Inspection on 19/01/06 for Garston Manor Nursing Home

This inspection was carried out on 19th January 2006.

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

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

Other inspections for this house

Garston Manor Nursing Home 26/10/06

Garston Manor Nursing Home 02/06/05

Garston Manor Nursing Home 13/01/05

Garston Manor Nursing Home 06/07/04

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

CARE HOMES FOR OLDER PEOPLE Garston Manor Nursing Home 10 Knowles Hill Road Newton Abbot Devon TQ12 2PW Lead Inspector Rachel Proctor Unannounced Inspection 19th January 2006 11:30 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 Garston Manor Nursing Home DS0000028671.V280427.R01.S.doc Version 5.1 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. Garston Manor Nursing Home DS0000028671.V280427.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Garston Manor Nursing Home Address 10 Knowles Hill Road Newton Abbot Devon TQ12 2PW 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) 01626 367654 01626 367662 Mr Robert Malcolm Parkhouse Mrs Edith Magaly Parkhouse Mrs Edith Magaly Parkhouse Care Home 24 Category(ies) of Dementia (24), Mental disorder, excluding registration, with number learning disability or dementia (24), Old age, of places not falling within any other category (24), Physical disability (24) Garston Manor Nursing Home DS0000028671.V280427.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service Users over the age of 60 years may be admitted to the home One Service User (named elsewhere) who is under the age of 60 may reside at the home. 2nd June 2005 Date of last inspection Brief Description of the Service: Garston Manor is a large Victorian house set in a third of an acre of landscaped garden, overlooking the market town of Newton Abbot. It aims to meet the needs of elderly mentally ill people who may also have a degree of physical care needs. There are 18 single and 3 double rooms with wash hand basins and nurse call alarms. In addition there is a large lounge and two separate dining rooms. The home has a registered nurses on duty at all times, they are trained to assess the nursing and social care needs of each service user. The care staff support the trained nurse in providing the care for the service users. There is a large, level garden area that provides a secure outdoor area for the service uses. The home invites comments from service users and visitors through an anonymous satisfaction questionnaire that is available in the main reception area of the home. Garston Manor Nursing Home DS0000028671.V280427.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The commission for social care inspection has introduced key standards to be inspected over each inspection year. Therefore, unless it is felt necessary by the inspector, some standards will not be inspected. To obtain a full picture of the home it is recommended that previous reports also be taken into consideration. This unannounced inspection took place on the 19th of January between 11:30 a.m. and 3 p.m. A tour of the home was completed and some records were inspected. The inspectors spoke to some residents and their representatives and observed the lunchtime handover with the staff team. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Garston Manor Nursing Home DS0000028671.V280427.R01.S.doc Version 5.1 Page 6 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 Garston Manor Nursing Home DS0000028671.V280427.R01.S.doc Version 5.1 Page 7 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): The standards in this section were not assessed on this occasion. At the previous inspection Key Standard 3 was fully met. Key Standard 6 does not apply because the home does not offer intermediate care. EVIDENCE: Garston Manor Nursing Home DS0000028671.V280427.R01.S.doc Version 5.1 Page 8 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 The way individual service users health, personal and social care needs are set out in their individual plans of care, this enables the staff to provide care that is tailored to the individuals needs. EVIDENCE: Three services users were case tracked during the inspection. Their plans of care had been developed from a comprehensive assessment, which included risk management. These were linked to how the individual responds to and are affected by their illness. The start of each care plan had a pen picture of the service user and how the illness they have affect their day-to-day life. The care planning process provides clear information for staff regarding the care individual service users require to maintain their mental health, physical health, personal care and emotional care needs. The staff observed working with the service users during the inspection were speaking to them in a friendly and supportive way, sometimes reorientation them to time and place. When a service user asked the same questions repeatedly staff responded in a clear friendly way each time they asked. Garston Manor Nursing Home DS0000028671.V280427.R01.S.doc Version 5.1 Page 9 Garston Manor provides care for some service users who have challenging behaviour. The incidents and triggers for the behaviour were well documented. The service users identified at the risk of challenging behaviour had a plan of care in place, which guided staff on how to reduce the risk of the challenging behaviour occurring. The staff observed were skilful in managing the service users agitation. The manager confirmed that staff receive training for managing challenging behaviour as part of their induction. The records of medication viewed for the three service users case tracked had been completed and signed in line with good practice. One service user who required medication crushed to enable them to take it had consent forms completed, which had been signed, these evidenced that the manager had clarified with the service users general practitioner and the pharmacist regarding the medication to be crushed. The manager confirmed that none of the current service users have pressure sores. She also reported that the district nurses regularly provide advice and support for the nursing home in relation to pressure sore management and prevention. Garston Manor Nursing Home DS0000028671.V280427.R01.S.doc Version 5.1 Page 10 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): 12,15 The service users are enabled, if this is their wish, to take part in activities. EVIDENCE: The staff team on duty during the inspection were providing one-to-one support for individual service users. The manager advised that the service users have weekly entertainment provided by external companies. These include movement and music, Antics and activities and party time. The home has two dining areas and the lounge; enabling those service users who do not wish to take part in activities to be accommodated. The manager advised that two of the current service users whose first languages was not English have been help by the provision of simple phrases in their own language that staff could use when they address them. The manager advised that family members and the existing staff team had provided them. Very little wastage was seen from the lunchtime meal. Those service users who required assistance to eat were being given this in a supportive discreet way by the staff. The manager advised that the service users are separated at lunchtime into those who are able to manage to eat independently and those who require some assistance. New food safety legislation introduced in January this year was discussed. The manager confirmed that staff would be attending training in the next few weeks provided by Teignbridge Council. Garston Manor Nursing Home DS0000028671.V280427.R01.S.doc