Inspection on 11/08/05 for Gerald House

This inspection was carried out on 11th August 2005.

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

Gerald House 18/06/07

Gerald House 12/06/06

Gerald House 12/01/06

Gerald House 10/03/05

Gerald House 21/06/04

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

CARE HOMES FOR OLDER PEOPLE Gerald House 4 Gerald Road Oxton, Birkenhead Wirral CH43 2JX Lead Inspector Les Hill Unannounced 11 August 2005, 9:00am th 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 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. Gerald House F52 F02 S18888 Gerald House V243313 110805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Gerald House Address 4 Gerald Road Oxton Birkenhead Wirral CH43 2JX 0151 652 1606 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr George Alan Shone Mrs Kamini Shone CRH Care Home 18 Category(ies) of (OP) Old age registration, with number of places Gerald House F52 F02 S18888 Gerald House V243313 110805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: One Named Adult with Learning Disabilities under 65 years of age in an overall total of 18 Two Named Adults under 65 years of age in an overall total of 18 Date of last inspection 10th March 2005 Brief Description of the Service: Gerald House is a detached property situated in Oxton, near Birkenhead, Wirral. The home is registered to provide personal care to 18 older people, though variations to the registered status of the home have been agreed to enable three residents below the age of 65 years to be accommodated at Gerald House. Accommodation is provided on two floors. Downstairs there are lounge and dining rooms and some bedrooms. Most of the homes bedrooms are situated on the first floor that is accessible by stairs or passenger lift. Outside there are car parking spaces to the front and a reasonably sized, enclosed garden to the rear. Gerald House is located in a residential area but some local shops are within walking distance and bus routes to Birkenhead pass close to the home. Gerald House F52 F02 S18888 Gerald House V243313 110805 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection of Gerald House took place on Thursday 11th August 2005 over a period of three hours. It involved the examination of some records, a tour of the building and discussions with seven of the residents. The inspection was part of the Commission’s requirement to visit and report on each registered care home on two occasions each year. What the service does well: What has improved since the last inspection? Some improvements have been made to the assessment documentation used at the home. Improvements have also been made to the care planning arrangements. Gerald House F52 F02 S18888 Gerald House V243313 110805 stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Gerald House F52 F02 S18888 Gerald House V243313 110805 stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Gerald House F52 F02 S18888 Gerald House V243313 110805 stage 4.doc Version 1.40 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 standard(s) 1, 2, 3, 4, 5 and 6. Assessments have been updated but need to be undertaken consistently and improved to ensure all areas of need are included. EVIDENCE: The home’s statement of purpose and service user guide were examined at the CSCI inspection on 10th March 2005 and were found to meet the requirements identified in National Minimum Standards. Records of resident’s financial affairs are kept separate to the care records in the home. Each of the resident’s funded by the local authority has a contract in place that includes the responsibilities of the placement agency, the care provider and the resident. The home has its own contract/terms and conditions of residency that is provided to any resident who is self-funding, although the same document was found on some of the funded residents files. Examination of two residents care files showed that the home undertakes a pre-admission assessment and that the information informs the care planning and risk assessment processes. The documents used had been updated since Gerald House F52 F02 S18888 Gerald House V243313 110805 stage 4.doc Version 1.40 Page 9 the previous CSCI inspection to include relevant information about a prospective resident’s mental health status. Whilst the documents are improving there is still a need to ensure a consistent approach to the assessment process and ensure that all needs are identified. The present owners have supported residents in Gerald House for approximately 16 years and have experience of running two other homes. Residents who spoke with the inspector were complimentary about the services and the support they received. Some had lived in other homes and had transferred to Gerald House where they said they were very happy. Prospective residents and their families are encouraged to visit the home and to spend some time there before making a commitment to stay. Gerald House is not contracted to provide intermediate care. Gerald House F52 F02 S18888 Gerald House V243313 110805 stage 4.doc Version 1.40 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 standard(s) 7, 8, 9 and 10. Some work had been undertaken to develop the quality of care planning and this needs to be consolidated and improved. The health care needs of residents are identified and appropriate support is provided. Residents are treated with dignity and their right to privacy is respected. EVIDENCE: Examination of two residents files confirmed that care plans are in place and are being reviewed on a monthly basis. The care plans are kept in a folder that is accessible to all staff and are used to assist them in working with individual residents. The inspector discussed the development of the plans with the home’s manager and agreed that although progress had been made there was still the opportunity for further improvement. Resident’s health needs are recorded and access to health care professional is sought when necessary. The home has links with three GP surgeries and has good support from district nurses when they are