Inspection on 31/10/06 for Garswood

This inspection was carried out on 31st 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 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 13/02/06

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 31st October 2006 12:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Garswood DS0000005345.V308499.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. Garswood DS0000005345.V308499.R01.S.doc Version 5.2 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.V308499.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 42 OP The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 13th February 2006 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 the proposed manager Miss Pippa Bates. Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two days lasting 11.5 hours. This was the key unannounced inspection to be carried out as part of the regulatory requirements. One inspector visited the home for the process of inspection. As part of the inspection process all areas of the home were viewed including bathroom facilities and some of the residents bedrooms. Care records and other residential home records were inspected including staff files and records relating to the servicing and certification of equipment and services provided at the home. Discussion took place with the proposed manager; senior care supervisor, cook and one to one interviews with three staff. Several residents were also spoken with. Four of the residents were interviewed confidentially and their views of the home and the care provided obtained. Relatives were spoken with also. Residents were also canvassed for their views via the Commissions questionnaires, which were sent out to the home prior to the inspection visit. Some of their views are included in this report. What the service does well: Residents living in Garswood were very complimentary about how they are cared for. Residents’ comments included, “ It’s lovely, it’s like being at home”, “all the staff and carers are very kind”, “you get plenty of attention, there are plenty of staff around”. Residents are able to live their lives as they please with the Christadelphian faith being paramount to them. All of the residents interviewed were complimentary about how their care is delivered. Comments received from residents include, “staff are nice” and “staff are lovely, it’s not only with me, they are good with everybody”. Residents are able to live their lives as they please with the Christadelphian faith being paramount to the majority of residents. The home provides all residents with a high standard of living. Excellent support from staff, relatives, friends and ‘friends of Garswood’ ensure that the residents are able to live their lives as they please. The policies and procedures in place ensure that all residents and staff are protected from abuse. The home has a clear complaints procedure in place for residents and some of the residents interviewed confirmed that they had confidence that staff would deal with any concerns they had. One resident stated, “I wasn’t happy having to wait for my pudding and had a chat with the cook and it’s now been ‘re arranged’ ”. Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 6 The home provides residents with a comfortable and well-maintained service that is continually looking to improve facilities for the residents who live there. The home places great emphasis on ensuring staff are skilled at meeting the residents’ needs. The training programme includes all mandatory training and additional specialist training. The home promotes the health, safety and welfare of residents and staff to a high level. This ensures they are protected. The home encourages family and friends to visit the home regularly and this was observed during the inspection. Family interviewed confirmed that they are made very welcome when they visit the home. Relatives interviewed stated, “we are always made to feel welcome, we have had two cups of tea already, we visit regularly, it’s a lovely home”. Residents interviewed stated, “we have visitors anytime really”. Friends of Garswood visit the home regularly and offer their support where needed for any of the residents. Residents interviewed stated, “many activities are run by a group of Christadelphians called ‘friends of Garswood’ and they also do the daily ‘readings’. What has improved since the last inspection? Residents are much more settled now that the proposed manager has been in place for some months and staff views are that the home is a happy place to work. Residents comments include, “I’d like to say how much I like being at Garswood”. Staff comments include, “I love it, it’s a lovely atmosphere from the top down”. The assessment process has greatly improved and therefore ensures that residents admitted to the home have their needs met. The assessments viewed were detailed and comprehensive. Through discussion with the residents it is apparent that many of the residents knew the home well prior to becoming a permanent resident through visiting, friends, relatives or holidaying at Garswood. The recruitment procedures have improved since the last inspection. The home place a strong emphasis on thorough checking of staff prior to employment and ensuring staff are skilled at meeting the residents’ needs. Medication is audited on a regular basis with documentation kept. The home have arranged for additional staff to attain the NVQ qualification to Level 2. The home has had many additional improvements and refurbishment to improve the facilities for the residents over the past year some of which is included in this report. The new wheelchair access from the front lounge patio area to the lower garden enables residents to access the rear gardens. Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment process has greatly improved and therefore ensures that residents admitted to the home have their needs met. Standards assessed OP 3. OP 6 is not applicable EVIDENCE: Three of the residents care files were ‘case tracked’ (this means the inspector examines all care documentation including care plans and assessments in detail). All three residents were assessed prior to admission to the home with documented evidence in place to confirm this. The assessments are detailed and comprehensive including healthcare needs, sleep pattern, social needs, recreational needs and religious needs. All prospective residents are invited to the home, to spend some time there and meet with the residents. Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 10 This gives the prospective resident some insight into how the home is run and if it may suit their needs. Many of the residents have visited the home regularly or for holidays prior to taking up residency. One of the residents case tracked has been ‘trying out’ Garswood as a prospective residence by staying there on a temporary part time basis and getting to know the other residents and staff. They have now made a decision to live at Garswood on a permanent basis. It is apparent that residents are not rushed into making decisions and have the time to reflect. This is good practice. Residents interviewed about the home meeting their care needs stated, “ I’m happy with everything, it couldn’t be better”. Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home needs to ensure that medication prescribed is always in stock to ensure that residents are not placed at risk. Standards assessed OP 7,8,9,10 EVIDENCE: Three residents care plans and care records were case tracked. Care records were detailed including any professional healthcare intervention and are up to date. Care records include risk assessments, manual handling assessments, self-medication assessments, nutritional assessments, waterlow scores (tool to identify risk of developing pressure sores) and falls risk assessment. Care plans evidence full details of all health and personal care needs. These have also been individualised to the residents’ particular health and personal care needs. The home has accessed specialist advice for one of the residents whose needs are becoming more difficult to manage. Therefore the resident has been reviewed and medication has been altered. Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 12 Additional support has been arranged for the resident to have physiotherapy on a regular basis. The family are aware of the changing needs of their relative and visit regularly. Residents and their relatives’ signatures to agree the care planned are in evidence. One new residents care plan is to be signed by their family on their next visit as discussed with the proposed manager. The medication records evidence residents’ photographs for easier identification. The proposed manager assesses all staff that are trained to administer medication and documented evidence is in place to confirm this. This is good practice. A list of staff signatures/initials is available. If the home has to employ agency staff to work in the home on a temporary basis they do not administer medication. Senior staff carries out this procedure. This is good practice. Aberdeen’s (medication records) were viewed. Antibiotics prescribed for residents need to be administered over a longer period of time throughout the day as discussed rather than 8am, 12.30pm and 4.30pm. This will ensure a better effect as the medication isn’t taken in a shorter span of time. One or two medications that arrive in the middle of the monthly order are not entered correctly on the Aberdeens therefore this needs rectifying so that the manager is able to follow an audit trail if need be. Records show that when a prescribed medication is for one or two tablets it is not clear what the residents had therefore it must be recorded on the Aberdeen if the resident had one or two. One of the residents was without Digoxin medication for seven days due to a mix up with the monthly ordering system. Therefore it is recommended that the prescriptions be checked following receipt from the surgeries and then forwarded on to the chemist to prevent this occurring again. One of the residents Aberdeens shows signatures are missing on two days with regard to prescribed medication. A returns book is in place and contains the full details required. The home now has a ‘controlled drug’ cupboard. Temazepam stored in the home for residents prescribed use is audited on a regular basis, which is good practice. During the unannounced visit it was apparent that residents are cared for as all were well groomed. A private pay phone facility is available for residents who do not have their own telephone. During the induction process, new staff are advised on how they communicate with residents ensuring their approach is respectful residents dignity is maintained always. Residents interviewed stated, “the staff are all lovely”. Staff accompany residents to the hospital clinics for any health care needs. Health professionals visit residents in the privacy of their own rooms. Feedback from the Commissions questionnaires includes comments from residents with regard to the use of agency staff. Comments received included, “care is not as good when provided by agency staff” and “agency ‘staff’ that don’t know what to do, even the simplest of tasks”. These concerns had been raised with the proposed manager and she has taken action to ensure that unsuitable agency staff are not hired to work at the home. Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 13 The proposed manager has arranged with the agency that only staff that are experienced and very familiar with the residents and the home be ever employed. The All bedrooms have their own en-suite facility and the additional bathroom facilities were viewed throughout the home where residents have a choice of bathrooms to use with staff assisting were needed. Bedrooms are single occupancy unless a married couple shares them. Residents interviewed were complimentary about the staff employed at the home and confirmed that staff always communicated with them in a respectful manner. During interviews with the residents it is apparent that this is the usual behaviour of staff. One resident interviewed stated, “staff are lovely, it’s not only with me, they are good with everybody”. Privacy is maintained always and staff knock on residents doors prior to gaining permission to enter. Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are able to live their lives as they please with the Christadelphian faith being paramount to the majority of residents. The home provides all residents with a high standard of living. Excellent support from staff, relatives, friends and ‘friends of Garswood’ ensure that the residents are able to live their lives as they please. Standards assessed. OP 12,13,14,15 EVIDENCE: Most of the 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. In the past few weeks the home is now enabling a small amount of people from other religions to live in the home. This does not seem to have had any adverse effect on the residents who have lived in the home for some years. Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 15 Residents interviewed stated, “my daughter in law visits me regular, I’m very happy with everything” and “my daughter visits from Yorkshire every week, and I was able to attend my grandsons wedding with help from the staff”. Residents also have the support and friendship of ‘friends of Garswood’ who are able to assist in taking residents out or to just spend time with them. Residents go the Christadelphian Church for regular services and daily readings are held in the large sitting room. Residents who are not of the faith are able to follow their individual religion where wished. There are some activities in the home with residents choosing if they wish to attend or not. The activities include daily readings, the church visit to provide a bible class, art works, exercise class, mid week shop, afternoon activities with staff such as games, sing-a-longs, videos with coffee and chocolates and bingo. The home also offers supermarket trips, trips out, barge trips with lunch, botanic gardens and visits to the tearooms in the village of Birkdale. Residents interviewed stated, “activities are available and I take part in some of them”. Staff interviewed commented, “it’s one big happy family now and residents are happy, we are doing more with the residents than we have ever done”. Some of the residents have a particular interest in gardening, with one resident commenting, “I have grown some tomatoes and eaten them, and put out in some other plants including pansies a few days ago”. Feedback from the Commissions resident questionnaires includes, “we have many activities, “friends of Garswood” visit us regularly a few times every week and we go tour main meeting hall in Southport on Sunday mornings”. A ‘loop system’ is in place in the meeting room so that hearing impaired residents are able to communicate more effectively. All residents have their own bank accounts and manage their money with assistance if needed from relatives. Sefton Advocacy contact details are available for residents who wish to use this service with residents having made use of this in the past. It was evident during the inspection that most 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. One resident stated, “the room is okay, it’s big enough, I have a china cabinet for all my ‘nicknacks’ ” and another resident stated, “It’s lovely, it’s like being at home”. The menu offers residents choice at each mealtime with residents also able to choose an alternative to the menu choice if wished. Feedback from the Commissions questionnaires from residents stated, “There is always plenty of food and a choice if needed, there is fresh fruit available”. The senior cook has implemented a new ‘personal likes and dislikes’ list for new residents and also identifies their favourites. Meals are served in the dining room at set times but this can be varied to suit the resident where needed. One resident prefers to eat their meals separately and this is accommodated. Staff interviewed stated, “the food is brilliant, the residents have a really good choice”. Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 16 A daily diary is kept in line with ‘the safer food business’ guidance. Records are kept of fridge/freezer temperatures (including residents and staff fridges), list of what residents eat each day, any specialist diets, delivery temperatures and cleaning schedules. Residents interviewed stated, “the food is fine, but I did not like having to wait for my pudding, and had a chat with the cook and it’s now been re arranged”, “we get home baking” and “we have a nice variety of food with chicken today and fresh salmon yesterday”. The Commission sent questionnaires ‘have your say about …’ to residents who live in the home. Residents comments included concerns about cold plates and cold meat being served occasionally, this has now been resolved and residents confirmed during interviews that food was now always served hot on warmed plates. Staff are available to assist residents where needed with mealtimes and drinks. This was observed during the inspection and the service was offered in a discreet manner. Residents interviewed confirmed that regular refreshments are available with some residents having additional facilities in their rooms therefore maintaining some independence. The home is in the process of purchasing a people carrier with wheelchair access, which will benefit the residents. Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The policies and procedures in place ensure that all residents and staff are protected from abuse. Standards assessed. OP16, 18 EVIDENCE: The complaints procedure is on display on the residents’ notice board. It is clear and easy to follow. The complaints record was viewed but there have been no complaints since the last inspection. Residents interviewed were aware that they could complain but none had found anything to complain about. Residents stated, “it’s okay here, you can’t really complain” and “I’m happy here, I have no complaints”. One resident stated, “I find it difficult to complain, the managers are always very helpful”. Other residents who commented in the Commissions questionnaire stated, “I find it difficult to make complaints-personal reasons/upbringing/my faith” and “this is something I don’t wish to do, but would talk things through with staff or management first”. The manager meets with the residents monthly on a one to one basis and increases these private visits where needed. This is good practice. The home has clear policies and procedures in place with regard to abuse. Through discussion with staff it is apparent that they are aware of and have a good understanding of the various forms of abuse. Staff confirmed that they have attended previous abuse training. Training records confirm this. Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 18 Staff interviewed stated, “It’s a lovely atmosphere from the top down and it’s reflected in the attitude coming back from the residents who all seem to be happy”. One of the residents comments included in the Commission questionnaires stated that they were unsure of the complaints procedure therefore the home have now set up a welcome pack, which includes a copy of the complaints procedure. Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The home provides residents with comfortable and well-maintained service that is continually looking to improve facilities for the residents who live there. EVIDENCE: The inspection process included a full tour of the home including many of the residents’ bedrooms. The home is decorated and furnished to a very high standard and has undergone major refurbishment. A new call system has been fitted throughout the home to include residents’ bedrooms, toilets and corridors, new ceiling lights to the top floor and two floors in the annexe. A new patio door has been fitted to the rear patio area and wheelchair lift access has been fitted to enable residents to access the lower garden or patio. One of the residents’ bedrooms including the guest bedrooms has been decorated. Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 20 Other bedrooms viewed are in a very good state of décor. New windows have been fitted to the front of the main lounge and the side corridor windows. The garden pond has been filled in and new fencing has been installed around the garden. The garage has been converted to office use. Office accommodation has been upgraded and the lower games room has been converted to staff accommodation at present but is not in use. One of the residents commented in the have your say about questionnaires that their bedroom ceiling was showing ‘rain marks’, which is thought to have been caused when the new roof was being fitted. The builders were at the home during the inspection to repair this. A maintenance person is employed for 30 hours each week and records evidence ‘jobs to be done’ and the date they are carried out. External contractors are in use on a regular basis also. The home has a high standard of cleanliness and this is evidenced throughout the home. Residents interviewed confirmed the home is clean and were very happy with the cleanliness of their bedrooms. The gardens and grounds are well maintained with many mature shrubs and flowers in evidence. Laundry facilities are sited on the lower ground floor away from the food preparation areas. Hand washing facilities and protective clothing is available. Residents interviewed confirmed they are happy with the laundry facilities. An approved contractor collects the clinical waste. All laundry surfaces are easily cleaned and laundry floors are impermeable. Policies and procedures are in place and up to date. There is a sluicing facility and foul laundry is washed at temperatures of 65oC. Bedding is sent out to a laundry facility. Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The home place a strong emphasis on thorough checking of staff prior to employment and ensuring staff are skilled at meeting the residents’ needs. Standards assessed. OP27, 28,29,30 EVIDENCE: Staffing levels ensure sufficient staff are on duty to meet the needs of the residents and ensure the home is clean. The housekeeping staff provides a laundry service for residents and bedding and other items are sent out to a laundry service. A full time and part time cook including additional staff are employed to cover all days of the week in the kitchen. The home also employs an administrative clerk to support the Manager with administrative duties. Between five or six care staff are on duty in the mornings, four to five in the afternoon and evenings and three overnight. One of the residents interviewed stated, “I need a little more support from staff but am reluctant to ask, I would like to see more staff employed so that they could sit and chat with you as generally they are very busy with other residents who can’t do for themselves”. This resident felt that the home has changed over the years, as some of the other residents were becoming frailer leaving less time for staff to sit and chat. Additional staff are on duty when needed and is dependent on residents needs. Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 22 Feedback from the Commissions questionnaires evidenced comments including, “there are plenty of staff around, I am very happy and content”. Staff interviewed stated, “there is always enough staff on duty and when residents are poorly they still get the care and extra staff are brought in, it depends on how ill the resident is”. The home also provides staff to escort residents to hospital, which is good practice. At present one of the residents is very ill in hospital and the manager has arranged that the resident always has a member of staff or one of Garswood’s friends to be with them. This is excellent practice. The inspector witnessed the arrangements being made to continue the support throughout the night. Ten of the care staff are trained to Level 2 NVQ and additional staff have commenced the training in August 2006. Three staff files were viewed and documentation examined. The staff files evidences all pre employment checks are in place and includes previous employment history, originals or copies of certificates of training attended in previous employment, two written references, application forms, signed contracts, health questionnaires, photograph of employee, staff supervision and appraisals, interview notes, acceptance of employment offer and staff handbook acceptance although this is now being reviewed. CRB (Criminal Record Bureau) and POVA (Protection of Vulnerable Adults) first checks are in place and include volunteers/friends of Garswood. Staff files evidence induction training for all new employees. Staff interviewed confirmed they had received an induction. The home have a very good training schedule to include all mandatory training and additional specialist training for staff to ensure that they are trained and competent to meet the varying needs of the residents. All 23 care staff employed have first aid training and other training attended this year includes Abuse, continence, Dementia, Drug administration, Fire warden training, basic food hygiene, health and safety, COSHH (control of substances hazardous to health), moving and handling and training for trainers, TOPSS induction, Parkinsons Disease, Epilepsy awareness, infection control and Diabetes awareness. Certificates awarded to staff for the training attended is evidenced in staff files. Further training arranged for staff to attend this year includes POVA. The home is keen to ensure all staff are confident in meeting the needs of residents and the training programme confirms this. During discussion and interviews with staff it is apparent that they have an understanding of the illnesses that can affect older people and are confident that they are able to meet the varying needs of the residents who live at Garswood. Carers interviewed stated, “I get enough training to do the job” and “we get enough training, it’s a wonderful atmosphere, it’s a good team and very supportive”. Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home promotes the health, safety and welfare of residents and staff to a high level. This ensures they are protected. Standards assessed. OP33, 35, 38 EVIDENCE: Standard 31 has not been assessed, as the Commission has not yet interviewed the proposed manager. The proposed manager has been employed by the organisation at a senior level (trainee manager) for 3.5 years in another Christadelphian home. Following the resignation of the previous manager the proposed manager (who is qualified to NVQ Level 4) has been employed as the acting manager at Garswood since 1st March 2006. Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 24 In this time the proposed manager has continued to update all her mandatory training, attended a first line manager’s course and gained the RMA (Registered Managers Award) in July this year. Residents interviewed stated, “so far I have found the new manageress very helpful when I have needed to see her about anything, (not necessarily if I am not happy”. Staff interviewed stated, “the manager is very good, you can go to her if you need anything, she is open to suggestions”, “the residents like the new manager” and “the new managers great”. The proposed manager audits the medication monthly including residents who self medicate. Each member of staff trained to administer medication is discreetly assessed on a regular basis at different times and documentation evidences these checks. The pharmacist carried out an audit in August this year. The controlled drugs are audited with records kept. Care plans are audited monthly and documented. Audits are also carried out on accident records for one resident who at present is having a number of falls and the home are trying to identify how best to prevent these falls where possible. The home have now installed discrete equipment that will alert the staff to the residents movement in their room and this is passed onto the call bell system so that staff can be alerted. The building is checked monthly and 3-6 monthly a full audit is carried out. The most recent audit was viewed. The assistant General Manager carries out a health and safety audit annually with a report produced each year. This covers all areas including gardens, structure of the building, environmental health compliance and maintenance of services. The most recent audit was viewed and evidences a full detailed report of all areas discussed. The audit identifies if any further action is to be done and also comments on the good progress carried out from the previous audit. The proposed manager meets with residents on a one to one monthly or sooner if need be. She is able to communicate with the residents in private. The friends of Garswood carry out ‘welfare visits with questionnaires’ on an annual basis and obtain the views of 25 of the residents each year with different residents canvassed each time. The results of which were viewed and are positive in their views about living at Garswood. Through feedback and discussion with the residents the candlelit dinners have re commenced and wine and sherry with classical music evenings. Two welfare visitors visit each Saturday to chat with the different residents each time and complete a questionnaire following their visit. A representative of the friends of Garswood also carries out a monthly ‘owners’ inspection audit and checks various areas including an audit of residents’ monies and records. The General Manager carries out a six monthly inspection visit, which is documented. Residents meetings are held regularly with the most recent one in October this year and minutes where viewed. Informal staff meetings are held on a weekly basis and are recorded. Formal staff meetings are held three monthly when all staff are expected to attend. Staff appraisals/supervision is in place. Forms are made available to relatives/visitors to the home (next to signing in book) so that they can feedback any comments to the home. So far none has been received. Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 25 Policies and procedures in the home have been reviewed in the past two months. Residents who have small amounts of money held on their behalf at the home have records in place. The money is usually sent in by families for payment of items such as hairdressing, newspapers and shopping. Receipts are in evidence for all financial transactions. Each resident has a ‘money’ book and records are also held on computer. Families are advised that they can check all the records held when wished. These records are checked monthly by the Trustees of Christadelphian Care Homes. Direct debits are set up for fees payment. Some resident have the support of their families or solicitors where needed. Air conditioning has been fitted to the lounge and dining rooms in June this year. All servicing of all equipment and appliances is in date including emergency lighting, fire alarm systems and equipment. The Environmental Officer has visited the home in February this year and produced a good report and recommended that non peeling paint be applied to two shelf racks and this has been carried out. All gas appliances and boilers have been serviced. The lift and hoists have been serviced. An approved contractor collects clinical waste and sharps. Accident records are audited monthly. A fire risk assessment of the whole building was carried out in October and a six monthly risk assessment particular to fire risk is carried out six monthly. First aid boxes are situated in all bathrooms, kitchen, laundry and care office. Bathing temperatures are checked prior to residents use and recorded. Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 26 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 4 Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 28 STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement The Registered Provider must ensure that all care staff responsible for the administration of medication signs the Aberdeen (medication sheets) at the time of administration. This is an outstanding requirement. Timescale for action 11/12/06 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 OP9 Good Practice Recommendations The inspector strongly recommends that antibiotics should be administered throughout the day as discussed unless the GP instructs otherwise. That is for eight hourly please administer eight hourly. The inspector recommends that all medication booked into the home outside the monthly order should be correctly recorded. The inspector recommends that where one or two tablets are prescribed they should record the amount. 2. 3. OP9 OP9 Garswood DS0000005345.V308499.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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. 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