Inspection on 12/12/08 for Gifford House Care Home

This inspection was carried out on 12th December 2008.

CSCI found this care home to be providing an Adequate service.

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

Gifford House Care Home 27/10/09

Gifford House Care Home 07/01/08

Gifford House Care Home 23/07/07

Gifford House Care Home 09/01/07

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2009.

CARE HOMES FOR OLDER PEOPLE Gifford House Care Home London Road Bowers Gifford Basildon Essex SS13 2DT Lead Inspector Mrs Bernadette Little Unannounced Inspection 12th December 2008 10:00 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 Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 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. Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gifford House Care Home Address London Road Bowers Gifford Basildon Essex SS13 2DT 01268 554330 01268 498070 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) AMS Care Limited Alan James Young Care Home 61 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (39), Old age, not falling within any other of places category (61) Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Number of places not to exceed 61 in total. One named person known to the Commission, aged under 65 years. Date of last inspection 7th January 2008 Brief Description of the Service: Gifford House Care Home is a purpose-built, elegant two-storey building situated in a rural location but within easy access of Saddlers Farm roundabout, and all major local routes including the M25, A127 and A13. Parking is available on site. There is a large enclosed garden area, which is accessible and includes seating a patio area as well as walks. The home provides care (with nursing) and accommodation for up to 61 older people, including up to 39 people who have dementia. All bedrooms are single and ensuite and sited on both floors. There are also a number of lounges and lounge/ dining rooms, a smoking room and a quiet room/visitors room, as well as several areas around the home where additional seating is available. A passenger lift provides access to all levels within the home. The home has six assisted bathrooms and three shower rooms, and well equipped laundry and kitchen facilities. The homes weekly fees currently range from £535.00 to £750. Additional charges to residents are for hairdressing and chiropody. There are no charges to residents for staff escorts to hospital appointments etc. Residents make individual arrangements with the local newsagent in relation to newspapers and magazines, provide their own personal toiletries and would also pay the going rate for taxis to appointments. Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. The site visit was undertaken over a nine hour period on one day by two inspectors as part of the routine key inspection of Gifford House. A specialist of pharmacist inspector was also present for part of the day to review medication. There were 55 people living at Gifford House. Time was spent with residents, visitors and staff and information gathered from these conversations, as well as from observations of daily life and practices at the home have been taken into account in the writing of this report. The manager submitted an Annual Quality Assurance Assessment (AQAA) as required prior to the site visit. This is required to detail their assessment of what they do well, what has improved and what could be done better. This information was considered as part of the inspection process. Prior to the site visit, we sent the manager a variety of surveys to distribute and that asked questions that were relevant for each group, such as for residents, relatives, staff, care managers and healthcare professionals. Completed surveys were received from three residents supported by relatives, one resident directly, six relatives, two staff, and three health professionals. The information they contained are included in this report. A tour of the premises was undertaken and records, policies and procedures were sampled. As part of the inspection process, a short focused observation was undertaken within one unit at Gifford House. This involved the inspector observing four people who use the service for a continuous period of 2 hours and recording their experiences at regular intervals. This included observing their state of wellbeing, how they interacted with staff members, other people who live at the care home, visitors, and the environment. We also looked at records and documents including their care plans, and spoke to staff members. The manager and registered provider were present during the site visit and assisted with the inspection process. While a number of improvements are noted from the last inspection, including in relation to care planning, there remained identified shortfalls in the care planning system that could impact on care outcomes for residents. As this has been an outstanding requirement from previous inspections, the registered provider was sent a letter of serious concern, to which they have responded. The outcomes of the site visit were fed back in detail and discussed with them and opportunity was given for clarification where necessary. Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 6 The assistance provided by all of those involved in this inspection was greatly appreciated. What the service does well: What has improved since the last inspection? The statement of purpose and service user guide have been updated and expanded to provide good quality of information to people thinking of using the service. Some more permanent staff had been recruited allowing more consistency and continuity of care for residents. All the required records were available on files sampled to show that the necessary information and checks had been obtained for prospective staff. A robust recruitment procedure safeguards residents. Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 7 Staff had been provided with more training to help them to do their job to a standard that support residents more effectively. The way that training was recorded and evidenced had also improved. Staff were receiving formal supervision on a regular basis. This provides support for staff and enables them to look at their practice and plan with their manager any actions that need to be taken to support residents or training that staff may need to do this more effectively. A deputy manager had been recruited who supported the manager and also spent time working alongside staff in caring for residents. This assisted in communication and provided another person who was able to give training to staff. Practices and procedures for the safe storage, recording and administration of medicines have improved. 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. The summary of this inspection report can be made available in other formats on request. Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5. Standard 6 does not apply to this service Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents can expect to be provided with good information on which to base a decision to live at Gifford house and to have an assessment of their needs to confirm that these can be met there. EVIDENCE: There is a clear and informative statement of purpose that has recently been updated and that sets out the aims and objectives of the home. The service user guide has also recently been updated and is written in clear print supported by photographs and symbols to make it easier to read and understand. The documents contained the required information and meet the requirement from the last inspection. Copies of the service user guide were seen to be available in resident bedrooms and a visitor and residents spoken with confirmed that it had been provided to them as part of the pre-admission process. A survey received from Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 10 a relative suggested it would be helpful if relatives were given a small leaflet to inform them on issues such as signing in and out of the home, door keypad numbers, times of meals and what to do on hearing the alarm bell. Surveys received from people using the service confirmed that they were given enough information about the home before they moved in so they could decide if it was the right place for them. The AQAA states that all prospective residents are sent a letter setting out the terms and conditions before they are admitted to Gifford house. Surveys received also confirmed that they had received a contract stating their terms and conditions. Copies of these were also seen to be available on the resident files sampled. In their AQAA, the manager confirms that residents are only admitted after a full assessment, except in cases of an emergency when this is done within 48 hours. The manager or the deputy manager undertake all the pre-admission assessments. The files for three more recently admitted residents were reviewed. These demonstrated that a preadmission assessment had been undertaken so that the manager could be sure that the persons needs could be met at Gifford House. Letters were also seen on each file from the manager confirming to the person that based on their assessment, their needs could be met. The service user guide invite people to visit the home prior to their admission to allow them to look around, meet people and ask questions to help them reach decision in their choice of home. Relatives spoken with confirmed that they had been able to do this. In the AQQA, the manager confirms that intermediate care is not offered at Gifford House. Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there are generally positive care outcomes for residents, some shortfalls in care planning means that residents cannot be assured that all of their needs would be met. EVIDENCE: The manager’s AQAA states that they had developed a care plan format that was person centred and identifies and records how they meet residents’ needs and contains risk assessments. A number of care plans reviewed showed an improvement from the last inspection including for example routine weekly recording of resident weights to support monitoring of nutrition and support healthcare. The AQAA also states that care plans are reviewed monthly to ensure it is updated and changes in the resident’s condition made. However areas were identified where full or up to date information was not included in care plans to ensure accurate information was available on how the persons’ needs were to be met. Examples included no management plan of care where a high risk of Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 12 falls was identified, or where the assessment information identifies a grade two pressure area on admission. Where a person presents behaviour that challenged the care plan stated that there were no identified triggers, but where these were clearly identifiable on reading the daily care notes. Daily care notes were also generally noted to be improved and to have with more detail. However, some recording continued to show examples such as fluid intake poor, will phone GP tomorrow but no further information on what action was taken. A nutrition assessment indicated no risk for a resident, yet it was clear from discussion with staff and the care notes that the person was not eating and having only limited fluid intake. The opposite information was recorded in the daily nutrition records. The GP had been informed on the day of the site visit and a fluid chart recently out in