Inspection on 07/10/05 for Glengariff

This inspection was carried out on 7th October 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Glengariff 14/10/08

Glengariff 07/11/07

Glengariff 29/01/07

Glengariff 01/02/06

Glengariff 22/03/05

Glengariff 21/08/04

Glengariff 27/02/04

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

CARE HOMES FOR OLDER PEOPLE Glengariff 59 Moss Lane Pinner Middlesex HA5 3AZ Lead Inspector Clive Heidrich Unannounced Inspection 7th October 2005 09:00 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 Glengariff DS0000017534.V256666.R01.S.doc Version 5.0 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. Glengariff DS0000017534.V256666.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Glengariff Address 59 Moss Lane Pinner Middlesex HA5 3AZ 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) 020 8866 5804 020 8426 3357 Mr & Mrs D.E Spanswick-Smith Mrs Karen Spanswick Smith Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Glengariff DS0000017534.V256666.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd March 2005 Brief Description of the Service: Glengariff is a registered care home providing personal care and accommodation for up to 16 older people. The group of people living at the home at the time of the inspection were of mixed gender. There were five vacancies at the time of the inspection, although a number of these were on hold. The home is a family-run business, having been established by the owners in the 1960s. The manager is the daughter of the owners. She has been much involved in the business over a number of years, and became the home’s registered manager in 1995. The family own a similar care home, Abbotsford, at 53 Moss Lane. The home is situated in a quiet residential area of Pinner. It is fifteen minutes walk from local shops and public transport links. The forecourt has parking for a maximum of seven cars. The building has a ground and a first floor. Access is by passenger lift or stairs. All bedrooms are fully furnished, with some on the ground floor. The home has two communal bathrooms, both of which have facilities to support with getting in and out of the bath. There are four other individual toilets available. The home has a large lounge that offers three interconnected areas, one of which doubles as the dining area. The home also has a paved garden to the rear. Glengariff DS0000017534.V256666.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place across a dry day in October. It lasted until 2pm. The lead inspector was accompanied by the local CSCI pharmacy inspector who audited the home’s medication systems. The lead inspector met with the majority of the eleven service users living in the home at the time, along with two professional visitors, various staff members, and the manager who was present from about 10am. The inspection also involved the checking of some records, observing care practices, and inspecting most of the home’s environment. The inspectors thank all at the home for their patience and helpfulness throughout the inspection. What the service does well: What has improved since the last inspection? Work has started for the redecoration and refurbishment of areas of the home that need it. Medication systems, as audited by the CSCI pharmacy inspector, were judged to have improved significantly since the last such visit. Formal supervision sessions have been introduced to staff members in a smallgroup format, to provide further support for their work. Glengariff DS0000017534.V256666.R01.S.doc Version 5.0 Page 6 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. Glengariff DS0000017534.V256666.R01.S.doc Version 5.0 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 Glengariff DS0000017534.V256666.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed on this occasion. EVIDENCE: Glengariff DS0000017534.V256666.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Service users’ needs are mostly set out in an individual plan of care. Some areas of the plans need reviewing to ensure that all significant needs are included, and that they have explanations of how staff should address these needs. Service users’ health care needs are very well met in practice. Service users’ medication needs are supported by much-improved practices and systems since the last CSCI pharmacist’s visit. Service users are treated kindly and individually by an experienced staff team. They are given privacy as wished for. EVIDENCE: The individual care plans of two service users were checked through. The plans reflected sufficient detail about many of the needs of the service users. Feedback from staff and daily records showed that there were a small amount of ongoing needs that were not being addressed within the plans. Monthly reviews were recorded as taking place, but they seldom added anything to the plans. This was discussed with the manager, and it was agreed that the home Glengariff DS0000017534.V256666.R01.S.doc Version 5.0 Page 10 would instead aim to summarise the key needs of each service user monthly and explain what any changed plans are to address these needs. It was identified that some service users’ risk assessments were in need of