Inspection on 07/01/08 for Gifford House Care Home

This inspection was carried out on 7th January 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 12/12/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Gifford House Care Home London Road Bowers Gifford Basildon Essex SS13 2DT Lead Inspector Mrs Bernadette Little Unannounced Inspection 7th January 2008 09:20 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.V355140.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.V355140.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.V355140.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 23rd July 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 £515.00 to £675. 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.V355140.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 1 star. This means the people who use this service experience adequate quality outcomes. This was the second unannounced key inspection of Gifford House this year. Due to the number of regulatory requirements and areas of judgements identified as poor at the home’s first key inspection, further random unannounced inspections took place on 15th October 2007 and 16th November 2007. A copy of the random inspection reports can be made available on request and relevant aspects are reflected as part of this report. As a result of unsatisfactory medication practices and procedures, a Statutory Requirement Notice was issued on 10th December 2007. This was assessed at this inspection by the specialist pharmacist inspector and was found to have been met. This site visit was undertaken by two inspectors. All of the key standards and the manager’s progress against previous requirements from the last key inspection and subsequent additional inspections in October and November 2007 were inspected. A specialist pharmacist inspector accompanied the inspectors for part of each of the site visits. 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 services 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. Prior to the first key inspection, the registered provider had submitted an Annual Quality Assurance Assessment, detailing what they do well, what could be done better and what needs improving. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. Additionally a tour of the premises was undertaken, residents, visitors and staff were spoken with and their comments are reflected throughout the report. Prior to the inspection, surveys were sent to the home for distribution to interested people, including relatives and staff. Six surveys were received from relatives and one from a staff member. Health and care professionals were contacted so as to seek their views by survey about the services provided. One response was returned to the Commission for Social Care Inspection. Gifford House Care Home DS0000067933.V355140.R01.S.doc Version 5.2 Page 6 The manager, registered provider and other members of the staff team assisted the inspector. Feedback on the inspection findings were summarised at the end of the day with the manager, registered provider and their consultants. The opportunity for discussion and/or clarification was given. The assistance of all who took part in this inspection process is appreciated. What the service does well: What has improved since the last inspection? The care plan format has been changed and all care plans rewritten to better support staff to identify and meet residents’ individual needs. Audits are being carried out to ensure that care plans record the required information on each person’s needs and, that once a satisfactory level of information is in place, it is maintained and kept up to date. Practices and procedures for giving medication to residents has improved and the recording of when medication is given or not is of a much better standard. The process for the recruitment of staff has improved since the last key inspection with the required checks being completed in a timely way to safeguard residents. The organisation of formal staff induction is developing. Formal staff training in basic topics, including medication and moving and handling has increased greatly and there are better systems in place to overview and manage this. Gifford House Care Home DS0000067933.V355140.R01.S.doc Version 5.2 Page 7 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.V355140.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.V355140.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, 3, 4 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People considering moving into Gifford House are given sufficient information about the home to make an informed choice about living there and will have their needs assessed to ensure that the staff team are able to meet them. EVIDENCE: A statement of purpose and a service user guide are available in the home and have recently been updated and includes the information required. The service user guide provides information about many aspects of living at Gifford House, including the invitation to visit and advises of the availability of all inspection reports on request. It now includes clear information on the range of fees payable but does not include a copy of the standard contract to be used. It has not been updated to reflect the commission’s current contact details. The AQAA states that the service user guide is provided to interested people at pre-admission and if they come to look around the home, and this was recorded on the files sampled, which is good practice. Gifford House Care Home DS0000067933.V355140.R01.S.doc Version 5.2 Page 10 The files of two of the more recently admitted residents were inspected. These showed that the manager completed a pre admission assessment prior to admission in one case so as to ensure that they are able to meet the prospective resident’s needs. A Care Management assessment undertaken by a local authority that identified the person’s needs was available on another file where the person lived some distance away. Information had also been obtained from the person’s previous care home. An undated pre-admission form from Gifford House was also on the file. As part of the assessment process, formal assessments were completed relating to falls, moving and handling and pressure area care. Nutrition assessments were available on some files. The care manager survey received confirmed that the assessments arrangements in place usually ensure that accurate information is gathered and that the right service is planned and given to individuals. The AQAA advises that letters are sent to prospective residents or their representatives and files sampled showed that the management team write to prospective residents confirming that, based on their assessment, the home can meet their needs. Gifford House does not provide intermediate care. Gifford House Care Home DS0000067933.V355140.