Inspection on 08/10/07 for Gittisham Hill House

This inspection was carried out on 8th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 29/08/06

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 Unannounced Inspection 8th October 2007 07:00 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.V344628.R01.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.V344628.R01.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.V344628.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th August 2006 Brief Description of the Service: Gittisham Hill House is a Care Home near Honiton, Devon. The Registered Provider is Gittisham Care Limited.. 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. There is an ongoing programme of activities provided by the staff, and the home is supported by the local primary health care team. The range of fees set out in the home’s tariff for the year 2007/08 are: Single Room Single Room with en suite Double Room Short Stay or Respite Care from £470 per week from £575 to £625 per week from £440 per person per week from £100 per day Copies of inspection reports will be available in the home on request. Gittisham Hill House DS0000021940.V344628.R01.S.doc Version 5.2 Page 5 Gittisham Hill House DS0000021940.V344628.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Several weeks before this inspection took place the home completed an annual quality assurance assessment which was submitted to the Commission. Survey forms were given to the people living and working in the home, and to relatives and visitors. We received 13 responses from people living in the home, 10 responses from staff, and 8 responses from relatives and visitors. The information we received has helped us to form the judgements made in this report. We had received a concern regarding people being woken and dressed early, prior to the arrival of the day staff. Therefore this unannounced inspection began at approximately 7am and finished at approximately 5pm. 30 people were accommodated on the day of this visit. During the day we talked to the manager, deputy manager, and two ‘responsible individuals’ for the company (one outgoing, and one person just about to take over this role). We also spoke to a district nurse who regularly visits the home, a trainer/assessor employed by East Devon College, a musician who regularly visits the home to entertain the people living there, three relatives who were visiting the home, three further members of staff, and 6 people who live at the home. We also spoke briefly to a number of other people living and working at the home. We left survey forms to be distributed to the people living and working at the home, and also to people who regularly visit the home. Any matters arising from the responses to these forms will be taken up with the home separately, as they are likely to be received after this report has been completed. During the day we carried out a tour of the home, checking 14 bedrooms (randomly chosen) 3 bathrooms and toilets, all of the lounges, dining areas and communal areas, the kitchen and garden. We looked at four care plans and followed the records maintained on each of these people from the point when they first enquired about accommodation at the home to the day of this visit. We also spoke to each of these people in order to ensure that the plans contained all of the information required by the care staff to meet all of their care needs. Other records seen during the day included records of staff recruited since the last inspection, records of the induction and ongoing training provided to staff. We looked at the arrangements for dealing with purchases made on behalf of people living at the home. We checked that medicines are stored and administered safely in the home. We also sat in one of the dining areas at lunchtime to find out what the meals are like, and to see if mealtimes are a pleasurable experience for people living at the home. Gittisham Hill House DS0000021940.V344628.R01.S.doc Version 5.2 Page 7 What the service does well: People told us that this is a happy and well-run home. We received many positive comments including – “The home regards each person in their care as a unique individual having their own rights and responsibilities. A home is as good as it’s staff. The dedication and cheerfulness of the two at the top has filtered through to those at the bottom making Gittisham a happy place.” “I would consider the home to be clean. All staff encourage the residents. I have never noted rudeness or lack of time to anyone. It appears the residents are very well cared for.” “I feel very satisfied with the care and attention my mother receives at Gittisham House.” The home has good admission and assessment procedures in place. People are visited by a manager in order to carry out an assessment of their needs and to give them as much information as possible, both written and verbal, about the home to help them decide if the home is suitable. Visits to the home, including day care, are encouraged wherever possible. Very good care planning systems are in place that ensure that people receive all of the health and personal care they require. Staff are well trained and supervised and there are good communication systems in place to ensure that staff respond promptly to any changing needs. The people we talked to were full of praise for the good standards of care provided in the home. The home works closely with each person and their families and friends to provide a good range of activities each day to suit all interests and abilities. There is a programme of regular activities organised by the home. On the day of this inspection a professional musician visited the home. There is a minibus and people can go on regular outings or shopping rips. Visitors to the home are welcomed, and the relatives and visitors we talked to were full of praise for the way the home involves them in the care of their loved –ones. The home takes good steps to ensure people are safeguarded from harm. The staff have received training on the protection of vulnerable adults. There are systems in place to ensure any concerns or complaints will be listened to and acted upon appropriately. All areas of the home both inside and out have been decorated and furnished to a very good standard. All parts of the home were found to be clean and fresh. The furnishings and decorations are of a very good standard and appear comfortable and attractive. Gittisham Hill House DS0000021940.V344628.R01.S.doc Version 5.2 Page 8 Good procedures have been followed when recruiting staff to ensure they are entirely suitable. Good practices have been followed by taking up criminal record checks and obtaining satisfactory references before new staff are confirmed in post. All staff have received a very good level of training, including nationally recognised qualifications (known as NVQ’s) and all health and safety related topics. The home is well-managed. Good procedures are in place to seek the views of the people living in the home and their relatives and/or representatives and to ensure that there are a range of systems in place to maintain and improve standards within the home are keep people safe. 