Inspection on 26/01/06 for Gittisham Hill House

This inspection was carried out on 26th January 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 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 21/07/05

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 Inspection 26th January 2006 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Gittisham Hill House DS0000021940.V280366.R02.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 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 DS0000021940.V280366.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Gittisham Hill House Address Sidmouth Road Honiton Devon EX14 3TY 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) 01404 42083 01404 549447 www.tssg.co.uk Gittisham Care Limited Ms Carol Ann White Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30) of places Gittisham Hill House DS0000021940.V280366.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st July 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 DS0000021940.V280366.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection lasted for approximately 6 hours. During the visit discussions took place with six residents, 4 staff and the manager, Carol White. Most of the core standards were covered in the last inspection on 21st July 2005. During this inspection the main focus was on medications, food and finances – these were the standards not covered in the last inspection – plus care planning. What the service does well: What has improved since the last inspection? Good systems are in place to monitor the care needs of the residents, and as a result staffing levels have been increased at certain times of the day, and covering specific care tasks. A second minibus has recently been purchased. This is larger than the first minibus and has enabled the home to provide a much wider range of outings. Gittisham Hill House DS0000021940.V280366.R02.S.doc Version 5.1 Page 6 The decoration, furnishings and fittings are constantly being improved. A former office area has been altered to provide a food preparation area and the kitchen and laundry facilities are due to be upgraded in the very near future. 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 DS0000021940.V280366.R02.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Gittisham Hill House DS0000021940.V280366.R02.S.doc Version 5.1 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 the following standard(s): EVIDENCE: These standards were not covered during this inspection. The home does not provide intermediate care. Gittisham Hill House DS0000021940.V280366.R02.S.doc Version 5.1 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 the following standard(s): 7, 9, The home has good care planning systems in place. These would be further enhanced by greater detail on the summary sheet in those cases where the care needs are complex. There are safe systems of storage and administration of medicines in place. However, greater care should be taken in the recording of medicines administered to reduce the risk of error. EVIDENCE: A sample of care plans were seen during the inspection. Detailed assessments are drawn up on or before admission. From these assessments care plans are drawn up and a top sheet summarises the daily care needs. This sheet provides a clear set of instructions for staff to follow. Where the care needs are complex the top sheets do not always give sufficient detail. Carol White said they are planning to computerise the care planning system and this will allow them to include more information about how the resident wants to be cared for. Gittisham Hill House DS0000021940.V280366.R02.S.doc Version 5.1 Page 10 A member of staff was observed during the midday medicine administration round. The home used a ‘Nomad’ monitored dosage system. The medicines are stored in a locked trolley in a locked cupboard. The senior staff that administer the medications have received instruction from the pharmacist. In addition, those staff who have undertaken NVQ training have been observed by a tutor from East Devon College and certificates have been issued when the tutor was satisfied that they were competent in this task. The home has a secure refrigerator for medicines that must be kept cool. The records for medicines received, administered and returned were generally satisfactory. However, there were a few unexplained gaps. Carol White agreed to follow this up to ensure no errors were made. The home has detailed policies and procedures in place on the administration of medicines. Gittisham Hill House DS0000021940.V280366.R02.S.doc Version 5.1 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 the following standard(s): 12, 13, 15 The home continues to improve the excellent range of activities and outings to suit all interests and needs. Residents are able to keep in touch with friends and family. Excellent transport facilities are provided to enable residents to get out and about in the community. Menus are balanced and varied. The home is constantly improving the standard and range of meals in order to meet all dietary needs. EVIDENCE: The home continues to provide a wide range of activities to suit all interests. Since the last inspection a second minibus has been purchased. This has enabled an even greater range and frequency of outings. Residents talked about how much they enjoy these outings. Other activities provided include individual and group exercise sessions, cooking, arts and crafts, games, and reading. The home has four main lounge/dining room areas plus smaller areas, all of which can be used flexibly to provide lounge, dining and activity rooms. In this way, residents who do not wish to join in with any activity can sit comfortably elsewhere without disturbance. The home also organises regular social events to which friends and families are invited. Gittisham Hill House DS0000021940.V280366.R02.S.doc Version 5.1 Page 12 Residents talked about how the home enables them to visit friends and family. Visitors are always made welcome, although the home discourages visits at meals times if possible. A copy of the regular menus was provided for this inspection. Staff go around to every resident each day to find out their preferences for the midday and evening meals. If they do not like the main meal on offer a suitable alternative is agreed with them. Records showed that a good choice is always offered. The menus are balanced and varied. Fresh fruit and vegetables are used daily. A selection of fresh fruit is available on request and is offered on a daily basis. The cooks are booked to attend courses on nutrition for people with diabetes and dementia in care homes. The kitchen is bright, clean and modern. A previous office space next to the kitchen has recently been altered to provide a food preparation area. Work is to be carried out on the kitchen in the near future to provide even better facilities. Residents said the standard of meals provided is always very good. Gittisham Hill House