Inspection on 07/09/06 for Georgian House Nursing Home

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 Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Georgian House Nursing Home 02/11/05

Georgian House Nursing Home 19/07/05

Georgian House Nursing Home 20/01/05

Georgian House Nursing Home 19/07/04

Georgian House Nursing Home 23/12/03

Georgian House Nursing Home 03/06/03

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

CARE HOMES FOR OLDER PEOPLE Georgian House Nursing Home 20 Lyncroft Gardens Ealing London W13 9PU Lead Inspector Ms Susan Woolnough-Singh Key Unannounced Inspection 11.15 7 September 2006 th 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 Georgian House Nursing Home DS0000010947.V294259.R02.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. Georgian House Nursing Home DS0000010947.V294259.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Georgian House Nursing Home Address 20 Lyncroft Gardens Ealing London W13 9PU 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) 020 8567 6232 020 8567 1955 Mr and Mrs Hopley Mrs Margaret Hopley Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability over 65 years of age (0), of places Terminally ill (0) Georgian House Nursing Home DS0000010947.V294259.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 28 medical beds for the elderly of which 4 patients may be received for palliative care. One named service user age 63 years old can be accommodated, as agreed by the Commission for Social Care Inspection, on 8th November 2005, whilst the home meets the needs of all service users. The home must advise CSCI when the service user no longer resides at the home. 2nd November 2005 Date of last inspection Brief Description of the Service: Georgian House Nursing home is registered with the CSCI as a care home with nursing for 28 older people, four of whom may receive palliative care. The building comprises two semi-detached houses combined into one detached property, with parking at the front and a large landscaped garden and patio to the rear. There are twelve single and eight double bedrooms. Communal facilities include a large lounge and a separate dining room. The property is on a quiet residential street, not very far from central Ealing. Georgian House Nursing Home DS0000010947.V294259.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out between 11.15 am and 7.55 pm on 7th September 2006. The Inspector was advised that the Registered Manager was not expected at the home that day. The Sister in Charge was co-operative and provided appropriate assistance throughout the inspection. At the time of the inspection the home had five service user vacancies. All of the Key National Minimum Standards for Older People were assessed during this Inspection. The Inspector spoke with six service users and two relatives. A discussion was held with the staff group at the end of their shift. At the last unannounced Inspection on 2nd November 2005, three requirements were made. Two had been met and one was outstanding. The outstanding requirement relates to risk assessments of the property. What the service does well: The home has maintained a qualified and experienced staff group; this has benefited service users by providing continuity of good working relationships. Service users appeared well cared for and comfortable in their environment. They reported being happy with the standard of care provided at the home. The home was found to be clean, hygienic and well maintained throughout. The environment was safe, calm and homely. Georgian House Nursing Home DS0000010947.V294259.R02.S.doc Version 5.1 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. Georgian House Nursing Home DS0000010947.V294259.R02.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Georgian House Nursing Home DS0000010947.V294259.R02.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4, and 6 The 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 relatives are able to view the home prior to admission; confirmation in writing is now given that assessed needs can be met. EVIDENCE: Service users and their relatives are able to visit the home prior to admission to participate in assessing the homes capacity to meet their needs. The home now sends out a letter to service users and their families confirming that assessed needs can be met; this was a requirement of the previous inspection. The inspector examined four service users files and care plans. There was evidence that an assessment had been made of the prospective service users care needs prior to admission. The home does not provide intermediate care. Georgian House Nursing Home DS0000010947.V294259.R02.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Records seen indicate that service users daily health and personnel care needs are met; service users also confirmed this, as did relatives spoken with. There are policies and procedures in place for the safe administration of medication. EVIDENCE: A care plan is available for each service user four of these were examined. Care plans contained information on how the daily health and social care needs of service users would be met. The care plans contained information on personal care, mobility and social and spiritual needs. There was sufficient detail to inform carers of the action to take in respect of care tasks. Care plans also include a risk assessment in the following areas: Georgian House Nursing Home DS0000010947.V294259.R02.S.doc Version 5.1 Page 10 Bed Cot Sides Nutrition screening Falls and moving and handling, Continence and elimination Sleeping patterns. Care Plans are hand written. It is to be recommended that these are typed and printed. They will be easier to read and more accessible to both service users and staff. A record is available for individual service users on visits received by Health Care professions this was examined. This record contained information on when service users had seen the Doctor, Community Psychiatric Nurse, and Chiropodist etc. The action that had been taken was recorded. Information on service users care plans indicated that their individual health needs were being monitored; such as one service user had been referred to a dietician and one service user had been referred and then discharged by the Tissue Viability Nurse. Where service users share a room screening is provided. Service users when asked about staff attitude and the care they receive spoke positively. Personal care tasks are undertaken within service users bedroom and bathrooms. Staff were seen to knock on service users bedroom doors. The home has satisfactory policies and procedures on the storage and administration of medication. A regular audit of storage and administration systems takes place by the Pharmacist who supplies service users medication. The last audit had taken place in March 2006. There were no pending medication issues reported by the Pharmacist. An appointed company collects and disposes of unused medication. The Nurse in Charge when asked said there was a strict policy on covert medication. If service users are unable to swallow properly, the General Practitioner prescribes liquid medication. The home does not have a Monitored Dosage System, this is being considered. At the present time medication is administered from individual bottles. Georgian House Nursing Home DS0000010947.V294259.R02.