Inspection on 10/01/06 for Garswood House

This inspection was carried out on 10th January 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 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

Garswood House 07/09/06

Garswood House 22/09/05

Garswood House 02/12/04

Garswood House 03/06/04

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

CARE HOMES FOR OLDER PEOPLE Garswood House Wentworth Road Ashton-in Makerfield Wigan Greater Manchester WN4 9TZ Lead Inspector Kath Smethurst Unannounced Inspection 10th January 2006 09:30 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 House DS0000005734.V269568.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 House DS0000005734.V269568.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Garswood House Address Wentworth Road Ashton-in Makerfield Wigan Greater Manchester WN4 9TZ 01942 728333 01942 276682 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) www.clsgroup.org.uk CLS Care Services Limited Anne Julie Washington Care Home 40 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (40), of places Physical disability over 65 years of age (8) Garswood House DS0000005734.V269568.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 40 service users to include:up to 40 service users in the category of OP (Older People) up to 8 service users in the category of PD(E) (Adults with Physical Disabilities over 65) The service should employ a suitably qualified and experienced manager who is registered by the CSCI. One named service user (MC) may be admitted in the category of DE(E). The Home`s Statement of Purpose must be altered to set out how the service and facilities offered by the Home will meet the needs of the one individual service user with Dementia by 31/3/05. The home`s Manager and senior carers must be adequately trained to meet the specific needs of the two individual service users with Dementia by 31/3/05. The Home`s carers must be adequately trained to meet the specific needs of the one individual service user with Dementia by 31/3/05. 2nd December 2004 2. 3. 4. 5. 6. Date of last inspection Brief Description of the Service: Garswood House is a single storey building with well-maintained garden areas, situated in the middle of a housing estate, approximately a mile from AshtonIn-Makerfield town centre. It is close to shops and other local facilities and is well served by public transport. The Home is spacious with several lounges. All bedrooms are single and some have an ensuite toilet facility. There are ample communal toilets and bathrooms situated throughout the home. Garswood House provides personal care and support for forty people over the age of sixty-five years eight of who may have a physical disability. The home is owned and managed by CLS Care Services Limited who have 40 plus homes around Cheshire and the Wigan area. Garswood House DS0000005734.V269568.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 10 am. It took place over five and a half hours during the morning and afternoon. The inspector looked around some but not all of the home, checked care plans, medication and some records. To get more information about the home the inspector spoke to five residents, four staff and the manager. What the service does well: What has improved since the last inspection? Good progress has been made by the manager to make sure that the things, which needed improving from the last inspection, have been done. New staff now receive more training when they start work, which helps them to care for residents properly. Garswood House DS0000005734.V269568.R01.S.doc Version 5.1 Page 6 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 House DS0000005734.V269568.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 House DS0000005734.V269568.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): Not inspected during this visit. EVIDENCE: Standards 3 and 4 were examined during the last inspection and were found to be satisfactory. Garswood House DS0000005734.V269568.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): 7, 8 & 9 In the main care plans were detailed, up to date and reflected the care needed, but some records had not been completed, which meant important information had not been documented. Health care needs were well met with evidence of good multi disciplinary working taking place on a regular basis. The medication at this home is well managed promoting good health. EVIDENCE: Three care plans were examined. All contained comprehensive information relating to residents personal, social and health care needs. Daily entries in care notes were completed in all the plans examined and gave a good indication of the care provided and residents well being. The plans were easy to read, had been regularly reviewed and set out clear guidance for staff to take when providing care. There was written evidence that the plans had been signed and agreed by either the residents or their representatives. All the residents spoken to all said they were satisfied with the care provided. The care plans examined contained some very good information in respect to residents past lives, needs, likes/dislikes and chosen lifestyle. For example one read “ Very nervous at night-needs lots of assurance and likes the door locked” Garswood House DS0000005734.V269568.R01.S.doc Version 5.1 Page 10 a second “ In the evening likes to watch TV in her room and has a collection of videos” a third “ Very smart lady who has a lot of pride in her appearance”. While they majority of the records of resident’s weights were completed regularly, omissions in recording were noted in one of the care plans examined. In this instance the resident had not been weighed since October 2005. It is important to regularly weigh residents to ensure their nutritional needs are being met and as such needs to be addressed. It was also noted that this particular resident was regularly refusing a bath however there was no indication in care notes why this was the case or any action taken to explore and resolve this matter. Both these issues were discussed with the manager who offered assurances they would be addressed. Comprehensive risk assessments were in place in all files examined. They covered areas such as nutrition, pressure areas, moving and handling, bedrails and falls. All had been reviewed and updated on a regular basis. The health care needs of residents were being met. Individual care records inspected showed evidence of regular health checks from General Practitioners, chiropodist, optician and district nurses. Procedures were seen in the Home that described safe medication handling. Currently one resident administers some of her medication. A risk assessment has been completed for this resident. Staff responsible for administering medication have undertaken appropriate training. Medication storage was orderly and secure with no evidence of over stocking. However in one instance it was noted that eye drops were not dated on first opening. This needs to be addressed to ensure they are not used for extended periods. Medication Administration Records (MAR) were supplied by the pharmacy except for example when additional medication was provide mid-month then, care staff made hand written entries. Handwritten entries were signed, checked and independently countersigned which is recommended good practice. The medication records inspected were clear and up to date. A separate system is in place for recording the receipt, disposal and administration of controlled drugs. Controlled drugs are securely stored. Garswood House DS0000005734.V269568.