Inspection on 26/10/06 for Garston Manor Nursing Home

This inspection was carried out on 26th October 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 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 19/01/06

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 & Mandy Norton Unannounced Inspection 26th October 2006 10:00 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.V306868.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. Garston Manor Nursing Home DS0000028671.V306868.R01.S.doc Version 5.2 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.V306868.R01.S.doc Version 5.2 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. 19th January 2006 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 resident. The care staff support the trained nurse in providing the care for the resident’s. There is a large, level garden area that provides a secure outdoor area for the residents use. The home invites comments from resident’s and visitors through an anonymous satisfaction questionnaire that is available in the main reception area of the home. The Inspection report is displayed in the entrance area of the home. The fee levels stated October 2006 are up to £530 the actual cost is dependant on the needs of the resident. Further information about the home and its services including fee levels is available on the Garston Manor web site. Extra costs include any hairdressing and chiropody, the resident’s request. Garston Manor Nursing Home DS0000028671.V306868.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection. The inspection was carried on 26th October 2006 by two inspectors. Two district nurses who provide support for the home manager and the registered nurse team were present during part of this inspection. The inspectors examined a range of documents including staff and residents files. Discussion took place with the manager and staff on duty were also spoken with. A tour of the home was completed. The homes manager/Owners were present throughout this inspection. Comment cards were received from relatives and health and social care professionals prior to the visit to the home. Some of the comments received have been used in this inspection report. Information received since the last inspection has also been taken into account in this inspection report. What the service does well: What has improved since the last inspection? What they could do better: Since the last inspection one allegation has been made, which raised concern about the staff teams ability to use manual handling equipment and their understanding of manual handling risk assessments. It also raised concerns about the registered nurses understanding of the pressure sore risk assessment tool they use to assess residents. The manager needs to ensure that all care staff receive practical instruction for use of manual handling aids and improve staff understanding of manual Garston Manor Nursing Home DS0000028671.V306868.R01.S.doc Version 5.2 Page 6 handling risk assessment processes. This should ensure that staff continue to use safe manual handling techniques that protect the residents from harm. The manager also needs to ensure that the registered nurses have sufficient information regarding the pressure sore risk assessment tool used. This should ensure that the registered nurses continue to take appropriate action to reduce the risk of a pressure sore developing for residents identified as at risk. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Garston Manor Nursing Home DS0000028671.V306868.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Garston Manor Nursing Home DS0000028671.V306868.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents and their relatives can have confidence that the staff at Garston Manor will assess their health and social care needs in a way that enables the residents to maintain their dignity. EVIDENCE: The owners have developed a web site, which enables those who are interested to look at the homes facilities and services on line prior to visiting the home. This includes a description of the of the homes environment with photographs and a floor plan of the home. How care is planned and the aims and objectives of the service are also covered. The statement of purpose and service users guide is regularly up dated and revised copies sent to the Commission. These were easily available in the home for residents and other to see on request. The assessment process adopted by the manager is comprehensive and has been up dated and improved since the last inspection. This enables resident’s health and social needs to be assessed holistically. These assessments include Garston Manor Nursing Home DS0000028671.V306868.R01.S.doc Version 5.2 Page 9 health, personal and social care needs. A continuous risk assessment process ensures that the residents care needs are monitored and changes in their care needs reflected in their plans of care. Garston Manor Nursing Home DS0000028671.V306868.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The way individual residents mental and physical health care should be managed has been well set out in their individual plans, this should enable staff to provide care in a way that meets the residents needs. However the manager should ensure that all staff understand risk assessments in use and how best to reduce the identified risks in order to protect the residents. EVIDENCE: Four residents care was followed as part of the inspection. Residents had a plan of care developed form their assessment of need. Their plans of care had been reviewed monthly or sooner if the residents care needs had changed. There are very clear care plans regarding how staff should care for the residents mental health needs. These plans of care also provide guidance for staff on how to manage any challenging behaviour the resident may have. The social worker responsible for some of the residents care management at Garston Manor said, “ The staff have been able to care for residents with complex mental health