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users appeared to be satisfied with the care offered in the home. Activities are arranged for service users; participation could be improved. Service users are encouraged to exercise some choice over their daily routines. Service users are offered a satisfactory menu and a choice of main meals. EVIDENCE: The Inspector spoke with service users and staff about life in the home. On the whole service users spoke positively about the staff and their life in the home. A weekly activity sheet is available. Weekly music sessions takes place, other activities are board games and activity books. A Hairdresser and Reflexologist visit the home weekly; Ealing Library supplies books to the home. When spoken with some of the service users mentioned these activities. Watching television and reading was the most popular activity recorded in the activity record. When spoken with staff said that it was hard to motivate service users Georgian House Nursing Home DS0000010947.V294259.R02.S.doc Version 5.1 Page 12 to take up more activities. It is to be recommended that the staff team look at ways to encourage service users to participate more in activities. On the day of the inspection service users were doing colouring and word search in the afternoon. In the evening service users and some visitors were in the main lounge. Service users and staff were talking the atmosphere appeared relaxed. Service users tend to watch television in their bedrooms. Service users maintain contact with their families. One service user had gone out to lunch with his/her family on the day of the inspection. The Inspector spoke to the staff group about choices that service users could make in their daily lives. Service users are able to choose their clothes and how they spend their day in the home. A choice is made at meal times. Staff said that service users do not usually like to deviate from their routines. A cook is employed for the preparation of meals. He cooks the main meal of the day and makes some preparation for tea in the evening. Two service users when asked said they liked the food and there was a choice. The Menu was seen this was varied and looked well balanced. The Inspector sampled the meals during the inspection; the food was judged to be satisfactory. Georgian House Nursing Home DS0000010947.V294259.R02.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are aware that they can make a complaint and to whom but are not familiar with the official complaints procedure. There are policies and procedures and staff training in place to protect the welfare of service users. EVIDENCE: A Complaints Procedure is available this is contained in the Service Users Guide and the Residents Handbook. The Complaints record book was examined as part of the inspection. The last entry was dated 2003. No complaints had been made to Commission for Social Care Inspection with regard to the home. The Inspector spoke with service users about the complaints procedure. One service user knew of the complaints procedure and relatives spoken with mentioned that an external organisation could be contacted. Other service users where able to name whom they would talk to but did not recall the procedure. The Nurse in Charge confirmed that the London Borough of Ealing Protection of Vulnerable Adults policy is available in the home. It was also confirmed that Georgian House Nursing Home DS0000010947.V294259.R02.S.doc Version 5.1 Page 14 staff have received training in the Protection of Vulnerable Adults. The Inspector saw the Whistle Blowing policy and that staff had signed when they had read this. The Nurse in Charge also confirmed that the home does not manage service users finances. Service users families will bring in requisites or these are purchased and relatives are given an invoice. Georgian House Nursing Home DS0000010947.V294259.R02.S.doc Version 5.1 Page 15 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 and 26 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A well-maintained, comfortable and homey environment is offered to service users. . EVIDENCE: The Inspector had a tour of the communal parts of the home. The home is well maintained, clean and the décor is of a satisfactory standard. A large lounge, and small lounge with a television are on the ground floor. The space in the lounge allows for informal seating arrangements, which add to the homely atmosphere. The seating is not arranged around the television. The lounge looks out on to a well-tended and mature garden, with seating on a small patio area. The home was judged to be very clean and tidy on the day of the Inspection. Georgian House Nursing Home DS0000010947.V294259.R02.S.doc Version 5.1 Page 16 There are shortfalls with regard to health and safety risk assessments. These are covered under Standard 38 (safe working practices) Georgian House Nursing Home DS0000010947.V294259.R02.S.doc Version 5.1 Page 17 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 and 30 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An appropriate number of experienced staff are on duty to meet the needs of the service users. Care Staff are offered the opportunity to undertake NVQ training in care to further their competence and understanding in this field. A range of training is available for the development of staff. The home needs to ensure that all staff has received the relevant training in health and safety. Satisfactory recruitment practices are in place. This