Inspection on 02/06/05 for Garston Manor Nursing Home

This inspection was carried out on 2nd June 2005.

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

Garston Manor Nursing Home 26/10/06

Garston Manor Nursing Home 19/01/06

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 Announced 2 June 2005 nd The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Garston Manor Nursing Home D54-D07 S28671 Garston Manor V222751 020605 Stage 4.doc Version 1.30 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 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 RParkhouse@aol.com Mr Robert Malcolm Parkhouse, Mrs Edith Magaly Parkhouse Mrs Edith Magaly Parkhouse Care home with nursing 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 D54-D07 S28671 Garston Manor V222751 020605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 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. Date of last inspection 13.01.05 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 entrance of the home. Garston Manor Nursing Home D54-D07 S28671 Garston Manor V222751 020605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The commission for social care inspection was 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. The inspection took place over one day on the 2nd of June 2005. A tour of the environment was completed with the manager. Some records were inspected during the inspection. The inspector spoke with the staff, service users and the relatives visiting during the inspection. What the service does well: What has improved since the last inspection? What they could do better: Although the home has a robust recruitment and employment policy for new staff; one of their existing long-term senior staff members has still to complete the CRB check. This has prevented Garston Manor from meeting the required standard. Garston Manor Nursing Home D54-D07 S28671 Garston Manor V222751 020605 Stage 4.doc Version 1.30 Page 6 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 D54-D07 S28671 Garston Manor V222751 020605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Garston Manor Nursing Home D54-D07 S28671 Garston Manor V222751 020605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3 The service users and their relatives can have confidence that the staff at Garston Manor are confident and capable to fully assess their health and social care needs in a way that enables service users to maintain their dignity. EVIDENCE: The owners had provided with the Commission and up-to-date statement of purpose and service users guide. This provided clear information and was easily available in the reception area of the home. Relatives asked said they had been given information about the home and its services prior to the admission of the relative. They also said they were kept informed. The assessment process adopted by the manager is comprehensive. This enables service users need to be assessed holistically. This includes assessment of health, personal and social care. A continuous risk assessment process ensures that the service users needs are monitored and changes in their care requirements reflected in their plans of care. Garston Manor Nursing Home D54-D07 S28671 Garston Manor V222751 020605 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10, Service users and their relatives are involved in developing their plan of care as far as possible. This ensures that the service users care needs are met in a way that they would do themselves if they were able. EVIDENCE: The care plans at Garston Manor provide information on individual care needs of the service user. These are linked to how the individual responds and is affected by their illness. The start of each plan of care has a pen picture of the service user and how the illness they have affects their day-to-day life. The care plan continues to address the identified care needs the service user has. These include their mental and physical health care needs as well as the personal and social care needs. The staff observed during the inspection was speaking to the service users in a friendly supportive way. There were reorientating them to time and place in a friendly respectful way. When service users asked the same questions repeatedly staff responded in a clear friendly way each time they asked. Garston Manor Nursing Home D54-D07 S28671 Garston Manor V222751 020605 Stage 4.doc Version 1.30 Page 10 The action staff should take to reduce the risk of the service user displaying challenging behaviour were well documented. The staff observed were skilful in managing service users agitation. The service users who required their medication to be crushed to enable them to take it had consent forms completed, which had been signed. The registered nurses take the responsibility for giving the service users their medication. The records of medication given had been signed. None of the service users at Garston Manor have been assessed as able to self medicate. How one service users pressure sore was being managed had been recorded. The manager confirmed that the district nurses regularly provide advice and support to the nurses at the home in relation to pressure sore management. She confirmed that the district nurses advice is sought on a regular basis. District nurses case notes were seen in one service users room who was receiving care from them. Garston Manor Nursing Home D54-D07 S28671 Garston Manor V222751 020605 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15, The staff team at Garston Manor endeavours to provide meaningful activities for the service users in their care. Mealtimes are a social occasion for the service users and staff to enjoy. EVIDENCE: Monthly entertainment is provided from a music group, photographs of their last visit were displayed on a notice board in the lounge. The manager advised that if the service users or their relatives wanted the photographs they were given copies. A further activity group provided by an external company attends the home one afternoon a week. The activities they provide include painting, rubber stamping and paper craft. Staff were encouraging the service users to take part in singing familiar songs and drawing. Five service users were taking part. The lounge is split into three areas, this allows service users to choose whether they wish to participate in the activities provided or watch television. The statement of purpose includes information of the relatives and how they can be involved at Garston Manor. Two comment cards received by the home identified how the relatives perceive the care at Garston Manor. The manager Garston Manor Nursing Home D54-D07 S28671 Garston Manor V222751 020605 Stage 4.doc Version 1.30 Page 12 completes an annual quality audit of the home requesting comments from relatives, general practitioners, district nurses and other professionals who visit the home. The inspector was shown actions that have been taken following the previous years quality audit. Classical music was playing in the background in the lounge throughout the inspection. Two of the service users asked said they were enjoying listening to the music. To relatives asked said there is usually music on in the background when they visit. The staff were observed consulting with the service users about their personal choices. Where they would like to sit, whether they would like a drink or what they would like to eat. At the lunchtime meal observed the service users who required assistance were being given this in a sensitive supportive way. Very little wastage was seen at the lunchtime meal. The manager confirmed that the food is prepared fresh daily. Fresh vegetables were used for the lunchtime meal and a homemade sponge pudding was available for sweet. The service