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. Gittisham Hill House DS0000021940.V344628.R01.S.doc Version 5.2 Page 9 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Gittisham Hill House DS0000021940.V344628.R01.S.doc Version 5.2 Page 10 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.V344628.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5 and 6 Quality in this outcome area is excellent 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. EVIDENCE: Before a new person moves into the home there is an exchange of information, helping the person and their family to decide if Gittisham Hill House is the most suitable place for them. The manager or deputy manager will visit them in their own home (wherever possible) or hospital to carry out an assessment of their needs. The home also gathers as much information as possible from health and social care professionals, and from relatives or representatives in order to make sure they will be able to offer the right care and accommodation. The forms we saw during this visit that are used to gather this information are comprehensive and cover all aspects of the person’s Gittisham Hill House DS0000021940.V344628.R01.S.doc Version 5.2 Page 12 needs. Information gathered at this stage is use to draw up an initial care plan that will be reviewed again within one month of the person moving in. People are given detailed written information about the home before they move in. At the time of writing this report further information about the home and the company can be found on the internet at http:/www.tssg.co.uk/sspages/gittisham.php People are invited to visit the home before moving in. We met people who had received day care for a period before deciding to move in permanently. This had been particularly helpful to them, enabling them to get to know the environment and the people before they decided to move in permanently. The home does not provide intermediate care. Gittisham Hill House DS0000021940.V344628.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has very good systems in place that ensure that people receive all of the health and personal care they require, in a sensitive, respectful and safe manner. EVIDENCE: We looked at four care plan files and followed the records from the initial assessment to the day of this visit. We looked at the assessments carried out on all aspects of their health and personal care needs, and how this information had been transferred into the main care plan. We found the information was clearly set out, easy to read and easy to find relevant information quickly. We found that the home has regularly assessed and improved their care planning system in order to develop a system that best suits the home and their routines, and have liaised with individuals, their family and the staff team to ensure everyone agrees with the way the information is presented. Gittisham Hill House DS0000021940.V344628.R01.S.doc Version 5.2 Page 14 Each care plan file had an assessment of the person’s nutritional needs, including a record of their weight. The outcome of this has been passed to the cook, and in the kitchen the daily menus clearly showed the individual dietary needs, likes and dislikes of each person. Skin care assessments have been carried out by the district nurses for those people who have been identified as being at risk of skin problems including pressure sores. During the day we talked to a district nurse who regularly visits the home and she said that in future she will arrange for a skin care assessment to be carried out on all new persons moving in, therefore ensuring that everyone is safeguarded from developing skin problems. The files contained moving and handling assessments, and also risk assessments on any other identified risks. Staff told us the home has a good range of moving and handling equipment. We saw plenty of hoisting equipment around the home and readily available wherever needed by staff. The main care plan is an A4 page covering all aspects of the person’s preferred daily routine, and sets out clearly and concisely how the care staff should assist them with all of their care needs. The plans are regularly reviewed with the person (and their family or representatives where appropriate) and amended to ensure they are always up-to-date. We saw how daily work sheets are drawn up allocating care tasks to each member of staff, and it was possible to check from the records, for instance, if a person had received a bath on their preferred day/time as set out and agreed in the care plan. We could also see from the care plans what time the person usually wakes in the morning, and their preferred time of going to bed. This was also reflected in the daily work sheets. We could also see from the daily reports completed by both the day staff and night staff any changes to the normal daily routine, or to the care provided by staff. There are handover sessions between each change of shift to ensure that any changes in care needs are passed on to care workers verbally as well as in writing. We talked to each of the four people whose care plans we had read. We were satisfied that the care plans accurately covered all aspects of their care needs, and explained clearly to the staff how the person wanted to be assisted. We found good evidence to show that the home works closely with all of the local health and social care professionals. They have referred appropriately for GP advice and treatment, and have worked closely with the district nurses to ensure all health care needs have been met. We talked