Inspection on 23/07/07 for Gifford House Care Home

This inspection was carried out on 23rd July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Gifford House Care Home 27/10/09

Gifford House Care Home 12/12/08

Gifford House Care Home 07/01/08

Gifford House Care Home 09/01/07

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

CARE HOMES FOR OLDER PEOPLE Gifford House Care Home London Road Bowers Gifford Basildon Essex SS13 2DT Lead Inspector Bernadette Little Unannounced Inspection 23rd July 2007 07:35 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.V345064.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.V345064.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 Mr 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.V345064.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Number of places not to exceed 61 in total. Date of last inspection 9th January 2007 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 £513.00 to £650. 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.V345064.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection included a site visit undertaken by two inspectors, Bernadette Little and Michelle Love, who were at the home from 7:30 a.m. to 8:30pm. Additionally, due to concerns at the first key inspection and again at the random inspection, a specialist pharmacist inspector also spent a number of hours at the home inspecting and feeding back on the homes management of medication. While improvements were noted at a pharmacist random inspection in April 2007, there continues to be identified concerns regarding the management of medication at Gifford House. A tour of the premises was undertaken and records, policies and procedures were sampled. Care files for three residents were case tracked and others were sampled for individual care management issues, making a total of nine. Five residents, two visitors, four staff, the care manager, the homes registered manager and the registered provider were spoken with. 20 survey questionnaires were sent to the home to make available each to residents and relatives prior to the site visit. The registered provider explained that he had arranged for a copy of the survey to be sent to the relatives of all service users, approximately 60 in total. 9 surveys were also provided to staff and the opportunity given to the manager to copy these and provide them to further members of staff should they require them. Surveys were also sent to a chiropodist, two district nurses, five GPs, and eight social workers/care managers from different funding authorities, including five within the Essex region. By Friday, 10th August, responses were received from five staff, one social worker/care manager and one GP (apologies were received from another GP who felt unable to answer the questions). Responses were also received from nine relatives and five residents. Comments received from all the sources are reflected throughout the report. The registered manager completed an Annual Quality Assurance Assessment (AQAA) document and returned it to the commission prior to the site visit. Information from this document was also used to inform this report. The registered manager and registered provider were very supportive of the inspection process, providing information in a timely manner and as requested, and expressing clear commitment to wishing to provide a good quality service. Due to the number of requirements identified and the number and areas of judgments identified as Poor at the homes first key inspection, an additional unannounced random inspection took place in April 2007. This focused on specific issues such as staff recruitment/ induction/training, medication and care management for residents and found very limited improvements. Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 6 Discussion of this site visit’s findings again took place in specific detail with the registered manager and registered provider on the day. Some additional improvements are noted at this key inspection. These however are again limited in consideration of the issues involved and this inspection identified continuing major areas where the home is not meeting national minimum standards, complying with regulation and providing safe and quality care outcomes for residents. While the improvements were noted positively, guidance and advice was given on the concern regarding, and the need to address without delay, the Regulations and National Minimum Standards that the home continue not to meet. A number of the requirements from the last inspection report have been combined in the requirements section at the end of this report. The commission will continue to monitor Gifford House and unless the requirements are met, will review the situation and take appropriate action. What the service does well: What has improved since the last inspection? Recently admitted residents had had their needs assessed by the home before they were offered a place there and the home had written to them to say that they could care for and meet these needs. Residents were also given a contract so that they had more information on their rights and responsibilities for living at Gifford House. The premises were safer for residents than at the last inspection and no hazardous items were seen to be available to residents. Aspects of infection control were also notably improved. Bedroom doors now Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 7 had the persons photograph/name on the outside to help people to recognise their own personal space from all the other doors. Two peoples’ signatures were also now recorded for withdrawal of residents’ money, which is a safer system and protects people. The rotas were better maintained. Some training had also been provided for some staff in safe moving and handling, first aid and medication, which protects both staff and residents and helps staff to look after residents better. 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.V345064.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.V345064.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, 4, 5 Quality in this outcome area is adequate. Prospective/residents are provided with some information about the home and can visit before making a choice to live there. Their needs will be met by the premises and the equipment available, but not necessarily by the number and skills of the staff caring for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Surveys received from service users, relatives and other stakeholders indicated that they were/are provided with enough information about the home. The AQAA advises that the service user guide is given out at pre-admission visits and that the home encourage prospective residents and relatives to visit the home prior to making a choice. Gifford House has produced a reviewed statement of purpose and service user guide since the last inspection. Copies were seen to be made available within the home at the time of the site visit. A copy of the most recent inspection report was not displayed in a prominent place in the home, but the registered Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 10 manager advised that it usually is but that the displayed copy was given to a social worker very recently. The statement of purpose does not include all the information required by regulation and schedule for