Inspection on 17/10/06 for Gildawood Court

This inspection was carried out on 17th October 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Gildawood Court 20/10/09

Gildawood Court 13/07/09

Gildawood Court 23/04/09

Gildawood Court 29/04/08

Gildawood Court 30/04/07

Gildawood Court 09/11/05

Gildawood Court 05/07/05

Gildawood Court 13/01/05

Gildawood Court 05/08/04

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

CARE HOMES FOR OLDER PEOPLE Gildawood Court School Walk Attleborough Nuneaton Warwickshire CV11 4PJ Lead Inspector Sandra Wade Key Unannounced Inspection 17th October 2006 08:05 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 Gildawood Court DS0000004236.V314862.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. Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gildawood Court Address School Walk Attleborough Nuneaton Warwickshire CV11 4PJ 02476 341222 02476 344300 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) Gildawood Court Residential Homes Ltd Mrs Johann Madejowska Care Home 60 Category(ies) of Dementia - over 65 years of age (60) registration, with number of places Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th November 2005 Brief Description of the Service: Gildawood Court is a purpose-built, 60-bed care home for older people and is registered to provide personal care for those people diagnosed with dementia. Any nursing needs are accessed via the community as required. It provides permanent care, short stay accommodation, and day care facilities. The home is situated close to the centre of Attleborough and within a mile of Nuneaton town centre. Local amenities are within reach by foot or wheelchair, and there is parking at the front of the building. The home is divided into five units, which accommodate eleven, twelve or thirteen service users in each. Each unit has a lounge and dining area, which is fitted with a kitchen area. All bedrooms are single and have en-suite lavatories with washbasins. There are sufficient numbers of lavatories and bathrooms situated around the home. There is a large activity room which is used for day care and which can be accessed by permanent residents. There is also a family visiting room that can also be used as a smoking area. The home has a hairdressing room and enclosed gardens. At the time of inspection the fees for this home ranged from £387 – 460.00. Extra charges are made for hairdressing (£6-7), chiropody (£10.00), Dentist (£15.50), Aromatherapist (£3.00) and newspapers. Gildawood Court DS0000004236.V314862.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 key inspection to Gildawood for this inspection year. The inspection process consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. This inspection took place between 8.05am and 7.40pm. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (if possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Records examined during this inspection, in addition to care records, included, staff recruitment records, training records, social activity records, staff duty rotas, health and safety records and medication records. Before the inspection, a random selection of residents and relatives were sent questionnaires to seek their independent views about the home. Comments received are included where appropriate within this report. A pre-inspection questionnaire was received from the home on 2 May 2006; some of the information contained within this document has also been used in assessing actions taken by the home to meet care standards. What the service does well: During the inspection staff were observed to be kind, caring and patient towards the residents. Residents are encouraged to maintain family contact and to make choices about their care to support their independence and wellbeing. There did not appear to be any rigid rules or routines in the home and residents could spend their time as they chose. The environment is being maintained to a good standard and is pleasantly decorated. The home has clear systems in place for managing complaints and full investigations are carried out as necessary to prevent residents being placed at risk of harm. Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 6 Staff training is being addressed on an ongoing basis to ensure residents are being cared for by qualified and competent staff. What has improved since the last inspection? What they could do better: An up-to-date Service User Guide with information about the home needs to be devised so that prospective residents have the information they need to make an informed choice whether to stay at the home. Assessment records of residents need to be kept on files consistently to show an assessment of needs has been carried out. A letter needs to be written to residents following their assessment to confirm the home can meet their needs. Care plans still require further work to ensure they are up-to-date, demonstrate resident’s needs and show that these needs are being met. Medication is in need of review to ensure this is being managed effectively to safeguard residents. Further work is required in relation to the management and provision of social activities to more effectively support the dementia care needs of residents. The home need to ensure there are sufficient records to demonstrate choices of wholesome and nutritious food are being provided on an ongoing basis. The provision of hand-washing facilities for staff in the sluice and laundry areas needs to be addressed. Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 7 A review of staffing is required to ensure there are sufficient numbers of staff on duty at all times to support the care needs of the residents and maintain effective services. Sufficient records must be maintained in regard to criminal records checks so that it is clear staff are safe to work with the residents. The home must be able to demonstrate that the quality of care and services is being monitored. Any questionnaires completed by residents or their representatives must be available with the results and any details of improvements made as a result of the quality monitoring. Some actions are required in regard to the management of resident monies held in a bank account to ensure this is kept separate from the business of the home. A review of formal staff supervision is required to ensure this is provided for each member of staff six times per year consistently. Actions are required to address the health and safety issue of the electric hobs in kitchenettes as these could present a burn risk to residents if staff were unable to fully supervise the all areas. 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. Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents do not have all of the information they need to make an informed choice about where to live. Assessment of residents are carried out prior to their admission but not all documentation is available to confirm this to ensure their needs are met. EVIDENCE: The home have developed a Service User Guide which gives information about the care and service provided but this did not contain a copy of the inspection report or contract to enable prospective residents and their families to make informed decisions about organising a placement at the home. Residents are assessed prior to their admission to identify their needs and ensure the home can meet these needs but the assessment records for a person recently admitted were not available on the file. The manager stated that an assessment would have been completed despite the records not being available. Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 10 The manager advised that following the assessment of a resident she makes a telephone call to the family or representative to confirm the placement has been accepted. The manager confirmed that currently a letter is not written to confirm the home can meet the resident’s needs which is a requirement of the care home regulations. Gildawood Court DS0000004236.V314862.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 at least once during a 12 month period. 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. Residents care needs are set out in care plans but it is not clear these are always being met. Medication is not being effectively managed to ensure the health and safety of the residents. EVIDENCE: Residents are cared for across 5 units in the home. It was evident that the home is caring for residents with varying levels of dependency. Staff felt that some of the most dependent residents were placed on a particular unit in the home and the care of two residents in this area was reviewed. An additional resident was selected for review from a different unit. The care records for one resident showed that an assessment of their needs had been carried out before their admission and care plans had been devised in relation to the needs identified. Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 12 Staff had completed a document giving some background information about the resident but not all sections had been completed such as times they liked to get up, nighttime routine. Staff explained that the resident had high dependency needs and was not able to mobilise. Records stated that a pressure relieving mattress was in use and staff were to cream the skin in high-risk pressure areas such as the heels, feet and legs. A care plan had been developed showing that this person had a pressure sore and the district nurse had been contacted but no further actions were listed and no instructions as to how the pressure areas should be managed were detailed. The daily records said that the district nurse had visited and dressed the sores and that staff were to ensure this resident always sat on a pressure cushion and was turned at regular intervals during the night. These Instructions should be written into the care plan so that all staff are clear on how the pressure areas should be managed and to prevent any possible oversight in care. It was observed during the inspection that the resident was sitting on a pressure cushion but there were no turn charts seen to confirm the resident was being turned during the night. Body charts were not in use which can help to show the location of the sores and the severity of these so that staff can monitor the healing process. The daily records indicated that a bruise to the hand had been identified recently; this could also be recorded on a body chart so that staff have an overall picture of wounds to the body. The manager said that the resident was being turned every 2 hours to prevent too much disruption to sleep and the district nurses were maintaining records of the pressure areas. As records completed by district nurses belong to them, the home should maintain their own records of any pressure areas/wounds to demonstrate the wounds are being monitored and appropriate care is being given. A risk assessment for falling out of bed had been completed due to this person having unpredictable movements. A bed rail was being used and this had been signed by the resident’s family to confirm their agreement to it being used. The moving and handling risk assessment for this resident showed a score of 19 but there was no explanation as to what this meant. An oral health assessment had also been completed with a score of 6 but again it was not clear what this meant. Care records confirmed that this person experienced pain upon movement. Staff confirmed this and medication records showed