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, 13 & 14 Daily activities within the home are well managed offering choice variety and interest. Visiting arrangements are good ensuring links between residents and their relatives and friends are maintained. Personal support is offered in such a way as to enable residents to exercise choice and control over their lives. EVIDENCE: On the day of the unannounced inspection, the routines of daily living were observed to be flexible. Residents were seen to be getting up in the morning at times that suited them. Staff were attentive to the needs of the residents. They took time to sit, chat and socialise when their duties allowed. A friendly but respectful banter was observed between residents and staff. Activities are displayed in the reception area. Activities advertised include crafts, board games, exercises, sing-a-longs and bingo. One to one activities also take place such as assistance with letter writing and sending e-mails. The home employs an activities organiser. However on the day of inspection she was on leave this resulted in the advertised activities not taking place. Despite this written records and feedback from residents indicated leisure activities do take place on a regular basis. One resident spoken to said there were “enough Garswood House DS0000005734.V269568.R01.S.doc Version 5.1 Page 12 things going on for me”. A second resident described the activities arranged at Christmas and said she had a “ lovely Christmas” at the home. Another resident advised she did not want to join in the activities and was appreciative staff respected this and did not try to persuade her to do so. Age appropriate games and a good supply of books were in evidence. Televisions are provided in all lounges. In addition care plans take note of residents social interests. Regular residents meetings are held regularly and well attended. The minutes of the last meeting were examined and indicated residents were satisfied with the range and frequency of activities available. During the last inspection some residents said they would like Sky TV installed as they enjoyed watching sport. During this visit these residents once again said they would like Sky to be provided. Discussion with the manager indicated this is being considered. Residents wishing to maintain their religious links are encouraged to do so. Care plans contain details of resident’s preferred religion. The home has an open visiting policy. There are no restrictions on the time people visit. Evidence of this was highlighted in the visitor’s book where entries showed residents friends and relatives visiting at different times during the day and evening. The only time restrictions would be imposed is when requested by residents or during the night. Residents spoken to expressed satisfaction with care provided and organisation of life at the home. Observation of care practice and information in care plans indicated residents are encouraged to make choices. For example in respect to where they spend their day. While some residents chose to sit in the lounge a number were observed to spend their time in their own rooms. This was further illustrated in care plans. For example one care plan instructed staff that a resident “Likes a cup of tea before retiring” and “ Likes to spend a lot of time in her room” while a second indicated that the resident “ Doesn’t like to use any perfumed products”. Garswoods policy on admission is that residents are encouraged to bring in personal items that will help them to settle in to life at the home, the extent of which is agreed prior to admission. Evidence of personalisation was seen in resident’s bedrooms where personal mementoes and photographs were on display. The manager advised that residents were able rise and retire when they wished. Residents who were able to comment also confirmed this. One resident said, “You can please yourself what time you get up and go to bed”. Most residents hand over hand the responsibility for their financial affairs to their representatives. However if possible residents are encouraged to manage their own finances. Garswood House DS0000005734.V269568.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): 18 The policies and procedures of the home ensure residents are safeguarded from abuse or harm. EVIDENCE: A corporate Adult Protection and Prevention of Abuse policy is in place, which incorporates, whistle blowing. The home ensures all staff completes a POVA and CRB (Protection of Vulnerable Adults Register/Criminal Records Bureau) before they commence work. When new staff are appointed they are given a leaflet, which details the abuse policy. Training in the signs and recognition of abuse is covered during induction. The home has recently purchased a video produced by “Action on Elder Abuse” and refresher training for all grades of staff is planned for April 2006. Staff spoken to understood the potential indicators of abuse and were aware of the steps they needed to take if there was a suspicion or allegation of abuse. Garswood House DS0000005734.V269568.