Inspection on 27/03/07 for Glebefields Care Home

This inspection was carried out on 27th March 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

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

CARE HOMES FOR OLDER PEOPLE Glebefields Care Home Stratford Road Drayton Banbury OX15 6EH Lead Inspector Christine Sidwell Unannounced Inspection 27th March 2007 10:00 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 Glebefields Care Home DS0000068183.V333973.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. Glebefields Care Home DS0000068183.V333973.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Glebefields Care Home Address Stratford Road Drayton Banbury OX15 6EH 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) 01295 738133 01295 738766 glebefields@majesticcare.co.uk Ross Healthcare Limited Mrs Philomena Morton Care Home 50 Category(ies) of Dementia - over 65 years of age (9), Old age, registration, with number not falling within any other category (50) of places Glebefields Care Home DS0000068183.V333973.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of service users to be accommodated at any one time must not exceed 50. 20th June 2006 Date of last inspection Brief Description of the Service: Glebefields Care Home is situated in Drayton, a village near to the market town of Banbury, and is owned and managed by Glebefields Ltd, part of Ross Healthcare Ltd. The home provides personal and nursing care for up to 50 people aged from 60 years. Registered nurses are on duty 24 hours a day. The home is a converted Victorian house and has accommodation on three floors with a lift. Views from most windows are across open countryside. Six bedrooms are available as double rooms. En-suite facilities are available in the majority of bedrooms in the new extension, together with increased communal space. There is a garden, which is accessible to residents. Car parking is available at the front of the home. The home’s fees range from £518 to £700 per week. Glebefields Care Home DS0000068183.V333973.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of this established home since it has reregistered to provide care for up to nine people who suffer from dementia. The inspection was conducted over the course of three days and included a one day unannounced visit to the home. The key standards for older people’s services were covered. Information received about the home since the last inspection was taken into account in the planning of the visit. Prior to the visit, a questionnaire was sent to the manager with comment cards for distribution to service users, relatives and visiting professionals. Five residents, 14 family members, four general practitioners and one healthcare professional returned the questionnaires. Service users and families were also spoken to on the day of the unannounced visit. Discussions took place with the manager, operations manager, nursing and care staff. Care practice was observed. A tour of the premises and examination of some of the required records was also undertaken. The homes approach to equality and diversity was considered throughout. What the service does well: The care needs of potential residents are identified with them, prior to their move to the home, to ensure that they can be met. One family said that this had contributed to making the move as easy as possible in the circumstances. Residents’ personal, healthcare and medication needs are met. Medication is managed well and the home has good relationships with the local general practitioners. Residents may stay with their own general practitioner if they wish and remain in the same area. Staff were observed to treat residents with respect. Residents have choice as to how they spend their day. Activities are organised on a regular basis and families and friends are welcomed to the home. The standard of food is high, promoting residents’ well being and meeting their nutritional needs. Mealtimes were seen to be a sociable occasion and the residents spoken to said that they enjoyed their meals. The standard of accommodation and cleanliness is good, providing residents with a clean and comfortable place in which to live. There are good standards of infection control. There are staff available, in sufficient numbers and with the right attitude and skills, to meet the needs of residents. Staffing levels are good and there is a regular training programme, which the staff said they found helpful. Recruitment practices are thorough and checks are undertaken before staff start work. Glebefields Care Home DS0000068183.V333973.R01.S.doc Version 5.2 Page 6 The home is well managed for the benefit of residents. There is an experienced manager and a quality assurance programme has been implemented. Safe working and care practices have been implemented. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Glebefields Care Home DS0000068183.V333973.R01.S.doc Version 5.2 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 Glebefields Care Home DS0000068183.V333973.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care needs of potential residents are identified with them, prior to their move to the home, to ensure that they can be met. EVIDENCE: The files of four residents were examined. All had evidence that the manager or senior nurse had visited them prior to their move to the home and their needs had been assessed. One resident and their family, who had moved to the home within the last week, confirmed that they had been visited in hospital and had met the manager. They were happy with the information that they had been given and said that the staff had worked hard to make the move as easy and comfortable as possible. There was evidence in the files that care managers’ assessments have been sought where appropriate. The documentation used to guide the assessment of potential residents who are self funding is comprehensive. Glebefields Care Home DS0000068183.V333973.R01.S.doc Version 5.2 Page 9 Care plans are drawn up following assessment and the family of one resident spoken to confirmed that they had been involved in this. Residents’ cultural and religious needs are identified as part of the assessment. All of the five residents who returned the questionnaires said that they had been given enough information about the home before they moved in. The home does not offer intermediate care although respite care and interim care following hospital admission is offered. Glebefields Care Home DS0000068183.V333973.R01.S.doc Version 5.2 Page 10 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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ personal, healthcare and medication