Inspection on 06/03/06 for Girtrell Court

This inspection was carried out on 6th March 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Girtrell Court 28/08/07

Girtrell Court 30/06/06

Girtrell Court 06/12/05

Girtrell Court 14/01/05

Girtrell Court 06/08/04

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

CARE HOME ADULTS 18-65 Girtrell Court 5 Woodpecker Close Saughall Massie Wirral CH49 4QW Lead Inspector Leila Mavropoulou Unannounced Inspection 6th March 2006 02:00 Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 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 Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 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 Adults 18-65. 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. Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Girtrell Court Address 5 Woodpecker Close Saughall Massie Wirral CH49 4QW 0151 605 1806 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) Metropolitan Borough of Wirral Susan Joy Lovato Care Home 20 Category(ies) of Physical disability (20) registration, with number of places Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The matters detailed in the attached schedule of requirements must be completed in the stated timescales. The service should at all times employ a suitably qualified and experienced manager who is registered with the National Care Standards Commission. Date of last inspection 6th December 2005 Brief Description of the Service: Girtrell Court is a care home registered to provide care for twenty service users who have a physical disability. It provides permanent accommodation for fourteen service users and there are six bedrooms, which are used to provide respite care for service users living in the community. The home is a single storey property with ample car parking facilities for visitors and staff at the front of the home and there is a large grassed area to the rear of the property. All service users private accommodation is provided in single bedrooms. There are also a number of communal rooms, which can be used by service users, for a variety of recreational purposes. All parts of the home are easily accessible by wheelchair users and there are many aids and adaptations in the home to meet the needs of service users. In the main, the home is generally well maintained, although some communal area would benefit from refurbishment. The home is staffed twenty - four hours a day with assistance being given to service users in all areas of personal care. Staff in the home support service users to maintain as independent a lifestyle, as possible and to access local community facilities. Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which lasted five hours. During which time the inspector discussed with the manager and member of staff on duty various issues regarding the care provided to the service users. The inspector observed how service users care was provided and interaction with staff. In addition, various service users records and the building were inspected. What the service does well: What has improved since the last inspection? Some staff have been recruited to the vacant care staff posts and the service is now managed by the registered manager of the service. The agency staff at the care home now has meetings with the registered manager of the service to improve communication regarding service users care. One of the service users is moving to a placement, which is more suitable for their needs. Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 Page 6 What they could do better: 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. Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Service users needs are assessed before they are offered a place at the care home to ensure that they have the necessary resources to meet the assessed needs of the service user. EVIDENCE: The Statement of Purpose provides information about all aspects of the service provided at Girtrell Court such as: staffing level, philosophy of care, activities etc. The Statement of Purpose is easy to read. The information contained in the Statement of Purpose enables prospective service users and placing health professional to make an initial decision regarding the suitability of the service. The registered manager would assess the service user needs prior to admission to ensure that the facilities offered are suitable and staff have the necessary skills to meet the service user assessed needs, providing this was a permanent placement. Girtrell Court has for some time only been accepting new service users as emergency respite and planned respite, when the registered manager is unable to make their own assessment. Discussion with the registered manager indicated that the information obtained from the pre-admission assessment, an initial service user plan and risk assessment is developed showing how the assessed needs of the service users would be met. Prospective service users are encouraged to visit the home to meet other service users and staff to get a “feel” for the home. The visits will vary depending on individual needs and preferences. Many of care staff have several years experience of working with people with physical disability. Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 The staff monitor closely the service user health to ensure that appropriate care and support is provided to maintain their health. EVIDENCE: The service users have detailed care plans and risk assessments showing how their assessed needs would be met and how identified risks would be minimised. The service user plans inspected showed that where possible the service user has been consulted about the content of the plan. The plans are reviewed at regular intervals. Discussion with service users and staff showed that service users make decisions over their daily lives, such as recreational activities, going to day centre, personal relationships etc. A record is kept of social activities, which service users participate in. The staff assist service users with their finances where necessary and a record is kept of incoming and outgoing of service users finance. This is audited externally at regular intervals by the Responsible Individual and Wirral Social Services finance department. Staff support service users to take responsible risk assessments and risk assessments are developed to show how the risk would be minimised. The Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 Page 10 service has a missing person policy, which is implemented when there is an unexplained absence of a service user. Service users records are well maintained and kept in a secure place. Staff are aware of the service’s policy on confidentiality of information as it forms part of their induction. Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Staff support service users to engage in activities of their choice and to maintain and develop new skills. EVIDENCE: The service has a fully adapted kitchen, which service users could use to develop practical life skills. Many of service users attend a day centre where they engage in a range of activities and meet others that do not have the same disability. Staff support service users to maintain and develop new skills such as: painting, swimming etc. Girtrell Court is close to local shops, pubs etc. Thus, some service users are able to access these services independently. The staffing level at Girtrell Court allow for staff to accompany service users to community facilities. However, generally these outings have to be planned in advance. Service users access a range of community services and are integrated into all aspects of community life. This is made easy as the service has access to range of transport options such as: taxi, dial a ride etc. Staff would support service users that wish to vote. Discussion with service user confirmed this. Observation of the staffing rota and discussion with staff showed that the staffing level reflect the level of service user activity throughout the day. Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 Page 12 Some entertainment is brought into the home such as: a visiting guitarist on Friday evenings and a Ukrainian Evening was held recently. Some service users recently visited the Floral Pavilion. Discussion with the registered manager and service user file seen showed that service users are supported to maintain and develop personal relationships. The service has an unrestricted visiting policy and service users are able to choose where to see their visitors. Service users bedrooms seen showed that they were well furnished and that most were personalised with service users personal belongings. Observation during the inspection showed that service users are able to choose to be on their own or with company. Service users have easy access to all parts of the building as all of the accommodation is on the ground floor and the building has wide corridors and doors. Observation of staff with service users showed that staff did not interact with service users as much as they could. This was particularly evident during the evening meal. Currently, the service users are not responsible for household tasks due to the level of their disability. On the day of the inspection the kitchen was being deep cleaned and fish and chips bought for tea. The staffing level at teatime was sufficient to provide the appropriate level of assistance for service users. Observation of service users being assisted at this meal showed that service user’s rights to dignity were not being respected as one staff was feeding a service user in a standing position, another service user was being fed and the staff member was eating and speaking to another staff at the same time. Observation of a service user requiring a liquidized meal showed that the staff member went into the kitchen to prepare the meal without using any protective clothing. On this shift there were a significant number of agency staff and one staff spoken to indicated that he was not aware of service user needs. The mealtime was not rushed but it did not promote service users rights and staff did not appear to acknowledge that they were in the service user’s home. Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 The quality of care provided to service could be improved through the employment of permanent staff. EVIDENCE: The service has appropriate aids and equipment to ensure that service users are transferred correctly, with the minimal discomfort and risk to service user and staff. The high level of agency staff used does not guarantee continuity of care to service users even though the registered manager requests that the employment agency send the same staff to Girtrell Court. Observation of service users showed that they are dressed to reflect their taste. All equipment used by service users are assessed by a qualified occupational therapist and where necessary other professional advice is sought to promote the health and safety of service users, such as: speech therapist, GP, continence adviser etc. Service users receive regular health checks from the dentist, optician, chiropodist etc. as evidenced in their personal files and staff would accompany service users to outpatient appointments. The service maintains a record of all service users medication received into the care home, administered and returned to the pharmacist. However, inspection of the controlled drugs showed that they were not accurately recorded. All staff responsible for the administration of medication has received training. Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 Page 14 Information is kept wherever possible on service users wishes if they become terminally ill or dying to promote their rights and choice. Discussion with the manager indicated that service users would be cared for at Girtrell Court as long as the service needs could be met. Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The service has various policies and procedures to protect service users from abuse. EVIDENCE: The service complaints procedure is the same one used by Wirral Social Services. Staff would support service users to make complaints. It is recommended that any concerns raised by service users that a record is kept of all concerns received and what action has been taken to resolve it. The service has a copy of the Wirral Adult Protection Procedure and over the past twelve months on two occasions’ incidents of abuse has been referred to the Wirral Adult Protection team. All permanent staff have received training in managing physical and verbal aggression. Training on abuse is part of all permanent staff core training, which they must complete within a specific time from the date they commence their employment. Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 The service is well suited to meeting the needs of its intended service user group. EVIDENCE: The service is clean and generally well maintained even though some parts of the service such as the communal areas require redecorating to improve the quality of the environment for service users. All parts of the service are easily accessible to wheelchair users. The furnishings are of a good quality, many of which have been specially designed and purchased to meet the needs of individual service users. The rooms at Girtrell Court are bright and all parts of the home used by service users were found to be clean. The corridors and doors are wide to enable wheelchair users to move around independently easily. All accommodation is provided in single bedrooms and is personalised to reflect individual needs such as: tracking hoists, specialist beds, etc. The furnishings in service users bedrooms are of a good quality and service users are able to lock their doors, which staff could override in an emergency. Service users bedrooms have adequate electrical power points for their electrical equipment. All of the small electrical appliances are PAT tested by visual inspection. The service has a number of assisted baths and walk in showers to meet the needs of service users. At the time of the inspection, the two assisted baths Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 Page 17 were serviced and it was recommended that they are replaced within month, as they were scratched. The service has a number of small communal areas, which service users could use. These areas could be used for a variety of purposes. The service has many aids to promote service users independence such as: electric door openings, lower electrical switches, over-head tracking for hoists, etc. all of which are serviced at regular intervals. The service laundry is sited away from the food preparation area. On the day of the inspection there were a number of bags filled with continence pads, which had a malodour. This was because the macerator machined was not working and had not been reported to the manager. In recent weeks, the machine has been repaired. Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35 The service must recruit permanent staff to the vacancies to promote service users wellbeing. EVIDENCE: The staffing levels at Girtrell Court meet the needs of service users. However, this is met mostly by temporary agency staff which does not promote continuity of care to service users. In addition it makes the managing the home very difficult as the manager cannot guarantee the quality of staff provided by the agency nor their experience in working with the service user group, as evident during the care and support provided at tea-time on the day of the inspection. Since, the last inspection the registered manager of Girtrell Court has introduced meetings with the agency staff and a handover from one agency group to another, which is recorded. Most of the permanent staff of Girtrell Court have completed their NVQ level 2 in care. Observation of staff on the day of inspection did not show that they were committed to providing quality care to service users nor did they show understanding of service users needs. The service operates a robust recruitment procedure, which promotes the safety of service users. Since the last inspection the service has had a recruitment campaign and some of the vacancies have been filled with permanent staff. The recruitment campaign is ongoing, to fill all of the vacancies. All staff have a Criminal Records Bureau Check, two written references and are given a terms and conditions of employment before they commence their employment at the care home. Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 Page 19 The manager is now providing group supervision to agency staff every two months. In addition, staff meetings are held monthly and all members of the management team are responsible for supervision of some staff. Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,40,41,42 The service must have a stable staff group to deliver a quality care/support to service users. EVIDENCE: Girtrell Court has an experienced and competent registered manager who has completed her NVQ level 4 in management, and she is also a qualified nurse. Discussion with the registered manager indicated that she has not pursued any training in the last twelve months for a number of reasons. The service quality assurance has not been actively implemented in the last twelve months due to changes and staffing at the care home. This should be reinstated to monitor the quality of care provided to service users. The service has regular monthly visits by the Responsible Person and a copy of their report is forwarded to the Commission. The service policies and procedures are reviewed regularly by Wirral Social Services policy unit and copies of amended policies are forwarded to all of its services. Policies and procedures are amended to reflect changes in legislation and best practices. Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 Page 21 The record keeping at the care home could be improved as staff were unable to locate some information during the inspection and some service users medication records were inaccurate, The service promotes the health and safety of service users by ensuring that all equipment used is serviced regularly and that regular internal checks are carried out such as weekly fire checks. The service maintains a record of all accident/incidents to service users and staff and where necessary the Commission is notified as evidence from regulation 37 notification notices received. The registered person must ensure that the building has a current fire risk assessment and that a risk assessment of the building is carried out and reviewed at regular intervals. Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 2 28 3 29 3 30 2 STAFFING Standard No Score 31 2 32 2 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 2 X 2 3 2 2 X Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 Page 23 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA17 Regulation 12 Requirement The registered person must ensure that service users that service users are supported in a manner, which promotes their respect and dignity. The registered person must ensure that an accurate record is maintained of all service users medication received in to the care home, administered and returned to the pharmacist, The registered person must ensure that all equipment in the care home is in good working order (assisted baths). The registered person must ensure that all equipment is in good working order (macerator for incontinence pads) and that soiled pads are appropriately stored. The registered person must ensure that staff have the necessary knowledge and skills to meet the needs of service users. The registered person must review the impact of the level of agency staff used and its impact on the quality of care provided to DS0000035848.V286115.R01.S.doc Timescale for action 30/04/06 2 YA20 13 30/04/06 3 YA27 23 30/04/06 4 YA30 13 & 23 30/04/06 5 YA31 18 30/04/06 6 YA32 24 30/04/06 Girtrell Court Version 5.1 Page 24 service users. 7 YA37 10 The registered person must ensure that the registered manager undertakes periodic training to maintain their skills and knowledge. The registered person must ensure that all information required to be kept at the care home are well maintained, accessible and accurate. The registered person must ensure that the care home has a current fire risk and building risk assessments. 30/05/06 8 YA41 17 30/04/06 9 YA42 13 30/04/06 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 2 Refer to Standard YA22 YA24 Good Practice Recommendations The registered person should maintain a record of all concerns raised by service users or their representatives. The registered person should plan the redecoration of communal areas of the home, as they are beginning to look worn. Girtrell Court DS0000035848.V286115.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Liverpool Local Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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