updating, to ensure the minimisation of risks. The manager explained that a new format was about to be used in terms of fall management. She agreed that the general assessments would benefit from reviewing and updating. The feedback from a couple of health professional visitors during the visit was positive about how the service users’ health needs are addressed. Comments included that staff follow instructions, that staff communicate well amongst themselves, and that staff refer any concerns appropriately. The manager was able to fully explain about the health needs of individual service users. Checks of attendance at health professional appointments, and of staff following up on professional checks, were found to take place suitably. It was also clear from records that staff communicate with each other to address service users’ health needs. The dental needs of service users were discussed with the manager following a lack of information about this within the two service user files checked. She clarified that their local dentist provides free services only on an as-needed basis. It was agreed that the manager would look into the dentists providing some training to staff, to complement their knowledge of the concerns with service users’ mouth care needs that should be referred to the dentist. Service users may also use the services of a local private chiropodist, whose details were on display on the notice-board in the hallway, in addition to the NHS service. No concerns about service users’ nail or mouth care were observed during the visit. Regular weight checks records are kept for all service users. Checks of these found no concerns about the weight monitoring of service users. Medication systems, as audited by the CSCI pharmacy inspector, were judged to have improved significantly since the last such visit. A separate report about this is available on request. Feedback from service users about the staff working in the home was almost completely positive. One service user said that staff treat them well, and another that staff always attend if called. The lead inspector observed staff treating service users respectfully and kindly. Good support is provided to ensure that service users’ individual appearances are appropriate. Glengariff DS0000017534.V256666.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15 Service users are able to reasonably choose lifestyles in the home that match their preferences. The provision of interactive activities in the afternoon for service users however needs to happen daily. Service users are provided with an appealing diet of generally home-cooked food that meets their needs. EVIDENCE: At the start of the visit, one service user was up and dressed and using the lounge. Staff explained that all service users had received breakfast at around 8:30am as is the norm. They also noted that they support service users to get up when the service user is ready. Hence this process appeared to be unhurried, and was completed late morning. Drinks and biscuits were served to everyone at around 11am, and lunch took place at around 1pm. The lunch for the day, of home-cooked battered fish with chips and fresh vegetables, was written on the menu-board in the lounge during the morning. Staff responded appropriately to requests from service users at lunch, and there was no-one who needed significant staff support. Glengariff DS0000017534.V256666.R01.S.doc Version 5.0 Page 12 All service users spoken with were positive about the food in the home, and stated that they get enough to eat. Records showed that snacks can be acquired even very late in the evening. The manager clarified that she plans to implement a pre-planned system of ensuring that service users are offered an activity each day, and that she is discussing its implementation with afternoon staff. This is necessary, as the activities book suggests more often than not, there are no activities offered in the afternoon. The manager stated that she felt that this book reflects poorly on activities taking place. Those service users asked fedback that there is generally enough to do. The manager was keen to show the artwork that some service users had recently undertaken with the support of staff. Service users continue to benefit from regular visits of a musician and a hairdresser. The home also provides for recreation through a television, recorded music, newspapers, the mobile library service, and a number of friendly cats. Glengariff DS0000017534.V256666.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed on this occasion. EVIDENCE: Glengariff DS0000017534.V256666.