needs are met in a manner which protects their autonomy and dignity. EVIDENCE: The care of four residents was ‘case tracked’. Their files contained comprehensive care plans and the staff spoken to were knowledgeable about their care. They had been reviewed regularly and updated when appropriate. The residents and family members who returned the questionnaires said that they were involved in planning their care and that the staff were responsive to residents’ wishes. The risk of residents acquiring pressure damage due to immobility is assessed and the appropriate equipment is made available. One resident had acquired pressure damage in hospital and the records showed that this was now improving. The monitoring of the improvement could be improved by more accurate measurement or, with the resident’s permission, taking photographs at intervals. The resident concerned had the appropriate pressure relieving equipment. Glebefields Care Home DS0000068183.V333973.R01.S.doc Version 5.2 Page 11 A nutritional risk assessment had been undertaken and dietary supplements were prescribed. The staff and chef were aware of this. However, the administration of the supplements was not recorded in the care plans nor the medication administration chart. This should be reviewed and a clear policy be agreed and implemented. Continence assessments are undertaken and appropriate aids are provided by the Primary Care Trust, (PCT). Residents are able to remain with their own general practitioner (GP) and one resident spoken to said he was pleased to have been able to do this. There is evidence in the files that residents are reviewed regularly by their GP. Five GPs returned the questionnaires and all said that the home communicated clearly with them and that any specialist advice was incorporated into the resident’s care plan. There was evidence that falls assessments are undertaken. One nurse takes the lead in this topic and has undertaken additional training in falls prevention. Medication is managed well. There are medication policies in place. Storage facilities are satisfactory. Records are kept of medication entering and leaving the home. The medication administration records were accurately completed. Controlled drugs were stored satisfactorily and all entries to the controlled register were signed. A contract is held for the safe disposal of unused medication. The staff nurse spoken to said that medication was not administered covertly. If a resident refused medication this would be recorded. If the medication was essential and the resident lacked the capacity to make to the decision, the doctor and family would be informed and a way forward agreed. The staff were observed to be treating the residents with respect and their dignity was protected. All care is given in residents’ rooms. This was confirmed by a health professional who was visiting on the day of the unannounced visit. The general practitioners said that they saw residents in their rooms. Residents may have a telephone to use in the privacy of their own rooms. One gentleman who had recently moved to the home was pleased that he now had access to the internet and his email. Glebefields Care Home DS0000068183.V333973.R01.S.doc Version 5.2 Page 12 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have choice as to how they spend their day. The standard of food is high, promoting residents’ well being and meeting their nutritional needs. EVIDENCE: Residents are encouraged to maintain control over their daily lives, and staff offer choices regarding daily routines whenever possible. Residents’ meetings take place. All the families spoken to and those who returned the questionnaires said that they were made to feel welcome and could visit at any time. There is a programme of daily activities and the home is in the process of appointing an activities co-ordinator. The families spoken to also said that they could visit their family member in private. Residents are encouraged to bring personal items with them to personalise their rooms and many had chosen to do so. There is a varied menu and four meals are offered daily. There is a choice of cooked breakfast, lunch and evening dinner. Soup and sandwiches are offered at supper. Pureed foods and special diets are available if necessary to meet residents’ cultural and religious needs. Glebefields Care Home DS0000068183.V333973.R01.S.doc Version 5.2 Page 13 The chef attends residents’ meetings where ideas for the menu are discussed. All food is ‘home cooked’ with fresh ingredients. The residents spoken to on the day and those who returned the questionnaires said that they enjoyed their meals. The staff were assisting those who needed help discreetly. The chef assists the carers in monitoring whether residents are enjoying their meals by keeping records of any meal or course that is returned to the kitchen and discussing this with residents, the manager and care staff to ensure that meals are eaten and enjoyed. This is good practice. The dining room is newly redecorated and mealtimes were observed to be a sociable occasion. Glebefields Care Home DS0000068183.V333973.R01.S.doc Version 5.2 Page 14 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints and protection policies and procedures work well, giving residents and their families confidence that their concerns will be addressed. EVIDENCE: There are complaints policies and procedures in place. A complaints log is kept and action was seen to be taken in response to concerns and complaints. All the residents who returned the questionnaires said that they knew who to speak to if they were unhappy. The family members who returned the questionnaires said that they were aware of the complaints procedures although none had had occasion to make a complaint. One family member said that she had expressed a concern and that it had been dealt with by the time she returned the next day. The home is aware of the local multi agency strategy for the protection of vulnerable adults and has made one referral, which was dealt with appropriately. The Commission for Social Care Inspection has not received any complaints about the home and has not been notified of any allegations made to the local authority. Glebefields Care Home DS0000068183.V333973.R01.S.doc Version 5.2 Page 15 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of accommodation and cleanliness is good, providing residents with a clean and comfortable place in which to live. EVIDENCE: The home has just completed a major extension to provide a dedicated dementia care unit, which will open shortly. The extension has been built to a high standard and is in keeping with the style of the