Inspection on 29/08/06 for Gittisham Hill House

This inspection was carried out on 29th August 2006.

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 26/01/06

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 Key Unannounced Inspection 29th August 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.V307488.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 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 gittishamcare@aol.com 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.V307488.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th January 2006 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 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. Basic fees range from £380 to £600 per week. Copies of inspection reports will be available in the home on request. Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection began at 11 am and finished at 6.30pm and was carried out by two inspectors. Several weeks before the inspection a questionnaire was completed by the home and forwarded to the Commission. Survey forms completed by 22 residents, 23 relatives and visitors and 11 care staff. During the visit four residents were case tracked. This process involved meeting the residents and checking their care plans and all records relating to them including daily reports, accident reports, health records, and administration of medicines. Records required by legislation were inspected. A tour of the home was conducted and discussions were held with residents, staff and managers. What the service does well: Residents and their relatives expressed complete satisfaction in the way information is shared before admission. Good written information about the home is provided. Assessments are carried out by the home. Prospective new residents and their relatives or representatives are encouraged to visit and get to know the home before any decision is made to move in. The overall level of information contained in the care plans is excellent although some adjustments are recommended. The health care needs of the residents have been very well met. Attention to personal hygiene needs and assistance with skin care and continence is excellent. Good systems are in place for the safe administration of medicines. Medicines are stored securely. Records of medicines administered have been well maintained. Staff have received suitable training in medicine administration. The home provides a very good range of activities to suit most interests and abilities. There is a fortnightly programme including regular outings, entertainments, art, crafts and games. Residents are regularly consulted to ensure the range of activities is suitable. Families and friends consulted during this inspection were generally full of praise for the home and the way they are welcomed and involved in the home. Comments include – “I am very pleased with the standard of care that my Mum receives at Gittisham, which is all down to the hard work and dedication of the manager Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 Page 6 and her team. It has a lovely, homely atmosphere and Mum is very happy there.” “I have nothing but praise for Gittisham – the staff are lovely, caring and cheerful. The matron and assistant matron always keep me informed and they have nursed my Mum back to health after a disastrous stay in hospital.” “I feel this home is very clean, friendly and has a happy atmosphere whenever I visit. I should imagine it is very well run.” There was good evidence during the inspection of how the home ensures residents are able to make decisions and choices in all aspects of their daily lives. Privacy and dignity is respected. The standard of food provided is excellent. The cooks take a pride in providing wholesome and tasty meals to suit all tastes and dietary needs. Residents were full of praise for the meals provided. Good systems are in place to ensure that complaints, concerns and comments are acted upon openly, promptly and fairly. Staff have received training on the protection of vulnerable adults. A range of good policies and procedures are in place to ensure residents are protected. Residents’ finances are safeguarded by good procedures. The home is situated in a lovely woodland area just outside of Honiton. The property has been maintained, decorated and furnished to a high standard throughout. The home is spacious bright, clean and homely. Residents’ bedrooms have been individually decorated and furnished to a high standard. Staffing levels are sufficient to meet the needs of the residents. Recruitment files seen during the inspection showed that new staff have been carefully vetted before they have been confirmed in post. Training has been given a high priority. Training has been provided in a wide range of health and safety and care topics, including NVQs. (These are nationally recognised qualifications) Comments received from residents, staff and visitors showed that the home is well managed. There are good systems in place to constantly check the quality of the services and facilities and make improvements where necessary. What has improved since the last inspection? Care plans have been improved to provide greater detail about how residents were to be assisted by staff throughout the day. Records of medicines administered by the home have improved to ensure that there are no unexplained gaps in the records. Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 Page 7 Suitable locks have been provided on toilet and bathroom doors to ensure residents have complete privacy. 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.V307488.