Inspection on 25/05/05 for Gloucester House Nursing Home

This inspection was carried out on 25th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Gloucester House Nursing Home 19/04/07

Gloucester House Nursing Home 06/06/06

Gloucester House Nursing Home 03/11/05

Gloucester House Nursing Home 14/12/04

Gloucester House Nursing Home 29/06/04

Gloucester House Nursing Home 11/02/04

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

CARE HOMES FOR OLDER PEOPLE Gloucester House Nursing Home Lansdowne Road Sevenoaks Kent TN13 3XU Lead Inspector Elizabeth Baker Unannounced 25 May 2005 09:55 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. Gloucester House Nursing Home H56-H06 S26173 Gloucester House V226956 240505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Gloucester House Nursing Home Address Lansdowne Road Sevenoaks Kent TN13 3XU 01732 741488 01732 741664 Gloucester@agecare.org.uk AgeCare, The Royal Surgical Aid Society 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 Philippa Jane Saunders Care Home with Nursing 54 Category(ies) of Old age (54) registration, with number Physical disability (10) of places Terminallhy ill (10) Gloucester House Nursing Home H56-H06 S26173 Gloucester House V226956 240505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14 December 2004 Brief Description of the Service: Gloucester House Nursing Home is a care home providing nursing care for 54 Older People. Age Care, The Royal Surgical Aid Society, is the registered provider. The home is a purpose built two-storey building. Accommodation is on two floors. A 13-person passenger lift is available. Bedroom accommodation comprises 42 single and 6 double bedrooms. All bedrooms have ensuite facilities. The home is divided into four villages. Each village has two-day rooms. In addition to these day rooms, a large communal dining room and lounge are situated on the ground floor. A library/computer room is located on the first floor. All rooms used by residents are connected to the nurse call system. The rear gardens are designed to enable physically disabled and wheelchair users to move easily around. The home is approximately one mile from the main A25 trunk road and Sevenoaks Town Centre. Sevenoaks has a good range of amenitities including shops, banks, places of worship, restaurants, cinema and theatre. Sevenoaks is served by public transport, including rail services to London and the Kent and Sussex Coast. There is ample car parking. Gloucester House Nursing Home H56-H06 S26173 Gloucester House V226956 240505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over eight hours on the 25 May 2005. Lead Inspector Elizabeth Baker carried out the inspection. A partial tour of the home took place. Residents and staff were spoken with both privately and collectively. Senior Nurse Mrs W Braund provided assistance. Feedback was provided to the Registered Manager Mrs P Saunders at the conclusion of the inspection. Some judgements about the quality of care, life and choices were taken from direct conversation with residents, direct observation and evidencing records held at the home. Some records were inspected as part of case tracking and to assess work on recommendations made at the previous inspection. At the time of the visit 49 residents requiring nursing care were residing at the home. What the service does well: What has improved since the last inspection? What they could do better: Progress on replacing some corridor carpets is slow. These carpets as well as the new one in reception room are badly stained in many places, giving a poor Gloucester House Nursing Home H56-H06 S26173 Gloucester House V226956 240505 Stage 4.doc Version 1.30 Page 6 first impression of the home. The standard of cleaning in certain areas has declined, which presents a potential risk to residents and staff. Communication methods must be developed to ensure residents with sight impairments are better informed particularly in respect of the home’s complaints procedure, service user guide and statement of purpose. Registered Nurses and other care staff must ensure nursing records and supporting documents, are complete of residents all known needs and problems, to ensure they receive the appropriate care. Registered Nurses must ensure the medication records are maintained to provide a precise administration audit trail, to ensure residents’ safety. For their own protection, Registered Nurses must not re-sheath needles. The majority of residents live at the home for the rest of their lives. The home is also registered for Terminal Illness. As death and dying is an important aspect of care “last rites” information must be obtained and recorded to minimise any undue distress to relatives and or advocates at a sensitive time. 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. Gloucester House Nursing Home H56-H06 S26173 Gloucester House V226956 240505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Gloucester House Nursing Home H56-H06 S26173 Gloucester House V226956 240505 Stage 4.doc Version 1.30 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 standard(s) 1, 3 and 5 The current format of the home’s Statement of Purpose and Service User Guide is inadequate for residents with sight impairment to make an informed decision about the home. Residents are assessed in their current surroundings and encouraged to visit the home prior to admission to ensure the home is appropriate. EVIDENCE: The home’s Statement of Purpose and Service User Guide are only available in plain English format, making it difficult for residents with sight impairments to make an informed choice. The home has a number of residents who are registered blind. The Manager and or other Registered Nurses endeavour to visit prospective residents in their own surroundings to carry out a detailed assessment of their needs prior to a decision of admission being made. The prospective residents and or their representatives are encouraged to visit the home prior to admission. Gloucester House Nursing Home