Inspection on 01/06/06 for Garth House

This inspection was carried out on 1st June 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

Garth House 18/12/07

Garth House 15/12/05

Garth House 18/07/05

Garth House 29/11/04

Garth House 05/08/04

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

CARE HOMES FOR OLDER PEOPLE Garth House Tower Hill Road Dorking Surrey RH4 2AY Lead Inspector Pat Collins Unannounced Inspection 09:30 1st June 2006 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 Garth House DS0000013322.V292893.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. Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Garth House Address Tower Hill Road Dorking Surrey RH4 2AY 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) 01306 880511 01306 877640 Assured Healthcare Limited Mrs Janet Maureen Ann Starr Care Home 42 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (42), of places Physical disability over 65 years of age (42), Sensory Impairment over 65 years of age (20), Terminally ill over 65 years of age (20) Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. A maximum of 20 Service Users may also fall within the category DE (E) - Dementia, over 60 years of age A maximum of 20 Service Users may also fall within the category TI (E) - Terminally Ill, over 60 years of age A maximum of 20 Service Users may also fall within the category SI (E) - Sensory Impairment, over 60 years of age A maximum of 42 Service Users may fall within the category PD (E) Physical Disability, over 60 years of age Services Users may be admitted from the age of 60 years. It is recommended that this room be registered on a temporary basis while the married couple occupies their double room. When the double room becomes a single occupancy for whatever reason than the registration will be reduced to 41 again. 15th December 2005 Date of last inspection Brief Description of the Service: Garth House is a care home with nursing for older people including people with physical disabilities, sensory impairment and dementia from the age of 60 years. Placements may be permanent or short term and service provision includes respite, palliative and convalescent care. Caring Homes Ltd purchased the home in November 2005 and is part of a group of seven care homes operated in Surrey by the same organisation. These homes are part of a wider network of care homes, specialist centres and independent hospitals operated by Caring Homes Ltd in England and Scotland. Situated within walking distance of Dorking Town centre, Garth House is an elegant, detached three - storey manor house. It has a large, mature, wellmaintained garden and a large furnished patio. Car parking facilities are available. Bedroom accommodation is mostly single occupancy with en-suite facilities. Bedrooms are arranged on three floors, accessible by two passenger lifts. Communal areas are on the ground floor. These comprise of three comfortable lounges, two dining rooms, an air-conditioned garden lounge and conservatory. A full time registered nurse-manager is employed who is responsible for the day-to-day management of the home. Weekly fee charges ranged between £750 and £1000 as of May 2006. Additional charges were for private physiotherapy, a proportion of hairdressing costs, NHS chiropody and dental services, personal newspapers and magazines, escort fees and personal telephone calls. Incontinence products Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 5 may also incur an additional charge. Prospective service users and their representatives are informed about the services and facilities of the home in literature available from the home. A copy of the latest inspection report is available in the home or direct from the Commission for Social Care Inspection (CSCI). Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was the first key inspection of the home since its re-registration in November 2005. It draws together the cumulative assessment, knowledge and experience of service provision at Garth House during this period. It also takes into account the findings of an unannounced inspection visit undertaken by one regulation inspector on 1st June 2006. The duration of this visit was nine hours and all key national minimum standards for older people were inspected at the time. A tour of the premises was undertaken and records, policies and procedures were sampled. Discussions took place between the inspector and the home manager also the regional manager and with individual staff members. Student nurses on practice placements at the home also contributed to the inspection process. A number of service users were also consulted and given opportunity to express their views about the home. Information received after the inspection visit in comment cards from seven relatives/visitors, six service users, a general practitioner and two health care professionals also informed the inspection process. The inspector would like to thank all who contributed to this process. What the service does well: The atmosphere of the home was observed to be friendly and welcoming. Staff were professional and caring in their approach towards service users. Individual service users consulted by the inspector expressed positive views about the management and general operation of the home and about standards of care. Some comments were “ staff are supportive” and “ my relative is happy at the home. He is looked after by staff that are always kind and listen to his needs “. The management and administration of the home was efficient and record keeping was organised. Prospective service users and/or their representatives had access to information needed to enable an informed decision regarding the home’s suitability. All admissions were based on comprehensive needs assessments prior to admission. Service users or as appropriate their representatives were in receipt of contracts/statements of terms and conditions of residency. Based in all available information it was concluded that the health and personal care needs of service users were being met. Principles of respect, dignity and privacy were put into practice at the time of the inspection visit. Service users’ rights and independence was also overall well promoted within a risk management framework. The organisation was aware of legislation, guidance and best practice