CARE HOMES FOR OLDER PEOPLE
Glencoe House Nursing Home 23 Churchtown Road Gwithian Hayle Cornwall TR27 5BX Lead Inspector
Diana Penrose Unannounced 28 July 2005 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Glencoe House Nursing Home D52-D04 S61826 Glencoe V240523 280705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Glencoe House Nursing Home Address 23 Churchtown Road Gwithian Hayle Cornwall TR27 5BX 01736 752216 01736 752216 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Alexandra Maggs Mrs Tracey Brooking Care Home with Nursing 20 Category(ies) of Old age, not falling within any other category registration, with number (20), Physical disability (10), Terminally ill (5) of places Glencoe House Nursing Home D52-D04 S61826 Glencoe V240523 280705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1). To admit one named person with a learning disability which is outside of the Homes registered categories. Date of last inspection 07/03/05 Brief Description of the Service: Glencoe is a Care Home providing accommodation, personal and nursing care for up to 20 older people. The home is situated on the edge of the village of Gwithian, near to the towns of Camborne and Hayle. It is set in its own grounds, with ample parking and is easily accessible by road. Accommodation is provided across two floors. The upper floor is accessible by lift. The accommodation is pleasant and homely, attractively decorated and very clean. There is ample communal space in addition to service users own bedrooms. Most of the bedrooms are single rooms. There are two double rooms. The Registered Provider is actively involved in the running of home and spends three or four days each week at the home.The Registered Manager and staff present as competent, friendly and caring. Glencoe House Nursing Home D52-D04 S61826 Glencoe V240523 280705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Glencoe Nursing Home on the 28 July 2005 and spent six hours at the home. This was an unannounced visit. The purpose of the inspection was to gain an update on the progress of compliance to the requirements that were identified in the last inspection report dated 07.03.05. In addition the inspector focused on the following key areas of care: choice of home, assessment and care planning, health care, leisure, complaints, some of the environment and some management areas. On the day of inspection 18 service users were resident in the home. The methods used to undertake the inspection were to meet with a number of residents, staff, the registered manager and registered provider to gain their views on the services that Glencoe offer. Glencoe’s records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of this inspection. What the service does well:
The home makes every effort to meet the requirements and recommendations set by the Commission for Social Care Inspection. There is a statement of purpose and service users guide that inform prospective service users and their family about the home. Copies are readily available in the home. One man said he had received good information about the home when he was looking for a suitable place for his relative. The Registered Manager visits prospective service users whenever possible prior to admission. She undertakes an assessment to make sure the home can meet the needs of the person before making any decision to admit them to the home. She gets as much information as possible and contacts the family, Social Services, GP and Nurses as necessary. The assessment is recorded and used to produce a written plan of the care to be given to the service user. The care plan is detailed to ensure staff know what is required to meet the persons needs and assessments included to reduce any risks. Service users said they had been involved with the planning process. The plans are reviewed every month and any changes recorded. Daily records are kept for each service user and they are informative. Service users spoken with said their health needs were met and they had access to their GP or other health professionals when required. There is equipment in the home for assisting with the moving and handling of service users. There is also equipment to help prevent pressure sores developing, for example special mattresses and cushions. Staff are trained to use any equipment provided. Glencoe House Nursing Home D52-D04 S61826 Glencoe V240523 280705 Stage 4.doc Version 1.40 Page 6 There is a medicines policy and relevant guidelines and reference books for staff to refer to. Medicines are administered by a trained nurse and records are kept. The home endeavours to provide activities and entertainment to suit the service users accommodated. Service users said they had enough to do; they had television, videos, radio and books or magazines to read as well as visitors. Visitors said they are welcome in the home at any time and can phone whenever they wish. There is a record kept of visitors to the home. There is a complaints procedure that is included in the statement of purpose. The home has received very few complaints. The home is well furbished, decorated and maintained; it is warm, clean and homely with no unpleasant odours. The grounds are tidy and there is an area at the back of the home for service users to sit if they wish. There is a laundry on site and service users were wearing clean clothes. Relatives spoken with were very happy with the service provided. There is a policy and procedures in place to reduce the risk of infection. Handwashing facilities for staff are good and gloves and aprons are provided and seen to be used. The home has a thorough recruitment policy and prospective employees are interviewed prior to employment. All relevant checks such as criminal record checks are done before new staff start work and references are obtained. Staff said they know what is expected of them, they receive terms and conditions of employment and are given a job description. The management of the home try to make sure that working practices are safe. Staff have regular training and equipment service checks are undertaken and up to date. Accidents are reported as they should be and audited by the Registered Manager to try and prevent future occurrences. What has improved since the last inspection?
