Inspection on 04/07/05 for Gibsons Lodge

This inspection was carried out on 4th July 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 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 19/12/05

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 Nursing Home Gibsons Hill London SW16 3ES Lead Inspector Margaret Lynes Announced 4 July 2005, 09:20 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. Gibsons Lodge Nursing Home G53-G53 S19026 gibsonslodge V179123 040705 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Gibsons Lodge Nursing Home Address Gibsons Hill, London, SW16 3ES 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) 020 8670 4098 020 8670 4261 Gibsons Lodge Limited Mrs Shola Oluyemisi Adedugbe Care Home 46 Category(ies) of Dementia - over 65 registration, with number Old age of places Gibsons Lodge Nursing Home G53-G53 S19026 gibsonslodge V179123 040705 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Maximum of 14 service users in the DE (E) category Date of last inspection 7/2/05 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, and 32 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 Nursing Home G53-G53 S19026 gibsonslodge V179123 040705 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced, and was conducted over one day, taking 9 hours to complete. During that time a number of records were examined, a tour was made of the premises and time was spent talking with service users and staff. Due to ongoing concerns regarding the number of unmet requirements, this home received an additional inspection last year. At that visit it was noted that of the eight outstanding requirements two had finally been met, four remained outstanding, while it was not possible to assess two as they related to staff records, which were not available at the time of the visit. This inspection showed that two of those unmet requirements had finally been met however four remained unmet. This is of concern at some of them relate to staff recruitment, staffing levels, and the admission of service users who do not fall within the registration category of this home. This inspection has resulted in a further 6 requirements being made. These new requirements should not be difficult to meet, and in meeting them the home will improve the overall quality of the service being provided, and improve the well-being of the service users. What the service does well: What has improved since the last inspection? What they could do better: Gibson Lodge is registered to care for 32 service users who need nursing care because of their age and general frailty, plus a further 14 service users who require nursing care, but who also suffer from dementia. At the time of the Gibsons Lodge Nursing Home G53-G53 S19026 gibsonslodge V179123 040705 stage 4.doc Version 1.30 Page 6 annual inspection last year the home was clearly informed that they must stop admitting clients with dementia because they already had double the number they were registered for. In spite of this, the home has continued to admit clients in this, and indeed in the elderly mental health category, thus persistently breaching the conditions of their registration. Another area of major concern is the recruitment practice of the home. Given that an Enforcement Notice concerning this issue was served on Gibson Lodge’s sister home recently, it was of great surprise to find that little effort had been made to ensure that the recruitment documentation was of a satisfactory standard in this home. An immediate requirement notice was left with regard to the above issues, and consideration is being given as to further enforcement action. Requirements have been made relating to the issues outlined above, and they have also been made in relation to a number of other areas. The manager should be able to rectify most of these with little difficulty. One of the few areas of concern for relatives and service users was the lack of stimulation and suitable activities. The Inspector would agree with this, and it is a matter of urgency that the home recruits a designated activities co-ordinator. 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 Nursing Home G53-G53 S19026 gibsonslodge V179123 040705 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Gibsons Lodge Nursing Home G53-G53 S19026 gibsonslodge V179123 040705 stage 4.doc Version 1.30 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 standard(s) 3 and 4 (6 is N/A) The home is failing to ensure that the needs of service users admitted to the home can be met. While pre-admission assessments are carried out, because the home has greatly exceeded the number of clients with dementia that it is registered for, there is no guarantee that the staff team will be able to meet the specific needs of all of these service users. In trying to accommodate so many service users ‘out of category’, the result will be a diminished service to all residents. EVIDENCE: Gibson Lodge is registered to care for 32 service users who need nursing care because of their age and general frailty, plus a further 14 service users who require nursing care, but who also suffer from dementia. In spite of clear instructions to cease admitting over their registered numbers for clients with dementia, the home has continued to admit clients in this, and indeed in the elderly mental health category, thus persistently breaching the conditions of their registration. Since the last annual inspection some 15 service users with dementia/mental illness have been admitted. At the time of this visit the home Gibsons Lodge Nursing Home G53-G53 S19026 gibsonslodge V179123 040705 stage 4.doc Version 1.30 Page 9 had just 17 service users in the elderly category, 20 clients with dementia, and 6 clients with mental illness. Gibsons Lodge Nursing Home G53-G53 S19026 gibsonslodge V179123 040705 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 and 10 The service user plans seen adequately covered the health and personal needs of the service users, but did not include reference to their social care needs. This means that the staff team are not aware of the differing needs of their residents, and cannot fully know what specific care should be given. Staff ensure that each resident is able to access community based health facilities as and when required. There did not, however, seem to be a consistent approach to the care of pressure sores or other wounds. There was also a lack of assessments for, for example, pressure area care, nutrition, risk and manual handling. This means that staff may not be aware of specific treatment to be given, which in turn can have a detrimental effect on the service user. The medication administration records were being satisfactorily maintained. From observation and