required. Residents also have visits from the optician and from the dentist. The continence adviser will carry out assessments when requested to do so, but the process can take seven or eight weeks during which time the home is required to fund the costs of any equipment needed. Gerald House F52 F02 S18888 Gerald House V243313 110805 stage 4.doc Version 1.40 Page 11 The manager has recently changed the arrangements for pharmacy support to the home. Medicines are provided in “blister packs”. A check of the arrangements for administering medicines in the home was carried out and found to be satisfactory. All prescriptions are ordered and checked by the home before being dispensed by the pharmacist. The home’s manager was advised to enlist the assistance of the pharmacist when medicines are changed and the change is not reflected in new prescriptions. The homes policies and procedures expect that residents will be treated with dignity and respect. During a tour of the building the homeowner knocked on each bedroom door and waited for a reply before entering. Residents told the inspector that staff were very kind and always treated them with respect. Residents can entertain their family and any other visitors, including GP’s in the privacy of their own room. Gerald House F52 F02 S18888 Gerald House V243313 110805 stage 4.doc Version 1.40 Page 12 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 standard(s) 12, 13, 14 and 15. Residents were helped to exercise choice over their lives. EVIDENCE: Staff at the home provide a range of activities that residents can choose to join in. Some of the residents are able to go out from the home alone, others are taken out in small groups either for a walk or in the manager’s car. One of the residents excused herself from discussion with the inspector as she heard an activity that she particularly enjoyed was beginning and she wished to join in. Activities provided include, music and TV, exercise groups, Bingo, videos and films, quizzes, reminiscence card games and individual one-to-one activity. The manager had a large selection of wools and was hoping she could persuade some of the residents to take up knitting. Some of the residents told the inspector they were happy with their own company and did not always wish to join in activities. Visitors to the home are welcomed at any time. The local priest attends to share communion with those residents who wish to maintain their romancatholic faith. The home will support residents of other religious denominations to maintain attendance at church or to contact the appropriate clergy. Gerald House F52 F02 S18888 Gerald House V243313 110805 stage 4.doc Version 1.40 Page 13 Residents told the inspector that they are able to make choices about their everyday lives. They can choose when to get up and when to go to bed. They can choose to stay in their own rooms or spend time in the communal lounges. One resident had chosen to spend time alone, in the dining room. Another resident told the inspector that she was free to go out into the community whenever she wished. A four-week menu was in place and resident’s had a choice of food at each mealtime. The menu had been created around the likes and dislikes of residents and was reviewed with them, from time to time. Residents spoke positively about the quality of food provided in the home. Gerald House F52 F02 S18888 Gerald House V243313 110805 stage 4.doc Version 1.40 Page 14 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 standard(s) 16, 17 and 18. Residents are protected from abuse. EVIDENCE: The home has a complaints procedure in place that is known to residents in the home. Some residents told the inspector they would feel able to complain if things were not right. No complaints have been made to the home or to CSCI since the inspection in March 2005. All of the residents are included on the Electoral Register and have the opportunity to vote in national and local elections. The home has various policies and procedures in place to protect residents from abuse, including Wirral Borough Council’s procedures for dealing with adult protection matters. The procedures are accessible to staff. Staff have been provided with training on the subject of adult protection through NVQ courses. Gerald House F52 F02 S18888 Gerald House V243313 110805 stage 4.doc Version 1.40 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 standard(s) 19, 20, 21, 22, 23, 24, 25 and 26. Residents live in a safe and well-maintained environment. EVIDENCE: Gerald house is situated in a residential area of Oxton Wirral. It is conveniently located for local shops and bus routes to Birkenhead. The home is well decorated and furnished in domestic style and it is clear that on-going maintenance is given appropriate priority. Lighting throughout the home is domestic in character. Contract gardeners maintain the grounds. The home’s laundry is situated in a shed in the back garden area. The CSCI inspection in March 2005 identified that bleach was being stored openly in the shed. The home’s manager had undertaken a risk assessment of the bleach but it is still recommended that it be locked in a cupboard to ensure complete safety. Gerald House F52 F02 S18888 Gerald House V243313 110805 stage 4.doc Version 1.40 Page 16 Lounge areas are bright and comfortably furnished. The homes separate dining room has domestic style furniture and tables were laid with cloths and individual place settings. Bedrooms were light and decorated to a good standard. The rooms had been personalised by residents with items of furniture, pictures and ornaments brought in from their own home. Many of the bedrooms have been provided with an en-suite WC and wash hand-basin. However there are sufficient WC’s around the home to meet the needs of all residents. The home has three bathrooms two of which have adapted bathing facilities. The third bathroom is fitted with a shower. Aids and other equipment to assist residents with a disability are provided around the home. Ramped access is provided at the front door. A passenger lift, and staff call systems