practice will be improved with the evidence of interview notes for prospective staff. EVIDENCE: Service users and relatives were asked for their opinion on staffing levels. On the whole it was felt that there were enough staff on duty although there appeared to be less at weekends. A comment was made that sometimes care staff doubled up as domestic workers. The Registered Manager informed the Inspector after the inspection fieldwork that a care assistant only works as a care assistant when employed to do so and this may be to cover sick leave. Georgian House Nursing Home DS0000010947.V294259.R02.S.doc Version 5.1 Page 18 The staff group when met by the Inspector said that they really enjoyed working in the home and with each other. They said they were interested in the service users and were glad that the home did not employ agency staff; they felt that this was a positive point. The staffing establishment consists of nine registered nurses one of whom is the Registered Manager, and thirteen care staff. During waking hours seven staff are on duty on the morning shift, this includes two Registered Nurses. Six staff one of which is a registered Nurse covers the afternoon evening shift. One Registered Nurse and two carers cover the night shift. A domestic works on the morning and the afternoon shift and a cook works in the morning. The Nurse in Charge confirmed that four care staff had completed an NVQ Level 2, two staff are currently studying for the NVQ and two are due to commence with this. The Inspector received a training Matrix from the home. A range of training is offered to staff in the care and conditions of older people. It was noted that some of the training in relation to health and safety had not been received by all of the staff, namely Manual Handling, Infection Control and Food Hygiene. Not all staff had received Protection of Vulnerable Adults training. The Registered Manager forwarded information to the Inspector stating that further health and safety training will take place in January 2006. When examined staff files evidence was seen of three completed staff induction courses; one had been completed but the paperwork was not on file. The Nurse in Charge said she would try to locate this. The Inspector examined the personnel files of four staff to check that Schedule Documents (employment checks) were in place. This was the case. The Inspector was informed that the Registered Manager and a Registered Nurse interview candidates. The Inspector recommended that interview notes be made. This is good practice and the home will be able to demonstrate that the experience and attitude of prospective staff has been explored. Georgian House Nursing Home DS0000010947.V294259.R02.S.doc Version 5.1 Page 19 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, 36 and 38. The Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered Manager has the experience and qualifications to manage the home in a competent manner. An annual quality assurance is not in place to measure the homes success in meeting its aims and objectives. Health and safety systems were in place. A comprehensive fire risk assessment for the home is required. EVIDENCE: Observations made by the Inspector throughout the inspection process indicated that the ethos of providing a warm, caring and homely environment for service users was being met. Georgian House Nursing Home DS0000010947.V294259.R02.S.doc Version 5.1 Page 20 Service users or their next of kin are given the opportunity to complete questionnaires on the quality of care at Georgian House. The questionnaire results are then analysed on an annual basis. However, at the time of the inspection the Inspector was not aware of a Quality Assurance system incorporating an annual audit and development plan. Health and Safety training is in place for staff, guidelines for this were seen. Fire records were seen. Weekly testing of fire alarm points takes place; these were recorded in the diary. Documents were forwarded to the Inspector to confirm that fire drills take place on a quarterly basis. The fire alarm system had been serviced in February and September 2006 and extinguishers in April 2006. The passenger lift was serviced on the day of the inspection. The Inspector was advised that the home does not manage service users finances; relatives, who are invoiced for any money spent on service users behalf, usually do this. Staff supervision takes place, supervision notes comprise of a checklist record. The Registered Manager forwarded a number of documents to the Inspect as confirmation of Health and Safety risk assessments. These included a fire risk assessment for the premises, which was last reviewed on 1st January 2006. The document states areas of good practice in regard to fire safety. A document demonstrating that all areas of fire safety have been risk assessed is required for this purpose. COSHH, medication and kitchen health and safety assessments were also forwarded. Georgian House Nursing Home DS0000010947.V294259.R02.S.doc Version 5.1 Page 21 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 3 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 X X X X X X 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 2 X 3 X X 2 Georgian House Nursing Home DS0000010947.V294259.R02.S.doc Version 5.1 Page 22 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 OP30 Regulation 18 (1) (a) 12 (1) (a) 24 13 (4) (a) Requirement A Plan stating how identified shortfalls in health and safety training will be addressed must be forwarded to the Inspector. The Registered Person must introduce an annual audit and development plan. The premises must be risk assessed for fire safety. Timescale for action 01/12/06 2. 3. OP33 OP38 01/04/07 01/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP16 OP7 OP12 OP29 Good Practice Recommendations Service users should be reminded where they will be able to locate the Complaints Procedure. Care Plans should be typed to make them clearer to read. The service users group should be consulted on activities for the home. A record of recruitment interviews should be made. Georgian House Nursing Home DS0000010947.V294259.R02.S.doc Version 5.1 Page 23 Commission for Social Care Inspection West London Area Office 58 Uxbridge Road Ealing London W5 2ST 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 Georgian House Nursing Home DS0000010947.V294259.R02.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!