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All of them Service users live in an established and clean environment that has older-style décor and furnishings. The home needs redecoration in some areas whilst other areas such as the lounges have recently benefited from this. Plans are in place to redevelop the kitchen and laundry areas, fit radiator covers, and install further sinks, which will help to minimise risks to service users from accidents or infection. Service users’ bedrooms are sufficient and comfortable. Service users are supported to acquire any equipment they need to increase mobility and independence. EVIDENCE: The home has a lot of older-style furnishings and décor that both reflect its long-standing use as a well-established care home and which are likely to match the preferences of most service users. Those service users spoken with spoke positively of the environment and their bedrooms, and stated that the home is kept warm enough. Glengariff DS0000017534.V256666.R01.S.doc Version 5.0 Page 15 The home has been in a tired but passable state of repair in some areas in recent years. The lounge areas were redecorated earlier this year to good effect, and the outside of the home was in the process of appropriate redecoration during this visit. The manager noted that further planned internal refurbishments would shortly be taking place. These include: • extensive work on the kitchen that has already included consultation with the local environmental health department, • a phasing-in of radiators covers that will start with those that present the most risks of scalding, • upgrading of the laundry area facilities, and • some redecoration of bathrooms and toilets. The home has a reasonably-accessible garden area that is due to be refurbished before the next summer. This should enable greater ease of mobility for the service users to at least access the garden furniture on the patio. A number of bedrooms were seen. Many had older-style furnishings that were in a sufficient state of repair. The recommended furnishings under standard 24 were in place within most rooms seen. All bedrooms have fixed staff-call bells for service users to use if they need support. Cords can be attached to these, so that service users may call for staff whilst seated. A check of the system found both the bell to go off, and for a staff member to attend promptly. It is recommended that staff undertake regular and recorded checks of these systems, in case any bell is not otherwise discovered to be faulty. The manager explained that she has contacted the local falls specialist unit directly, on behalf of service users who are identified as having needs in this area. That service provides assessments and equipment, but the home will also provide the equipment where the manager feels that it is clearly needed. A number of service users have individually-named zimmer-frames that allow greater independence of mobility. The home has two hoists with which to assist service users to get in and out of the bath or for other mobility support issues. Professional checks of these hoists were up-to-date. There were no concerns about cleanliness and odour, from the tour of the home undertaken during this visit. Glengariff DS0000017534.V256666.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 30. Service users are supported by an established and knowledgeable staff team and so are in safe hands at all times. Whilst staffing levels are reported to be sufficient to meet service users’ needs, records of this must be improved on. EVIDENCE: The manager stated that there is currently one staffing vacancy in the home. It will be filled once appropriate recruitment checks have been made. Many of the staff have worked in the home for many years, and hence the turnover of staff is very low. A few staff live at the back of the premises, and are hence available on-call should any difficulties arise, especially at night. The manager noted that she aims to uphold the staffing levels, but that they occasionally go one short when the service user occupancy level is lower (as during the inspection). The roster records for the home were not being kept up-to-date, which suggested that major shortfalls may sometimes occur. There was however no feedback from service users about this. The deputy noted that a new recording system was about to be introduced, and the manager agreed to ensure that sufficient records are kept. The manager stated that the home continues to uphold minimum NVQqualified staffing levels, as was established at previous inspections. She plans to enrol more staff on an NVQ course early next year. The most recent training for staff was earlier this year, for fire safety training and a medication course that ran across a number of weeks. Glengariff DS0000017534.V256666.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 36 and 38. Service users benefit from staff that are appropriately supervised, good lines of communication between the manager and staff, and an experienced management approach of the home. The home is run in the best interests of service users in many ways, but there needs to be a formal audit of service users’ and the representatives’ views to ensure that the service’s progression is clearly linked to those views. Service users and staff benefit from sufficient standards of health and safety in the home. EVIDENCE: Formal supervision sessions have been introduced to staff members in a smallgroup format, to provide further support for the work. The manager showed good awareness of how to make these sessions beneficial for all. Records are being kept of the meetings. Glengariff DS0000017534.V256666.R01.S.doc Version 5.0 Page 18 The manager was able to explain about the working-practice concerns that some staff