Inspection on 30/04/07 for Gildawood Court

This inspection was carried out on 30th April 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report 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 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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Gildawood Court School Walk Attleborough Nuneaton Warwickshire CV11 4PJ Lead Inspector Sandra Wade Key Unannounced Inspection 30th April 2007 08:25 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.V335201.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.V335201.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.V335201.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th October 2006 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 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 facilities to assist 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. There is also a family visiting room that can currently also be used as a smoking area. 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 £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.V335201.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 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 care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development, and outcome for residents. Since the last key inspection two random inspection visits to the home have taken place. One took place on 5 February 2007 to follow up progress made in regard to specific Requirements made at the last inspection. These related to Care Planning, Medication and Staffing. The outcome of this inspection was that poor progress had been made in addressing these matters. Following this visit a further random visit was undertaken by the Pharmacist inspector on 1 March 2007 to undertake a detailed audit of medication management. Medication management continued to be poor and this inspection resulted in several requirements being made for the home to address. 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 and residents. It took place between 8.25am – 5.30pm. A separate inspection of medications took place on 3 May 2007 by a Pharmacist Inspector between 10.45am and 1.20pm. Details of this are incorporated within this report. Three service users 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 service user care files and focusing on outcomes. 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, personal allowance 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. Twelve relative comment cards were returned during April 2007. Comments received are included where appropriate within this report. A pre-inspection questionnaire was received from the home on 2 April 2007; some of the information contained within this document has also been used in assessing actions taken by the home to meet care standards. Gildawood Court DS0000004236.V335201.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The medicine management has improved to a high standard. Records now confirm that prospective residents have been assessed by the home and their needs identified so that the home knows they can meet these needs. Infection control practices in the home have improved, new sluicing arrangements have been introduced and a new hand washbasin has been fitted in the sluice area so staff can wash their hands to maintain hygiene. Gildawood Court DS0000004236.V335201.R01.S.doc Version 5.2 Page 7 Additional care staff have been employed to help improve staffing levels, and staffing arrangements have been reviewed to help free up care staff time at busy periods so they can provide more effective care to the residents. A full audit of all staff files has been undertaken to ensure all records are in place including criminal record checks prior to staff being employed to safeguard residents. Good systems are now in place to monitor the views of service users and relatives on the quality of care and services provided. The management of resident personal allowances has improved. Records and monies held are now accurate with receipts in place to confirm all transactions undertaken. The frequency of formal staff supervision has improved to enable the manager to identify any issues in regard to staff competencies and training needs and act upon these accordingly. What they could do better: 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. 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 require further work to ensure risks identified are suitably managed by staff to safeguard residents. Although efforts have been made to improve social activities, actions are now required to implement plans in place to ensure all residents have the opportunity of some social activity or social stimulation to maintain their health and wellbeing. 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 or who may have allergies so that it is clear what they are receiving. 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. Gildawood Court DS0000004236.V335201.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.V335201.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.V335201.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, 3 and 4 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. It is not clear that residents always know that the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A Statement of Purpose and Service User Guide are available for the home, which give information about the care and services provided. The Service User Guide provided did not contain a summary of the Commission’s inspection report or the Terms and Conditions for the home. The manager confirmed that a summary inspection report is provided with the Service User Guide so that people have this information prior to making a decision to stay in the home. The manager advised that arrangements could be made in the home to produce any records in large print if required. She also advised that the Gildawood Court DS0000004236.V335201.R01.S.doc Version 5.2 Page 11 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. Since the last inspection work has been undertaken on improving the records used to record assessment information. This has meant that staff have more information about the people who are going to be staying at the home to help them when planning the support required to meet their needs. Records viewed contained copies of assessments carried out by social workers as well as the home manager. It was not clear that the home had written to the prospective residents to advise them that the home was suitable and able to meet their needs. Gildawood Court DS0000004236.V335201.