Inspection on 13/02/06 for Garswood

This inspection was carried out on 13th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Garswood 29/01/08

Garswood 31/10/06

Garswood 20/10/05

Garswood 22/02/05

Garswood 31/08/04

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

CARE HOMES FOR OLDER PEOPLE Garswood 32 Trafalgar Road Southport Merseyside PR8 2HE Lead Inspector Mrs Margaret Van Schaick Unannounced Inspection 13th February 2006 09:00 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 Garswood DS0000005345.V283606.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. Garswood DS0000005345.V283606.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Garswood Address 32 Trafalgar Road Southport Merseyside PR8 2HE 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) 01704 568105 Christadelphian Nursing & Residential Care Mrs Lesley Denise Porter Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Garswood DS0000005345.V283606.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 42 OP The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 20th October 2005 Date of last inspection Brief Description of the Service: Garswood is an older detached property dating back to 1892 that had been converted into a care home in 1948 and provides residential care for forty-two Older Persons. There is a large extension to the rear of the property and substantial garden grounds surround the property on three sides with ample parking for visitors and staff. It is situated in a residential area of Southport close to public transport and within easy reach of the amenities that serve the Southport and Birkdale area. The home provides accommodation over four floors, with lift access to each floor. There is ramp access to various parts of the home also. Garswood has 26 single bedrooms and 8 double bedrooms all have en-suite facilities. The communal space provides one dining room, two lounges and a conservatory. There are also small seating areas situated throughout the home which some of the residents where observed to use. The large games/function room is in the process of being renovated. The home has a ramp in place, which enables service users to access the rear gardens. The home has a summerhouse, which is pleasantly situated in the rear garden. The home has suitably adapted equipment to assist with the varying needs of the service users. There is a call-bell system throughout the home. A ‘loop system’ is in place in the meeting room for the hearing impaired resident. Garswood is owned by a Charity Organisation, Christadelphian Care Homes and is managed by Mrs Lesley Porter. Garswood DS0000005345.V283606.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day and lasted 6 hours. This was the second unannounced inspection carried out this year as part of the regulatory requirement for care homes to be inspected at least twice a year. As part of the inspection process all of the public areas including bathroom facilities and some bedrooms were viewed. Care records and other documentation including staff files and records relating to the servicing and certification of equipment and services provided at the home were viewed. Discussion took place with the Deputy Manager, Senior Care Supervisor and one to one interviews with two of the care staff. Several residents were also spoken with. Five of the residents were interviewed confidentially and their views of the home and the care provided obtained. What the service does well: Residents living in Garswood were very complimentary about the care and support received from the staff. Comments from residents include “staff are very good, very kind and helpful” and “we would have to go a long way to find anywhere better”. Residents are able to live their lives as they please with the Christadelphian faith being paramount to their lives. Residents and staff interviewed were confident that had they any concerns they would be acted on promptly and the home has a clear complaints procedure in place for residents use should they need to use it. Residents are able to receive visitors when they wished with staff providing refreshments. Residents’ comments include “When any visitors come they are offered refreshments and some stay to lunch, they are made to feel very welcome”. Friends of Garswood visit the home regularly and offer their support where needed for any of the residents. One resident stated, “Some of our ‘friends of Garswood’ come and take us out, they are very helpful”. Garswood is a clean and well-maintained home that provides a high standard of comfort and safety to the residents who live there. The organisation has just carried out an environmental audit, which has identified Garswood DS0000005345.V283606.R01.S.doc Version 5.1 Page 6 repairs/refurbishment required over the year, and as discussed in this report building work is in process with safety of the residents in mind. 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. Garswood DS0000005345.V283606.R01.S.doc Version 5.1 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 Garswood DS0000005345.V283606.R01.S.doc Version 5.1 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 the following standard(s): 3 was assessed. Standard 6 is not applicable The home needs to ensure that all prospective residents are fully assessed prior to admission to ensure the home can meet their needs. EVIDENCE: Through examination of records it is apparent that one resident admitted to the home was not fully assessed by the home prior to admission. A copy of the assessment process from the hospital from where the resident was transferred identifies the resident required nursing care. As Garswood offers personal care only it was not appropriate to admit this resident, as the home would not have been able to meet their needs. Garswood is registered to offer residential care only. Nursing care is not provided. One resident interviewed stated, “I have stayed at the home for respite on a previous occasion before being admitted to the home in the last year”. This is evidence of good practice and ensures the prospective resident is able to meet with the permanent residents, which helps them to make a choice about where to live. Staff are also able to meet with the prospective resident and can make a decision as to whether or not the home is going to be suitable for them. Garswood DS0000005345.V283606.R01.S.doc Version 5.1 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 the following standard(s): 8,9,10 The home needs to review the medication training to ensure all staff are competent to deliver medication to the residents. EVIDENCE: The medication file evidences a list of staff signatures and photographs of residents for easy identification. Aberdeen’s (medication records) are generally well