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Inspection on 08/06/05 for Ghyll Grove Residential and Nursing Home

Also see our care home review for Ghyll Grove Residential and Nursing Home for more information

This inspection was carried out on 8th June 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The use of sedative medication is closely monitored and used minimally so that residents are alert and can have a better quality of life.

What has improved since the last inspection?

There were very little improvements noted since the previous inspection. The employment of a dedicated activities coordinator has improved the range of social and occupational activities offered to people living in the house.

What the care home could do better:

Staff could act in a more respectful manner when dealing with assisting and handling residents. Staff could also communicate better with residents. Nursing staff must ensure that residents receive their medication at appropriate intervals and that any risks to residents of injury through falls etc are assessed and managed so as to minimise these risks. The layout of the furniture could be more homely and less institutional in nature so as to provide a more pleasing and comfortable environment for people who live there. The overall management of the home could be better so as to ensure the safety, wellbeing and quality of life is improved for people living there.

CARE HOMES FOR OLDER PEOPLE Ghyllgrove Residential and Nursing Home - Kennett House Ghyllgrove Basildon Essex SS14 2LA Lead Inspector Carolyn Delaney Un-announced 8th June 2005 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. Ghyllgrove Residential and Nursing Home - Kennett House I56-I06 S15535 Ghyllgrove (Kennett House) V233114 080605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ghyllgrove Residential & Nursing Home - Kennett House Ghyllgrove Basildon, Essex SS14 2LA Address 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) 01268 273173 01268 288289 BUPA Care Homes Ltd Mrs Christine Ann Walton CRH 150 Category(ies) of Older people (OP) 150, Dementia over 65 registration, with number (DE)(E) 30, Terminally Ill (TI) 4. of places Ghyllgrove Residential and Nursing Home - Kennett House I56-I06 S15535 Ghyllgrove (Kennett House) V233114 080605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th September 2004 Ghyllgrove Residential and Nursing Home - Kennett House I56-I06 S15535 Ghyllgrove (Kennett House) V233114 080605 Stage 4.doc Version 1.30 Page 5 Brief Description of the Service: Kennett House is one of five houses which make up Ghyllgrove Nursing and Residential Home.Kenneth House provides nursing care and accommodation for up to a maximum of thirty people who are over the age of sixty five years who have a diagnosis of dementia oe Alzheimers disease. The home is situated in a residential area close to Basildon town centre. Kenneth house has an open plan dining / lounge area with a small kitchen area where residents and their visitors may make drinks etc. There is also a quiet room where residents may receive visitors in private. Outside there is a small well-maintained garden area.The unit is managed overall by the homes registered manager, Kit Walton. The day to day management of the house is the responsibility of a senior nurse (Head of House). Ghyllgrove Residential and Nursing Home - Kennett House I56-I06 S15535 Ghyllgrove (Kennett House) V233114 080605 Stage 4.doc Version 1.30 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection of Kennett House was carried out on 8th June 2005. Lead inspector, Carolyn Delaney and second inspector, Michelle Love, carried out the inspection. During this inspection assessment documents, care plans and assessments in respect of potential risks to residents, were examined. Staff duty rotas and training files were examined and two members of staff were spoken with. The serving of breakfast and lunchtime meals was observed. As this is the first time that Kennett House has been subject to an individual inspection and inspection report there have been no regulatory requirements or recommendations carried forward from the previous inspection. What the service does well: What has improved since the last inspection? There were very little improvements noted since the previous inspection. The employment of a dedicated activities coordinator has improved the range of social and occupational activities offered to people living in the house. Ghyllgrove Residential and Nursing Home - Kennett House I56-I06 S15535 Ghyllgrove (Kennett House) V233114 080605 Stage 4.doc Version 1.30 Page 7 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. Ghyllgrove Residential and Nursing Home - Kennett House I56-I06 S15535 Ghyllgrove (Kennett House) V233114 080605 Stage 4.doc Version 1.30 Page 8 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 Ghyllgrove Residential and Nursing Home - Kennett House I56-I06 S15535 Ghyllgrove (Kennett House) V233114 080605 Stage 4.doc Version 1.30 Page 9 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) 3 Assessments of residents nursing and care needs are not carried out and recorded in a consistent manner so as to determine that the home can meet these needs. EVIDENCE: Assessments in respect of residents needs were carried out prior to a place being offered to the individual. However these assessments were not detailed in many cases as to the specific needs that residents have and how these needs affect their ability to carry out daily activities of living. Some assessment documents had not been signed and dated by the person carrying out the assessment. Many