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5, “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” The home has good admission and assessment procedures in place, ensuring that residents are able to make an informed choice about where they want to live. However, the initial assessment form could be expanded to cover all areas in NMS3. EVIDENCE: During the inspection residents and staff talked about the process of admission into the home. Prospective new residents and their families or friends are encouraged to visit the home and have a look around. Written information about the home is given to the prospective resident and/or their representatives. Assessments by social services and/or health professionals help to form the initial assessment (where these have been carried out). The Manager or Deputy Manager will visit the prospective new resident to carry out an assessment and, where appropriate, they will also liaise with the next of kin or the person’s chosen representative. With this information the home assesses Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 Page 10 whether they can meet the person’s needs. The inspectors looked at some of the written assessments completed by the home. Where assessments have been received from health and social services there was good evidence that all areas of need had been covered. Where there is no information provided by health or social services, the home has a form that provides a short summary of most areas of needs. It was recommended that this form is expanded to ensure it covers all areas in National Minimum Standard 3. – for example, foot care. It was also recommended that information gathered during the assessment is used to form an initial agreement with the resident (and, where appropriate, their chosen representative) about the level of care that is to be provided. (For example – the number of baths or showers each week that will be provided). Residents expressed satisfaction with the admission process to the home. Comments included “I came and had a look around. I feel it is the right place for me because I am happy here.” “We visited, met the manager, who showed us round. Impressed by clean, bright presentation of the house and friendly atmosphere”. “Everything is alright. My family and I chose this home for me. And I made the right decision. This is the best place for me”. The home does not provide intermediate care. Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 Page 11 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, 8, 9, 10 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” The overall level of information contained in the care plans is excellent although some adjustments are recommended. The health care needs of the residents are generally well met. Some improvements are needed in the recording of some evidence. Residents are safeguarded by good methods of administration and recording of medicines. Some recommendations have been made to provide further safeguards. Residents are treated with dignity and their privacy is respected. EVIDENCE: Care plans seen during the inspection showed that, after the first few weeks of settling into the home, the care needs are reviewed and a more comprehensive care plan is drawn up. The plans provided good information to staff about how the residents wanted to be cared for, and about their chosen daily routines. Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 Page 12 They include details about what time the resident wants to get up and go to bed, how they want to be guided and assisted with personal care tasks, and information about their social needs and the activities they like to participate in each day. Some recommendations were made that the care plans include additional detailed information about the care and health needs, for example, skin care and continence care. This will enable staff to have easy access to up-to-date information and progress of any treatment. It was also recommended that where the resident has chosen a relative or friend to act as their representative, there is clear evidence to show that they have been involved in the drawing up and agreement of the care plan. Comments received from relatives/representatives who completed survey forms prior to the inspection indicated that the majority were satisfied with the level of communication within the home. Others suggested this could be improved. Daily reports have been completed by staff. These show that care plans have been followed and give good information about daily events. The home also keeps good daily records of information given to staff at handover sessions between shifts. The care plans include details of nutritional needs. Weight is monitored regularly to ensure that residents are receiving a diet that meets their individual needs. During the inspection a District Nurse who was visiting the home was interviewed. She praised the home highly for the level of care provided to each resident. She felt that the staff are competent and well trained and are able to identify any potential health problems promptly. She praised their observation of potential skin care problems and talked about how they request advice and treatment immediately they notice any changes to the skin. She also praised the way the home follows the instructions of the health care professionals. During the day a GP also visited the home. Comments received from residents and their relatives about the level of medical support provided include – “The staff call the doctor when they think I need to see him or when I ask to see him”. “Appears to be good, with doctor available frequently, and also district nurse, as well as the care staff”. “They call the doctor when needed especially recently when I was a bit poorly and had blood tests etc”. Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 Page 13 “I see Dr when I need him”. Records of medicine administration were seen. The home uses a weekly monitored dosage system known as a ‘Nomad’ system. Staff have received training on the safe administration of medicines. GP’s have carried out annual medicine reviews. Records have been well maintained. The procedures followed by the home were found to be satisfactory, but the following recommendations were made in order to provide additional safeguards – - The home should see the repeat prescription scripts before they are sent to the pharmacist in order to check accuracy. - The home should maintain a record of medicines received in to the home - The home should record when creams and lotions are opened. Alternatively they should record the date the creams should be discarded after opening (This will ensure to ensure maximum efficiency and safety of the creams). During the inspection there were numerous examples of how the home ensures residents are treated with dignity and respect. The Manager and staff talked about how they balance residents’ wishes to be as independent as possible, while at the same time reducing or eliminating any risks to their safety. Assistance is provided with personal care tasks where risk assessments show this is required. Staff have received training and instruction on how to allow the residents as much privacy and dignity as possible. Locks are provided on bedroom, bathroom and toilet doors. Care plans set out how residents want to be guided and supported. Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 Page 14 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, 14, 15 “Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service.” A very good range of activities is provided to suit most interests and abilities. The home maintains good contact with residents’ families and friends. Residents are enabled to have choice over all aspects of their daily lives. Residents receive well-balanced and nutritious meals to suit individual tastes and dietary needs. EVIDENCE: During the inspection there was evidence of a wide range of activities and outings regularly provided. A poster in the hallway shows the planned activities for each day. These are on a fortnightly rota and include games, musical entertainments, reminiscence, and arts and crafts. The home has a minibus and residents talked about how much they enjoy the regular outings. Residents talked about the things they liked doing. Their comments include – “Puzzles, all the general things…” Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 Page 15 “I like the activities. We make Easter bonnets. I like the music activity and like to sing along. I do not have religious needs” “I always go with the activity of the home in which I enjoy most.” “Particularly enjoy trips out in the bus and in-house quiz’s”. “I don’t like drawing.” “I play bingo and other games but especially enjoy singing”. A few residents commented that they would like to do more – “I would like more to be organised” “Would like to go out on trips more”. However, from discussion with the manager, staff, residents and visitors on the day of the inspection there was evidence that the home provides a very good range of activities throughout the week. These are both group activities, and on a one-to-one basis. While not all residents want to, or are able to join in all of the organised group activities the home ensures that there are activities to suit everyone during the week. Residents were seen doing puzzles, reading, sitting in the garden, and listening to music. Residents talked about the outings, barbeques and social events regularly organised. Around the home there were displays of art and craftwork by the residents. Comments received from staff also confirmed that the home provided an excellent standard of activities. Residents’ meetings are held on average every 2 months. These cover many aspects of daily life at the home including activities and meals. Comments received from families and visitors showed that they are always made welcome when they visit the home. Regular social events such as barbeques are held which families are invited to. The manager talked about how she has tried to hold meetings for relatives but found people cannot always attend due to personal commitments. She is therefore about to write to them to invite them to meet with the home on a regular basis at times to suit the families. Throughout the inspection there was good evidence of how residents are encouraged to make choices about all aspects of their daily lives. The care plans showed choice of daily routines. Records showed how residents choose what they want to eat, what activities they want to participate in, and what they want to wear. Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 Page 16 Residents expressed complete satisfaction in the standard of meals provided. The cook takes great pride in providing home-cooked, tasty and nutritious food. She knows the likes and dislikes of each resident, and alternatives are always provided if residents do not like the main meal on offer. Sample menus were provided for the inspection. The staff keep good records of the meals provided to each resident every day. There was evidence to show that the home keeps up-to-date with good practice guidance and menus are adjusted regularly to ensure the highest standards. The kitchen was found to be clean and in good order. Plans are in place to provide an enlarged and completely refurbished new kitchen in the near future. Comments from residents about the standard of food included – “My mother has put on weight since being in the home, so I assume she continues to eat well.” “Food is very good. I like it all. I get plenty to eat. Staff would get something else if I didn’t like something. Christmas food is especially nice.” “It is always good and I really love the food. Home from home.” “These are always of a high standard” “Food is excellent” “The food is very good, and I enjoy everything” Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 Page 17 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): 16, 18 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” The home welcomes complaints, concerns and comments and is able to demonstrate these have been acted upon openly, promptly and fairly. Residents are protected from the risk of abuse by well-trained staff and good policies and procedures. EVIDENCE: The home has a comprehensive and easy to read complaints procedure. This is set out in the information given to residents and their representatives on admission, and is also displayed in the entrance hallway. A log book on display in the hallway gives details of complaints and how they have been dealt with. This record shows that the home is open and transparent about how day-today issues are dealt with. Carol White said they would keep a