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. Residents care needs are set out in care plans but it is not clear these needs are always being met. The home has worked hard to improve the medicine management and achieved this. Staff are fully aware of the importance of the safe handling of medicines and have a good clinical knowledge of the medicines they administer and all nine requirements left at the last pharmacist inspection on 1st March 2007 had been met. 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 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. Three people who use the service were case tracked across three different units. Following the key inspection to the home in October 2006 where a full inspection of the home was undertaken, two random inspections were Gildawood Court DS0000004236.V335201.R01.S.doc Version 5.2 Page 13 undertaken in February and March 2007 to follow up specific issues including care planning and medication. These inspections identified that little progress had been made in addressing all areas as required to ensure that residents were receiving sufficient care to meet their needs. During this inspection a marked improvement was found in regard to care plans and medication. Care plans had been devised for each resident and records were organised into sections so that information about residents could be easily located and acted upon by carers. All nine requirements made in regard to medication during March had been addressed. Comment cards received by the Commission for residents confirmed seven people felt the care home met the needs of their relative and five felt the home “usually” met their needs. In response to the question “Does the care home give the support or agreed care to your relative”? Seven responded “always”, four responded “usually” and two stated “sometimes” one of these stated, “if they have enough staff working”. During the inspection it was evident that staff have a good relationship with the people who use the service and effectively interacted with them. Staff were knowledgeable about residents and able to provide the inspector with information about their health care needs. The manager was fully aware of matters relating to gender care and advised that some residents had expressed a particular wish about who they did not wish to provide care to them. She advised that staff were aware of this and all efforts were made to support the residents’ wishes. One resident was noted to have an allergy and required a special diet. Arrangements had been made by the home to purchase specific food items to ensure this allergy did not cause ill health to the person using the service. A good supply of varied food items were available for this person. Care records gave clear information about the allergy and staff spoken to were aware of this and the symptoms associated with it. Records stated that staff should observe what the resident eats but records were not being kept to confirm this and to ensure the resident was receiving a suitable foods in relation to their allergy as well as a nutritious and safe diet. Risk assessments had been completed for all residents’ case tracked. Actions were listed for staff to manage the risks but these were not always sufficiently detailed to ensure the risk was reduced. One person had fallen twice and both occasions appeared to be at night. The risk assessment said to make sure the person always had their stick. This is not sufficient to prevent the risk of a fall at night as staff would not necessarily always know when the resident was up and about unless there were systems in place to alert them to this. Gildawood Court DS0000004236.V335201.R01.S.doc Version 5.2 Page 14 One person was identified by staff to have a compulsive disorder. Staff were able to explain how this presented itself and the actions they had been taking to try and manage it. There was no care plan or risk assessment on file confirming this disorder or how staff should approach it to ensure a consistent approach by all staff. The assessment records for one person stated that they had diabetes. There was no care plan identified to show how this was being managed and no blood sugar monitoring records. It was not clear how staff would be able to identify if this persons blood sugar was high or low as there were no details explaining the symptoms of this. Medication records confirmed this person was on medication for their diabetes. One person was being seen by district nurses so that their wounds could be dressed. Daily records confirmed visits from the nurse. There was no care plan in place or body map to identify that this person had wounds or to explain how these were being managed. This could result in an oversight in care. It was not evident that care plans for the management of dementia have been developed so that it is clear how this affects each individual resident and what their care needs are. Care plans should provide staff with information on how the symptoms associated with this condition should be managed for each person. The last two inspections identified that accidents and incidents in the home had resulted in several residents sustaining fractures. The manager advised that she is monitoring the situation. It was evident from records seen that people who use the service have access to doctors, district nurses, chiropody and opticians as well as other specialist services when required. The pharmacist inspector visited the home on a separate day from the main inspection. The inspection took two and a half hours. Random medicines were selected from all the five medication rooms and supporting medicine charts and care plans were looked at. One person who lived in the home and one care assistant who administered the medicines were spoken with. The home has purchased a medicine trolley for all the five separate medication rooms within the home. Concern was expressed that these rooms were