Inspection on 09/01/07 for Gifford House Care Home

This inspection was carried out on 9th January 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 23/07/07

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 9th January 2007 08:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Gifford House Care Home DS0000067933.V326449.R02.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.V326449.R02.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 (2), 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.V326449.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To provide care to two named residents with dementia, known to the Commission, aged under 65 years. Number of places not to exceed 61 in total, including up to 39 places for people who have Dementia. New service Date of last inspection 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 showrooms, and well equipped laundry and kitchen facilities. The homes weekly fees range from £506.45 to £625. Additional charges to residents are £6 to £17 for hairdressing and £10 per visit for chiropody. 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.V326449.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first inspection of Gifford House Care Home since its registration in August 2006. This key inspection was undertaken by two inspectors, Bernadette Little and Christine Bennett, who were at the home from 8am to 7:20pm. Five residents, seven visitors, seven staff, the care manager, the homes registered manager and the registered provider were spoken with. A tour of the premises was undertaken and records, policies and procedures were sampled. Care files for four residents were case tracked and others were sampled. Subsequent to the site visit, one relative was spoken with by telephone. A GP, a social worker and a healthcare professional were also spoken with. 20 questionnaires were sent to the home to make available to residents and relatives prior to the site visit. Three responses were received by the Commission for Social Care Inspection. Requests for comments/information was sent to families and comments received from two subsequent to the site visit. A pre-inspection questionnaire was received from the registered manager prior to the site visit and information from this document was also used to inform this report. Discussion of the inspection findings took place in detail with the care manager, registered manager and registered provider. Guidance and advice was given on the concern regarding, and the need to address without delay, the high number of Regulations and Nation Minimum Standards that the home were not meeting. An immediate requirement notice was issued to the home 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. A request was also made for an inspection by the specialist Pharmacy inspector due to concerns regarding the medication. Comments received from all the sources are reflected throughout the report. What the service does well: Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 6 Gifford House Care Home gives residents a very pleasant and comfortable environment to live in. Many of the staff were seen to chat in a friendly and respectful way with residents while they undertook other tasks. Residents and visitors spoken with said that the food is nice. Visitors were welcomed at Gifford House. What has improved since the last inspection? 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.V326449.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Prospective users of the home had been provided with limited information to enable them to be fully informed about the service before making a choice to live there. Unless privately funded, residents were not provided with information about the terms and conditions of their rights and responsibilities as residents at the home. The home had admitted residents outside their category of registration, or without fully assessing all their needs so that they could assure the residents that they could meet these. Staff had not been provided with the appropriate training they needed to ensure that they could meet residents’ needs. Prospective service users/relatives were encouraged to visit the home before moving in as part of their decision-making. Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 9 EVIDENCE: Residents and relatives spoken with felt they had been given information about the home. The registered manager advised that prospective users of the service are sent a brochure and other information about the home as part of marketing. He confirmed that the Statement of Purpose or Service User Guide had not generally been made available. This does not comply with Regulation. The manager had a copy of the Service User Guide and Statement of Purpose in his file in the office. They were not generally available in the home. One survey received included the comment “ things are a lot different to what they said they would be” The registered manager was advised that the Service User Guide needed to be amended to reflect the changes to Regulation in September 2006, in relation to information on fees and charges made by the home. The Statement of Purpose needs to be developed now that the home is up and running, and able to include all the information required by Regulation and Schedule 1. This includes the information in relation to staff training. The registered provider stated that privately funded residents are provided with a written contract of their terms and conditions. Other residents are not provided with a statement of terms and conditions as outlined in National Minimum Standard 2. The five survey forms received confirmed that the residents had not received a contract. The Service User Guide states that a contract will be given to residents to read and sign with a copy for them to retain. Some relatives spoken with confirmed that the manager had undertaken a preadmission assessment. Preadmission assessments were not found on all files sampled. The manager advised that one resident, who was on respite care, had not been assessed prior to admission, but was being assessed during their stay at the home. The Service User Guide states that the home manager or a senior member of staff will assess all residents prior to admission where possible. The manager advised that this had not always occurred and more recently he had relied on the information provided by the social worker’s COM5 document, which he felt contained good information. One survey form received stated positively that due to a difficult situation, the home had