H56-H06 S26173 Gloucester House V226956 240505 Stage 4.doc Version 1.30 Page 9 Residents are admitted on a trial basis and arrangements are made to assist them and their representatives in arranging transfers to other care facilities if that it is their wish. Gloucester House Nursing Home H56-H06 S26173 Gloucester House V226956 240505 Stage 4.doc Version 1.30 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, 9, 10 and 11 Residents are treated with respect so their dignity is assured. Residents care needs, wishes and risks are not adequately recorded, which could lead to some important aspects of care being overlooked. Some residents are at risk, as they are not properly supported with their medications. EVIDENCE: Four residents were interviewed. For case tracking purposes their care records were inspected. Through discussion with staff it was evident that care needs were known and mostly being addressed. Disappointingly this information was not always recorded in the respective plans. It was difficult to establish whether the plans had been composed with input from the resident and or their representative as they did not contain residents’ signatures or reference to any involvement. Care plans are supplemented with clinical risk assessments and other nursing records. For a resident who is registered blind and likes to go for a walk, the Missing Persons form was incomplete and the risk assessment did not record if all relevant parties as well as the resident, had been involved in the ultimate decision. For a resident with special dietary needs, there was no current nutritional risk assessment form. It was difficult to obtain a current picture of a particular resident’s night care needs, as the Gloucester House Nursing Home H56-H06 S26173 Gloucester House V226956 240505 Stage 4.doc Version 1.30 Page 11 supporting papers were not kept in date order. There was no specific care plan for a resident with osteoporosis, including details of the specific administration requirements of a once a week medication for this condition. Residents receive input from other specialist health care professionals when their assessed needs require this. Registered Nurses support residents with their medications. Medicine administration details are recorded on resident’s individual computer generated charts. A chart referring to PRN medicines (administer when required) had been altered to regular administration. There was no indication of who and why the handwritten changes had been made nor the date the changes came into effect. A resident said they had a particular food allergy. The corresponding medicine chart stated “no known allergies”. The care plans did not contain this information either. For legal purposes there must be a clear audit trail of medicines administered. Some Registered Nurses continue to re-sheath sharps, presenting themselves with an unacceptable risk of a needle stick injury. The home is registered for Terminal Illness. The records inspected did not provide sufficient information in respect of residents’ wishes and preferences in respect of death and dying. This is an important aspect of care and must be addressed to prevent additional distress to relatives at a sensitive time. This issue is outstanding from previous inspections. Gloucester House Nursing Home H56-H06 S26173 Gloucester House V226956 240505 Stage 4.doc Version 1.30 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, 13, 14 and 15 The home provides a variety of appetising meals and caters for special diets. Residents are provided with a vast choice of social, religious and recreational activities to enrich their lives. EVIDENCE: An art workshop was taking place on the day of the inspection. Many residents enjoy this activity and their work is displayed throughout the home. The home is now arranging for some of the work to be displayed at Sevenoaks Library as well as a London Art Gallery. Although some residents have pursued painting as a hobby throughout their life, for others this is a new found talent. Some residents have re-gained dexterity by taking up this new hobby. Staff should be applauded in this initiative. All residents are provided with a monthly written programme of activities. Current activities include Tai Chi, poetry, bingo, quizzes, knitting circles. A resident said she enjoys the Tai Chi exercises and another resident said they had enjoyed playing bingo. The home has a mini bus. External trips for May include Hever Castle and Polhill Garden Centre. A resident said she had enjoyed a trip to the Bluewater Shopping Centre. Special occasions and birthdays are celebrated at the home, recent events being VE Day and a resident’s 90th Birthday. Gloucester House Nursing Home H56-H06 S26173 Gloucester House V226956 240505 Stage 4.doc Version 1.30 Page 13 Some care records contained social care plans. The plan for a particular resident was not reflective of the information described at the inspection. A choice of appetising and varied lunchtime meals was served to residents. Most residents spoken with were complimentary about their meals. Comments included “very good food – just like home cooking”, I’m not hurried to finish my meals” and “food is good”. Where to eat is flexible in that residents have the option of taking their meals in the main dining room or in the small dining areas situated in on each “village”. Some residents prefer to eat their meals in the privacy of their bedrooms. Large print menus are circulated to all residents on a weekly basis. The day’s menu was seen displayed in the main reception room. Although this is very useful for residents who can see and read, it may present difficulties for residents with sight impairments in that they have to rely on staff to inform and remind them of the daily choices. Gloucester House Nursing Home H56-H06 S26173 Gloucester House V226956 240505 Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Not all complaints are handled properly to provide residents with confidence that their concerns and views will be listened