example relating to the number, relevant qualifications and experience of the staff working at the care home, the fire precautions and other emergency procedures, or the arrangements for ensuring reviews of care plans. Discussion with the registered provider confirmed that the home will continue to be registered for 61 people in total, including up to 39 people who have dementia, and while for the present it will continue to offer one place to a person with a mental disorder, the home does not wish to register over all to provide care for people with a mental disorder. The service user guide is well presented and written in large print in clear language. It does not comply with the amendment to regulation that requires details of the total fees payable for various services and the arrangements in place for charging and paying for services/additional services for self funded clients. Documentation was sampled for three more recently admitted residents and indicate that the home undertook a pre-admission assessment and also had available information other relevant sources for example a local authority COM 5 form. One of the homes own assessments showed that the resident’s family had been involved in providing information. Two of three files sampled demonstrated that the home had written to the prospective resident confirming that, based on their assessment, the home could meet their needs. Signed and dated contracts were seen on the three files, two of which were privately funded and one was funded by a local authority. Premises and equipment did meet residents’ needs effectively. Staffing levels and skills/competence did not. Assessment of nine individual care management files along with direct observations demonstrated that residents of Gifford House have a wide variety of specific individual needs and conditions including diabetes, Parkinsons disease, dementias, continence, mobility, communication, anxiety, aggression as well as more general care and nursing needs. The section on Staffing identifies that there is no evidence to show that the majority of staff have had training on many of the basic issues and this continues into the more resident specific issues. Observation of practice and reading of care plans and daily care notes does not reassure that all staff are competent to manage residents specific individual care needs effectively. Gifford House Care Home DS0000067933.V345064.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 poor. Residents can not be assured that their health and personal needs will be set out clearly in a plan of care that supports staff to provide them with individual, safe, quality care outcomes, or offers them safe management of medication. Not all residents will find that their privacy and dignity is respected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Nine care files were sampled randomly from across the three units, three in full detail and the other six for more specifically identified issues. Some areas of some of the care plans showed good detail such as the person’s preference for night-time routines, the detail of the type of continence aids to be provided, information on religious/cultural needs and safe custody of medication. Files contained a sheet that identified the persons strength and weaknesses and the many areas where the person might still be independent and require limited interventions so respecting their dignity. Also noted positively was a recent Life Pathways plan that contained good detail of the goal/aim and actions/ instructions for staff to follow. Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 12 Of the five staff surveys received two felt they were given up-to-date information about the needs of the people that they were to provide care to. The plan of care for a person living at the home for almost 4 weeks contained information on limited elements, referring to supervision with washing and dressing (but no detail for staff on how this support was to be given in practice), management of falls and wandering/risk of leaving the home, but with no specific information on how to manage these. Information on the resident file from a funding authority indicates that they had had a number of falls, were at high risk of leaving the home and also had some specific behavioural issues. A falls risk assessment had not been completed by the home. The homes risk assessment checklist identifies no current risk/no previous history of absconding but adds the comment that the resident could leave the home, and the document states there is no current risk of falls/no previous history but with the added comment ‘remains a risk of falling and at risk of wandering’. There was no reference to the persons clear mental health needs as identified in the Care Program Approach review records. One resident’s assessed information from the local authority identified that they would require skilled intervention to ensure their safety and that of those around them and reduce the likelihood of situations escalating as they do have the potential for physical aggression. The home’s care plan to manage this was poor and does not specifically detail how the aggression manifests, possible or known triggers and how it is to be managed by staff. The person was observed at lunchtime to become verbally very challenging to staff, who did not deal with the situation particularly well or with dignity for the resident. No risk assessment was in place relating to the specific need. Care notes indicated that the person has pressure sores. Three days later care notes record two small grade 2 pressure sores and details that nutritional supplement drinks have been provided and an airflow mattress is to be placed on their bed. There was no evidence that steps had been taken to purchase/obtain an airflow mattress for this person. The care plan made no reference to the person having the pressure sores. No risk assessment was in place and the Waterlow (a risk assessment for the likelihood of skin breakdown) had not been updated for two months previous to this. The resident’s safe custody of medication sheet does not detail that they receive pain relief, yet they are prescribed paracetamol. The sheet was dated some seven months previously and had not been updated. The other care plans sampled did show some areas of good detail with clear instructions for staff to follow to provide the consistent care needed to manage the persons individual issue, with regular review. In the main however many areas of the care plans provided more evidence that peoples’ assessed needs had not been included in their care management instructions, that appropriate risk assessment had not been undertaken or kept Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 13 updated and that there was poor information for staff to help them to manage residents’ needs including aggression/physical aggression, inappropriate behaviours, refusing to take medication, wandering including into other residents’ bedrooms at night and on several files information on their social/leisure activities and wishes for end of life had not been completed. A risk assessment indicated a very high risk for a resident and required two hourly changes of position, a high nutritional/calorific intake and they also needed fluids to be constantly encouraged. The nutritional assessment however identifies there