CARE HOMES FOR OLDER PEOPLE
Ghyll Royd House New Ghyll Royd Guiseley Leeds Yorkshire LS20 9LT Lead Inspector
Mary Bentley Unannounced Inspection 6th March 2006 10:40 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 Ghyll Royd House DS0000001340.V285495.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. Ghyll Royd House DS0000001340.V285495.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Ghyll Royd House Address New Ghyll Royd Guiseley Leeds Yorkshire LS20 9LT 01943 870720 0113 871212 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) Ghyll Royd Nursing Home Limited Mrs Ann McGregor Care Home 76 Category(ies) of Dementia (15), Mental disorder, excluding registration, with number learning disability or dementia (15), Old age, of places not falling within any other category (61), Terminally ill (3), Terminally ill over 65 years of age (3) Ghyll Royd House DS0000001340.V285495.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 1st September 2005 Brief Description of the Service: Ghyll Royd House is a 76 place care home for older people, it provides nursing care and has a unit dedicated to the care of people with dementia. The home also has a number of places dedicated to the care of people with terminal illnesses. It was purpose built as a care home and was first registered in 1995. The home is situated in Guisley, a short walk from local shops and facilities including good transport links to Otley, Ilkley, Leeds and Bradford. The building is well maintained and has pleasant gardens. Accommodation is on two floors, there are 72 single and two shared rooms and the majority have en-suite facilities. There are a number of communal areas on both floors, these include large lounges and dining areas and small lounges where residents can sit quietly or meet their visitors. The home has level access and there are two passenger lifts. Car parking is available. The home is internally divided into 3 units; Yew and Rowan provide general nursing care and Beech is the specialist dementia unit. Each unit has a designated manager who is accountable to the Registered Manager. The Registered Manager is responsible for all aspects of the day-to-day running of the entire home. Ghyll Royd House DS0000001340.V285495.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Over an inspection year from April until March, care homes have a minimum of two inspections a year; these may be announced or unannounced. The last inspection was announced and took place in September 2005. There have been no further visits until this unannounced inspection. This inspection was carried out by one inspector and lasted approximately six hours. The people who live in the home prefer the term resident; therefore this will be the term used throughout this report. During the inspection, I looked at records, saw care staff carrying out their work and spoke with residents, visitors, staff, the manager and the owner. Comment cards/questionnaires for residents and visitors were sent to the home before the inspection. These provide an opportunity for people to share their views of the home with the Commission for Social Care Inspection. Comments received in this way are shared with the provider without revealing the identity of those completing them. What the service does well:
Ghyll Royd House provides a clean, pleasant and safe home for residents. It is decorated throughout to a high standard. The communal areas and bedrooms are suitably equipped and furnished to meet residents’ needs and have good natural light and ventilation. The home has wide corridors and this creates a feeling of spaciousness. The home has friendly and welcoming atmosphere and there are no restrictions on visiting. Residents are treated with respect and dignity and are consulted about how their care needs will be met. The carers of less able residents are involved in planning care and are kept informed of changes in relatives’ conditions. One person said that staff cared for her as much as they did for her relative. Other people described the staff as “excellent” and one resident made a special mention of the chef who prepares “little treats” for her. A variety of social activities are offered. These include activities within the home and opportunities to take part in social events outside of the home. The mobile library visits the home. A monthly newsletter gives information on past and planned events. The complaint procedures, statement of purpose and copies of previous inspection reports are available in the home for residents and/or their representatives. Ghyll Royd House DS0000001340.V285495.R01.S.doc Version 5.1 Page 6 The home has a good reputation in the local community and two people said they had chosen it for this reason. One visitor said they thought the home was comfortable and seemed to have plenty of staff. The home has an excellent training programme and it was clear that staff appreciated this. 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. Ghyll Royd House DS0000001340.V285495.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 Ghyll Royd House DS0000001340.V285495.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): These standards were not inspected, for details please see the report dated 1st September 2005. EVIDENCE: Ghyll Royd House DS0000001340.V285495.R01.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 Residents’ personal and health care needs are met in a way that respects their privacy and dignity and the care records support this. Residents’ are protected by the homes systems for dealing with medicines. EVIDENCE: The care plans of four residents were looked at. Since the last inspection the home has made some changes to the format used and the care plans now set out in detail how the health, personal and social care needs of residents will be met. The care plans seen were reviewed monthly. The care plans showed that residents and/or their representatives are involved in planning care and relatives confirmed this. Each unit is allocated a number of supernumerary hours every week to make sure that nursing staff have enough time to keep the records up to date. This is good practice. Risk assessments were in place dealing with all areas of risk including nutrition falls, moving and handling, the use of bed rails and the risk of developing pressure sores. Many of the risk assessment forms have been reviewed and improved since the last inspection.
