records. • Discussing with three staff their experiences working in the home. • Discussion with other service users, their relatives and staff. • 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? Pre admission assessment procedures seem satisfactory and well documentedalthough contemporaneous notes should be kept. A system of care plan review has been introduced, although a recommendation has been given regarding how this can be developed. An additional hoist for moving and handling has been purchased, and moving and handling training is about to commence. The Garsewednack Residential Home DS0000054567.V296273.R01.S.doc Version 5.2 Page 6 vast majority of staff have a satisfactory Criminal Bureau check / Protection of Vulnerable Adults check. However some further work needs completing regarding this issue as outlined below. A suitable system of maintaining service user monies is in place. What they could do better: The inspection has resulted in 11 statutory requirements (required to be implemented within a specified time by law), and 7 recommendations (suggested for good practice.) Although there are suitable levels of satisfaction from service users, these issues need to be addressed. There are some minor improvements required to the medication system, and all staff must receive appropriate external training regarding handling medication. It is recommended that the registered providers enable one service user to have a downstairs bedroom, and another service user to have a single bedroom when vacancies occur. The registered providers are also recommended to monitor that service users get a choice when they get up and go to bed. However service users have said they have a choice regarding this issue. One service user made an allegation of possible abuse from an unspecified member of staff. Such allegations must always be recorded, and always referred to Cornwall Adult Social Care (Social Services) for investigation, and to make a judgement. This matter has now been referred to the authority. It is also recommended that staff awareness and training regarding abuse / adult protection is improved. One member of staff had not had a Protection of Vulnerable Adults (POVA) check completed. All staff must have a ‘POVA First’ check completed before they commence work, then a full enhanced Criminal Records Bureau /POVA check completed before they work unsupervised. This is to ensure service users are in safe hands. Carpet in toilets and bathrooms needs to be removed and replaced with, for example, lino. The current flooring is unhygienic. All toilet and bathroom doors need to be lockable. Service users need to be offered a lock on their bedroom doors where this is appropriate. Training required by law (i.e. regarding health and safety issues) must be provided to all staff. There are some improvements required to health and safety precautions (e.g. ensuring suitable checks on gas appliances and the electrical hardwire circuit). The inspector has recommended an Occupational Therapist be consulted regarding access from fire doors, although the fire authority have said current arrangements are satisfactory. Garsewednack Residential Home DS0000054567.V296273.R01.S.doc Version 5.2 Page 7 The Commission has notified the registered providers several times regarding the need to provide dementia training for staff, and set up a quality assurance system. Failure to implement these two requirements now, within the timescales set, could result in legal action. It is disappointing that these regulatory issues have not been addressed, as in some respects, this creates a skewed picture of what is a good service. It is very much hoped the registered providers will take the appropriate action to address these issues within the deadlines set. Service users and other stakeholders can be assured the Commission will monitor the situation. 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. Garsewednack Residential Home DS0000054567.V296273.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 Garsewednack Residential Home DS0000054567.V296273.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. Service users are issued with suitable terms and conditions of residency and, where appropriate, a social service contract at the time of admission. This enables service users to be aware of their rights and responsibilities. The pre admission assessment procedure is good, and enables the registered persons to ascertain they can meet the needs of service users, before admission is arranged. EVIDENCE: Copies of resident terms and conditions of residency or contracts (if privately funded) were available for inspection. The registered provider or a senior member of staff assesses service users before they are admitted. Some service users confirmed they or their relatives visited the home before formal admission was arranged. Some service users said an assessment was completed before admission was arranged, although others could not remember this happening. Copies of assessments were available for inspection in service user files. It is suggested contemporaneous notes of pre admission assessments are retained for inspection. Garsewednack Residential Home DS0000054567.V296273.