specific to equality and diversity, promoting respect for all people equally and valuing people’s differences. The inspector was informed that equality and diversity training for staff was planned. Service users were Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 7 noted to receive support to enable them to practice religious beliefs. Social activities were age - appropriate and stimulating. Discussions with staff and service users demonstrated an understanding and practices that promoted a social model of disability. The home had attained the Investors in People Award for its programme of staff training and professional development. This had positive benefits for service users by ensuring staff acquired skills and knowledge to be able to meet their needs. It was positive to note that a high percentage of care staff held qualification in care at a minimum of NVQ Level 2 or equivalent. Registered nurses were also well supported in their continuous professional development through internal and external training opportunities. Adaptation training was provided for nurses who had qualified overseas. Placements were also provided at the home for student nurses from Surrey University. Quality audits were a regular feature of the home’s internal and external management systems. Service users and their relatives/representatives were randomly consulted to establish their views about the home. What has improved since the last inspection? Nurses were gradually transferring information over from existing care documents to care plans and risk assessments used by Caring Homes Ltd. A new development also was the senior sister’s involvement in a continence promotion programme organised by the local primary care team. There were clearly positive benefits to individual service users from professional links between the home and continence advisors. A number of nurses had attended continence study days as part of this programme to enable comprehensive inhouse assessment of incontinence. This was aimed to improve individual service users’ quality of life. The assessment process related to the continence promotion programme also implementation of the new corporate care plans and risk assessments was noted to be at an early stage. Though of significant importance to the wellbeing and health of service users, progress in this area was inevitably slow owing to the work entailed being time intensive. The home was also in the process of changing over from contract catering services to in-house provision. The manager anticipated that this change would improve management support to catering staff and enhance catering provision. The manager informed the inspector of a recent review of the management of the home’s missing persons procedures and of environmental and individual risk assessments following a missing persons incident. It was noted that a digilock had been recently fitted to the front door and the stated intention was to alarm all other external doors. This work has since been carried out. A positive development since the last inspection was that the home now had a moving and handling trainer on the team. Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 8 What they could do better: Care planning and review processes need to be more inclusive of service users and where appropriate, their relative/representative. The care documentation sampled identified shortfalls in care planning and risk assessment practices. Whilst it is acknowledged that staff were on the implementation of new care plans and risk assessments it is essential that during this interim period that existing documentation be maintained up to date reflecting and addressing service users’ current needs and risks. It was also noted that the senior nurse had recently received training relating to use of a new nutritional assessment tool. It was stated that it was the intention to cascade this training to all nurses. The nutritional assessments examined were incomplete and noted also that care plans were not always generated from nutritional assessment where warranted to address individual needs and risks. Menu planning arrangements should offer service users opportunities to be consulted and menus offer choice of food at lunchtime. It was positive to note an improvement plan to address this shortfall. The staff training records evidenced a rolling programme of staff training in moving and handling and no concerns in this area of practice were noted at the time of the inspection visit. Feedback from a professional with concerns about moving and handling practices at the home was received. The home manager was advised by the inspector to consult this professional in this matter and subsequently has confirmed acting on this advice. Some environmental hazards required urgent action, specifically external fire exit doors were not fitted with alarms despite the significant risk this posed to at least one service user accommodated. It was positive to note the home manager had been pro-active in trying to address this shortfall. Since the inspection visit confirmation was received from management that these alarms had been installed. Also a lock had been fitted to the cellar door accessible to service users restricting access to staff only. Both environmental hazards identified weaknesses in the home’s health and safety risk assessments. A further concern identified at the time of the inspection visit was the failure to adequately observe a service user who had been the subject of recent serious missing persons incident to ensure her safety. The kitchen required a thorough deep clean and improvement to kitchen cleaning schedules. Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 9 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. Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 10 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 Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 11 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): 1, 2, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users and their representatives had access to the information necessary to enable an informed choice about the suitability of the home. Prospective service users needs were assessed prior to admission. They had contracts/statements of terms and conditions, which clearly informed them about the service they would receive and of fee charges. EVIDENCE: The home’s Statement of Purpose and Service Users Guide was a combined document containing all statutory elements and had been recently updated. This was accessible to prospective service users and their representatives on a table in the reception area, together with other relevant informative documents. These included the latest inspection report, complaint procedure, menu and activities programme. Feedback from service users and relatives confirmed satisfaction with the level of information provided prior to admission. This enabled an informed choice about the home’s suitability. Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 12 Completed pre-admission assessments were on the service users’ files sampled. The use of the corporate assessments had been implemented since the home’s change of ownership. Detailed needs assessments had been undertaken prior to admission to ensure needs could be met. Individuals sponsored by care management or by the primary care team also had copies of care management (health and social services) assessments on their files. The admission procedures included wide ranging assessments of risk and needs, identifying equipment and aids necessary, which was then recorded in care plans. These were compiled after admission and constituted the planning framework for each service user. Records included a history of medical issues; also identified community health care professionals’ involvement in the care of service users. Admission procedures included obtaining personal biography information and details of service users’ personal interests and likes and dislikes. At the time of this inspection nurses were at an early stage of transferring to use of corporate risk and other assessments and to a new care-planning format. Observations identified nurses required further training to enable this process. The home manager was aware of this and training stated to be imminent. In the interim the importance of maintaining existing risk assessments and care plans up to date was discussed. Observations identified shortfalls in assessments and care plans that required attention. It was positive to note that collectively staff were qualified and skilled to meet the needs of prospective service users. Also that systems ensured staff were fully informed of the needs of new service users. Clear information about contracts/terms and conditions of residency and of fees and extra charges was supplied to all service users or as appropriate, their relative/representative. Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 13 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 adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care received by service users was based on assessment of needs. Some care plans and risk assessments however were noted to require further development and updating to ensure all needs were addressed. Areas identified for further development include care planning and reviews to ensure this process is inclusive where practicable for service users and as appropriate, relative/representatives. Principles of respect, dignity and privacy were being put into practice and equality and diversity needs of service users were addressed based on records sampled and comments from service users. Medication practices enabled service users to retain responsibility for their own medication where safe to do so. Service users were mostly protected by the home’s medication policies and procedures. EVIDENCE: Consultation with service users at the time of the inspection confirmed overall good satisfaction with standard of care and the day-to-day operation of the home. Responses received from service users in the six comment cards Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 14 returned, confirmed four considered their care and support to “always” meet their needs and two stated that their needs were “usually” met. Corporate risk assessments and care plans new to the home were at an early stage of implementation. These will enhance those in place currently, which for some service users needed to be further developed and some in need of updating. Nurses were noted to require further training to enable them to implement some of the new corporate assessment tools. Though systems were in place to illicit whether service users and as appropriate, relatives wished to be involved in the care planning process and reviews, this information was not specified on the relevant admission forms. It was not evident from the information available that service users were invited to engage in care reviews at agreed intervals throughout the year other than those organised by care management. Contact with one of the respondents following this inspection confirmed no arrangements in place to involve this person or the service user concerned in care planning. The respondent stated such an opportunity would be welcomed. Most respondents were satisfied with communication between the home and themselves, stating they were consulted and informed of care decisions and about important matters affecting their relatives. Information from one respondent however identified this was an area of dissatisfaction. The view was expressed that staff needed to be proactive in communicating significant information regarding changes in the condition of this person’s relative. The inspector was informed of past omissions in notifying the same respondent of incidents/accidents in which injuries had been sustained, despite the expressed wish to be contacted in such matters. The respondent also emphasised the positive aspects of care at the home and referred to improvements in the home’s conduct, which was attributed to the recent change in ownership. It was stated that social care activities had further developed and social events were being planned which it was perceived by a relative would increase accessibility to the home manager. Less specifically it was stated that changes “had improved the welfare of service users”. The inspector observed care and attention to service users’ appearance and standard of dress. The principles of respect, dignity and privacy were evidenced in the care practices observed. Positive relationships were noted to exist between individual service users, staff members and student nurses. Pressure