Inspection on 02/06/09 for Gillibrand Hall Nursing Home

This inspection was carried out on 2nd June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gillibrand Hall Nursing Home 11/03/10

Gillibrand Hall Nursing Home 18/01/10

Gillibrand Hall Nursing Home 02/07/07

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 16/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Gillibrand Hall Nursing Home Folly Wood Drive Chorley Lancashire PR7 2FW     The quality rating for this care home is:   one star adequate service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Denise Upton     Date: 0 2 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 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): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Century Healthcare Limited 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 Additional conditions: 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 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-six 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 Care Homes for Older People Page 4 of 36 Brief description of the care home 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. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection focused on outcomes for the people living at the home and involved gathering information about the service from a wide range of sources over a period of time. The unannounced site visit took place during a mid week day and spanned a period of just over ten hours. At the time of the site visit, 46 people were in residence, this included 19 residents in the dementia care unit. Twenty two of the thirty eight standards identified in the National Minimum Standards - Care Homes for Older People were assessed along with a reassessment of the recommendations made at the last key inspection. We (The Care Quality Commission - CQC) spoke with the registered manager, and two nurses that were on duty. In addition, we spoke individually and in private with two Care Homes for Older People Page 6 of 36 residents, one relative and brief general discussion took place with several other residents throughout the course of the day in communal areas of the home. This helped to form an opinion as to whether Gillibrand Hall Nursing Home was meeting the needs and expectations of the people who live there. Information was also gained from the annual quality assurance assessment (AQAA) completed by the registered manager prior to the site visit taking place. This is a self assessment that focuses on how well positive outcomes are being achieved for people using the service. A number of records were viewed and a tour of the building took place looking at communal areas of the home, bathrooms and some individual bedroom accommodation. Time was also spent observing the relationship between staff and residents as they went about the days activities. Details of current fees and what is included in the fees is available from the home. The last key inspection took place in July 2007. In May 2008, an Annual Service Review took place. An annual service review is a report that we write for good or excellent services that have not had a key inspection in that current inspection year. This does not routinely include a visit to the service. The review is an analysis of all the information that we have gathered about the service since the last main inspection. The report relating to this Annual Service Review is held at the CQC office and would be made available on request. What the care home does well: What has improved since the last inspection? What they could do better: People living at the home generally have an individual, written care plan in place. This tells staff what people can do for themselves, what they like and dont like and what help or assistance they may require. On one of the care records looked at, a care plan had not been devised from the pre admission assessment information even though the resident was already living at the home. In consequence, staff did not have the written information they needed to be sure they were meeting the individual needs of this person. The way medication is managed and recorded should be improved. The medication administration record was incomplete and did not always give a clear account of what medication had been administered or refused by a resident. Staff should be more careful to sign, date and countersign any hand written entry in the medication Care Homes for Older People Page 8 of 36 administration record. Staff making the entry need to take ownership of the record and a second person is required to confirm accuracy of the record. This would help to protect people living at the home. The environment in the dementia care unit should be improved to provide a more stimulating and homely place to live. This would help people living in the unit to benefit from a living area that was more suited to their individual needs. 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 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 36 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People moving into the home are given information about the home and have their needs assessed so they will know if their needs can be met there. Evidence: Prospective residents on request, are provided with the written information they need to make an informed choice about whether to live at the home. Since the last inspection, the homes Statement of Purpose and Service User Guide have been updated and amended to make sure that the information provided is accurate and up to date. Once admitted to the home, all residents receive a copy of the Service User Handbook. This incorporates the homes Statement of Purpose and the Service User Guide as well as additional information about the home. This provides residents and their family with comprehensive information about the home and the services and facilities provided. It is understood that this information could be provided in an alternative, more suitable format for a particular resident if required. Care Homes for Older People Page 11 of 36 Evidence: Whilst there is no doubt that the information provided is detailed and comprehensive, for some residents there may be too much information to read through and in consequence some residents may not make themselves aware of the information provided. Consideration could be given to providing a free standing, easy read