place. The manager confirmed that the assessment of risk and the plan of care should have been updated and a clearer management strategy in place. Surveys received from residents indicated they felt they received the medical support they needed. One relative added the comment “there has been concern about getting the GP to attend, but we understand this has now improved”. Surveys received from three healthcare professionals were positive regarding the care provided to people at Gifford House. One said “delivers quality highend care to those in need and is flexible and well motivated as a team”. Another said “ I have very high regard for Gifford House due to the high standard of care provided to my patients. If my intervention is required I get contacted early to enhance the possibility of a good outcome.” A Pharmacist Inspector examined practices and procedures for the safe handling, use and recording of medicines. Medicines are stored securely and in suitable conditions, which are temperature controlled. This ensures the quality of medicines in use. However, on arrival, the container used to store medication waiting to be disposed of was open with medication accessible. This is unsatisfactory since unauthorised people may access medication. We expect this to be managed rather than make a requirement on this occasion. We examined the medication in use, medication records and associated care records for several residents in the home. Records are kept of when medicines are received into the home, when they are given to residents and when they are disposed of. These were generally in good order and provide an audit trail of medicines used. We found a discrepancy in the disposal record of one medicine which could not be accounted for and this needs to be improved. Care plans for people whose medication is given by special means and on a “when required” basis should be expanded to provide more detailed guidance for staff and to protect residents. We expect this to be managed without the need to make a requirement. Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 13 We watched medication being given to some people on Radcliffe Unit and this was done professionally with due regard to people’s dignity and personal choice. Residents spoken with said they felt their privacy and dignity was respected by staff, for example when coming into their room or when providing personal care. Surveys from health professionals also confirmed that in their experience this care service respects residents’ privacy and dignity. Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect opportunities for social activities and to exercise choice in areas of daily life, including meals, that are in some ways more readily available to more able residents. EVIDENCE: The AQAA states that three activities co-ordinators were now employed so that there were activities available in each unit. A pictorial programme of activities was available that showed the activities available, mostly on weekdays and that included quiz, bingo, reminiscence, pets as therapy, ball games, one to one time and church service. One activity was planned for each day, many of which were suitable for groups and not for those who need more one to one support and stimulation. Outside entertainers were available and children from a local school were singing for residents during the site visit. Residents spoken with in the downstairs unit said there were activities available that they could choose to join in with. Surveys indicated that residents felt there were usually activities available they could join in with. A relative survey said “the entertainment programme is frequent and well attended, especially in the summer” while Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 15 another said “not enough stimulating activities to meet the needs of my relative. Resident doesn’t feel comfortable in the group, needs one-to-one simulation e.g. playing cards”. The short focused observation indicated that there is a need for improvement in activities for people living with the experience of dementia. The manager and registered provider agreed and advised that one activity coordinator has recently left them without warning. The AQAA also acknowledges a need to further “increase the amount of daily life and social activity currently offered”. A healthcare professional commented that one way the home could improve is in the provision of activities for people who ‘wander’. Visitors spoken with said they felt welcome at Gifford House and one person said it is like a home from home. Residents spoken with said that their visitors were welcomed. Residents spoken with a said they can make choices for example regarding food, where to sit or whether to join in activities. Staff asked how they believed residents can operate choices and control in everyday life said in food and drinks, in what time to get up and go to bed, in the way they spend their time, whether to have a bath or shower, and when, what they wanted to do/whether or not to join in activities and what to wear. A staff member said that even when people seem not really able to make a choice, they would always offer a couple of appropriate outfits and see if the person shows any indication of a preference, also “that way their clothes are matched and they would look good and that supports their dignity as you would not want them wearing ‘ odd’ clothes, the way you would help your own parents”. As stated in the section on environment, limitations on residents, and their rationale, should be recorded. A survey from a health professional notes that residents in the upstairs units routinely try to open the exit door and while they are usually easily distracted, there does not seem to be care planning in place to take