Inspection on 29/04/08 for Gildawood Court

This inspection was carried out on 29th April 2008.

CSCI found this care home to be providing an Adequate service.

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

Other inspections for this house

Gildawood Court 20/10/09

Gildawood Court 13/07/09

Gildawood Court 23/04/09

Gildawood Court 30/04/07

Gildawood Court 17/10/06

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Gildawood Court School Walk Attleborough Nuneaton Warwickshire CV11 4PJ Lead Inspector Sandra Wade Key Unannounced Inspection 29th April 2008 08:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Gildawood Court DS0000004236.V361988.R01.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.V361988.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th April 2007 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 carried out by the district nurse. 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 kitchenette. All bedrooms are single and have en-suite toilets with washbasins. There are sufficient numbers of toilets and bathrooms situated around the home. There are 6 bathrooms and two of these have assisted facilities to help people in and out of the bath. There are also 5 walk-in shower rooms. There is a large activity room which is used for people who visit the home for day care and which can be accessed by permanent residents if they wish. The home has a hairdressing room and enclosed gardens. There is level access into the home and from doors into the garden areas for people with mobility difficulties or wheelchair users. The accommodation is spacious and allows for easy access by wheelchairs. Accommodation is over two floors and can be accessed via a shaft lift. At the time of inspection the fees for this home ranged from £395 - £517.00. These are subject to change. Extra charges are made for hairdressing (from £7), chiropody (£10.00), Dentist consultation fees, Aromatherapist (£3.00) newspapers, taxis, dry cleaning and visitor meals £3.00 (need to be prebooked). Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The visit took place between 8.00am to 7.00pm. A completed annual quality assurance assessment (AQAA) was received from the service prior to the inspection along with three completed surveys from staff. Three people who were staying at the home were ‘case tracked’. The case tracking process involves establishing an individual’s experience of staying at the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. Other files were viewed to follow up specific issues and to confirm how these were being managed. Records examined during this inspection, in addition to care records, included staff training records, the Service User Guide, staff duty rotas, kitchen records, accident records, financial records, complaint records and medication records. The inspector chose to observe residents by sitting in one of the lounge/dining rooms during periods of the day including lunchtime to ascertain how their care and services are provided. A tour of the home was undertaken to view specific areas and establish the layout and décor of the home. What the service does well: The home is managed by an experienced manager who is keen to raise standards within the home and is supportive to staff. Residents received detailed assessments before they are admitted to the home so it is clear whether their needs can be met. Staff observed were friendly and approachable. Good systems are in place for managing any personal allowance money of residents provided to the home for safekeeping. Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 6 The staff interviewed were knowledgeable about the medicines they administered and treated residents with respect when administering them. The majority of medicines had been administered as prescribed and recorded reflected practice Residents are encouraged to maintain family contact and to make choices about their care to support their independence and wellbeing. Comprehensive training programmes are in place to ensure qualified and competent staff cares for residents. Food provided in the home is appetising and is freshly cooked by a qualified cook. What has improved since the last inspection? What they could do better: Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 7 The Service User Guide for the home needs to contain all of the required information so that prospective residents can make informed choices on whether to stay at the home. This includes the Summary of the inspection report and Statement of Terms and Conditions for a residents stay. A further review of care plans is required to ensure these fully reflect the care needs of residents and detail the staff actions required to meet these needs. Risk assessments for pressure area care need to clearly indicate the level of risk so that this can be managed appropriately. Continued actions are required to improve social activities and stimulation of residents. Records of food provided in the home need to be maintained so that it is clear all residents are receiving sufficient nutritional intake to support their needs. This includes details of food provided for residents on special diets. The mealtime experience for residents needs to be improved so this is an enjoyable, social event where all residents who need assistance or encouragement can be supported as appropriate. Staffing within the home requires further review to ensure there are sufficient staff available to meet the needs of residents at all times. Although some steps have been taken to improve staffing for the home, it is apparent that further action is required to ensure this is suitably addressed. The home needs to install a good quality assurance system to identify staff that do not adminsiter or record medicines as the doctor intended and to ensure that all prescribed medicines are available for administration at all times. The privacy and dignity of residents needs to be maintained consistently to ensure residents are appropriately dressed and personal care needs attended to. Towels and flannels need to be replaced after use in resident’s rooms to enable personal care to be addressed as needed. Systems for managing laundry need to be reviewed regularly to ensure residents always receive items back that they have passed for washing. The unpleasant odour in the Annex building needs to be removed so that residents live in a hygienic and fresh environment. Staff records need to contain all of the required information including two written staff references to demonstrate sufficient checks are being made to safeguard residents. Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 8 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. Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 9 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.V361988.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3 were assessed. Quality in this outcome area is adequate. Prospective users of the service are provided with some information about the home and assessments are carried out prior to any admissions so that care needs can be identified and arrangements made for these to be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the homes Service User Guide was requested. This contained information about the care and services provided including the fees charged. The document produced was mostly in large print to allow for easy reading. The manager has previously told us that the organisation could arrange for records to be provided in picture format, Braille or on tape to support those residents who may need records provided in this format. The Service User Guide did not include a summary of the home’s inspection report or a Statement of Terms and Conditions for the home as required. The manager said that these documents are usually attached. It was advised that Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 11 the home ensure all of the required documentation is contained within the Guide to ensure the full document is given out. This will ensure that prospective residents or their representatives have all the information they need to help them make a decision about the home. Assessments of residents are carried out prior to admission to ensure the home can meet their needs. Copies of these are kept on the care files for each resident. Records seen contained sufficient information about the care needs of residents, this will enable staff to develop suitable plans of care to meet these needs. Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8 ,9 and 10 were assessed. Quality in this outcome area is adequate. Individual plans of care are in place but it is not always clear the care needs of residents are being met. Not all the medicines had been administered as prescribed at all times This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents are cared for across 5 units in the home. It was evident through observations and discussions with staff that the home is caring for residents with varying levels of dependency. Three people who use the service were case tracked across three different units. Care plans had been devised for each resident. They are organised into sections so that information about residents can be easily located and acted upon by carers. Care needs identified was being reviewed monthly and any changes in support documented. In some cases the original care plans had been developed in Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 13 2006 and it was confusing when reading care plans what was current and what needs still applied. In one case a resident had a care plan for sleep patterns/disturbed sleep. This was first developed in 2006 when there were problems in this area. The latest review showed that the resident did not complain of sleepless nights and often got out of bed independently to use the toilet. It was therefore not evident a care plan was needed. The assessment records for one person stated that they had diabetes. A care plan had been devised for management of nutrition, which stated the resident was to have “a regular health routine of meals and snacks that cater to diabetic needs”. There was no indication as to whether their blood sugar levels needed to be monitored or details of the symptoms a person would display if their blood sugar levels were high or low. This is important so that staff know how to identify this and know what actions they should take. Records were not being kept of meals provided to residents with diabetes to confirm they were receiving an appropriate diet. Risk assessments had been completed across a number of areas to show those residents at risk of poor nutrition, falls and developing sore areas to the skin. Care plans in some instances contained detailed information on how to manage these risks but some did not. For example, the assessment tool used for risks of pressure sores for all files seen contained scores against set criteria. The final score was recorded but there was no reference sheet to tell the staff if the score meant the resident was at low, medium or high risk of developing sore areas to the skin. This is important so that staff can ensure that the correct care is given to reduce the risk of this happening. In one care plan a resident has lost weight each month since January 2008. Records seen did not show what actions should be taken by staff to monitor this although it was evident from the doctors sheet on the care plan file that a food supplement had been prescribed due to the residents weight loss. Incident records completed by the home showed several residents had challenging behaviour. Some residents had lashed out at staff and residents and in some cases injuries had occurred. The care plan records were viewed for one of these residents. There was no specific care plan written telling staff how to manage this. There was a care plan in place to “calm confusion and help maintain memory” which detailed that the resident could get “a little obstinate and upset” but there was no specific reference to managing this behaviour. Details should also include the “triggers” that tend to create the behaviour. A consistent approach in managing this is important to reduce the risk of harm to residents and staff. Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 14 A care plan in place for management of communication showed that staff needed to be very patient with this resident as they could become very frustrated because staff cannot understand them. Daily records showed that staff were trying to control this to a degree with medication but sometimes the resident was refusing this. Daily records are being completed which is good practice but they did not report on each of the care needs detailed to show us that these were being met consistently. Daily records should give a picture of the resident’s health and the support provided over each 24hour period. The privacy and dignity of residents was reviewed. Since the last inspection action has been taken to implement a night time care plan which states information such as whether the resident would like their door open or closed and what clothing they would like to wear which is good practice. One of the more independent residents had chosen to keep their door locked and had been issued with a key which they were able to use. They advised that they liked the freedom of being able to lock their room when they wanted and advised that staff respected their privacy. Residents generally looked well kempt but there were some with no socks, slippers or tights/stockings on and some had unkempt hair. Staff reported that some residents were reluctant to allow them to give personal care and some whose hair had been done by the hairdresser would wet it and spoil it. One resident was found with their hands in their desert dish with food down their front and on their skirt. Their skirt was quite wet from the food and the resident looked unwell and was drifting in and out of sleep. A member of staff was told of this and removed their dish and cleaned their hands. No attempt was made to change the resident ‘s clothes or check they were all right. The resident told the inspector they were cold and on touching their hands were very cold. A blanket was then requested from the member of staff who went to collect one for them. The resident said they were in pain with their leg and this was followed up with the senior carer who was able to confirm through records that the resident had been refusing pain killers. The carer also explained that the resident had a tendency to say things that were not true. Another resident in the same lounge was also noted to have food down their clothes. Care plan records confirmed that the doctor, district nurse and chiropodist are being called upon to provide professional advice and support when required. The pharmacist inspection took place at the same time as the key inspection. It lasted just over two hours. The medicines awaiting destruction and the old medicines charts were looked at together with some current medicines and Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 15 their charts. Care plans and daily records were also looked at. One member of staff was spoken with during the inspection and a medication round observed. The handling of medication has deteriorated slightly since the last pharmacist inspection last May 2007. The manager had failed to identify this. Some medicines had been recorded as administered when they had not been; others administered but not recorded as such. One care assistant interviewed had a reasonable understanding of the medicines she administered. Further knowledge about what the medicines were for would enable her to look after the clinical needs of the residents better. The care assistant undertaking a medication round followed good practice in preparing, administering and recording the administration of medicines. Some medicines prescribed for use when required had supporting protocols though these were not available for all medicines prescribed for occasional use. Staff checked the prescriptions before they were dispensed and checked the medicines and charts against a copy of these before they were administered. All quantities of medicines were accurately recorded and hand written medicine charts were well written and recorded all necessary details. New residents medication received into the home was checked with their doctor before they were administered. One medicine was out of stock for one week while a new supply was sought from the doctor. Staff had not noticed that they would run out and didn’t request a replacement prescription until they had none left. This resulted in the resident not being administered this prescribed medication for seven days. There were four medication rounds in one day, the earliest at 6am. If the resident was not awake at this time, these times were changed to suit the resident after consultation with the doctor. Care plans supported the medication prescribed but the information to support the resident was difficult to find easily. Again the manager had failed to recognise this All controlled drugs were stored correctly and all balances were accurate and records correctly documented. Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15 were assessed. Quality in this outcome area is adequate. There are some social activities provided to satisfy the social care needs and interests of people who use the service. Residents enjoy the food provided and are given some choices in how their care is delivered to help support their independence and feelings of wellbeing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection an Activities Co-ordinator had been employed to enable the residents to continue with an active life. The manager however reported that this person is now no longer in post and arrangements are currently being made to employ another Activities Co-ordinator. It was observed that the level of social activity and interaction with residents was limited. In one lounge for a period of time tabletop activities were taking place. This included looking at books and using glitter pens to colour in pictures. A visitor came into the lounge at one point and sat with their relative, the atmosphere lifted with the resident enjoying the chat social interaction. Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 17 A resident who was given a book to read told the carer they could not see it because they did not have their glasses. The carer left the lounge to try and find them and sometime later came back and said she could not find them. The resident therefore sat at the table for a long period of time staring at the same page of the book or drifting in and out of sleep. Some residents were observed to just sit in chairs and close their eyes with little conversation from staff or other residents. Others enjoyed the freedom of being able to walk around the building and some went outside. The music and television were on at various times of the day and residents in one lounge enjoyed listening to the music over the lunchtime period. In another they listened to music during the morning and some sang along to it. The past hobbies and interests of residents had been documented within their care plans with indications on whether they would like to be involved in any activities provided by the home. In the daily records for one resident it was evident they helped with the daily “chores” and enjoyed visiting other units to help with the washing up. The activities sheet in another file showed that for this year the resident had mostly had their hair done and family visits and no other social activity. Since the last inspection actions have been taken to develop “activity” areas around the home. In one section there is a “nursery” with cot, pram and dolls. Residents were observed during the day to use the dolls and pram. In another area a laundry and library has been created. The manager said there is a Sweet trolley that had proved successful and in the absence of the Activity Organiser staff were providing social activities and social stimulation when possible. The manager confirmed that arrangements can be made to support religious needs and advised this included the provision of Holy Communion within the home if required. There is an open visiting arrangement in the home and those seen were made to feel welcome by staff. The Annual Quality Assurance Assessment (AQAA) forwarded to us by the manager states that family/visitors are encouraged to visit and continue to be part of the residents life such as take meals with their relative or accompany them on outings. Most of the staff were noted to have a good relationship with residents and were caring and supportive towards them. There were some instances where residents were sat in a lounge with a member of staff with minimal staff interaction. This brings into question the skills of the member of staff to effectively communicate and interact with the residents. Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 18 The “Night Care Plan” developed since the last inspection shows resident choices in regards to times they like to go to bed, sleeping positions, what drink they like, whether they like the window open or closed and what clothing they like to wear. The care plan also shows what assistance the residents would like in regards to toileting. This demonstrates the home is taking into consideration resident choices. One resident was able to confirm that staff carried out their care in accordance with the choices they had made. Gildawood continues to benefit from having an experienced and dedicated Catering Manager who has worked at the home for many years. The manager is committed to producing nicely presented home cooked food for the people who use the service. Since the last inspection the menus have been reviewed and now contain two choices of main meal as opposed to one. It was observed at lunchtime that two choices were given this included fish pie or shepherds pie with mashed potatoes carrots and vegetables. The food looked hot, was well presented and generous portions were given. Menus held by the cook continue to contain limited information in regards to the meals, snacks and drinks provided. Menus still do not show that the home are providing a prepared snack meal in the evening after supper to help maintain the health and nutrition for people who use the service. They also do not make clear breakfast options and, all snacks that are provided and the range and choice of drinks available. Menus do indicate that a hot drink is provided at 10-10.30 am, 3- 3.30pm and 6 – 10pm. Fully detailed menus are not made available to residents. A relative had expressed concern with us that they had observed staff using “smart price” soup as alternative meal for a resident which they did not consider a suitable nutritional alternative. Staff surveys completed within the home showed that staff also felt concerned at times with the quality of the food being used. One member of staff states “a soft meal is not always offered for residents that are unable to chew food” another states “food for residents very cheap quality”. On viewing the food stores during the inspection it was found that some of the foods were of the “value” variety such as biscuits, minced beef, quiche, tins of fruit and soups but there were also a variety of other foods in cupboards and freezers which had been ordered from a catering firm. The manager said that the cook frequently made her own homemade soups but did have a budget to work to. It was felt that recent food increases had impacted on the variety of food and quality of food that could be ordered. It was also established that the Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 19 cook has some restrictions in regards to ordering foods by having to use the organisations allocated catering supplier. The mealtime experience was observed in one of the lounges and this was not a positive experience both for residents and staff. This was partly due to only one member of staff being around for most of the time leading up to when the meal was served. The carer attempted to seat residents at the table around 12 noon, 25 minutes before the meal arrived. Bread had been buttered and put on each of the two tables. A resident starting eating this before the meal arrived and a carer stated several times to save the bread for the meal. This did not work, so she covered the bread with cling film, which was then removed by another resident who also started to eat the bread. It was difficult for the one member of staff to constantly observe the residents at all times but it was clear this incident did not help in making the mealtime experience a pleasant one. One resident stood in the doorway and the carer attempted to get them to sit at the table but this was not successful. Another resident had their hat and coat on and said they were going “down the town”. At one point this resident decided to leave through the patio door and said they were going to visit their dad. The carer did not see this as she was attending to another resident. This resident was eventually located and encouraged to come back into the dining