Ghyll Royd House DS0000001340.V285495.R01.S.doc Version 5.1 Page 10 The records showed that residents have access to health care services through their GPs and the local PCT (Primary Care Trust). To make sure that residents health care needs are appropriately met the home consults with community health care specialists including Community Psychiatric Nurses, Tissue Viability Nurses and Dieticians Medicines are stored correctly within the home. For those residents who are administered their own medication the appropriate risk assessments are in place. A random selection of controlled medicines was checked on two units and was correct. The home has implemented a new system for disposing of medicines to comply with recent changes to the law; the policy on the disposal of medicines is in the process of being updated. One of the pharmacists from the local PCT is currently piloting a new training programme for nurses on the safe management of medicines and a number of nurses in the home are taking part in this. Ghyll Royd House DS0000001340.V285495.R01.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): 15 Residents are provided with good, varied and nutritious food and every effort is made to cater for individual choices and preferences. EVIDENCE: At the last inspection a number of residents commented unfavourably about the food. It was clear that the home has done a lot of work on this area since then. The home has a four weekly menu and this shows that a varied and balanced diet is offered to residents. The menus are changed four times a year and residents are consulted about their preferences, sponge puddings are a particular favourite at the moment. A choice is offered at all meal times and salads and vegetarian options are provided on request. Residents are consulted one day in advance about their choice of meal and alternatives to the published menu are offered for example one resident chooses to have chicken for lunch five days a week. For residents who are nutritionally at risk extra calories and protein are provided for example by adding cream to porridge and cream and eggs to mashed potatoes. Fresh fruit is provided every day and the home uses fresh vegetables, which are delivered three times a week. Staff have attended training on nutrition and consult with dieticians about residents special dietary needs.
Ghyll Royd House DS0000001340.V285495.R01.S.doc Version 5.1 Page 12 Lunch service was observed during the inspection, the meal choices were corned beef hash with a selection of seasonal vegetables and creamed potatoes or pasta carbonara. The majority of residents had chosen the corned beef hash. The meal was well presented and looked and smelled appetising. Residents said they enjoyed it. Some residents in one of the first floor dining rooms said they had to wait for their meals to be served until residents in the other dining area had been served. The home rotates the order in which each dining area is served first so that the same residents are not having to wait all the time. Where necessary residents were helped with their meals, and residents were provided with plate guards and other appropriate aids to help them continue to eat independently. Ghyll Royd House DS0000001340.V285495.R01.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): These standards were not inspected, for details please see the report dated 1st September 2005. EVIDENCE: Ghyll Royd House DS0000001340.V285495.R01.S.doc Version 5.1 Page 14 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, 22, 24 & 26 The home provides a pleasant and comfortable setting for residents. It is decorated to a high standard and is clean, safe and well maintained. EVIDENCE: The home was clean and there were no unpleasant odours. The home had an Environmental Health inspection approximately two months ago and no recommendations were made. It is well equipped to meet residents’ needs: corridors are fitted with handrails and call bells are available in all areas used by residents. The bedrooms and communal areas are nicely decorated and the furnishings and equipment are suitable to meet residents’ needs. Residents had their personal belongings around them. The required procedures are in place to reduce the risks of cross infection and to make sure that waste is disposed of correctly. Notes from staff meetings showed that staff are regularly reminded of the importance of following the correct procedures for control of infection. Staff are trained on control of
Ghyll Royd House DS0000001340.V285495.R01.S.doc Version 5.1 Page 15 infection policies and procedures. The laundry is well equipped and was clean and well organised. Ghyll Royd House DS0000001340.V285495.R01.S.doc Version 5.1 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 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): 28 A team of well-trained and competent staff meet residents’ needs. EVIDENCE: The home has 70 of care staff qualified to NVQ (National Vocational Qualification) or above. The home has an excellent training programme; the deputy manager delivers training in house and co-ordinates external training courses. She holds the training budget and from next week she will be reducing her clinical hours to 12 per week to allow her more time to provide training. Staff were very positive about the training both in terms of the range of subjects covered and the quality of the training provided. Ghyll Royd House DS0000001340.V285495.R01.S.doc Version 5.1 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 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 and 37 The home is well managed and the manager is well able to discharge her responsibilities. She offers good leadership to the staff and ensures the residents are protected and cared for in a correct manner. Residents’ financial interests are safeguarded. EVIDENCE: The manager has been in post for approximately two and a half years, she is a nurse. She has completed the Registered Managers Award and does regular training to update her skills and knowledge. The manager provides strong leadership and lines of accountability are clearly defined within the home. The owner visits the home regularly and sends monthly reports of these visits to the CSCI. The home issues questionnaires once a year to residents, relatives and staff. The results are analysed and any issues that are identified are dealt with. The
Ghyll Royd House DS0000001340.V285495.R01.S.doc Version 5.1 Page 18 manager is aware that the results of the annual survey must be made available to residents, relatives and other interested parties. The manager said she walks around the home every day, as well as monitoring how care is being delivered this gives her the opportunity to talk to residents and relatives. The home holds formal relatives/residents meetings about once a year. Regular staff meetings are held for all grades of staff. The home does not get involved in managing residents finances and does not act as “appointee” or “agent” for any resident. Small amounts of spending money are held for some residents. All transactions are recorded and receipts are available for all money spent on residents’ behalf. Records are stored safety in the home; all the required records were available, up to date and accurate. Residents and their representatives have access to their care records. Ghyll Royd House DS0000001340.V285495.R01.S.doc Version 5.1 Page 19 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 3 X 3 X 3 X 3 STAFFING Standard No Score 27 X 28 4 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 2 X 3 X 3 X Ghyll Royd House DS0000001340.V285495.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP33 Regulation 24 Requirement A report of the findings of the quality assurance survey must be made available to service users, their representatives and other stakeholders. Timescale for action 28/07/06 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. Refer to Standard OP35 Good Practice Recommendations The manager should audit the spending money accounts. Ghyll Royd House DS0000001340.V285495.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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