Inspection on 21/07/05 for Gittisham Hill House

This inspection was carried out on 21st July 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Gittisham Hill House 08/10/07

Gittisham Hill House 29/08/06

Gittisham Hill House 26/01/06

Gittisham Hill House 01/03/05

Gittisham Hill House 15/07/04

Gittisham Hill House 20/02/04

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

CARE HOMES FOR OLDER PEOPLE Gittisham Hill House Sidmouth Road Honiton Devon EX14 3TY Lead Inspector Vivien Stephens Unannounced 21st July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Gittisham Hill House D54-D06 21940 Gittisham Hill House 227514 050705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Gittisham Hill House Address Sidmouth Road, Honiton, Devon EX14 3TY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01404 42083 01404 549447 Mr John Hale Lewin, Gittisham Care Limited, Broomhill House, Southfield Way, Tiverton, Devon, EX16 5AJ Ms Carol Ann White Care Home 30 Category(ies) of OP - Old Age (30) registration, with number DE(E) - Dementia - over 65 (30) of places Gittisham Hill House D54-D06 21940 Gittisham Hill House 227514 050705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 01/03/2005 Brief Description of the Service: Gittisham Hill House is a Care Home near Honiton, Devon. The Registered Provider is Gittisham Care Limited. The Responsible Individual visits 2 to 3 times a week, and is in almost daily contact. The home consists of two parts, the original country house, and two purpose built extensions now connected by a link corridor. It provides accommodation for 30 older people mostly needing care because of dementia. They are supported by the Alzheimer Society, and are members of the Registered Nursing Homes Association, although they do not provide nursing care. The majority of rooms are single. The accommodation is on two levels, the second being reached by a chair lift. The grounds are spacious and the woodland is attractive. In the grounds are ‘close care’ bungalows not registered with the Commission. Service users have an ongoing programme of activities provided by the staff, and the home is supported by the local primary health care team. Gittisham Hill House D54-D06 21940 Gittisham Hill House 227514 050705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection started at 2.30pm and finished at 5.30pm. Carol White, manager was present, plus her deputy manager and three care staff. At the time of this inspection there were 30 residents accommodated and no vacancies. During the inspection the communal areas were seen, plus a random sample of bedrooms. A random sample of records were seen including care plans and recruitment files. During the inspection ten residents were interviewed plus one person who lives in the close-care bungalows and was visiting the home. Four residents and four relatives/visitors completed comment cards prior to the inspection. A pre-inspection questionnaire was completed and forwarded to the Commission prior to the inspection. What the service does well: The home has very good admission procedures, with careful assessments being carried out to ensure the home is able to meet the needs of any prospective new resident. The care plans are detailed, and provide easy to follow instructions to staff on how the residents want to be cared for. The home has very good relationships with local health professionals and ensures residents’ health needs are fully met. Residents are treated with respect and their privacy is ensured. Residents who are dying are given individual care with sensitivity and respect for their wishes. The home provides an excellent range of activities and leisure facilities. There is a minibus for outings and shopping trips. Relatives and friends are always made welcome. The home encourages friends and family to be involved in all aspects of the daily life at the home, in accordance with the wishes of the residents. Relatives and friends spoke highly of the care provided and the way they are involved and consulted. There are good procedures in place to address any concerns or complaints raised. Staff have received training on the protection of vulnerable adults. Gittisham Hill House D54-D06 21940 Gittisham Hill House 227514 050705 Stage 4.doc Version 1.30 Page 6 The home has been well maintained throughout. All areas were bright, clean, comfortable, and homely. Further improvements are planned in the near future. Staffing levels are satisfactory in relation to the needs of the residents. Residents praised the staff and manager highly for their caring manner. Good recruitment procedures are in place. Staff have received training in a wide range of topics including NVQ’s. The safety of residents and staff is protected by regular safety checks, maintenance of equipment, provision of safety equipment and protective clothing. What has improved since the last inspection? 