CARE HOME ADULTS 18-65
Gibraltar Road Nursing Home 35 & 64 Gibraltar Road Halifax West Yorkshire HX1 4HE Lead Inspector
Liz Cuddington Unannounced Inspection 31st October 2005 12:10 Gibraltar Road Nursing Home DS0000001052.V254963.R01.S.doc Version 5.0 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 Gibraltar Road Nursing Home DS0000001052.V254963.R01.S.doc Version 5.0 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 Adults 18-65. 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. Gibraltar Road Nursing Home DS0000001052.V254963.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Gibraltar Road Nursing Home Address 35 & 64 Gibraltar Road Halifax West Yorkshire HX1 4HE 01422 352418 01422 322552 linda.gibson45@ntlworld.com 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) Mayfield Trust Mrs Lynda Gibson Care Home 13 Category(ies) of Learning disability (13), Learning disability over registration, with number 65 years of age (13) of places Gibraltar Road Nursing Home DS0000001052.V254963.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 9 service users accommodated between 35 and 64 Gibraltar Road, Halifax HX1 4HE 4 service users accommodated between 334 and 336 Hopwood Lane, Halifax, HX1 4HE 23rd February 2005 Date of last inspection Brief Description of the Service: The four houses at Gibraltar Road and Hopwood Lane provide both nursing care and personal care to younger service users with learning disabilities. The houses are all domestic dwellings, situated within the local community. All the houses have accommodation over two floors. 35 Gibraltar Road has a passenger lift and 64 Gibraltar Road has a stair lift. The houses are on bus routes and are within easy reach of Halifax. There is ample on street parking near all the houses. Gibraltar Road Nursing Home DS0000001052.V254963.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. During the inspection I visited both of the houses on Gibraltar Road. I did not visit the two houses on Hopwood Lane this time, although I have been there during previous inspections. I was welcomed into both 35 and 64 Gibraltar Road and would like to thank the ladies and gentlemen who live there, and the staff, for their hospitality and for taking the time to talk to me. I would also like to thank the staff and management for their assistance. During the inspection I assessed nineteen of the 43 National Minimum Standards. I spent time talking with six service users to gain their views on their home and the support services they receive. I talked to four members of staff about their work and also spent time looking at files and other records. This was a good inspection showing improvements in several areas. It has resulted in two statutory requirements and two good practice recommendations being made. One of the requirements has been carried forward from previous inspections and must be dealt with without further delay. What the service does well:
The ladies and gentlemen who commented said how much they liked living at their home and what good support they have from the staff. One lady kindly showed me her personal file which was very interesting. The lady also showed me her bedroom and some of her favourite belongings. People are supported to go out and about to their chosen places of interest and the Trust employs outreach workers to provide this support, along with the other staff. Personal choice and the freedom of service users to live their lives in the way they wish is considered very important. The development and review of the plans of care and support includes the service user and other people who the individual wishes to have present. The plans show that healthcare professionals, such as Occupational Therapists, are consulted when needed. Suitable formats are used to make documents more easily accessible. The people who commented said that they enjoyed their meals and the mealtimes were relaxed and pleasurable times of the day. Vegetables and fruit, grown in the garden at number 35, are used in the meals. The interaction between service users and staff is friendly yet still professional. Gibraltar Road Nursing Home DS0000001052.V254963.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Gibraltar Road Nursing Home DS0000001052.V254963.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gibraltar Road Nursing Home DS0000001052.V254963.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 Appropriate pre-admission assessments are carried out to make sure the home can meet an individual’s needs. EVIDENCE: The individual plans of care and support which I examined showed that the pre-admission needs assessments had been carried out. The plans showed how the person’s needs are to be met and detailed any specialist input from healthcare professionals such as Occupational Therapists or Physiotherapists. At the last inspection there was a significant number of agency staff working at the four houses. The manager said that now almost all the staff are employees of Mayfield Trust. This allows the organisation to make sure there is a good staff balance, providing the range of skills and experience to deliver the support and care needed by the service users. Gibraltar Road Nursing Home DS0000001052.V254963.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6&8 Service users and their representative, if they wish, are involved in planning their own personal care and support. Service users are also involved in the decision making about how their home and the organisation is run and managed. EVIDENCE: The individual plans I looked at in detail showed that the service user and their representatives are involved in drawing up and regularly updating their plan of care and support. The plans are written in straightforward language and illustrated using ‘clip art’ pictures. Where a plan has been updated it reflects the service user’s changing needs. The general information service users need is produced in pictorial format, where appropriate. Although it is done informally, service users have the opportunity to contribute to and participate in the decision-making processes. A service user sits on Mayfield Trust’s Board of Trustees. Gibraltar Road Nursing Home DS0000001052.V254963.R01.S.doc Version 5.0 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 15, 16 & 17 The people who live at the houses on Gibraltar Road and Hopwood Lane have the opportunities and support to enable them to live their lives in the way they choose. Privacy and self-determination are respected. Interaction between service users and staff is excellent and meals and mealtimes are enjoyed. EVIDENCE: The people who live at the houses on Gibraltar Road and Hopwood Lane are supported to take up educational and employment opportunities according to their wishes. Outreach staff are employed to support service users to go out and about to places that interest them. The rest of the staff also do this, alongside their other work. Service users families and friends are welcomed into their home, with service users agreement. There are opportunities for people to make friends outside the home environment. Gibraltar Road Nursing Home DS0000001052.V254963.R01.S.doc Version 5.0 Page 11 It was clear from observation that service users have the freedom they need to make choices about how they wish to lead their daily lives. All the private bedrooms have locks fitted to enable service users to maintain their privacy. The relationship and interaction between service users and staff was seen to be relaxed and friendly. Staff treat service users with respect and consideration. Everyone enjoyed their meals and the service users choose the menus. Alternatives are provided if someone does not wish to eat the main choice. I was there during two mealtimes and saw that they were an unrushed and enjoyable part of the day. Some service users also enjoy going out for their meals. Number 35 has a garden growing fruit and vegetables which are used for the meals. Gibraltar Road Nursing Home DS0000001052.V254963.