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): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst resident’s health and care needs were identified and planned for, other shortfalls in care planning could adversely affect outcomes for residents and their wellbeing. EVIDENCE: A random sample of care files were examined as part of this inspection. Information recorded overall was notably improved from the last key inspection and provided a good level of detail in several areas. Discussion with individual members of staff indicated that they had a good knowledge and understanding of residents personal care needs but there was some limited understanding of how people’s dementia affects their activities of daily living. Interaction between staff and residents was seen to be appropriate, respectful, and friendly. The AQQA identifies that there could be better greater consistency throughout the care plans. Care records show that further development of the care Gifford House Care Home DS0000067933.V355140.R01.S.doc Version 5.2 Page 12 planning and risk assessment processes is needed and these were discussed with the management team at the time of the inspection. Staff need to ensure that individual resident’s needs are fully recorded, and include the interventions required and undertaken so as to ensure the appropriate delivery of care. This includes for example where a clear high risk relating to pressure area care is identified or specific information on which hoist and sling is to be used, end of life care, social interests and residents’ individual preferences. Particular attention must also be afforded to those people who have a diagnosis of dementia /deteriorating mental health and the care plan must include details of how this affects their daily living activities and specific interventions required by care staff to manage this proactively. Daily care records were observed to be varied in their level of information and detail and further development is required to ensure that records include staff interventions so as to evidence actual care delivery by staff to individual people. Since the last key inspection it was positive to note that behavioural charts for some individual residents had been developed so as to record behaviours exhibited, actual care delivery by care staff/outcomes and to detect possible trends and/or common themes. It was disappointing to note that behavioural charts were not completed for all residents who exhibited challenging behaviour and information detailed within daily care records was not always transferred or cross referenced to the behavioural record. Formal risk assessments were completed for residents in relation to falls, manual handling and pressure area care and generally were detailed and comprehensive. Risk assessments for specific areas of assessed risk were also completed. Survey information and comments from residents and relatives during the site visit showed that are satisfied with the level of care provided at Gifford House and one comment was “ we could not ask for more”. Residents spoken with said they found their privacy and dignity to be respected, for example staff knock on doors before entering people’s room. The survey from the care manager also noted that they found the home to be respectful of the privacy of the resident. Records showed that residents have access to a range of healthcare services and professionals such as GP, optician, chiropodist, district/tissue viability nurse services, consultant psychiatrist as and when required. Residents spoken with confirmed that they receive appropriate help with their healthcare needs. Staff spoken also confirmed more effective systems/relationships with healthcare professionals that benefited residents. It was noted positively that a short term care plan had been put in place in repose to a resident being unwell and being prescribed antibiotics. A Statutory Requirement Notice was served on 10th December 2007 due to continued non-compliance with requirements made concerning the safe Gifford House Care Home DS0000067933.V355140.R01.S.doc Version 5.2 Page 13 administration and recording of medication given to residents. During this inspection, medication was seen to be given as prescribed by the residents’ GP and medication administration records were completed well; there were no unexplained omissions in the records. Where medication is prescribed and given in variable doses e.g. “one or two tablets”, then the actual dose given is now recorded. The requirements of the Statutory Notice have therefore been complied with but it is important that these improvements are sustained to protect the health and well being of residents. Where people are prescribed nutritional supplements when they are not eating well there must be a clear record made of when these are used and the quantity the person has taken. Gifford House Care Home DS0000067933.V355140.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): 12. 13. 