sore prevention and treatment records demonstrated due diligence in this area of practice though some sampled required updating. A range of pressure relieving mattresses and cushions were available. Incidences of pressure sores occurring in the home were low. The senior nurse also informed the inspector of action in progress to promote continence and improve the management of incontinence. Service users were all registered with a general practitioners (GP). The GP routinely visited the home weekly and at other times as required. A summary Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 15 of the outcome of GP’s visits was maintained individually in service users records. Feedback in a comment card returned by a GP confirmed clear communication and effective partnership arrangements between the home and the medical practice. The GP was satisfied with the overall care provided by the home to his /her patients. It was stated that a senior member of staff was always on duty to confer with during GP’s visits. Positive feedback was received regarding communication, care and the management of the home from one health care professional after the inspection. Feedback from another health care professional who acknowledged observations were based on minimal time spent in the home once a week, did highlight a specific area of moving and handling practice to require monitoring. This information was clarified with the respondent who agreed to raise this matter directly with the home manager. The inspector also drew this issue to the manager’s attention. Practices for the prevention of cross - infection were satisfactory. Staff followed universal infection control procedures. Sluice rooms were clean and sluice machines were operational. Laundry practices were considered satisfactory. Protective clothing and gloves were accessible to staff and suitable disposal arrangements made for clinical waste. The staff training matrix submitted following the inspection visit as an accurate record of staff training identified that a substantial number of staff had not had statutory infection control training. Medication management was underpinned by clear, unambiguous corporate policies and procedures. Medicine keys were stored securely. Medication storage in the medication trolley was at a premium. Liquid aperients medication bottles were observed by the inspector to be left on top of the trolley, which was then left in a corridor unattended for a significant period of time. The nurse had left the trolley during the drug round to respond to a request for assistance from a service user experiencing difficulty in using the phone. The same bottles of medication were later left on top of the trolley in the treatment room. These were accessible to service users as the door was wide open. Separate lockable storage was provided for medicines for internal use and those requiring cool storage. The treatment room was clean and hygienic. Medication records for administration, receipt and disposal, also risk assessments for those self-medicating were satisfactory. Oxygen levels and medication refrigerator temperatures were all regularly monitored and records maintained. Disposal arrangements for medication were also satisfactory. Controlled drugs were stored, recorded and administered in accordance with statutory requirements. Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 16 Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 17 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 outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were able to choose their lifestyle, social activities and to keep in contact with family and friends. Observations concluded that independence, choice and autonomy in service users lives was promoted, commensurate with service users’ individual capacity, needs and levels of risk. Cleanliness and hygiene standards in the kitchen required significant improvement. Also staff engaging in serving and handling food required relevant training. Though service users received a healthy, varied diet there was a need for more choice to be incorporated into menus. EVIDENCE: The home’s ethos promoted an enabling environment in which risk taking for individual service users was appropriately balanced with their aspirations for independence and choice. A service user informed the inspector of staff respecting his individual autonomy and privacy, which he greatly valued. He considered this to be of paramount importance to his quality of his life and wellbeing. He stated that he went out most days independently, overcoming environmental barriers, which can inhibit people with disabilities from leading independent, fulfilling lives. Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 18 The therapeutic value of regular contact with family and friends was recognised in the home’s operation. Comments from visitors confirmed all were made welcomed by staff. Service users were offered and encouraged to maximise individual capacity, enabling personal autonomy and choice. Two care assistants were stated to have delegated responsibility for planning and coordinating the home’s social care programme. This was displayed prominently in the reception area. Activities were stated not to be daily in accordance with the expressed wishes of service users. The programme viewed demonstrated provision of a weekly gentle exercise session provided by a qualified physiotherapist also an ‘extend’ exercise class provided by a trained member of staff. Craft sessions, professional entertainment, special celebration social occasions at Easter, Christmas, Halloween, Burns Night and organised excursions were also included in the activities programme. Raised flowerbeds were available for service users who wished to pursue gardening interests. At the time of the inspection staff were engaging service users in decorating a lounge with football banners in readiness for watching the World Cup on television. Service users had enjoyed a trip to Brighton earlier this year to see the Holiday on Ice show. Provision was made of newspapers and books in the home. Garth House operates an equal opportunity admissions policy and is non – denominational regarding arrangements for meeting service users’ religious beliefs. Service users and their relatives are expected to make their own arrangements