is little or no risk present, the qualified nurse on duty advised that the resident is not turned two hourly and that fluid charts are not in place and do not need to be. Care notes varied in their quality and content and records such as “ all care needs met” were unhelpful. On occasions there is only one entry during the day, which explains nothing about the persons well-being or how they spent their day, which would help in reviewing care plans and quality care outcomes. Regular recordings of residents refusing medication, becoming “violent and aggressive” record no other information on staff interventions and how the resident was cared for. Care notes indicated that tablets had to be crushed for a resident, as they were resistant to taking their medication. There was no record of this being identified as a restriction of the persons rights. On another occasion where medication had been omitted or was not available for staff to give to the person, had no evidence that advice had been taken from the GP as to how this might affect the persons well-being. Care notes showed where a resident had a fall and later complained of pain in their right hip and were unable to walk. The GP was to be called but there was no evidence of this occurring until the third day, when the person was taken to hospital and had a fractured hip. Files indicated where residents had been supported to access health care services such as the Parkinsons clinic, assessment for dysphasia, GP, optician and chiropody Visits. Records also indicated where the home have endeavoured to obtain medication review from a community psychiatric nurse and were trying to liaise with a resident’s social worker for greater support. The survey received from a GP said that the home usually seeks advice and acts on it to manage and improve the individuals health care needs, that while there have been occasional minor prescription dispensing problems, communication with the home has been good where necessary to resolve the problems and that the individuals health care needs are usually met by the service. The registered manager and responsible individual advised that medication training had been recently provided for the qualified staff by a qualified pharmacist. Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 14 A senior qualified staff member was observed to physically handle a resident’s tablets before putting them into the persons mouth, which does not respect the residents dignity and introduces a risk of cross infection. A specialist pharmacist inspector examined the practices and procedures for the safe use and administration of medicines. In general the policy and procedures for the safe use of medicines provide staff with clear guidance, but there are areas where these could be improved. Storage facilities provided for the storage of medicines are well controlled, tidy and secure. The room and fridge temperatures are monitored daily but it is of some concern that the fridge temperature had been recorded as being outside the recommended range of 2 – 8 C without any action taken by staff to investigate the performance of the fridge or the quality of medicines stored there. The policy and procedures give no guidance for staff on what action should be taken in these circumstances. The medicines round was observed on both the ground floor and one of the units on the first floor. Medication was administered with regard to residents’ choice and dignity. The trolley used for medicines was left open, unattended, and sometimes with medication openly accessible on the top of the trolley, while staff administered medicines to residents. This increases the risk that residents or other unauthorised people may have access to medicines they are not prescribed. The morning medication round on the first floor did not finish until 11.30 since the person administering the medication was interrupted so many times by other staff for advice, access to keys etc. Lunchtime medication is then given at 1.00 – 1.30pm and so some residents may receive medicines too close together. This procedure for administering medicines must be reviewed to minimise this happening. Medication and care records examined showed some worrying deficiencies. • Records made when medicines were administered to residents were signed after the medication was assembled and before they were actually taken by the resident. This may lead to an inaccurate record and in one case, the care notes indicated that a resident had refused to take their medication, but the medication record form was signed to indicate that they had done so. • A number of residents did not have medication administered since it was “out of stock”, sometimes for a period of up to 10 days. Suitable procedures must be put in place to ensure there are adequate supplies of medicines held for the continued treatment of residents since not to receive continued treatment, or to abruptly stop treatment, could put residents at risk. • There were few unexplained gaps in the medication administration records providing no clear indication of whether medication had been administered or not. Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 15 • • • Medication was not being administered as prescribed, for example a medicine prescribed to be used twice a day was recorded as only being administered once a day. One resident’s medication carried the instruction to increase the dose gradually but there was no guidance for staff on how to do this. Handwritten medication record charts were not signed and dated by the person completing them and they were not filled in correctly with the date of use and so the date the medication was administered to residents was not clearly recorded. Where medication is administered in variable doses e.g. one or two tablets, the actual number of tablets/doses given was not consistently recorded. It was reported that some residents needed to have medication crushed before they can take it. Crushing medication alters the properties and possibly the effects of the medication, and carries a risk to staff who are doing so. There is no guidance for staff on the procedure for crushing tablets and there are no agreements in place, from professionals, residents or their families that this in an acceptable practice. Some residents were prescribed medication on a “when required” basis to control behaviour. Not all of these had clear guidance within care plans of the circumstances that such medication is to be used. This is important to prevent misuse of medication and provide a consistent approach by staff. Medicines that are controlled under the Misuse of Drugs Act and associated regulations are stored and recorded properly. Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 16 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 poor. Residents’ experience of the homes current lifestyle will vary with some people having their social, religious, recreational, nutritional needs and choices met effectively while others will not have a positive experience not have their needs/choices met to an acceptable standard. Their visitors will be welcomed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information from surveys, observation on the day of the site visit and discussion with relatives staff and residents indicated that for some residents there is a good variety of activities available if residents wish to participate in them. For other residents, particularly those in the units caring for people with dementia, this did not seem to be as extensive or expected, indicating perhaps that some relatives did not understand that appropriate social stimulation and interactions can be provided to people with dementia, with an adequate and skilled staff team. The home provides a planned programme of activities each month. This was noted positively to have been produced in a pictorial format. It was recommended that this be reconsidered and perhaps produced for a week at a time so that the symbols could be larger to support easier recognition for some residents. The activities available offer a good choice and include art and Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 17 crafts, board games, reminiscence time, jigsaws, walks in the garden, dart games and bowling, hand and nail care, book reading, listening to music, oneto-one chats and fortnightly church services. Activities are mainly confined to weekdays but Sundays do sometimes include the opportunity to attend movie time, with ice cream, popcorn and drinks provided. There was also evidence of some outings and outside entertainment in the home. Many of these activities would not be viewed as specifically appropriate or geared towards people who have complex needs/dementia/behaviour that challenges. Staff advised that the activities coordinator had played ‘’soft’ darts and skittles with the residents in one of the units that offers care for people with dementia, and while some had joined the others were too tired. Limited activities were observed at the day of the inspection and the interaction provided to residents by some staff members was poor. Lounge areas were not always supervised by a member of staff and residents were left unattended. Rosters indicate that the activities coordinator works in the home usually between 10am and 4:30pm four days a week. The training matrix indicates that the activity co-ordinator undertook training on dementia one day this year. The responsible individual advised that another activity co-ordinator has been appointed and is awaiting completion of recruitment checks. Care plans had not been developed to identify residents individual social care needs based on their previous leisure pursuits and interests, with clear actions that identify how residents current needs are to be met. Residents abilities had not fully been taken into account in the programme of activities and the current inadequate staffing levels did not allow these to be part of the everyday care provided by care/nursing staff as well as the activities coordinator. Visitors are welcome at Gifford House and this was confirmed by those spoken with. Some visitors who sat supporting residents were provided with food at teatime, while others were not. One relative commented “ they treat patients with kindness and respect and a care manager said that there client felt that their privacy and dignity was respected at the home. The GP also expressed the view that the home respected individuals privacy and dignity. Clearly other comments in this report indicate that this is not always achieved, for example a relatives observations that residents must wait a long time for assistance when they need to go to the toilet, or that some residents are not adequately supervised and wander into the rooms of other residents, as well as the example given below regarding the lunchtime observations. The home uses a four week rolling menu. This was displayed for residents but it was recommended that it could be more appropriate for some residents to provide it in a pictorial format. There were three main choices of lunch on the Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 18 day of the site visit, minced beef/dumplings, tuna pasta bake, salad and omelette, with mashed/potatoes, carrots and green beans. There was a choice of desserts between apple pie and custard or ice cream and jelly. The lunchtime meal was observed in the dining room used by the two upstairs units. The dining area was very cramped at lunchtime and at one point there were 18 residents and seven members of staff in the room. One resident was observed to ‘ interfere’ with other residents and to upset them with inappropriate verbal interaction overheard. Three residents then requested to go to the toilet, disrupting events still further and it was unclear whether residents had been offered the opportunity to go to the toilet prior to going to the dining room. The event noted in the next section regarding the inappropriate handling of a resident was noted to occur at this time. Additionally two staff members tried to manually lift a resident from their wheelchair onto a dining chair, which is of course unsafe and in contravention of safe working practice. When this proved unsuccessful, a qualified member of staff advised that they would get a handling belt. This was more effective in safe handling, but the two staff did not work in sync with each other until the qualified staff took control of the situation, demonstrating a lack of staff skill and competence in caring safely for residents. The resident was observed to be upset by the incident and was overheard to say “ oh bloody hell.” This lunchtime was observed to be disorganised with residents seated at the table and in some cases given their food without the cutlery. Not all residents were asked if they wish to wear an apron and not all residents were offered the choice of drinks available. Some staff were observed to stand-up while assisting individual residents with feeding. These practices were not respectful of residents’ dignity and right to choice. Food provided to residents was plentiful and looked appetising. A comment from a relative who visits very regularly said “ the food is very good and quite variable”. Indications from residents were also positive regarding the food served. The teatime meal was also observed in this dining room, which had less residents in the afternoon. Staff members confirmed that the teatime meal is a very busy time. Staff were heard to use residents names, and gently encourage residents to eat and drink. All but one member of staff sat while helping residents to eat, and good eye contact and smiles were noted. Staff were appropriately tactile with residents, responding to a hand held out, and gave praise and encouragement. Residents were offered choices and more tea, sandwiches or cake. Staff wore the same kind of aprons as residents and used tongs to serve the food, which is good practice. The teatime meal was also observed in the downstairs dining room, where some residents from upstairs came to have their meal. It was observed that some staff behaved differently with those residents who are more able, being more chatty and interactive than with those who have complex needs. Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 19 Discussion with staff and observation indicated some rigidity with regard to drinks during the day. Residents asked the inspector for tea during the morning, and when this was passed on to staff, the inspector was informed that they would have a cup of tea at 11.30 and not before. The record of food served did not indicate how much food a resident had eaten, and this was not noted as recorded regularly in the daily care notes. This was particularly pertinent for some residents to ensure effective monitoring of nutritional intake and would have supported ongoing effective management of care review along with the nutritional risk assessment and weight monitoring. Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 20 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, 18 Quality in this outcome area is poor. Residents of Gifford House will have information on how to raise their concerns. Residents are not best safeguarded by the homes policies and procedures, staff training or recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Clear information on how to make a complaint was available in the service user guide. Information on the homes complaints procedure was also contained in the leaflet displayed in the small quiet lounge used by visitors. Information was available on contacting the commission, which is positive but it could have a clearer explanation that the commission does not investigate individual complaints. Additional information could be provided on contacting local authorities/funding authorities with any concerns the person may have regarding the service provided. The complaints and compliments file was available in the office and it was noted positively that this was much better organised than previously. It contained a front sheet with a profile, date etc and separate recordings of the complaint and investigation. The file was displayed on top of filing cabinets in the office and advice was provided on taking action to ensure confidentiality and protect information. A number of compliments and thank you cards have been received by the home and included comments such as “ thank you all for looking after me so Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 21 well” and “ thank you for all the love and wonderful care given to (resident), the staff are a credit to the home”. Four complaints had been recorded since the last key inspection and these included two relating to dehydration/lack of fluids, a staff member altering a prescription, and poor attitude from another staff member. Additionally two issues have been referred under PoVA (Protection of Vulnerable Adults and now known as Safeguarding), one raised by a social worker and the other by a relative. The first issue related to inappropriate use of medication and outcomes were considered unsubstantiated as the service user involved was unable to provide any information and the home was stated to have addressed any issues raised. The second and more recent referral related to poor care, poor care management documentation and poor communication and interactions with relatives. An investigation is undergoing and outcomes have not yet been concluded, but the home have recorded that policy issues are to be put in place and education on bereavement to be provided to staff. A resident’s care notes recorded that a complaint was reported by resident family regarding their general poor condition and dressings not being done. This complaint was not logged by the home and the registered manager advised that he was not aware of it. The home’s policy and procedure on abuse identified different types of abuse and advised contact with the commission for social care inspection, but with incorrect contact information. It also referred to reporting to head office, and social services or the police in different circumstances. There was no information available on the current Safeguarding Adults guidance and protocol, or referral information and reporting documentation. The key inspection report of January 2007 includes the advice “The manager should ensure that the home has current guidance in relation to the local protocol for protecting vulnerable adults”. As can be noted in the following section on Staffing, the majority of the staff files sampled did not evidence any training in protecting/safeguarding vulnerable people. The manager advised that outside training is being arranged for staff on this issue. A whistleblowing procedure was available to staff “ to raise serious concerns”. It was written in clear language and advised staff to report to the manager as a first step or to the managing director. It did not refer to any information for staff on reporting to the relevant authorities outside the home. An incident was observed by an inspector where a member of staff physically pushed a service user manually from the back and when the resident resisted, the staff member came round the front of the resident, grabbed them by both wrists and pulled them along. This was reported to the homes manager and Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 22 the responsible individual who confirmed they would take immediate appropriate action. The homes restraint procedure advises that restraint was to be used only as required in self defence or where there was a risk to others, that it must be in the persons plan of care and any implementation must be reported. The home’s training matrix demonstrates that none of the staff have yet had training in the management of behaviour that challenges. The report of the key inspection of January 2007 and the random inspection of April 2007 identifies a requirement that staff are provided with this training as it is an identified need for several of the residents at Gifford house. The manager advised at this site visit that training is being arranged for a staff on this issue. Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 23 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, 26 Quality in this outcome area is good. Residents of Gifford House live in a safe, well maintained and pleasant home that offers good facilities, with the exception for those who need to use the upstairs dining room. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Gifford House has three named units, two upstairs, Linford and Radcliff and one downstairs, Betts. Time and money has been invested in ensuring a high standard of furniture, fittings, décor, equipment and facilities. The upstairs units have their own satellite kitchen equipped with kettle, toaster, fridge etc to maintain a more homely environment. These are to be provided with dishwashers so that care staff can complete the washing up of the units crockery and cutlery after meals. All residents have single bedrooms that have an ensuite toilet and wash basin. There are assisted spacious bath and shower rooms on each floor/unit. There are separate toilets available around the home with close proximity to communal areas. All areas of the home were well appointed to ensure Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 24 accessibility for all residents, including the pleasant and well maintained gardens that provide seating areas as well as walks, and the wide doorways and spacious corridors. The upstairs dining room was again identified as inadequate in space and facilities for the number of residents who use the room and the number of staff required to support them, and this contributed to some residents having a poor dining experience. The registered provider confirmed the inspectors view that the lunchtime meal in this units was disorganised at least. It was noted positively that bedroom doors contained a clear photograph of all the residents, along with their name and the bedroom number to assist with recognition. Residents could have their own telephone installed. Bedrooms and ensuite had lockable facilities, which demonstrated respect for privacy. Some bedrooms were well personalised with individual photographs, ornaments and other small familiar pieces It was noted positively that the laundry chute was locked to ensure residents safety and no hazardous items, such as cleaning fluids or latex gloves were stored in an unsafe manner and so residents were safeguarded. The concerns noted at the last key inspection relating to infection control had been addressed. Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 25 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): 27, 28, 29, 30 Quality in this outcome area is poor. People living at Gifford house will not have enough staff available to keep them safe and meet their needs. Staff are not provided with the right training to give best care to residents and are staff recruitment practices do not safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 57 people were resident at Gifford House at the time of the site visit, an increase of 16 residents since the last key inspection. Staffing levels had also been increased. Copies of rosters provided demonstrated that there were generally 3 qualified staff plus the clinical manager on duty each day. Information on care staffing levels provided indicated that this was erratic, in the week prior to the inspection, morning care staffing levels (including agency staff) were recorded as ranging from 11 down to 7 staff and afternoon/evening care levels went from 10 to 8 on different days. Rosters demonstrated that in that same week, night staffing levels ranged from 3 qualified staff on duty with 4 care staff to 1 qualified staff and 4 care staff on the Saturday and Sunday night prior to the inspection. Discussion with staff, information from surveys but in particular observations on the day of the site visit indicated that the staffing levels and staff deployment in the home continue not to be adequate to meet residents needs and to keep them safe. The responsible individual’s regulation 26 reports for April, May and June reflected that he had, at times, observed a lack of supervision of residents where this was clearly necessary. The May report Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 26 identifies a need for a minimum of one qualified staff and three care assistants on each unit initially, with the view to observing whether their residents make it necessary to have more care assistants at some or all of the time. The responsible individual was informed at the time of the last inspection that this number of staff were in place at that time and for a lesser number of residents, and was identified then as inadequate. The inadequacies in the numbers of staffing has been clearly identified in the surveys and the verbal comments received from residents, relatives, the GP and the staff providing care at the home. Of the five staff surveys received none stated that they felt that the home always provided staffing levels on each shift that gave enough time to meet the assessed needs of residents. The home has had a high turnover of staff with a 27 full or part-time staff having left since it opened some nine months ago. The use of agency staff has been implemented since the last key inspection to support the home to be able to offer increased staffing levels. Some agency staff, but also some of the permanent staff were noted to be working 12 hour shifts each day. While accepting that this provides some continuity to residents, it is recommended that this is carefully managed to ensure that staff do not become overtired and a risk to themselves or residents. It was also noted that some staff (both qualified and care staff, and both day and night staff) were working an excessive number of hours, with staff recorded as working 54 hours, 60 hours, 66 hours and 72 hours in the week prior to the site visit. Records made by the responsible individual demonstrate that he undertakes unannounced night-time visits, which is a positive approach and his openness in recording the issues found is commended. It was concerning to note occasions where staff were found sleeping on duty, or sleeping on their night-time breaks, and warnings had been given to staff about this type of culture. An Immediate Requirement was issued to the home at the key inspection of 9th January 2007 due to the concern relating to the lack of staff training, both in the basic mandatory safety issues and the more specialist areas particular to the needs of the residents that Gifford House Care Home accommodates. Some minor improvement was noted at a random unannounced inspection of the home on 13th April 2007 with regard to staff induction and training, with reassurance from the registered manager and register provider that this would improve. The inspection reports of both site visits clearly identified requirements that the home needed to provide increased numbers of staff to meet residents’ needs, that the staff be recruited in a safe manner to protect residents, and that the staff were suitably trained and competent to meet residents’ needs, and were provided with induction/training by the home to achieve this. Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 27 The staff surveys received indicated that two staff felt they had received some induction and were being provided with the training relevant to their role. The other three staff felt that they had had poor or no induction and were not been provided with appropriate training for their job. The AQAA provided by the registered manager advised that 4 of the 19 permanent care staff have achieved NVQ level 2 or above, and 11 other staff are working towards it. Staff recruitment files were sampled for two qualified nursing staff, an administrator and a member of the care staff team, all of who were recruited since the last key inspection. The file was requested for another member of staff, but this was not available. It was advised as being with the home’s consultant group for advice. The registered persons were reminded that regulation and schedule requires the files for all staff to be available for inspection at all times. The files for both qualified nurses contained appropriate application, references and checks obtained in a timely manner. One had evidence of their nursing qualification and other relevant training courses but not on fire, health and safety or medication. The other file had no evidence of any qualifications or training, including moving and handling, fire, food handling, dementia care, protection of vulnerable adults, the latter only being covered amongst other subjects on a first day induction sheet. The second file had no record of induction. Both files contained a record of a personal identification number (PIN) but no evidence that this PIN related to this person or that the nurses’ registration was current. The administrator’s file had appropriate records including a Povafirst check and the person was being supervised until receipt of their Criminal Record Bureau check. The care workers file sampled did not contain a photograph as required, and had no evidence of identity. There was no evidence to support their work eligibility status. Gaps were identified in their employment history and there was no evidence that the home had explored this. There was no evidence of the staff member having had