Inspection on 15/01/07 for Gilby House Care Home

This inspection was carried out on 15th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gilby House Care Home 31/07/09

Gilby House Care Home 19/05/09

Gilby House Care Home 16/10/07

Gilby House Care Home 06/03/06

Gilby House Care Home 01/11/05

Gilby House Care Home 29/11/04

Gilby House Care Home 26/05/04

Gilby House Care Home 02/03/04

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Gilby House Care Home High Street Winterton Scunthorpe North Lincolnshire DN15 9PU Lead Inspector Stephen Robertshaw Unannounced Inspection 15th January 2007 09:30 Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 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 Gilby House Care Home DS0000002787.V313877.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 and Care Homes for Adults 18 – 65*. 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. Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gilby House Care Home Address High Street Winterton Scunthorpe North Lincolnshire DN15 9PU 01724 734824 01724 734824 info@prime-life.co.uk www.prime-life.co.uk Prime Life Limited 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) Mr Upenyu Thomas Magorokosho Care Home 22 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (22), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (1) Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user over the age of 65. This individual can continue to be accommodated in the home until there is a change in their individual circumstances which means the home can no longer meet their assessed needs. 6th March 2006 Date of last inspection Brief Description of the Service: Gilby House is registered to provide nursing care to adults who experience mental health problems. The home is situated in Winterton, a village close to Scunthorpe. The home is a converted Victorian building in the centre of the village. There have been more recent extensions to the premises. Its location gives service users good access to local shops, pubs and other facilities within the village community. There is also a regular bus service into the town of Scunthorpe. The home has a web-site and email address that has been included in this report. This makes the home easier to access for families, friends and outside carers. The range of fees payable to the home were not available at the time of inspection. Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit to the home was unannounced and took place on 15 January 2007. The inspector was in the home for approximately six and a half hours. The evidence for the report was gathered through visiting the home speaking to twelve of the service users, contact with four outside professionals, interviews with the manager and staff, and seven staff questionnaires that were returned to the inspector. The inspector was able to look at all the key documents such as care assessments, care plans, daily records and the home’s policies and procedures. The inspector also saw individual service users rooms and the homes gardens. The manager had completed a pre-inspection questionnaire. This had been returned to the Commission before the site visit-taking place. This showed the services that are provided in the home. What the service does well: What has improved since the last inspection? The windows in the home are much cleaner this makes it a more pleasant place for the service users to live. Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 6 There is a choice of meals made available now at all meal times. The floor in the medication room had been replaced this means that it is safer for the service users and staff to walk on and reduces the risk of any falls. Systems have been put in place to make sure that the home has all of its electrical systems assessed to make sure that they are safe. Smoking is no longer allowed in the dining area. This had made the room a more pleasant environment for the service users when they are eating their meals. Supervision of the staff is more regular than before, this means that the management can make sure that the staff understand what the needs of the service users are. It also means that if they are not sure then the right training can be given to them. 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. Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 and 5 Quality in this outcome are is good. This judgement has been made using available evidence including a visit to this service. This means that all of the service users have their needs fully assessed before they are admitted in to the home to make sure that the staff had the knowledge and skills to care for them. EVIDENCE: The home’s statement of purpose and service user guide had been updated to include the details of the current manager of the home. Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 9 At the time of the site visit there were twenty-two service users living at the home and the inspector observed all of the written documentation in the home relating to three of the service users. All of the care files that were seen by the inspector included full assessments of the service users’ needs. The assessments were a combination of those completed by the placing authority and the home’s pre-admission information. Where appropriate they were also supported with Care Programme Approach assessments and risk management plans. The assessments identified all of the service users social and healthcare needs. Interviews with the staff, staff training records, interviews with professional visitors to the home and discussions with service users all supported the evidenced that the home has the capacity to meet the assessed needs of the service users. Most of the service users living at the home have lived there for some time. However all those spoken to by the inspector stated that they had been given the opportunity to visit the home before they moved there on a more permanent basis. One service user stated, ‘I visited a couple of times and the staff came to see me in my home before I came here’. The service users’ care files included terms and conditions of their residency at the home. This included detail of any third party payments due to the service users themselves in relation to the service and care provided to them. Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 and 10 Quality in this outcome are is good. This judgement has been made using available evidence including a visit to this service. This means that the service users’ individual needs and choices are generally met at the home. EVIDENCE: The service users’ care files all included care plans detailing how their individual needs must be met at the home. These had been regularly monitored and evaluated and where appropriate new or changed care plans had been implemented. Service users spoken to by the inspector stated that the staff were able to look after them and that they believed that all of their Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 11 care plans were being followed by the staff. Where appropriate Care programme Approach partners were identified in the care plans and identified their roles in the care of the service users. The staff make a record of the daily lives for each of the service users. These detail any patterns of behaviour or fluctuations in mental health problems. Some of these records only included the initials of the staff that completed them. For a clear audit trail these should be full signatures so that the staff including the comments can be recognised. Where risks were identified in the daily lives of service users, their care plans were supported with risk assessment and risk management plans. These had also been regularly evaluated to make sure that they were still relevant to the care of the individual service users. Direct observation by the inspector and reading of documents in the home supported the evidence that the service users are provided with choice throughout their daily lives. Service user meetings are regularly held and these also provided evidence that the service users are asked for their views on how the services provided in the home should be improved. The service users stated to the inspector that they decide for themselves what time to rise from and retire to bed, they also said that they could choose to eat wherever they wanted. Since the last inspection the home has included a choice at all meal times. Several service users commented that it was ‘better’ because there was now a choice, however four service users all said that ‘the quality of the meals is bad’. Two service users stated that on some days they go out to the local shops to buy a sandwich as an alternative to the meals being provided at the home. The records of the service user meetings showed that the quality of the meals being provided at the home had been a long running problem at the home. The home has a new manager in position and there was evidence that plans were being made to work with the kitchen staff to improve the quality of the meals provided to the service users. All of the confidential information held in the home was stored in accordance with the Data Protection Act 1998. Direct and indirect observations during the course of the site visit supported that when confidential information was being discussed between staff, or between staff and service users’ confidentiality was appropriately maintained. Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15 16 and 17 Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to this service. Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 13 This means that the personal lifestyles of the service users are supported at the home, however the activities that are made available to them are limited in frequency and diversity and the quality of their meals are poor. EVIDENCE: The service users spoken to by the inspector stated that they are supported through a variety of ways to maintain and develop their social, emotional, communication and independent living skills. The care plans observed by the inspector supported that these areas were being addressed for all of the individual service users. This included identification of service users’ personal, religious and cultural needs. Part of this information included the recognition of the service users’ last wishes in the event of their deaths including the type of religious or non-religious service that they would require. None of the service users were involved in maintaining jobs due to the problems associated with their mental health problems. However service users are supported to continue with training and education that is based in the community. The home is situated in the centre of the local community and there are good relationships between the service users, staff and business people in the area. This includes a local café that service users like to visit, and the local public house that contact the staff at the home if they have any concerns for individual service users that live there. Activities in the home are quite limited. The staff said to the inspector that the service users were not motivated to get involved in anything much, however several service users said that they would like to do more at the home than ‘watch television’. The records and photographic evidence in the home provided evidence that the service users are regularly supported to go out to activities in the community. This included day trips to the coast and other places of interest. Individual service users records and discussions with the inspector supported the evidence that they are encouraged and supported to maintain their relationships with their family and friends. Service users’ care files showed that their preferred form of address and observations showed that these terms were used at all times by the staff. Since the last inspection a choice of meals has now been included at all mealtimes in the home and a greater variety of meal is provided. Records of service user meeting show that they are consulted in relation to what they would like to be included on the homes menus. However several service users commented on the poor quality of the meals that are provided. They stated Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 14 that this often depended on who was on duty in the home’s kitchen. They also said that when they made comments to the cook they were often spoken to sharply by them. Two service users stated to the inspector that they buy sandwiches from a local shop if they don’t like the meals that are provided in the home. The manager and deputy manager of the home stated to the inspector that they were aware of these problems and were actively working with the kitchen staff to improve the quality of the meals provided and to improve their communications with the service users. Recorded evidence supported that the management of the home were attempting to improve these areas of concern. Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) Service users retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 and 21 Quality in this outcome are is good. This judgement has been made using available evidence including a visit to this service. This means that the service users personal and healthcare needs are all met at the home. EVIDENCE: The service users’ healthcare needs are met through the nurses that are employed at the home and support from the service users GP’s and other healthcare professionals that are based in the community. The service users spoken to by the inspector said that when they were seen by healthcare Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 16 professionals they were always seen in private unless they asked for one of the care workers from the home to support them. The service users’ care plans identified when there had been any changes in the service users’ healthcare needs and they support that they now required to maintain as much independence as possible. Healthcare professionals involved with the service users at the home informed the inspector that they believed that they home was ‘very effective’ in identifying and meeting the service users needs. None of the service users at the home administer their own medication. All of the prescribed medication at the home is administered by the nurses that are employed there. The care staff also receive medication training to ensure that they understand the effects that the medication can have on the service users. The medication records were all up to date and had been accurately recorded. This included the records for the controlled drugs in the home. The staff were observed administering medication to the service users by the inspector and all appropriate legislation and good working practice guidelines were followed. The medication room was well ordered and the medication fridge and room temperatures were monitored on a daily basis. The home had previously had difficulties in arranging for a local GP to visit service users at the home. However since the new manager has been in position this is no longer a problem and the GP will visit service users at the home when this is requested. This has been a positive move forward as several of the service users feel very uncomfortable waiting in a doctor’s surgery because of their mental health problems. The home also has access to an optician that will visit the service users at the home. Again this is in the best interests of the service users that do not have the confidence to see an optician in the community. Each of the service users that were case tracked by the inspector had their last wishes in the event of their deaths identified. This will ensure that all of the social, religious and cultural needs of the service users will be met through the home. Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome are is adequate. This judgement has been made using available evidence including a visit to this service. This means that the service users are generally protected from abuse at the home; however, some of the home’s employment procedures may put the service users at risk of abuse. EVIDENCE: The home has a clear complaints procedure and the service users spoken to by the inspector stated that they understood how to make a complaint if they had any in relation to the care that they receive at the home. One complaint was received directly to the Commission. This was an anonymous complaint in relation to an inappropriate response to service users by Gilby House staff when they were attending the local doctors surgery and a lack of confidentiality. The complaint was passed on to the practice manager of the service. No formal response to the complaint has been received from the surgery. However, the practice manager of the doctors surgery verbally stated that there were no concerns shown by any of the doctors or surgery staff that Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 18 the care staff from Gilby were rude or discourteous to the service users and that their care needs were always maintained confidentially. Staff training records showed that they receive training in relation to the protection of vulnerable adults. This training was provided through National Vocational Qualifications (NVQ’s), local authority training and internal training provided through the corporate body. However, the employment procedures in the home could place the service users at risk of abuse. A newly appointed care worker at the home commenced their employment without the appropriate Criminal Reference Bureau (CRB), or POVA first safety vetting. Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,27,28 and 30 Quality in this outcome are is adequate. This judgement has been made using available evidence including a visit to this service. This means that the service users are generally provided with a good and safe environment, however there are some areas of the home that require to be improved. EVIDENCE: Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 20 The home is generally safe for the service users, but there were some concerns in relation to the environment. A shower room previously identified in inspection reports continues to smell very badly and the floor appears very dirty. Another toilet on the same floor also had very bad odour problems. The manager stated that there might be a problem with the sewage drains in the home and these would be reported to the company’s estate department. However the inspector’s tour of the premises identified that there were no other areas of the home that had poor odours with the exception of the smoking lounge. Bedroom 1 has an en-suite wall. Damp continues to appear on the walls on the outside of the shower unit. The conservatory door is damaged and is difficult to secure therefore three service users complained that they cannot use this area at night as the internal door is locked to stop unauthorised entry in to the home. The windows in the smoke lounge were much cleaner that at the last inspection. However the area was dense in smoke and would have benefited from better ventilation. Due to the amount of smokers using this room the smoke is that thick at times that it floats in to the corridors and non smoking areas of the home. Although it is recognised that some service users with mental health problems ‘self-medicate’ through smoking there are several service users that do not smoke that live there and the smoke offends them. Since the last inspection smoking has been stopped in the dining area of the home and this has much improved the atmosphere and environment of the room. The service users stated that they were happy with their individual rooms and several of the service users invited the inspector to visit their rooms. One of the service users does not have the conventional furniture and fittings in her rooms, however their social worker stated that this was their personal choice and the placing authority were satisfied with the provision of care in the home. The washing machines at the home are all programmable to disinfection and sluicing standards and the machines have automatic feeds on them so the laundry staff do not have to have any contact with any caustic materials. There is also a smaller laundry in the home where the service users can do their own washing to maintain their independence skills, or to improve their skills with the hope that this will lead them on to more independent living. The passenger lift was out of order at the time of the site visit, however this had been reported (waiting for parts) however all service users with mobility problems have rooms on the ground floor. Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35 and 36 Quality in this outcome are is poor. This judgement has been made using available evidence including a visit to this service. This means that the staff that care for the service users receive the appropriate supervision and training to make sure that they can meet the needs of the service users, however failure to adhere to recruitment procedures has the potential of placing service users at risk. EVIDENCE: Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 22 The staff spoken to by the inspector had all received a clear job description and interviews with the staff showed that they understood their own roles and responsibilities and those of their colleagues. The staff induction plans follows the requirements of the Sector Skills Councils workforce strategy targets and all new staff to the home undertake an induction to the home. The staff training records and interviews with the staff show that they are effective in meeting the needs of the service users. The staff rotas indicate that there are always appropriate numbers of staff available to the service users. Seven staff returned questionnaires to the Commission. These were all positive in relation to the care of the service users and the management of the home. Five of the questionnaires identified that the home’s menus were limited and the presentation of the food was poor. The recruitment procedures for the home were recently not followed. A new member of staff was employed at the home to work with the service users before any security vetting had been carried out. Although the inspector recognises the difficulty in employing new staff this procedure could seriously place vulnerable service users at risk of abuse. Staff supervision has improved since the new management team were appointed, however staff are still not receiving the recommended minimum of formal supervision to make sure that they are meeting the needs of the service users. Service user opinions of the capabilities of the nursing and care staff varied widely between each other and also contradicted themselves at other times of the day. This could be seen as a direct result of their mental health problems and whatever was effecting them at any given time. These views varied from ‘no point in them, they do nothing’ to ‘they are great’. One of the service users communicated with the inspector at several different times during the site visit. Although she was making her views known she was also responding to ‘inner voices’ and found difficulty in maintaining any topic of communication without the other voices ‘interfering’. The staff were well aware of the service users needs and had sought additional support from the service users psychiatrist. A great deal of professionalism and patience was seen to be offered by the homes staff to all of the service users. Approximately 55 of the of care staff working at the home have achieved NVQ 2 or equivalent. This means that they are exceeding the requirement for NVQ training. Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 23 Staff training records and interviews with staff supported that they receive all of the mandatory training and also receive specialist training to understand the needs of service users with mental health problems. Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41 and 42 Quality in this outcome are is good. This judgement has been made using available evidence including a visit to this service. Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 25 This means that that the management of the home understand the needs of the service users and the staff and their approach is open and supportive. EVIDENCE: The manager of the home has recently undertaken a ‘fit person’ interview with the Commission and was successful in being accepted as the Registered manager of the home. The manager of the home is a qualified RMN and RGN and has completed the Registered Managers Award. He has worked in England for several years and his work visa expires in May 2007. The manager stated that he expected that the visa will be extended to a permanent status when the application is made to renew it. The manager of the home also attends all of the mandatory training with the staff group. Staff interviewed by the inspector, and discussions with service users supported the evidence that the management of the home is open, positive and inclusive. Regular staff and service user meetings are held by the management to allow both groups to be able to offer their views on the development of services in the home. One service user said ‘the new manager listens to you, and changes things. We have a choice of meals now he is here’. Staff spoken to by the inspector stated ‘supervision is getting more regular’ and ‘the manager understands the needs of the service users’. Direct and indirect observations made by the inspector during the site visit showed that the manager of the home does not restrict himself to an office, he walks around the home on a regular basis and integrates with the service users and staff. He was seen to be well received by all of the service users and the staff. Two service users spoken to by the inspector (together) stated that ‘the manager is very good, he has changed a lot of things here and has promised to improve the quality of meals so this is ok’. The home’s quality assurance and monitoring system is undertaken corporately and the results are returned to the home. The company’s quality assurance rates the home as providing ‘superior’ services. The information for the report includes questionnaires returned by service users and comments made by professional visitors when they visit the home. Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 26 The home’s policies and procedures are produced corporately. A small handbook with prompts in relation to the policies and procedures are made available to all of the staff. The records that are maintained in the home were all up to date and had been accurately recorded. The only improvement in the records would be the inclusion of full signatures of the people completing them and not just initials. All of the appropriate records were stored in accordance with the Data Protection act 1998. The management of the home ensures, as far as is reasonably practicable, the health safety and welfare of the service users and the staff. A safety certificate for the hard wiring systems in the home was not available. However the inspector spoke to the Company’s estate manager who assured the inspector that provision had been made for this to be undertaken as part of an overall programme for the company’s homes. This had previously been a standing requirement for the home to support the health and safety of the service users. The gas systems in the home all had up to date safety certificates. The fire systems are regularly monitored and serviced and all of the mobility aids in the home are regularly serviced and maintained. The passenger lift was out of use, however the maintenance records supported that it had been reported and actions were being taken to report it. Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 3 27 2 28 3 29 x 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT Standard No Score 37 4 38 3 39 3 40 3 41 2 42 2 43 X 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 4 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Gilby House Care Home Score 3 3 3 3 DS0000002787.V313877.R01.S.doc Version 5.2 Page 28 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA17 Regulation 16 (2i) Requirement The registered person must make sure that the quality of the choice of meal provided and the quality of the presentation of the food is appropriate to the service users needs. The registered person must ensure that no staff commence work at the home until after they have received and appropriate Criminal Record Bureau check, or in extreme circumstances a POVA first check. This will help to ensure the health and safety of the service users. The registered person should repair the damage to the wall of bedroom 1 caused through damp. The registered person must improve the ventilation/extraction systems provided in the smoking lounge. The registered person must ensure that the odour problems in the shower room are controlled appropriately. Original timescale of DS0000002787.V313877.R01.S.doc Timescale for action 15/02/07 2. YA23 YA42 19 (1,2) 16/01/07 3. YA24 16 (J) 30/03/07 4. YA27 13 (4a 30/03/07 5. YA42 27 16 (k) 30/03/07 Gilby House Care Home Version 5.2 Page 29 01/06/06 has not been met. This also includes the male toilet that is located on the same floor. 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 YA36 YA41 YA42 Good Practice Recommendations The registered person should make sure that the care staff receive regular formal recorded supervision and a record is maintained in the home. The registered person should make sure that all staff recoding information on the home documents includes their full signatures and not just their initials. The registered person should ensure that the programme to provide the home with a current safety certificate for the electrical systems is completed. (The original timescale of 26 May 2004 had not been met. However a plan was identified for this to be put in to place) Gilby House Care Home DS0000002787.V313877.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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. 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