that a high dosage of painkillers were being used. During the inspection this resident was seen seated in the lounge but for most of the day was very sleepy with their eyes closed constantly. Staff advised that this resident had been particularly sleepy Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 13 today and it was possibly due to a flu injection that they had received earlier in the day. Staff were caring and supportive towards the resident and were observed to assist the resident to eat and drink with lots of encouragement. Weight records showed that there were slight variations between weights but any losses were being identified and acted upon. The photograph of this resident showed that they wore glasses and the records also confirmed this. The resident was observed not to be wearing these. Staff said that the glasses had gone missing and they could not find them. Daily records available for this resident were not being completed in sufficient detail to confirm the care prescribed was being carried out. A second care plan file was viewed. This showed that the resident had a poor appetite but this problem was now being managed. The resident said that the food was “all right” but staff always gave her too much. A care plan had been devised in relation to this person’s short-term memory loss and confusion and instructions stated that staff were to report and document any changes in this persons behaviour. It was not evident from reading the daily records that this aspect of the residents care was being monitored. This person was able to hold a meaningful conversation with the inspector and said they felt well looked after in the home. This resident had recently fallen twice in the home. A care plan had been devised in relation to these falls and a risk assessment had been completed but it was not evident that all risks had been fully evaluated and sufficient actions taken to reduce the risk of this happening again. It was noted that since the last inspection there has been several falls in the home resulting in fractures. This matter was discussed with the manager with a view to actions being taken to reduce the risks of these injuries and accidents. The home has suitable facilities to assist with mobility and moving and handling of residents. Staff were asked if any residents were displaying symptoms of aggression and challenging behaviour. Staff advised that there was one person in the home in particular that could be aggressive although they were “fine” most of the time. The care plan file for this resident was viewed. A care plan had been devised for the verbal abuse and aggression and appropriate detailed actions had been identified for staff to follow. The care plan stated that some of the verbal aggression was linked to the resident thinking others had moved or taken things from her room. Staff confirmed that this can be a problem in the home due to the confusion of residents and them wandering into the wrong rooms. Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 14 It was not evident that a specific form was being completed each time this person presented challenging behaviour so that staff could identify at a glance the amount of times the aggression is presenting itself. This would assist staff in deciding if any further actions are needed to address this behaviour. Staff are recording incidents in the daily records but they would have to read through all of the records to find out this information. This resident was noted to get angry with another resident when they went to draw the curtains behind her. Her anger was increasing the longer the resident was around and there was an angry exchange of words, a member of staff effectively diverted the other resident away from the window. One care plan showed that the resident had obtained a wound in July and due to an infection, this wound had not healed. The resident was observed to have a dressing over this wound and when asked about it indicated they felt no discomfort. It was difficult to hold a conversation with this resident due to the extent of their memory loss and confusion. The resident frequently tried to explain things because she could not remember the word she was trying to say. Although there was no specific care plan for communication, the care plan relating to the short-term memory loss and confusion gave instructions on how staff should communicate with the resident. It was not evident that communication aids such as pictures or symbols are being used which could help residents to communicate more effectively with staff. The manager said that they sometimes did use pictures to explain what they were saying to residents or staff would draw something to help the resident understand what they were saying. The manager said that staff did not have usually have any problems in communicating with residents as each resident had their own way of indicating what they wanted which staff were familiar with. Each care plan viewed contained a professional visits sheet showing dates of visits from the doctor, district nurse, chiropodist or dentist etc so that it was clear residents are receiving this specialist support. Comment cards received by the Commission from residents had been completed with the assistance of staff from the home. Three were received in total and each of these confirmed that residents liked living in the home and felt well cared for. Two comment cards were received from relatives, one stated that they felt satisfied with the overall care provided and the other person ticked between the yes and no boxes to indicate they were neither satisfied or dissatisfied with the overall care provided. A review of medication was undertaken and a medication cabinet was available for each