discussion with service users, the Inspector was satisfied that service users right to privacy was upheld. EVIDENCE: Each of the files inspected contained a service user plan and these were supplemented by a dependency level assessment. They did not, however, Gibsons Lodge Nursing Home G53-G53 S19026 gibsonslodge V179123 040705 stage 4.doc Version 1.30 Page 11 contain any reference to social care needs. Comment has been made in previous inspection reports regarding cross-referencing the needs identified in the service user plan to the daily notes. This is still not being done, so it is not always easy to identify what specific action staff have taken to meet individual service user’s needs. It was surprising to find that there were not any pressure area or nutritional assessments on file, while staff were inconsistent in completing manual handling and general risk assessments. A number of service users suffer from pressure sores however the treatment varied, and appeared to depend on which nurse was on duty. This was discussed with some of the nurses and the manager. The former felt that there should be a documented plan of care for each wound, and that this be consistently followed. The manager agreed but felt that some of the inconsistency arose because of changes made to treatment on the advice of the tissue viability specialists. This is true to a point, but does not account for all of the many different dressings being used for the same individuals. A number of service users kindly talked with the Inspector and they all felt that the staff made a point of respecting their privacy. Gibsons Lodge Nursing Home G53-G53 S19026 gibsonslodge V179123 040705 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, 13, 14 and 15 Although the staff do provide a number of activities, the lack of a designated activities co-ordinator does mean that there is not always enough stimulation for service users. This was a view shared by a number of relatives and residents. A number of service users met with the Inspector and they all felt that they were enabled to exercise choice and control over their lives. Visitors are encouraged to call. The lunchtime meal was sampled and was well prepared and appetising. Service users said that they found the food to be good. EVIDENCE: The home did have, for a time, the services of an activities co-ordinator, and it appears that she was popular and the activities she provided were enjoyed and appreciated. Unfortunately she chose to move on a number of months ago, and since then the home has been unable to recruit to the vacant post. This is one of the few areas that relatives and service users commented negatively about. They felt that there needed to be more stimulation and availability of activities. While the staff team do try to engage with the service users, their lack of skilled knowledge in this area and the fact that they also have their Gibsons Lodge Nursing Home G53-G53 S19026 gibsonslodge V179123 040705 stage 4.doc Version 1.30 Page 13 care duties to perform means that there is little, on a regular basis, to entertain the residents. The food was sampled and was well presented and appetising. No adverse comments were received about the meals, indeed one service user commented that the food had noticeably improved of late, and that the chef was responsive to service user’s requests. This same service user said that she would like to meet with the chef and other service users as a group, on a regular basis, so that the menus could be discussed. This is a valid suggestion and one that should be taken on board by the manager. Gibsons Lodge Nursing Home G53-G53 S19026 gibsonslodge V179123 040705 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 and 18 The home has a satisfactory complaints procedure in place, which is accessible to service users, and this is supplemented by a comments box in the main hallway. There was an adult protection procedure in place which, if followed by staff, will offer sufficient protection to service users. Unfortunately, this was somewhat negated because the recruitment procedures were still not satisfactory – see comments in Standard 27. EVIDENCE: No complaints had been made to the home since the last inspection visit however one anonymous complaint was made directly to the Commission. This complaint raised a number of issues, not all of which, on this visit, were substantiated. Two elements were upheld – the inconsistent wound care and the admission of service users out of category. Both of these have been discussed earlier in this report. The home has finally met the outstanding requirements re the need to revise both the Protection of Vulnerable Adults procedure and the restraint procedure. These are now satisfactory. Gibsons Lodge Nursing Home G53-G53 S19026 gibsonslodge V179123 040705 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) 19 and 26 A brief tour was made of the communal areas and generally the home was in a good state of repair. All of the areas inspected were safe, clean, pleasant and hygienic. This means that service users are provided with a welcoming, homely and pleasing environment in which to live. EVIDENCE: The communal areas, including some of the bathrooms and WC’s were inspected. All were found to be well kept and clean. Service users commented that their bedrooms were always kept clean and pleasant by the staff team. Service users are able to bring in their own personal possessions, and it was nice to see rooms outfitted with furniture brought in by the residents. There is an ongoing need for the home to purchase hospital type beds, as the divans that are still used are not suitable if service users need to use to hoist to be lifted. Gibsons Lodge Nursing Home G53-G53 S19026 gibsonslodge V179123 040705 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, 29 and 30 While the number of qualified staff on duty met the minimum levels, the number of care assistants consistently fell below the minimum levels previously agreed. This means that the needs of service users cannot always be attended to promptly. In spite of previous requirements, the home had not improved its recruitment procedure. This means that new staff are not properly vetted before being appointed, which places the service users at unnecessary risk. New staff are expected to work through an induction programme and a new inhouse training programme has been purchased which should provide staff with the opportunity to improve/enhance their skills. This will then have a beneficial effect on the care being provided to service users. There is a need for qualified staff to be enabled to attend additional courses so as to ensure that their skills are kept up to date. There also needs to be a drive towards care staff achieving NVQ level II qualifications as only 3 have achieved this so far. 