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this area is adequate. The judgement has been made using available evidence including a visit to the service. All service users have a care plan and these are reviewed. This ensures staff have suitable information to provide care, and care plans amended when changes in service users’ needs occur. Healthcare support seems appropriate so service users can be assured they will receive suitable support from medical practitioners. The operation of the medication system is adequate, and some improvements are required to improve the system. Staff work with service users in a manner, which respects their privacy and dignity, although one service user expressed concerns regarding the conduct of one member of staff. Issues regarding the diverse backgrounds of service users appear suitably addressed. EVIDENCE: There is a copy of a care plan in each service user file. Staff said care plans were accessible to them. The care plan format is satisfactory, and staff said they found the care plans useful and informative. Service users and their relatives did not seem aware of care plans and did not seem to have any involvement in their development and review. Care plans are reviewed, but not monthly as suggested in the National Minimum Standard. Advice was given regarding improving the review system i.e. replacing the tick box system with a more narrative style, which would be more quantifiable. It is also suggested Garsewednack Residential Home DS0000054567.V296273.R01.S.doc Version 5.2 Page 11 key workers could carry out this task with service users and their representatives (where this is possible.) Service users said they were satisfied with the healthcare support they received. This includes visits from GP’s, district nurses, chiropodists, dentists and opticians. The registered providers have a satisfactory medication policy. Medication is administered via the monitored dosage system. The system was generally satisfactory; storage was generally fine and records appropriate. However some problems were noted: • Some medication was not signed for, although it appears it was administered. • There was excess medication stored for some service users. • One service user did not receive her night medication, on one occasion, as there did not appear to be any in stock. The service user said this situation had not happened before. • Although some staff had received suitable training in the storage and handling of medication, this had only been ‘cascaded’ from other staff, to at least one member of staff. Service users said they felt staff worked with them in a manner, which respected their privacy and dignity. The majority of service users were positive about their care, although some appeared indifferent. Service users comments included the home was either ‘good’ or ‘not bad’, service users were ‘well cared for’, staff and management were ‘decent’ and ‘very nice people’. A relative also commented the current owners had made significant improvement regarding care since they took over the home. The inspector spoke to several service user relatives who were all positive about staff, management, service user care and the home. Service users said personal care was provided to a good standard. The relative of one service user said the person would possibly benefit from a downstairs bedroom, as they found it difficult to get upstairs. Subsequently she spent the daytime in the lounge, but would possibly spend more time in her bedroom if it were easier to get there. Another service user, who shared a bedroom, said she would like her own bedroom. The registered provider said the person had only just moved in, and the registered provider’s policy was to offer people who had shared bedrooms a single bedroom when these became available. It is recommended the needs of these two service users be reconsidered when possible. One service user made an allegation against an unspecified member of staff. The matter has been referred to Adult Social Care (Social Services) for further investigation. Other service users, and staff had not experienced, or said they were not aware of any abusive practices. Garsewednack Residential Home DS0000054567.V296273.R01.S.doc Version 5.2 Page 12 The registered provider has appropriate policies regarding equal opportunities and anti discrimination. The registered providers were able to demonstrate suitable knowledge and awareness of equality and diversity issues regarding the care of service users. There are currently no service users from ethnic minorities, although the registered providers stated they would be more than happy to accommodate service users from other cultures. The local population is predominantly Cornish, and from ‘White-UK’ background. Issues regarding sexuality, gender and disability seem to be suitably addressed. Garsewednack Residential Home DS0000054567.V296273.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. Routines are satisfactory so service users can live a lifestyle that meets their needs. Visiting arrangements are flexible. Arrangements to assist service users with their finances are satisfactory so service users can maintain choice and control over their lives. Meals are provided to a good standard, so service users receive a wholesome and nutritious diet. EVIDENCE: Service users said they could get up and go to bed when they wished. About half of service users spend the majority of their time in one of the lounges, while others choose to spend the majority of their time in their bedrooms. The Commission for Social Care Inspection did investigate a concern that service users had to get up from before 6am, and that breakfast must be served by 8am. The commission could find no hard evidence of this. There is however a task schedule in the staff room which instructs night staff to begin getting service users up before the end of their duty, and to serve breakfasts. The registered providers said service users did have a choice what time they got up and have their breakfast, and the schedule was to remind night staff to assist service users who wish or are ready to get up early. It did seem clear to the inspector that many service users did wish to rise early, and no service users stated they were forced to get up early and have their breakfast by a Garsewednack Residential Home DS0000054567.V296273.R01.S.doc Version 5.2 Page 14 certain time. However the registered providers should continue to monitor this situation. There are some organised activities for example an organist visits regularly. An