for meeting religious and spiritual needs though staff will endeavour to support service users in these arrangements. A Church of England service took place monthly at the home and a Communion service on alternate months. This arrangement reflected the religious beliefs of the majority of service users currently accommodated. The care records sampled contained information regarding service users social, cultural, religious and recreational interests. The contract for external catering arrangements had been terminated by management. The home was imminently due to take over this responsibility. The chef currently employed by the contract catering company had been offered employment by the home in the capacity of head chef. He informed the inspector he did not have a catering qualification but had relevant catering experience and confirmed he possessed a food hygiene certificate. The chef had met with the organisation’s hotel services manager and they had discussed the intention to draw up a new four weekly rotating menu. This will afford choice of all meals, which was currently not the practice at lunchtime. There was an element of choice for breakfast and for the evening meal. Though the home’s literature stated meal provision was based on service users known choices this was not evident other that for a service user’s known preference to be offered an alternative to red meat; also for individuals with special dietary needs. The literature also stated the requirement for choices of Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 19 food differing from the main menu to be pre-ordered in advance. Discussions with service users confirmed most were unaware that they could request an alternative to the main menu at lunchtime. There were no systems for consulting service users when planning menus at the time of the inspection. The chef stated his intention to implement monthly meetings between himself and service users for consultation about menus; also to obtain feedback and suggestions about meals. The views expressed by service users relating to the current standard of catering were variable. Comments ranged from some service users “sometimes” liking the food to others “usually” liking the food. Individual service users expressed personal food preferences for changes to the menu that at the time of the inspection visit they felt unable to influence. A comment in a service user’s returned comment card stated, “sometimes she does not get enough meal”. Other changes noted were plans for increased kitchen assistant support for the chef. Observations indicated the chef was under significant pressure to fulfil his current range of responsibilities. Direct observations in the kitchen environment identified the need for this area to be deep cleaned, including all appliances and the extractor hood over the cooker. Cleaning schedules also required review and improvement to ensure adequate standards of cleaning and hygiene in the kitchen. The oil in the deep fat fryer was noted to be in need of changing. The only food mixer had not worked for three months. Service users had a choice of where they ate their meals. Some sat in the dining rooms, others had their meals in lounges or in their bedrooms. Dining tables were nicely laid and food presentation was satisfactory. Staff serving food and assisting service users with eating wore clean tabards. The atmosphere in the dining room was pleasant and unhurried. Effort was made to promote and maintain eating skills through verbal prompting and provision of suitable aids. Records of staff training did not evidence that nurses and care staff who were involved in serving food had received basic food hygiene training. Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s complaint policy and procedure ensured a prompt response to complaints and adequate record keeping. A copy of the complaint procedure was included in the statement of purpose/service users guide and displayed in the home. Robust, effective procedures were in place to safeguard vulnerable adults. EVIDENCE: The home had a comprehensive complaint procedure a copy of which was included in the Statement of Purpose/Service Uses Guide. This was issued to service users or their representative on admission. A copy was also displayed in the entrance hall and complaint/suggestion forms were openly accessible in this location. Discussions with the manager confirmed informal communication systems operating to inform her of dissatisfaction expressed by either service users or visitors; also of remedial action taken in response. There were records of two written complaints received by the manager since the home’s re - registration. Records were comprehensive and included outcomes of investigations and action taken to resolve complaints. Complainants were notified of this in writing. There had been no complaints made to the CSCI about the home since re-registration. Safeguarding vulnerable adult procedures were in place including local multiagency procedures. Records demonstrated that staff received protection of vulnerable adults (POVA) awareness training as part of their induction. There Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 21 was a rolling programme of POVA training for staff and some staff were booked to attend multi-agency POVA training organised by Surrey County Council. All staff were confirmed to have been issued with a personal copy of the organisation’s whistle blowing procedure contained in a staff handbook. It is recommended that a notice is displayed with contact details of al relevant agencies staff may wish to contact as part of the organisation’s whistle blowing procedures. There had been no allegations or suspicions of abuse reported since the home was re-registered. Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 22 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, 20. 