Service User Guide specifically for residents, to encourage people living at the home to read easily about the services and facilities made available. During the site visit, six people living at the home were case tracked. This is a way of inspecting that helps us to look at services from the point of view of some of the people who use the service. We track peoples care to see whether the service meets their individual needs. All the residents that were case tracked had a pre admission assessment undertaken prior to being admitted to the home. This helps to make sure that residents are only admitted to Gillibrand Hall Nursing Home if their health, personal and social care needs could be met. The pre admission assessment is usually carried by the registered manager or by another senior member of staff who has experience in this area. The information obtained, along with any other relevant assessments conducted by other agencys such as health assessments are taken into account. This collated information, along with any further information provided by family or other advocates, provides the basis of the initial plan of care. All this helps to make sure that as much information as possible is gained in order for the registered manager to make an informed judgment as to whether the home could provide the level of care and support required. In the main, the pre admission assessments that were seen, were generally completed well and provided good, relevant information. However in one instance, the pre admission assessment of a very recently admitted resident was sparse. There was very little information recorded in order to develop a good plan of care. The pre admission assessment also said that this person could communicate well but it was clear that this was not necessarily so at the time of the site visit. It is important that as much information as possible is obtained from as many sources as possible prior to admission. Only then will the management team be in a position to make an informed judgment as to whether the current needs and requirements of a prospective resident could be met at the home. Without good pre admission information and the development of a good care plan, staff are not provided with sufficient direction and guidance in order to provide a person centered service. Care Homes for Older People Page 12 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs were, in the main, being met by staff that respected their privacy and dignity. Evidence: In the main, individual plans of care were in place and five of these were viewed. However in respect of one recently admitted resident there was no actual care plan, staff were relying on the sparse pre admission assessment information and the outcomes of a number of risk assessments that had been completed on admission. Whilst there was no evidence that this persons needs were not being met, given that some pre admission information was available along with outcomes of some risk assessments, there was no reason for a rudimentary care plan not to be in place. An initial care plan should be developed from the pre admission assessment information and further developed over the first few days as new information becomes available. This would support the verbal information sharing about a new resident and ensure that all staff had the same written information about the level of care and support required. Staff had not been provided with this written instruction or guidance, Care Homes for Older People Page 13 of 36 Evidence: consequently there was potential for an inconsistent service to be provided that did not meet this persons needs. There was some inconsistency in the plans of care evidenced. Separate care plans are written for each area of need, such as personal care, mobility and health care. Some of the care plans that were available were in the main, clear and detailed to guide and direct staff. This enabled staff to provide an individualised, person centred service that was delivered in a consistent way. This also helped to make sure that residents were encouraged to do what they could for themselves and promote independence whilst ensuring that all staff were giving the same amount of help when required. However other care plans were less well developed and although full pre admission assessment information was available, some of the information had not been carried forward to the care plan. For example, in respect of one resident, social interests and hobbies were clearly identified on the pre assessment information made available but there was no actual care plan in place to support these interests. Therefore it was difficult to establish whether individual social care needs were being met. For this same person, the pre admission assessment highlighted nutrition as a specific need, a nutritional assessment was in place but there was no actual care plan in place for nutrition. Likewise, with regard to a recently admitted resident, the pre admission assessment identified that this person had periods of confusion but there was no care plan evident in order to advise staff how to help this person during the periods of confusion. In another instance a mood assessment indicated that the resident experienced periods of low mood but again there was no care plan in place to advise staff how to support this person during these periods. This can lead to inconstancies in the way staff interact with this person. Although generally the pre admission assessments seen did identified the individuals social and religious care needs and requirements, often there was no care plan in place in respect of these issues. From the care plans evidenced, there was nothing specifically written about the support that may be required to enable the resident to participate in these activities. It is important that information available from the pre admission assessments are carried forward to the care plan, so that the holistic needs and requirements of each individual resident are known. This would enable staff to support the resident to ensure that social, religious or any cultural needs, as well as personal and health care needs are met when living at the home. A variety of risk assessments, specific to the individual, are undertaken including a nutritional assessment and manual handling assessment. Generally any significant risk assessment outcome is incorporated in the