behaviour problems and assisted them to maintain their personal dignity.” The manager advised that she has regular contact with the consultant Psychiatrist who oversees the mental health care of the residents. Garston Manor Nursing Home DS0000028671.V306868.R01.S.doc Version 5.2 Page 11 Where residents had specific general health care needs there was evidence that the home manager had sought advice from the residents GP and the district nurse team. The district nurse commented that “they are regularly asked for advise regarding wound care, although on occasions they said they would have liked to have been asked earlier”. At the time of the inspection the district nurses were assisting with the wound care management of two residents. An allegation received about lack of care for a resident who developed a pressure sore has been received since the last inspection. This resident’s general health had been deteriorating over a period of time. The manager had completed a plan of care, which assessed the risk of pressure sore development. However the high-risk score had not prompted the staff to provide a high dependence pressure relief mattress. There appeared to be some confusion as to who was responsible for providing the high dependency pressure relief mattresses. Since the allegation the owners have provided several more high dependency pressure relief mattresses for residents. The owner advised “this had increased the number of pressure relief mattresses from 3 to 8 for 24 clients”. At the time of the visit to the home all residents who required high dependency pressure relief systems had them. Concerns were also raised as part of this allegation about the staffs ability to safely use manual handling equipment and their understanding of safe manual handling practices. The district nurses had reported that on two occasion when they visited the home staff were not following the residents manual handling risk assessment by using a hoist and had tried to lift a resident with out using a hoist who was unable weight bare. The inspectors saw evidence that all staff had received basic theory training for manual handling. The manager advised that four staff including her self had completed a manual handling practical trainers course. The duty rota provided showed that one of these members of staff was on duty each shift. The manager confirmed that all staff would receive practical instruction for manual handling and in the interim she would ensure that all staff understood the importance of following the manual handling risk assessments completed for individual residents. The inspectors saw comprehensive training manuals for manual handling and health and safety. These were easily available for the staff. Each resident case tracked had a manual handling risk assessment in place, which guided staff regarding the safest way to carry out manual handling tasks with the resident. The district nurses responsible for supporting the home manager and staff with general health care for the residents had completed general health care assessments on all the residents at Garston Manor. The district nurse had advised that this was part of the new partnership agreement with the local Primary Care Trust and GP practices, which should ensure that all residents in care homes are assessed annually by an NHS nurse. The owner raised concerns about the way these assessments took place at Garston Manor. The district nurses reported that they were satisfied that the resident’s general health care needs were being meet, although they did note that several residents had dry and crusty areas on their feet. They had also offered to provide advice and support for the staff team at Garston Manor relating to general physical health care issues for the residents on a monthly basis. Garston Manor Nursing Home DS0000028671.V306868.R01.S.doc Version 5.2 Page 12 Records in the resident’s plans of care support that the residents GP had been contacted when changes in the resident’s health occurred. Three residents with diabetes had this controlled by the diet they received. The chef advised that he provides a diabetic diet for these residents in conjunction with the home manager. The manager advised that the registered nurses complete blood sugar monitoring for these residents. It was unclear from the resident’s records if these residents had regular checks from the diabetic specialist team regarding the management of their diabetes. The manager confirmed that she contacts the GP if there are any concerns. How resident’s foot care is managed was discussed with the manager. She advised that some of the residents were unable to have a chiropodist attend to their feet because their mental health problems prevented them having their feet attended to safely. The manager further advised that these residents foot care is managed by the staff team. However it was unclear if staff had received training in foot care management. The manager advised that all diabetic residents had their foot care managed by the chiropodist. The manager has confirmed that residents who required their medication to be crushed to enable them to take it had consent forms completed, which had been signed. She also stated that the registered nurses take the responsibility for giving the residents their medication. None of the residents at Garston Manor have been assessed as able to self medicate. The resident’s medication is stored in a locked treatment room, a drug fridge is provided for medication, which needs to be kept cool. The staff observed during the inspection were speaking to the residents in a friendly, supportive and respectful way; some times reorientation them to time and place. When residents asked the same questions repeatedly, staff responded in a clear friendly way each time they asked. The staff were actively encouraging the residents to join in with discussions and activities. Garston Manor Nursing Home DS0000028671.V306868.