not routinely locked especially as they contained confidential information and one medicine cabinet was unlocked on entry to the room. The home has installed a good system to see the prescriptions prior to dispensing and to check the dispensed medicines and medicine charts received into the home. The home uses eleven doctor’s practices and also obtains prescriptions from outlying clinics. This has posed problems in maintaining a Gildawood Court DS0000004236.V335201.R01.S.doc Version 5.2 Page 15 continuous supply in all instances but every feasible step was taken to ensure they do obtain all the medicines on time to administer. Random audits of medicines and medicines charts indicated that the medicines had been administered as prescribed and records reflected practice. The majority of care plans looked at supported the administration of the various prescribed medication. Medicines prescribed on a ‘when required’ basis had a supporting protocol detailing their use to enable staff to only administer them under certain circumstances. Regular medication reviews are sought and for all new people who live in the home, medication is reviewed on entry. The manager has taken steps to ensure that written consent is obtained for medicines administered covertly if necessary in line with the Mental Capacity Act 2007. All Controlled Drug balances were correct and corresponded with the medicine chart. The care assistant interviewed and the manager both had a very good clinical knowledge of the people who live in the home and their medication to be able to support their needs. This was commended. The manager has installed a good quality assurance system to regularly check the medicines on a weekly basis and all care assistants’ individual practice every eight weeks in line with supervision. This has helped the home reach this high level of medicine management seen and staff were keen to maintain this. The inspection process identified that staff are aware of protecting the dignity of people who use the service when hoisting and assisting them in their personal care. Staff also recognise when residents want their own space and quiet time. During the tour of the home in the morning it was found that some people were still in bed asleep but their bedroom doors had been left open. This does not promote the privacy and dignity of the resident and this practice should be reviewed. Gildawood Court DS0000004236.V335201.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, 15 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 activity schedule has been devised by the home detailing activities that will take place each week. A Day Care Supervisor is employed by the home and provides activities for the people who use these facilities. Staff confirmed that the permanent residents could join them. The pre-inspection questionnaire completed by the manager of the home states activities provided include, activities of daily living such as towel folding, washing dishes, tidying. Also listed is bingo, dominoes, craft sessions, Summer Fete, singer twice monthly. Visits listed are to the local park, cafes, shops and garden centre. Gildawood Court DS0000004236.V335201.R01.S.doc Version 5.2 Page 17 The manager confirmed that arrangements can be made to support religious needs and advised at one time holy communion was provided in the home but the resident concerned no longer now required this service. Some people spent their time walking from one lounge to another, one was observed listening to music in the lounge and clearly enjoying this, another danced to the music. During the inspection some people who use the service were observed to use the kitchenettes to make tea, wash up and dry dishes. One resident asked what activities were taking place today and was invited to attend the day care room to participate in activities arranged. There were no specific organised activities observed in the other areas of the home other than the day care room. Resident care plans viewed contained limited information in regard to activities making it difficult to know if their social interests were being fully recognised and acted upon. As residents within the home suffer from confusion and short-term memory, it was difficult to be sure from speaking to residents that they were able to participate in activities of interest to them. Comment cards received from relatives made some reference to needing more activities in the home. One person responded to the question “How do you think the home can improve” by stating, “more stimulation for residents, only have TV” another wrote “more entertainment, more trips outside the home, social wellbeing of patients made better in some cases”. Another person wrote “I am quite happy with X’s care at the moment” and also stated the home “need more activities/stimulation for residents”. The manager advised that they had recruited an Activity Organiser who was due to take up their position in the near future. The manager confirmed this would allow more time to be spent exploring appropriate activities and ensuring people who use the service could benefit from an increased level of social activity in the home. The home had purchased some hats and handbags for recreational use and the manager said there were old films, videos and large print books on each unit in the home, which residents could use if they wished. Care plans had been written taking into consideration choices of the people who use the service. This included for example one persons wish to wash their own face when personal care is being given. It was observed that times people got up in the morning varied demonstrating they have the choice to get up and have breakfast when they wanted. Gildawood Court DS0000004236.V335201.R01.S.doc Version 5.2 Page 18 During the morning the care staff were observed to prepare toast and cereal for the residents in the kitchenettes on each of the units. Care staff confirmed that they did this each day. Gildawood benefits from having an experienced and dedicated Catering Manager who has worked at the home for many years. It was evident from discussions with the catering manager that she takes great pride in producing good home cooked food for the people who use the service. Main meals in the home are prepared