care plan. Action is taken to minimise or eliminate any identified risks. However advice and guidance given to staff in respect of a specific plan of care for one resident was inappropriate and could have put the Care Homes for Older People Page 14 of 36 Evidence: resident and staff at risk. The Company operate a none restraint policy but the care plan advised staff to restrain this resident during specific instances. This could have caused serious harm. For this same resident, a care plan was available with regard to assisting this persons communication and mood but these had not been completed so staff had no written direction on how to address these issues. It was evident that some of the care plans evidenced contained information that did not necessarily fit the heading. Care should be taken to ensure that the information specified on a specific care plan relates to the topic of that care plan and not something that does not apply. In another instance a care plan was evident in respect of challenging behaviour, however the care plan did not advise how staff they were to respond to this and there were no actual strategies in place in order to protect this person. A behaviour chart was in place for this person but nothing had been completed since 09/02/09. There was nothing to suggest that this persons care needs had changed but nor was there any evidence of why the challenging behaviour chart was not been completed. Staff should also be careful in what they write in reports. It was noted that one daily report entry said that one resident was pleasantly confused. There was no indication of what this meant, the term used was subjective and did not provide any relevant information for the rest of the staff team. As previously stated in this report, some of the care plans evidenced did give good information for staff to follow but it is essential that all care plans are of the same good standard in order to make sure that staff have clear and detailed information about the individual care needs and requirements of each resident and to ensure that a person centred service is offered to all residents. Although the two residents spoken with individually could not really remember if they had been involved in the development of their care plan or if they had seen their care plan, a relative spoken with did confirm that she was asked about her husbands care needs and that she has been shown her husbands care plan that had been discussed with her. This relative also said that she had no worries at all about her husbands care needs being well met at the home. Residents and the relative spoken with told us that the health care needs of people living at the home are well met. The relative spoken with explained how her husbands health and well being had improved since living at Gillibrand Hall through the attention he had received from the staff team. An individual record is maintained of all health professional visits for each client. This is good practise and ensures that a good record is kept of health care visits and the frequency of need. The majority of medication is dispensed into blister packs by the pharmacist and stored safely in the home in locked cabinets. The registered manager confirmed that Care Homes for Older People Page 15 of 36 Evidence: only registered nurses have responsibility for the administration and recording of medication at the home. It is understood that all staff with responsibility for the administration and recording of medication are required to undertake a competency assessment on an annual basis. This is to ensure that they remain competent to administer medication. The medication administration records of five people were viewed. A photograph of the person is attached to the individual medication administration record, this is good practice and helps prevent mistakes being made. However some improvement is required particularly when recording medication administered in order to ensure a clear audit trail and for the protection of people living at the home. It was noted that there were many dose omissions without explanation. This suggests that staff are not recording medication administered immediately after the medication has been given. In one instance, although a resident had been prescribed medication on a daily basis, the drug administration record showed that no medication had been administered for a whole day. There was no explanation as to whether this was accurate information or if the medication had been given but not recorded as such. It was also sometimes difficult to differentiate between what was medication that was to be administered at prescribed times and what was medication to be administered when needed. For example, for one resident Ensure had been prescribed, on the medication administration record for this supplement, there were many dose omissions without explanation. There was no indication whether this supplement had been prescribed to be taken daily or when required. The supplement could have been given but not recorded as such. In another instance, the pharmacist label said that two sachets of a particular medication was to be given daily. This medication appeared to have been given when required. It is important in order to keep people safe, that their medication is given as prescribed. If the dose or frequency of a particular medication as prescribed by the residents G.P. is no longer required, this should be discussed with the G.P. It is also recommended that individual protocols are developed for when required medication is prescribed. This would advise staff under what circumstances it would be appropriate to give this medication to ensure consistency of use. It was noted that hand written entries on the drug administration record had not been countersigned or dated. It is strongly recommended that whenever a hand written entry is required on the drug administration record, as well as this being signed and dated by the person making the recording, a second member of staff should check the entry and countersign to confirm accuracy of the recording. This should be the exact replica of the pharmacist label. This would help to keep people safe. Discussion with two residents and a relative confirmed that the maintenance of residents privacy and dignity is upheld at all times. The relative spoken with gave a Care Homes for Older People Page 16 of 36 Evidence: good account of the way staff had been careful to maintain her husbands privacy and dignity and said that staff were also respectful towards her husband and herself. There were no concerns at all about these important matters and the relative felt confident that this would continue to be the case. Policies and procedures are in place that guide staff to ensure residents privacy and dignity is respected at all times. These important topics also form part of the National Vocational Qualification (NVQ) training that has been undertaken by the majority of staff. The preferred term of address of each resident is identified at the time of admission and always respected. Care Homes for Older People Page 17 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities are made available for people living at the home. This means that residents have opportunity to participate in activities suited to their needs and capabilities. Evidence: The company has a designated activities co-coordinator with responsibility for ensuring that a range of activities are made available suitable to meet the needs of residents. This includes, a weekly bake and share day, an exercise class, a hairdressing and pamper day, bingo and a reminiscence quiz. There is also a weekly visit by a Aromatherapist that is very much enjoyed by some residents and a PAT dog regularly visits the home with its owner so that residents can enjoy spending time with a dog when living at Gillibrand Hall. Some residents enjoy card making and two social work students currently working at the home have devised word searches and crosswords using staff and residents names and information about Gillibrand Hall. This has proved popular. Occasionally an outside entertainer visits the home and residents are able to enjoy outings to various places of interest by using the Companys mini bus. There are some additional activities provided in the dementia care unit. This is to make sure that people are provided with activities that meet their particular social care needs and Care Homes for Older People Page 18 of 36 Evidence: requirements. A sensory room is provided that was seen to be well used during the course of the visit. A sensory ball, paints and a parachute game have also proved popular that also helps to improve hand to eye coordination. Whilst this offers a range of activities for residents to enjoy, as there were very few individual social care plans available, it was not possible to establish if the identified, individual social care interests identified during the pre admission process were being carried through and provided for. It is important that identified social care needs are given as much importance as other care needs so that the expectations of residents can be met. Recently the Company has installed digital television. This means that each television in the home whether in a communal area of the home or in individual bedroom accommodation, can access at least 12 different television channels. This has increase the range of programmes available so that residents can watch more television programmes that they enjoy. In order to help meet residents religious needs, there is at minimum, a monthly visit from a minister of the church to conduct a service for residents that wish to participate. A lay person from the local Catholic Church also visits on a regular basis to offer Mass and additional visits can be requested at any time of the residents choice. There have also been occasional visits from the local school and Brownies to entertain residents, especially over the Christmas period. People living at Gillibrand Hall are encouraged to maintain contact with their family, so that they can continue to be part of family life. As seen at the time of the visit, visitors are made welcome at any reasonable time and residents can entertain their guests in a communal area of the home, the garden areas or in the privacy of their individual bedroom accommodation. There appeared to be a good, comfortable relationship between relatives and staff with one relative saying, To be truthful the staff have a heart of gold, they are very easy to talk to and they are looking after me as well, great they are. People living at the home are supported to make decisions about their day-to-day lives, such as when to go to bed, when to get up and how to spend their time. Wherever possible residents are encouraged to become involved in choosing the decoration for their own bedroom and encouraged to personalise this personal space with their own important things. Individuals are also supported to manage their own financial affairs for as long as they are able and wish to do so. For some people however, a family member or other advocate takes on this responsibility. Details of advocacy services are also made available for residents and their family to access if and when they choose. Care Homes for Older People Page 19 of 36 Evidence: Residents spoken with said they were happy with the meals provided. The main two hot course meal is at lunchtime, there is a choice of menu and the main meals served on the day of the site visit were nutritious and tasty. Breakfast is at a flexible time to suit the requirements of each resident and the tea time meal also offers a choice of usually a hot choice or salad, soup, sandwiches and then cakes and puddings. Fresh fruit is available at all times including meal times and is usually also on the trolley with the mid morning and mid afternoon drink. There is a four week rotating menu that is reviewed in consultation with residents to reflect seasonal changes. Some residents choose to eat their meals in their individual bedroom accommodation and this is supported. Drinks are always available on request and during the warmer weather, residents are encouraged to drink juice throughout the day. Jugs of juice were seen in some of the communal areas of the home for residents to help themselves to. A number of residents require a soft meal for ease of eating, this is done in such a way as to enable the resident to taste each element of the meal. As observed, staff assist residents at mealtimes discretely to maintain the dignity of the person. Two residents are diabetic and their menu is determined by this. A number of residents are prescribed a nutritional supplement to supplement their normal diet. Specialist diets in respect of medical, religious or cultural