room for their meal. Another resident kept getting up from the table and walking around. It was clear that the residents sitting at the tables were getting impatient. At 12.25pm the meal trolley arrived and attempts were made to get residents to sit back at the table. One resident had their head lowered down to the table and was rocking backwards and forwards. They began to eat very slowly and sometimes stopped to fiddle with their clothing at 12.50pm most of the food was still on their plate. One resident was not eating their meal and the member of staff asked if they wanted something else. They offered toast and marmalade, which the resident said they would like. One person ate half of their meal and got up and left the dining room. Some time later they returned in a change of clothes and took their plate back and began to eat the rest. Staff were so busy watching residents and trying to prevent them from leaving the dining room or playing with their food that there was little time for them to support and encourage residents with their food where this was needed. It was clear that the staff support available was not sufficient to make the mealtime experience a pleasant and enjoyable one. The minimal staff support also places residents at risk of not having a sufficient nutritional food intake. Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 20 No records are kept of meals the residents have been provided with so that the home can demonstrate a wholesome and nutritious diet is being provided consistently. Any special dietary needs should also be documented and the food provided demonstrated such as any specific food provided to diabetics. The manager agreed to review this. The manager had taken action to ensure the weight of residents is monitored and records seen for 42 residents showed that 22 of them had lost weight in April and 20 had gained weight. The Annual Quality Assurance Assessment (AQAA) document provided by the manager shows that all residents in the home require help, supervision or prompts in order to ensure they eat their meals. The main kitchen was clean and tidy and freezers were well stocked with food. Temperatures of fridges and freezers had been recorded and all were within the required guidelines to store food safely. The Catering Manager had prepared the evening meal and care staff had taken this to the lounges to give to residents. Freshly baked cakes were also available. Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. Quality in this outcome area is adequate. Policies and procedures are in place but working practices do not always ensure residents can be fully protected from the risk of harm or abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure for the home is detailed in the Service User Guide and each resident is given a copy this on admission. It is also displayed in the entrance foyer of the home. Contact information is clearly detailed with telephone numbers and addresses. There had been three complaints received by the home since the last inspection these included the door not being answered in the evening, a concern around medication management and the personal care and management of hygiene including a problem with ants in a resident’s room. Each complaint had been fully investigated and responses made. The manager advised that none of the complainants had come back to her to state they were unhappy with the homes response. We have received one complaint since the last inspection. This complaint had also been sent to the home and was in regards to personal care management and hygiene. This was discussed with the manager. The manager was able to advise on all actions taken including that they have a pest control contract, Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 22 which enables regular visits to be made to the home to check and destroy any ants. In regards to concerns around personal care, despite efforts by staff to address this it was observed there were still some residents wearing food stained clothing or were in need of attention to personal care. On viewing the accident/incident records in the home, there were numerous residents who were displaying challenging behaviour. Some residents had hit out at other residents as well as staff and some had caused injuries. It was not evident that this was being closely audited and acted upon by the home to ensure to reduce the risks of harm to both residents and staff. Records seen only showed that audits were being undertaken on the numbers of accidents and incidents only. A policy on the ‘Protection of Vulnerable Adults” was available in the home and staff spoken to had done training on the prevention of abuse. It was not evident from speaking to staff that they know the processes for reporting abuse other than having to alert their manager. It was advised that staff are made aware of the full procedures for managing any allegations of abuse. Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 21 and 26 were assessed. Quality in this outcome area is adequate. The home is safe and generally well maintained but some attention is needed to address the unpleasant odour and stained carpets in areas of the home identified to ensure residents live in a pleasant and hygienic environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The main building was found to be suitably decorated and well maintained. A new carpet had been fitted to resident areas, which has much improved the outlook of the home. Staff room areas off the corridors however had not been fitted with new carpet and were stained and marked and looked unsightly against the new carpet. The Annex building still has the original carpet in place so does not look as well presented when entering this area. There was also a strong unpleasant odour on entering this building as well as on the top floor. Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 24 People who use the service have spacious bedrooms and the different units can be accessed via wide corridors, which are suitable for wheelchair users. The home is divided into five units. Units 1, 2 and 4 accommodate twelve people, unit 3 accommodates eleven people and unit 5 accommodates 13 people. Residents can freely access units 1,2 and 3 but units 4 and 5 require the use of a door code to enter them. The units are not clearly identifiable/colour coded 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 safely. Residents can access the garden from patio doors in all ground floor living areas and from various corridors in the home. Since the last inspection funding had been obtained for two raised flowerbeds. These had recently been completed for the benefit of the residents. All bedrooms are single and have an en-suite toilet and washbasin. Those seen were clean but they did not all have towels and flannels because they had not been replaced after use. These should be replaced at the time they are removed to ensure they are always available to residents. 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. One resident who showed the inspector their room felt they had everything they needed. It was evident the resident had been able to personalise their room with their own furniture and effects. There are two bathrooms in the home with specialised Parker baths; these are designed to allow residents to easily use them. Other bathrooms have baths with a separate hoist, which staff would need to use to support people to get into the bath. Staff confirmed these bathrooms are rarely used and the walk in shower rooms are used more frequently. There are two laundry rooms in the home, which have three washing machines between them to support the needs of the home. The housekeeper confirmed that carers are expected to sluice laundry items where appropriate before they are washed. A sluice room was viewed and contained disposable gloves, aprons and hand washing facilities and staff were observed to wear tunics to aide good infection control practices. Since the last inspection a hand wash sink has been fitted into the laundry so that staff can maintain effective hygiene. Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 25 During the tour of the home it was found that in some rooms the residents had items of clothing that did not belong to them. This increases the risk of residents wearing clothing that does not belong to them which does not respect the residents’ dignity. The housekeeper explained that all residents clothing either should have a name or number written in them to prevent clothing being put in the wrong rooms. Some of the numbers or names in clothing were difficult to read because they had worn away. The manager said that it was the carers’ responsibility to regularly check rooms and make sure residents had the right clothing and sufficient clothing. Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 27,28,29 and 30 were assessed. Quality in this outcome area is adequate. 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager said the home continue to aim to have 10 - 12 carers on duty during the day and five or six at night. At the time of this inspection there were 56 residents in the home and two in hospital. Discussions with the manager and staff confirmed that there had been some improvement in staffing arrangements in that there had been less staff off sick or absent. The manager explained this was due to changes in the home’s policies and procedures for managing this. Staff are now required to attend a ‘return to work’ interview each time they are sick to confirm their reasons for absence. If staff continue to report in sick, disciplinary procedures may be followed. There has also been a move by the home to only employ full time staff and reduce the numbers of part time staff. This has been done to help improve the consistency of care to the residents as well as reduce the high numbers of part time staff. Although progress has been made in regard to some issues relating to staffing, it was evident there remains times of the day when staff are busy and are not Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 27 able to give the time they would like to the residents. This in particular applies to meal times. The home have not fully addressed staffing issues raised at the last inspection and have not increased the number of staff on each shift since to ensure issues raised previously and again during this inspection are addressed. Duty rotas seen showed that there are mostly ten carers on duty during the day. There are sometimes 9 carers between 7am and 8am and there are five or six carers on night duty. The staff survey that was carried out by the home showed that several staff felt the home had “poor staffing sometimes”. Staff surveys received by us showed that staff feel there are “sometimes” enough staff to meet the needs of people who use the service. One states, “the home is quite often short staffed which is not only stressful for us but dangerous for the residents”. Relatives had raised their concerns at the meeting held on 27 February 2008 that residents were not being bathed or showered enough and teeth/dentures were not being cleaned regularly. A resident spoken to said “staff are very helpful in many ways” but “staff need to be more vigilant”. It was observed during the day that staff had limited time to spend with residents. Staff acknowledged that on some days there was better staff attendance than on others. Staff spoken to and surveys viewed indicate that staff continue to feel they are not paid well for the work they do which they consider impacts on the effective staffing of the home. It was established that staff who attain a National Vocational Qualification (NVQ) in Care are also not paid any additional monies to acknowledge this attainment to make them feel valued within the working environment. Staff within the home are not allocated to any particular unit and duty rotas do not show which staff are supporting each unit. It remains difficult to assess that the home are staffing each unit in accordance with the dependency needs of the residents as well as the number of people who need to be cared for. The issue of locating staff within the home remains difficult as the home is large and staff are spread over five units. Staff do not carry phones or communication aids and therefore rely on office telephones. If a resident should have an accident, staff would have to leave them to make a call from the office. This is not an ideal situation as the resident may be distressed and would have to be left. This could also place both the resident and the staff member at risk of