these residents out. The manager’s AQAA states that mealtimes are viewed as social occasions offering a choice of food in an unhurried and comfortable environment. They also state that residents are offered three cooked meals per day. The menu available confirms this with three choices at lunchtime. The deputy manager advised that lunchtime in the upstairs unit has been put back for half an hour, to ensure ample time between breakfast and lunch for residents. Surveys received from residents indicated that they are generally satisfied with the meals provided. A relative had added a comment for a resident my meals are puréed, but always presented nicely. Residents spoken with confirmed they had enjoyed their meals. The lunch and tea time meals were observed both in the upstairs and downstairs dining rooms. Tables were pleasantly set with cloths. Residents Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 16 were offered choices, including two meals from which to make an active choice, which is good practice. Meals were well presented. Staff supporting residents sat with them to assist with feeding and apart from one occasion, the interaction between staff and residents was positive and patient and respectful. Staff were also seen to monitor residents and encouraged them to stay at or return to the table to eat their meal. Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management team has systems in place that generally help to ensure the complainants views will be listened to and that residents are safeguarded from abuse. EVIDENCE: The management team have a complaints procedure that identifies steps to take to make a complaint, and the timescales within which they can expect action and response. Information on the complaints procedure was available in the home and clearly explained in the service user guide. It provides contact details for the local social services and the statement of purpose has current contact details for the Commission as required. The AQAA states that a record is kept of all complaints and compliments and that four complaints had been received in the past twelve months, two of which had been upheld. A log of complaints was available that recorded relevant information. This was supported by evidence of investigation and responses to the complainant and so met the requirement of the last inspection report. One of these complaints had been referred by the Commission and the complainant stated that they had raised the issues verbally with the manager previously. A survey received indicated that a relative had raised an issue regarding stained crockery but this continued to occur. These verbal complaints were not recorded and this is an area for development by the manager. Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 18 A number of cards and letter of thanks and compliment were seen to have been received with comments such as “for help, kindness and support given or taking on outing, obviously a great success. All surveys received from residents and relatives confirmed that they know who to speak to if they were unhappy and would know how to make a complaint. Staff surveys received confirmed they would know how to respond if a concern was raised with them. The manager states in their AQAA of up-to-date procedures on safeguarding adults are available. Following his attendance and the safeguarding adult conference, the team have adopted the Dignity Challenge approach as detailed in the service user guide. As recommended at the last inspection, the whistleblowing procedure had been extended to include contact details for staff on relevant authorities. The training matrix and files sampled confirmed that staff had had training in safeguarding vulnerable people. A number of staff spoken with, both new and long serving, confirmed that they had attended training on safeguarding, were clearly able to identify types of abuse and were aware of whistleblowing procedures. The Commission received anonymous information earlier this year of poor care of medication practices at the home, which was passed by the adult safeguarding team to social services quality and development team to review and monitor. The registered provider of Gifford House advised it was likely that this was linked to a dissatisfied staff member. The manager confirmed that there had been no safeguarding referral or restraint events at Gifford House since the last inspection and that the Commission would be notified immediately should this occur. It was noted positively that the training matrix identifies that a number of staff have recently completed training on risk and conflict management and this was confirmed on files sampled. Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People at Gifford house live in a pleasant, clean and safe environment that meets their needs. EVIDENCE: All areas of the home were viewed including some residents’ bedrooms. The home was, as always, well maintained, with a high standard of furnishing and décor. Peoples bedrooms were personalised to various degrees with photographs etc. and residents spoken with said they were satisfied with their own rooms. There are ample bath and shower facilities on each unit. Each unit has a lounge with a hearing loop system and satellite kitchen and there are other areas quieter seating areas available as well as a smoking room. All areas of the home are wheelchair accessible. The maturing garden is accessible to residents of the downstairs unit. Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 20 No health and safety issues were observed. There was safe storage of hazardous items. Window restrictors and hot water temperatures were sampled throughout the home to ensure they were safe for residents. None of the residents in the downstairs unit had a key to lock their bedroom. To ensure that residents had opportunity to exercise choice and control, we sampled a number of residents’ files and found confirmation that the question had been asked about their preference for this or risk assessed to see if it was safe for them to have a key. The bedrooms of several residents in the upstairs units for people living with dementia were locked during the day and the key kept by staff. Staff advised that this was because some residents wander into the rooms of other residents and damage their personal items, which does not respect their privacy. This limitation on peoples’ choice and the rationale behind it was not recorded on the file for each person affected by it to demonstrate respect for peoples’ right to make decisions and choices. Staff did say that some people like to go back to their room after lunch to rest and rooms are unlocked for them when ever they wish to go there. Some of the crockery in Betts unit was stained, both in the cupboard and on completion of a dishwashing cycle. The report of the homes quality assurance showed that the management team had previously been informed of this. The registered provider stated that there was an automatic mix of the liquid into the machine that will now be adjusted to address this. All areas of the homes were clean with no unpleasant odours. Surveys received from residents indicated that they found the home fresh and clean and one person said they have found the cleaning staff very hard working and also the laundry staff and feel these people are overworked and underappreciated by the management. Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to be supported by adequate numbers of competent staff and to be safeguarded by the robust recruitment procedures in place. EVIDENCE: Staff rotas and surveys indicated that staffing levels are adequate but that staff would like to have more time to spend with the residents. Staff spoken with the said that the staffing levels are adequate to meet residents needs if everybody turns up but occasions when staff phone in sick cause a problem as it takes time for agency staff to get to the home. They added that the provider tries to use regular agency staff on each of the units so that at least residents know the staff and the staff know the routines. This offers more consistency and continuity of care for residents. Residents and relatives spoken said that staffing numbers are satisfactory, that staff come when they ring the bell and listen to what people say. Resident surveys confirm that staff are generally available when they need them and that staff listen to them and act on what they say. This shows respect for residents. Two relatives had concerns about some of the agency staff used regarding language skills and lack of staff available at night especially if the few staff on duty are agency staff. The registered provider confirmed there are more agency staff that they would like, mainly at night and they are Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 22 continuously endeavouring to recruit additional permanent staff of a suitable calibre. All surveys received from relatives indicated they felt that the care staff generally have the right skills and experience to look after the residents properly. The manager advised of using a different company to arrange NVQ training for staff. The matrix identified that of 27 permanent care staff, nine have achieved NVQ level 2, five have commenced in this training and six staff have commenced NVQ level 3, a noted improvement. Recruitment files were sampled for three permanent staff employed since the last inspection. These showed that all the required information, references and checks were in place prior to the staff starting to work at Gifford House, so safeguarding residents. This is a noted improvement from previous inspections and meets the requirement identified in the last inspection report. Profiles were sampled for agency staff identified from recent rotas. These were current, confirmed required references and checks were in place, and that appropriate induction and training had been provided. Initial inductions to Gifford House were recorded for some but not all agency staff. Induction records to skills for care standards were available on the three permanent staff files reviewed, completed to various levels dependent on the time the staff had been employed. They were supported by evidence of training on issues such as moving and handling, medication, fire, health and safety, safeguarding adults, dementia awareness, risk and conflict management, infection control and food safety and hygiene. Following evidence of disappointing interaction between a carer and residents, an additional induction record was sampled. This has not been fully completed although training had been provided. The management team advised that they were already monitoring the person’s performance. Staff spoken with said they felt they were offered plenty of training and support at Gifford House. Staff surveys indicated they were generally satisfied with their induction and communication systems and were being given training relevant to their role. A detailed and well maintained training matrix was in place that identified the start date of induction for each person, their NVQ status, all basic training as well as additional training on topics such as pressure area care, nutrition, disability discrimination, palliative care, stoma care and other conditions pertinent to the needs of the residents of Gifford House. While continued development is expected, this is a further noted improvement since the last inspection and the requirement issued at that time is considered met. A number of surveys contained positive comments regarding the staff including the care staff are very friendly and I have a very high regard to all that work there, décor, cleanliness efficiency and kindness. Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents of Gifford House can expect a service that is increasingly effectively run, seeks their views and promotes their health and safety. EVIDENCE: Since the last inspection and the manager has completed the Registered Managers Award and a palliative care course. Additionally, a deputy manager has been appointed who has experience in caring for people living with dementia. The deputy also undertakes two shifts per week working as part of the nursing team thus providing additional management and clinical support. Recent rotas viewed did not show either the manager or deputy in the home regularly at weekends to consistently maintain this level of support. Previous rotas provided did show that this did occur on occasions. Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 24 This report identifies a number of improvements since the last inspection and where requirements and recommendations have been met and implemented. This demonstrates a positive management approach to developing and improving care outcomes for people using the service. The management team have a quality assurance programme in place that includes obtaining views from residents and relatives. The analysis of the surveys was readily available within the home and included individual comments as well as statistics. Results overall were very positive particularly the satisfaction with the nursing care provided. The AQAA confirms that audits are undertaken of care plans, medication and the environment. The registered provider is involved with the home on a regular basis and undertakes detailed monthly reviews of the home as required with reports available to evidence this. A number of records were reviewed as part of this inspection process. Accident records and notifications were appropriately maintained. A monthly analysis is undertaken of accident records to monitor for any patterns that could help for example in falls prevention. Rosters did not contain the full names of all staff for clarity and accuracy. Employment history dates in employment applications were not as fully detailed as required to ensure any gaps could be explored. The manager holds small amounts of personal money in safekeeping for residents. A two signature system is operated and records inspected were in good order with receipts available. Records and balances for three residents were sampled at random and found to be in order. The managers AQAA states that staff receive supervision every eight weeks. Staff files sampled showed that supervision is taking place regularly. The deputy manager advised that a new system has been introduced where staff receive an initial performance audit followed by recorded and reviewed supervision sessions. Surveys receive from staff confirmed that their manager meets regularly with them to give them support and discuss how they are working. The management team have a health and safety policy and the systems in place to promote the well-being of all those at Gifford House. Evidence was available that a health and safety audit had been undertaken by an outside consultant earlier this year. A sample of safety inspection certificates including for the nurse call, fire alarm and emergency lighting systems were available and current. Records showed weekly tests of the fire alarm and fire door selfclosures. Records show routine fire drills take place but these do not record the names of care staff as they stay on the units with the residents. The manager stated that all staff participate in a fire drill as part of their fire training and induction and again as part of their six monthly fire training update. A recent letter from Essex Fire and rescue service records a satisfactory standard of fire safety evident. Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 25 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 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 3 3 3 X X 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 2 3 Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15 Requirement So that residents are cared for safely and in a way that meets all of their care/nursing needs, care plans must identify all their individual assessed needs, be up to date and supported by risk assessment and provide staff with sufficient information to enable them to offer residents proper and consistent care and assistance. This includes areas identified in the report such as preventative pressure care, management of behaviour that challenge, medication, restrictions, preventative pressure area care and social care needs and interests. This is an outstanding requirement. Timescale for action 15/01/09 Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 27 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 OP12 Good Practice Recommendations Ensure that all people living at the home, including those people who have cognitive impairments, have their social care needs. Limitations placed on residents and their rationale should be recorded. A system should be available to record verbal complaints and how they are actioned. 50 of care staff should achieve NVQ Level 2. Rosters should contain the full name of all staff, both permanent and agency for accuracy and clarity. Employment history records should contain specific dates so that gaps can be clearly identified and explored to safeguard residents. 2. 3. 4. 5. 6. OP14 OP16 OP28 OP37 OP37 Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Gifford House Care Home DS0000067933.V373497.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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