unit. Staff advised that one person gives out the medication which means that the cabinet has to be opened and locked again between each Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 15 resident. The manager confirmed that the organisation had agreed the home could have a medications trolley to make the administration of medicines easier. The home will however need to ensure there are sufficient trolleys to store all medications in the home and manage the rounds within the set medication administration times. Medication was viewed in three units. In one medication cabinet both oral and external medications were being stored in the same area in the cabinet which is poor practice. There was a packet of Immodium in the cabinet with a handwritten name on it which had not been prescribed by the doctor. There were also other various items of medications with handwritten names on them that had not been prescribed. Items were also found in other cabinets within the other units with handwritten names on them. The homely remedies policy seen stated that a “definitive” list of agreed medications could be taken without consulting the GP and this should be attached to the document. The policy on “Administration and Control of Medicines” viewed did not have a list of agreed medications attached. The policy should include what medications the home want to buy and list the dose, maximum daily dose, cautions, warnings and any circumstances when they should not be used. The administration of any homely remedies should be recorded in a separate book with a running total as well as on the Medication Administration Record (MAR) for the person who has been given it. A packet of Anadin was found in the cupboard out of its original box. This contained no details of whom it belonged to or how it was to be used. There were several eye drops in the home with no names on them so it was not clear whom they were for. Some of the eye drops in use had no opening date on them so that staff were clear when they needed to be disposed of. The medication fridge was sticky inside and two glass dishes with eye drops in were also sticky. Minimum and maximum temperatures of the fridge were being documented to confirm that medications are being stored at safe temperatures. The full amount of medications available at the beginning of the prescribing period were not being documented consistently on the Medication Administration Record (MAR) so that staff could audit the amount received, given and remaining were correct. One medication stated that it was only to be used every three months but it was not clear from the MAR when the next dosage was due. Staff had to look back at the old MARs to identify this. Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 16 Controlled drugs were being stored in a secure facility. Records checked were accurate in confirming the amount of medication available and given. It was noted that the controlled drugs cabinet was also being used to store money and a cash book which is not appropriate. Fentanyl patches, which come in packets of five, had been removed from their boxes and placed in one box. One box contained 19 patches when the box stated there were five. It is poor practice to remove medication from its original packaging as this could lead to medication errors. A member of staff had handwritten “PRN” on the blister pack containing Loprazolam 1mg which means this is to be taken as required. It was not evident that the doctor has prescribed them to be taken “as required” and records had not been completed to confirm the doctor had agreed to this. Some of the tablets in this pack had been pushed out and put back in again and sealed with sellotape which is not appropriate practice. The blister pack was dated July 2006 suggesting this medication may no longer be required. In regard to maintaining the privacy and dignity of residents, it was observed during the inspection that staff called residents by their preferred names and staff knocked bedroom doors before entering them. Staff were respectful to residents but it was observed that some residents had unkempt hair despite detailed care plans being in place to address personal care. Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13,14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users do not always find the lifestyle in the home matches their expectations and preferences but they do enjoy the food provided and are being afforded some choices in how their care is delivered to help support their independence and feelings of wellbeing. EVIDENCE: An Day Care Supervisor is employed by the home. This person provides activities for the day care residents and the permanent residents are invited to join them. It was identified that some of the residents do not like to move from their familiar surroundings to the location of the day care room where these activities are provided. Staff confirmed that sometimes the residents who come to the home for day care find it difficult to “tolerate” the permanent residents due to the varying types of behaviour these residents present. The manager confirmed that care staff on each of the units do provide some activities for the residents but no activity schedules had been developed to confirm the range and frequency of these. As residents within the home suffer from confusion and short-term memory, it was difficult to be sure from Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 18 speaking to residents that they are able to participate in activities of interest to them. The care plan for one resident showed that they liked conversation, music, photographs and being involved in group activities. Activity records recorded did not show that these social activities were being