further harm. This is outstanding from the previous Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 28 inspection and no progress has been made in addressing this matter by the organisation. The management should conduct a full assessment of the needs of the residents and the care staff required to meet these needs, taking into account issues raised in this report. In addition to the carers there are dedicated staff who provide a laundry, cleaning and catering service to the home. There are two cooks who between them cover seven days a week and they are supported by 2 kitchen assistants. Three staff records were reviewed in detail. Two of the files contained two written references as required but one only had one reference. The manager felt that the reference had been obtained but had been misfiled. Additional information recorded included dates of employment, criminal record bureau checks and evidence of checks against the Protection of Vulnerable Adults Register. It was not clear that appropriate action had been taken in response to information provided on one of the recruitment checks. The manager advised that a discussion had taken place with the member of staff but this had not been recorded. It was not clear from records in place that an employment gap in one of the records had been discussed. Staff records confirmed that new staff undertake induction training based on the “Skills for Care” induction standards. This requires them to undertake specific training modules over a number of weeks so they can build up their competencies to care for residents safely. Staff training is provided on an ongoing basis. The training schedule showed that this includes moving and handling, fire, infection control, food hygiene as well as training linked to the needs of residents such as dementia, medication and skin pressure area care. It was not clear from records whether staff had completed equality and diversity training. The manager felt that some staff would have completed this training as part of their National Vocational Qualifications (NVQ). The Annual Quality Assurance Assessment (AQAA) document provided by the home shows there are 58 carers employed and 30 of these have attained an NVQ II in Care. This shows that the home is exceeding the standard for 50 of care staff to achieve this and is to be commended. The training schedule viewed confirmed the care staff who have achieved this qualification and also shows that further staff have been enrolled to complete this training. Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35 and 38 were assessed. Quality in this outcome area is adequate. 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. Systems are in place to monitor the quality of care and services but it is not clear the home is always being run in the best interests of service users. This judgement has been made using available evidence including a visit to this service. 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). Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 30 Discussions with staff confirmed that the manager continues to share a good working relationship with staff. Quality surveys carried out by the home show that staff feel they are well supported by the manager of the home. Surveys that staff completed also showed that they all felt they are given the training relevant to their role but there are mixed views on whether they have the right support, experience and knowledge to meet the different needs of people who use the service. Surveys completed by the home and also for us showed that there are not always sufficient staff numbers and staff continue to feel underpaid by the organisation. The home has systems in place to monitor the quality of care and services provided it is not clear that the quality monitoring is fully identifying and addressing issues which are impacting on resident care. The inspection process has shown that the home cannot always sustain the quality of service and care that both residents and relatives would like. Relative meetings are held three monthly and service users can also attend. These meetings give the manager an opportunity to report on issues relating to the management of the home as well as discuss any concerns relatives may have. Notes of these meetings are kept and were viewed. The last meeting was held on 27 February 2008 and issues discussed included laundry/housekeeping (some problems with missing items and quality of washing), food (requests for more fluids, fresh fruit and concern that food was being taken away from residents too quickly at mealtimes), personal care provision (more baths/showers and teeth cleaning requested) and the need for activities and social stimulation to be increased for some residents. The manager had responded to the above matters within the notes indicating that more staff training would be provided in relation to laundry and personal care and social activities would be reviewed. The manager should ensure that all issues raised are fully addressed and continue to be monitored to ensure the same issues do not reoccur. It was also recorded in the notes that relatives had stated that staff within the home did a “brilliant job” and they were “very happy” with the care being provided. Staff surveys received by us show that staff feel sometimes there are not always enough staff to provide the service they would like. Observations on the day of inspection showed that social stimulation for residents is limited and staff had limited one-to-one time to spend with residents. The administrator manages of resident monies (personal allowances). Detailed records are maintained and receipts are kept for transactions Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 31 undertaken. The money and records for residents were found to be accurate and were being stored safely. Formal staff supervision sessions do take place with staff and to ensure they become familiar with all aspects of service and any training needs are identified and acted upon. Staff files viewed showed that staff had received supervision within the required timescales to ensure the target of six times per year can be met. Systems are in place to ensure health and safety is managed effectively. The Annual Quality Assurance Assessment (AQAA) forwarded to us showed that health and safety checks were being carried out regularly to ensure the safety of residents. A random selection of records was checked to confirm this. Records seen showed that hot water temperatures were being regularly checked. Electrical portable appliances had been checked and deemed as safe to use in March 2008. The gas records showed that a fault had been found on 28.3.08, the manager said that arrangements had been made for this to be addressed on 3.5.08. Hoists had been checked and were next due for a service in September 2008. The lift had been checked on 4.4.08 and water Legionelleas check had been undertaken on 3.4.08. Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 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 2 3 X 2 X X X X 2 STAFFING Standard No Score 27 2 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 2 3 Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Suitable care plans must be developed for specialist care needs such as diabetes and challenging behaviour. This is to ensure there is no oversight in care and helps to promote a consistent approach to meeting care needs. Care records must demonstrate care needs identified is being met consistently. Outstanding from last inspection. 2. OP9 13(2) All prescribed medication must be available for administration at all times. New supplies must be sought in a timely manner to ensure service users receive their prescribed medication. 31/05/08 Timescale for action 30/06/08 3. OP9 13(2) 30/06/08 A robust quality assurance system must be installed to assess staff competence in the safe handling of medicines and appropriate action must be taken if staff fail to administer medicines as prescribed or accurately record what they have DS0000004236.V361988.R01.S.doc Version 5.2 Page 34 Gildawood Court done 4. OP15 17(2) Sch4 Records of food provided need to be maintained. Records must be sufficient to show that each person who uses the service is provided with a suitable wholesome and nutritious diet. This includes details of any special diets provided for specific individuals. Outstanding from October 2006 and 2008 inspection (recommendation). 5. OP18 13(6) Appropriate action must be taken to address the challenging behavior of residents by training staff or by other measures. This is to prevent residents being harmed or placed at risk of harm or abuse. An assessment of the unpleasant odour in the home must be undertaken and an action plan devised to remove this and minimise this for occurring again. Sufficient numbers of staff must be available to meet the needs of the residents at all times. Outstanding from the October 2006 and new timescale of 31/07/07 not met. 8. OP29 19 A review of recruitment procedures is required to ensure:• • Gildawood Court 31/07/08 30/06/08 6. OP26 16(2) 30/06/08 7. OP27 18 (1) 30/06/08 30/06/08 Two written references are obtained and are available. Gaps in staff employment Version 5.2 Page 35 DS0000004236.V361988.R01.S.doc histories are explained and recorded. • Information provided on staff recruitment checks, which could impact on the safety of residents, is fully risk assessed and recorded appropriately. This is to ensure the home has a robust recruitment procedure to safeguard residents. 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 OP1 Good Practice Recommendations The Service User Guide should contain a copy of the Terms and conditions for the home and summary inspection report. This needs to be made available within all copies given out so that prospective residents have full information about the home before any decisions are made on whether to stay. Risk assessments need to clearly demonstrate the level of risk to the health and safety of the resident to ensure appropriate action can be taken to manage this. This in particular applies to pressure sores. Staff should ensure that the dignity of residents is not compromised by their appearance. This in particular applies to ensuring their hair has been attended to when required and clothes are clean and dry. People who use the service should be able to regularly engage in suitable local, social and community activities, which are of interest to them. Evidence needs to be available to show this so that it is clear the social wellbeing of people who use the service is being maintained. DS0000004236.V361988.R01.S.doc Version 5.2 Page 36 2. OP8 3. OP10 4. OP12 Gildawood Court 5. OP15 Detailed menus should be made available to people who use the service so that they are fully aware of the choices available including choices of breakfast, snacks or drinks. This would also allow staff to know what meals/snacks are available each day so they can tell residents when they ask. It is advised that all comments relating to food quality, variety and choices as detailed in the body of this report are reviewed to ensure the cook has the flexibility required to address these. It is advised that further training is provided to staff on the procedures followed in the event of an allegation of abuse so they understand how these matters are investigated in order to safeguard residents. Stained and marked carpets need to be suitably cleaned or replaced to ensure the environment is pleasant and clean for residents. Towels and flannels need to be available to residents at all times so they can attend to their hygiene needs. 6. OP15 7. OP18 8. OP26 9. 10. OP26 OP27 Regular checks should be made of residents clothing to make sure the items they have belong to them. It is advised that duty rotas are reviewed to show staffing arrangements for each unit in the home including ancillary staff support to show units are being staffed sufficiently. Any codes on duty rotas should be defined. Risk assessments should be developed on how staff should seek help in an emergency if they find themselves alone with a resident in lounge areas to make sure residents are safeguarded. Regulation 37 notices need to be forwarded to us consistently. This in particular relates to incidents of challenging behaviour of residents which place other residents and staff at risk of harm. 11. OP27 12. OP37 Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Gildawood Court DS0000004236.V361988.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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