in the main kitchen and transferred to units a heated trolley. The trolley is then taken to the kitchenettes on each of the units to deliver the meals. It was observed that most residents had their meal in the dining areas but some had them in their rooms. There were no napkins or serviettes on the tables seen and one person asked for a tissue. It was observed in one lounge that several residents asked the care staff what they would be having for lunch. Staff said they did not know and would tell them when it arrived. Menus were not seen in units to confirm the meals that were going to be served each day. On the day of inspection the meal provided was a mince hot pot with mashed potato and a good selection of vegetables plus gravy. The meal looked appetising and good sized portions were served. There was no alternative choice provided. The Catering Manager said that usually there was a second choice but one had not been done today. She stated if someone asked for something else this could be provided. One person was noted to have something different to the mince hotpot due to having an allergy to the stock cube used in the mince hotpot. The Catering Manager said that an alternative stock cube could have been used to enable this person to have the same as everyone else but the supply of these had been blocked by the organisation. On speaking with a manager from the organisation present at the inspection, it was advised that this was a misunderstanding and the catering manager should have been able to obtain the stock cubes requested. It was explained that new ordering processes had commenced in the home, which staff were getting used to and this matter would be looked into and rectified. It was evident that the meal on the menu was not the meal served and it was not evident records of meals provided each day were being kept in sufficient detail to identify each resident was receiving a satisfactory diet. This also applied to people on special diets. This is important so that it is clear people on special diets are being provided with suitable food to support their health and wellbeing. The main kitchen was clean and tidy and freezers were well stocked with food. Temperatures of fridges and freezers had been recorded and were satisfactory. Gildawood Court DS0000004236.V335201.R01.S.doc Version 5.2 Page 19 The Catering Manager had prepared the evening meal and this was all stored in a dedicated fridge for staff to collect for each unit. Freshly baked cakes were also available. It was not evident 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. The catering manager said that there are sufficient supplies of snack foods in the kitchen, which staff from the units can use if residents wish to have snack in the evening. The amount of cutlery and crockery in the kitchen was limited. The Catering Manager said that she tried to keep a good stock of these in the kitchen but they were often taken and used on the units leaving her short if they were not returned. The amount of cutlery and crockery available may need to be reviewed to ensure there are sufficient for all units as well as the kitchen. Gildawood Court DS0000004236.V335201.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. Quality in this outcome area is good. . 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We have received no complaints since the last key inspection to the home. A complaints procedure is available for the home and is displayed in the reception area and is also available in the Service User Guide for the home. The names and telephone numbers of all contacts are not fully clear so that people who may wish to write or telephone to make a complaint know who to contact. The manager reported that only one complaint had been received since the last inspection to the home. This had been in regard to medication. The preinspection record for the home confirms that all five complaints received in the last 12 months had been responded to within 28 days in line with the homes complaints policy. Relative surveys returned to us show that all relatives know how to make a complaint about the care provided in the home should they need to do so. A policy on the ‘Protection of Vulnerable Adults” was available in the home. Gildawood Court DS0000004236.V335201.R01.S.doc Version 5.2 Page 21 Since the last key inspection there has been one safety issue reported to us concerning a resident absconding from the home without this being identified by staff. This was followed up during a random inspection to the home in February and the manager advised actions had been taken to prevent this happening again. There have been no further occurrences of residents absconding from the home since this time. Training records confirmed that staff had either completed training on the prevention of abuse or this was planned so that they all will know what types of abuse there is and what to do if they observe abuse or this is reported to them. Gildawood Court DS0000004236.V335201.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 21 and 26 were assessed. Quality in this outcome area is adequate. People who use the service live in a well-maintained, clean and comfortable environment with enclosed gardens to support their safety. Some adjustments to the environment and garden would further support dementia care needs as well as improve the management of hygiene in the laundry. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Areas of the home viewed were suitably decorated and well maintained. People who use the service have spacious bedrooms and the different units can be accessed via wide corridors, which are suitable for wheelchair users. Overall the home was found to be clean and tidy. There were no unpleasant odours in areas viewed. 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 Gildawood Court DS0000004236.V335201.R01.S.doc Version 5.2 Page 23 people. Units 1,2 and 3 can be freely accessed by residents 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 although there are no hard surface walkways for wheelchair users or for people with mobility aids to be able to fully appreciate the gardens. 