supported. The sheet relating to activities on the care plan showed the resident’s hair and nails had been done but no other activities were detailed. The care plan for another resident showed that they had participated in an activity in the day care room in September but it was not clear what this was and the only other activities listed for September were having their hair and nails done. This resident said that they got bored in the home and slept a lot because of the lack of activities. They suggested it would be nice if activities were put on in the evenings like a dance as opposed to just “sitting around”. Main meals in the home are prepared in the main kitchen and transferred to a heated trolley. The trolley is then taken to the kitchenettes on each of the units to deliver the meals. The main kitchen was clean and tidy and there was a good selection of food and drinks available. Temperatures of fridges and freezers had been recorded with the exception of on the day of inspection. The manager said she would follow this up as appropriate. During the morning the care staff were observed to prepare toast and cereal for the residents in the kitchenettes. Staff confirmed that they did this each day. Menus forwarded to the inspector as part of the pre-inspection questionnaire did not show that choices are being offered for the main meal or at teatime. The supper menu shows that only tea and cakes are being provided as opposed to a more substantial snack which should be available to ensure residents’ nutrition and health can be maintained. At lunchtime some of the residents were already in the lounge and they chose where they wanted to sit at the table, others were escorted to the table and asked where they would like to sit. Some residents remained in their rooms. It was observed that a choice of cottage pie or scampi was offered with mashed potato, chips, peas or tomatoes. The desert was apple crumble. The meal was delivered to one unit at 12.10pm and two staff served the meals from the trolley while a further two staff gave the meals to the residents and gave them support where needed. Meals looked appetising and residents seemed to enjoy them. One resident said the meals were “alright” but staff gave her too much. One resident said they liked the food; one resident said Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 19 “the staff come round” with the food but declined to answer if they liked the food. The special meals such as the liquidised and soft diets were delivered to the dining room at around 12.30pm after the other residents had eaten. Staff were then able to focus their time on feeding those residents who needed one to one support. Staff were observed to be patient and supportive whilst feeding these residents and did not rush them. Staff asked residents if they liked what they were tasting, they constantly checked with residents that they wanted to continue to eat to ensure they were not eating against their wishes. Those on soft or liquidised meals were observed to eat most of the generous portions provided. One resident who was being fed by staff took a long time to eat due to their frail health and being very sleepy. The member of staff feeding the resident was patient and caring to ensure the resident was not rushed. It took nearly an hour to give this resident a drink plus their main meal and desert. The main course was reheated in the microwave once during this time to ensure the meal remained warm. Due to the time involved in feeding this person it is likely that some of the meal would not have remained warm. The cook had made sandwiches for teatime and it was noted that these had all been made with white bread and were either cheese or cheese and tomato. This did not show that a varied choice of sandwiches is being provided. The manager said that brown bread was used in the home but the residents tended to prefer white. Due to the dementia care needs of residents in this home, staff accept that the way their care is delivered has to be based on their choices. One resident was noted to wear their nightclothes for breakfast, staff confirmed that this was the resident’s choice and they had refused to get changed when staff had suggested it. It was observed both during and after breakfast that staff gave this resident the option to change. Eventually the resident agreed to go back to their room to get dressed. During breakfast some residents had cups of tea whilst others had mugs suggesting their choices were being considered. Care plans had prompts for staff to ask families the preferred daily routines of residents so that these could be respected as far as possible. It was evident that families are able to visit the home when they wish and are able to be involved in planning and agreeing resident care. On the day of inspection visitors spoken to said they visited the home regularly to provide support to their relative which included assisting the resident at mealtimes. Two comment cards were received by the Commission from relatives, one stated that they are kept informed of important matters relating to their relative, the other stated that they were not. Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives know that their complaints will be listened to and acted upon and systems are in place to protect residents from abuse. EVIDENCE: A complaints policy is in place and both residents and relatives are aware of this. This was confirmed in comment cards received by the Commission from relatives and residents. Since the last inspection the Commission has received no complaints regarding this home but records confirmed the home had received four complaints. Issues raised concerned: staff attitude, an unexplained injury to a resident (this was also referred to the vulnerable adults team for investigation) ,the behaviour of a resident towards another resident, untidiness/cleanliness of a room, poor personal care and lack of activities. All concerns had been fully investigated and responded to by the manager and actions had been taken in regard to issues raised within these complaints. The manager confirmed that the family of the resident with the unexplained injury were satisfied with the actions the home had agreed to take following the investigation process to safeguard residents. A policy on the ‘Protection of Vulnerable Adults” was available in the home. Training records confirmed that staff had either completed training on the prevention of abuse or this was planned. Staff spoken to said they would refer Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 21 any incidents of abuse observed or reported to them to the manager or person in charge. Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a well-maintained, clean and comfortable environment with suitable outdoor facilities to support positive experiences for residents. The management of infection control is in need of review to ensure staff can maintain hygiene effectively and safeguard residents. EVIDENCE: Areas of the home viewed were suitably decorated and well maintained. The home is divided into five units, which accommodate eleven, twelve or thirteen service users in each. It was noted that these units are not clearly signposted so that residents and visitors to the home are clear which unit they are in. Each unit has a lounge and dining area which is fitted with a kitchenette. There is a shaft lift to the first floor enabling residents to have access to all areas of the home. Gardens are enclosed to enable residents to use these Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 23 safety. Residents can access the garden from patio doors in all ground floor living areas and from various corridors in the home. All bedrooms are single and have an en-suite toilet and washbasin. Communal toilets are also available on each unit. Bedrooms seen had been personalised with items of furniture, pictures and personal belongings to make them more homely. Bedroom doors had a selection of photographs or pictures selected by the residents to assist them in recognising their own room and it was observed during the inspection that these did help residents to locate their room. In one bedroom viewed the walls were paint-chipped and items of clothing were found in the room that belonged to a different resident. This included underwear and a dressing gown. In another room the glass in a picture frame was broken. Assisted bathing and shower facilities are available to enable residents with poor mobility to be bathed safely. Toiletries seen were named to help prevent these being used communally. There are two laundry rooms in the home which have three washing machines between them to support the laundry needs of the home. Staff were observed to wear tunics in the laundry and they said they wear disposable aprons if they have to do any sluicing which involves handling heavily soiled items. It was noted that there was no dedicated sink for staff to wash their hands in the laundry to maintain good infection control practices. The sluice room also did not have a dedicated hand wash sink and this room was very cluttered making it difficult for staff to use this effectively. Staff said that the bedpan washer did not work and they were therefore being cleaned by hand. Overall the home was found to be clean and tidy. There were no unpleasant odours in areas viewed with the exception of one bedroom which was brought to the attention of the manager. The manager said that bedroom carpets were being regularly cleaned and advised that some carpets had been identified for replacement. Gildawood Court DS0000004236.V314862.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 at least once during a 12 month period. 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. Staff are caring, supportive and suitably trained to care for residents but sufficient numbers of staff are not always on duty to meet the needs of residents consistently. EVIDENCE: The manager confirmed that they aim to have twelve carers on duty during the day and six carers on duty at night. The manager works over and above these numbers. Duty rotas show that these numbers are not being achieved consistently. Rotas seen for September 2006 show that the start times of carers vary in the morning from 7.15 to 9am and during these times the numbers of staff on duty vary from 8 staff up to mostly 10 or 11. During conversations with staff they confirmed that sickness and holidays was a problem in the home and this was resulting in them having to pick up extra duties to care for the residents. Staff said that they had to do this because the extra shifts cannot always be covered. In addition, there was a general opinion amongst staff that they are poorly paid which has affected staff morale. It was clear through observations and discussions with staff they are dedicated to the care of the residents but they find it hard to maintain their standards of care when working with reduced staffing numbers. In addition, it was found that carers are also carrying out other duties outside of their caring duties such as preparing breakfast in the morning plus any additional items at teatime which may need cooking or preparing. It was Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 25 observed in one unit that one carer was doing the breakfast and supervising the dining area and there was one other carer available to get the residents up, dressed and into the dining area. It was noted that there are cookers on each unit within the