separate record of complaints, to include any matters that are confidential or where residents want their complaint to be dealt with privately, or where there may be issues covered by the Data Control Act that requires the information to be held securely. Residents who responded to this inspection by completion of a survey form were generally clear about how to make a complaint, or whom they would make a complaint to. Families and representatives who completed comment cards also indicated that they were generally happy about the complaints procedure. Comments included – Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 Page 18 “Family can make complaints to the manager” “If I’m not happy I tell Matron” “I would talk to Caroline if I was not happy about something. I have never been unhappy about things here. I am sure they would do something about it if I wasn’t happy” Since the last inspection one complaint has been forwarded to the Commission by a relative. This matter has been investigated by Devon Social Services and the outcome has yet to be concluded. However, points raised by the complainant have been covered within this inspection to ensure that the care offered to all residents is satisfactory. This has been confirmed, and reflected throughout this report. Information provided for this inspection showed that all staff have received a range of training on the protection of vulnerable adults including ‘whistle blowing’, and have seen training videos on how to recognise poor practice and abuse. Staff were able to demonstrate an awareness of adult protection procedures. The home has policies and procedures in place to ensure the risk of abuse is reduced or eliminated. Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 Page 19 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, 26 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” The home has been maintained, decorated and furnished to a high standard. All areas of the home are clean. Residents are protected from the risk of cross-infection. The home must ensure that the ventilation of the laundry does not compromise the fire precautions within the home. EVIDENCE: The home is situated just outside Honiton in an attractive woodland setting. There is a safe and secluded small garden, plus walks in the surrounding area. There are a number of ‘close care’ bungalows in grounds – these are privately owned and not included in the registration of the home. The property has been well maintained both internally and externally. During the inspection a random selection of approximately half of the bedrooms were seen, all of the communal areas, half of the bathrooms and toilets, plus the Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 Page 20 kitchen and laundry. All areas of the home have been attractively decorated, and the furnishings are of a high standard. Bedrooms have been individually decorated and appeared bright, clean and safe. The home has a comfortable and welcoming appearance throughout. There are plans in place to make further improvements to the home with the provision of an enlarged and refurbishes kitchen and new laundry facilities. There are signs around the home to help residents with dementia find their way around easily. Bedroom doors have signs or pictures to help residents to locate their own room. An occupational therapist was consulted over the planning of the garden area to ensure the layout is safe and suitable for people with mobility problems. Radiators have been guarded throughout the home to prevent the risk of burns. The home was found to be clean and fresh throughout. Residents’ comments about the cleanliness of the home include – “It’s lovely” “Spotless” “The freshness, cleanliness and décor has improved and continue to improve, under this management” “The home is always very clean and fresh smelling” The laundry was found to be in good order, clean and tidy. There are good systems in place to ensure that, as far as possible, all clothing is returned to the correct owner after laundering. Staff and managers explained how, from time to time, new clothes that do not have labels are brought into the home by families or sometimes labels become illegible. In these circumstances staff make very effort to liaise with residents and relatives to find the correct owner as quickly as possible. Good infection control systems are in place throughout the home. The exit door to the outside from the laundry was found to be wedged open during the inspection. This was discussed with the manager, Carol White. Following this inspection the Commission consulted Devon Fire and Rescue Service who confirmed that the practice is safe. The home also consulted their independent fire specialist who determined that the exit door is not, in fact, a fire door (as indicated by the sticker on the door) and therefore can be held open without compromising safety. Following his advice the home have decided to place an automatic door closer on the internal door between the laundry and the home in order to provide an even higher level of protection from fire. Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 Page 21 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, 28, 29, 30 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” Staffing levels are sufficient to meet the needs of the residents. Good recruitment methods are used in order to safeguard residents. Staff have received a good level of induction and ongoing training covering all aspects of residents’ needs. EVIDENCE: Sample staff rotas were provided by the home prior to this inspection. These showed that the staffing levels are satisfactory to meet the needs of the residents. On most days there is one manager plus five care staff on duty from 7.30am to 7.30pm, plus one or two cooks, maintenance persons, one administrator, a driver, and two domestic staff. In addition the deputy manager works from 2pm to 6pm five days per week. In the evenings between 7.30pm and 9pm there are three care staff on duty. Between 9pm and 7.30am there are two waking night staff on duty. Four staff files were seen during