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. In some cases this helped and in others, the residents still became confused where their room was. Residents spoken to were positive about their rooms and one volunteered to show the inspector their room. This person felt they had everything they needed. There are baths with hoists to support people to get into the bath and there are also walk-in shower rooms with chairs for residents to use whilst having a shower. 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. They said they wear disposable aprons if they have to do any sluicing which involves handling heavily soiled items. This helps to maintain hygiene and good infection control practices. It was noted that there was no dedicated sink for staff to wash their hands in the laundry to maintain good hygiene. Staff confirmed the sink in this room was used to soak items. On the day of inspection it contained items that the maintenance person had been using. The manager said she would organise for a hand wash sink to be fitted in this room. Since the last inspection the sluice room has been fitted with a hand wash sink so staff can wash their hands and the broken bedpan washer has been removed. A sluice washing facility is available for cleaning any commodes. Gildawood Court DS0000004236.V335201.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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 confirmed that the home still aim to have 12 carers on duty during the day and six at night. During February 2007 the home received a ‘random’ inspection to review some of the requirements made at the last key inspection in October 2006, which included a review of staffing. The random inspection identified staffing arrangements were poor and there had been no clear changes made. Staff across all units confirmed the proposed staffing numbers were not being achieved consistently with sickness, holidays and absences affecting these. During this inspection, it was found there had been some progress in addressing staff recruitment and how staff are organised within the home to free up some time when staff are particularly busy but there remains issues around staffing which need to be addressed. The manager confirmed there were 58 residents in the home. It was evident from viewing duty rotas that there continues to be variable numbers of staff available at certain times. Gildawood Court DS0000004236.V335201.R01.S.doc Version 5.2 Page 25 Sometimes there are eleven or twelve staff on duty but due to start times of some staff and sickness there are still occasions when there are only 9 staff on duty to cover five units. The manager advised that she had recently recruited more staff and there had been some improvement in sickness numbers, which had helped to keep staffing numbers more stable. Staff spoken to said there had been some improvements in staff availability due to changes in how staff are organised. An example given was the change in when medication is given out. This has been moved to later in the morning so that staff can focus on helping to get residents up and dressed before giving out medications. The home had also purchased medication trolleys, which staff confirmed had helped to cut down on the time medications are administered. 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. During the day some staff who had been identified to work on a particular unit were seen in various different units in the home. Staff were always friendly and supportive to residents when observed during the inspection. Staff were also noted to be rushed and busy and there were still long periods of time when some residents were left unsupervised. In one lounge a resident told the inspector they were concerned because they could not locate an item of underwear and they felt uncomfortable, they had not managed to find a member of staff to report this to. Residents arriving in one lounge were walking around looking to be provided with a drink but staff were busy undertaking other duties to be able to give them a drink when they wanted one. One resident had scratch wounds to their legs, which had been bleeding and had stained their clothing. The inspector advised a member of staff of this and they told the inspector they had just come on duty, the staff member took the resident to their room to attend to this. Comment cards received by us from twelve relatives made numerous references to staffing in response to the questions asked including the questions “What does the home do well”? and “How do you think the home can improve”? One stated “they take very good care of my relative they treat them kindly and with great respect”, “they seem relaxed in the company of staff even though they are busy”. The same person wrote “I think they could employ more staff, they are often short of staff due to illness and maternity leave”. Another person wrote, “sometimes I feel that there isn’t enough staff on duty they seem quite harassed, perhaps one or two more staff would help”. This same person wrote that staff are “friendly and approachable”. One person wrote, “the staff treat the residents with dignity and respect which is good for all concerned”. They also wrote “sometimes short of staff”. Another person Gildawood Court DS0000004236.V335201.R01.S.doc Version 5.2 Page 26 wrote, “the carers work really hard but the home appears to be understaffed most of the time leaving the elderly residents unsupervised for long lengths of time”. 