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. Gittisham Hill House D54-D06 21940 Gittisham Hill House 227514 050705 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Gittisham Hill House D54-D06 21940 Gittisham Hill House 227514 050705 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Good admission procedures are in place to ensure the home can meet the needs of all prospective new residents. EVIDENCE: The home carries out detailed assessments on all prospective new residents. Care plan files sampled during the inspection provided information on all aspects of the care needs of those residents. The prospective resident had been interviewed before admission, and information had also been obtained from other relevant people, including relatives, health and social care professionals. The management and staff are sensitive to the wishes of the resident concerning the information held by the home. They have taken care to maintain confidentiality at all times, including when talking to residents’ families and representatives. Gittisham Hill House D54-D06 21940 Gittisham Hill House 227514 050705 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 10, 11 The home has excellent care plans that ensure staff provide care according to the residents’ wishes. The home ensures residents’ health needs are fully met. Residents are treated with respect and their privacy is ensured. Residents who are dying are given individual care with sensitivity and respect for their wishes. EVIDENCE: The home has detailed care plans, agreed by the residents, and covering all aspects of needs. These are several pages long, and so a top sheet has been drawn up summarising the care needs and giving straightforward instructions to care staff. The care plans cover health needs, and include risk assessments for health related problems. The plans include weight charts, dietary needs, and fluid monitoring charts where relevant. On the day of the inspection two district nurses were visiting the home. They were full of praise for the high standards of care provided at the home, and confirmed that there is good communication between the home and relevant health care professionals. Gittisham Hill House D54-D06 21940 Gittisham Hill House 227514 050705 Stage 4.doc Version 1.30 Page 10 Residents said that they are always treated with the utmost kindness and respect by the staff. Staff were observed knocking on doors, and talking to residents in a helpful, friendly and supportive manner. Residents are able to lock their bedroom doors if they wish. Treatment and examination by health professionals are carried out in the residents’ own room or in the treatment room on the ground floor. The care of residents who are dying was discussed with staff. The care plans set out any special instructions to staff. Doctors and nurses are involved and provide support where needed. The home ensures they are aware of any special wishes relating to death and dying including funeral arrangements. Families are encouraged to visit and stay overnight if they want. If no family or friends are able to sit with the resident a member of staff will sit with them. Gittisham Hill House D54-D06 21940 Gittisham Hill House 227514 050705 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 The home provides an excellent range of activities in order to meet the individual interests and needs of each resident. Relatives and friends are always made welcome. The home encourages friends and family to be involved in all aspects of the daily life at the home, in accordance with the wishes of the residents. Staff provide appropriate help to enable residents to have choice and control over their lives. EVIDENCE: On the day of the inspection there were a number of activities taking place. A member of staff was helping a group of residents with artwork. Some residents were outside in the garden, and others were sitting in their rooms or in the lounge watching television. There were several groups of residents engaged in friendly conversation. Earlier in the day a music and movement session was held. One resident talked about how much he enjoys reading, and said he always has a good supply of books. The previous Sunday the home had a barbeque that was well attended by residents, relatives and friends. On the following Sunday a large notice in the Gittisham Hill House D54-D06 21940 Gittisham Hill House 227514 050705 Stage 4.doc Version 1.30 Page 12 entrance hallway invited residents and relatives to attend one of the regular meetings. An agenda was displayed. Also displayed around the home were notice boards giving a wide range of information about forthcoming activities and events. Residents talked about outings and shopping trips in the minibus. During the inspection staff were seen welcoming visitors to the home. Relatives who responded to questionnaires sent out by the Commission confirmed they are always made welcome and kept well informed. Comments included “We are always made welcome when we visit and can leave knowing that she receives the care needed at all times, which gives me great relief.” Residents talked about how they are able to make choices over all aspects of their daily lives. They talked about the times they choose to get up and go to bed, about where they sit, what they want to do, and where they want to go. The care plans set out exactly how each resident wants to be cared for. Gittisham Hill House D54-D06 21940 Gittisham Hill House 227514 050705 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 The home has good procedures in place to ensure complaints are acted upon appropriately. The home has taken a wide range of actions to ensure residents are protected from abuse. EVIDENCE: The home has a clear complaints procedure. Residents and relatives said they knew how to make a complaint and felt confident any issues would be resolved quickly and fairly. No complaints have been made either to the home or to the Commission in the last year. All staff have received training on the protection of vulnerable adults. The home has detailed policies and procedures in place. These are held in the office, but key policies have also been given to staff in a staff handbook. Gittisham Hill House D54-D06 21940 Gittisham Hill House 227514 050705 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25, 26 The home is comfortable, attractive, spacious and well maintained. Residents have brought furniture, pictures and personal effects in order to make their rooms feel homely. Good measures have been taken to protect residents from harm. A wide range of equipment has been provided to help residents move around the home safely. EVIDENCE: The home is situated just outside Honiton, surrounded by woodland, lawns and well-maintained gardens. In the grounds there are a number of ‘close care’ bungalows, and building works are taking place to provide more ‘close care’ accommodation. The home has three main lounges and two dining rooms. These rooms are used flexibly to provide activity areas, alternative dining space or as quiet sitting areas where residents can entertain visitors if they wish. Gittisham Hill House D54-D06 21940 Gittisham Hill House 227514 050705 Stage 4.doc Version 1.30 Page 15 There are 26 single and two shared bedrooms. 