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team at Garston Manor continue to endeavour to provide meaningful activities, which promote dignity for the residents in their care. EVIDENCE: The staff team on duty during the inspection were providing one-to-one support for individual residents. The pre-inspection questionnaire received in August listed the activities provided for residents. These included skittles, dominoes and snakes and ladders, card games, rubber-stamping and singalong. This is not a complete list of the activities provided by the staff for the residents. The manager advised that the activities are organised on a day-byday basis to fit in with the residents needs. The three residents whose first languages was not English continue to be helped by the provision of simple phrases in their own language that staff can use to address them. Since the last inspection new staff have been appointed who are able to communicate with the residents in their first language. The manager advised that this I had encouraged those residents to participate more in the activities provided. One relatives comment card stated “the family have all found the owners and staff very kind and attentive” they also indicated that their relative had “settled in very quickly”. The manager advised that the residents and their relatives are always treated with respect and encouraged to join in. Garston Manor Nursing Home DS0000028671.V306868.R01.S.doc Version 5.2 Page 14 The manager confirmed that the new chef had completed the training offered by Teignbridge environmental health team regarding the new food hygiene legislation implemented in January 2006. The chef advised that they had found the training useful and the information packs a good resource for the home. There are two dining areas for the residents use. The residents were using both these dining area during the inspection. The residents who required assistance to eat their meals were being given this by staff in a supportive discreet way. The residents were eating their meals at their own pace in an unhurried way. Very little wastage was seen at the lunchtime meal. The manager confirmed that the menus are changed regularly and a rotational menu continues to be offered for the residents. Examples of the menu were provided with a pre-inspection information. These showed a varied menu, which is nutritionally balanced. Individual residents plans of care have nutritional risk assessments completed, this enables residents at risk of malnourishment and dehydration to be identified and their care targeted to reduce the risk. Although the staff had not been recording when the residents had refused care, the manager confirmed that staff do try to work with the residents and encourage them to accept care. The manager advised that she would discuss with the staff team the need to document the times when care offered had been refused by the residents. Garston Manor Nursing Home DS0000028671.V306868.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents and their representatives can be reassured that the staff team are Garston Manor will address any concerns they have sensitively. EVIDENCE: The complaints procedure is easily accessible in the reception area of the home. The commission has received one complaint/allegation since the last inspection. The commission is satisfied that the home manager has acted proactively in addressing the concerns raised by the complaints/allegation. This has ensured that the residents continue to receive the care they need from suitably qualified staff team. The recruitment processes adopted by the home protects the residents from unsuitable staff. The manager confirmed that all staff receives adult protection training. A training matrix provided with the pre-inspection information also confirmed to this. The staff files view during the inspection had copies of the certificates for training individual staff had undertaken. This confirmed that staff had received training relevant to the care of the residents Garston Manor. An individual staff personal portfolio checklist continues to be used. The manager confirmed that all staff working in the home had had a CRB criminal records bureau check completed. Copies of completed CRBs were seen in the staff files viewed. Garston Manor Nursing Home DS0000028671.V306868.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents of Garston Manor continue to be provided with a well maintained, safe, pleasantly decorated home. EVIDENCE: The redecoration of individual residents rooms and replacement of carpets has continued since the last inspection. Individual residents rooms entered were attractively presented, clean and fresh smelling. Individual residents had personalised their rooms with items of personal choice. These included photographs, pictures and other small items important to the residents. The manager advised that alternative flooring had been provided in one resident’s room to reduce the risk of odours. The manager confirmed that the resident’s rooms and communal areas are redecorated on a regular basis to ensure they are attractively presented and continue meet the resident’s needs. The shared rooms have screening provided for the residents who use them. Garston Manor Nursing Home DS0000028671.V306868.R01.S.doc Version 5.2 Page 17 The home has a large lounge, which is divided into three distinct areas to give the residents choice. Residents were using this lounge during the inspection, some residents were watching television and others are sitting talking to staff. There are two dining areas available for the resident’s use both of these were being used during the inspection. The gardens of the home are attractively presented. A patio area is available, which is directly accessed from the lounge. The manager advised that during the summer month’s residents spent time out in the garden. Photographs of the barbecue the staff had organised for the residents during the summer months were provided. Bathroom and toilet facilities are easily accessible from the resident’s private rooms and