Inspection on 12/06/06 for Gerald House

This inspection was carried out on 12th June 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 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

Gerald House 18/06/07

Gerald House 12/01/06

Gerald House 11/08/05

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 Inspection 12th June 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Gerald House DS0000018888.V288896.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. Gerald House DS0000018888.V288896.R01.S.doc Version 5.1 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 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) Mr George Alan Shone Mrs Kamini Shone Mrs Kamini Shone Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Gerald House DS0000018888.V288896.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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 12th January 2006 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 registration have been agreed to enable three residents below the age of 65 years to live at the home. 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 rear garden. 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. Weekly fees are set at £365.73 to £395 Gerald House DS0000018888.V288896.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection of Gerald House was undertaken on Monday 12th June 2006 over a period of 2.5 hours. It involved the examination of records, meeting with the Registered Person, with six residents and with staff on duty. The Registered Person had completed a CSCI questionnaire prior to the inspection. Gerald House provides a warm and caring environment that is appreciated by residents. Standards of record keeping have improved but need some additional attention. This inspection was carried out as part of the Commission’s responsibility to visit and report on all registered care homes. What the service does well: What has improved since the last inspection? What they could do better: Recommendations have been made to ensure that reviews of residents needs make reference to the original care plan and that records of staff supervision are more detailed. Gerald House DS0000018888.V288896.R01.S.doc Version 5.1 Page 6 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 DS0000018888.V288896.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gerald House DS0000018888.V288896.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 and 6 Prospective residents are provided with information about the home. EVIDENCE: The home’s statement of purpose and its service user guide were examined during the CSCI inspection in January 2006 and contained all of the required information. No changes have been made to the documents in the past six months. Records of resident’s financial affairs are kept separate to the day-to-day care records. Each of the residents funded by the local authority has a care contract in place that includes the responsibilities of the placing agency, the care home and the resident. The home has its own contract that is provided to every resident. Three resident’s care files were examined during the inspection. A preadmission assessment had been completed by senior staff at the home prior to the offer of a placement and was located in all but one of the files. In this latter situation, the resident had been living some considerable distance from the Wirral and the home accepted an assessment undertaken by the placing Gerald House DS0000018888.V288896.R01.S.doc Version 5.1 Page 9 authority that was faxed through. From the information available it would appear that the resident is appropriately placed in Gerald House. The home’s documents were updated prior to the last CSCI inspection and contain useful information from which a care plan can be constructed. Prospective residents and their families are encouraged to visit the home and to spend some time there before making a decision to stay. The owners of Gerald House have been providing care and support at the home for more than 16 years and have experience of running other homes in the past. Residents who spoke with the inspector were complimentary about the care provided by staff at the home and said that although they would prefer to live in their own home, they were happy at Gerald House. The home is not contracted to provide Intermediate Care. Gerald House DS0000018888.V288896.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Resident’s health and personal care needs are set out in a plan of care. Medicines are being managed safely. EVIDENCE: Care plans are kept separately from the main care file and are made directly available to staff. Care plans were in place for two of the residents whose files were examined but the third resident had only been admitted, in an emergency situation, the previous Friday and a care plan had not been produced. Improvements have been made to the care plans over the past twelve months and the work is being maintained. There was evidence to show that reviews are being undertaken on a monthly basis but the report did not always refer back to the plans of care for individual residents. It is important for the ongoing care and support of residents that reviews identify any progress or regression in their needs and any amendments to the ways in which staff provide support are identified and recorded. In this way the home can demonstrate that they are providing each resident with the support that is necessary to keep them safe. Gerald House DS0000018888.V288896.R01.S.doc Version 5.1 Page 11 Resident’s health care needs are given appropriate priority and access to health care professionals is sought when necessary. A record of interventions by health care professionals is maintained on the resident’s care file. The home reports that it receives good support from GP’s and from district nurses. Links have also been made with domiciliary dental and optical services. The process for completing continence assessments and awaiting the provision of appropriate pads is still taking up to eight weeks. 