kitchenettes which the residents can easily access and which could pose a burn risk if they were used or remained hot. Staff confirmed that if they were to cook something, the electric hobs stayed hot for a long period of time and it was a concern to them that residents could come to harm. No risk assessments were in place stating how this risk should be managed. The manager has subsequently advised that the organisation is to remove the hobs and she agreed to devise risk assessments until such time this is addressed. Duty rotas for the home show that on most days there are two catering staff working from 8am till 2pm to support the catering needs of 60 residents. On some rotas there were three staff available for three days until 3.30pm. The manager confirmed that carers provide any additional catering needs of residents outside of these times. It is clear that by using care staff to carry out catering duties, this reduces caring provision available in the home. During the inspection residents were noted to be demanding of staff time. Staff were observed to busy and have minimal time to give residents one to one attention outside of meal times despite their best efforts to do so. Since the last inspection a number of residents have had accidents/falls resulting in fractures. The manager confirmed that there were some residents in the home who were quite “poorly” and some residents who were determined to be independent but were unsteady on their feet which has contributed to the falls. The manager said that the home have their own bank of staff and they are called upon when necessary to cover shifts but acknowledged there had been a problem with sickness over the last three to four months. The manager also advised that the organisation was reviewing current salaries. The two comment cards received by the Commission from relatives showed that they both felt there were insufficient staff numbers on duty. This home has the benefit of their own training staff who organise and provide training on an ongoing basis. New staff attend induction training and records are kept of this training to demonstrate their competence. Training schedules viewed showed that statutory training is being provided regularly to ensure all staff can provide safe and effective care to the residents. This training includes, fire safety, food hygiene and the moving and handling of residents. The training co-ordinator provided a schedule showing that 25 care staff out of 60 have completed a National Vocational Qualification (NVQ) II in Care and a further five staff are in the process of completing this. Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 26 This training helps to support staff in providing more effective care to the residents. Some care staff have also had the opportunity to further enhance their care skills by taking the NVQ III. Three staff records were reviewed to establish recruitment practices carried out. All files contained two written references, dates of employment and evidence of checks against the Protection of Vulnerable Adults Register. Two files contained criminal records checks and one file contained a written record stating the check had been carried out. The information recorded on this record was not sufficient to show the date the criminal record check was applied for and returned to ensure this has been done before the person was employed. The Administrator advised that new documentation had been provided by the organisation for implementation which required more details to be completed and therefore should address this matter. Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 27 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a home which is run by a person who is of good character and who is suitably qualified to care for the residents. The monitoring of the quality of care and services could not be fully demonstrated to confirm the home is being run in the best interests of service users. EVIDENCE: The manager of the home has been in post since May 2005 but was working in the home before this in a senior position. She has attained the Registered Managers Award, a Diploma in Health Education Dementia Studies, the D32/33 Assessor Award and is a trained Registered General Nurse (although not practising). All staff spoken to said that they felt well supported by the manager. Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 28 The manager said that relatives meetings are held but these have not always been well attended so it was proposed to hold these quarterly. The manager said detailed agendas would be prepared so that relatives were aware of items for discussion and could be consulted on matters relating to the management of the home. The manager said that clinical audits are regularly carried out which include monitoring the quality of services provided in the home. Records were not available in the home to confirm this quality monitoring. The home need to be able to demonstrate that residents and their representatives have been consulted on the quality of care and services provided. Any results of surveys should be published and made available to residents detailing any changes in practice that have occurred as a result of the surveys being carried out. A review of pocket monies for residents was carried out. The money available for four residents was found to be accurate in accordance with records in place. Receipts were available to confirm transactions made. The inspector was advised that one resident had their personal allowance paid into a home account as opposed to an individual named account. A copy of the details of this residents account was requested and it was noted that the documentation provided also contained details of other Gildawood