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 Medicines are not being administered safely and in accordance with guidance. EVIDENCE: I did not carry out a full audit of medicine administration on this occasion. However, I observed an example of poor practice at one of the houses which has resulted in a statutory requirement. The member of staff on duty had not received training in medicine administration and, rightly, was not handling service users medicines. A trained member of staff had been to the house before lunch and poured out a dose of a service user’s liquid medicine and left it open on top of the medicine cabinet, along with the bottle. This is unsafe practice and breaches Care Standards Act 2000 regulations and the guidelines of The Royal Pharmaceutical Society, with regard to secondary dispensing of medicines and safe storage of medicines. Gibraltar Road Nursing Home DS0000001052.V254963.R01.S.doc Version 5.0 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 The complaints handling procedure is satisfactory and the draft pictorial version will be helpful. EVIDENCE: A draft complaints procedure has been produced in a pictorial format, which looked as though it would be very suitable for service users. There is a book available to record any complaints which are received and the procedure for dealing with complaints and concerns is clear. Gibraltar Road Nursing Home DS0000001052.V254963.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29 & 30 Both houses I visited met environmental standards. When the re-decoration programme has been completed, the appearance of number 35 will be improved. EVIDENCE: Both houses on Gibraltar Road are accessible to service users. There is a passenger lift at number 35 and a stair lift at number 64. Ramps are provided where needed to make the house more accessible. Furnishings and fittings in the houses are domestic and suited to the needs of the service users. There is a programme for renewal of the carpet in the hallway of number 35 as well as re-decoration throughout the house. Some rooms have been redecorated and looked very nice. There are suitable adaptations fitted to assist service users where needed. Both houses are kept in a clean and hygienic condition. Laundry floors are covered in impermeable material to meet infection control standards. The washing machine I saw had a sluice wash programme. Gibraltar Road Nursing Home DS0000001052.V254963.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 & 36 There is a consistent staff team employed now and the staff training arrangements and co-ordination shows improvement. Staff supervision and annual appraisal is taking place. EVIDENCE: The staff team are almost all employed by Mayfield Trust with minimal use of agency staff. This is a considerable improvement from the last inspection. There also appears to be low rates of sickness absence and staff turnover. The staff rotas are adjusted to reflect the changing needs of the service users. As far as possible, service users are able to have the staff members they prefer working with them. The organisation employs a part-time member of staff to co-ordinate all the training for the Trust’s staff. The home has a training and development plan and assessment for each of its staff, linked to the needs of the service. A new member of staff confirmed that she had undertaken the induction training and was waiting to start the Learning Disabilities Award Framework (LDAF) foundation training. Staff have regular one to one supervision sessions with their line manager as well as an annual appraisal. I was told that the staff who carry out supervision have received suitable training. Staff files contain a copy of the organisation’s disciplinary and grievance procedures.
Gibraltar Road Nursing Home DS0000001052.V254963.R01.S.doc Version 5.0 Page 16 Gibraltar Road Nursing Home DS0000001052.V254963.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 & 42 The quality assurance system has still not been properly developed and implemented. The fire alarm testing and staff fire safety lectures are now being done. Opened food packages are not being properly sealed and labelled. EVIDENCE: Only one service user’s quality assurance questionnaire was seen on the file and there were none from relatives and other stakeholders. I appreciate that this is a time of change for the people living in and working at these four houses. However, the requirement to implement a suitable and effective quality assurance system has been in place since the Care Standards Act 2000 took effect in April 2002. Staff are now receiving fire safety training and records show that fire alarms are being regularly tested. When food packages such as bags of frozen vegetables are opened and not finished, they need to be date labelled and carefully sealed to make sure the food remains in good condition and is used up as soon as possible after opening. Gibraltar Road Nursing Home DS0000001052.V254963.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 3 X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X 3 X X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X X X X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X 3 X 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Gibraltar Road Nursing Home Score X X 1 X Standard No 37 38 39 40 41 42 43 Score X X 1 X X 2 X DS0000001052.V254963.R01.S.doc Version 5.0 Page 19 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 YA20 Regulation 13(2) Requirement Timescale for action 30/11/05 2 YA39 24 All medication must be administered safely, in accordance with the guidance of the Royal Pharmaceutical Society The quality assurance system 31/01/06 must be properly developed and implemented. N.B. This has been a requirement of previous reports. Continued noncompliance will result in enforcement 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 Refer to Standard YA24 YA42 Good Practice Recommendations The programme for renewal of carpets and re-decoration needs to progress with minimal delay. Opened packages of food stored in cupboards, refrigerators or deep freezers need to be date labelled and sealed. Gibraltar Road Nursing Home DS0000001052.V254963.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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