taken their relative from a local area without assessment. It was also noted that one resident had been admitted outside the homes category of registration. The registered manager and registered owner were advised to ensure that all residents had had a proper preadmission assessment, so the home could Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 10 reassure themselves that they could meet the residents need and that the person was suitable in relation to the needs of the other residents at the home. They were also informed that Regulation required them to confirm in writing to each service user that based on the assessment, the home could meet that persons needs. All staff have not been provided with appropriate mandatory basic training for example in relation to the safe moving and handling of residents, food hygiene, first aid, infection control, etc. Other than a short session on dementia during induction, neither had they had training specific to the needs of the residents, including in relation to dementia, which as the home is registered in this category of care would be considered mandatory. Additional training in relation to conditions associated with older people also needs to be considered for example in relation to continence management, diabetes or Parkinsons disease. Relatives and residents spoken with confirmed that they were welcomed and encouraged to visit the home prior to admission. Gifford House Care Home does not provide intermediate care. Gifford House Care Home DS0000067933.V326449.R02.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, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care management documentation did not include all the necessary information to tell staff about residents’ needs, to ensure that they could be met consistently. Risk assessments were not in place for several identified issues to ensure the safety of residents and staff. The medication system was poorly managed and so did not safeguard residents’ health and wellbeing. Residents’ views had not always been sought to show respect for them as individuals with rights. Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 12 EVIDENCE: A number of care plans files were tracked and others were sampled for specific issues. Some contained photographs of the resident as required, while others did not, up to ten weeks after admission. On one file, the care management documentation did not evidence the involvement of the resident for example, by their signature, although the resident was able to provide this. A record of the resident’s needs was completed on the third day after their admission (approximately 10 weeks prior to this site visit) and covered a number of areas, one of which related to the need for hoisting for all transfers. No moving and handling assessment was available and no safe plan of work for the resident or the staff involved. It was noted positively that nutritional risk assessment and tissue viability risk assessment has been undertaken. An ‘ agreement’ for the use of bed rails for this person was on file, as was a protocol for their use. This was signed by a nurse but not by the resident or other relative. There was no risk assessment in place to evidence that these were safe to be used for this resident. As no agreement had been sought there was no record of their being used as a potential restraint/infringement of the persons rights. The actual care plan included four of the resident’s area of needs, and did not include all aspects of their health and welfare. Monthly evaluations of the care needs had been undertaken twice since admission. Both stated that the resident did not wear glasses. It was evident from discussions with the resident, from observation of the photograph on the file and from discussions with the registered manager that this was inaccurate and that the resident did need to wear glasses all the time. The monthly evaluations stated that the resident saw the chiropodist monthly, there was no record of this in the section of the file for recording chiropody treatment. In the record of GP visits, one entry identifies the reason why; the other gives no indication as to why the resident was seen by the GP. Of the five surveys received, only one felt that they received the medical support that they needed and three felt that this was usually received but with the added comment “ but you have to keep asking.” The fifth indicated that they felt medical support was sometimes received as needed but this was not to be taken as a criticism of Gifford House, but to the length of time it took the doctors surgery to arrange a visit at the home for a patient. Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 13 On another care file sampled the personal profile was not completed. The section on identified needs was not completed (ten weeks after admission), for example in relation to dietary needs, finance, health care needs, personal care needs, leisure, medication etc., although a later statement indicated that the resident was fully mobile, continent and could manage their own personal care. The care plan was again very limited and mainly related only to the management of inappropriate behaviours. This did not have clear instructions on all aspects for consistent management. Three other care plans sampled showed generally very little detail on all aspects of the residents needs and welfare, or how this is to be met in practice on a daily basis for each individual person, including management of risks in relation to falls, pressure sores, nutrition or management of behaviour that challenges. The social worker spoken with felt that while it was early days, the resident appeared well, but was confused so could offer no feedback, but generally impressions were positive and the care plan was made available. A care plan for a respite resident was sampled which stated that the resident was continent. However in discussion, the relative advised that the resident was now wearing a pad that was put on the resident when they came into the home. Staff spoken with advised that carers no longer have any input to care plans, which are now completed and managed by the qualified staff. Care staff rely on the information given to them each shift about the residents they are to look after that day. Four relatives of spoken with stated that, since admission to the home their relatives were wearing incontinence pads, although they had not used to them prior to coming to Gifford House. A relative also stated that their relative (in an upstairs Dementia unit) “is lucky to get a bath once a week”. The GP spoken with advised of some difficulty where staff were calling or faxing for home visits inappropriately, and that “some staff were better than others”. The doctor advised generally of no concerns regarding the care offered at the home. The healthcare professional said of Gifford House “ Lovely, this is one of the better ones” and viewed the communication as good and staff as co-operative. Staff spoken with showed an understanding of respecting residents’ privacy and dignity of for example only knocking on doors before entering, and that a resident has their own telephone installed so that they can speak privately. A relative advised that a resident prefers male carers but that the home is unable to provide these as the home are having trouble recruiting male staff. Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 14 One resident spoken said that staff were generally polite and respectful and that the one qualified staff who had shouted at her last week had now left. (This was confirmed by the registered manager). A relative spoken with the said their relative was ” always clean, shaved and wearing their own clothes”. A resident said staff are “generally polite and respectful, and are kind and caring but I sometimes have to wait during the day for the bell to be answered, and I have an accident as the girls are busy elsewhere”. A payphone is available for residents to make telephone calls. This is situated in the main hallway and provides no privacy to residents. The registered provider was made aware of this is an issue prior to the homes opening, but advised that telephone system supplier state that the phone cannot be moved. Consideration should be given to providing better privacy to residents in this area. There was no care plan in relation to medication on files sampled. The upstairs medication room was not fitted with a room thermometer and was extremely warm. Records were not being maintained of temperatures to ensure safe storage. There was no fridge available in the upstairs medication room, this meant that staff had to go downstairs each time to bring up the required medications. A medication for one resident did not indicate how many tablets were being administered where there was a choice of one or two prescribed. Omissions were noted on the Medication Administration Recording (MAR) sheets for four other residents sampled, these included medication related to Parkinsons disease, where medications need to be taken on a regular basis. It was not possible to determine whether the medications had actually been administered and just not signed for, as the blister pack system was not being used effectively or systematically. Medication was being taken from any day on any week, rather than methodically following the day and week patterns. Protocols were not in place in relation to medications that were prescribed on and ‘as required’ basis. Photographs to assist with the identification and accuracy of administration were available on MAR sheets for some residents but not for others. It was observed on the upstairs unit that a qualified nurse left the drugs trolley open and unattended on the corridor while taking the residents’ medication to them into the dining-room. The temperature in the downstairs medication room was also not being recorded, neither was the fridge temperature. Medication for one resident indicated that while they should be eight remaining tablets, there were actually 22 in the box. Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 15 Protocols were not in place relating to a homely remedy (paracetamol) for one resident sampled, and no indication of whether one or two tablets were being given. For another resident paracetamol were being administered but no record was being kept. Medications for some residents on MAR sheets were hand transcribed, but with no second signature to confirm the accuracy of the information. A list of specimen signatures/initials for those who are deemed competent to administer medication was not available. The blister pack medication system was again not being used in sequence on this unit. Controlled drugs were appropriately stored and recorded in a bound book. These medications were sampled for two residents who found to be accurate. Controlled drugs for another resident were found to be accurate in number. These were recorded as having been destroyed as the resident had died. This was inaccurate as they were still available. The manager advised that there had been problems with the pharmacist and difficulty of obtaining the blister packs on the appropriate day, but that a meeting had been held to address this. The care manager advised that it was one nurse who was responsible for the non-sequential use of the blister pack system. It was discussed that this was not possible as there are at least three qualified staff on shift each day and the situation was found on both floors. It was of concern that the care manager was aware of the poor management of the medication system, and that effective action had not been taken to address this. Because of the concerns raised relating to the medication system, a separate site inspection was undertaken by a specialist pharmacist Inspector on 16th February 2007. This continued to identify concerns identified and made known to the registered provider and registered manager at the first site inspection. The pharmacist inspector’s judgement on the practices for handling and recording of medicines within the home are poor. A separate report has been sent to the home. Gifford House Care Home DS0000067933.V326449.R02.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): 12, 13, 14, 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home did not identify or meet the needs of some residents in relation to their preferences or their religious needs. With limited social activity staff time and inadequate care staffing levels, there was limited opportunity for residents to have meaningful activities to meet their social and emotional needs. Visitors were welcomed. Choices were provided in some aspects of daily life but not met for other residents. Residents were provided with a nutritious diet. They were not always adequately supported to enjoy it fully due to limited staffing levels/deployment. Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 17 EVIDENCE: Rotas provided at time of the site visit showed that Gifford Lodge had an activities coordinator on duty hours 10am to 4pm twice per week, for in excess of 40 residents. A relative said “ the activities girl is good with him but shes not here enough”. Another resident said “ the activities person doesnt come very often, it gets boring”. A relative stated that the activities coordinator does very little more with them than make tea. A member of staff said that if the activities lady is not on duty, staff do not have time to do things with the residents. A care plan for a resident in relation to leisure recorded “ no interest in anything at all” and the ‘Action’ to address this was recorded as ” there is an activity coordinator”. A personal history was seen on one file, which provided detailed information written by a relative. This file referred to the resident’s religious needs for communion to be brought to them at the home. There was no record of this service being sought by the home or of the resident receiving communion. The five surveys received varied in their view as to whether there were activities arranged by the home that they could always take part in. One thought sometimes, one thought usually, one thought always, two advised there were activities but added “ some patients do not want to join in” or “ has dementia so it is a bit difficult for her to join in”. There were several visitors at the home on the day of the site visit. Visitors, residents and relatives confirmed that visitors were welcomed at Gifford House. A resident advised that there are not enough staff first thing in the morning to enable them to get up early as they would prefer, and to have their breakfast earlier, “ I am used to being an early bird”. The resident was observed to come to the dining room for their breakfast at 10:10am. The qualified staff on the downstairs unit was noted to ask residents if she could give them their medication. Residents were also offered a choice of breakfast, including a cooked breakfast. Residents spoken with said that they could choose to spend time in their rooms if they wanted to, or choose their clothes. The level of choices offered to residents in the dementia unit was less clear and residents spoken with were unable to clearly express their views. Care plans sampled indicated that the home was to manage the medication, but did not evidence an assessment of how this decision was reached including Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 18 any assessed risks, or show any consultation with the residents to offer a choice, where this was able to be obtained. The dining rooms were well presented with round tables that seated four residents. Tables were set with cloths and residents had a choice of meals. There was no menu board displayed for residents and those spoken with did not know what was going to be on the menu that day. They advised that staff had come round the day before and offered them a choice. Many said they enjoyed the food. Three of the five surveys indicated that residents always liked the meals at the home and included comments such as “ excellent, good choice” and “ they are excellent…. the whole atmosphere at mealtimes is good… the staff are encouraging”. The two remaining surveys indicated that meals at the home were usually liked. One included the comments “ the meals are getting smaller… lots of patients needed help feeding, but there is no one to help.” Another relative subsequently spoken with advised that portion sizes are smaller now and not adequate on the dementia unit, particularly the teatime meal, which is the last meal that residents receive before breakfast the following day. There were ample food stocks in the kitchen and the chef advised of a satisfactory food budget. Observation of the mealtimes indicated that they were not sufficient staff available in the dining rooms at all times to serve food and support residents to eat their meals, or to provide this support while meals were still warm. Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure had not been made readily available to interested parties. The home had not formally investigated/recorded a complaint made and communication was poor. Training for all staff would better protect residents. EVIDENCE: Gifford House Care Home has a written complaints procedure. The registered manager stated understanding that it needs to be updated to more clearly identify that the Commission for Social Care Inspection does not investigate individual complaints. Forms for recording complaints were also available. The complaints procedure was not displayed in the home but individual leaflets were readily available in the quiet room, which is immediately off the main foyer, and which, the owner advised, is regularly used by relatives. The complaints procedure is also clearly referred to in both the Statement of Purpose and the Service User Guide, but this had not generally been made available. Relatives and residents spoken with stated that they would feel able to raise any concerns with the registered manager or the care manager, with the belief that they would respond to them appropriately. Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 20 The home has recently received one written complaint that was also copied to the Commission. The manager advised that he had only just become aware of it due to a breakdown in communication with his care manager that had now been addressed. He also advised that each of the individual issues identified in the complaint had been addressed at the time they had occurred. However none of these had been recorded as complaints/concerns raised, and there was no record of the investigation, outcome and actions taken. Advice was provided on recording all complaints and concerns raised, and of keeping a log for ease of access while allowing the individual forms to be stored confidentially. The homes policies and procedures on protection of vulnerable adults and whistleblowing were not inspected on this occasion as they were considered as part of the homes registration. Staff who were employed from the outset of the homes opening were provided with basic training on protecting vulnerable adults in induction. More recently appointed staff have not been provided with this training by Gifford House Care Home. Those with previous experience may have had this training in previous employments but Gifford House were not able to evidence knowledge of this. Staff spoken with were generally able to recognise various forms of abuse and said that they would report it to their manager. They were unaware in some cases of any further steps that could be taken. The home should make staff all aware of the whistleblowing procedure. The manager should ensure that the home has current guidance in relation to the local protocol for protecting vulnerable adults. Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Gifford House provides residents with a well maintained, clean and pleasant living environment. The available communal space was not well used to provide the best experience for residents. Equipment and furniture met residents’ needs. The upstairs units did not provide the best orientation support for all residents. Aspects of health and safety and infection control practices did not best protect residents. Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 22 EVIDENCE: The registered provider has invested time and money in ensuring a high standard of furniture, fittings, décor, equipment and facilities. Rooms had ample natural lighting. Windows were fitted with restrictors and radiators were protected to ensure resident safety. The front door is fitted with a keypad coded entry system. There is access to pleasant and well maintained gardens that provide seating areas as well as walks. Many of the rooms have views over the garden at the back or over the fields to the front of the premises. The home has three named units, two upstairs, Linford and Radcliff and one downstairs, Betts. The downstairs lounge diner presented as spacious. The use of the one dining room for the residents accommodated upstairs was not well considered and the room presented as crowded during breakfast time. 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. Corridors and doorways are wide allowing easy access for wheelchairs and equipment. Corridors are fitted with appropriate handrails. A seated weighing scale and a hoist were available. Specialist beds had been provided in all rooms. Many of the bedroom doors contained a clear photograph of the resident, along with their name and the bedroom number to assist with recognition. It was disappointing to note that had not been provided on some of the occupied bedrooms, particularly to assist residents who may need additional help with orientation. Storage space was provided on each unit for wheelchairs, which is positive. Staff were seen to transport residents in wheelchairs that were fitted with footplates, which is good practice. Call bell points were available in all communal rooms, and accessible in bathrooms and toilets. The cord for the call bell points in residents’ bedrooms sampled were not always positioned to be easily accessible. Many residents or their representatives had been able to choose their bedroom prior to admission. Bedrooms are well furnished, with lockable facilities both in the bedroom and in the ensuite. Some bedrooms were well personalised with individual photographs, ornaments and other small familiar pieces. Residents had the option of having their own telephone installed, and this was seen in one of the rooms sampled. To assist with the transfer of laundry from upstairs to down, a laundry chute is sited on the upstairs corridor. This door was found to be unlocked and Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 23 considered a potential hazard to residents, particularly as many of the residents in this upstairs area had dementia. The registered provider confirmed that this should have been locked and that he would make sure it was made safe immediately. The cleaners’ cupboard next to the lounge on the upstairs unit was noted as unlocked and containing hazardous items. Protective gloves were seen to be available in a drawer in a residents bedroom and in communal areas such as toilets and bathrooms. The registered manager agreed that this could present a potential risk of choking for vulnerable residents. It was disappointing to see used continence pads in a bathroom bin that was not fitted with a yellow bag, but had a yellow bag left on top of it. A used pad was also seen on the dressing table in a resident’s room. A wheelchair without footplates was noted in one of the resident shower rooms and it was piled high with clearly dirty clothes belonging to both male and female residents. The laundry and kitchen areas were well-equipped and clean. Some relatives stated that there had been problems with laundry going missing. Other relatives and residents said that the laundry, and the laundry assistant were very good. There had been no laundry assistant employed at weekends, which meant a backlog of laundry at the start of the week, as well as care staff trying to undertake some laundry tasks at weekends instead of being able to spend all of their time caring for residents. The manager advised that this has now been addressed and that another person has been appointed to undertake laundry at weekends. Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 24 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. This judgement has been made using available evidence including a visit to this service. The home was not providing staffing levels to meet its own stated assessment or to meet the observed needs of residents. Staff deployment was not well organised to safeguard residents. Staff recruitment did not best protect residents. All staff had not been appropriately trained in basic mandatory issues to protect residents or themselves. EVIDENCE: The registered manager advised that the home were trying for a ratio of one carers to 5 residents and one qualified staff to 15 residents during the day, with one carer to 15 residents and one qualified staff to 30 residents at night. This was not actually occurring at the time of the site visit. Staff do not sign in and out for their shifts, so there was no record of hours actually worked. There were six carers, three qualified staff and the qualified care manager on duty at the time of this inspection where there were 41 residents living at the home, with two additional residents admitted during the afternoon. On the downstairs unit with nineteen residents there was one qualified staff and three Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 25 carers. Over the two upstairs dementia units there were five staff including two qualified with twenty four residents. The rota provided during the inspection did not concur with the staff on duty at the time and it had not been kept up-to-date to reflect changes. There was also a lack of clarity in the management team regarding their awareness of which staff were actually on duty that morning, and staff shortages later that day and whether action had been taken to address it. The rota also demonstrated that the night staffing