the inspection. These showed that careful recruitment procedures have been carried out before new staff have been confirmed in post. These include at least two satisfactory references, criminal record and protection of vulnerable adults checks. New staff have undertaken Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 Page 22 very thorough and well-documented induction training to meet nationally recognised standards. Staff have received a good range of on-going training on a wide range of subjects over the last year. Training that has been provided, and training planned for the next few months includes – Medication awareness, advanced medication (senior staff), first aid refresher, infection control, wound care, therapeutic activities for people with dementia, abuse awareness, challenging behaviour, nutrition in diabetics, fire prevention, health and safety, and food safety. The home employs sixteen care staff plus the manager and deputy manager. Of these, six care staff currently hold NVQ level 2 or 3. Four staff are currently in the process of obtaining an NVQ. Five care staff recruited from overseas were qualified in their home countries as District Nurses. These staff are due to start NVQ level 3 in the near future. Although the home does not meet the current recommended level of 50 staff trained to an equivalent of NVQ level 2 or above, when the staff currently undertaking NVQs have completed their training this will bring the level of trained staff well above 50 . The staff employed from overseas already hold relevant qualifications, and have had relevant experience. Any gaps in their training will be addressed through completion of NVQ level 3. To ensure overseas staff have good communication skills the home has enrolled them on weekly English classes at a local college. Staff who responded to this inspection through completion of a survey form indicated a high level of satisfaction in their work. A couple of staff commented that if they could change anything they would like to have more staff to enable them to spend more time on a one-to-one basis with residents. However, overall comments were very positive, and included – “They always try to do a lot with, and for, the residents – like activities every day, and go out to shows, and have BBQ’s and tea dances and encourage families to come.” “The home is improving in all aspects all the time, from training for all, to furniture and fittings.” “The staff are happy in their work and with each other. Only staff who have a genuine approach to care survive in this home.” Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 Page 23 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): 31, 33, 35, 38 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” The home is well managed. Comprehensive systems are in place to ensure the quality of the facilities and services are constantly monitored and improved where necessary. Residents’ finances are safeguarded by good procedures. Good systems and training are in place to ensure the safety of residents, staff and visitors. EVIDENCE: The home is managed by Carol White. She has had many years of relevant experience and is currently undertaking NVQ level 4. Residents, staff and Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 Page 24 visitors expressed complete confidence in the way the home is managed. Comments include – “I am very pleased with the standard of care that my Mum receives at Gittisham, which is all down to the hard work and dedication of the manager and her team. Good systems are in place to constantly monitor the quality of the services and facilities provided. Questionnaires are regularly sent out to residents, relatives and visitors. The owner of Gittisham Care Ltd regularly visits the home and completes a monthly report that is forwarded to the Commission. Meetings are held on a regular basis with residents. Staff meetings are also held regularly. Complaints, concerns and comments are encouraged and acted upon in order to improve the care provided. 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. Records of health and safety checks were seen during the inspection. Fire equipment has been checked and serviced regularly. Accident reports have been completed as required. These showed that accidents have been attended to promptly and medical attention has been provided where necessary. Equipment has been maintained and serviced regularly. Risk assessments have been carried out on the environment. Staff have received training in all health and safety related topics. Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 Page 25 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 3 3 2 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 4 4 X X X 4 X 3 STAFFING Standard No Score 27 4 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 4 X X 3 Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations The initial assessment form should be expanded to cover all areas in NMS3. As much information as possible should be included in this form in order that it can form an initial agreement over the level of care to be provided, and also to form an initial care plan to be followed by care staff. Where residents are unable to contribute fully to their care plans the home should be able to show how they have liaised with the resident’s chosen representative to agree the information contained in the care plans and how staff will meet the agreed care needs. 2 OP7 Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 Page 27 3 OP9 The following enhancements to the administration of medicines - The home should see the repeat prescription scripts before they are sent to the pharmacist in order to check accuracy. - The home should maintain a record of medicines received in to the home - The home should record when creams and lotions are opened, or record the date they should be discarded after opening. Gittisham Hill House DS0000021940.V307488.R02.S.doc Version 5.2 Page 28 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.V307488.R02.S.doc Version 5.2 Page 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!