Inspection on 07/09/06 for Garswood House

This inspection was carried out on 7th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 House 10/01/06

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 7 &8 th th Unannounced Inspection September 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.V300986.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 House DS0000005734.V300986.R01.S.doc Version 5.2 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.V300986.R01.S.doc Version 5.2 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). 10th January 2006 2. 3. 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. Fees range from £311.12 to £370 per week. Garswood House DS0000005734.V300986.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection site visit took place over a period of eleven hours. Two inspectors visited. One of the inspectors looked at the way staff gave residents their medicines. The home had not been told that the inspectors would visit. The inspector looked around parts of the building and checked some paperwork about the running of the home and the care given. To get more information about the home five residents, the manager and four staff were spoken with. Carers were also watched as they went about their work. Before the inspection comment cards were sent to residents, relatives and people such as social workers, district nurses and doctors. Two residents and three doctors returned the comment cards. What the service does well: Most residents are happy with the way staff look after them. One resident said “staff treat me with the utmost respect and care, they couldn’t be better” a second described staff as “kind”. Before any resident comes into the home, the staff make sure they receive an assessment (a detailed record of exactly what help the person will need) from the Social Services Department, to make sure the home will be able to care for them properly. The records kept on residents (care plans), includes a lot of information about the things residents need support with and the things they like to do. This means staff have the information they need so they can make sure residents get the care and support they need. Each resident had a named carer, called a key worker, who would help them have a bath, go shopping for them or keep their clothes tidy. The staff ask residents and their relatives what they think about the food, activities, environment and staff and what things they could to do to improve residents lives. Staff have done a lot of training, which helps them look after people properly. The home makes sure that before staff starts work they are properly checked to make sure they are suitable to care for people living in the home. Garswood House DS0000005734.V300986.R01.S.doc Version 5.2 Page 6 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 House DS0000005734.V300986.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Garswood House DS0000005734.V300986.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Residents are properly assessed prior to admission in order to ensure the home is able to meet any identified needs. EVIDENCE: Inspection of the records of two of the most recent admissions showed a full assessment of physical care needs had been completed and where applicable social work assessments had been taken note off. The assessment document was detailed and included information relating to physical needs and personal preferences. All assessment documents had been signed and agreed by residents or their representatives. Discussion took place in respect of the assessment process undertaken. The acting manager advised that if possible prospective residents are visited prior to admission at home or hospital, whether they are paying for themselves or the local authority funds their care. This was felt important to ensure the home Garswood House DS0000005734.V300986.R01.S.doc Version 5.2 Page 9 was able to meet needs. Good practice was noted in that when a resident had been admitted to hospital a further assessment was carried out (prior to discharge) to ensure the home could continue to meet their needs. If possible the home will arrange for prospective residents to visit prior to admission so they can meet the staff and other residents. If this is not possible relatives usually looked around the home prior to their relative’s admission. New residents are allocated a key worker. Feedback in a returned resident comment cards indicated they were provided with sufficient information prior to coming to live at the home. Garswood House DS0000005734.V300986.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Care plans were detailed, up to date and provide staff with the information they need when delivering care. Health care needs were well met with evidence of good multi disciplinary working taking place on a regular basis. Whilst the medication policies and procedures were detailed some shortfalls were identified which need to be addressed. Personal support is offered in such a way as to promote residents privacy. EVIDENCE: Three care plans were examined. All contained comprehensive information relating to residents personal, social and health care needs. Each area of risk has a separate record. Supplementary information includes personal care record and weight. Daily entries in care notes were completed in all the plans Garswood House DS0000005734.V300986.R01.S.doc Version 5.2 Page 11 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. The care plans examined contained some very good information in respect to resident’s likes/dislikes and chosen lifestyle. For example one plan read, “I like to be bathed by a female care assistant”, “I prefer to wear trousers” a second, “I enjoy reading the daily newspaper, which I have delivered to the home” and “I do not like cheese”. Two of the plans contained life profiles with information about important events, previous jobs, places visited on holiday, war experiences, interests, style fashion, memorable moments, current interests, sporting interests, preferences and aims and aspirations. Good practice was noted as the information provided gave readers a good insight as to the people, things and events important to residents. One area staff need to address is in regard to the recording of residents spiritual and religious needs. In one of the plans examined this information had not been recorded in the relevant section so was difficult to access. This