DS0000021940.V280366.R02.S.doc Version 5.1 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 the following standard(s): EVIDENCE: These standards were not covered during this inspection. Gittisham Hill House DS0000021940.V280366.R02.S.doc Version 5.1 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 the following standard(s): 19, 21 All areas of the home have been maintained to a high standard. Safety is given a high priority. Bedroom doors have suitable locks to ensure privacy and dignity. However, some bathrooms and toilets do not have locks – this is recommended. EVIDENCE: The home employs a maintenance man to ensure that all areas of the home are always in good order. The maintenance man was carrying out health and safety checks at the time of this inspection to ensure all environmental risk assessments are up-to-date and all areas are safe. During this inspection the communal areas were seen plus one bedroom. All areas were bright, modern, attractive and comfortable. There is a regular plan of redecoration and upgrading to ensure standards are always high. At the time of this inspection building works were in process in the grounds to provide further ‘close care’ bungalows. Further improvements are also planned in the Gittisham Hill House DS0000021940.V280366.R02.S.doc Version 5.1 Page 15 near future for the main home including improved laundry and kitchen facilities. All bedroom doors have locks to ensure privacy if required. However, some of the communal toilets did not have suitable locks. Carol White explained that this was because of fears that residents may fall and prevent staff from having quick access. However, after discussion she agreed to provide locks that can be opened quickly from the outside in an emergency. Gittisham Hill House DS0000021940.V280366.R02.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 30 The home provides a very good level of staff to meet all care needs. Staffing levels are constantly monitored and improved. Training of staff is given a high priority. The staff are competent, caring and professional in their manner. EVIDENCE: Staffing levels have been further improved since the last inspection. In the morning there is 1 manager, 1 care manager plus 5 care staff. In the afternoon there is 1 manager, 1 care 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. Carol White said that staffing levels are constantly monitored. They are in the process of recruiting new staff to cover the ‘sundown’ period when some residents may get restless. This will enable staff to devote more individual time to those residents who require assistance during the evenings. At the time of this inspection a tutor from East Devon College was visiting the home. She confirmed that the college has very good links with Gittisham Hill House, and that training is given a high priority by the home. The home provides a wide range of training including NVQ’s, in-house and exterior Gittisham Hill House DS0000021940.V280366.R02.S.doc Version 5.1 Page 17 training courses. Evidence was provided of future training courses booked for 2006 including report writing and record keeping, supervision skills, dementia and dealing with challenging behaviours, elder abuse, care of the dying, plus regular updates of all health and safety related topics. Gittisham Hill House DS0000021940.V280366.R02.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 36 The home has a very good range of methods to ensure the quality of facilities and services are constantly monitored and improved. Excellent systems are in place to ensure financial matters are safeguarded. Staff are well supervised. EVIDENCE: The home continues to use a variety of methods to ensure they are constantly monitoring and improving the standards of facilities and care provided. Methods include questionnaires, meetings, notice boards, newsletters, and staff supervision. Staff interviewed during the inspection said they feel encouraged and enabled to air their views. They talked about regular supervision, staff meetings, daily handover sessions plus informal daily conversations. They said they felt able to voice their opinions and that these Gittisham Hill House DS0000021940.V280366.R02.S.doc Version 5.1 Page 19 are always respected and considered. They also said they felt able to talk to the managers at any time if they have any concerns. The staff said they felt there is a happy atmosphere and good working relationships throughout the home. The home is planning an open day on 19th February where friends and families are invited to visit and talk about all aspects of the home and care provided. In the past they have organised relatives’ meetings but found that by limiting the time to either an evening or an afternoon there has always been a number of relatives who could not attend due to work or home commitments. By widening this to a whole day they are hoping more families will be able to attend. Another improvement recently introduced has been closer links between key workers and families through the use of individual communication books in each resident’s room. This book enables both relatives and key workers to make comments and requests to ensure the residents’ needs are always met. During the inspection records of financial transactions on behalf of residents were checked. The home does not hold cash on behalf of residents. Instead the home has a petty cash float, and all purchases such as toiletries, hairdressing or other personal requirements are paid through the petty cash system. Relatives or representatives are then invoiced once a month. Gittisham Hill House DS0000021940.V280366.R02.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 x 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 x 4 X 2 X X X X x STAFFING Standard No Score 27 4 28 x 29 x 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 4 X 4 4 X X Gittisham Hill House DS0000021940.V280366.R02.S.doc Version 5.1 Page 21 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. 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 2 Refer to Standard OP7 OP9 Good Practice Recommendations Where necessary, the care plan summary sheet should be expanded to ensure staff have comprehensive instructions on how to meet each resident’s care needs. Systems should be put in place to ensure that unexplained gaps in the records of medicines administered are addressed promptly in order to ensure that no mistakes have been made. Suitable locks on toilet and bathrooms doors should be provided to ensure privacy and dignity while at the same time allowing staff to gain access quickly in an emergency. 3 OP21 Gittisham Hill House DS0000021940.V280366.R02.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Exeter 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. Extracts may not be used or reproduced without the express permission of CSCI Gittisham Hill House DS0000021940.V280366.R02.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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