A considerable amount of work has been undertaken around the building since the last inspection. The kitchen has been refurbished and a new cooker is due to arrive in August. Some of the bedrooms have been re-decorated and look clean and fresh. Curtains and carpets have been replaced where needed and these have been tastefully chosen. Curtain screens in a shared room were in the process of being changed to promote privacy for the service users occupying the room. The water temperature in areas accessed by the service users has been regulated to reduce the risk of scalds. The downstairs windows have been fitted with restrictors where appropriate according to an assessment of risk. The bathroom carpet has been replaced with a washable floor covering that can be more easily cleaned and reduces the risk of the spread of infection. The medicines policy has been updated and now includes the use of oxygen, lotions, creams and insulin. The Registered Manager now undertakes regular audits of the medicine records and ensures the care documentation is signed. Furniture brought into the home by service users is recorded. All fire doors were appropriately closed or locked during the inspection.
Glencoe House Nursing Home D52-D04 S61826 Glencoe V240523 280705 Stage 4.doc Version 1.40 Page 7 There is now a policy for the safekeeping of service users money in place. The transaction sheet has been reviewed and adapted to incorporate signatures. 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. Glencoe House Nursing Home D52-D04 S61826 Glencoe V240523 280705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Glencoe House Nursing Home D52-D04 S61826 Glencoe V240523 280705 Stage 4.doc Version 1.40 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 standard(s) 1 and 3 Prospective service users are given information about the home enabling them to make an informed decision. Service users are only admitted to the home following an assessment of their needs that ensures the home can provide adequate care EVIDENCE: The home has a suitable of purpose and service users guide that are presented in a colourful folder with photographs of the home. They comply with the regulatory requirements. The Registered Manager explained the procedure for the initial assessment of prospective service users and completed assessment documents were inspected. The home uses the Standex system for recording the assessment details. Information from Social Services and hospital staff is also obtained. An individual plan of care is compiled from the initial assessment. Glencoe House Nursing Home D52-D04 S61826 Glencoe V240523 280705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 9 Individual care plans are generated for each service user that inform and direct the staff in their care provision. Service users have access to health care services as necessary to ensure their assessed needs are met. There are suitable systems and policies in place for dealing with service users medicines: extra vigilance in some areas will further ensure service users safety. EVIDENCE: Each service user has a written care plan, which is reviewed monthly. The Standex system is used. Risk assessments include Waterlow scoring, nutrition, moving and handling, falls and dependency scoring. The care plans are compiled with the service user or representative but not all were signed. Daily records are maintained and the care staff record in these as well as the nurses. The documentation is comprehensive and informative. Service users spoken with said their health needs were met and they had access to their GP or other health professionals when required. Pressure relieving equipment and equipment for moving and handling is provided. Staff receive training in the use of equipment. There is a suitable medicines policy and system in place for the administration of medicines. Storage is safe and secure. All medicines received into the home are recorded and signed for on the medicine administration chart. Not all
Glencoe House Nursing Home D52-D04 S61826 Glencoe V240523 280705 Stage 4.doc Version 1.40 Page 11 transcribing was signed by two members of staff. Alternative arrangements must be made to ensure that medicines prescribed for an individual service user are not be administered to anyone else, for example Lactulose syrup. The medicine round was undertaken in a safe and professional manner. Glencoe House Nursing Home D52-D04 S61826 Glencoe V240523 280705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 13 The home provides some activities and aims to offer a lifestyle that meets individual service users needs. Links with family, friends and the community are good and allow service users the opportunity to socialise. EVIDENCE: The Registered Manager has tried to involve relatives and friends in deciding on activities for service users, with little response. Activities are provided according to the service users wishes, mainly television, radio and magazines. Service users said the staff spend time talking with them and this was observed. The Registered Manager said a musician visits the home from time to time. The Registered Provider has undertaken an activities course. There is a record of visitors to the home and there were visitors in the home