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 passed to the pharmacist for dispensing. The home’s policies and procedures expect that residents will be treated with respect. During the course of the inspection staff were observed to speak politely and to support residents personal care needs in private. Residents told the inspector that staff are very kind and supportive and always treat them with respect. Residents can meet with visitors in their own room or in one of the communal areas around the home. Gerald House DS0000018888.V288896.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14 and 15. Residents are helped to make choices in their life. 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 alone, whilst others are taken out for a walk or in the manager’s car. Activities provided include music and TV, exercise groups, Bingo, videos and films, quizzes, reminiscence and card games and individual one-to-one activity. Not all the residents wish to join in with group activities and they can choose to spend time on their own, observing the others or following an individual interest. Visitors to the home are welcomed at any time. The local priest attends to provide Holy Communion, and the home will support residents of other faiths who wish to attend church or to be visited by the clergy. Residents are able to get up and go to bed when they choose to. They can spend time in the communal lounge areas or in their own room. Residents who go out unaccompanied or with friends are asked to let staff know where they are going and when they expect to return for reasons of personal safety. A four-week menu is in place and residents who do not wish to take the main meal on offer are provided with and alternative. The menus have been put Gerald House DS0000018888.V288896.R01.S.doc Version 5.1 Page 13 together around the likes and dislikes of residents and are reviewed with them from time to time. Residents who spoke with the inspector about the food were complimentary about the range and quality of meals provided. Gerald House DS0000018888.V288896.R01.S.doc Version 5.1 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 the following 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 and their visitors. Residents said they would feel able to raise any concerns with staff at the home if they felt the need to do so. No complaints have been received at the home or by CSCI since the inspection of Gerald House in January 2006. All of the residents are included on the Electoral Register and are eligible to vote in local and national elections. The home has policies and procedures in place to protect residents from abuse and also has a copy of Wirral’s adult protection procedures. The procedures are available to staff and the home’s manager told the inspector that staff training in adult protection is to be provided in the near future. No allegations of abuse have been made at the home over the past twelve months. Gerald House DS0000018888.V288896.R01.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, 20, 21, 22, 23, 24, 25 and 26 Residents live in a safe and well-maintained environment. EVIDENCE: Gerald House is situated in the residential area of Oxton Wirral. It is conveniently located for local shops and bus routes to Birkenhead. The home is well decorated and is furnished in a domestic style. Light fittings around the home are also domestic in character. Contract gardeners maintain the grounds and on-going maintenance is given appropriate priority. The home’s laundry is located in a wooden building at the rear of the home that also doubles as a storeroom for cleaning materials. The lounge is situated at the front of the home and is fitted with individual chairs and a TV. A dining room with some additional comfortable chairs is located across the hall from the lounge. Dining tables are laid with cloths and individual place settings. Gerald House DS0000018888.V288896.R01.S.doc Version 5.1 Page 16 The inspector had undertaken a full tour of the home on previous inspection visits. During this inspection three of the bedrooms were seen and it was confirmed that standards of decoration and comfort are being maintained. Most of the bedrooms have an en-suite WC and wash hand-basin. The three rooms without this facility have the use of a WC just by the door. The owners are considering plans to make all of the bedrooms, en-suite. Residents are encouraged to personalise their room with items of furniture, pictures and ornaments brought in from home. Two of the home’s three bathrooms have adapted bathing facilities; the third is fitted with a shower. Aids and equipment to support residents with a disability are provided throughout the home. Ramped access is provided at the front door. A passenger lift and a staff call system are in place. Hot water delivered to resident’s bathrooms and showers is thermostatically controlled. Hot water delivered to resident’s bedrooms is not controlled in this way but notices warn that water may be hot. The owners have given assurances to the Commission that in situations where an individual resident may not be able to manage the hot water, a risk assessment would be completed and appropriate actions taken. On the day of this inspection the home was clean and there were no offensive odours. Gerald House DS0000018888.V288896.R01.