21, 22, 23, 24, 25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home and maintenance and managements practices enabled service users to live in a comfortable environment that promotes independence. Observations during the inspection visit identified some environmental hazards, which have since been remedied. The general environment with the exception of the kitchen was clean and hygienic. Odour control throughout the home was excellent. EVIDENCE: The location of the home was suitable for the service users for whom the home was intended. The premises had been extended and carefully restored over the years, tastefully combining modern facilities with the original Edwardian architectural features of the building. This had created an elegant, comfortable nursing home environment, which was overall nicely decorated and furnished and well maintained. The extensive, mature landscaped gardens afforded an attractive outlook from many of the rooms. The south facing, relatively new Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 23 garden room, which was air-conditioned, afforded direct access to a large furnished patio area and to the garden. The inspector sampled bedrooms therefore not all were viewed on this occasion. The bedrooms seen were personalised, decorated to a good standard, clean and comfortably furnished with good quality furniture. There were photographs of family members and other personal items in bedrooms. Service users demonstrated ownership of their private space. All service users consulted stated they were happy with their bedrooms. All but two had en suite facilities. Beds were a combination of heights and some owned by service users. The manager stated that moving and handling risk assessments took account of the need for adjustable height beds to ensure safe practice at all times. Four assisted bathrooms with suitable baths and shower facilities were available throughout the home. The nurse call system was installed in all areas of the home. It was recommended that a permanently fixed call bell be positioned beside a toilet in a ground floor bathroom. This was currently located at the other side of the room and relied on staff’s memory to detach this and give it to service users using the toilet. All bathrooms and toilets were clean and hygienic and odour free. Communal lounges were comfortable, adequately ventilated and uncluttered. The standard of decoration in most corridors and communal rooms was good. The appearance of the corridor near the kitchen and in the kitchen area used for washing dishes and making hot drinks would be enhanced by redecoration. A small number of carpets in the home were noted to be shabby in appearance. The storage of wheelchairs was being constantly monitored by management to ensure fire exits kept clear and the environment maintained free of hazards. Storage in general was at a premium particularly food storage facilities. Staff did not have a staff room and were noted to use the second dining room for coffee and meal breaks. A staff notice board was located in the corridor outside the kitchen. A number of safety hazards in the environment were identified during the inspection visit. Specifically unrestricted access to a steep flight of stairs leading to the basement laundry, which were a potential risk to vulnerable service users. At the time of this inspection the regional manager agreed that a digi-pad type of lock would be fitted to this door immediately. Subsequent feedback from the manager confirmed that a lock had since been fitted to the cellar door restricting access to staff. External fire doors were not alarmed at the time of the inspection visit posing a risk to at least one service user accommodated, and potentially to others. A recent incident in which this individual had left the home unobserved had not been managed appropriately by the nurse in charge. The home’s missing persons procedure had not been appropriately implemented on that occasion. The manager reported having obtained estimates for fitting alarms to these Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 24 doors during the inspection visit and has subsequently confirmed the doors are alarmed. It was noted that a digi-pad lock had been recently fitted to the front door. Other potential hazards to service users were the provision of a first floor flat roof terrace used in the summer by service users and staff. This was noted to have ramped access and safety railings. The manager emphasised that service users were supervised at all times in the use of this terrace to ensure their safety. Some radiators in bathrooms and in corridors had not been fitted with radiator covers in compliance with the national minimum standards. The manager stated that the Health and Safety Executive Department had carried out risk assessments of the same and determined risk to service users was low. Hot water temperatures were safe and regularly monitored and windows fitted with restrictors, which were regularly inspected by the maintenance person. Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 25 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 using available evidence including a visit to this service. Recruitment practices protect service users. Staffing numbers and the skill mix of staff are appropriate for the assessed needs of service users, taking account of the size, layout and purpose of the home. All staff received induction training and a rolling programme of staff training was ongoing. Some shortfalls in statutory training were identified however. EVIDENCE: A recorded staff rota was in place and inspected. This accurately depicted the numbers and skill mix of staff on duty. Observations indicated that the ratio of staff to service users was adequate to meet the needs of service users. Staffing levels fluctuated, adjustments made in response to planned activities of the home; also to ensure adequate supervision and mentoring of student and adaptation nurses. Nurses, care staff and student nurses were professional in their conduct and appearance. They were courteous and respectful towards service users and each other during the inspection visit. Employment practices were underpinned by equal opportunities principles. The team was multicultural in composition and staff employed whose first language was not English confirmed they attended language classes at college if needed. Staff on duty on the day of the inspection visit mostly had satisfactory command and comprehension of the Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 26 English language to enable them to communicate with service users and fulfil their role. Though no adverse comments relating to communication were received at the time of the inspection, two service users have since commented that they sometimes