levels had not been met on the night prior to the inspection. This was also indicated on other rotas. In view of the reported level of resident needs at night, the night staffing levels need to be reviewed and be maintained at a level that meets residents’ needs safely. The rotas do not allow any time for hand over between shifts, which does not assist with communication in the best interests of residents, for example consistency and continuity. Staff attend a specific point each day to be allocated an area of work for that shift. Relatives spoken with expressed concern that they had requested assistance from staff to support a resident on different occasions, but that this had not been given as the staff stated they were not assigned to that resident. The manager confirmed that this was not acceptable. Rotas indicated that many staff worked long shifts of 12 hours per day. The manager advised he had addressed the situation of a staff member working excessive hours/excessive days without a break. The home do not use agency staff but try to provide cover from amongst their own staff on their off duty days, or from bank staff. It was identified however that there can be difficulty in trying to get their own staff to cover additional shifts, for example to stay on or come in early when there are already working long days/twelve hour shifts. Observations at mealtimes both upstairs and down indicated poor organisation of staff/tasks and an inadequate level of staffing to support residents. It was discussed with the registered provider and a registered manager that ancillary staff hours should allow for the upstairs dining room to be cleaned before the mornings breakfast so that residents do not have to wait for this to occur before they can eat, and that the provision of support staff to serve food would free care staff to undertake care tasks. There were long and frequent periods of time observed when there were no staff in lounges with residents, which is a concern. This was also identified by relatives as a concern, especially in the dementia units. Staff spent time walking residents from the lounge at one end of the building where there had been taken when they got up, to the dining room some distance away, for their Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 26 breakfast. This did not present as effective organisation of staff time or of quality outcomes for residents. Residents and relatives spoken with or who offered comments in surveys were most complimentary about the staff, for example “staff are excellent and dedicated” “carers really do their best.” Survey forms from relatives identified their concern regarding the inadequate staffing levels being actually available on the unit to provide hands on care to the residents, for example “ staff are under a lot of pressure due to constant lack of staff”, “ visitors/family are constantly acting as the eyes to help the carers out” “being EMI and a very volatile environment… imperative that a carer needs to always be in the lounge area at any given time” The registered manager advised that he had been in contact with a company to arrange NVQ training for staff, both at level 2 and level 3 in health and social care, and that 16 staff to date had expressed interest. Three staff recruitment files sampled, one for a qualified staff, one for a care assistant and one for an ancillary staff. Application forms included a declaration of health and offences. Parts that had not been completed were not evidenced as followed up. Job descriptions and contracts of employment were not on file, the job descriptions were available in the home. All files contained a photograph, an appropriate Povafirst and/or criminal records bureau check, which is positive. One did not contain evidence of identity as required, one contained only one reference and the other contained a second reference that had been obtained after the person and started working at the home. None of the files contained any record of induction or evidence of any training. Staff employed at the time of the home’s opening had a brief preliminary induction that included some sessions on issues such as health and safety, lifting and handling, food handling and hygiene, protection of vulnerable adults, managing challenging behaviour as well as fire strategy and extinguishers. There was no induction record or record of training contained on any staff file sampled. The registered manager confirmed that he is not a qualified trainer with regard to moving and handling. The manager said he believed that some kitchen staff did have training certificates. He was not sure what these were and there was no record or copies available. An Immediate Requirement notice was left with the owner and registered manager requiring them to take immediate action to arrange training and to Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 27 provide the Commission with information on their plan and timescales for this to occur. Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 28 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, 32, 33, 35, 36, 37, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. As demonstrated throughout the report, Gifford House did not present as effectively managed to provide the best quality care outcomes for residents. The management were approachable to residents and relatives. Quality monitoring, including regulation 26 reports had not identified the concerns or ensured effective actions to address them. Residents’ finances were generally safeguarded. Staff were not provided with appropriate supervision and support. Records were not always accurate/fully complete so as to best protect residents. Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 29 EVIDENCE: The registered manager is a qualified nurse and has experience managing care homes. Residents, relatives and staff spoken with said that he is approachable. It was noted that the registered manager had admitted a resident outside the home’s registration category, which is a breach of regulation. Advice was provided on immediate action to be taken to address this and reassurance required that it will not be repeated. It was of concern that the manager was not fully aware of the staff actually on duty on the morning of the site visit, or the staff shortage identified on the rota for the afternoon shift. It was also of concern that minimum staffing levels were not being met to meet resident need, and that appropriate action had not been taken by the manager. Communication in the senior management team was not effective, for example in relation to the staffing on the day of this site visit, the problems with the medication system, and in relation to the complaint received by the home. The lack of training for staff and lack of any immediate formal plan by the home to action this does not demonstrate effective forward planning. The registered owner advised that they had undertaken a questionnaire with residents and had thirteen replies. Some replies were positive regarding food, laundry and environment with comments such as “ very satisfied with all aspects”, “ far exceeds previous care experiences”. Some replies advise that the help support and information given is good, but other comments included “depends on the carer at the time, some attitude worrying”, “ concerned re training about washing and general care, give patients drinks and not just leave”. A relative/resident meeting has taken place, which is positive considering the time the home has been open. However one comment in the survey stated “ it was a very confrontational meeting”. The registered provider stated that this related to the way one relative acted and was not a reflection of the relationships between the management team and the residents/relatives. The registered owner has undertaken monthly visits to the home as required by Regulation 26 and provided written reports to the Commission. These had not identified the issues and concerns raised in this report. The registered owner was advised that, following changes to the regulation, the reports are no longer required to be sent, but must be maintained on the premises and available for inspection. Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 30 Some residents look after their own money or relatives look after it for them. The record of money kept by the home for three residents was inspected. This was kept appropriately in individual wallets with individual records and receipts available. Records contained a date, and a record of money in and out and the balance. There was no signatures recorded on the sheets and advice was provided to the manager. The registered manager confirmed that formal supervision has not yet been provided to staff, as he is still discussing the allocation of qualified staff to the units to ensure consistency to cascade the sessions. A policy on supervision was available as well as forms for recording and the manager advised that it is hoped to commence supervision within the next four weeks. Accident records were inspected and it was noted positively that these are audited by the registered manager. Comments on the inaccuracy of the rosters has been previously included. Part of the registration certificate was displayed and this was not the up-todate version. Advice was provided to the registered manager and owner of the need to inform the Commission formally when an agreed variation for an individual resident no longer applied at the home. Photographs were not available of all residents as required. Inspection certificates for example such as for gas, electrical fixed wiring, lift, nurse call, or fire safety system were not inspected on this occasion as they were viewed at the time of registration. The homes own weekly record for the checking of the fire alarm was well maintained at their weekly check of selfclosing fire doors or extinguishers had not been undertaken regularly. A monthly check had been undertaken of the temperature of the hot water outlets. The owner will clarify as to whether cold water temperatures also need to be checked. A record of the portable appliance testing was available. A record of fire drills was maintained. This evidenced that not all staff had been included in a fire drill/practice. Some issues in relation to health and safety of residents were previously noted in the section on Environment. Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 31 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 1 1 1 3 N/A 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 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 3 2 3 2 3 3 3 2 STAFFING Standard No Score 27 1 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 3 2 X 3 1 2 2 Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? N/A 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 4(2) Requirement The registered person must ensure that the statement of purpose is made readily available to service users and any interested party. The registered person must ensure that the service user guide is made readily available to service users. The registered person must ensure that the service user guide is amended to include all the information regarding fees, charges and services required by the changes to the Regulation from September 2006. The registered person must ensure that each service user is provided with a contract/ statement of terms and conditions. The person registered must ensure that a full assessment of the residents needs is undertaken prior to admission by DS0000067933.V326449.R02.S.doc Timescale for action 09/01/07 2. OP1 5(2) 09/01/07 3. OP1 5(1) 01/03/07 4. OP2 5(3) 01/03/07 5. OP3 14(3) 09/01/07 Gifford House Care Home Version 5.2 Page 33 a person qualified to do so and the resident assured in writing that, based on the assessment, the home will meet these needs. 6. OP4 18(1) The person registered must show 01/04/07 that the home can meet the assessed needs of residents and ensure that staff are provided with training to enable them to meet these needs. The person registered must ensure that residents views are obtained and respected as far as possible in relation to their individual care and involve them in their plan of care. The person registered must ensure that the care plan contains sufficient information to show all the residents needs and how the residents’ needs are to be met in practice. 