are installed. The CSCI inspection report of March 2005 recommended that upstairs windows are fitted with restrictors to prevent them opening too far. The matter was not checked on this inspection and so the recommendation is repeated. If the restrictors have been fitted the recommendation will be removed at the next inspection. Hot water delivered to resident’s bathrooms and showers is thermostatically controlled. Hot water delivered to wash hand-basins in resident’s bedrooms is not controlled. A notice identifies that the water may be hot. The homeowner told the inspector that all of the residents are able to manage the temperature of hot water in their bedrooms but if the staff had concerns about any resident then a risk assessment would be undertaken and appropriate action would follow. On the day of this inspection the home was clean and tidy and there were no offensive odours present anywhere in the home. Gerald House F52 F02 S18888 Gerald House V243313 110805 stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 29. Staffing levels are appropriate for the current group of residents. The home’s recruitment and selection procedures should be tightened to ensure they comply with safe standards. EVIDENCE: Rotas confirm that from Monday to Friday the home is staffed (during the daytime hours) by the manager and two carers. At all other times there are two care staff on duty. At night there is one wakeful carer and one member of staff sleeping in. Separate cooking and domestic are also employed. The home does not employ anyone below the age of 18 years and does not use agency staff. Eight of the home’s twelve care staff have an NVQ at level 2 or above and two other staff are in the process of working for the award. 75 of the staff have the award and therefore the home has exceeded the standard of 50 set down by CSCI. Three staff files were examined during the inspection. All had an application form and two references. However, one member of staff had been employed using a CRB check that was 12 months old. The arrangements for CRB and POVA checks were discussed and it was explained that a new CRB/POVA clearance must be obtained for each employment. Where a prospective employee has a recent CRB check they can be started before the new CRB check is received providing that the home has received POVA clearance. Gerald House F52 F02 S18888 Gerald House V243313 110805 stage 4.doc Version 1.40 Page 18 Additionally only one of the files contained a photocopy of a picture driving licence and a copy of a utility bill to confirm the person’s identity. The homeowner must ensure that all documents identified in Schedule 4 of the National Minimum Standards are kept in the home. The home takes advantage of free training in food hygiene, moving and handling, fire awareness and first aid and has ensured all staff are trained in the management of medicines. Copies of certificates gained are kept on the staff files. The inspector will confirm any other training that is provided at the next announced inspection. Gerald House F52 F02 S18888 Gerald House V243313 110805 stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, and 38. The home is run in the best interests of residents. EVIDENCE: The home’s joint owner/manager has successfully completed an NVQ level 4 in management. She is also an NVQ assessor. The manager works in the home and is directly involved in providing personal care alongside the care staff. She organises activities and is accessible at all times to residents, their visitors and staff. Observations during the inspection confirmed that the home is run in the best interests of residents and there is an open and inclusive atmosphere that permits discussion and the resolution of minor conflicts. As recorded earlier in this report, residents were complementary about the home, the staff and particularly the management and felt able to raise any concerns. Gerald House F52 F02 S18888 Gerald House V243313 110805 stage 4.doc Version 1.40 Page 20 The owner/manager had distributed questionnaires to residents requesting their opinions about the care provided at Gerald House. They had received a good response with mostly positive feedback. Where they had received a negative comment they had sought to address the matter through discussion and minor changes to the routines in the home. The owner/manager promotes a safe environment for residents and staff. This is achieved through regular checks on equipment, risk assessments and staff training in moving and handling etc. The fire alarms are being tested weekly and the emergency lighting is tested monthly. Six monthly fire drills are held in the home. The homeowner told the inspector that staff not on duty are trained in fire awareness by himself or his wife. Records identifying the dates on which staff are trained should be kept in the home. Gerald House F52 F02 S18888 Gerald House V243313 110805 stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 x x x x 3 Gerald House F52 F02 S18888 Gerald House V243313 110805 stage 4.doc Version 1.40 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement The home must ensure that preadmission assessments are completed and contain all relevant information. The home must ensure that service users plans are completed to include all areas of need. The home must ensure that corrosive substances (bleach) are kept locked away at all times. The home must ensure that staff records include all the documents specified in Schedule 4 national Minimum Standards, Care Homes for Older People. Timescale for action 30/09/05 2. OP7 15 30/09/05 3. OP19 13(4)(a) 11/08/05 4. OP29 18 30/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Gerald House F52 F02 S18888 Gerald House V243313 110805 stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 3rd Floor, Campbell Square 10 Duke Street Liverpool L1 5AS 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 Gerald House F52 F02 S18888 Gerald House V243313 110805 stage 4.doc Version 1.40 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. 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