the lounge/dining room areas. This allows residents to have easy access to toilet facilities. Disinfecting sluices are available for disposal of clinical waste. Since the last inspection a pad disposal system has been installed for incontinence pads. This has reduced the need to store soiled pads for collection; there by reducing the potential for unpleasant odour in areas the residents have access to. The number of toilet and bathroom facilities provided a Garston Manor meet the required standards for the number of residents. The manager has provided clear infection control policies and procedures for the staff. Staff providing personal care for residents were using the gloves and aprons provided. Hand sanitizer liquid gel is also provided in the home for visitors and staff use. A clinical waste disposal system is in place, which uses a yellow bag system. The contract with the clinical waste company was available for inspection. Three domestic staff are employed. Two of the staff spoken to during the inspection told the inspector they like to keep the home clean and fresh for the residents and one commented “They took pride in the appearance of the home”. Garston Manor Nursing Home DS0000028671.V306868.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents at Garston Manor are cared for by a staff team who are skilled in managing their mental health care needs. However the lack of staff training for practical manual handling and clear understanding of pressure sore prevention may put the residents at risk. EVIDENCE: A duty rota was provided by the manager with the pre-inspection information. This gave the names of registered nurses, health care assistants and ancillary staff employed by the home. The information provided indicated that new staff had joined the staff team since the last inspection. The duty rota confirmed that registered nurses are on duty each shift to direct the care of the residents; a team of health care assistants supports them. The manager confirmed that a staff handover of the care needs of the individual residents continues. A record of the handover for each shift is kept; this has a brief record of any issues discussed about individual residents. The district nurses advised that staff are always helpful when they visited to see individual residents. Staff on duty during the inspection appeared to be meeting the needs of the residents. Staff were observed working with residents on a one-to-one basis during the inspection. The staff appeared skilled in managing the residents mental health needs. One relatives comment card received stated, every Garston Manor Nursing Home DS0000028671.V306868.R01.S.doc Version 5.2 Page 19 time I have visited -- I had been delighted to see how well -- is cared for in every way. The information folder available for the registered nurses/nurse in charge has been further developed since the last inspection. This gives clear information for the registered nurses about contact numbers for GPs, district nurses, care managers and other health professionals. Their responsibilities regarding the management of the shift and the resident’s care is also outlined in this information. Sufficient domestic staff are employed to keep the home clean and fresh and the residents personal clothing maintained. One member of the domestic staff spoken to said there took pride in their work and like to see the home kept clean and fresh for the residents. The manager advised that she continues to be committed to ensuring that the staff receive the training they need. At the time of the inspection five of the nine health care assistants employed had achieved an NVQ level 2 or above in care. This exceeds 50 stated in the National Minimum Standards. The duty rota showed that more staff are employed on a full-time basis that the previous inspection. Four staff files for staff appointed since the last inspection were examined. All staff files contained references. However two staff files only contained one reference each. The manager advised that newly appointed staff are kept under close supervision and where written references had not been provided a verbal reference was sought. However a record of verbal references taken had not been noted in the staff file. There was evidence that criminal record bureau checks had been completed for all four staff. The staff record matrix provided indicated that all staff had a criminal records bureau check completed. The manger advised that one member of staff was employed as student, a training agency directly employed this member of staff and Garston Manor was providing the work placement. The information available within the staff members file indicated that they had received the appropriate checks prior to starting work. The training records for these four staff indicated that they had received induction training. Copies of certificates available in their staff files evidenced other courses the staff members had completed. One newly appointed member of the domestic staff team had completed infection control training and COSHH (Control of Substances Hazardous to Health) training as well as their induction. This member of staff was able to confirm the training they had received, commenting” I am supported to do my work” The manager provided a training matrix for inspection, which showed the training courses that staff had completed. These included mandatory training such as fire safety, manual handling and health and safety. The manager confirmed that the mandatory training is repeated regularly. Records confirming staff had received fire training were provided. Four staff members spoken to were able to confirm they had received fire training and knew where the fire extinguishers were placed and said they knew how to use them. The induction training folder, included information regarding health and safety, basic manual handling and care of the residents. However although staff had received theoretical training for Manual handling not all had received practical