requirements can be provided if required. Care Homes for Older People Page 20 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints policy and adult protection policy in place. This, along with staff training helps to protect residents. Evidence: Gillibrand Hall Nursing Home has the company complaint policy and procedures in place, which includes details that any complaint would be responded to within a maximum of 28 days. From information in the Annual Quality Assurance Assessment (AQAA) completed by the deputy manager prior to the site visit taking place, no complaints have been received by the home in the last twelve months. The Care Quality Commission (CQC) has also received no complaints during the same time period. It is understood that a record of any complaint would be kept that included details of any action/investigation taken. Written details of the complaint procedure are also incorporated in the Service User Guide, a copy of which is provided to each resident. This shows that complaints are taken seriously and would be acted upon to improve the service. The residents spoken with could not remember if they had seen the complaint procedure, however they did say that they would talk with staff if they were unhappy about anything. The relative however was very clear that she would speak with the Matron but went on to say that she never had any concerns and was very pleased with the home. A variety of policies and procedures continue to be in place for the protection of Care Homes for Older People Page 21 of 36 Evidence: residents. This includes an adult protection policy and procedure and a whistle blowing policy to help protect people living at the home from abuse or discrimination. Except for very recently employed care staff, all staff have received mandatory training regarding protection and abuse. The remaining care staff will be provided with this important training in the near future. Care staff also receive guidance in respect of adult protection as part of their National Vocational Qualification training (NVQ). Opportunity is also provided for this topic to be discussion during one to one supervision and at team meetings. This helps to remind staff of the importance of protecting residents and the responsibility of the staff group in this matter. The recently introduced legal requirement for care homes to apply the guidance regarding the deprivation of liberty is being addressed at Gillibrand Hall. The registered manager attended a course regarding the recently introduced Mental Capacity Act deprivation of liberty safeguards. A screening checklist is now in place for each person living at the home that lacks capacity to make a decision about the arrangements being made for them to receive the care and support they need that is in their best interests. Some of the completed deprivation of liberty checklists were seen on some of the care records evidenced. It is understood that the qualified staff at the home have all now received this cascaded training and care staff working at the home have been made aware of the requirements of the new legislation. Care Homes for Older People Page 22 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A clean, pleasant and comfortable environment is provided for those people living at the home. However some parts of the building require redecoration. Evidence: Gillibrand Hall is an older listed building set in its own grounds. In consequence the internal rooms, including bedroom accommodation vary in size and design. Since the last key inspection, a sensory room has been provided in the dementia care unit. This is now a well used resource. The dementia care unit is situated on the upper floor and although light and airy there is one large lounge area with an open dining area to the side and a smaller room that at the time of the site visit was provided with two dining tables, chairs and housed the medication trolley. This room seemed to be under used by residents and could have been make more interesting and inviting for resident to enjoy a quiet place and take themselves away from the main lounge. The main lounge area could also have been made more attractive and homely. Chairs were placed around the walls, this did not aid conversation or interaction and created an institutional feel rather than a homely environment. Consideration should be given to creating a more domestic type of environment such as chairs being placed in small groups so that residents that enjoyed each others company could spend time together without the feeling of being constantly in a group. Although some limited artwork had been made to improve the bare walls in the main lounge, this is an area that should be Care Homes for Older People Page 23 of 36 Evidence: further developed to provided a tactile and more stimulating environment for the people living there. The corridors in the dementia care unit were also bland and again there was sufficient wall space to create an imaginative, tactile and stimulating area for residents to enjoy. There is an on-going programme of refurbishment and renewal to the physical environment of the home. Along with the sensory room, a wet room has been provided, replacement windows have been fitted to bedrooms on one of the corridors. This has made the bedrooms warmer and more comfortable. Since the last inspection, some bedrooms have been refurbished with new furniture, new carpet, bed throws and curtains. This has helped to improved the internal living environment. It was noted however that in some of the bedrooms in the dementia care unit, the furniture needed replacing to provide a more modern and attractive environment. The majority of bedrooms are for single occupancy, some of which are provided with an en-suite facility. The registered manager confirmed that all bedrooms are provided with a lockable area where the individual resident can store personal items. Locks are provided on individual bedrooms doors with the resident retaining the key within a risk assessment framework. However it was noted that bedrooms on the dementia care unit had the bedroom door locked by staff. Although the registered manager said that a risk assessment was always in place to determine if a resident could hold a key to their bedroom safely, no actual risk assessment in respect of this matter were seen in the care records of the people case tracked living