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. Given that the home currently has considerably more residents with dementia/mental illness than it is registered for, it was required following the last annual inspection to immediately increase staffing levels. The rotas for two weeks were examined. On every shift there Gibsons Lodge Nursing Home G53-G53 S19026 gibsonslodge V179123 040705 stage 4.doc Version 1.30 Page 17 was a shortfall of between 1 and 3 carers on duty. Any further failure to meet the minimum levels could lead to enforcement action being taken. The quality of staff recruitment is another issue that has been raised on frequent occasions. It was of great concern to find on this visit that the standard had not improved. The files of 6 new staff were examined. All bar one of these had commenced work in the home prior to CRB/POVA checks being carried out. Only two had supplied the required two references, while there was no clear evidence that all staff who needed a work permit had one. Additionally, a number of the new staff had failed to complete a health declaration, or supply a complete work history. This is unacceptable. An immediate requirement notice was left with the manager, and consideration is being given to further enforcement action. There was evidence on just one of the new staff files that the staff concerned had received an induction to the home. The manager explained that this was because the staff would keep their induction programme with them so as to make it easier to work through. On completion it would be filed. Staff training undergone in the past year included first aid, POVA, fire safety and moving and handling. Qualified staff are expected to supervise and teach the carers however the proprietors must not overlook the fact that they too need to be enabled to attend training courses so that they can maintain their continuous professional development, as required by the Nursing and Midwifery Council. Only 3 of the care staff have achieved an NVQ level II award – there needs to be a concerted effort made if the home is to achieve the 50 target set out in the Standards by the end of this year. Gibsons Lodge Nursing Home G53-G53 S19026 gibsonslodge V179123 040705 stage 4.doc Version 1.30 Page 18 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) 33, 35 and 38 The home now has in place a quality assurance system, which enables the management to identify any areas where the service is sub-standard and then, hopefully, take action to improve it. This means that the home is run in the best interests of the service users (to the extent that it is able, given the low staffing levels). None of the service users have any of their financial interests managed by the home. The lack of up to date risk assessments for both individual service users and the premises in general, indicated that the home was not being maintained to an appropriate level of safety, thus putting service users at risk. EVIDENCE: The quality assurance system includes audits of the various working practices in the home. These audits are carried out at regular intervals and the results Gibsons Lodge Nursing Home G53-G53 S19026 gibsonslodge V179123 040705 stage 4.doc Version 1.30 Page 19 were available for inspection. The manager is about to start sending out questionnaires to service users and relatives so as to gain their views of the service being provided. She also plans to start holding relatives meetings. While the home does have risk assessment documentation in place, this has not been reviewed for over a year. The Inspector could not find any evidence that risk assessments had been carried out on all newly admitted service users. Gibsons Lodge Nursing Home G53-G53 S19026 gibsonslodge V179123 040705 stage 4.doc Version 1.30 Page 20 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 1 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 1 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x 3 x 3 x x 2 Gibsons Lodge Nursing Home G53-G53 S19026 gibsonslodge V179123 040705 stage 4.doc Version 1.30 Page 21 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 29 Regulation 19 Requirement The proprietor must ensure that staff provide all the necessary documentation before commencing work. The previously set timescale has not been met. The proprietor must inform the CSCI how he plans to address the issue of having admitted more clients with dementia than he is currently registered for. The previously set timescale has not been met. The service user plan must be based on needs identified during the initial assessment and should be used as a basis for the care provided. The previously set timescale has not been met. The number of staff on duty must not fall below that indicated on the staffing notice. As the home currently has 12 more residents with dementia/mental health than it should, an additional care must be added to each shift. The previously set timescale has not been met. The provider must not admit any further residents in the dementia G53-G53 S19026 gibsonslodge V179123 040705 stage 4.doc Timescale for action 4/7/05 2. 4 14 30/7/05 3. 7 15 4/7/05 4. 27 18 4/7/05 5. 3&4 14 4/7/05 Page 22 Gibsons Lodge Nursing Home Version 1.30 6. 7. 8. 7 8 12 15 12 16 9. 30 18 10. 38 13 category until such time as the number of such clients in the home falls below 14. At no stage should clients in the mental health category be admitted. Service user plans must include reference to social care needs. The manager must ensure that there is a consistent approach to wound care. The registered person must ensure that service users are provided with an adequate variety and number of activities. The registered person must ensure that qualified staff are enabled to attend training courses. The number of care staff on NVQ level II courses also needs to be increased. The manager must ensure that risk assessments are carried out both on the premises in general, and for each service user, and that these are regularly reviewed. 4/8/05 4/7/05 4/8/05 4/9/05 4/8/05 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. 2. Refer to Standard 15 24 Good Practice Recommendations It would be good practice to enable service users to meet periodically with the chef to discuss the menus. The registered person must continue to replace divan beds with more appropriate hospital type beds. Gibsons Lodge Nursing Home G53-G53 S19026 gibsonslodge V179123 040705 stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 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 Nursing Home G53-G53 S19026 gibsonslodge V179123 040705 stage 4.doc Version 1.30 Page 24 - 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!