funds. The home must ensure that this resident has a named account which is not used by the registered person in connection with the management of the home. Staff supervision is being carried out but the training manager confirmed this was not fully up-to-date. Each member of care staff should receive formal supervision six times per year to confirm their competence and compliance to the homes policies and procedures as identify any need for training. The pre-inspection questionnaire completed by the manager states that the Environmental Health Officer had visited the premises in February 2006. The manager confirmed that recommendations were made to address appropriate storage of eggs, flaking paintwork near the food trolley storage area and making available food safety documentation. The manager advised that these matters were being attended to. Health and Safety documentation viewed in the home confirmed that the following checks had been done:Gas Safety – 12.5.06 Service of Hoists – 7.6.06 Lift Safety – 22.5.06 Electrical Portable Appliance Testing – 21.11.05 Legionella 6.10.05 Fire Risk Assessment – February 2006-11-05 Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 29 The manager said the out of date legionella check had been reported to the organisation so that this could be addressed. The manager has been subsequently advised that this only needs to be done every five years. Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 1 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 2 X 2 Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5 Requirement The registered person is to ensure an up-to-date Service User Guide is available in the home with all of the required information. The registered person must ensure that assessment records are available consistently to confirm residents needs have been suitably assessed. Timescale for action 31/01/07 2. OP3 14(1) 30/11/06 3. OP4 14(1)(d) The registered person must write 30/11/06 to service users following their assessment to confirm the home is suitable to meet their needs. The registered person must ensure that assessments and care plans are specific to each resident’s personal care needs and are maintained and up to date. Outstanding from previous inspections from 30.12.04. 28/02/07 4. OP7 OP7OP7 5. OP9 13(2) The registered person shall make 30/11/06 arrangements for the recording, DS0000004236.V314862.R02.S.doc Version 5.2 Page 32 Gildawood Court handling, safe keeping and safe administration of medicines received into the care home. The registered person must address issues raised in the body of this report. 6. OP12 16(2)(m)( n) The registered person must be able to demonstrate that arrangements are in place to enable all residents to engage in local, social and community activities and that residents are being given the opportunity to participate in these activities. The registered person must demonstrate that wholesome and nutritious food is being provided consistently which is varied and available at such time as may reasonably be required by service users. (eg the provision of menus and records showing choices and meals/snacks being provided). 8. OP26 16(2) The registered person is to review infection control practices within the home to ensure hygiene can be managed effectively. The registered person must ensure that issues detailed in the body of this report are addressed and in particular the provision of staff hand-washing facilities and effective sluicing procedures. 9. OP27 18 (1) The registered person must ensure there are sufficient numbers of staff available to meet the needs of the residents consistently. This includes a review of catering staff hours DS0000004236.V314862.R02.S.doc 28/02/07 7. OP15 16(2)(i) 31/01/07 28/02/07 31/01/07 Gildawood Court Version 5.2 Page 33 and availability. 10. OP29 19 The registered person must ensure sufficient information is kept on file to confirm criminal record checks have been applied for and received. The registered person must be able to demonstrate that there is a system in place for reviewing and improving the quality of care provided at the care home. The registered person is to ensure that any report produced following this review is made available to residents. The registered person is to review the comments made in the body of this report linked to the quality of care and services. 12. OP35 20 The registered person is to 30/01/07 review the management of the personal allowance for the resident identified during the inspection. The home must ensure that where appropriate, named accounts are held which are not used in any way in connection with the management of the care home. The registered person must be able to demonstrate that care staff are being appropriately supervised. The registered person must ensure any unnecessary risks to the health and safety of residents are identified and removed. The registered person is to take appropriate action in regard to the electric hobs/cookers in the Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 34 31/12/06 11. OP33 24(1) 28/02/07 13. OP36 18 30/01/07 14 OP38 13 30/11/06 kitchenettes to safeguard residents. Risk assessments must be completed as appropriate. The registered person must ensure that the picture frame with broken glass is replaced to ensure resident safety. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP38 Good Practice Recommendations The registered person is advised to ensure records are in place which confirm the Legionella check is to be is completed five yearly as opposed to annually. Gildawood Court DS0000004236.V314862.R02.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 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. 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