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. At the last inspection a question was asked how staff would make contact with another member of staff if a resident was to have an accident in the lounge and they were at that time alone. It was identified the member of staff would have to leave the resident to make a call from the office. This clearly is not an ideal situation as the resident may be distressed and would have to be left. There has been no progress in addressing this matter although the manager did say they had tried walkie talkies which had not been successful due to staff forgetting to carry them with them at all times. Duty rotas show there is one member of catering staff available from 7.30am to 8am, two catering staff from 8am to 2pm and one member of catering staff from 2pm to 3.30pm to cater for 60 residents. Care staff confirmed that they carry out catering duties including the preparation of breakfasts and any food required outside of these times. This would inevitably take they away from their caring duties. Duty rotas showed that there are usually two or three housekeepers on duty each day to complete the cleaning for the home and the laundry. On the day of inspection all areas viewed were generally clean and tidy which is an improvement from the previous inspection to the home. Staff said they felt the staffing for the home was sufficient when they had the newly employed staff working in a supernumerary capacity, which meant there were three staff on some units instead of two. Staff also said that when these extra staff were around this made a big difference to the residents, as they were happier because more staff were at hand to help and talk to them. The manager advised that staffing in the home had improved over recent weeks. She advised that action had been taken to speak to staff who were continually off sick and this had resulted in reduced sickness levels in the home. This home has the benefit of their own training staff that organise and provide training on an ongoing basis. New staff attend comprehensive induction training and records are kept to confirm training units undertaken. In some cases staff are asked to complete questionnaires to demonstrate their competence and understanding of the training completed. The training officer advised that issues relating to the equality and diversity of the service are discussed during induction training. Gildawood Court DS0000004236.V335201.R01.S.doc Version 5.2 Page 27 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 almost 50 of all care staff have completed a National Vocational Qualification (NVQ) II in Care. Additional staff are either currently completing this training or are scheduled to do so which means the home will soon achieve the 50 target of all care staff to complete this. 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. Since the last inspection a full audit of staff files has been undertaken to identify whether all of the required information has been collated as part of the organisations recruitment practices. The audit showed records have been obtained appropriately and any outstanding information had either been requested or followed up which is good practice. Two staff records were reviewed in detail. Files contained two written references, dates of employment, criminal record bureau checks and evidence of checks against the Protection of Vulnerable Adults Register. It was noted that on one file the references were from friends as opposed to a previous employer despite information on the previous employer being given. Records must demonstrate that appropriate actions have been taken to seek references from previous employers to enable full considerations to be given to the persons suitability for the their employment. Gildawood Court DS0000004236.V335201.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38 were assessed. Quality in this outcome area is good. 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 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.V335201.R01.S.doc Version 5.2 Page 29 Discussions with staff confirmed that the manager shares a good working relationship with staff and staff feel supported by the manager. The home has good systems in place to monitor the quality of care and services provided. Relative meetings are held three monthly and service users can also attend. The manager advised that the last meeting was held in February 2007 and the next one due was 23 May 2007. 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. In addition to the meetings, satisfaction surveys are also used to assess people’s views on the service provided. The home had received 29 surveys from service users, relatives/friends in response to those sent out. Questions were asked about information provided, health and social care, activities, complaints, environment and meals. An example of the responses is detailed below: 96 of service users said they were addressed in the manner they would prefer. 54 said they had actively been involved in their own care planning. 42 or residents said they participate in activities offered with the majority saying “not always”. 65 said they would like to go on more outings. 94 stated there were offered 3 meals a day and 84 of these said they were “tasty”. Some action points following the receipt of surveys had been identified by the manager such as auditing care plans; displaying the complaints procedure in the entrance area of the home and ensuring the homes brochure is given out to all prospective residents. It was noted that the comments that relatives had written on surveys were not reflected in the feedback report and it was therefore not clear what actions had been taken by the home to address individualised comments. The manager said that these had been dealt with directly with the person and recorded in care plans where appropriate. A number of relatives commented in surveys returned to us that they felt staffing for the home needed to be improved. They acknowledged that staff always appear to be “busy”. This inevitably will impact on the quality of service the staff are able to provide. Staff have acknowledged that residents are “happier” when the staffing for the home is sufficient. In addition to the service user/relative surveys, staff were also asked for their opinions in a separate survey. 