original building. En-suite rooms are available in the new extension. The remaining part of the home is in a good state of repair. The pre inspection questionnaire showed that routine maintenance is undertaken and that equipment is maintained regularly. There are no CCTV cameras. Glebefields Care Home DS0000068183.V333973.R01.S.doc Version 5.2 Page 16 There are control of infection policies and procedures in place. The systems for sorting soiled laundry are good and up to date washing machines have been installed to ensure that personal clothes can be disinfected if necessary without being washed in extremely high temperatures. Staff were observed to wash their hands and staff have access to alcohol hand rub to reduce the risk of cross contamination. There were no offensive odours in the home and the standard of cleanliness is high. Residents do, however, share hoist slings, which should be addressed. Those residents who need assistance with a hoist should have individual hoist slings in line with guidance issued by the Department of Health in 2006. Glebefields Care Home DS0000068183.V333973.R01.S.doc Version 5.2 Page 17 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are staff available, in sufficient numbers and with the right attitude and skills, to meet the needs of residents. EVIDENCE: There is a staffing rota which was up to date and reflected the number of staff on duty on the day of the unannounced visit. Residents had a choice as to when they got up but all were up by coffee time. The residents who returned the questionnaires said that there was always, or usually, staff available when they needed help. Eleven of the fourteen family members who returned the questionnaires said that in their opinion there were always sufficient staff on duty. The home was very clean and tidy on the day of the unannounced visit and the laundry was being managed well, indicating that the home had sufficient ancillary staff. Two of the fourteen carers hold the national Vocational Qualification in Care at Level 2 and a further five overseas carers hold a professional qualification in care obtained in their own country. The manager said that the home had had difficulty in supporting the National Vocational Qualifications courses but had now accessed an external trainer to assist with this. The remaining carers were registered to complete the course. Glebefields Care Home DS0000068183.V333973.R01.S.doc Version 5.2 Page 18 There are policies and procedures in place covering recruitment of staff. Three recruitment files were examined and all contained evidence to show that staff identity was checked, references were taken up and Criminal Records Bureau disclosures were sought before staff commenced work. The staff spoken to had undertaken an induction programme. Not all records contained an up to date photograph of the staff member and this should be addressed. The training records were seen and showed that all staff, including night staff, have had the basic mandatory training, and that a range of specialist training has been undertaken. All staff, including the ancillary staff, have had an introduction to dementia care in preparation for the opening of the new unit. There are appraisal and supervision systems in place and the home achieved the Investors in People Award in 2006. Glebefields Care Home DS0000068183.V333973.R01.S.doc Version 5.2 Page 19 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 for the benefit of residents. EVIDENCE: There is an experienced manager in post who has achieved the Registered Managers Award. The staff spoken to said that the atmosphere was open and that their input was valued. There are clear lines of accountability with the organisation’s central management team. Residents and staff are involved in the running of the home. Glebefields Care Home DS0000068183.V333973.R01.S.doc Version 5.2 Page 20 An annual development plan is developed for the home. The home has implemented a quality assurance system which involves a regular audit of the quality of the service audit. An initial audit has been undertaken by the manager although the operations manager has yet to undertake her verification audit. There is a need to complete the cycle, for the initial audit to be verified and for action plans to be developed to further improve the service as a result of the findings. There was some evidence that residents are consulted and minutes of residents’ meetings are kept. Until recently these were chaired by a resident. The operations manager undertakes regular quality assurance visits and copies of the reports written after these are kept on file in the home. The home keeps small amounts of petty cash for some residents and records are kept. There are health and safety policies and procedures in place. The training records showed that staff had had training in the basic mandatory training areas, including moving and handling, infection control, food hygiene, first aid and fire training. Staff were observed to be using moving and handling equipment correctly. One resident said that she didn’t like the hoist but she always felt safe. The service records for equipment and major services are up to date. There has been a lapse in the checking of some weekly safety checks recently, which should be addressed. Glebefields Care Home DS0000068183.V333973.R01.S.doc Version 5.2 Page 21 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Glebefields Care Home DS0000068183.V333973.R01.S.doc Version 5.2 Page 22 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. 1 Standard OP29 Regulation 19(1)b Schedule 2 Requirement An up to date photograph should be in all staff recruitment files Timescale for action 31/05/07 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 3 4 5 6 Refer to Standard OP8 OP8 OP9 OP26 OP33 OP38 Good Practice Recommendations The monitoring of wound healing could be improved with better use of measuring tools and photography. A policy to record the administration of nutritional supplements should be agreed and implemented. A photograph of the resident should be affixed to all medication administration charts to reduce the risk of error. Those residents who need assistance with a hoist should have individual hoist slings in line with guidance issued by the Department of Health in 2006. The quality assurance cycle should be completed and the initial audit verified and action plans developed. Weekly health and safety checks of equipment should be maintained. Glebefields Care Home DS0000068183.V333973.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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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