activities person visits fortnightly who organises crafts, movement and various other activities. Singers from the church visit fortnightly. Staff also organise other activities with service users for example games, quizzes and manicures each afternoon. Some service users who spent most of their time in their bedrooms did not seem aware of what activities are available, and it would be beneficial to publicise the activities available each day more widely. Mrs N Brazier did say staff should remind service users at lunchtime what activity is available in the afternoon. It may also be beneficial to some service users if a library service was offered, although a limited choice of books are available in one of the lounges. Service users said they could receive visitors when they wished. The inspectors spoke to several service users friends and relatives who said they felt the home offered a good service. The registered provider said links have developed with the local church and chapel. The registered provider assists with the management of money for some service users. Records kept seem satisfactory. Mr Brazier acts as agent for one service users benefits in the absence of anyone else externally who wishes to take on the task. Records are kept regarding this. Service users said they either look after their own monies or these are managed by their relatives / legal representatives e.g. via power of attorney arrangements. Service users said they were able to bring small items of furniture and their belongings to the home. The inspector shared a meal with service users on the first day of the inspection. This comprised of roast lamb, vegetables and potatoes. For sweet, apple crumble was served. The meal was to a very good standard. Although a choice of main meal is not provided, service users said staff were aware of preferences, and an alternative is provided where necessary. Service users said they enjoyed the food provided. A choice of a hot and cold evening tea is offered. Biscuits or cakes are offered at morning coffee and afternoon tea. Suitable records of menus, and food provided, are maintained. Special diets (e.g. pureed meals) are provided as required. Garsewednack Residential Home DS0000054567.V296273.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this area is adequate. The judgement has been made using available evidence including a visit to the service. The registered providers have suitable procedures regarding complaints and adult protection. However implementation of the adult protection procedure appears poor, so service users cannot be assured they are suitably protected. EVIDENCE: The registered provider has satisfactory procedures regarding complaints and adult protection. Staff and service users showed some awareness of the procedures, and were able to say whom they would approach if they had a complaint or were concerned about abuse. There has been some difficulty in the registered providers obtaining adult protection training for staff, although this has now been arranged for some. The inspector suggested staff should at least read the adult protection policy as part of their induction, and also watch the county council’s ‘No Secrets’ video. Most staff and service users all said they had not witnessed any bad or abusive practices. However one service user made an allegation to the inspector regarding an unspecified member of staff. There was no record of this and the matter had not been referred to Cornwall Adult Social Care (Social Services). The provider had concluded there was no evidence the incident occurred. However the registered provider must always record incidents and refer such matters to Cornwall Adult Social Care (Social Services) in line with the registered provider’s adult protection policy, so the county council can make a decision what action needs to happen. Other aspects of the registered provider’s adult protection policy must be followed. Garsewednack Residential Home DS0000054567.V296273.R01.S.doc Version 5.2 Page 16 The majority of staff have Criminal Record Bureau check, and a Protection of Vulnerable Adults check (where applicable). However one member of staff, who started after July 2004 only had a copy of a Criminal Records Bureau check completed by their previous employer. Although the member of staff seemed pleasant and trustworthy, without the appropriate disclosures there is no evidence that service users are not put at risk. The checks are not transferable, and need to be repeated each time a member of staff is recruited. A POVA First check must be completed before a member of staff commences employment. The provider is referred to section 6 of CSCI’s In Focus: Safe and sound? publication, which is available free at www.csci.org.uk. , as well as the Criminal Records Bureau website. Garsewednack Residential Home DS0000054567.V296273.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21,24, 26 Quality in this area is adequate. The judgement has been made using available evidence including a visit to the service. Garsewednack provides a pleasant, homely, clean and well-maintained environment for service users to live and feel at home in. However floor covering needs replacing in the upstairs toilet and bathroom. Where appropriate, locks need to be fitted to bedroom doors, bathrooms and toilets to improve service users’ privacy and security. EVIDENCE: The building was inspected. The building appears to be generally well maintained, clean, pleasantly decorated and homely. There is a pleasant garden, which service users can use. Garden furniture is provided outside for service users benefit. The front of the house needs to be painted and Mr Brazier said this issue would be addressed shortly. All communal rooms are homely and comfortable. There is a large lounge, which is used by the majority of service users. There is a smoking lounge and quiet lounge. There