Inspection on 05/07/05 for Gildawood Court

This inspection was carried out on 5th July 2005.

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

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

Other inspections for this house

Gildawood Court 20/10/09

Gildawood Court 13/07/09

Gildawood Court 23/04/09

Gildawood Court 29/04/08

Gildawood Court 30/04/07

Gildawood Court 17/10/06

Gildawood Court 09/11/05

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 Louise Thompson Unannounced 05 July 2005 09:15 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 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 v236377 e53 s4236 gildawood court v236377 050705 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Gildawood Court Address School Walk Attleborough Nuneaton Warwickshire CV11 4PJ 02476 341222 Telephone number Fax number Email 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 registration, with number of places GILDAWOOD COURT v236377 e53 s4236 gildawood court v236377 050705 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The manager must obtain the Registered Manager Award by 31 December 2006. Date of last inspection 13 January 2005 Brief Description of the Service: Gildawood Court is a purpose-built, 60-bed care home for older people and is registered to provide specialist dementia care. It provides permanent care, short stay accommodation, and day care facilities.The home is situated close to the centre of Attleborough and within a mile of Nuneaton town centre. Local amenities are within reach by foot or wheelchair, and there is parking at the front of the building. The home is divided into five units, which accommodate eleven, twelve or thirteen service users in each. Each unit has a lounge and dining area, which is fitted with a kitchen area.All bedrooms are single and have en-suite lavatories with washbasins. There are sufficient numbers of lavatories and bathrooms situated around the home. There is a large activity room for service users, and a family visiting room, which can also be used as a smoking area by those who choose to do so. The home has a hairdressing room and enclosed gardens. GILDAWOOD COURT v236377 e53 s4236 gildawood court v236377 050705 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection and took place over one day between the hours of 9.25 am and 5pm. This was the first visit for this inspection year. Staff co operated fully with the inspection. The registered manager was present throughout the inspection. The inspection process involved a tour of the home, talking with the manager, examining records and care plans, observation of care practices along with discussions with residents, staff and three relatives who visiting on the day of the inspection. What the service does well: What has improved since the last inspection? What they could do better: Assessment and care planning must improve so that the staff are able to know what to do for each resident and ensure that individuals care needs are met. The recording and storage of medicines needs further improvement to ensure that medicines are given and stored correctly. The manager must ensure that practices and procedures for safeguarding residents are robust and protect them from harm by other residents. Systems to monitor the quality of the services and care provided need to be developed further. GILDAWOOD COURT v236377 e53 s4236 gildawood court v236377 050705 stage 4.doc Version 1.40 Page 6 The most serious concerns from this inspection are that: staff are being employed without proper employment checks to ensure that they are suitable people to work with residents. Agreed staffing levels were not being maintained meaning staff had less time to spend with residents. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. GILDAWOOD COURT v236377 e53 s4236 gildawood court v236377 050705 stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection GILDAWOOD COURT v236377 e53 s4236 gildawood court v236377 050705 stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) these standards were not assessed as part of this inspection. EVIDENCE: GILDAWOOD COURT v236377 e53 s4236 gildawood court v236377 050705 stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Limited progress has been made on improving care plans and arrangements to ensure that the health,personal and social care needs of residents are identified and planned for. These shortfalls have the potential to place residents at risk.Systems for the mangement and administration of medicines are improving .Staff practice in maintaning privacy and dignity are good. EVIDENCE: Individual care plans are available but little progress has been made to ensure that all aspects of health, personal and social care needs of residents are identified and met. Assessment details recorded on admission to the home were incomplete. Plans remain brief and lacking in specific detail. Daily entries in care records identified changing care needs, which were not always reflected in resident care plans. Monthly evaluations by keyworkers do not adequately reflect the residents current care changes/needs. There were no risk assessments for moving and handling, pressure areas and risk of falls on care files examined. Discussion with staff suggested that needs were being addressed even though there was lack of specific care plans. This approach is dependent upon good verbal communications and staff memory. GILDAWOOD COURT v236377 e53 s4236 gildawood court v236377 050705 stage 4.doc Version 1.40 Page 10 The manager said that she was aware of the problems with the current care plans and intends to implement new