was discussed with the manager who offered assurances this would be rectified. A full range of risk assessments were in place covering areas such as nutrition, pressure area care, moving and handling, smoking, medication and falls. All had been reviewed and updated on a regular basis. Information provided by the homes staff to the CSCI (Commission for Social Care Inspection) showed that there had been a series of un-witnessed accidents where residents had sustained injuries. This was discussed with the manager. The manager advised that she audited accident records and had identified this issue. As a result she had referred those residents (who were regularly falling) to the “falls prevention service”. A nurse from the service had visited to undertake assessments and offer advice. This had proved useful and the number of such incidents had now reduced. In addition to internal reviews there was evidence of external reviews (Social Services) having taken place. Residents are allocated a key worker. Key workers take a “special interest” in individual residents, assist them with bathing and contribute to care plans. It was evident from discussions with staff they knew a great deal about resident’s preferences, likes and chosen lifestyle. Since the last inspection the manager has introduced monthly staff “practice meetings” where issues surrounding care practice are discussed. A “practice Garswood House DS0000005734.V300986.R01.S.doc Version 5.2 Page 12 meeting” took place on the day of the visit and was observed. The meeting covered national minimum standards for older people. Discussions indicated staff knew a great deal about residents and up to date good practice in caring for older people. Information was exchanged and staff contributed fully to discussions. In the main residents were happy with the staff and care provided. One resident said, “staff treat me with the utmost respect and care, they couldn’t be better”. However one resident who returned a comment card when asked whether staff listen and act on what you say wrote, “Sometimes it isn’t immediately and then it gets frustrating. But they are sometimes too busy or get called to other jobs”. The health care needs of residents were well met. Individual care records inspected showed evidence of visits from general practitioners, chiropodist, optician and district nurses. Prior to the inspection comment cards were sent to local general practioners in order to ascertain their views. Three were returned to the CSCI (Commission for Social Care Inspection). None of the general practioners had any concerns about the care provided for residents and all indicated communication was good. The policy and procedures describing the handling of medication provide clear guidance to the staff managing residents’ medicines. Two residents had chosen to manage some of their own medicines. Written assessments of safe selfadministration had been completed but one needed updating, as it did not clearly describe the support needed to enable the resident to safely selfadminister her medicines. Staff explained that they prepare the days medication for the resident each morning. This should be discussed with the supplying pharmacist as they may be prepared to directly fill the resident’s dosette. Part of the morning medication round was observed. The home was short of medicines pots. Tablets were taken to residents in a glass, and left on the table if they were not taken directly. One resident left the table leaving two medicines behind; another resident spotted this. Records showed that there had been an accident this month where another resident took someone else’s medication. The management of the medication round needs to be reviewed to reduce the risk of this type of accident happening again. Risk assessment for residents who are left with medicines to take in their own time need to be kept up-to-date. Records of the receipt of medicines into the home and of unwanted medicines sent for disposal were maintained. This enables the safe handling of residents medicines to be tracked. The medication administration records were mostly clear and up-to-date. There were some ‘gaps’ in the records, particularly for Garswood House DS0000005734.V300986.R01.S.doc Version 5.2 Page 13 recording the application of prescribed creams. The manager was aware of the ‘gaps’ and working to improve the record keeping through regular audit. The manager was asked to confirm the dosage instructions for two medicines. In one case the label instructions were not the same as those on the record sheet. In the other instance it was not possible to tell whether a medicine handwritten onto the medicines record was still needed. Medicines were correctly stored and safely locked away within the medication room. The fridge thermometer was not working and needs replacing to enable the temperature to be accurately monitored. Anecdotal evidence from residents indicated that staff respected their privacy and dignity. During the inspection staff were seen to treat residents with respect and consideration, were attentive to individual needs and discreet when providing assistance. Written evidence in care plans showed that resident’s needs in respect to dignity were considered important. For example personal care and appearance. One plan read, “I like to be bathed by a female care assistant” and “I like to look smart & visit the hairdressers once a week” a second “I like my nails long not short. I also like to wear nail varnish”. Garswood House DS0000005734.V300986.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this area is good. This judgement has been made from the evidence gathered both during and before the visit to the service. Daily activities within the home are well managed offering choice variety and interest. Visiting arrangements in the home 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. Meals are good and the needs of residents are well catered for with a balanced and varied selection of food provided. EVIDENCE: On the day of the visit, 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. A friendly but respectful banter was observed between residents and staff. Garswood House DS0000005734.V300986.R01.S.doc Version 5.2 Page 15 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. For example recent activities included a trip out for lunch and a dance evening. Some residents have also been involved in art therapy sessions. The manager’s brother is an artist and has undertaken a project with eleven of the residents. The residents painted self-portraits, which were displayed at an exhibition at the Turnpike Gallery in Leigh. The portraits will now be displayed in the home. The aim of the project was to integrate people of all ages in art. Residents who took part enjoyed taking part in the sessions and the work produced is of a very high quality. 