is a large dining room. Bedrooms are individualised and comfortable. A stair lift is provided to assist service users to get upstairs. Garsewednack Residential Home DS0000054567.V296273.R01.S.doc Version 5.2 Page 18 Communal bathrooms and toilets are satisfactory. All three baths have a chair lift. Bathroom and toilet doors are not lockable, and a lock needs to be provided, with an over riding facility, if necessary. The carpets in the upstairs toilet and bathroom, on the landing, need to be replaced, as they are soiled and possibly unhygienic. Bedrooms are not lockable. The national minimum standard states all bedrooms should be lockable. However this needs to be balanced with service user wishes, and their capacity to lock their doors. The registered provider must address this issue by (a) ascertaining if current service users wish to have a lock on their bedroom doors (b) risk assess whether they have the capacity to use a door lock (e.g. due to disability or dementia) (c) ascertain whether new service users wish to have a door lock (e.g. at the time of pre admission assessment). Decisions need to be documented. Mr Brazier said there is a lockable cupboard in each bedroom, and valuables can be stored in the office. Suitable kitchen and laundry facilities are provided. Cleaning staff are employed, and the home was clean and hygienic at the time of inspection. The inspector was concerned about the ability of service users to get out of the building in a fire via the rear doors of the main house. The doors can only be opened by turning a wheel lock, which could be quite difficult in an emergency situation, and if service users have problems with dexterity. Mr Brazier said he had discussed this matter with the fire brigade and they had said the locks were satisfactory. The registered providers need to pay careful consideration to this issue and monitor the situation. For example it is recommended that an Occupational Therapist be consulted. The rear fire escape staircase will also need painting when the rest of the building is painted. Garsewednack Residential Home DS0000054567.V296273.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this area is variable from poor to good. The judgement has been made using available evidence including a visit to the service. Staffing levels appear satisfactory so service users can be assured they will get suitable levels of staff support. Recruitment records contain generally adequate information but some improvement is required so service users can be assured there are suitable recruitment procedures and checks in place. Staff training provision is poor and needs improvement. Staff must receive appropriate training as required by regulation so service users can be assured staff have suitable skills to cater for their needs. Equal opportunities issues regarding recruitment and work practices seem appropriately addressed. EVIDENCE: Rotas show two members of staff are on duty from 0800 to 1500. (One of which is on duty from 0800 to 1300). There are two staff on duty from 1500 to 2200, and two waking night staff on duty from 2200 to 0800. One of the managers is on call. The registered providers have experienced above average staff turnover, but efforts have been made to address this. Suitable numbers of staff were on duty on both days of the inspection. The registered providers said they spend four days a week at the home, and the Assistant Manager works 5 days a week at the home. The registered providers have a suitable approach to providing National Vocational Qualifications for care staff, and a majority of staff are qualified at least to NVQ 2 in care. Garsewednack Residential Home DS0000054567.V296273.R01.S.doc Version 5.2 Page 20 Staff training required by regulation needs improvement. Staff files inspected show gaps in training required by regulation. This includes first aid, manual handling, infection control, handling of medication, food handling and fire instruction. All staff need to receive training in infection control, fire and manual handling. The registered providers said they would address this by setting up accredited training via ‘Mulberry House’ training (infection control and moving and handling). The infection control nurse can also provide infection control training. Mrs Brazier and the deputy-Alison Smith, have attended a moving and handling ‘training for trainers’ course. The registered provider will provide internal training (fire)- Mr Brazier and Ms Smith are to attend a fire warden course shortly and then arrange in house training. If staff handle food (e.g. from making a sandwich) they must receive suitable external training e.g. a food hygiene certificate. The local college will be able to provide this training. There must always be at least an ‘approved first aider’ on the premises. St John’s Ambulance can provide this training. All staff handling medication must receive training from an external trainer e.g. a pharmacist. Some of the seniors have training regarding medication, but this needs to be provided to all medication handlers. In some cases medication training has only been cascaded by senior staff. The home is registered to provide care for service users with dementia (4)/ mental disorder (4). Although care practices for these service user groups seems satisfactory, staff need to have training to meet these people’s needs. This requirement has now been notified four times and no action has been taken. Previous inspection reports have also detailed how this standard is not met. This requirement is subsequently renotified. Failure to comply with the within the timescale set may result in the Commission for Social Care Inspection (CSCI) taking legal action. One service user has epilepsy. Again staff need to have training to meet this person’s needs, and procedures need to be documented. The District Nurse may be able to provide a