any current/updated training. A first-day induction record identified that the person needed moving and handling training, and this was planned/booked for two months after their start date. There was no other evidence of induction/training on this file. An additional file sampled for a longer serving member of the care staff team was noted to contain current moving and handling and emergency first aid certificates but no photograph or evidence of identity. Of four additional files for qualified staff sampled only one had evidence of qualifications and training and none had evidence of induction. One long Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 28 serving member of staff’s file sampled contained a certificate of successful completion of Skills for Care common induction standards and learning undertaken, but no certificates were recorded as having been seen and there was no identification of further learning needs. The file also contained certificates for moving and handling and emergency first aid, as well as an inhouse session on dementia and protection of vulnerable adults. The mission statement in the service user guide states “ our staff are trained and experienced in providing the specialised services that you may require”. The statement of purpose states an aim of the home as being “ to provide staff supervision and a staff training programme to enable staff to improve the services that we offer and keep them updated on all aspects of care and development”. It was noted positively that profiles were maintained for agency staff. Profiles however were not available for two of the three agency care staff who were on duty at the time of the inspection, and one was not additionally available for an agency staff member on duty that night. The training matrix provided by the registered manager identified that seven of the permanent/bank qualified nursing staff had no evidence of current moving and handling training. Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 29 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, 38 Quality in this outcome area is poor. Residents live in a home that is not effectively managed in all aspects and while the environment is safe concerns regarding their well-being and safety continue. They will have the opportunity to express their views about the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is a registered general and registered psychiatric nurse. The AQAA identifies that the registered manager and proprietor have extensive knowledge and experience of managing care homes. Both have consistently expressed the desire to provide a high quality service and to meet and exceed national minimum standards, but to date this has not been evidenced as demonstrated in this report. The registered manager is to complete the Registered Manager Award as part of the homes plan for Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 30 improvement in management and administration in the next 12 months and has recently completed moving and handling training. Gifford House has a quality monitoring system and the results of surveys undertaken between January and April 2007 were available in the quiet room. The analysis of outcomes indicate for example 100 satisfaction overall with nursing care, 79 with social activity provision and 71 of residents involved in the survey thought the food was good. Comments and suggestions were listed but there was no evidence of an action plan as to how these were to be developed and implemented. The responsible individual has routinely completed the required monthly visits and reports on the home and these were available for inspection. It is of some concern that they are not effectively picking up and dealing with the identified areas where the home is not complying with regulation. Minutes were available to show that a residents/relatives meeting had been held since the previous key inspection. The home also produces a quarterly newsletter/ bulletin as a means of communication and these were readily available in the quiet visitors room. Accident records were sampled and were appropriately completed on individual sheets. There was evidence that they were audited monthly by the registered manager. Photographs were again not available of all residents to assist staff with identification. A random sample of records of money looked after for five residents demonstrated that records and totals were appropriate and tallied. A new accounting sheet had been devised and a double signature system was now in place as recommended at the last inspection. The files sampled for evidence of supervision varied with one qualified nurse having had three supervision sessions in recent months, two having had one session and two other long were serving members of care staff had no supervision records on the file. The records of supervision indicated limited agenda topics and for senior staff particularly, did not consider developmental or training needs. The staff surveys received expressed strong views that staff did not feel supported by the manager, that staff feel unappreciated and are generally not happy. A relative commented very positively about the staff themselves but that they felt that the issues within the staff team were picked up by, and affected, residents. There was a lack of clarity for staff on who the actual manager of the home is, and that staff who expressed the view that the manager was inexperienced, had poor people skills and bullied and swore at people were not actually referring to the registered manager. However, the situation demonstrates even further the need for stronger and more effective management at Gifford House. Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 31 One staff member advised that since the last inspection, the management were trying a little harder to listen to staff and clients needs, and trying hard to improve the service. No obvious health and safety issues were identified on the premises at the time of the site visits. However, a certificate that demonstrated inspection of the passenger lift, emergency lights and fire alarm since commissioning last year was not available. An inspection certificate relating to the fire extinguisher was dated July 2007 was available. It was noted positively that fire drills were occurring more regularly. The responsible individual advised that fire training for staff has been in-house and by watching a DVD. He also advised however that proper fire training was now being arranged for staff and that one person had received fire marshal training. The home was maintaining a record of hot, but not cold water checks at the last key inspection and the responsible individual was to clarify whether cold water temperatures also need to be checked. It was advised at this inspection that no clarity had yet been obtained. Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 32 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 2 3 3 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 2 X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 3 X 3 2 X 2 Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 33 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 OP1 Regulation 5(1) Requirement So that interested people have open access to all the required information, the service user guide needs to include all the information regarding fees and charges, including where a nursing contribution is paid, and responsibility for payment of required by the changes to the Regulation from September 2006. This is an outstanding requirement from the reports of the inspections of 19/01/07 and 13/04/07. 