Random inspection report
Care homes for older people
Name: Address: Gillibrand Hall Nursing Home Folly Wood Drive Chorley Lancashire PR7 2FW one star adequate service 02/06/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Denise Upton Date: 1 1 0 3 2 0 1 0 Information about the care home
Name of care home: Address: Gillibrand Hall Nursing Home Folly Wood Drive Chorley Lancashire PR7 2FW 01257270586 01257232989 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Century Healthcare Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 50 Number of places (if applicable): Under 65 Over 65 0 50 0 dementia old age, not falling within any other category physical disability Conditions of registration: 50 0 50 The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. Dementia - Code DE. Physical disability Code PD. The maximum number of service users who can be accommodated is: 50. Date of last inspection 0 2 0 6 2 0 0 9 Care Homes for Older People Page 2 of 9 Brief description of the care home Gillibrand Hall is a listed building, set in its own grounds, within a residential area close to Chorley town centre. Public Transport does serve the area nearby and the home is now accessible via the new Gillibrand north estate. The home provides care for up to fifty residents of either sex that have nursing and/or personal care needs. At the time of the site visit, forty-two people were living at the home. Accommodation is set on two floors. Currently, the ground floor offers accommodation for residents who require nursing or personal care and the first floor for residents who suffer from dementia. The first floor is served by a passenger lift . A number of rooms are equipped with en-suite facilities and both floors have enough communal space. Residents have use of an enclosed courtyard, and garden areas to the front of the building, both of which are furnished with appropriate garden furniture. Information about the facilities and services provided can be found in the homes Statement of Purpose and Service User Guide. The current fees for residential accommodation at Gillibrand Hall range from £435:00 per week to £686:50 per week. Care Homes for Older People Page 3 of 9 What we found:
This unannounced, random inspection to Gillibrand Hall Nursing Home was undertaken by the lead inspector and a pharmacist inspector. The visit in total lasted for a period of approximately three and three quarter hours. We spoke with the Director of Nursing and the recently appointed homes manager. Discussion also took place with a small number of qualified staff working at the home. We also looked at a number of records relating to care planning, and medication practices. At the last key inspection that took place in June 2009, these key areas were identified as requiring improvement. An unannounced random inspection visit was undertaken in January 2010 to establish what progress had been made. At that time although some improvement was noted, there were still shortfalls that needed to be addressed. This further unannounced random inspection was to establish what further progress and improvement had been made. At this site we looked at the care records of six residents. Two of these residents had been admitted to the home since the last random inspection and the remaining four, were care files that at the last random inspection site visit required some improvement. The two care files of the recently admitted residents were found to be comprehensive and detailed. Each area of identified need except one had a separate care plan. Each care plan was relevant to the assessed need and provided good detail of how an aim was to be achieved. This provided staff with the same clear and detailed written information so that an individualised and appropriate level of care and support could be consistently offered. A variety of risk assessments were in place and there was evidence that these, along with the individualised care plans had been formally reviewed. The area of need without a relevant care plan related to the religious assessed needs of a recently admitted resident. We were told that in practice, this persons religious care needs were met at the home as identified in the admission documentation. This appeared to have been an oversight. A detailed, relevant care plan was in place for all other areas of assessed need. A care plan in respect of one resident gave good detail of why this particular resident may exhibit certain behaviour including aggression and how staff were to respond to this. This was good practice that advised staff well. By providing good detailed intervention strategies for staff to follow, possible trigger situations are defused and the situation prevented from escalating whilst helping to ensure that a calm and relaxed atmosphere is maintained. The review and update of all existing individual plans of care has now been completed to good effect. In almost every case a detailed care plan was in place for every area of assessed need. In respect of the updated plans of care seen, there was only one instance where a need identified at the last site visit, was still without a relevant care plan. There was clear documented evidence seen at the last site visit, and also seen at this site visit, that this particular resident may experience depressive episodes or try to harm themselves. This is an important issue that has potential to seriously impact on the well being of the individual resident. It is essential that a care plan be put in place to advise staff what to do if they were concerned, or what triggers may suggest medical intervention was required. Although we were told that this particular resident had not
Care Homes for Older People Page 4 of 9 exhibited any signs or symptoms that may suggest a re-occurrence of the earlier incident, a care plan should be in place in respect of this issue. The range of other care plans that were in place in respect of this resident were relevant and informative. Improvement had also been made to ensuring that care documents are signed and dated by the person making the entry. This ensures that the writer takes ownership of the recording and also to confirm accuracy of the detail written. This also assists in care plan audits. Whilst good progress has been made in ensuring that detailed and relevant plans of care are now in place for all areas of identified need, it is essential that this improvement be maintained. Only by ensuring that high standards in respect of care planning are upheld, will staff be provided with the important information that they need in order to provide a consistent high quality service that is personalised to meet individual care needs and requirements. We were told that in order to address this issue, a representative of the Royal College of Nursing is to deliver care plan training for all qualified nursing staff working at the home. This important training has been arranged to take place in May 2010. We carried out this visit to check how medicines were being handled because we found some serious shortfalls on our last visit that resulted in us issuing several requirements to make urgent improvements. We checked medicines records, medicines stock and looked at a sample of care plans. Overall we found good improvements in the handling of medicines that meant they were now being handled in a much safer way. Records of medicines received into the home, given to people and disposed of were usually signed and up to date. We saw regular recorded checks that were carried out weekly and monthly to make sure nursing staff were giving and recording medicines correctly. When any mistakes were found action was taken immediately to help prevent them happening again. We gave some further advice about dating records of medicines receipt more clearly and some advice about improving the records of medicines carried forward to a new month so they could be more easily accounted for. All nursing staff had their competency formally assessed by the managers and action had been taken against staff that had failed to follow the policies and procedures of the home. Medicines records were now being completed more accurately and we saw a general improvement in the handling of medicines stock. We saw some good paperwork to support the use of when required medicines used for controlling agitation and pain and when any medicines were not given a clear reason was recorded. Our detailed checks of the current stocks and records showed medicines were usually being given to people correctly. Medicines that needed to be given before food were now usually given at the right time because a pre mealtime medicines round had been properly organised. We found some minor discrepancies that we discussed with the managers and gave some advice about how these could be monitored more closely. We looked at how liquid medicines were handled because our previous visit had found some mistakes. We found good improvements and these were now better organised and the correct measuring equipment was now being used. We also found medicines were now being disposed of correctly when they were no longer required and accurate records
Care Homes for Older People Page 5 of 9 of this were now being made. We looked at how external medicines such as creams were given and recorded. New records were now being used for these, which had helped make some good improvements. When we checked one persons creams that were kept in their own room we found they were not securely stored. We also found their records were not always signed so we gave some more advice about how to make improvements to help make sure they are safely used. We re checked the care plans of several people that refused their medicines on a regular basis and found their mental capacity had now been properly considered. Thorough assessments of their capacity had been carried out that meant their rights were now being properly protected. We checked how controlled drugs (medicines that can be misused) were handled. The cupboard used for storage was suitable and we saw complete and accurate records. Secure storage and accurate records help prevent the misuse and mishandling of controlled drugs. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 9 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 9 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 7 A plan of care should be in place in respect of a specific assessed need with regard to two individual residents that was identified at this inspection. The improvement to the care planning process and the detail and information incorporated in the individual care plan should be maintained at all times. This would ensure that all staff had the same high quality written information so that a consistent service is always offered. The organisation and recording of medicines stock should be improved so that all medicines can be easily accounted for. 2 7 3 9 Care Homes for Older People Page 8 of 9 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 9 of 9 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