09/01/07 7. OP7 12(2) 8. OP7 15 01/04/07 9. OP8 13(4)c The person registered must 09/01/07 undertake appropriate risk assessments and demonstrate safe management of risks to residents, for example relating to bedrails and in bed rails, moving and handling, nutrition etc. The person registered must ensure that restraint is only used to secure the welfare of residents in exceptional circumstances and where this occurs, appropriate records must be maintained. This includes the use of bed rails. The person registered must ensure the promotion of continence for residents and provide staff with training to support this. DS0000067933.V326449.R02.S.doc 10. OP8 13 (7)(8) 09/01/07 11. OP8 12(1) 01/03/07 Gifford House Care Home Version 5.2 Page 34 12. OP9 13(2) The person registered must ensure that there is a safe and effective system operating for the management of medication, including recording, handling, safekeeping, safe administration and disposal. The person registered must ensure that residents privacy is respected and action taken to address the siting of the residents telephone. The person registered must ensure that residents that residents are consulted about their social interests, and facilities, staff and training must be provided to meet them and care plans must include details of how they are to be met. 09/01/07 13. OP10 16(2)b 01/04/07 14. OP12 16(2)m 01/03/07 15. OP12 16(3) 16. OP14 12(2) The person registered must 09/01/07 ensure that as far as possible, residents have the opportunity to attend religious services of their choice. The person registered must 09/01/07 ensure that residents are given the opportunity to make decisions regarding their care and opportunity to exercise control over their life where this is appropriate, for example with the management of medication, or their preferred time to get up and eat. The person registered must ensure that residents are given ample food, and with adequate support to take the food and maintain nutrition for those who need that support. The person registered must DS0000067933.V326449.R02.S.doc 17. OP15 16(2)i 09/01/07 18. OP16 22 (5) 09/01/07 Version 5.2 Page 35 Gifford House Care Home ensure that a copy of the complaints procedure is given to all service uses and in a format that is suitable for them. 19. OP16 22(3) 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. The person registered must ensure that residents are best safeguarded and all staff are provided with training on protecting vulnerable adults as well as training on positive management of behaviour that challenges. 09/01/07 20. OP18 13(6) 09/01/07 21. OP19 13(4) The person registered must 09/01/07 ensure that all areas of the home remain safe for residents. This includes issues identified in the report including for example the laundry chute not being secured. The person registered must ensure that residents have ample space in which to eat comfortably and that better use is made of the available communal living spaces to meet resident need. The person registered must ensure that suitable adaptations and support are available to residents to meet their needs, for example signage and orientation. The person registered must ensure that effective arrangements are in place to prevent the spread of infection at the home. This refers to issues raised in the report for DS0000067933.V326449.R02.S.doc 22. OP20 23(2)f 09/01/07 23. OP22 23(2)n 01/03/07 24. OP26 13(3) 09/01/07 Gifford House Care Home Version 5.2 Page 36 example, dirty clothes from different residents being piled on the wheelchair or the failure to dispose safely of used incontinence pads. 25. OP26 13(4)a&c The person registered must ensure that all parts of the home to which residents have access at kept free from hazards to their safety as far as possible. This refers to issues raised in the report, for example residents having access to hazardous items in the cleaning cupboard, which was unlocked, or residents having access to disposable gloves, which could present a choking hazard. 09/01/07 26. OP27 18(1) 09/01/07 The person registered must ensure that at all times there are suitably qualified and competent staff on duty in sufficient numbers to meet residents needs in terms of their health and welfare. This refers to both the number of staff on duty each shift and to the deployment of staff. The person registered must 09/01/07 evidence robust and safe recruitment procedures and have all the required records and documents available at all times for inspection. The person registered must ensure that all staff receives training to the work they are to perform. This refers to induction training, basic mandatory training for all staff such as moving and handling etc, and resident specific training. The registered manager must DS0000067933.V326449.R02.S.doc 27. OP29 19, 17(2) Sch 2&4 28. OP30 18(1)&(3) 09/01/07 29. OP31 9(2)b(i) 09/01/07 Page 37 Gifford House Care Home Version 5.2 demonstrate that they have the skills and training to manage the home effectively. 30. OP31 10(1)& (2)a The registered provider must demonstrate that they are carrying on the home with sufficient care, competence and skill and undertake any necessary training to ensure this. The registered person must continue to develop systems for monitoring and improving the quality of the care services provided by the home. Monthly visits undertaken by the registered provider to be to a degree that allows him to form an opinion of the standard of care provided in the home and other matters as required by Regulation. The person registered must ensure that staff are appropriately supervised. 09/01/07 31. OP33 26 09/01/07 32. OP33 26 09/01/07 33. OP36 18(2) 01/04/07 34. 35. OP37 OP37 17(1)a The person registered must 09/01/07 ensure that a photograph is kept in the home of each service user. 17(2)Sch4 The person registered must 09/01/07 ensure that the duty roster details all members of staff working at the care home, is kept up to date and accurate and their record must be kept of whether the roster was actually worked. 23(4)e The person registered must ensure that staff working at the care home regularly participate in fire drills. 09/01/07 36. OP38 Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 38 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practices for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations The minimum frequency that residents are to have baths should be recorded in their care plans and the actual events recorded in their care notes. Information should be displayed in a suitable place and format to inform residents of the menu. The complaints procedure should be amended to clarify the Commission’s position on complaints investigation. The practice of staff working long/full day shifts should be reviewed. 50 of care staff should achieve NVQ Level 2. Two signatures should be obtained for withdrawals of residents money, this should include the resident where possible. 2. 3. 4. 5. 6. OP15 OP16 OP27 OP28 OP35 Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 39 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 Gifford House Care Home DS0000067933.V326449.R02.S.doc Version 5.2 Page 40 - 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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