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): The standard of the environment within this home is good providing residents with an attractive, homely and clean place to live. EVIDENCE: Garswood House is well maintained internally and externally. Nevertheless improvements to the fabric of the building continue. For example, the parquet flooring in the dining room is due to be sanded and stained. The Home is spacious with several lounges, a dining area, activity and hairdressing rooms. These areas are furnished with good quality items. Ornaments, pictures and flowers enhance the homeliness of these areas. In the main standards are good but it was noted that some of the arm chairs were showing signs of wear and tear and need to be replaced as part of the planned programme of renewal. It was also noted that the link corridors were quite cold. Consideration should be given to providing additional heating to Garswood House DS0000005734.V269568.R01.S.doc Version 5.1 Page 15 these areas. One of the doors in the link was observed to be badly damaged and as such needs to be repaired or replaced. The garden areas are tidy, well maintained, safe, secure and accessible for residents. Residents spoken to made no adverse comments about environmental standards in the home. Garswood House DS0000005734.V269568.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): 28, 29 & 30 Recruitment procedures for staff are robust which ensures people living in the home are protected. A comprehensive training programme is in place, which equips staff with the skills, and knowledge to meet residents assessed needs. EVIDENCE: Residents spoken to said staff looked after them well. One resident said staff cared for residents “Well” and “Worked hard”. Many of the staff have worked at the home for a considerable time and staff turnover is relatively low. It was clear from the comments of staff that they liked working at the home and felt they worked well as a team. The files of four staff employed indicated that all necessary recruitment checks had been undertaken. All staff files examined contained: written application forms, 2 references, Criminal Records Bureau (CRB) check and verification of identification. A comprehensive staff development programme is in place and records of training are maintained. There was evidence that new staff undertake induction training that meets the National Training Organisation (NTO) specification following which foundation training is undertaken. All grades of staff have a training profile, which identifies training needs. Since the last inspection the home has achieved Investors in People status. Ongoing training is available and there is ample evidence that these opportunities are taken up. NVQ (National Vocational Qualifications) are Garswood House DS0000005734.V269568.R01.S.doc Version 5.1 Page 17 actively promoted. Currently 48 of staff are in receipt of NVQ level 2 and 3. A further eight staff are currently undertaking NVQ training. Once these staff have completed their training the home will exceed the 50 target required. It was also pleasing to note that training opportunities are made available to catering and domestic staff. For example all domestic staff have attained relevant NVQ awards. Recent courses undertaken include food hygiene, moving and handling, first aid, medication, health and safety, dementia care, infection control and fire safety. Staff who commented confirmed that training was encouraged and widely available. One member of staff described the training as being “good”. Garswood House DS0000005734.V269568.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): 31 & 38 The home is well managed resulting in a consistent and reliable service for the people using it. In the main Health and safety practices are satisfactory, but not all equipment service records were accessible which meant that important information was unavailable. EVIDENCE: The manager has extensive experience in running care homes for older people. Although she has considerable experience, she has continued her professional development. The manager is currently undertaking the NVQ level 4 registered managers award, which she hopes to complete this year. The manager is aware she needs to complete the award to continue managing the home. Staff spoken to all indicated that the manager provides clear leadership and direction. One member described the manager as being “ very supportive and approachable.” Residents who commented were all aware of whom to approach if they had a concern or problem. Garswood House DS0000005734.V269568.R01.S.doc Version 5.1 Page 19 In the main health and safety issues were satisfactory. Policies and procedures are in place and cover a range of topics linked to health and safety. Documentary evidence was available of staff having completed health and safety training including safe moving and handling techniques and first aid. All accidents and incidents had been recorded and reported correctly. Fire safety records showed that that all fire tests and maintenance procedures had been undertaken regularly. Records also indicated that fire drills and instruction had taken place at frequent intervals. Records examined provided evidence of regular inspections and maintenance checks of equipment and the building undertaken by external contractors. However it was noted that an up to date gas safety certificate was unavailable for inspection. To demonstrate the gas installation is safe a copy needs to be forwarded to the CSCI. Garswood House DS0000005734.V269568.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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X X X X X X STAFFING Standard No Score 27 X 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 X X X X X 2 Garswood House DS0000005734.V269568.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care plans must reflect full details of service users assessed needs and actions necessary to meet identified needs including a record of resident’s weight. To ensure eye drops are not used for an extended period the date first commenced must be indicated. As part of the planned programme of renewal the old and worn armchairs must be replaced. The damaged door in the link corridor must be repaired or replaced. 50 of staff must be in receipt of NVQ level 2. The manager must attain the NVQ level 4 registered managers award. To demonstrate the gas installations is safe a copy of an up to date safety certificate must be forwarded to the CSCI. Timescale for action 16/02/06 2. OP9 13 16/02/06 3 OP19 16 & 23 01/08/06 4 5. 6. 7. OP19 OP28 OP31 OP38 16 & 23 18 9 13 & 16 16/02/06 01/01/06 01/08/06 16/02/06 Garswood House DS0000005734.V269568.R01.S.doc Version 5.1 Page 22 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. 3. Refer to Standard OP12 OP19 OP27 Good Practice Recommendations Consideration should be given to providing Sky TV for residents. Consideration should be given to providing additional heating in the link corridor. Consideration should be given to providing an additional member of staff at night. Garswood House DS0000005734.V269568.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 House DS0000005734.V269568.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. 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