in the unit. Care must be taken to make sure that people are not deprived of their liberty or restrained from using their own bedroom accommodation without good cause. Outcomes of the methods used to determine this should be clearly recorded. There are sufficient communal toilets and bathrooms, including a bathroom housing a specialist parker bath to meets the needs of residents accommodated. It is understood that one of the bathrooms on the ground floor of the building is to be made into another wet room. This bathroom should however be provided with a suitable window covering to protect the privacy and dignity of people using the room. There are also plans to have a new heating system fitted and the extensive grounds and car park are to be further developed. On the ground floor of the building there are two separate lounges, a dining room, the kitchen and laundry, along with further bedroom accommodation. Generally the accommodation seen on the ground floor was comfortable, clean and cosy. However like the dementia care accommodation, the corridors would benefit from some redecoration and repainting. It is understood that this is already planned. Care Homes for Older People Page 24 of 36 Evidence: At the time of the site visit some residents and their guests were sitting out in the sunshine at the front of the building. This area provides a peaceful environment with lawns, trees and flowerbeds and a gazebo. There is also an internal courtyard that is provided with seating, tables, plants and trees for residents to enjoy. This is now a more attractive place for residents to spend time. There are a variety of policies and procedures to advise staff in the control of infection. However information in the AQAA indicated that not all staff have been provided with infection control training. This should be provided to make sure that all staff are aware of how to prevent cross infection. Laundry facilities are sited in a separate designated building and do not intrude on residents. The industrial washing machines have the capacity to meet disinfectant standards and floor and wall finishes are easily cleanable. The registered manager explained that there is a good system in place to ensure that residents freshly laundered clothes are returned to them. The relative spoken with spoke highly of the laundry service and said that her husbands laundry was always returned to him and that the laundry assistant was a lot better than me at laundry. Care Homes for Older People Page 25 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people that live at the home are supported by well trained, staff who have in the main, gone through a thorough recruitment process, so their needs are met and they are safe from possible harm or poor practice. Evidence: Staffing levels at Gillibrand Hall are determined by the assessed needs of residents accommodated. Registered nurses are employed at the home as well a care staff. Additional qualified and care staff are on duty during busy periods of the day and there are sufficient waking watch qualified and care staff on duty during the night time period to ensure that the assessed needs of people living at the home are met. There are sufficient ancillary staff employed to ensure standards in respect of maintenance of the building, domestic tasks and catering arrangements are maintained. Observation confirmed that current staffing levels appeared to be appropriate in meeting the needs and requirements of current residents. Staff were able to spend some time talking with residents and the atmosphere was relaxed and comfortable. The registered manager confirmed that although there were sufficient staff on duty during each shift period to addressed residents assessed needs, staffing arrangements are kept under review. It is understood that at present there is only one registered mental health nurse employed at the home that has the experience and training to provide good, holistic Care Homes for Older People Page 26 of 36 Evidence: dementia care and guide staff in best practice. It is important that people in the dementia care unit are supported by a staff team that has specific skills and knowledge to provide good dementia care that is put into practice in order to provide a positive experience for people living in the unit. From discussion with the registered manager it is understood that all designated staff working in the unit are to receive new, more indepth dementia care training. This will help to equip staff with the skills to provided a good person centred service. Recently some designated staff have been assigned to work in the dementia care unit in order to provide a more consistent service. This is good practice and helps residents to be assisted and supported by a small number of staff who enjoy working with people with dementia. Consideration could be given to employing other nurses who are experienced in providing good dementia care so that the staff team working in that unit are encouraged and well supported to provided a consistently good service. From discussion with the registered manager and information in the AQAA, there is a good commitment to National Vocational Qualification (NVQ) training. This has resulted in the majority of care staff having achieved at minimum an NVQ level 2 in care or are currently in the process of undertaking this award. Some of the newer members of the care staff team are waiting for a date to be confirmed to commence this training. Several members of the care staff team have also gained a higher NVQ level 3 qualification and one member of the team is hoping to commence a level 4 management qualification award. There is an expectation that all care staff will achieve an NVQ qualification and this is to be commended. This means that residents will be supported by well trained care staff team that have had their competency assessed. From discussion with the registered manager, it is understood that any newly appointed members of the care staff team are routinely provided with nationally recognised Skills for Care induction training. This makes sure that newly appointed care staff have the basic skills and understanding to ensure that they are competent to provided an appropriate level of care and support. A care supervisor has specific responsibility for providing induction training and to ensure that workbooks are completed on time. Century