kept but there is evidence of absence of staff signatures on occasions. The home need to identify which staff are omitting the medication/signatures and address this by additional training and assessment of their ability to continue to be responsible for the administration of medication in the home. Some of the residents who were prescribed daily medication were in fact requesting it on a prn (when needed) basis. These residents need to have their medication prescription reviewed so that the prescribed medication is recorded exactly the same on the Aberdeen’s and the medication container. The resident who is prescribed Diazepam 2mg/5mls is at present being administered 1ml at present therefore this needs to be reviewed. Records of controlled medication such as Temazepam are kept and just need the outstanding balance to be carried forward and documented as Garswood DS0000005345.V283606.R01.S.doc Version 5.1 Page 10 discussed. The home is about to purchase a ‘controlled drug’ cabinet. A returns register is also in place with the pharmacist signature in evidence. During the unannounced visit to the home the residents were appropriately dressed and well groomed. Residents requiring support with regard to personal care were very complimentary about the staff employed in the home. Where needed care staff assist residents to the hospital clinics for any health care needs. Residents are also able to consult with other health professionals in the privacy of their own rooms. Residents commented, “Senior staff sit down and discuss care changes”. All bedrooms have their own en-suite facility and there are additional bathroom facilities throughout the home where residents have a choice of bathrooms to use with staff assisting were needed. Residents feel that staff employed at the home always treat them with respect and promote their dignity. During interviews with the residents it is apparent that this is the usual behaviour of the staff whenever and whoever they care for. Privacy is maintained always and staff knock on residents doors prior to gaining permission to enter. Families and friends are encouraged to visit when they wish and guest accommodation is available, as some of the visitors to Garswood have travelled long distances. Garswood DS0000005345.V283606.R01.S.doc Version 5.1 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 the following standard(s): 12,14 Residents are able to live their lives as they please with the Christadelphian faith being paramount to their lives. EVIDENCE: Residents at Garswood choose to live their lives by practising their faith and live amongst their ‘brothers and sisters’ have made a conscious decision to live in the home. Residents interviewed are able to live their lives as they please with many able to come and go when wished. “We can go out as we please, I just let the staff know, it’s quite a relaxed atmosphere,” commented one resident. Some residents have the support of staff or friends of Garswood assist in taking them out when able. One resident commented that “they had made some friends” since being admitted to Garswood. Residents are able to go to the Christadelphian Church for regular services and daily readings are held in the large sitting room. Resident’s comments include “You can go to the daily reading if you want to, sometimes I’m not up to it, so I don’t go”. There are some activities in the home with residents choosing if they wish to attend or not. A ‘loop system’ is in place in the meeting room so that hearing impaired residents are able to communicate more effectively. Comments from the residents regarding food served include “there is a choice of food available with plenty of choice at teatime and plenty of fresh fruit, vegetables and home baking”. One resident commented, “we have cooked breakfast, it’s very good, Garswood DS0000005345.V283606.R01.S.doc Version 5.1 Page 12 my husband enjoys it”. Mealtimes are at set times but can be flexible where needed. Residents are encouraged to bring in to the home some of their belongings where wished. It was evident during the inspection that many of the resident’s bedrooms held many items of personal interest. Residents interviewed were very happy with their bedrooms and the facilities offered at Garswood. On resident commented, “I’m very happy, Garswood is still ‘our home’ and we live quite well” Sefton Advocacy contact details are available for residents who wish to use this service with residents having made use of this in the past. Garswood DS0000005345.V283606.R01.S.doc Version 5.1 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 the following standard(s): 16,18 Residents and staff interviewed were confident that had they any concerns they would be acted on promptly and the home has a clear complaints procedure in place for residents use should they need to use it. EVIDENCE: A complaints procedure is in place and staff advised that no complaints were received in the last year. Residents interviewed were aware that they could complain but none had found anything to complain about. Residents in the home commented “you would have to go a long way to finding anything better”. The home has clear policies and procedures in place with regard to abuse. Through discussion with care staff it is apparent that they are aware of and have a good understanding of the various forms of abuse. Staff interviewed, have confirmed that they have attended previous abuse training. Care staff were complimentary about working at Garswood with comments including “staff are very kind, it’s a nice atmosphere, people talk to people as people and “the home is very calm”. Care staff interviewed have also stated that they find senior staff approachable. Garswood DS0000005345.V283606.R01.S.doc Version 5.1 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 the following standard(s): 19,26 Garswood is a clean and well-maintained home that provides a high standard of comfort and safety to the residents who live there. EVIDENCE: The home was not fully toured during this inspection and although building work is continuing, including redecoration it has not had an adverse impact on the cleanliness of the home. High standards of cleanliness were apparent in the areas visited including resident’s bedrooms. One resident when asked how she liked their bedroom replied, “I do and I don’t get the feeling that I’m hemmed in”. The areas of the home that are being refurbished have safety for the residents and staff as a high priority. The grounds are well maintained and all building work is kept contained. The home has an ongoing plan of maintenance with contracted work carried out also where planned. The rear patio area is in the process of being upgraded following the recent building works. The inspector was able to view