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The majority of residents can be assured that they will be provided with a range of activities, food and drinks to suit their preferences, however lack of care staff involvement means that not all residents needs are met. EVIDENCE: Gifford House employs staff specifically to manage and provide social activities for the people who live there. A planned programme of events is displayed in a large pictorial format to make it easier for people to see and understand. It includes a variety of group and individual activities as well as a regular in house religious service. The new resident assessment and care plan documentation sampled showed limited information on the person’s life history and past interests as well as a plan to meet their current needs and wishes. Residents spoken with who were able to express a view stated that they enjoyed some of the activities and could choose to participate or not as they wished. A group of residents were seen to chat, laugh and clearly enjoy the activities going on, these include listening to music and singing, folding things and playing skittles. The activity co-ordinator interacted enthusiastically and positively with residents downstairs as did other staff observed. Gifford House Care Home DS0000067933.V355140.R01.S.doc Version 5.2 Page 15 It was evident that for some staff there was a separation of duties between providing care support and activities and further developments could be made in helping staff understand how, in carrying out their daily duties in supporting residents, they could engage and stimulate them. It was noted during the specific short observation that the activities co-ordinator and one member of staff interacted well with residents, providing warmth, inclusion and verbal interaction. Other staff came in and out of the lounge area with little consideration/thought to talk to residents. Discussions with staff indicated a lack of understanding and capacity to engage positively with residents. Residents and relatives spoken with confirmed that visitors are welcomed and this is stated clearly in the service user guide. Relative surveys advised that the staff team support contact between residents and relatives. Residents spoken with and able to express a view confirmed that they are able to exercise choices in their daily lives, such as how and where they spend their time, when they get up and go to bed and what they wear and eat. The AQQA makes no reference to the menus or provision of meals to residents. Residents spoken with said there was a good range of meals and they liked what was on offer and others were observed to enjoy the meal. Nutritional risk assessments were seen on some files and were supported by a care plan and records of regular weight monitoring. Records of food provided indicated the person’s intake of food, a varied diet and a gradual weight increase. One relative survey stated “the food always look and smells wonderful” and “I feel that residents don’t get enough to drink”. The lunchtime and teatime meals were observed both upstairs and downstairs units during the inspection and a choice of meals was available. Residents were provided with assistance where this was required but not all staff showed patience. Observation of mid morning tea in one upstairs unit showed that staff did not offer residents a choice of hot or cold drinks, or support residents to express a preference, perhaps with visual prompts. All were given tea and later, all were given an orange drink. One person was handed a biscuit but was offered no choice in this and no other resident in that unit was given/offered a biscuit, which does not respect choice or dignity. Gifford House Care Home DS0000067933.V355140.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents had access to good systems to raise complaints and people feel confident to use it. Residents were generally safeguarded by the systems now in place although some gaps in knowledge do not best protect residents. EVIDENCE: A satisfactory complaints procedure and policy is available within the home and is included as part of the service user guide. The complaints procedure is clearly displayed and residents spoken to confirmed that if they had any areas of concern/complaint, then they would feel able to discuss this with either relevant staff, the manager or the owners. Relatives’ surveys forwarded to the commission showed that they all knew how to make a complaint and were aware of the complaint procedure. One survey said that they “always discuss issues with the management and so have never needed to consider escalation.” The home has a formal and well organised system for the logging of complaints. Since the last key inspection, one formal complaint relating to inappropriate responses from a senior staff member to a relative who felt bullied and a lack of action in relation to a healthcare need, has been received by the home and copied to the commission. This was responded to formally and the commission copied into this on request. Records were not maintained of the scope of the investigation to support the actions stated to have occurred and outcomes were not clearly identified. However, changes in procedure have Gifford House Care Home DS0000067933.V355140.R01.S.doc Version 5.2 Page 17 been introduced. A number of ‘thank you’/compliment cards and letters had been received by the home and had been logged. The AQAA does not include any reference to protecting people. The management of safeguarding of people living at Gifford House was reviewed and areas for improvement were identified. During the November random inspection, an incident was identified in care in a resident’s care notes that would clearly have come under the heading of an event that affected their well-being, that the manager stated awareness of, that had not been notified to the commission as required and clearly indicated that the safeguarding team should at least been contacted for advice. The registered provider did make this contact once made aware, advice was provided by the safeguarding team and no further action was decided as necessary. The manager had reviewed the policy and procedure on managing abuse. This includes information on informing the