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. Residents wishing to maintain their religious links are encouraged to do so. Local clergy visit the home on a regular basis. The home has an open visiting policy. There are no restrictions on the time people visit evidence of which was highlighted in the visitor’s book, where entries showed residents friends and relatives visiting at different times during the day and the evening. The only time restrictions would be imposed is when requested by residents. Residents spoken with expressed satisfaction with care provided and organisation of life at the home. It should be noted a number of residents have memory and communication difficulties so were unable to confirm they were able to exercise choice. Nevertheless observation of care practice indicated residents could 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. Staff were observed asking residents which meal option they preferred. Resident’s rooms are personalised and residents are able to bring personal items in the home. Care plans take note of personal preferences and chosen lifestyle. For example one plan read, “I like my door locked” and “I never wear trousers” a second, “I like a bath in the evening”. Garswood House DS0000005734.V300986.R01.S.doc Version 5.2 Page 16 Menus were examined and were found to be well balanced and nutritious. Menus are compiled centrally for all CLS establishments but are adapted to suit resident’s preferences. A choice is offered at every meal. Breakfast is served on a flexible basis from 8.30am to 10.30 am residents were observed having their breakfast at various times during the morning. One resident spoken to confirmed she was able to have her breakfast when she wished. The main meal is served at teatime with a lighter meal served at lunchtime. Drinks and snacks are offered throughout the day. Meals are eaten in the main dining room but if they wish residents may eat their meals in their rooms. The dining area was clean and efforts had been made to give an air of domesticity. Dining tables were tastefully set so ensuring a congenial atmosphere. Lunch on the day of inspection consisted of soup, sandwiches and beans on toast. A good selection of sandwich fillings was available. The meal was well presented and in sufficient quantities. Staff were sensitive and discreet when providing assistance, no one was rushed and second helpings were offered. Staff were also observed offering options and alternatives. Good practice was noted in that a member of staff was aware a resident did not like the dessert and ensured an alternative was provided. Special occasions are celebrated. For example on the day of the visit one of the residents was celebrating her birthday and the cook had prepared a birthday cake. Residents able to comment had no complaints about the quality, quantity and choice of food provided. The manager indicated that CLS were currently reviewing the mealtimes. It was planned to introduce a new system called “marvellous mealtimes”. The aim being to make mealtimes more leisurely and with fewer interruptions. Staff would also sit and eat the meals with residents, medication would be given at a different time (unless required) and people asked not to visit at mealtimes. The manager advised this system had been introduced in other homes in the group and was working well. Garswood House DS0000005734.V300986.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. The home has a satisfactory complaints system with evidence that residents feel their views are listened to and acted upon. Policies, procedures and training were in place to safeguard residents from abuse or harm, and for taking any concerns seriously. EVIDENCE: A detailed complaints procedure is in place. Details of how to complain are contained in the “Service User Guide” which each resident has a copy of. A system is in place for recording complaints. The homes complaints book was examined and showed five complaints had been logged since the last inspection. The complaints related to car parking and care practice. There was written evidence these complaints had been thoroughly investigated including details of the steps taken to rectify the issues and a copy of the report sent to the complainant. All the concerns raised had been resolved to the complainant’s satisfaction. No formal complaints have been received by the CSCI (Commission for Social Care Inspection) over the past year. Good practice was noted in that residents are regularly asked for their opinions about the home in regular residents meetings. Examination of the minutes show residents felt able to make suggestions about how the service could be improved. Residents able to comment indicated they knew whom to approach Garswood House DS0000005734.V300986.R01.S.doc Version 5.2 Page 18 with a concern or complaint. However feedback in one returned resident comment card indicated he/she was unaware of the procedure. This is an area the manager should explore during the next residents meeting. 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) check before they commence work. No recent POVA (Protection of Vulnerable Adults) investigations have taken place. 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 updated annually. 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.V300986.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 & 26 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. In the main the standard of the environment within this home is good providing residents with an attractive, homely and clean place to live. However some improvements are needed to ensure standards don’t fall below an acceptable level. EVIDENCE: Garswood House is a single storey building situated in the middle of a housing estate, approximately a mile from Ashton-In-Makerfield town centre. It is close to shops and other local facilities and is well served by public transport. Garswood House is in the main well maintained. Nevertheless improvements to the fabric of the building continue. For example, the parquet flooring in the dining room has been sanded and stained, one of the lounges re-decorated and new dining tables and chairs purchased. Garswood House DS0000005734.V300986.R01.S.doc Version 5.2 Page 20 The home is set in extensive grounds. The garden areas well maintained and enclosed. This ensures residents can enjoy the garden in safety. Garden furniture is also provided for residents. 