of the people living on Kennett House would be incapable of making decisions and choices regarding where they live and where it is practicable relatives and or other representatives are encouraged to visit the home so as to assess its suitability. Ghyllgrove Residential and Nursing Home - Kennett House I56-I06 S15535 Ghyllgrove (Kennett House) V233114 080605 Stage 4.doc Version 1.30 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 & 10 Staff working on Kennett House do not always act in a manner, which meets the needs of, and promotes and maintains the wellbeing of residents who live there. EVIDENCE: Care plans did not contain sufficient detail in respect of residents needs. For example one resident who required special care when moving, did not have a care plan in place for how staff were to appropriately assist this person with mobilising. Staff were observed to pull this resident in an inappropriate manner when transferring into a chair. Other residents who displayed aggressive behaviour such as verbal and physical aggression did not have detailed plans in respect of any specific times or events which may trigger these behaviours and it was also not clear what action staff took in the event of when residents did display aggressive behaviour. There were assessments in respect of risks to residents of injuring themselves from falls etc. These assessments were not always clear as to the degree of Ghyllgrove Residential and Nursing Home - Kennett House I56-I06 S15535 Ghyllgrove (Kennett House) V233114 080605 Stage 4.doc Version 1.30 Page 11 risk posed and it was noted that for one resident who had bruising resulting from several falls, there was no plan in place so as to manage and reduce the risks to this person. Qualified nurses administer medication and wherever possible the use of antipsychotic and sedative medications is minimal so as to improve the quality of life for people living in the home. The house’s Head of Home said that medication was administered in the morning to each person when they got up and had breakfast so as to allow people the choice as to when they got up. This is good practice. However there was no system in place for ensuring that people who had their morning medication at a later time were administered their lunchtime medication so as to ensure that the appropriate time in between administration of medication as prescribed is achieved. Staff did not speak to residents in a respectful manner during the morning of the inspection. Some staff were seen to put apron / tabards on residents at mealtimes without explaining what they were doing. Some staff were also heard to speak abruptly to residents. Ghyllgrove Residential and Nursing Home - Kennett House I56-I06 S15535 Ghyllgrove (Kennett House) V233114 080605 Stage 4.doc Version 1.30 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 & 15 Staff do not always provide stimulating recreational and occupational activities for people living on Kenneth House. Residents are not assisted or supported in an appropriate manner at mealtimes. EVIDENCE: An activities coordinator is employed to provide a range of social, leisure and occupational activities for people who live on Kenneth House. Residents have one to one time and are encouraged to undertake activities such as crafts so as to maintain manual dexterity and mobility. The activities coordinator was noted to interact in a very positive way with residents and one member of staff who had been recruited to work from one of the other houses for this mornings duty took his tea break and spent it chatting with one resident. However some other staff working on this house were noted to assist residents without speaking with them. The layout of the furniture on Kennett House is institutionalised and not conducive to promoting activities. Meals provided looked appetising and were served in a well-presented manner Ghyllgrove Residential and Nursing Home - Kennett House I56-I06 S15535 Ghyllgrove (Kennett House) V233114 080605 Stage 4.doc Version 1.30 Page 13 and residents are offered a choice of foods at each meal. The manner in which residents were assisted at mealtimes was noted to be poor. Staff did not offer prompts or sit with residents who needed assistance. One resident was asleep when the lunchtime meal was served. Staff did not attempt to wake this person and told inspectors that their meal would be served when they awoke. When this person did awake, the dessert course was being served and this was given to the resident before the main course. One other resident with visual impairment was served his meal with a plate guard, which was broken and offered no use to this person. Staff were noted to speak abruptly and loudly to residents. One member of staff was heard to say ‘Drink your soup’ in a loud and abrupt manner to one resident. Ghyllgrove Residential and Nursing Home - Kennett House I56-I06 S15535 Ghyllgrove (Kennett House) V233114 080605 Stage 4.doc Version 1.30 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 & 18 Complaints are dealt with according to the homes policy and procedure and acted upon appropriately. Staff working on Kennett House do not always act in a manner, which protects residents living there. EVIDENCE: Records in respect of complaints received indicated that complaints were acted upon promptly and actions taken to resolve issues. One resident’s relative said that any issues were addressed quickly and that they felt confident that their views were taken into account. Staff receive training in respect of the protection of vulnerable adults and while there was no evidence that residents