care documentation, a meeting was held recently to discuss and develop suitable risk assessments. Comment cards returned to the inspector by residents and their families indicated that all but one of the respondents felt that they were well cared for by the staff. Three residents and three relatives told the inspector that the staff were kind and caring, that their needs were met and that they were happy with the care. Since the last inspection systems for the management and recording of medications have improved. Three of the senior staff told the inspector that they had completed training in medication administration etc. The following issues were discussed with the manager: The care and medication records of one service user recorded the discontinuation of one medication by the GP. This was not recorded when the next months MAR sheet was issued and the medication was given for a number of days. The manager contacted the GP and dealt with this during the inspection. A number of medicines in bottles had no pharmacy label to indicate the resident and indications for usage. Staff had written the name of the resident on the bottle. Returns of controlled drugs had not been recorded for one resident who was admitted for respite. The manager told the inspector that a meeting had been arranged with the pharmacist to discuss issues with regards to the delivery and receipt of medications etc. The medications policy is currently being reviewed. Staff were observed treating the service users with dignity and respect during the inspection. GILDAWOOD COURT v236377 e53 s4236 gildawood court v236377 050705 stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed as part of this inspection. EVIDENCE: GILDAWOOD COURT v236377 e53 s4236 gildawood court v236377 050705 stage 4.doc Version 1.40 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Arrangements for protecting residents from harm/abuse need further development. EVIDENCE: Since the last inspection the adult abuse policy has been reviewed the training coordinators are responsible for cascading this to all staff and this is also included in the homes induction programme for new staff members. Training records viewed demonstrated that 22 staff members have attended training on abuse; the manager said that this training is ongoing. Other policies regarding management of residents monies, whistle blowing etc are currently under review. Records viewed for one resident identified a number of incidents of physical and verbal aggression towards other residents, some resulting in injury. The care plan and other records did not record fully the action taken by the manager and staff to minimise the risk to other residents. Staff were observed during the afternoon dealing with verbal outbursts by the resident which was directed at other residents in the vicinity. Staff dealt with the situation professionally and appropriately. The manager told the inspector that if necessary one to one supervision is provided. GILDAWOOD COURT v236377 e53 s4236 gildawood court v236377 050705 stage 4.doc Version 1.40 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 25 and 26 The standard of décor within this home is good with evidence of ongoing maintenance and redecoration. The home presents as a homely and comfortable environment for residents. EVIDENCE: Gildawood Court is a purpose-built, 60-bed care home for older people and is registered to provide specialist dementia care.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 area. All bedrooms are single and have en-suite toilets with washbasins. There are sufficient numbers of toilets and bathrooms situated around the home. The design of the home allows for residents to walk freely between the units and to access a secure garden area should they wish. At the time of this inspection the home was observed to be clean and tidy and free from obvious odours. Residents are encouraged to personalise their rooms with evidence of this seen during a tour of the home. Furniture and furnishings are comfortable and homely and suited to current residents needs. Since the last inspection a Legionella risk assessment has been completed and the management of clinical waste has been reviewed. GILDAWOOD COURT v236377 e53 s4236 gildawood court v236377 050705 stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 The procedures for the recruitment of staff are slowly improving; shortfalls in some pre employment checks potentially place residents at risk. The number of staff available is below agreed levels and potentially leaves residents at risk of needs not being fully met. EVIDENCE: Duty rotas observed for the period June/July 2005 demonstrate that care staffing levels are not being met. This is largely due to an increase in the level of sickness. A total of 39 shifts during this period were recorded as sick (unplanned) two as absent and a further 3 recorded as leave due to unforeseen family circumstances. A further two staff are on long term sick and two on maternity leave. The manager told the inspector that staff were doing additional hours to cover these shifts and other support staff were moved to care duties. These hours were not always recorded on the duty rota and it was not possible to accurately identify the hours worked during this period. The manager said that staff sickness levels are being monitored and staff seen as appropriate. Three relatives said that staff were available to assist with care if needed. Staff said that occasionally some shifts were below staff levels because of sickness and although these shifts were busy they were able to meet residents needs. At the time of