do experience problems with language barriers. They stated this sometimes had the outcome of staff not understanding them and acting on what they said. The home’s recruitment and vetting procedures ensured statutory requirements were fully met. It was noted that an agency used to supply catering relief staff was established to not routinely carry out CRB Disclosures for workers. A risk assessment was carried out at the time of the inspection visit for an agency cook booked for the weekend. Arrangements were put in place for this worker to be directly supervised when in the proximity of service users. The regional manager was noted to advise the manager of the details of an agency supplying catering staff whose vetting procedures included obtaining CRB Disclosures for future reference. Other areas of discussion with the home manager included the need to compile a central CRB record for the team, containing information in accordance with CRB guidance. Also for a change to the storage of CRB Disclosures and to ensure compliance with timescales for their disposal. The manager demonstrated commitment to the training and development programme for the staff team. She is a qualified nurse with higher education diplomas and is a qualified nurse assessor. Provision is made at the home of placements for student nurses from Surrey University. Adaptation training is also arranged for nurses who qualified overseas. The home had achieved the Investors in People Award and had a programme of induction and foundation training for the team. Qualified nurses were supported in updating their clinical skills and knowledge through in-house and external training courses. Observation of the staff - training matrix identified gaps in statutory staff training for the team in first aid, food hygiene and infection control. A number of staff employed as care staff were noted to be qualified nurses in their country of origin. Their qualifications were considered by the Home Office to be equivalent to NVQ Level 3. The home was compliant with the national minimum standard for employment of at least 50 of care staff qualified to NVQ Level 2 or equivalent. The manager stated that NVQ training was available for care staff. Domestic staff, the laundry assistant and kitchen assistants on duty at the time of the inspection were hard working. They had all received induction training. A programme of statutory training was ongoing for ancillary staff. Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 27 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, 34, 37, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The manager is appropriately qualified and experienced to competently manage the home and ensure effective leadership to the team. The overall judgement for this outcome area was effected by the potential risks to service users in the environment during the inspection visit albeit they have since been responded to by management. Also by the recent shortfall in management competency of a nurse left in charge of the home at the time of a recent missing persons incident. It was evident that arrangements at that time did not adequately safeguarded service users. Information available also indicates the need to review and monitor some aspects of moving and handling practice. Quality assurance systems are in existence and are gradually being replaced by corporate systems. Record keeping practices overall were of a good standard though some care plans and risk assessments required review and developing. Accounting and financial systems were subject to regular audits. EVIDENCE: Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 28 The home manager is a qualified nurse who has extensive relevant experience in public and private health care sectors and in departments of nurse education and higher education. The manager has attained diplomas in education and higher education and the registered managers award qualification and is a student nurse assessor. The manager was overall responsible for the day to day management of the home, budgeting, marketing, training, recruitment, adaptation training for overseas nurses, mentoring student nurses and maintenance of the staff rota. She line managed all senior nursing staff and a proportion of senior care assistants. Additionally the senior housekeeper, administrator and maintenance manager. The home’s management structure did not include a deputy post. A senior qualified nursing sister deputised for the manager in her absence and had specific delegated management responsibilities. At the time of this inspection visit both the home manager and senior sister were on duty. The regional manager was also present for part of the inspection including the feedback session. Registration categories were discussed with the home manager. It was suggested that management might wish to review and reduce the numbers within some categories of registration to a more realistic level. Observations concluded that Garth House was competently managed and administered to meet the home’s stated purpose. This ensured the safety of service users when the manager and senior sister were on duty. The majority of relatives/visitors responding in comment cards expressed satisfaction with the conduct of the home and quality of care and services. Feedback did however also identify the need for the care planning and review process to be more inclusive of service users and as appropriate their representatives. The manager and senior sister were aware of weaknesses in current care plans and risk assessments and were addressing the same. Comments from relatives/service users representatives confirmed most though not all were satisfied with arrangements for communication with them. The need for individual wishes of service users and relatives/representatives should be again reviewed and systems in place to ensure staff in charge of the home act on this information. Feedback from service users consulted during the inspection visit confirmed the home met their expectations and they considered their care to be good. Service users responding after the inspection in comment cards were mostly satisfied though some highlighted the need for improvement in catering, communication and staff availability. Individuals’ also expressed dissatisfaction with the medical support received however