Inspection on 19/12/05 for Gibsons Lodge

This inspection was carried out on 19th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Gibsons Lodge 17/01/08

Gibsons Lodge 29/05/07

Gibsons Lodge 17/05/06

Gibsons Lodge 04/07/05

Gibsons Lodge 22/11/04

Gibsons Lodge 27/05/04

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

CARE HOMES FOR OLDER PEOPLE Gibsons Lodge Gibson`s Lodge Nursing Home Gibson`s Hill London SW16 3ES Lead Inspector Margaret Lynes Unannounced Inspection 19th December 2005 1:05pm 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 Gibsons Lodge DS0000019026.V273496.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 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. Gibsons Lodge DS0000019026.V273496.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Gibsons Lodge Address Gibson`s Lodge Nursing Home Gibson`s Hill London SW16 3ES 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) 020 8670 4098 020 8670 4261 Gibson`s Lodge Limited Mrs Shola Oluyemisi Adedugbe Care Home 46 Category(ies) of Dementia - over 65 years of age (14), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (8), Old age, not falling within any other category (24) Gibsons Lodge DS0000019026.V273496.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. A maximum of 14 service users in the DE(E) category. Six specified service users in the Dementia - over 65 (DE(E)) category who are in excess of the 14 DE(E) service users that the home is registered for may reside at the home. As and when any of these service users are no longer in receipt of services from this home, the places will revert back to the Old age (OP) category. Reinstate eight places in the Mental disorder - over 65 (MD(E)) category at the home. The home will thus be registered for 8 MD(E), 14 DE(E) and 24 OP service users, including the six specified service users referrred to in condition no. 2. In order to cater for the needs of the service users, staffing levels must be maintained at the following levels: One of the qualified staff on each shift must be RMN qualified. The number of carers on each shift must be increased by one, thereby giving seven carers on each day shift and four on duty overnight. 4th July 2005 3. 4. Date of last inspection Brief Description of the Service: Gibson Lodge is a 46-bed nursing home set in a quiet residential area, yet well placed for access to local transport links. The home caters for up to 14 elderly residents with dementia, 8 elderly residents with a mental illness, and 24 elderly infirm clients. Accommodation is provided in a mix of single and double rooms. There are several communal areas, and the home benefits from a very attractive, large garden. The stated aim of the home is to provide the residents with a secure, relaxed and homely environment in which their care, well being and comfort are of prime importance. Gibsons Lodge DS0000019026.V273496.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection, carried out over the course of several hours, was to determine if the home had taken steps to meet the requirements that were made following the inspection in July of this year. The last report contained ten requirements. The manager has now taken steps to deal with all of these with the exception of some relatively minor issues in staff documentation. Due to concerns regarding staff recruitment practice and staffing levels, an Immediate Requirement Notice was left with the manager at the conclusion of the July inspection. Two follow up visits were then made to determine if matters had improved. They had not, and the home was served with a Statutory Enforcement Notice in September for persistently failing to ensure that the recruitment process in the home was of a satisfactory standard. A further visit was made to the home in November, to check that the Notice had been complied with, which it had. What the service does well: What has improved since the last inspection? What they could do better: Having already been served with an Immediate Requirement Notice followed by a Statutory Enforcement Notice with regard to staff recruitment, it was surprising that the staff files inspected were not 100 complete. While they only lacked a photograph and a full work history (which had been given but not recorded) it is imperative that all of the information required in the Regulations is provided before work commences. Gibsons Lodge DS0000019026.V273496.R01.S.doc Version 5.0 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. Gibsons Lodge DS0000019026.V273496.R01.S.doc Version 5.0 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 Gibsons Lodge DS0000019026.V273496.R01.S.doc Version 5.0 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): 3 and 4 The home has finally resolved the issues surrounding the number of service users that it had admitted who were outside either the categories or the allocated number (in a category) for which the home is registered. This means that there should be a much more robust pre-admission assessment, and from this only clients suitable for the home will be admitted. EVIDENCE: After much discussion and debate, and the imposing of requirements, the registration of this home has finally been amended to accurately reflect the clients who are resident there. Firm guidelines have also been laid down by the Commission, which will hopefully prevent similar problems occurring in the future. As it stands now, therefore, the home has 8 beds registered for the elderly with a mental health illness who require nursing care; 24 beds for older persons who require nursing care because of their general frailty; and 14 beds for clients with dementia – again who require nursing care. As there are a considerable number of clients with dementia in excess of the 14 allocated Gibsons Lodge DS0000019026.V273496.R01.S.doc Version 5.0 Page 9 beds, the home cannot admit any more residents who fall into this category until the number of such clients in the home falls below 14. Gibsons Lodge DS0000019026.V273496.R01.S.doc Version 5.0 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 and 8 On this visit it was clear that work had been done to bring the service user plans up to date, and to