talk regarding epilepsy to all care staff. This should include what staff need to do to assist the person when they are having a seizure / recovering from a seizure. Recruitment records were also inspected. Records are generally satisfactory. However the registered provider’s application form needs to contain the applicant’s employment history. Any gaps in employment need to be investigated, and a reference needs to be obtained from the last employer. Evidence of identity needs to be maintained on file (e.g. birth / marriage certificate, driving licence). Criminal Records Bureau checks and references were maintained on files. A copy of an induction checklist was maintained on staff files. Garsewednack Residential Home DS0000054567.V296273.R01.S.doc Version 5.2 Page 21 A concern regarding the Criminal Record Bureau / Protection of Vulnerable Adults check regarding one member of staff is outlined in the Complaints and Protection section of this report. The provider is referred to CSCI’s In Focus: Safe and sound? publication which is available free at www.csci.org.uk which outlines more regarding these issues. The registered provider has appropriate policies regarding equal opportunities and anti discrimination. The registered providers were able to demonstrate suitable knowledge and awareness of equality and diversity issues regarding the appointment and management of staff. Garsewednack Residential Home DS0000054567.V296273.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this area is variable i.e. poor to good. The judgement has been made using available evidence including a visit to the service. The registered providers appear to be suitably experienced and qualified to manage the home. However, they need to increase their focus to ensure regulatory issues are addressed. This will ensure residents receive a service, which should be consistently good in all areas. There is little evidence of quality assurance activity taking place. Subsequently the registered providers ability to demonstrate they are listening and addressing issues of concern, e.g. from service users, is limited. The registered providers have now been notified on three occasions regarding this issue, and enforcement action could follow if they now fail to take action. The registered providers approach to handling service users monies is satisfactory, so service users can be assured their financial interests are safeguarded, where the registered providers are involved in this area of their lives. The management of health and safety issues is poor and subsequently service users cannot be assured they live in a safe environment. Garsewednack Residential Home DS0000054567.V296273.R01.S.doc Version 5.2 Page 23 EVIDENCE: The registered providers appear approachable, competent and have appropriate qualifications to manage the care home. The staff the inspector spoke to said the providers were good to work for, and provided sufficient guidance and support to help them to do their jobs. Service users and relatives of service users were positive about the registered providers approach. It is however of concern regarding the number of statutory requirements issued as a consequence of this report, and that some have been renotified on a number of occasions. The registered providers have a quality assurance policy, but there is no evidence this is implemented. A suitable quality assurance system must be introduced. This may for example include surveying service users and other stakeholders, introducing various quality assurance checks and /or having an annual development plan outlining improvements the registered providers intend to make. Mrs Brazier said there are several resident meetings a year, and this provides an opportunity, for example, for the menu to be reviewed. Any quality assurance system should include a plan to ensure the health and safety legal requirements, the National Minimum Standards for Older People, and any CSCI requirements are implemented. The registered provider is welcome to approach the inspector again regarding this issue for advice. This requirement has now been notified three times and no action has been taken. Previous inspection reports have also detailed how this standard is not met. This requirement is subsequently renotified. Failure to comply with the within the timescale set may result in the Commission for Social Care Inspection (CSCI) taking legal action. The registered providers look after some service user monies, for which suitable records are maintained. The inspector also spoke to the representative for one service user who had power of attorney and paid fees for their relative. They said invoicing was clear and there was no issues regarding this. The registered provider acts as agent for one service user’s benefits for which suitable records are kept. The registered provider has a health and safety policy. However records of checks required by regulation are variable. The records for the testing of fire equipment were not available for inspection, but Mr Brazier said suitable checks are completed regarding the fire alarm call points and emergency lighting. The accident book is maintained, there seemed to be a higher frequency of falls for some service users, but management said they were aware of the issues and addressing them. The chair lift and hoists are suitably serviced. The home has gas central heating. Gas appliances were last serviced in 2004, and a new landlord’s gas Garsewednack Residential Home DS0000054567.V296273.R01.S.doc Version 5.2 Page 24 safety certificate needs to be obtained. The electrical hardwire circuit needs retesting, and this is required every five years. Health and safety risk assessments seem satisfactory, and are reviewed. However there needs to be a risk assessment regarding the prevention of Legionella, and appropriate control measures need to be put in place. Information regarding this issue can be obtained from the district council Environmental Health Department. The registered provider tests portable electrical appliances, and records are maintained regarding this. Mr Brazier said he had checked with the Environmental Health Department regarding whether this arrangement was satisfactory, and this was confirmed. Gaps in health and safety training are highlighted in the ‘Staffing’ section of the report. Garsewednack Residential Home DS0000054567.V296273.