Inspection on 02/07/07 for Gillibrand Hall Nursing Home

This inspection was carried out on 2nd July 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Gillibrand Hall Nursing Home 11/03/10

Gillibrand Hall Nursing Home 18/01/10

Gillibrand Hall Nursing Home 02/06/09

Gillibrand Hall Nursing Home 03/05/06

Gillibrand Hall Nursing Home 03/02/06

Gillibrand Hall Nursing Home 04/08/05

Gillibrand Hall Nursing Home 31/01/05

Gillibrand Hall Nursing Home 19/08/04

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

CARE HOMES FOR OLDER PEOPLE Gillibrand Hall Nursing Home Grosvenor Road Chorley Lancashire PR7 2PL Lead Inspector Denise Upton Unannounced Inspection 12:45 2 & 3rd July 2007 nd 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 Gillibrand Hall Nursing Home DS0000025560.V336958.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. Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gillibrand Hall Nursing Home Address Grosvenor Road Chorley Lancashire PR7 2PL 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) 01257 270586 01257 262989 Century Healthcare Limited Ms Joan Lilian Calf Care Home 50 Category(ies) of Dementia (31), Old age, not falling within any registration, with number other category (31), Physical disability (6) of places Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 50 service users to include: Up to 31 service users in the category OP (Old age, not falling into any other category) Up to 31 service users in the category DE (Dementia) Up to 5 service users in the category PD (Physical Disability) aged 55 years and above. The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. One named service user in the category PD (Physical Disability), aged 50 years and above, may be accommodated within the overall number of registered places. 3rd May 2006 2. 3. 4. Date of last inspection Brief Description of the Service: 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 but access to the home is via a public right of way and a long driveway. The home provides care for up to fifty residents of either sex with a range of nursing and personal care needs. At the time of the site visit forty-one 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 have a diagnosis of 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, which is furnished with appropriate garden furniture. Information about the facilities and services provided can be found in the home’s Statement of Purpose and Service User Guide. A website is also available to anyone with access to the internet. Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit took place during the course of two consecutive mid-week days and in total spanned a period of just over fifteen hours. Twenty-one core standards of the thirty-eight standards identified in the National Minimum Standards-Care Homes For Older People were assessed along with a partial re-assessment of the requirements and recommendations identified in the last inspection report. The inspector spoke with the registered manager, an external manager of the company, two qualified members of staff, two care assistants, the cook on duty and laundry assistant. In addition, individual discussion took place with four people who live at the home and three relatives who were visiting. Several other residents were also briefly spoken with in a lounge area. A number of records were also examined and a tour of the building took place that included communal areas of the home and some bedroom accommodation. Information was also gained from a pre inspection questionnaire completed by the registered manager. In addition a number of residents and relatives and a General Practitioner also completed a Commission for Social Care Inspection survey forms that helped to form an opinion as to whether residents needs and requirements were being met. This key inspection focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. Currently the fees at Gillibrand Hall range from £386.00 to £607 00 per week. What the service does well: The registered manager at Gillibrand Hall is experienced in running a care home for older people and helps staff to understand the needs of older people. The staff group is enthusiastic and work well together to provide a good quality of care for people who live at the home. On relative commented, “The carers and staff are friendly and listen to the residents, taking an interest in them. I find them all friendly to myself and mum. They get involved which makes the residents feel wanted. On the whole it’s a homely place, and you feel it when you go in”. It is very clear that good relationships exist between residents and staff that help people living at the home feel comfortable and secure. Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 6 Residents and relatives are encouraged to have their say and help make decisions about the running of the home through a variety of ways that includes a questionnaire, informal discussion and daily interaction with staff. Meals are varied, well balanced and nicely presented offering choice and variety. All residents spoken with were very pleased with the variety and choice of the meals served. There are good systems in place for when new staff are recruited that helps protect people living at the home. What has improved since the last inspection? What they could do better: The registered manager and staff at Gillibrand Hall Nursing Home work hard to make sure that the needs of residents are well met and that people living at the home feel comfortable. However there are a number of things that could be improved. Some of the decoration and furnishings at the home looks tired and in need of refurbishment. The home has a plan in place to make improvements. The social activities that are made available for residents to enjoy are at present limited. The staff at the home recognises this and are trying to make some improvements. It is important that all staff have a variety of health and safety training in order to protect residents. At present not all staff have undertaken all the required training. However there is more health and safety training due to take place over the next few months. Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 7 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. Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 in part & 3. Quality in this outcome area is good. The home’s Statement of Purpose and Service User Guide are good at providing residents and prospective residents with details of the services the home provides enabling an informed decision about admission to the home. Gillibrand Hall Nursing Home has a good system in place to assess the needs and requirements of prospective residents prior to admission. This is to ensure that the home can provide the individual level of care and support required. However pre admission assessments could be improved by making sure that social, religious or cultural needs are incorporated This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last key inspection, the home’s Statement of Purpose and Service User Guide have been reviewed and updated and now provide up to date information covering a range of topics. However although the required Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 10 information is provided, the detail to be included in each document is mixed up between the two in documents. The Statement of Purpose and Service User Guide should be looked at again to make sure that the correct information is included in the correct document. Both documents should be free standing and some of the same required information is to be included in each separate document. It is strongly recommended that reference be made to Regulations 4 & 5, Standard 1 and Schedule 1 of the National Minimum Standards, Care Homes for Older People and the Care Homes Regulations to ensure compliance. Some of the information provided could also be expanded upon to make sure that it gives a good overview of what actually goes on in the home. All current residents have been provided with an individual copy. A resident who had been admitted to the home fairly recently and her relatives, all said that they had received sufficient written and verbal information about the Gillibrand Hall to decide if the home was suitable. Likewise, residents have also been provided with a revised and updated contract of residency. This sets out the terms and conditions of living at Gillibrand Hall. The Statement of Purpose, Service User Guide and a specimen contract of residency are given to people in the form of a service user’s handbook that can be provided in large print or in a language other than English. People are only admitted to the Gillibrand Hall Nursing Home following a pre admission assessment of the prospective residents’ current strengths and needs. This initial assessment, usually undertaken by the registered manager is to make sure that the home can provide the level of care and support required. The information obtained during the pre admission process could however be a bit more detailed and take into account the individual’s social, religious and cultural needs and requirements. These topics should be discussed with the prospective resident/relative with outcomes recorded. This would ensure that all requirements are known and that the people concerned were confident that they could be satisfactorily addressed. In some instances, to supplement the home’s independent assessment, further information is made available through a health and/or social services multi disciplinary assessment that provides further information regarding the prospective resident. The information gathered then enables the registered manager to make an informed decision as to whether Gillibrand Hall Nursing Home can meet the prospective resident’s current strengths, needs, wants and wishes. The information obtained then forms the basis of the initial plan of care. One person who lives at the home and her daughter both said that this process had been undertaken before the resident had been admitted to the home and Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 11 they also said that the staff had been helpful and welcoming throughout the pre admission and admission period. A further recently admitted resident stated that her family had been fully involved in the pre admission assessment and that a contract of residency had been agreed and signed. Gillibrand Hall Nursing Home DS0000025560.V336958.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): 7, 8, 9, & 10. Quality in this outcome area is good. There is a care planning system in place to provide staff with the information they need to meet resident’s needs. However, although information is recorded, the actual care plan could be more detailed. The health care needs of residents are well met with evidence of good multi disciplinary working taking place on a regular basis. The medication in this home is well managed promoting good health. Personal support is provided in such a way as to promote and protect resident’ privacy, dignity and independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the course of the site visit, four residents were ‘case tracked’. This involved looking carefully at all the information that is kept by the home Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 13 regarding these people including assessments, risk assessments and the individual plan of care. The care plans observed in respect of the people ‘case tracked’ were generally good however in some instances although an aim was identified, how the aim was to be addressed was not always clear. This therefore did not always provide staff with adequate written guidance to ensure a consistent service. Relevant risk assessments had been undertaken including bed