social services adult protection unit but does not include any contact details or refer to appropriate documentation for making referrals to support the person in this situation. The whistleblowing procedure was informative and written in easy to understand language. It does not include information for staff to contact the safeguarding team or give them contact details. The minutes of a care staff meeting in November records that staff were reminded of the whistleblowing procedure and that they can refer to outside agencies if necessary. Staff spoken with at this site visit confirmed that they knew where the whistleblowing procedure was kept in the home and that the would report any concerns to the management team. The training matrix states that the majority of staff have had training on safeguarding vulnerable people and this needs to continue to include all staff. The random inspection of October identified from daily care records an instance where restraint of a resident took place in response to challenging behaviour events, but this had not been acknowledged or recorded as a restraint and the commission had not been informed as required. While no incidents were observed or noted on the records sampled on this occasion, the management team must ensure support is given to staff to manage such events safely and effectively for all while respecting the individual. The management team’s restraint policy has been reviewed and notes that the commission must be informed if challenging behaviour is serious. The training matrix states that the majority of staff have now had training on dementia care and management of behaviour that challenges, and this needs to be supported by clear information on management strategies in individual residents’ care management documentation. Gifford House Care Home DS0000067933.V355140.R01.S.doc Version 5.2 Page 18 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, 24 and 26 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 live in a safe, clean and homely environment that is suitable for their needs. EVIDENCE: A tour of the premises was undertaken that included communal areas used by residents and some of their bedrooms and bathrooms. On the day of inspection the home was observed to be clean, odour free and no health and safety issues were highlighted. The residents’ bedrooms inspected showed them to personalised with items such as photographs, ornaments and books. All resident bedroom doors had a photograph of the person and their name to help residents with recognition. The upstairs units have keypad door access controls that ensure residents can not leave the unit unsupervised. The registered provider may wish in future to consider other aspects such as use of Gifford House Care Home DS0000067933.V355140.R01.S.doc Version 5.2 Page 19 colour and lighting to further enhance residents’ positive experience of the premises to support them with orientation. The use of space at mealtimes on the first floor was more comfortable for residents and staff at this site visit than previously and it is recommended that this is maintained when resident numbers increase. The lounge area in Radcliffe has been reorganised with chairs now placed round the edges, rather than a divide of chairs down the middle of the room and people sitting with their backs to others. Residents on the ground floor have easy access to a pleasant and well maintained garden that is well equipped, provides easy walks with places to stop and sit, as well as pleasant views from many of the rooms in the home. Gifford House provides residents with a comfortable and safe living environment. The residents spoken with were all complimentary regarding the home’s environment, their own bedroom and ensuite, the comfortable beds and temperatures and opportunity to open their window for fresh air as they chose. The standard of décor, furniture and fittings is high and is well maintained. One resident said of the home “ I like it here, and I can come and go to my room as I like.” Comments from relatives’ surveys included “ Gifford House is always clean” and “it provides a comfortable environment”. Some comments received indicated that some additional car parking spaces would be helpful for visitors. The Annual Quality Assurance Assessment identifies that their plans for improving the premises are to increase handyman hours so that they can act faster in response to running repairs. An incident occurred that caused the fire officers responding to have some concerns regarding the staff knowledge and ability to open the doors at night in an emergency. The registered provider responded promptly and effectively to the advice given by the fire officer, providing a different type of lock for the doors and introducing another access way outside the premises to ensure the safety of residents and staff. Gifford House Care Home DS0000067933.V355140.R01.S.doc Version 5.2 Page 20 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to be cared for by a reasonably stable and informed staff group, which offers them consistency of care. Recruitment and training procedures do not fully safeguard residents. EVIDENCE: Senior staff spoken with the confirmed that the current minimum staffing ratios are maintained at one qualified staff and four care staff on each of the units on the morning shift and one qualified staff and three care staff on the afternoon shift. The manager advised that there are two qualified and four care staff over the three units at night. There are currently nine vacant beds at Gifford House. Staff spoken with said that the staffing levels are better now and adequate to meet the needs of the current residents. In addition to staffing levels, the deployment of staff during this site visit was notably improved and staff were more readily available in the lounges, providing better supervision and support to the residents. The surveys received from relatives and the care manager indicated that they felt there was always or usually staff with the right skills and