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. While standards are generally good some improvements are required. The carpet (near the office leading to the dining room) is showing signs of wear and tear and needs to be replaced. It was also noted that the paintwork on some doors and skirting boards was chipped and required repainting. A sample of bedrooms was examined. Bedrooms were personalised with photographs and personal mementoes on display. Doors are fitted with locks that can be opened by staff in an emergency. Lockable storage space is also provided for residents to store items for safekeeping. On the day of the inspection the home was clean and odour control was good. Policies and procedures were in place with regard to infection control. Staff were provided with protective aprons and disposable gloves. Liquid soap and paper towels were provided near to hand washing facilities. Staff were observed to be maintaining good hygienic practices. All laundry is undertaken on site. While the majority of residents made no adverse comments about environmental standards in the home one resident who returned a comment card wrote, “Rooms need to be hoovered and cleaned more, especially under beds and behind cupboards”. This is an area the manager should explore in the next residents meeting. Garswood House DS0000005734.V300986.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Staff morale is high resulting in a committed and enthusiastic workforce, this ensures a consistent standard of care for people living in the home, but staffing levels need to be reviewed to ensure care needs are not compromised. 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. . However, there are some gaps in the induction-training programme that need to be addressed. EVIDENCE: Staff turnover at Garswood House is relatively low with a number of staff having worked at the home for some considerable time. This would indicate staff are well supported and happy in their role. Further evidence of this was highlighted in discussions with staff. All staff spoken with indicated they enjoyed working at the home. A written rota is maintained. The manager works on a supernumery basis. A home services manager, part time activity co-ordinator, and part time handyman are also employed Monday to Friday. During the day each shift Garswood House DS0000005734.V300986.R01.S.doc Version 5.2 Page 22 comprises of a care team leader and three care staff. Two staff work at night. Domestic and catering support care staff seven days a week. On the day of the visit staff were busy but responded speedily to requests for assistance made by residents. During this and previous inspections concerns were raised in regard to staffing levels in the evening, at weekend and at night when the manager and other support staff are not at work. For example (evening and weekend) there are four staff working on each day shift, one of these is a Care Team Leader who is counted in staffing but who carries out administrative and management tasks and is also responsible for the shift when the manager is not on duty. These duties could at times take care team leaders away from providing direct care to residents. While at night two staff support 40 residents throughout the night and given the layout of the building and dependency levels of residents this may not be sufficient. Two residents who returned comment cards also raised concerns regarding staffing levels. One resident wrote, “Not always enough staff available” a second, “Through being understaffed they cant be there pronto”. Staff spoken with also indicated more staff at these times would prove beneficial. The manager indicated in discussions and in the information supplied with the pre-inspection materials that if needs increased additional staff hours would be provided. Nevertheless it is strongly recommended additional staff be provided in the evening, weekend and at night. The files of three 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 staff development programme is in place and records of training are maintained. While the induction programme meets NTO (National Training Organisation) specifications, examination of one member of staff’s induction record showed some sections had not been signed as completed within specified timescales. This was discussed with the manager who offered assurances this would be addressed. Samples of training records were examined. The records confirmed the wide range of courses that staff had attended and that ongoing training is available. Staff spoken with were happy with the range of training provided by the home. One member of staff described training opportunities as being “Good”. Mandatory training needs are well met. Recent courses undertaken include, moving and handling, fire safety, health and safety, protection of vulnerable adults, assured safe catering, COSHH and first aid. Training records also show staff have undertaken a range of more specialised training, including dementia care, continence care, diabetes awareness, report Garswood House DS0000005734.V300986.R01.S.doc Version 5.2 Page 23 writing, management, dealing with conflict, assertiveness, stress management and NVQ (National Vocational Qualification) assessors award. NVQ (National Vocational Qualifications) are promoted. Currently 52 of staff are in receipt of NVQ level 2 and 3. A further five staff are undertaking the award and six are waiting to start training. It was also pleasing to note that training opportunities are made available to catering and domestic staff. For example some domestic staff have attained relevant NVQ awards. One area the organisation is asked to address is in regard to the availability of NVQ level 3 training for care team leaders. Discussion with staff indicated NVQ 3 is not currently available due to funding issues. Steps should be taken to investigate funding, as this is the most appropriate course for these staff. Garswood House DS0000005734.V300986.R01.S.doc Version 5.2 Page 24 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, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. The home is well managed resulting in a consistent and reliable service for the people using it. The home regularly reviews aspects of its performance through a good programme of self-review and consultations, which include seeking the views of residents, staff and relatives. A satisfactory accounting system was in place, which protected resident’s interests. In the main Health and safety practices are satisfactory, but not all equipment service records were up to date which could be potentially hazardous. Garswood House DS0000005734.V300986.