to the district nurse about the overall standard of care at the home, and she assured us that in her opinion the care is always of a high standard. She felt that the care staff are competent and well trained and work closely with her to ensure all healthcare procedures are followed correctly. Gittisham Hill House DS0000021940.V344628.R01.S.doc Version 5.2 Page 15 In the last year the home has acted upon the recommendations of the last inspection. They now have evidence to show they have seen prescription scripts before they are passed to the pharmacy. They clearly record the amount of medicines received into the home. They also record the date that creams and lotions are opened in order that staff know when they should be discarded. Other improvements include the introduction of charts to show when staff have applied creams and lotions. We looked at the way medicines are stored and administered in the home. We found they are stored securely, including any medicines that need to be kept cool. The records of administration have been well maintained. Records are now being kept of the amount of each medicine that is received into the home. This ensures that balances of medicines held in the home can be easily checked against the amounts administered. All staff who are responsible for administration of medicines have received some training on this subject. Some have received more comprehensive training than others, and Carol White said she had been looking at what further training may be necessary in order to ensure all staff have the level of knowledge recommended by the national training organisation known as Skills for Care. During the day we watched care workers assisting people with their daily routines. The staff were gentle in their manner, and sensitive to each persons’ need for privacy and dignity. We saw staff knocking on doors before entering. During the day we spoke to a relative of a person who had recently died at the home. The relative was clearly very satisfied with the level of care that had been given, and was full of praise for the home. They told us about the way the home had kept in touch with them at the end of the person’s life and how they had been completely reassured about every aspect of the care provided. The home has improved the way they gather information about people’s preferences for their care at the end of their life and any funeral arrangements. The deputy manager told us how the home approaches this matter, aware that this information needs to be gathered, while at the same time aware of people feelings and sensitivity about this subject. Gittisham Hill House DS0000021940.V344628.R01.S.doc Version 5.2 Page 16 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. 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. People can continue to lead their own individual choice of daily lifestyle with the help of skilled staff. The home works closely with each person and their families and friends to ensure their daily lives are stimulating and satisfying. EVIDENCE: This unannounced inspection was carried out as part of the normal inspection timetable. However, the time of arrival at the home was brought forward to 7 am in response to a concern raised by a member of the public relating to the time that staff wake people in the mornings and help them to get up. We were told that, approximately one year ago, the normal practice in the home was for the night staff to get between 18 or 19 people up and dressed before the day staff begin their duties. The complainant told us that this practice meant that staff had to start waking people as early as 4 am. Gittisham Hill House DS0000021940.V344628.R01.S.doc Version 5.2 Page 17 We found that 10 people were already up and dressed in the lounge when we arrived. We talked to 6 of those people but found that, due to the level of dementia they suffered from, it was difficult to establish for certain if they had woken naturally or if the staff had woken them. We also talked to staff, looked in their care plans, and looked at the daily work rotas for care workers. We found good evidence to show that these people normally wake early and start to get up before 7am. We were reassured that the home has identified each person’s preferred daily routines and has organised the working arrangements of the care staff around those individual needs. We were told that other people living in the home choose to get up later in the morning – one person often chooses to stay in bed until 11am. The manager, Carol White, regularly starts work at 7.30am and on a Sunday she works alongside the care staff providing ‘hands on’ care and in this way she is able to monitor care practices closely and prevent staff from slipping into poor care practices. At 7.30am the cook and kitchen assistant started to provide breakfast and drinks for those people who were already up. Breakfast trays were prepared and taken to those people still in bed or in their rooms beginning to get up fro 7.30 onwards. We also found good evidence to show that the home responds to individual’s choice of time to go to bed, including those who like to have a rest in the afternoons. Following this inspection the complainant gave us more details. This information was passed to the person who we refer to as the ‘Responsible Individual’ representing the company that owns the home. He carried out his own investigations and he told us he found no further evidence to support the alleged concerns. We have asked him to continue to monitor the situation. The outcome of this inspection and the investigation by the provider was that we found no evidence to support the allegations. During the morning we heard music and singing in one of the lounges, and in the afternoon a musician visited the home to entertain people. People told us how much they enjoyed his visit. Around the home we saw notice boards providing information about the regular activities planned each month. There was at least one activity planned for each day. We talked to a relative who regularly visits the home to do flower arranging with groups of people, and how these sessions have been very successful with increasing numbers attending each session. We also saw a flower arrangement that had been created in the last group session displayed in the entrance hallway. Information provided by the home prior to this inspection shows that the home