2. OP4 OP9 OP10 OP12 OP18 OP30 18(1) 13(2) 13(5) 13(6) 13(7) 23(4) Residents must be cared for by competent staff who are adequately trained in all areas of the residents’ assessed needs and safety requirements. This includes providing all staff with an induction to a recognised standard, all basic training including moving and handling and fire, and specialist/updated training as required for both care staff and qualified nursing staff, including mental health, social DS0000067933.V345064.R01.S.doc Timescale for action 01/10/07 23/07/07 Gifford House Care Home Version 5.2 Page 34 and emotional well-being, dementia care, management odd behaviour that challenges, medication and safeguarding people. This is an outstanding requirement from the reports of the inspections of 19/01/07 and 13/04/07. 3. OP7 OP8 OP14 15 12(2) 13(4) Sch 3(3) 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, and include were possible residents views and wishes. Care plans and associated health documentation, including risk assessments, must be kept up to date and provide staff with sufficient information to enable them to offer residents proper and consistent care and assistance. This includes areas identified in the body of the report such as preventative pressure area care management and management of behaviour that challenges. This is an outstanding requirement from the reports of the inspections of 19/01/07 and 13/04/07. 4. OP8 13 (7)(8) Sch 3 (3) To safeguard residents and respect their dignity and rights as a person, restraint must only be used to secure the welfare of residents in exceptional circumstances and where this occurs, appropriate records must be maintained. This is an outstanding requirement from the reports of Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 35 23/07/07 23/07/07 the inspections of 19/01/07 and 13/04/07. 5. OP9 12(1) Medication must only be administered in accordance with the prescribers’ instructions. Written protocols and guidance must be in place for medications prescribed on an “as required” basis. This is to prevent misuse of medication, provided consistent approach by staff and will make sure that residents received the correct treatment. This is an outstanding requirement from the reports of the inspections of 16/02/07 and 13/04/07. 6. OP9 13(2) There must be suitable procedures in place for the safe administration of medicines. There must be adequate supplies of medicines held for the continued treatment of residents. Records of the administration (or not the ministration) of medicines must be accurate and complete. This is to make sure the health and welfare of residents is protected. This is an outstanding requirement from the reports of the inspections of 16/02/07 and 13/04/07. 7. OP15 OP20 16(2)I 23(2)f Sch 4(13) So that residents receive ample nutrition there must be sufficient staff to provide residents with a positive dining experience and • provide adequate support to take the food and maintain nutrition for those who need that support. • make effective DS0000067933.V345064.R01.S.doc 23/07/07 23/07/07 23/07/07 Gifford House Care Home Version 5.2 Page 36 use/available adequate dining space for residents (This is an outstanding requirement from the reports of the inspections of 19/01/07 and 13/04/07.) • Care records and the records of food served need to record what residents have actually eaten/drank to enable effective monitoring and interventions where appropriate to ensure quality care outcomes for residents. 8. OP16 22(3) Sch4 (11) The person registered must ensure that all complaints made are fully investigated and inform the complainant within 28 days of the outcome of the complaint and if any action is to be taken. This is an outstanding requirement from the reports of the inspections of 19/01/07 and 13/04/07 and records of these must be maintained. 9. OP27 18(1) So that residents are 23/07/07 safeguarded and their care needs can be met there must be enough competent staff on duty to look after the residents, including supervising them, providing positive daily life experiences for them and quality care outcomes. This refers to both the number of staff on duty each shift and to the deployment of staff. This is an outstanding requirement from the reports of the inspections of 19/01/07 and Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 37 23/07/07 13/04/07 Additional care must be taken to manage the number of hours worked by care staff at the home that might compromise the competence. 10. OP29 19, 17(2) Sch 2&4 So that residents are safeguarded, there must be evidence of robust and safe recruitment procedures and all the required records and documents must be available at all times for inspection. This is an outstanding requirement from the reports of the inspections of 19/01/07 and 13/04/07 This includes for agency staff. 11. OP31 9(2)b(i) 10(1)& (2)a So that residents are safeguarded and provided with adequate care outcomes the registered manager and registered provider must demonstrate that they have the skills and training to manage the home effectively and are carrying on the home with sufficient care, competence and skill. This is an outstanding requirement from the reports of the inspections of 19/01/07 and 13/04/07 12. OP36 18(2) To safeguard residents and support staff the person registered must ensure that staff are appropriately supervised. This is an outstanding requirement from the reports of the inspections of 19/01/07 and Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 38 23/07/07 23/07/07 23/07/07 13. OP37 17(1)a 13/04/07 So that residents are safeguarded and staff supported to provide the right care to the right person, a photograph of each service user must be available. This is an outstanding requirement from the reports of the inspections of 19/01/07 and 13/04/07 23/07/07 14. OP38 13(4) a&c 23(2)c 23(4)c(iv) So that residents are kept safe, equipment such as the lift, emergency lighting and fire alarm systems must be maintained and inspected regularly. 23/07/07 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 Information should be displayed in a suitable place and format to inform residents of the activities programme. Residents should be able to Exercise choices in their daily lifestyle and have drinks available at all reasonable times that they want them. Information should be displayed in a suitable place and format to inform residents of the menu. The practice of staff working long/full day shifts/excessive hours should be reviewed. 50 of care staff should achieve NVQ Level 2. 2. OP14 3. 4. 5. OP15 OP27 OP28 Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 39 6. OP38 To protect residents from the Risk of infection from Legionella, the registered provider should carry out a detailed risk assessment regarding the safety of the water system and take action to confirm whether regular temperature checks should be undertaken on the cold water system. Gifford House Care Home DS0000067933.V345064.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 - 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. 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