15 bedrooms have en suite facilities. There are three bathrooms with specialist bath hoists, and two shower rooms. A number of bedrooms have been redecorated and refurbished in the last year. A maintenance person is employed and staff said that they note any repairs needed and these are attended to quickly. Residents are able to lock their bedroom doors if they wish. All radiators have been covered to prevent the risk of burns. All hot taps on baths have been fitted with thermostatic valves to prevent scalding. Staff also check and record bath temperatures. Windows on upper floors have been restricted to prevent accidental falls from the windows. In a tour of the home all areas were bright, clean and well maintained. All areas were free from any unpleasant odours. The home has a number of signs to help people with poor memory to find their way around. Some new professionally made signs have recently been purchased. More may be purchased in the future. The home has a wide range of equipment to aid mobility including stair lift, mobile hoists, handrails, and ramped areas. . Gittisham Hill House D54-D06 21940 Gittisham Hill House 227514 050705 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 Staffing levels are satisfactory in relation to the number and needs of the residents. Staff recruitment procedures ensure residents are in safe hands. The home provides a good level of training for the staff in all relevant subjects. EVIDENCE: On the morning of this inspection there was 1 manager plus 5 care staff. In the afternoon there was 1 manager, 1 deputy manager and 3 care staff. During the evenings there are 5 care staff until 7.30pm, 3 care staff until 9pm and then 2 care staff on waking night duties until 7am the next morning. The home also employs a cook until 5pm, 2 domestic staff between 8am and 2pm, an administrator and a maintenance person. Residents, visitors and staff said they felt the staffing levels were satisfactory. There is a staff handover session at 7am, 2pm and 7.30pm. Good written communication methods are also in place. Staff files were seen of the most recently recruited staff. These showed that application forms had been completed, good references obtained, CRB and POVA checks carried out, or, for staff recruited from oversees, Home Office documents were in place. Evidence was seen of good induction procedures. At the time of this inspection a large group of staff, including newly recruited staff, were receiving fire training from a professional specialist trainer. Gittisham Hill House D54-D06 21940 Gittisham Hill House 227514 050705 Stage 4.doc Version 1.30 Page 17 17 care staff are employed. Of these 6 staff hold either NVQ level 2 or 3 and a further 6 staff are in the process of obtaining NVQ’s. Other training has included fractures and falls, dementia, mental health, client handling, challenging behaviour, and health and safety related training. Gittisham Hill House D54-D06 21940 Gittisham Hill House 227514 050705 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 37, 38 The home is well managed. There is an open and friendly atmosphere throughout the home, with a wide range of methods of consulting with all relevant persons. The staff team are well supervised. The manager has a ‘hands on’ approach and leads by good example. Records have been well maintained. Residents and staff are protected by the health and safety practices, procedures and regular safety checks and maintenance. EVIDENCE: Carol White is in the process of obtaining NVQ level 4 and the Registered Managers’ award. Residents and visitors confirmed that there is an open and friendly atmosphere within the home. Many of the residents gave special praise for Carol White and the way the home is managed. Gittisham Hill House D54-D06 21940 Gittisham Hill House 227514 050705 Stage 4.doc Version 1.30 Page 19 The home has various methods of consulting with and seeking the views of residents, staff, relatives and visitors. These include questionnaires, meetings, notice boards, newsletters, and staff supervision. The records seen during this inspection had been well maintained. Information provided before the inspection showed that all safety equipment has been regularly maintained, and health and safety checks are carried out regularly. Gittisham Hill House D54-D06 21940 Gittisham Hill House 227514 050705 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 4 x x x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 x COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 4 x x x 3 3 Gittisham Hill House D54-D06 21940 Gittisham Hill House 227514 050705 Stage 4.doc Version 1.30 Page 21 no 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 Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Gittisham Hill House D54-D06 21940 Gittisham Hill House 227514 050705 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Exeter Office, Suites 1 & 7 Renslade House Bonhay Road EXETER, EX4 3AY 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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