assists people to follow their chosen religion. Every 3 weeks the vicar from Gittisham Village Church holds a service in the home. A Roman Catholic priest visits the home regularly. They also receive visits from Jehovah Witness for those who are members of this faith. In the last year the home has improved the level of staff dedicated to providing social activities. They have introduced new staff who are called ‘social carers’ Gittisham Hill House DS0000021940.V344628.R01.S.doc Version 5.2 Page 18 with the main aim of helping those people who may become restless at particular times of the day, or those people who may benefit from more individual attention. The home has a minibus that is used for regular outings and shopping trips. Some people talked about how their families visit regularly and sometimes take them out. The home has developed a variety of ways of liaising with families and friends, including regular meetings and social events, as well as inviting families to attend individual care plan reviews. We talked to the cook about the menus. The menus are balanced and varied and are regularly reviewed to take into account any changing tastes or seasonal foods available. At lunchtime people are offered at least two main alternatives. Special meals are prepared for those people who have specific dietary needs. ‘Finger foods’ are offered if people are unable to sit down at mealtimes due to the nature of their dementia – this ensures that people maintain a healthy weight and reasonably balanced diet. If people do not like either of the main meals offered the staff will always try to meet their individual preferences. We sat in the dining room at mealtimes and heard some of the comments. One person said she thought there was too much potato, and a member of staff quietly offered to take it away and change it – the person was happy with this response. Another person was overheard to say “Oooh, that was lovely! I did enjoy that!” after she had finished her meal. There are four main rooms used as either a lounge or dining room. There are also other quiet areas around the home where people choose to sit. The dining tables were attractively laid with tablecloths and floral arrangements, making mealtimes feel ‘special’. The kitchen was clean and in good order, although the fixtures and flooring were showing signs of wear and tear. The equipment was in good order, including a recently purchased new cooker. A recent inspection by the Environmental Health Officer showed that all aspects of kitchen hygiene and practices were found to be satisfactory. There are plans to provide a new kitchen in the not-too-distant future. Gittisham Hill House DS0000021940.V344628.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People can feel confident that the home takes good steps to ensure they are safeguarded from harm, and that any concerns or complaints will be listened to and acted upon appropriately. EVIDENCE: The home has a range of methods of encouraging people to make comments, raise concerns, or to complain about poor care or services. The complaints procedure 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 general complaints (not related to individuals) and how they have been dealt with. A separate book is also available in the office for any complaints relating to the care of individuals. People can also raise concerns or complaints through individual reviews, by regular quality assurance surveys, or by talking to any of the management team. Since the last inspection one complaint has been received by the Commission – see Daily Life and Social Activities for details. The home keeps a record of any complaints received and how they have been responded to. Information supplied by the home prior to this inspection showed that the home has received 2 complaints in the last year. Gittisham Hill House DS0000021940.V344628.R01.S.doc Version 5.2 Page 20 The staff recruitment and training files we looked provided evidence to show that 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. The home has policies and procedures in place to ensure the risk of abuse is reduced or eliminated. The home follows good recruitment practice that ensures all requires checks and references are taken up before new staff begin work. Gittisham Hill House DS0000021940.V344628.R01.S.doc Version 5.2 Page 21 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. 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. People live in a safe, clean and comfortable home that meets their needs. All areas have been decorated and furnished to a very good standard. EVIDENCE: We carried out a tour of the home, checking 14 bedrooms (randomly chosen) 3 bathrooms and toilets, all of the lounges, dining areas and communal areas, the kitchen and garden. We found that all areas have been very well maintained, and appeared bright, clean and free from any odours. There were plenty or places for people to sit during the day, and people were able to get up and move around the home safely. All areas were comfortably and attractively furnished and appeared homely throughout. In the last year improvements to the home have included re-vamping of the main hall and staircase. Some new chairs, cantilever tables and commodes Gittisham Hill House DS0000021940.V344628.R01.S.doc Version 5.2 Page 22 have been purchased. The outside of the house was re-painted earlier this year. People are encouraged to bring items of their own furniture, pictures and personal effects to make their rooms feel like home. Bedrooms have sufficient space to provide sufficient furniture to meet their personal needs. Many of the bedrooms have en suite facilities, and those that do not have toilets and bathrooms nearby. The maintenance man arrived at 8.30am and immediately checked the maintenance book to find out if there were any repairs that needed immediate attention. All areas of the home both inside and outside were found to be well maintained and in good order. Records we saw showed that risk assessments have been carried out on all areas of the home and regularly updated. There are signs around the home to help residents with dementia find their way around easily. New signs are planned for bedroom doors to help residents to locate their own room easily. 