rail assessments and an individual fire risk assessment in respect of each resident. There was evidence that care plans and risk assessments are reviewed on a regular basis and amended as required. A daily record is maintained for each resident. Whilst these are completed, the information provided is primarily focused on medical/personal care. It is suggested that the written detail be expanded to include activities or interests undertaken or visits out or visits by family to give a broader picture of what has been enjoyed. Members of staff spoken with confirmed that that they felt sufficient written information was provided to ensure a good quality of care, supplemented by a verbal handover of information at the beginning of each shift. This ensured that staff coming on duty, were made aware of any changes required to the level of support and care of each resident. One relative spoken with confirmed that she was aware of her mother’s plan of care and had been invited to contribute to its development. The resident herself was clearly aware of her own care plan and said that she would not have “anything signed unless I agree with it”. Another resident and her two daughters also said that this involvement had taken place and that the “care plan was commissioned with mum and ourselves” and confirmed that the care plan been signed by the relatives. These relatives also passed comment that “everybody was polite and understanding” and the resident herself said she “loved it” (the home) and the staff were “great, fantastic” and that she wanted to remain living there. Through discussion with staff and residents and observation of the ‘medical professional visit’ record, it was clear that resident’s health care needs are well met. There is a good relationship with health care professionals in order to maintain health and social well-being. Comments on the Commission for Social Care Inspection’ survey forms also confirmed that residents and their relatives felt that people who live at the home always receive the medical support that they needed. The general practitioner (G.P.) who completed the Commission for Social Care Inspection professional survey form stated that staff were, “Caring and Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 14 attentive”, with “an open and honest approach to care” and that they were good at “seeking medical attention promptly when needed”. It was noted whilst touring the home that specialist equipment was provided for those requiring it so that people living at the home were cared for in comfort. The pre inspection questionnaire showed that there had been no change to the medication policies and procedures since the last inspection so that current information was still being provided for staff in relation to the safe management of medications. The home has good systems in place for the administration and recording of medication. A representative of the company undertakes a medication audit on a periodic basis. This is to make sure that the home’s policy and procedures for the receipt, recording, storage, handling, administration and disposal of medication is adhered to. However, occasional dose omissions without explanation were noted on a small number of the medication administration records observed. This suggests that staff are not always signing the medication administration record immediately after the medication has been administered. Currently no resident is self-medicating their own prescribed medication. However residents retain this choice within a risk assessment framework. Residents spoken with were happy with staff administrating their medication. Whilst only qualified nursing staff actually administer medication, it is recommended that all care staff should be provided with medication awareness training in order to understand the principles of medication handling and records and the home’s policy on medication practices. Residents spoken with felt that their privacy and dignity was well respected and that staff were sensitive when they needed help with personal care. Staff were seen to be respectful and mindful of residents feelings with one relative stating on a Commission for Social Care Inspection survey form “My aunts have been fully involved in their care package and treated with respect and dignity”. A number of staff spoken with also commentated that they felt resident’s privacy and dignity was well respected within the home. Through direct observation in the dementia care unit, staff were seen to be very caring and respectful to residents and did not try to rush the resident. Residents were talked to and assisted at a pace that was acceptable to the individual. Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 15 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): 12, 13, 14 & 15. Quality in this outcome area is good. Residents are encouraged to maintain regular contact with their family and friends to ensure these relationships are sustained. Although some ‘in-house’ activities are arranged on a regular basis, the range of activities provided should be extended to enrich each resident’s social opportunities. Dietary needs of residents are well met with a balanced and varied selection of foods served that residents enjoy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Several residents spoken with confirmed they are enabled to exercise choice in what they choose to do each day. Social relationships are encouraged either through family/friends visiting or visits out in the local community. As observed, it was clearly evident that people who live at the home can entertain their visitors at a time of their choice either in a communal area of the home or individual bedroom accommodation. Relatives spoken with all felt that each Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 16 time they visited they were always made welcome and that they had a good