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager has extensive experience in running care homes for older people. Although she has considerable experience, she has continued her professional development and is currently undertaking the NVQ level 4 registered managers award, which she hopes to complete before Christmas. During the inspection, it was observed that staff and residents had no hesitation in approaching the manager if they had anything they wished to discuss. Effective internal and external quality assurance systems are in place such as staff and residents meetings and visitor/residents surveys. The last residents’ meeting took place on the 2/8/06. Examination of the minutes showed residents felt able to voice their opinions. For example one resident indicated that she did not like the new staff uniforms while another was concerned that dining tables had not been set properly. CLS representatives visit the home on a monthly basis to audit records and speak to residents and staff. A written report is then produced of the findings, which is then forwarded to the CSCI. The home has a system for recording the complaints of those who don’t wish to complain formally. Residents are informed of CSCI inspections and inspection reports are available for visitors and residents to read. In the entrance to the home “customer feedback forms” are available for residents or their representatives to complete if they wish. The manager and senior staff undertake regular quality audits of records for example accidents and care plans. The Contracts Section of Wigan Social Services Department, in conjunction with a company called RDB Limited, has undertaken a voluntary star rating of homes in Wigan. As part of the rating process an annual audit of quality is undertaken. This includes consultation with service users and staff. The home has a satisfactory accounting system in place. Staff could determine exactly how much money the home was holding for each resident. The Home looks after small amounts of resident’s personal allowances. Detailed records are held of all transactions. All monies held for safekeeping are kept individually. A record is kept of monies credited and debited and receipts were obtained for financial transactions. Secure facilities are provided for the safe keeping of money. Relatives manage the finances for the majority of residents. However if possible residents are encouraged to look after their own money. Discussion took place in respect those residents whose finances are managed by their relatives. The Home Services Manager advised that currently there were no issues with residents having access to their personal allowances. Senior staff audits residents monies kept for safe keeping on a regular basis. Garswood House DS0000005734.V300986.R01.S.doc Version 5.2 Page 26 With the pre-inspection materials, the manager provided a list of maintenance and associated records. A number were checked on the site visit on the 6th September, including the fire alarm and gas. It was noted that the gas safety certificate was out of date. The date on the service certificate indicated the last check was undertaken on the 8/6/05. To demonstrate the gas installation is safe a copy needs to be forwarded to the CSCI. . 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. Training records indicated that training and regular updates are provided to staff in key areas such as moving and handling, fire safety, first aid, food hygiene, fire safety awareness etc. There were satisfactory policies and procedures in place relating to the recording and reporting of accidents to residents and staff. Samples of accident records were examined and were found to be appropriately maintained. Garswood House DS0000005734.V300986.R01.S.doc Version 5.2 Page 27 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 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Garswood House DS0000005734.V300986.R01.S.doc Version 5.2 Page 28 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 OP9 Regulation 17 Requirement Timescale for action 08/09/06 2. OP9 13 3. OP9 13 .4. OP19 16 & 23 The registered person must ensure that there is an accurate up-to-date list of currently prescribed medication and the date and time of administration for every resident. The registered person must 22/09/06 ensure that assessment of safe self-administration, and the risk assessments for leaving residents with medicines to take in their own time are kept up-todate. The registered person must audit 08/09/06 the management of the medication rounds to reduce the risk of residents taking someone else’s medicines. As part of the planned 31/12/06 programme of renewal the carpet in the entrance must be replaced; and the areas of damaged paintwork repainted. Staff must complete topics specified in the induction programme within six weeks of commencing their duties. 31/10/06 5. OP30 12, 13 & 18 Garswood House DS0000005734.V300986.R01.S.doc Version 5.2 Page 29 6. OP31 9 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. 31/12/06 7. OP38 13 & 16 31/10/06 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. 2. 3. 4. Refer to Standard OP9 OP9 OP9 OP27 Good Practice Recommendations The thermometer in the medicines fridge should be replaced. More medicines pots should be purchased for use during the medicines round. The pharmacist should be asked whether they could dispense medicines into a dosette box to support safe self-administration. Consideration should be given to providing additional care staff in the evening, weekend and at night. Garswood House DS0000005734.V300986.R01.S.doc Version 5.2 Page 30 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.V300986.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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