experience to look after people properly. One person said they could “never be sure of the experience or skills of agency workers and another said “there is always the Gifford House Care Home DS0000067933.V355140.R01.S.doc Version 5.2 Page 21 issues of temporary staff and their willingness”. The registered provider and staff spoken with confirmed that they endeavour to use regular agency staff to improve consistency and continuity of care for residents. Two of the qualified staff spoken with confirmed that the consistency provided by the use of regular agency staff has been beneficial to both residents and staff. The registered provider stated that he was in the process of recruiting additional staff but is only willing to take on staff of a satisfactory calibre, and is ensuring safe recruitment procedures are achieved before their start date. The registered provider advised that as he is now managing the rotas, he is ensuring that staff do not work too many shifts that could put staff and residents as risk. Staff recruitment files were sampled. These showed more robust recruitment practices and appropriate references and checks were available and had been taken up in a timely manner. Application forms had been reviewed to include reference to the person’s physical and mental fitness to the job. Appropriate employment history and evidence of identity, qualifications and training were in place. Job descriptions were on files so that staff knew what was expected of them. A folder containing similar information regarding agency was available and well organised. A number of these were sampled from names on recent rotas. These contained the required information and also had first shift induction records to show that the staff had received basic information about the home and the residents. It was disappointing to later note that an agency staff member on their first shift at the home had not provided any evidence of identity and had been observed to provide one to one care to resident in their own room. The training matrix provided subsequent to the site visit shows that 15 of the 22 permanent care staff on the rota are in the process of undergoing National Vocational Qualification training, which is good progress, and one person has achieved this. Permanent staff are provided with a staff handbook and are given a first day induction, which identifies any formal training they require. The first day induction briefly covers several basic topics such as safeguarding vulnerable people, fire, health and safety, dementia care and management of challenging behaviour and is recorded on the person’s file. Skills for Care induction documents were seen to be available but there was limited evidence of their routine and structured use in the intended way that assesses competence and plans structured training. The availability of appropriate basic training to enable staff to meet residents’ needs and promote the well being of both groups has greatly increased in the past three months. Outside trainers have provided staff with such sessions as medication, moving and handling, first aid, fire, safeguarding vulnerable people, dementia care and management of challenging behaviours. While Gifford House Care Home DS0000067933.V355140.R01.S.doc Version 5.2 Page 22 evidence was provided later in the day that staff who persistently failed to attend training had been sent a recent letter, there was no record on their files that this had been effectively raised and managed at an earlier stage. The training matrix also shows the training planned for each of staff over the next three month period. This includes infection control, control of substances hazardous to health, food hygiene and further medication training for all qualified staff in March 2008. Gifford House Care Home DS0000067933.V355140.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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst management arrangements are generally sound, shortfalls identified during this inspection process could adversely affect outcomes for residents. EVIDENCE: The manager and registered provider have appropriate qualifications as well as experience in managing care homes. There have been identified ongoing concerns regarding the management of Gifford House and the resulting care outcomes for residents for some time. This resulted in additional random inspections being undertaken and the issuing of a Statutory Regulation Notice because of the concerns regarding medication management. The manager has not had the support of a clinical nurse manager for some months, but the registered provider has given more support, for example by managing the rotas, being involved in audits, assessing all recruitment files at the final stage Gifford House Care Home DS0000067933.V355140.R01.S.doc Version 5.2 Page 24 before appointments can be made and accessing the expertise and support of a consultancy group. At this inspection it was positive to note that some progress has been made by the management team at the home to address previous identified shortfalls and requirements. It is hoped that future inspections to the home will continue to evidence progress. The registered provider stated that there is now a clearer designation of tasks and responsibilities within the management team. Comments from the staff and relatives surveys show people find the management team approachable and one commented “management always make time to talk”. Staff spoken with also advised that they can approach managers. A quality assurance system is in operation at the home. A report of the survey of residents and relatives from May to September 2007 was displayed in the visitors’ room. Outcomes and comments included 100 satisfaction with nursing care and all who replied were satisfied with the premises, some people were satisfied with the activities provided while others think more are needed, staff were said to be always polite and friendly, with too many bank staff used or sometimes not enough staff. The registered person