Version 5.1 Page 11 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 The service users and their representatives can be reassured the staff team at Garston Manor will deal with any concerns they have sensitively. EVIDENCE: The complaints procedure remains easily available in reception area of the home. The commission had received no complaints since the last inspection. The manager confirmed that all staff had received adult protection training and that the homes policy for adult protection is available to them. The manager provided a template to be used to record supervision and staff performance this included all aspects of care and identified a further training required. An individual staff personnel portfolio checklist has been provided since the last inspection. This includes a check against the information required by the commission to be available in staff files. The manager confirmed that all staff have had a CRB check completed. The long-term member of staff who did not have a CRB check had left the home since the last inspection. The requirements set at the last inspection regarding CRB checks completed for all staff has been met. Garston Manor Nursing Home DS0000028671.V280427.R01.S.doc Version 5.1 Page 12 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): 19,26 The service users at Garston Manor continue to be provided with a well maintained, safe, pleasantly decorated home. EVIDENCE: The redecoration and replacement of carpets in service uses rooms has continued since the last inspection. Individual service uses rooms were attractively presented, clean and fresh smelling. Individual rooms had been personalised with items of the service users choice. The shared room in use had screening provided. Automatic lights were lighting one corridor on the first floor, which can be dark. In other first floor areas the inclusion of space lighting in the corridors has improved visibility without the need to use artificial light. Both dining rooms and the lounge were being used by the service users during the inspection. The large lounge was divided into three distinct areas; this was allowing the service users choice. The gardens have been stocked with a variety of shrubs and a patio area of the main lounge is easily accessible for the service users weather permitting. Garston Manor Nursing Home DS0000028671.V280427.R01.S.doc Version 5.1 Page 13 The majority of the service users were in the lounge during the inspection. Following the lunchtime meal some of the more frail service users were assisted to rest in their bedrooms. Bathrooms and toilet facilities are easily accessible from the service users private rooms and the lounge and dining areas. This allows service users to have easy access to the toilet facilities. Garston Manor Nursing Home DS0000028671.V280427.R01.S.doc Version 5.1 Page 14 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 The robust recruitment system and commitment to staff training should ensure that service users continue to be cared for by competent caring staff team. EVIDENCE: A duty rota was provided by the manager. This gave the names of the registered nurses and health care assistants employed at home. The manager confirmed that new staff had joined the staff team since the last inspection. The manager advised that at the changeover of the shift, lunchtime, morning and evening handover from one staff team to the other takes place. The inspector attended the lunchtime handover during the inspection. Members of the care team, domestic and kitchen staff also attended this. Each service user was mentioned during the handover and members of the staff team raised any concerns or suggestions regarding a particular service user. The manager advised that she felt it was important for everyone to be aware of what was happening in the home. A record of the handover for each shift was available this had a brief record of any issues discussed about individual service users. The staff on duty appeared to be meeting the needs of the service users housed at the time of the inspection. There are registered nurses on duty for each shift to direct the care of the service users, they are supported by a team of healthcare assistants. The manager had introduced a task sheet, which covered the tasks care staff should undertake during the shift. Garston Manor Nursing Home DS0000028671.V280427.R01.S.doc Version 5.1 Page 15 The manager has developed an information folder for the registered nurses in charge of the home. This gives clear information regarding the responsibilities and actions expected from the registered nurse. It also contains useful telephone numbers, which includes staff contact details and members of the multi-disciplinary team. Sufficient domestic staff are employed to keep the home clean and fresh and the service users clothes clean and pressed. Both staff members spoken to said they took pride in their work and liked to see the home is kept clean and fresh and the service users clothes returned to them. The manger advised that six of the twelve health care assistants employed have achieved NVQ level 2 or above. The manager confirmed that she was committed to ensuring the staff she employs are trained to a high standard. The manager confirmed that the requirement set at the last inspection that all staff must have a CRB completed has been met. The senior staff member who had not had a CRB completed at the last inspection had left since the last inspection. The duty rota contained the names of new staff appointed. Garston Manor Nursing Home DS0000028671.V280427.R01.S.doc Version 5.1 Page 16 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): 33,38 The management team at Garston Manor continue to work hard to ensure the home is well managed and provides a safe environment for service users that reflects their assessed needs. EVIDENCE: The manager has provided the commission with the results of the latest quality assurance audit completed. She confirmed that the audit was used to ensure that the services they provide were continuing to meet the needs of the service users and their families. The results of the audit were available for the service users and their representatives. The audit and other information about the home and the services it provides are also available on their web site. A tour of the home revealed that fire extinguishers and hoists had been serviced in line with good practice recommendations. The manager confirmed that all staff have regular manual handling up date and fire prevention training. The inspector was given a copy of the template in use to record staff Garston Manor Nursing Home DS0000028671.V280427.R01.S.doc Version 5.1 Page 17 supervision and training and development needs. The staff spoken to during the inspection said they liked working at Garston Manor and were supported by the management team to do their work. The manager is aware of her responsibility for the health and safety of the staff and service users at Garston Manor. The service users have comprehensive risk assessments in place for their heath and welfare. The manager advised that she was aware of the new food safety legislation introduced this month and advised that staff would be attending training regarding this. The duty rota had a system to identify the first aider on duty for the shift. Garston Manor Nursing Home DS0000028671.V280427.R01.S.doc Version 5.1 Page 18 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 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X 3 Garston Manor Nursing Home DS0000028671.V280427.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Garston Manor Nursing Home DS0000028671.V280427.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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