they were non-specific to enable these concerns to be pursued. The home’s general practitioner (GP) routinely Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 29 visited the home on a weekly basis and by request in between visits. He commented in positive terms about communication and partnership arrangements between the home and the medical practice. Comments from a health and social care practitioner identified one area of moving and handling practice to require monitoring. This feedback was in the context of direct observation of practice confined to a few service users in one area of the home once a week. At the time of the inspection visit staff were familiarising themselves with new corporate policies, procedures, risk assessments and care planning formats. The organisation had effective quality audit, quality control and quality assurance systems that were being gradually implemented. The administrator confirmed a regional administrator had conducted a recent quality audit. An audit of care planning/clinical practice had also been undertaken and an action plan was in place for improvement. The regional manager who was also the responsible individual on behalf of the company, carried out monthly visits in accordance with statutory requirements. Reports of these visits were available in the home and copied to the CSCI. The organisation’s quality systems were operating concurrently with quality systems in place prior to the home being sold. The manager stated monthly audits were carried out against the national minimum standards for older people across all departments. She advised that she prepared quarterly summaries of audit outcomes. The inspector examined returned questionnaires sent out by the home in April 2006 to a random sample of service users and their representatives. These were designed to canvas views about the home’s conduct. All expressed positive feedback on the home’s pre-admission and admission procedures. Most were satisfied in general with standards of care and the home’s operation. Discussed was the need to generate an action plan to demonstrate follow up action in response to any adverse comments arising from this process. Efficient record keeping systems and auditing arrangements were in place to ensure effective business management practices. Employers and public liability insurance was in place and the certificate for this displayed in a public area. The registration certificate was also displayed. An extensive range of health and safety policies and procedures and systems were in place. These were underpinned by various risk assessments in support of safe working practices. The inspector suggested that a moving and handling risk assessment be carried out specific to staff transporting laundry bags up and down stairs in use of the basement laundry. Hazards in the environment at the time of the inspection visit have since been reported by management to have been addressed. Details of these are recorded in the report in the section entitled Environment (Standards 19 – 26). The need for to review of accident record keeping practices was discussed with the home manager to ensure compliance with data protection legislation. Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 30 Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 31 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 3 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 3 3 x 2 1 Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 32 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 14(2), 15(2) Requirement For the registered person to ensure that all care plans are based on comprehensive needs assessments to ensure all needs and risks are addressed. For the registered person to ensure secure storage of all medication. Specifically nurses must not leave medication on top of the medication trolley in corridors or the unlocked clinical room. For the registered person to ensure that the food mixer is repaired or replaced. For the registered person to ensure that menus offer adequate choice of meals to service users. For the registered person to provide for staff (i) facilities for the purpose of changing and (ii) storage facilities. For the registered person to ensure staff receive all statutory training and training updates, specifically in infection control, first aid and basic food hygiene. For the registered person to DS0000013322.V292893.R01.S.doc Timescale for action 01/08/06 2. OP9 13(2) 02/06/06 3. 4. OP15 OP15 16(2)(g) 23(2)(c) 4(1)(b) 16(2)(g) 23(3)(a) 01/08/06 01/08/06 5. OP20 01/09/06 6. OP30 18(1)(a) 18(c)(i) (ii) 19 01/09/06 7. OP37 01/08/06 Page 33 Garth House Version 5.1 8. 9. OP37 OP38 17(1)(a) 16(2)(j) ensure the storage and disposal of staff’s CRB Disclosures in accordance with CRB policy. Also for a central CRB Disclosure record to be maintained for the team. For the confidential storage of accident records in accordance with Data Protection legislation. For the registered person to ensure that the kitchen and all kitchen appliances are deep cleaned and cleaning schedules and kitchen staffing resources and routines ensure satisfactory standards of kitchen hygiene. 01/07/06 14/06/06 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 5 6 7 Refer to Standard OP9 OP18 OP19 OP19 OP24 OP38 OP38 Good Practice Recommendations For the home to have a larger medication trolley. For contact telephone numbers to be displayed for staff use in connection with whistle blowing procedures for other relevant agencies. For a programme of replacement of carpets to be instituted. For the corridor outside the kitchen and the kitchen area used for making drinks and for washing up to be redecorated. For a programme to be instituted for replacing star locks on bedroom doors with a type more suitable to the needs and capacities of service users for their privacy. For an aid-memoir to be produced in support of the home’s missing persons procedure providing prompts for carrying out a search of the premises and grounds. For the registered person to consider fitting a fixed call bell is fitted beside the WC in the ground floor bathroom. Garth House DS0000013322.V292893.R01.S.doc Version 5.1 Page 34 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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. 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