the inspection staffing levels appeared to be suitable to meet the needs of the current residents. GILDAWOOD COURT v236377 e53 s4236 gildawood court v236377 050705 stage 4.doc Version 1.40 Page 15 The staff files of four recently appointed staff members indicated that the manager had not completed all the necessary recruitment checks to ensure the protection of residents. Two references were available on three of the four files viewed only one of these was from previous/most recent employers; gaps in employment were not always recorded. Three of the files contained little/no evidence of personal identification. All four files contained evidence of suitable CRB/POVA checks. GILDAWOOD COURT v236377 e53 s4236 gildawood court v236377 050705 stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 and 38 The newly appointed manager has a clear vision for the home and a good understanding of the areas in which the home needs to improve. Systems to monitor the quality of the service and obtain resident views are limited. The health and safety of those using the services are satisfactory. EVIDENCE: The registered manager has recently been appointed and is registered with the Commission for Social Care Inspection. The manager told the inspector of the issues which needed addressing and of her initial plans for the improvements required. Systems for the monitoring of the quality of systems are largely informal. Staff said that environmental audits are completed monthly. The home has a quality questionnaire but is considering alternative methods e.g. dementia care mapping which is better suited to the resident group. All policies are currently subject to review. GILDAWOOD COURT v236377 e53 s4236 gildawood court v236377 050705 stage 4.doc Version 1.40 Page 17 Certificates for the service and maintenance for major systems were available the manager said that these were done by appropriately qualified personnel. Staff training records viewed demonstrated that staff had attended fire, manual handling, health and safety and infection control training. A suitable system is in place to identify those still to attend. The report from the Health and Safety Officer’s visit in February 2005 indicated the need for additional risk assessment to be completed. The manager said that this had been commenced some risk assessments were still to be completed. Accident records and monthly reports were seen. GILDAWOOD COURT v236377 e53 s4236 gildawood court v236377 050705 stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION 3 x x x x x 3 3 STAFFING Standard No Score 27 2 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 3 x 2 x x x x 3 GILDAWOOD COURT v236377 e53 s4236 gildawood court v236377 050705 stage 4.doc Version 1.40 Page 19 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Timescale for action 30/09/05 2. OP8 12, 13 3. OP9 13 4. OP18 13 The registered manager must ensure that assessments and care plans are specific to each residents, health, personal and social care needs and are up to date. (Old timescale pf 30.12.04 and 30.4.05 not met) 30/08/05 The registered manager must ensure that there are risk assessment for falls, nutrition and pressure areas completed for all residents on a monthly basis. Where a risk is determined a care plan must be devised describing the actions to be taken to minimise the risk.(old timescale of 30/11/04 and 31/04/05 not met) The registered manager must 30/08/05 ensure that bottled medications are adquately labelled. The medications policy must be reviewed a completed copy is to be forwarded to the Commission. The registered manager must 30/08/05 ensure that robust procedures are implemented and maintained to ensure the protection of residents. Incidents of threatening or challenging behaviour by one Version 1.40 GILDAWOOD COURT v236377 e53 s4236 gildawood court v236377 050705 stage 4.doc Page 20 5. OP27 18 6. OP29 19 Sch 2 7. OP33 24 8. OP33 10, 12 resident to another must be reported in accordance with Regulation 37. The registered manager must ensure that staffing numbers are maintained within previously agreed levels.These should be determined according to the assessed needs and dependency level of residents. (Old timescale 13.01.05 not met) Duty rotas must accurately record the hours worked by staff members. The registered manager must ensure that staff files contain all evidence as specified in Schedule 2 of Care Homes Regulations 2001. Two references, one of which must be from the previous employer must be obtained prior to staff commencing duty.(Old timescale of 13.1.05 not met) The registered manager must establish and maintain suitable quality assurance and quality monitoring systems. This includes suitable means of obtaining the views of residents, family and other stakeholders e.g GP. Copies of quality reports must be forwarded to the Commission. (old timescale December 2004 and 31.05.05 not met) The registered manager must forward a timed action plan for the review of the homes policies. 30/07/05 30/07/05 30/09/05 30/08/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations v236377 e53 s4236 gildawood court v236377 050705 stage 4.doc Version 1.40 Page 21 GILDAWOOD COURT 1. 2. Standard OP7 OP8 The inspector recommends that staff record where residents or their representatives choose not to be involved in care planning/reviews. The inspector recommends that a planned dementia care mapping exercise is included in the quality plan with records kept. GILDAWOOD COURT v236377 e53 s4236 gildawood court v236377 050705 stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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