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. We talked to a care worker, the laundry assistant and one of the cleaning staff to find out if staffing levels and staff routines are adequate. We found that the staff took a pride in ensuring the home is always clean and safe. The staff reassured us that current staffing levels allow them sufficient time to follow good cleaning routines. People told us that laundry routines are good and ensure that people are always dressed in clean and neatly laundered clothes. Gittisham Hill House DS0000021940.V344628.R01.S.doc Version 5.2 Page 23 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. 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. People receive care from a staff team that has been carefully recruited and well trained, ensuring that safe practices are followed at all times. EVIDENCE: On the day of this inspection there were 3 care workers on waking duty overnight – one finishing at 7am and two finishing at 7.30am. The laundry assistant started work at 6am and the cook and kitchen assistant arrived at 7.30am. In the morning there were four care assistants plus a senior care assistant. There would normally be five care workers on that shift but one person had phoned to say they were off sick. One cleaning staff was on duty, plus a maintenance person and an administrator. The manager and deputy manager were duty throughout the day they normally arrange their hours to ensure there is management cover throughout the main part of the waking day. In the last year the home has increased the staff cover by employing staff during the afternoon/evening to work with those people who may become agitated or distressed at this time of the day due to the nature of their dementia. Gittisham Hill House DS0000021940.V344628.R01.S.doc Version 5.2 Page 24 We looked at the files of four staff recruited since the last inspection. We found that the home had followed recommended recruitment practice by taking up at least two satisfactory references and carrying out criminal record and protection of vulnerable adults checks before they were confirmed in post. We looked at the training records for all staff to ensure that new staff have received induction training during the first few days of work, and that there has been a satisfactory level of training in place for all staff, including regular updates of health and safety topics. Training records have been well maintained and provide a clear guide to the dates when essential training has been completed for each member of staff. This enables the home to identify easily when updated training is due. During the day we talked to a trainer who was visiting the home to assess the work of staff who have been undertaking nationally recognised training awards known as National Vocational Qualifications (NVQ’s). This person is employed by the local college. She told us she was entirely satisfied with the care practice within the home and the skills and competence of the staff. All of the staff either hold an NVQ or are currently undertaking these qualifications. Many of the staff have worked in the home for a number of years. Two staff we spoke to told us about the happy atmosphere within the home and how it is a good place to work, with good communication systems, a high commitment to training, and a positive approach to providing good care. Staff meetings are held regularly. There are ‘handover’ sessions between shifts to ensure staff starting work are updated on any changes. Gittisham Hill House DS0000021940.V344628.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 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. Good procedures are in place to seek the views of the people living in the home and their relatives and/or representatives and to ensure that there are a range of systems in place to maintain and improve standards within the home are keep people safe. EVIDENCE: The home has been managed by Carol White for a number of years. She holds a nationally recognised qualification known as NVQ 3 and has been working towards NVQ level 4 and the Registered Managers’ Award. Both Carol and the deputy manager have had many years of experience of managing a care home. They have a ‘hands on’ approach to management, working alongside Gittisham Hill House DS0000021940.V344628.R01.S.doc Version 5.2 Page 26 the staff team for a good proportion of their working week. They told us they have an ‘open door’ policy for staff, and welcome staff coming and talking to them about any matters of concern immediately. The people we talked to told us they felt the home runs smoothly and is well-managed. The representative of the company who is known to the Commission as the Responsible Individual visits the home on a regular basis and closely monitors all aspects of the management of the home. The home has a range of methods of checking the quality of the services they provide. Survey forms are sent out regularly to the people living in the home and/or their relatives. The most recent survey forms were received in June 2007 and the results were available for this inspection. The home was able to demonstrate how they have addressed any issues raised. The home does not handle any cash or financial affairs on behalf of people living in the home. Any expenses or items purchased by the home on behalf of people are invoiced to their family or financial representative once a month. Records of these invoices were available for this inspection and were found to be satisfactory. Records relating to the safety of the staff and people living in the home were seen. These included the fire log book, accident book, risk assessments and equipment maintenance. We saw records of staff training to show that staff are fully aware of the practices they must follow to ensure their safety. Protective equipment and clothing is provided as necessary. Gittisham Hill House DS0000021940.V344628.R01.S.doc Version 5.2 Page 27 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 4 x 3 x 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 3 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 3 18 3 4 X X X X X x 3 STAFFING Standard No Score 27 3 28 3 29 3 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.V344628.R01.S.doc Version 5.2 Page 28 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. Refer to Standard Good Practice Recommendations Gittisham Hill House DS0000021940.V344628.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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