instruction. The district nurses had raised concerns about the staffs Garston Manor Nursing Home DS0000028671.V306868.R01.S.doc Version 5.2 Page 20 knowledge and ability to use the manual handling aids provided as well as their understanding and use of the manual handling risk assessments. The manager was able to confirm that four staff had received practical manual handling trainers training. Evidence of this training was also available, this included a comprehensive manual handling trainer’s manual. The manager advised that all staff would receive practical instruction for manual handling within the next three months. The district nurses had expressed concern about the wound care management for one resident. They had also questioned how the registered nurses were interpreting the pressure sore risk assessments completed for residents. The registered nurses did not appear to have had received recent wound care or tissue viability training, which would up date their knowledge and skills. In order to continue to protect the residents from pressure sore development the staff should receive information regarding the use of pressure sore risk assessments and best practice for wound care. The inspector has been advised that very little training provision for wound care management has been provided for nursing homes. The inspector was also made aware that training previously offered by the tissue viability nurse specialist had not been provided. There was clear evidence that the manager uses the district nurse team for advice and support for wound care management. District nurses were visiting the home on a regular basis to monitor wound healing and complete dressings for two residents. The district nursing team have also offered to provide more training, advise and support for the RN’s in relation to wound care management for a three month period. Garston Manor Nursing Home DS0000028671.V306868.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management team are Garston Manor continue to work hard to ensure the home is well managed and provides safe environment for the residents and care that reflects their assessed needs. EVIDENCE: The manager provides the commission with the results of the latest quality assurance audit completed annually. The owners confirmed that the audit is used to ensure that the services they provide were continuing to meet the needs of the residents and their families. The results of the audit are available on the homes web site as well as in the home. The way money held for an individual resident is handled was discussed with the manager. Records were provided of expenditure and money held for individual residents. The money held for one resident was checked against the record held as correct. The manager confirmed that none of the residents Garston Manor Nursing Home DS0000028671.V306868.R01.S.doc Version 5.2 Page 22 have capacity to manage their own affairs. The pre-inspection questionnaire indicated the number of residents subject to power of attorney and guardianship orders. Secure facilities are provided for storage of money and valuables on behalf of the residents. The manager has introduced clear systems and practices for ensuring that staff are regularly supervised. The supervision and appraisal system includes staff development. Examples of these were seen in the staff files examined. A tour of the home was completed as part of the inspection. The service records of equipment used in the home were available for inspection. These showed that fire extinguishers, lifts and manual handling hoists are serviced regularly in line with recommendations. The manager was aware of their responsibilities for health and safety of the staff and the residents are Garston Manor. The manager has provided a written statement of policy, organisation and arrangements for maintaining safe working practices. The health and safety policies are easily available for staff. An accident recording system is in place, this records incidence of injuries or untoward incidents. There are also clear instructions for staff on how to report reportable accidents and instances to the relevant authorities. The residents have comprehensive risk assessments in place for the health, safety and welfare. However the manager should ensure that all staff understand the individual residents manual handling and pressure sore risk assessments, which will they enable them to take appropriate action to reduce the risks. Environmental risk assessments relating to prevention of legionella, food hygiene, hot water and surfaces temperatures were also available for inspection. Garston Manor Nursing Home DS0000028671.V306868.R01.S.doc Version 5.2 Page 23 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 4 X 3 X X N/A 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 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 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Garston Manor Nursing Home DS0000028671.V306868.R01.S.doc Version 5.2 Page 24 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. 1 Refer to Standard OP8 Good Practice Recommendations The manager should ensure that staff continue to understand manual handling risks assessments and are able to perform manual-handling tasks safely. The manager should ensure that the registered nurses have a good understanding of pressure sore prevention, to reduce the risk of residents developing pressure sores. All care staff should receive practical instruction for manual handling tasks. The manager should ensure that the registered nurses receive information to increase their understanding of pressure sore prevention for the residents. The manager should ensure that all staff receive training that enables them to meet the residents needs 2 OP30 3 OP38 Garston Manor Nursing Home DS0000028671.V306868.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Garston Manor Nursing Home DS0000028671.V306868.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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