has regularly undertaken the required monthly visits and reports of the home and these take into account all relevant areas. He has employed the services of a consultant to support the home to achieve improvement, meet national minimum standards and comply with regulation. The inspection process has identified occasions where the manager has not informed the commission of events that have affected the well being of residents as required and is an area where his knowledge needs to develop. Residents and relatives meetings are held. One relative survey confirmed that this is a place where plans, ideas and views can be discussed. The manager holds monies on behalf of residents and records are maintained in the home. Inspection of a random sample of individual resident’s monies showed that they were in order with receipts available and two signatures used to record transactions. Formal staff supervision is developing and being introduced for all staff. A cascade model is being used with the manager supervising qualified staff who supervise care staff. The majority of staff have had at least a first session. The manager advises that formal supervisor support is provided to them by the registered provider, who is supported by the consultant. Records were available that showed health and safety audits undertaken to ensure the safety and well-being of those who live and work there. These Gifford House Care Home DS0000067933.V355140.R01.S.doc Version 5.2 Page 25 included for example checks of the fire extinguishers and hot and cold water system. The registered provider confirmed that he has taken advice and the checks of the cold water system are unnecessary. Current certificates were available regarding the inspection of the emergency lighting system, passenger lift and hoists. Records evidenced that inspection of the fire alarm and nurse call system was booked for the week of the site visit. Accident records sampled were noted to be on individual residents files and appropriately detailed. The registered provider confirmed that the actions advised by the recent fire officer’ inspection had been undertaken, including the replacement of the front door lock to allow easier opening in an emergency, training for both day and night staff in evacuation procedures and the fitting of a gate adjacent to the dining room courtyard to enable easier evacuation. Audits have also been introduced for issues such as medication records to ensure compliance and the well-being of residents. Gifford House Care Home DS0000067933.V355140.R01.S.doc Version 5.2 Page 26 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 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 2 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 2 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 2 3 Gifford House Care Home DS0000067933.V355140.R01.S.doc Version 5.2 Page 27 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 Requirement So that interested people have access to all the required information, the service user guide needs to include all the required information and ensure it is up to date. 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 documentation 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 challenges, end of life care and social care needs and interests. This is an outstanding requirement from the reports of the key inspections of 19/01/07, 13/04/07 and 23/07/07. Ensure that all people living at DS0000067933.V355140.R01.S.doc Timescale for action 01/03/08 2. OP7 OP11 1512(2)1 3(4)Sch 3(3) 01/07/08 3. OP12 16(2)(m) 01/03/08 Page 28 Gifford House Care Home Version 5.2 and (n) the home, including those people who have cognitive impairments, have their social care needs. Ensure that all people living at the home are given opportunity to make choices and that their right to do this is respected and supported. 07/01/08 4. OP14 12(2) 16(2)i 5. OP16 22 Ensure that there is a clear audit 07/01/08 trail/records depicting complaints received, investigation, action taken and outcomes. This remains outstanding from the inspection of 23/07/07 6. OP18 13(7) (8) Sch 3(3) Ensure that restraint is only used 07/01/08 to secure the welfare of residents only in exceptional circumstances, staff are suitably trained and where restraint occurs records are maintained. This remains outstanding from the inspections of 19/01/07, 13/04/07, 23/07/07 and 15/10/07 7. 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 includes for agency staff. This is outstanding from the reports of the inspections of 19/01/07 and 13/04/07, 23/07/07, 15/10/07 and 16/11/07 07/01/08 Gifford House Care Home DS0000067933.V355140.R01.S.doc Version 5.2 Page 29 8. OP30 18(1)(c)& (i) Ensure that staff receive 01/03/08 appropriate training to the work they perform. This refers to continuing basic training issues for al staff as well as training on specific conditions associated with the needs of people living at the home. This will ensure that staff have the competence, confidence and ability to meet resident’s care needs. This remains outstanding from the inspections of 19/01/07, 13/04/07, 23/07/07, 15/10/07 and 16/11/07 9. OP31 OP37 9(2)b(i)10 So that residents are (1)& (2)a safeguarded and provided with adequate care outcomes the manager or registered provider must notify the commission of events as required by Regulation 37. 07/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP18 Good Practice Recommendations The whistleblowing and adult protection procedures should have up to date contact details for relevant agencies. 50 of care staff should achieve NVQ Level 2. Staff should be provided with formal supervision at least six times annually. OP28 OP36 Gifford House Care Home DS0000067933.V355140.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Colchester Fairfax House Causton Road Colchester Essex CO1 1RJ 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.V355140.R01.S.doc Version 5.2 Page 31 - 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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