have had with some service users’ behaviours. She noted that she informally meets with staff regularly to listen to such feedback, in addition to the new supervision sessions, and that actions to address the concerns are then taken. The manager is planning to undertake a formal audit, amongst people involved in the home, about the care provided, as required under standard 33. A report about the findings from this will be circulated. A number of health and safety systems were checked on. Weekly checks are recorded for the hot water temperatures from a sample of taps in the home, and for a sample of fire points across the home. There are also regular recorded checks of the temperatures of all fridges and freezers in the home. Temperatures were at an appropriate level. A sample of fridges and freezers were found to be sufficiently clean. Fire refresher training is provided monthly for sets of staff. Fire drills also take place monthly. It is recommended that records of these include the time of day and the length of time to evacuate, so as to better address any concerns. It is recommended that staff undertake and record visual checks of the emergency lighting on a regular basis, in case of any faults developing inbetween professional checks of these lights. The manager noted that this was the main advice of the fire authority at their recent visit of the home where standards overall were found to be satisfactory. Glengariff DS0000017534.V256666.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 3 2 3 3 3 2 2 STAFFING Standard No Score 27 2 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 2 X X 3 X 3 Glengariff DS0000017534.V256666.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 1 7 15 The manager must ensure that all the care needs of each service user are identified and addressed 01/12/05 within their individual care plan system. Improvements are needed to service users’ risk assessments in terms of reviewing them after a service user has falls, and in terms of stating the main actions needed to address any significant risks. (Previous timescale of 1/9/05 not met) 2 7 13(4), 14, 15 01/12/05 3 9 13(2) The two requirements of the CSCI pharmacy inspector’s report must be addressed. The manager must ensure that an activity for service users is planned for, offered, and recorded about every day of the week. (Previous timescale of 1/9/05 not met) 14/10/05 4 12 16(2)(m, n) 15/11/05 5 Glengariff 19 23(2)(b), The registered people must clarify in writing to the CSCI DS0000017534.V256666.R01.S.doc 01/12/05 Version 5.0 Page 21 39(h) what the refurbishment plans for the home are. (Previous timescale of 1/9/05 not met) The registered people must ensure that the upstairs bathroom and the toilet nearby have sinks installed. (Previous timescale of 1/10/05 not met) Upgrades to the home must include the covering of radiators to minimise risks of scalding. (Previous timescales of ‘by upgrade’ and 1/10/05 not met) A sink must be set up in the laundry room. (Previous timescales of 1/12/04 and 1/10/05 not met). The floor of laundry room must be replaced due to the significant crack in it across the room. 6 21 16(2)(j), 23(2)(j) 01/02/06 7 25 13(4), 23(2)(a) 01/12/05 8 26 16(2)(j), 23(2)(a) 01/10/05 9 26 23(2)(b) There must be a working light bulb fitted to the entrance area of the laundry room. The manager must ensure that the record of which staff worked which shifts is kept fullyrecorded and up-to-date. It is necessary for the manager to provide a report to involved people (service users, relatives, and the inspector) about a review of care at the home that includes consultation with service users and relatives. 01/12/05 10 27 17(2) sch. 4 part 7 01/12/05 11 33 24 01/11/05 Glengariff DS0000017534.V256666.R01.S.doc Version 5.0 Page 22 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 7 Good Practice Recommendations It is recommended for the monthly summaries of each service user’s individual plan to be changed to a separate and ongoing document that summarises the key needs of the service user monthly and explains what any changed plans are to address these needs. It is recommended for the manager to request their local dentist to provide some training to staff, about what needs referral to the dentist in terms of service users’ mouth care needs. All bathrooms and toilets felt functional. Refurbishments should make their appearance more attractive. It is recommended that staff undertake regular and recorded checks of the staff-call bells within bedrooms. The manager is recommended to enable further care staff to pursue the NVQ level 2 in care qualification. It is recommended that fire drill records include the time of day and the length of time to evacuate, so as to better address any concerns. It is recommended that staff undertake and record visual checks of the emergency lighting on a regular basis, in case of any faults developing in-between professional checks of these lights 1 2 8 3 4 5 21 22 28 6 38 7 38 Glengariff DS0000017534.V256666.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Glengariff DS0000017534.V256666.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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