were subject to any deliberate abuse, the manner in which some members of staff handled and spoke with residents was noted to be inappropriate. Ghyllgrove Residential and Nursing Home - Kennett House I56-I06 S15535 Ghyllgrove (Kennett House) V233114 080605 Stage 4.doc Version 1.30 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) 20 & 25 The layout and arrangements of furnishings in the communal areas of the home was not conducive to the needs of the people who live there. EVIDENCE: The communal areas, in particular the lounge was bare with little in the way of furnishings or decoration, which makes the home seem cold and uninviting. The arrangement of chairs in one corner in of the lounge, in two rows facing each other was noted to be ‘institutional’ and not conducive to promoting interaction between people in the home. Ghyllgrove Residential and Nursing Home - Kennett House I56-I06 S15535 Ghyllgrove (Kennett House) V233114 080605 Stage 4.doc Version 1.30 Page 16 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 & 30 Staff are employed in sufficient numbers and receive training in respect of the care of people living in the home. However staff were noted to act in an inappropriate manner when dealing with residents. EVIDENCE: Staff duty rotas indicated that staff were employed in sufficient numbers with appropriate numbers of qualified staff to meet the needs of people who live on Kennett House. As described elsewhere in this report staff did not always act so as to meet the needs of residents. Staff receive regular mandatory training such as moving and handling training, and other training relevant to the needs of the people living in the house. However as described elsewhere in this report some staff were seen to move, handle and speak to residents in an inappropriate manner and contrary to their training and good practice. Ghyllgrove Residential and Nursing Home - Kennett House I56-I06 S15535 Ghyllgrove (Kennett House) V233114 080605 Stage 4.doc Version 1.30 Page 17 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 The management and ethos of Kennett House does not best promote the wellbeing and safety of the people living there. EVIDENCE: The issues as raised in this report were fed back to the senior nurse who has worked on Kennett House for some considerable time on the house who simply replied ‘I know’. It was both disappointing and concerning that he did not appear concerned about the issues in respect of poor care practices, which were raised. Ghyllgrove Residential and Nursing Home - Kennett House I56-I06 S15535 Ghyllgrove (Kennett House) V233114 080605 Stage 4.doc Version 1.30 Page 18 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 x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 2 15 x COMPLAINTS AND PROTECTION x 2 x x x x 2 x STAFFING Standard No Score 27 2 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 2 2 2 x x x x x Ghyllgrove Residential and Nursing Home - Kennett House I56-I06 S15535 Ghyllgrove (Kennett House) V233114 080605 Stage 4.doc Version 1.30 Page 19 N/A 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(1) (2) Requirement The registered persons must ensure that a detailed assessment of residents needs is carried out prior to the person being offered a place at the home. The registered persons must ensure that each residents nusring, care, safety and welfare needs are recorded in a plan of care which is maintained up to date and accurate. The registered persons must ensure that so far as it is practicable that risks to residents of harm and / or injury are assessed and managed so as to minimise these risks. The registered persons must ensure that residents living at the home receive medication as prescribed and at appropriate intervals. The registered persons must ensure that staff act and treat residents in a manner which is respectful and promotes privacy, dignity and . The registered persons must ensure that residents are supported and assisted according Timescale for action 31/08/05 2. OP7 15 (1) (2) 31/08/05 3. OP8 12 & 13 (4) 31/08/05 4. OP9 13(2) 31/08/05 5. OP10 12(2) (3) (4) 31/08/05 6. OP15 12 & 15 31/08/05 Ghyllgrove Residential and Nursing Home - Kennett House I56-I06 S15535 Ghyllgrove (Kennett House) V233114 080605 Stage 4.doc Version 1.30 Page 20 7. OP18 13(6) 8. OP27 18 9. OP30 18 10. OP31 OP32 OP33 4 12 13 to their meals and that meals are provided unhurried. The registered persons must ensure that staff act in a manner which promotes the safety and wellbeing of residents living at the home. The registered persons must ensure staff are deployed so as to meet the needs of residents living ast the home. The registered persons must ensure that staff carry out their work according to he organisations policies and procedures, training and good practice. The registered personsmust ensure that the home is managed so as to best serve the interests and needs of the people living there. 31/08/05 31/08/05 31/08/05 31/08/05 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 OP20 OP25 Good Practice Recommendations A review of the arrangements in respect of furniture would benefit residents. Ghyllgrove Residential and Nursing Home - Kennett House I56-I06 S15535 Ghyllgrove (Kennett House) V233114 080605 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on sea, Essex SS2 6BG 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 Ghyllgrove Residential and Nursing Home - Kennett House I56-I06 S15535 Ghyllgrove (Kennett House) V233114 080605 Stage 4.doc Version 1.30 Page 22 - 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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