relationship with the staff group. At present, regular staff lead activities in the home for residents to enjoy is limited. It is understood that residents enjoy bingo on a weekly basis and board games, music and television are freely available. It is also understood that quiz’s, outside entertainers and reminisce sessions do take place but only on an occasional basis. Visits to the wider community are arranged with a trip out to Blackpool Illuminations and an ice cream parlour in recent months but again this only organised on an infrequent basis. Some resident do however enjoy regular visits to a local community centre and other local community facilities and pets for therapy and aromatherapy is made available. In addition, a local school and a Brownie group visit occasionally to entertain people living at the home and a school volunteer was working at the home as part of the work experience scheme. An activities organiser from the company visits Gillibrand Hall each week to organise some activities and an activities form that identified what each resident’s interests is available. However it did not appear that the individual activities people would like to do were always arranged. In the dementia care unit a staff member explained that not many communal activities take place except for one simple game that residents living there did enjoy with more one to one activities determined on a daily basis and dependent on the wants and needs of each resident. However to ensure that the social wants and needs of each individual resident is addressed, it is important that a wide range of activities be regularly provided suited to the individual that includes outside activities even if only for a walk in the grounds with a member of staff. A relative commented on a Commission for Social Care Inspection survey form that, “Gillibrand Hall allow people to do their own thing to a large extent. It would be nice though if they could organise some outdoor activities during the good weather even in the grounds of the home”. The management team are aware that this is an area that could be improved and are looking at ways to make sure that the individual social needs, wants and wishes of each resident is well met. It is particularly important that some of the activities arranged are suitable for residents who experience cognitive impairment or who have mobility difficulties in order to improve their quality of life and to provide a stimulating social environment. In helping address this issue, a member of the care staff team explained that she was going on a course to plan and develop an activities programme that would take into account the requirements of each person. It is understood that other members of staff are also anxious to get involved in looking at how Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 17 improvements could be made. It is important that all people living at the home are provided with similar opportunities to participate in regular activities appropriate to their wants and wishes and abilities. Residents are encouraged to maintain control of their own financial affairs for as long as they wish to and have capacity to do so. Information about local advocacy services is made available to residents and relatives in the Service User Handbook given to each resident at the time they are admitted to the home. Through discussion with residents and observation of some bedroom accommodation, it was evident that residents are encouraged to take personal possessions with them into the home to make their private accommodation more homely and comfortable. Meals and mealtimes at Gillibrand Hall are given prominence with a varied and balanced menu provided that is designed around the known likes and dislikes of people living at the home. Residents spoken with were all very pleased with the variety and quality of the meals served. People described the meals as “very good”. During the course of the inspection the evening meal was observed in the dementia care unit. There was a comfortable and relaxed atmosphere and staff were seen to be encouraging, sensitive and discrete when assisting individual residents to eat their meal. People were offered choice and asked individually what they would like to eat from the foods available. Residents sat to eat their meal where they were most comfortable and appropriate cups, cutlery, plate guards and mats were in use to help ensure that residents remained as independent as possible. Staff responded with concern when a resident did not feel like eating and responded positively by encouraging this person to try and eat more later. Discussion with the cook confirmed that the current menu was devised following consultation with residents. There is a four weekly rotating menu that is changed periodically to reflect seasonal availability. There was good evidence of fresh fruit and vegetables being served on a daily basis. There are good systems in place to ensure that the needs and requirements of residents with specific dietary restrictions can be adequately addressed. This can include medical, religious or cultural dietary needs in addition to specific preferences. As seen, blended meals are served in a way that ensures that the resident can experience the taste of each element of the meal and there was clear evidence that the instruction regarding dietary intake identified in the care plan was carried out by staff. Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 18 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): 16 & 18. Quality in this outcome area is good. Gillibrand Hall has a satisfactory complaints system and adult abuse policy and procedures for the protection of residents. Staff undertake formal adult protection training that further helps to protect residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A detailed complaints procedure was displayed within the home and also included within the written Service Users Guide, an individual copy of which is provided to each resident. This shows that people are given enough information about making a complaint should they wish to do so. All of the completed Commission for Social Care Inspection survey forms from residents and relatives indicated that they would know how to make a complaint, should they wish to do so. Likewise, residents spoken to at the time of the site visit said that they would know what to do if they were not happy about something at the home. A system was in place so that any complaints received are recorded and any recurring patterns identified and regularly monitored. The pre-inspection questionnaire showed that the home had received two complaints since the last inspection, which had been dealt with according to the home’s complaints Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 19 procedure. The Commission for Social Care Inspection has not received any complaints about this service since the last inspection. Policies and procedures were in place at the home in relation to safeguarding adults, which were in accordance with Department of Health guidance, so that people were fully aware of the action to take should an allegation of abuse be reported to the home. The majority of staff have received training in relation to safeguarding adults and the members of staff spoken with confirmed that they had received this training. Staff were aware of what they should do if they had any concerns about the welfare of anyone in their care to ensure that appropriate action would be taken. Further staff training in respect of adult protection has been arranged to take place in the near future. It is important that all staff undertake this training in order to help protect residents living at the home. Residents spoken with said that they felt safe and comfortable living at Gillibrand Hall and got on very well with the staff team. Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 20 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): 19 & 26. Quality in this outcome area is adequate. The standard of décor in this home is mixed and therefore does not always provide residents with an attractive and homely place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Gillibrand Hall is an older listed building set in its own grounds. Consequently the internal rooms including bedroom accommodation vary in size and design. The internal layout of the home provides a safe and pleasant environment for residents to live. However although some bedroom accommodation has been updated and provided with attractive furnishings and décor, some areas of the building are tired looking and in need of refurbishment including a bathroom on the first floor of the building. From discussion with the deputy matron, it was established that there is no shower facility on the first floor but it was hoped that a wet room would be provided to replace the existing bathroom. Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 21 This would provide greater choice and flexibility for residents and upgrade the facilities. It was noted that one bathroom on this floor was lacking a curtain or some other form of window covering. This should be provided to ensure privacy and dignity was respected when people are using the bathroom. It was also noted that some bedroom accommodation on the first floor was not provided with a lockable storage facility for the safe storage of items of a private or personal nature. This should be routinely provided. If there was an instance when it was not considered appropriate for a lockable storage facility to be provided for a particular resident, this should be recorded in the care plan. The specialist unit for people with care needs associated with dementia offers communal facilities that are pleasant and bright. However except for a few pictures on the wall and a music system, there appeared to be little to provide a stimulating and tactile environment for residents to enjoy. It is understood that consideration is being given to providing a sensory room. Whilst it is likely that most residents in the dementia care unit would very much enjoy this facility, the large communal area could be made a more inviting and stimulating environment for people with dementia. People living in this unit do however have a secure environment that they are able to walk round without restriction and also have supervised access to an inner courtyard in nice weather. Unfortunately this inner courtyard is enclosed by the high brick walls of the building and does not enable residents to view the grounds of the building or see people coming and going. It is recommended that an area of the garden be made secure to enable people accommodated in this unit access to the garden areas and a more interesting outside environment. Where bedrooms are shared it is only by agreement and screens are provided for privacy. Residents are given choice to move to a single bedroom when one becomes available. People also have choice of bringing personal items and pieces of furniture into the home to personalise their individual bedroom accommodation and to provide a more homely environment. The company have drawn up a refurbishment plan detailing work to be undertaken and a time scale for completion. Policies and procedures with regard to infection control have recently been reviewed and amended. Some staff have already undertaken infection control training that includes completion of an infection control workbook, however it is understood that all staff will undertake this important training within the next few weeks. Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 22 Laundry facilities are sited in separate building and do not intrude on residents. The laundry assistant spoken with said that there was a good system in place to ensure that items of clothing were washed, dried, ironed and returned to their rightful owner. The person spoken with also confirmed that there was always sufficient equipment and washing detergents etc made available to ensure the laundry was run efficiently. A number of residents and their relatives spoken with individually all commented that they were pleased with the accommodation provided. Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 23 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): 27, 28, 29 & 30. Quality in this outcome area is good. The arrangements for the induction and more advanced National Vocational Qualification (NVQ) training in care are good with staff demonstrating a clear understanding of their roles. The vetting and recruitment practices of the home are good, which helps to protect people who live at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Gillibrand Hall Nursing Home staffing levels and skills mix are determined in accordance with the individually assessed needs of people accommodated. Additional qualified nurses and care staff are on duty at peak times of activity and there are sufficient ‘waking watch’, qualified and care staff on duty at night to ensure the needs of people living at the home are adequately addressed. There is sufficient ancillary staff employed to ensure standards in respect of domestic and catering are maintained. Residents and staff spoken with considered that the level of staffing was sufficient to address individual needs and requirements and this was reflected in the staff rota observed. Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 24 One member of staff spoken with said that, “There are sufficient staff on duty except when somebody phones in sick. The matron tries very hard to get somebody else to come in at these times”. A resident also said that, I have no complaints I get all the help I need and the staff are very good. A relative commented on a Commission for Social Care Inspection survey form “The home is clean and sweet smelling, provides good food and I am happy for my mum to be cared for by them. Mum is happy and content and continues to thrive. She is very well cared for and the senior staff at Gillibrand Hall are very good. All in all, a good result”. There is a clear commitment to the training and development of all staff. It is understood that all newly appointed care staff undertake the ‘Skills for Care’ induction training programme and National Vocational Qualification (NVQ) training is positively encouraged. Currently just over 50 of the care staff team has achieved at minimum a nationally recognised National Vocational Training (NVQ) Level 2 award with several members of staff having achieved this award at a more advanced level. In addition several more members of staff are currently working towards completing this qualification at various levels. The deputy matron is also working toward achieving the registered managers award that is a nationally recognised qualification that managers of care home are expected to have achieved and another member of staff has already completed this course of study. Staff undertake a variety of other training that is appropriate to their role within the home. Although a substantial number of staff have undertaken a short dementia awareness course, it is recommended that all staff who work with people assessed as requiring dementia care, are provide with a more comprehensive and detailed dementia care course. This would provide staff with the level of skills, knowledge and understanding to provide a consistent service that takes in to account the specific requirements of people with dementia. Gillibrand Hall Nursing Home operates a structured recruitment process in order to protect people who live at the home. From observation of four recently appointed staff member’s personnel file, it was evident that the policy and procedures in respect of staff recruitment had been followed, including an application form, health questionnaire, formal interview, references and a Criminal Records Bureau, POVA First clearance had been obtained prior to the applicants actually taking up post at the home. Staff spoken with all felt that the staff group was supportive towards each other with one member of staff saying that she liked the communication and the structure of the management team who were “very approachable and understanding”. Another more recently appointed member of staff said that Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 25 “staff really are kind and caring and don’t lose patience, a good service is provided” Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 26 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): 31, 33, 35, 36 & 38. Quality in this outcome area is good. The registered manager is qualified and well supported by the senior staff in providing clear leadership throughout the home. The home reviews aspects of its performance through a good programme of self-review and consultations, which include seeking the views of, residents, staff and relatives. Systems are in place to ensure as far as possible the health and safety of residents, staff and visitors. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 27 The registered manager at Gillibrand Hall Nursing Home is experienced in managing a care home for older people and is a Registered General Nurse. In addition, the registered manager has obtained a D32/33 trainers award and is currently completing the Registered Managers Award. To further increase and update her skills and knowledge, the registered manager has also undertaken a variety of other recent training that includes adult protection, infection control, manual handling, dementia, and medication courses. Quality assurance and quality monitoring systems are in place in respect of residents, staff, relatives and other people with an interest in the home. Gillibrand Hall is also working towards achieving the ‘Investors In People’ award. Monthly team meetings take place along with the corporate matron’s meetings and heads of department meetings. In addition a monthly visit takes place by an external manager of the company who then writes a report on the conduct of the home. Although meetings for residents has been tried in the past, there was a poor response and this proved to be unsuccessful in finding out the views and opinions of the majority of residents. Current residents prefer one to one discussion with staff or through informal daily dialogue. However the views of residents, relatives and other people with an interest in the home are requested by way of a questionnaire that is provided every six months. Outcomes of the questionnaires are made known to residents and their relatives. The financial interests of people who live at the home are safeguarded by the financial procedures adopted. All residents, wherever possible, are encouraged to remain financially independent or assisted in this task by a family member or external advocate. As observed during the course of the visit, when the home does retain monies or valuables in respect of a resident, this is accurately recorded and secure facilities are provided for the safe keeping of monies and valuables held on behalf of the individual resident. There is a corporate system in place to ensure that all resident financial affairs, where the home is involved, are audited on a regular basis. In the past, formal one to one staff supervision had been allowed to lapse. However this had just been reintroduced and staff spoken with confirmed that they had recently received formal supervision at least once. Staff supervision has been devolved within the staff team and it is recommended that all staff with responsibility to formally supervise other staff be provided with appropriate training. This would enable staff with this responsibility to undertake the task appropriately and not allow the one to one supervision sessions to become a ‘chat’. Formal documented staff supervision should take place at least six times a year and cover at minimum, all aspects of practice, philosophy of care in the home and career development needs. Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 28 Gillibrand Hall Nursing Home has available a variety of policies and procedures to ensure the health, safety and welfare of residents, visitors and members of staff. At the time of the visit various records, maintenance records and certificates relating to equipment and instillations were examined and found to be up to date and in good order. All members of staff receive mandatory health and safety training covering a variety of topics such as manual handling, first aid, fire safety and staff who work in the kitchen have also received food hygiene training. It is recommended however that all staff that is involved in the preparation, cooking, serving food or assisting residents to eat be provided with this training. Likewise, mandatory infection control training should be provided to ensure that the risk of infection is minimised. It is understood that a programme of health and safety training and retraining has been scheduled to take place over the next few months. Environmental risk assessments are in place and the organisation has a designated health and safety manager who advises the home in respect of all aspects of health and safety. Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 29 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 correct information should be incorporated in the Statement of Purpose and Service User Guide even when the information is duplicated in each document. Some of the information provided could be expanded upon. The care plans could be improved by ensuring that when an ‘aim’ is identified, information is provided to detail how the ‘aim is to be achieved. Daily records should be expanded to provide detail of what the individual has done/enjoyed each day in addition to providing medical/personal care information. The medication administration record should be signed immediately after the medication has been administered. Consideration should be given to developing a weekly activities programme that takes into account the individual needs, requirements and capabilities of each resident. All staff should be provided with adult protection training. DS0000025560.V336958.R01.S.doc Version 5.2 Page 31 2 OP7 3 4 5 OP9 OP12 OP18 Gillibrand Hall Nursing Home 6 OP19 7 8 9 OP27 OP31 OP36 10 OP38 The planned refurbishment programme should be completed as detailed. All bathrooms should be provided with appropriate window coverings and all bedroom accommodation should be provided with an appropriate locking facility. The communal environment of the dementia care unit could be improved to provide a more stimulating and tactile environment. Consideration should be given to providing a secure garden area for people living in the dementia care unit. It is recommended that all staff that work in the dementia care unit provided with a more detailed and comprehensive dementia care training programme. The registered manager should complete the Registered Managers Award. Formal one to one staff supervision should take place at least six times a year. It is recommended that staff with responsibility for providing supervision receive adequate training. All staff should receive appropriate health and safety training that is regularly updated. In respect of qualified and care staff this should include manual handling, fire safety, first aid, food hygiene and infection control training. Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Gillibrand Hall Nursing Home DS0000025560.V336958.R01.S.doc Version 5.2 Page 33 - 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. 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