users asked said they liked the food. Service users who required puréed food had been given this prepared in a way that allowed them to taste each of the different food separately. Garston Manor Nursing Home D54-D07 S28671 Garston Manor V222751 020605 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18, The service users and their relatives can be reassured that the staff team at Garston Manor will deal with any concerns they have sensitively. When all the employment checks for existing long-term staff are completed, this will ensure service users continue to be protected. EVIDENCE: The complaints procedure was easily available in the reception area of the home. The log of the complaints received was provided for inspection. This included actions taken by the home staff team to address the issues or concerns raised by relatives or service users. The home has a robust adult protection policy and procedure. These had been reviewed in May 2005. There was evidence that staff had received training in adult protection. Not all the long-term staff had had a criminal records check completed since 2002. The manager confirmed that all the new staff employed have had a criminal records check applied for and a POVA first statement provided before they started work. Examples of this was seen into staff files. Garston Manor Nursing Home D54-D07 S28671 Garston Manor V222751 020605 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 25, 26 The service users at Garston Manor are provided with a well-maintained, safe, pleasantly decorated environment to live in. EVIDENCE: Several of the service users rooms had been redecorated since the last inspection. The reorganisation of the facilities in some of the existing rooms had been completed. The refurbishment has created one extra bed space at Garston Manor and provided en suite facilities in a further three rooms. The records of regular maintenance checks that are being completed were available for inspection. The home was fresh and clean and free from odour during the inspection. The shared rooms in use had screening provided. Two separate dining areas are provided for the service users use. A large lounge is available which has been divided into three distinct areas; this allows the service users more Garston Manor Nursing Home D54-D07 S28671 Garston Manor V222751 020605 Stage 4.doc Version 1.30 Page 15 choice. An outdoor patio area has seating for the clients to use. The gardens have been stocked with a variety of shrubs and spring flowers. The majority of the service users were in the lounge during the inspection. Two relatives spoken to advise that this is normally the case when they visit. Following the lunchtime meal some of the more frail service users were assisted to rest in their bedrooms after lunch. Bathroom and toilet facilities are easily accessible from the service users private rooms and the lounge and dining areas. This allows the service users to have easy access to toilet facilities. The inclusion of roof space lighting in the corridors of the home have improve visibility without the need to use artificial light. One corridor that did not have any natural light, has night lights plugged into electric sockets. Garston Manor Nursing Home D54-D07 S28671 Garston Manor V222751 020605 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30, The manager has introduced a robust recruitment policy for new staff, which should protect service users from unsuitable staff. The recruitment policy for employment checks needs to include the existing staff to ensure service users continue to be protected. EVIDENCE: Two new staff files viewed had a record of their criminal records bureau check application and the POVA first check. However one senior member of staff who has been with the home for several years has still to complete the required criminal records bureau check. The owners confirmed that they were exploring other options to fill their staff vacancies and were hopeful to have a full staff complement very shortly. Since the inspection in January the home no longer relies on registered nurses doing sleeping duties at night to cover shifts. Agency staff are employed to cover shifts shortfalls that the homes own staff are unable to cover staff. A list of the training the staff had received and had planned were provided. The two senior carers on duty explained how they monitored the staff training for the healthcare assistants in their team. They both provided a list of training staff in their team had completed. Two of the healthcare assistants spoken to during the inspection advice that they were in the process of completing the National Vocational Qualification level 3 in care. Garston Manor Nursing Home D54-D07 S28671 Garston Manor V222751 020605 Stage 4.doc Version 1.30 Page 17 The staff training received and planed and the response from the staff spoken to supports that the owners are committed to maintaining a well-trained workforce who are able to meet the needs of the service users. Garston Manor Nursing Home D54-D07 S28671 Garston Manor V222751 020605 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35, 37, 38 The management team at Garston Manor have worked hard to ensure the home is well managed and provides a safe environment for the service users and staff. EVIDENCE: The registered provider and manager are both first level nurses (RMN) with several years experience in the care field. The registered manager has recently completed a National vocational qualification level 4 in management. The results of the quality assurance audit completed in May 2004 were available for inspection. Two completed comment cards from service users relatives dated May 2005 were provided. The owner advised that the annual quality assurance review was being moved to October 2005 and the results would be provided for the commission once this had been completed. Garston Manor Nursing Home D54-D07 S28671 Garston Manor V222751 020605 Stage 4.doc Version 1.30 Page 19 The maintenance records inspected supports that the homes equipment is well maintained on a regular basis. Staff have access to the appropriate training for fire protection, manual handling and first aid. Service users assessments and care plans were fully completed and had been reviewed monthly. Medication records were available this had been completed as required. Apart from one long-term member of staff all the staff in the home had had a criminal records bureau check applied for, confirmation of these is provided for inspection. Each of the service users plans to use had a record of the money spent and the balance available in their personal funds. Receipts for attached for items or services purchased. Garston Manor Nursing Home D54-D07 S28671 Garston Manor V222751 020605 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 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 3 x 3 x x x 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x 3 x 3 x 3 3 Garston Manor Nursing Home D54-D07 S28671 Garston Manor V222751 020605 Stage 4.doc Version 1.30 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 29 18 Regulation 19(4)(b) (i) 19(4)(b)(i ) Requirement All staff must have a criminal records bureau check completed As above, all staff must have a criminal records bureau check completed Timescale for action December 2005 December 2005 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 Good Practice Recommendations Garston Manor Nursing Home D54-D07 S28671 Garston Manor V222751 020605 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI Garston Manor Nursing Home D54-D07 S28671 Garston Manor V222751 020605 Stage 4.doc Version 1.30 Page 23 - 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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