during the inspection. Service users said they could receive visitors in private and at any time. Visitors spoken with said they are always made welcome in the home and can call when they like. Service users said the telephone arrangements in the home are good. Some service users said they could go out with their relatives or friends if they want to. Glencoe House Nursing Home D52-D04 S61826 Glencoe V240523 280705 Stage 4.doc Version 1.40 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home has a satisfactory complaints procedure that ensures complaints are listened to and acted upon. EVIDENCE: There is a suitable complaints policy in the home and a method for recording complaints, the action taken and the outcome. There have been no complaints since the last inspection Glencoe House Nursing Home D52-D04 S61826 Glencoe V240523 280705 Stage 4.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The home and grounds are well maintained providing a safe environment for residents, staff and visitors. The home is clean and free from unpleasant odours making it a pleasant place for service users to live in. EVIDENCE: The home is warm, homely and clean and the grounds are tidy. The fire escape outside and garden fencing have been replaced. The kitchen has been refurbished and a new cooker has been ordered. Some bedrooms were being re-decorated and the corridors and doorframes were due to be painted. Service users spoken with were happy with their surroundings. A recent EHO report commented on the excellent standards at the home. The laundry is sufficient for service users needs and is the next area to be refurbished, a hot water supply for hand washing will be incorporated. Handwashing facilities in other areas of the home are satisfactory. There is an infection control policy and protective clothing was seen to be used. The bathroom carpet has been replaced with washable floor covering. The carpet in toilets must also be replaced with washable floor covering for infection control purposes.
Glencoe House Nursing Home D52-D04 S61826 Glencoe V240523 280705 Stage 4.doc Version 1.40 Page 15 Glencoe House Nursing Home D52-D04 S61826 Glencoe V240523 280705 Stage 4.doc Version 1.40 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29 Recruitment procedures are robust and offer protection to the service users. EVIDENCE: The home operates an equal opportunities policy. Recruitment files inspected contained the documents required by legislation. Staff are issued with terms and conditions of employment and a relevant job description. Relevant employment checks are made. Glencoe House Nursing Home D52-D04 S61826 Glencoe V240523 280705 Stage 4.doc Version 1.40 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Appropriate training and safety checks are undertaken to ensure the health safety and welfare of service users and staff. EVIDENCE: The management endeavour to ensure that working practices are safe. Relevant service checks take place as required. Staff receive statutory training regularly. The training records need to be updated. There is a person trained in first aid on duty at all times. The kitchen staff have all received food hygiene training. Accident reporting complies with data protection and the Registered Manager audits all accidents in the home. Health and safety risk assessments have been undertaken. Glencoe House Nursing Home D52-D04 S61826 Glencoe V240523 280705 Stage 4.doc Version 1.40 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x 2 STAFFING Standard No Score 27 x 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x 3 Glencoe House Nursing Home D52-D04 S61826 Glencoe V240523 280705 Stage 4.doc Version 1.40 Page 19 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13(2)17(1 )(a) Sch 3 Requirement Transcribing of medicines onto the MAR charts must be witnessed and dated with two signatures recorded (previous timescale not met) Medicines prescribed for an individual service user must not be administered to anyone else There must be hot water provided to the hand washing facility in the laundry. Carpets in toilets must be replaced with suitable flooring that can be washed, for Infection control purposes. Timescale for action 28/07/05 2. 3. 4. 9 26 26 13(2)17(1 )(a) Sch 3 13(3) (4) 13(3)(4)( a)(b)(c) 28/07/05 19/09/05 30/01/06 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. Refer to Standard 7 7 7 Good Practice Recommendations Audits of falls for individual service users should be recorded in their daily records All those involved in the care plan review should sign the relevant sheet. The service user or their representative should sign as agreeing their care plan
D52-D04 S61826 Glencoe V240523 280705 Stage 4.doc Version 1.40 Page 20 Glencoe House Nursing Home 4. 5. 6. 7 18 38 A monthly review of the care plans should take place and those involved should sign the relevant sheet The Adult Protection policy should include the reporting of incidents to the Commission for Social Care Inspection Staff training records need to be updated Glencoe House Nursing Home D52-D04 S61826 Glencoe V240523 280705 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection John keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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