Healthcare, the company that owns Gillibrand Hall has a structured recruitment policy and procedure in place for the employment of new staff. This helps to protect residents and to ensure that only suitable people are employed at the home. The staff files of four members of staff working at Gillibrand Hall were viewed, two of which were of staff that had been recently appointed. In the main, this included an application form, two references including one from the previous employer, a criminal records bureau disclosure and a check against the nationally held list of people have been deemed unsuitable to work with vulnerable people. Copies of certificates relating Care Homes for Older People Page 27 of 36 Evidence: to training completed with their previous employer were also available. However on one of the staff files observed only one reference was available, it appeared that a second reference had not been received even though the member of staff was working at the home. Since the site visit, the company has taken steps to make sure that this does not happen again. In addition, the managers of all the nursing homes in the group have been requested to check all staff files to make sure that no more mistakes had been made in the recruitment process. This appeared to be an isolated over site in an otherwise good recruitment process. Comments about the staff team and the level of care and support provided were all very positive. One person described the staff as, Smashing and the relative spoken with said she was, Very pleased with the home 100 . I am not just saying that, I really mean it. The same person went on to say that her husband was well cared for, she was always made welcome when visiting, her husband was happy and that she didnt need to worry. Care Homes for Older People Page 28 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed with systems, policies and procedures in place to ensure the health and safety of people living there are promoted and protected. Evidence: The Matron at the home, who is also the registered manager, is a qualified nurse, is experienced in running the home and has now successfully completed the Registered Managers Award. This is a qualification that all managers of care homes are expected to achieve to ensure they have the skills to manage the care home in the best interests of the residents. This is a home where the management and staff teams support each other for the benefit of residents accommodated. There are clear lines of accountability within the home and external management. Members of the senior management team visit the home on regular basis to audit records and to speak with residents and staff. This helps the senior management team to make a judgement as to whether the home is well managed and whether the care and support provided by staff at the home is meeting the needs of the people that live there. Care Homes for Older People Page 29 of 36 Evidence: Internal quality monitoring is considered important by the company and there are a variety of systems in place to make sure that the views and opinions of residents, their relatives, the staff team and other interested individuals are known. Corporate surveys are randomly sent out to a number of people including residents, relatives and other interested people on a six monthly basis. It is understood that generally there is a good responce. Comments are evaluated and a report published of the outcome of the surveys including areas for improvement. The report is provided to the homes manager and the senior management team monitors improvements. Although there is a system for staff to be informed of the result of the surveys at planned staff meetings, it is understood that there is no formal way that residents are informed of the outcomes and planned activity to improve standards even though they contributed some of the collated information. Consideration could be given to developing a system whereby all those that contributed to the findings were made aware of the outcome. Resident meeting have been arranged but did not prove successful. Likewise relative meetings were also arranged but these were not well attended. Residents and relatives appear to prefer to speak individually to a member of staff rather than speak in a more formal meeting. There is an development plan for the home that is updated annually and the home has also successfully maintained the Investors in People award (an external quality assurance monitoring organisation) demonstrating that there is a commitment to have the quality of care provided, assessed both internally and externally. Some residents also enjoy frequent daily dialogue with members of staff. This helps residents to say what they think about any aspect of their life at the home, at a time of their choice without waiting, so that any matters could be immediately addressed. People living at the home are encouraged to remain financially independent or are assisted in this task by a relative or other advocate. However where the home do retain monies for some people, a robust system is in place to protect the interests of residents. This includes clear and accurate records of any financial transactions undertaken, secure facilities to hold monies and regular financial audits in order to protect residents interests. The company has in place an appropriate staff supervision policy and procedures. Although some one to one staff supervision is taking place that could be evidenced from supervision records, this is patchy and staff are currently not being provided with the level of one to one supervision recommended. It is understood that either the registered manager or deputy manager currently have responsibility for the one to one supervision of staff and that guidance is available in order to be competent in Care Homes for Older People Page 30 of 36 Evidence: providing one to one supervision. Regular staff supervision can help to ensure that any performance issues are addressed and that staff receive clear leadership from the management team at the home. The home has a written statement of the policy, organisation and arrangements for maintaining safe working practices. Records relating to health and safety were seen. Records showed that equipment such as manual handling equipment and fire equipment are regularly serviced and that electrical installation and electrical equipment are