the most recent environmental audit carried out by CHC. The audit is comprehensive and detailed. Recommendations made are then discussed with CHC with areas prioritised Garswood DS0000005345.V283606.R01.S.doc Version 5.1 Page 15 and the work carried out where planned. The laundry facilities are sited on the lower ground floor away from the food preparation areas. Hand washing facilities and protective clothing is available. One resident commented, “I’m happy with the laundry service here”. The waste is collected on a regular basis. All surfaces are easily cleaned and laundry floors are impermeable. Policies and procedures are in place. There is a sluicing facility and foul laundry is washed at temperatures of 65oC. Bedding is sent out to a laundry facility. Residents interviewed were pleased with the laundry service at Garswood. The most recent environmental health report was reported as excellent with only one recommendation made. Garswood DS0000005345.V283606.R01.S.doc Version 5.1 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 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 Staff files must be audited to ensure all pre employment checks including full written references are in place to ensure the protection of residents. EVIDENCE: As the Registered Manager is on long term sick leave, the organisation have arranged for temporary management cover to ensure staff are supported during this time. The off duty rota evidences sufficient staff on duty to meet the needs of the residents. Domestic staff are employed to ensure the home is clean and to provide a laundry service. Resident’s comments include “there are always enough staff to help you”. The kitchen employs a full time and part time cook and kitchen staff to cover all days of the week. There are also two administrative staff to support the Manager with administrative duties. Due to the recent turnover of staff, for the first time the home is not able to meet the minimum standard required (50 ) for care staff to be trained to Level 2 NVQ. At present three care staff are qualified to level 2 and four to level 3. Three most recently employed trainee care staff have attended a TOPSS now (Skills for Care Training) course. Three staff files were checked. There is evidence of pre employment checks for each member of staff. Some of the references requested from previous employers have not been verified. In particular one staff member has only one reference in place, which relates to a four-week period of work. This is not sufficient. The letter sent out to the other previous employer had no recollection that the carer ever worked there. One other staff file evidences Garswood DS0000005345.V283606.R01.S.doc Version 5.1 Page 17 that the letter returned by the employer only confirms that that carer was employed there but has not given any further information as requested. The home needs to ensure that all staff references are authentic. Staff that have been employed at the home for some years and have only one reference in place is acceptable. The final staff file checked evidences two excellent written references. Staff files also evidenced interview notes are taken and documented, which is good practice. CRB (Criminal Record Bureau) checks need to be carried out for all volunteers/friends of Garswood. Garswood DS0000005345.V283606.R01.S.doc Version 5.1 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 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): 36,38 Garswood has in general a very good standard of health and safety with regards to residents and staff. The staff identified as requiring fire-training need to have this arranged as soon as possible to ensure the continued safety of the home. EVIDENCE: Standard 31 was not assessed this time as the Registered Manager is on long term sick leave. The staff files that were checked showed evidence of regular supervision with documentation in place. Staff interviewed also confirmed supervision was carried out. Volunteers should also receive training, supervision and support appropriate to their role. Garswood DS0000005345.V283606.R01.S.doc Version 5.1 Page 19 The organisation has their own trainer for manual handling therefore all new/permanent staff training needs are met. Staff interviewed confirmed they are due an update next month. The fire training is not up to date with some staff identified as requiring training. There is one hoist in place for the use of a resident. This hoist is serviced regularly with only the sling in use needing a regular audit to ensure safe working order. All servicing of all appliances in the home is carried out strictly to a timetable with evidence of certificates in place to confirm up to date records and certificates including emergency lighting, gas appliances, nurse call system, lift and fire and alarm systems and equipment. Control of Substances Hazardous to Health data has been updated and stored in the basement. Risk assessments and accident records are in place also. Garswood DS0000005345.V283606.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 3 X 3 Garswood DS0000005345.V283606.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 12 Requirement Timescale for action 28/02/06 2. OP9 13 3 OP9 13 4 OP29 18 The Registered Provider must ensure that all prospective residents are fully assessed prior to admission to Garswood and that they are identified as requiring personal care only. The Registered Provider must 28/02/06 ensure that all care staff responsible for the administration of medication sign the Aberdeens (medication sheets) at the time of administration and always. The Registered Provider must 14/03/06 ensure that all medication prescribed on a daily basis is given unless otherwise changed following a GP review. Where residents are requesting the medication on an irregular basis this must be discussed with the GP and recorded prn (when necessary) if this is agreed. With the Aberdeens evidencing this change. The Registered Provider must 14/03/06 ensure that all staff employed at the home has a minimum of two written references in place prior DS0000005345.V283606.R01.S.doc Version 5.1 Garswood Page 22 to commencement of employment. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP28 Good Practice Recommendations The inspector recommends that all controlled medications be audited regularly with the outstanding balance carried forward to the next page as discussed. The inspector strongly recommends that NVQ Level 2 training is provided again to ensure that a minimum of 50 care staff are qualified to that level as previously. Garswood DS0000005345.V283606.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 Garswood DS0000005345.V283606.R01.S.doc Version 5.1 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!