26 staff had responded to this. The outcome report showed that 83 felt their line manager communicated well with them and 92 felt communication with the manager of the home was “always” good. 48 felt that morale was good, 78 said they felt part of a team. Gildawood Court DS0000004236.V335201.R01.S.doc Version 5.2 Page 30 One member of staff had commented “all staff work hard”, another had written “the individual staff members are generally committed and see the residents as people”. Negative comments included not always having the right equipment to deliver personal care. One member of staff stated the home was “understaffed” and they received “poor pay”. The manager had written on the action plan that staff recruitment is ongoing and any staff leavers are being replaced in advance. It is not clear that the actions proposed by the home in response to surveys have been made available to relatives and visitors to the home so that they know their comments have been listened to and acted upon. The management of resident monies (personal allowances) is undertaken by the administrator of the home. Detailed records are maintained and receipts are kept for transactions undertaken. The money and records for residents were found to be accurate. The administrator advised that her records are audited by a representative of the organisation to confirm these are accurate. She advised the last time this had been done was in 2006. Formal staff supervision sessions do take place with staff and the manager acknowledged they had been behind and had been trying to catch up to ensure all staff receive this six times per year. This is to ensure they become familiar with all aspects of service and any training needs are identified and acted upon. The manager said she had now managed to catch up and information on supervisions carried out was held on file with training sheets. Those staff records viewed showed that staff had received supervision in March 2007. Systems are in place to ensure health and safety is managed effectively. The pre-inspection record for the home showed that health and safety checks were being carried out regularly to ensure the safety of residents. A random selection of records were checked to confirm this. Records in place confirmed service checks for hoists, bath chairs and fire equipment. Hot water temperatures had been recorded and were within safety guidelines to prevent scalds to residents. A Legionelleas check had been carried out in January 2007 and electrical portable appliances had been checked in November 2006. This information confirms that the home has effective systems for maintaining equipment and services to the home to promote the safety of people in the living in the home. Gildawood Court DS0000004236.V335201.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 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 2 X 3 X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Gildawood Court DS0000004236.V335201.R01.S.doc Version 5.2 Page 32 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 OP7OP7 Requirement Care plans must be developed for each care need identified for the person using the service with clear instructions to staff on how to meet these needs. This applies to specialist health care needs such as wounds, dementia, diabetes and challenging behaviour. This is to ensure there is no oversight in care provided to the person as well as helps to promote a consistent approach. Care records must demonstrate care needs identified are being met so that it is clear the person who uses the service is receiving the care prescribed to maintain their health. This in particular applies to daily records being completed. Risk assessments need to fully consider all actions required to manage the risks identified to ensure residents are safeguarded. Outstanding from February 2007 inspection. Gildawood Court DS0000004236.V335201.R01.S.doc Version 5.2 Page 33 Timescale for action 30/06/07 2. OP8 12(1) (a) 30/06/07 3. OP12 16(2)(m) (n) People who use the service must be able to engage in suitable local, social and community activities, which are of interest to them. Evidence must be available to show this so that it is clear the social wellbeing of people who use the service is being maintained. Part met from October 2006 inspection. Records of food provided must be maintained accurately. 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 inspection. Staff hand-washing facilities must be addressed in the laundry to maintain hygiene prevent the risk of spread of infection to people who use the service. 31/08/07 4. OP15 17(2) 31/07/07 5. OP26 16(2) 31/07/07 6. OP27 18 (1) Outstanding from October 2006 inspection. Sufficient numbers of staff must 31/07/07 be available to meet the needs of the residents at all times. This includes a review of catering staff hours and availability. Outstanding from the October 2006 inspection. Gildawood Court DS0000004236.V335201.R01.S.doc Version 5.2 Page 34 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. 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. Prospective service users should receive written confirmation following their assessment that the home is suitable to meet their needs. It is recommended that medicines are ordered earlier from outlying clinics to ensure that they are available to administer on a continuous basis. It is recommended that a keypad lock is installed on each medication room door and the doorstop is removed to ensure that staff lock the door when not in use. It is advised that the complaints procedure for the home contains contact names and telephone numbers so that anyone who wishes to make a complaint in writing or wishes to make telephone contact can do so. This information should also be made clear in the Service User Guide for the home. Menus should be made available to people who use the service so that they are fully aware of the choices available including choices of 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. The availability of napkins or serviettes would help to improve dining facilities for residents. Considerations should be given to making adjustments to the environment to support dementia care needs such as tactile aids, use of colour to identify areas, raised flower beds and walkways in the garden. It is advised that references from previous employers are sought where these are listed on application forms. This is DS0000004236.V335201.R01.S.doc Version 5.2 Page 35 2. 3. 4. OP4 OP9 OP9 5. OP16 6. OP15 7. OP19 8. OP29 Gildawood Court 9. 10. OP7 OP27 11. OP27 to ensure the home has a robust recruitment procedure to safeguard residents. The availability of drinks for residents should be reviewed to ensure residents have the opportunity to have drinks more regularly to help maintain their health and wellbeing. 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. Gildawood Court DS0000004236.V335201.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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.V335201.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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