also checked. The maintenance person has responsibility for undertaking a variety of weekly tests including fire alarm testing and water quality including the temperature of the hot water delivered from hot water outlets in resident accommodation. This helps to protect residents and prevent any accidental scalds. A variety of environmental risk assessment covering all areas of the home were evidenced. This helps to ensure a safe environment is maintained. All staff receive mandatory health and safety training including, fire safety training, first aid training and moving and handling training. Some staff have also undertaken food hygiene training including domestic staff. However it is recommended that all staff that prepare, cook or serve food or assist residents to eat their meal, be provided with this important training. The AQAA indicated that not all staff have received infection control training and this should be provided in order to help prevent the risk of cross infection. Manual handling training is briefly spoken about during induction training however newly appointed staff are not allowed to move people or use the manual handling equipment until they have received their formal manual handling training and deemed to be competent. This annual training is provided twice a year to make sure that all staff employed at the home receive this important training. All these checks, along side the training that staff receive, help to protect people living at the home, staff and visitors. Care Homes for Older People Page 31 of 36 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 36 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, Care Homes 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 1 7 15 All residents must have an 01/07/2009 up to date and accurate care plan in place. This would make sure that staff had clear, written guidance on how to meet the needs and requirements of each individual resident. People should not take up employment at the home until all the required clearances and references have been received and deemed to be satisfactory. This would help to protect people living at the home. 01/07/2009 2 36 18 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 1 Consideration could be given to producing a free standing, easy read Service User Guide specifically for residents. This would help to make it easier for newly admitted residents Page 33 of 36 Care Homes for Older People to find and read important information about the home. 2 3 The written pre admission assessment for all prospective residents should be sufficiently detailed in order to make an informed judgment as to whether the home could meet the assessed needs of that person and also to provide relevant information for the development of a good, holistic plan of care. The information on an individual care plan should only be about the particular topic of that care plan. It is important that staff can easily find relevant information at the place expected. Records completed by staff should be clear and prescise and explain exactly what is meant. Subjective terms should not be used. All relevant pre admission assessment information should be carried through to a care plan. This includes religious, social and cultural care requirements as well as health and physical care needs. All care plans should contain accurate information. Staff should be clearly made aware of the Companys no restraint policy. All hand written entries in the drug administration record should be signed and dated by the person making the entry and countersigned by a second member of staff to confirm accuracy of the recording. All staff with responsibility for the administration and recording of medication should sign the drug administration record immediately after the medication has been administered. There should be no dose ommissions without explaination. The drug administration record should clearly record if a medication is for when required use. Individual protocols should be introduced for when required medication is prescribed. This would advise staff of under what circumstances the medication should be given to ensure consistency of use. Medication not for when required use should be administered as prescribed. An individual care plan should be developed to address the social care needs of each resident. This information should then be used to further develop the social care programme so that the social care needs and expectations of people living at the home are met. A clear risk assessment should always be in place to determine if a resident is capable of holding a key to their bedroom accommodation. Care must be taken not to 3 7 4 7 5 7 6 7 7 9 8 9 9 9 10 12 11 19 Care Homes for Older People Page 34 of 36 restrict peoples liberty to use their individual bedroom accommodation without good cause. Methods used to determined this should be clearly recorded. 12 19 The ground floor bathroom should be provided with an appropriate window covering to protect the privacy and dignity of people using the facility. The refurbishment and redecoration programme should continue until all accommodation at the home is of the same standard. Thought should be given to the available accommodation in the dementia care unit to make this area more domestic in charactor, while providing a stimulating and tacktile environment suited to the specific needs of the people accommodated there and a quiter area where residents can remove themselves from the main group. All staff that have not done so and require infection control training should be provided with this important training. This would ensure that all staff are aware of how to prevent cross infection for the protection of residents accommodated. Consideration could be given to developing a system whereby residents, relatives and any other people that completed a survey can be informed of the outcome of the bi-annual internal quality monitoring surveys. Formal one to one staff supervision should take place at least six times a year and cover at minimum, all aspects of practice, philosophy of care at the home and career development needs. All staff that prepare, cook or service food or assist a resident to eat their meal should be provided with food hygiene training. 13 19 14 19 15 26 16 33 17 36 18 38 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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