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 Staffing levels are appropriate for the current group of residents. EVIDENCE: Rotas identify that from Monday to Friday the home is staffed (during day-time hours) by the manager and two carers. At other times two carers are on duty. At night the home has one wakeful carer and one sleeping member of staff on call. Separate cooking and domestic staff are employed. At the time of this inspection the home was carrying a vacancy for a part time cook. Gerald House does not employ staff below the age of 18 years and does not use agency workers. Information provided by the owner shows that 7 of the home’s 12 care staff have an award at NVQ level 2 or above, in care. Three other staff are working for the award. Three staff files were examined during the inspection and all of them contained the information required by Schedule 4 (6) of the National Minimum Standards, Care Homes for Older people. Application forms, two references and confirmation of CRB clearances were evidenced. The home takes advantage of induction training courses provided by Wirral Council that include food hygiene, moving and handling, first aid, adult protection and fire awareness. Additional training is provided in the management of medicines, diabetes control and adult protection. Domestic staff are being trained in COSHH Risk Assessment processes. Gerald House DS0000018888.V288896.R01.S.doc Version 5.1 Page 18 The homeowner told the inspector that he prefers to deal with any minor disciplinary matters through one-to-one discussion and verbal reprimands or warnings rather than to invoke formal procedures. Whilst this process may be appropriate for very minor issues that occur in the workplace, there is a need to ensure that all staff disciplinary matters are recorded and include outcomes and any actions taken. An attempt to refer to non-recorded discussions and actions would not be accepted in any formal proceedings that might occur later on. Gerald House DS0000018888.V288896.R01.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, 32, 33, 34, 35, 36, 37 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 joint owner(s)/manager work in the home and are directly involved in providing personal care. The manager organises activities and is available to residents and to their visitors to respond to any questions or concerns. Comments from residents are positive about the support they receive from the manager and her staff. One of the residents has told the inspector on several occasions that she is very happy in the home and views staff and other residents as part of her family. The homeowner(s)/manager are always interested in the needs of the residents and these become the focus of discussion during inspections. Gerald House DS0000018888.V288896.R01.S.doc Version 5.1 Page 20 The inspector is not aware of any financial matters that would affect the continued running of Gerald House. Apart from small amounts to pay for hairdressing etc, the manager does not manage any personal money on behalf of residents. The homeowner undertakes annual appraisal interviews with staff and has begun the process of regular, bi-monthly supervision. Records of the meetings were seen during the inspection. The process of supervision is important to ensure staff are carrying out their responsibilities appropriately, that any concerns they, or managers may have can be aired and dealt with and to identify training needs. Supervision is also a helpful way of giving positive feedback to staff when they have worked particularly well. The process in Gerald House should be further developed to ensure the supervision records are a permanent and potentially useful document and can be used when responding to any reference request, disciplinary process, or any other staffing matter in the future. The homeowners are at the final stages of their application for the Investors in People Award. They undertake an annual quality assurance survey amongst the residents and visitors to gain their opinion about the care and support provided at Gerald House. The owner has purchased a set of policies and procedures for use in the home. The homeowner(s)/manager promotes the maintenance of a safe working environment for residents and staff. All of the equipment is checked regularly and safety certificates issued. The electric wiring system has been checked and small items of equipment PAT tested. Confirmation of the work done was made available to the inspector and the contractor was preparing a safety certificate. Fire record books contained written confirmation of weekly fire alarm tests and checks on the emergency lighting system undertaken by the contractor. The new resident’s call system installed in November 2005 has also been checked. Gerald House DS0000018888.V288896.R01.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 3 3 3 3 3 N/A 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 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Gerald House DS0000018888.V288896.R01.S.doc Version 5.1 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP7 OP28 OP36 Good Practice Recommendations The manager should ensure that reviews of care plans make reference to identified needs and any amendments are recorded. The homeowner should ensure that any staff disciplinary actions are recorded and details maintained on the member of staff’s file. The programme of staff supervision should be developed to ensure full and detailed discussions take place and that records reflect the discussion and the outcomes. 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