include reference to all their needs – not only those relating to health. It was felt, therefore, that the service users’ needs were being identified, recorded and steps were being taken to meet them. There was improved recording of wound care, which meant that staff were aware of the treatment each service user required, and had recorded the treatment they had given. This is clearly of benefit to the service users. EVIDENCE: At the previous inspection, requirements were made regarding the need for the service user plans to be based on identified needs, and that they must include reference to social care needs. On this visit the files of four service users were examined. Each one contained a service user plan, which included social care needs, while the daily notes were being cross-referenced to the aforementioned plans. The wound care documentation was up to date; indeed at the time of this visit none of the service users had any wounds of any kind. Some had had Gibsons Lodge DS0000019026.V273496.R01.S.doc Version 5.0 Page 11 treatment until quite recently, however their wounds had healed and this had been appropriately recorded. Gibsons Lodge DS0000019026.V273496.R01.S.doc Version 5.0 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 After a considerable delay, the home has finally appointed a designated activities co-ordinator. This means that the service users social, religious and recreational needs can be addressed. EVIDENCE: The activities co-ordinator kindly came into the home to meet with the Inspector, even though she was unwell. Her time and effort were much appreciated. She has been able to commence activity programmes and to engage residents in 1:1 sessions. This is a much needed improvement. Gibsons Lodge DS0000019026.V273496.R01.S.doc Version 5.0 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): Not assessed on this visit. EVIDENCE: Gibsons Lodge DS0000019026.V273496.R01.S.doc Version 5.0 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): Not assessed on this visit. EVIDENCE: Gibsons Lodge DS0000019026.V273496.R01.S.doc Version 5.0 Page 15 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, 29 and 30 Given that there were 8 vacancies at the time of this visit, it was considered that the staffing levels were adequate. This means that staff should be able to respond to service users needs promptly and thoroughly. The recruitment procedure had improved, and once a missing photograph has been provided, and the work history for one member of staff fully documented, this Standard will have been met. This means that finally, service users will be both supported and protected by the home’s recruitment practice. The availability of training for staff has improved, which means that the staff team have been enabled to improve their knowledge which in turn will have a beneficial effect on the quality of care they give to service users. EVIDENCE: The staffing notice for this home states that there must be 3 qualified staff (2 x RGN) plus 6 care assistants on duty in the morning, 2 qualified staff (1 x RGN) plus 6 care assistants in the afternoon, and 2 qualified staff (1 x RGN) plus 3 care assistants on duty at night. Because of the high number of clients with dementia, this was amended, with an increase of 1 carer per shift required, plus the presence of an RMN on each shift. The rota provided showed that these levels were being maintained – once it was taken into account that there were 8 vacancies. Gibsons Lodge DS0000019026.V273496.R01.S.doc Version 5.0 Page 16 The poor recruitment practice was, as mentioned in the Summary of this report, the subject of a Statutory Enforcement Notice. A follow up visit indicated that improvements had been made, although there were still some gaps in the work history for some staff. On this visit, the files of the two newest staff were examined. Both were complete with the exception of a photograph for one, and a full work history for the other (it transpired that a full work history had been verbally given, but not recorded). The previous report commented on the need for qualified staff to be enabled to attend additional courses so as to ensure that their skills were kept up to date; and to also focus on care staff achieving NVQ level II qualifications. Since the last visit the manager has sourced training in POVA, infection control and decontamination and sterilisation in health care environments. She is looking for a suitable course in dementia training, and there has been an increase in staff wishing to undergo NVQ training. Gibsons Lodge DS0000019026.V273496.R01.S.doc Version 5.0 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): 38 Risk assessments for both individual service users and the premises in general were now being carried out, which means that the health, safety and welfare of the service users and staff was being promoted. EVIDENCE: At the last inspection it was required that the risk assessment of the premises be reviewed and brought up to date, while risk assessments of individual service users also needed to be carried out. The latter were now evident within the residents’ files while an external company has been engaged to carry out an annual health and safety risk assessment. To compliment this, the manager carries out her own risk assessments, and does monthly equipment checks, the records of which were available for inspection. Gibsons Lodge DS0000019026.V273496.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 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 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Gibsons Lodge DS0000019026.V273496.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? Yes 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 OP29 Regulation 19 Requirement The proprietor must ensure that staff provide all the necessary documentation before commencing work. The previously set timescale has not been fully met. Timescale for action 19/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Gibsons Lodge DS0000019026.V273496.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Gibsons Lodge DS0000019026.V273496.R01.S.doc Version 5.0 Page 21 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!