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 Standard No Score 16 3 17 X 18 2 3 X 2 X X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 1 Garsewednack Residential Home DS0000054567.V296273.R01.S.doc Version 5.2 Page 26 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 OP9 Regulation 13 Requirement Timescale for action 01/07/06 2. 3. OP9 OP18 13, 18 10, 12, 13, 37 4. OP18 10, 12, 13, 37 The registered provider must ensure improvements regarding the medication system: • Staff always sign medication sheets when medication is administered. • There is always satisfactory stock of prescribed medication. • Any medication, which is no longer, required, or if there is excessive stock, must be disposed of. Staff who administer medication 01/10/06 all must receive external training. Any allegation of abuse must be 01/07/06 referred to Cornwall Adult Social Care (Social Services), and the registered provider’s adult protection policy must be followed. A Criminal Records Bureau / 01/08/06 Protection of Vulnerable Adults check must be completed for one member of staff. A POVA First check must be completed before each member of staff DS0000054567.V296273.R01.S.doc Version 5.2 Garsewednack Residential Home Page 27 5. OP21 OP10 6. OP21 commences employment 12, 16, 23 All bathroom and toilet facilities need to have a: • Suitable locking device • Paper towel dispenser or towel rail / clean towel 13 The toilet flooring must be impervious to minimise infection control risks. Previous deadline of 30/01/06 not met. 2nd Notification 12, 16, 23 The registered provider must ascertain if service users should have a door lock i.e. by: (a) Ascertaining if current service users wish to have a lock on their bedroom doors (b) Risk assessing whether service users have the capacity to use a door lock (e.g. due to disability or dementia) (c) Ascertaining whether new service users wish to have a door lock (e.g. at the time of pre admission assessment). (d) Documenting decisions made. 18 The registered providers must provide staff with suitable training to do their jobs and meet regulatory requirements. Suitable evidence of training must be maintained. (1) Staff need to have appropriate health and safety training. Training must include fire training, food handling (if food is handled), infection control, first aid (i.e. there must DS0000054567.V296273.R01.S.doc 01/10/06 01/08/06 7. OP24 OP10 01/10/06 8. OP30 01/12/06 Garsewednack Residential Home Version 5.2 Page 28 9. OP30 18 always be a member of staff qualified to appointed person level on duty), manual handling. (2) Staff need to have training to meet the needs of service users with epilepsy. The registered provider must 01/12/06 ensure that all staff recieve training in older persons care especially in the area of dementia and memory loss. Previous deadline of 30/03/06 not met. 4th Notification. Please note possible enforcement action may follow if this issue is not now addressed. 10. OP33 24 A quality assurance process must be implemented. The findings of the quality assurance process must be forwarded to CSCI annually Previous deadline of 30/03/06 not met. 3rd Notification. Please note possible enforcement action may follow if this issue is not now addressed. 01/10/06 11. OP38 13 The registered providers must ensure health and safety standards are appropriately met. There must be evidence available for inspection that: (a) The boiler, and gas central heating system is serviced regularly e.g. annually. A landlord’s gas safety certificate must be obtained. (b) The risk of Legionella is DS0000054567.V296273.R01.S.doc 01/10/06 Garsewednack Residential Home Version 5.2 Page 29 (c) assessed, and appropriate control measures are put in place. The electrical circuit (hardwire) is tested at least every five years. 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 OP3 OP7 Good Practice Recommendations Contemporaneous notes of pre admission assessments are retained for inspection. Improve the current care plan review system i.e. replacing the tick box system with a more narrative style It is also suggested key workers could carry out this task with service users and their representatives (where this is possible.) in line with the regulations, and National Minimum Standard. The registered providers should monitor that service users are given the choice what time they can get up and go to bed. The registered provider should: • Ensure the activity programme is widely publicised. • Ascertain if Cornwall County Council can provide a library service to any service users who may wish to use such a service (e.g. for tapes, videos, DVD’s books, talking books etc.) Staff should read the registered provider’s adult protection policy during induction, and watch the county council’s ‘No Secrets’ video. The registered providers should consult an Occupational Therapist regarding improving locks on rear fire doors. Review bedroom allocation of two service users when vacancies occur. 3 4 OP10 OP12 5 6 7 OP18 OP22 OP38 OP10 OP24 Garsewednack Residential Home DS0000054567.V296273.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection St Austell Office 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 © 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.V296273.R01.S.doc Version 5.2 Page 31 - 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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