to, taken seriously and acted upon. Training and procedures are in place to ensure people living at the home are protected from abuse. EVIDENCE: With the exception of one, residents said they know who to speak to if they have a complaint or a concern. One resident said they had difficulty in conveying their views on the food they had received recently, as they did not know who to report the matter to. The concerns had not been recorded in the home’s complaints/comment book, neither was the Registered Manager aware of this. The home complaint’s procedure is only available in a plain English format. The complainant is registered blind. To ensure all residents are fully aware of the home’s complaints procedure, details must be available in a format appropriate to their assessed needs. Staff spoken with said they had received adult abuse training and described appropriately what they would do if they had a suspicion of adult abuse. Gloucester House Nursing Home H56-H06 S26173 Gloucester House V226956 240505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 22, 23 and 26 The standard of cleaning in certain areas of the home has declined and the condition of corridor carpets has not improved. Although the situation does not pose a serious risk to residents, it does not create a pleasant and pleasing environment to live in. Residents with sight impairments are potentially at risk because their specific environmental needs have not been appropriately assessed. EVIDENCE: Although the home was odour free, poor cleaning standards were seen in some parts of the home. In one bathroom cobwebs were hanging between ceiling mobiles and the window frame as well as the inside of the window frame, and the ventaxia in the first floor clinical room was dirty. There was debris on the floor in the physiotherapy/training room and the unit cupboard doors were marked with spillages. Carpets in corridors on both floors as well as the reception room, were badly stained, which is not environmentally pleasing to residents or visitors. The Commission had been previously been informed that some of the corridor carpets were to be replaced. Sadly this has not yet happened. Gloucester House Nursing Home H56-H06 S26173 Gloucester House V226956 240505 Stage 4.doc Version 1.30 Page 16 The width of corridors allows wheelchair users to move independently around the home. Handrails are also provided in corridors to aid mobility. The home employs its own Physiotherapist and residents interviewed said physiotherapy is important to them. However the home does not have appropriate facilities to assist mobile residents who are sight impaired. A recently admitted resident described the difficulties they encounter in moving around the home, finding their whereabouts and distinguishing staff. The Manager confirmed she would be seeking professional advice on how to address the matter. Gloucester House Nursing Home H56-H06 S26173 Gloucester House V226956 240505 Stage 4.doc Version 1.30 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 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) 27, 28 and 30 Staff morale is high resulting in an enthusiastic workforce that works positively with residents to improve their quality of life. The arrangements for induction are good and staff demonstrate an understanding of their roles and responsibilities. The Provider continues to demonstrate its total commitment to ensuring all staff are appropriately trained. EVIDENCE: Staff interviewed said how much they enjoy working at the home and that they are provided with training relevant to their roles. All new unregistered care staff are subject to a comprehensive induction programme, which equips them with the knowledge and skills required to effectively carry out their duties. The training coordinator maintains a matrix of core training, including fire, moving and handling and first aid. Registered Nurses and care staff receive additional training specific to their roles including palliative care, challenging behaviour, Parkinson’s’ Disease and Motor Neuron. The majority of unregistered care staff are or are working towards attaining NVQ level II care. Staff were undertaking their duties in an unhurried manner. Residents said staff respond to their calls quickly although they sometimes have to wait for actual assistance. In addition to care staff, staff are employed for administration, activities, management, cleaning, laundry, catering and maintenance. Gloucester House Nursing Home H56-H06 S26173 Gloucester House V226956 240505 Stage 4.doc Version 1.30 Page 18 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) 31, 32 and 36 The manager is supported by senior staff in providing clear leadership throughout the home. Residents’ views on services and facilities provided at the home are sought to ensure it is run in their best interests. EVIDENCE: The Registered Manager, Mrs Saunders, is a Registered General Nurse registered with the Nursing and Midwifery Council. Mrs Saunders is in the process of attaining the requisite Registered Managers Award and hopes to complete this by the end of the summer. All care staff receive regular supervision. Registered Nurses also receive clinical supervision, which ensures their nursing practice remains current. Residents meetings regularly take place and heads of departments are invited to attend. Indeed residents have specifically requested the chef attends the next meeting [scheduled for the 26 May 2005] so they can discuss certain matters with her. Gloucester House Nursing Home H56-H06 S26173 Gloucester House V226956 240505 Stage 4.doc Version 1.30 Page 19 The Provider’s representative visits the home on a regularly basis. However details of these visits are not always reported to the Commission on a monthly basis as required by Regulation 26. Gloucester House Nursing Home H56-H06 S26173 Gloucester House V226956 240505 Stage 4.doc Version 1.30 Page 20 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 2 x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 x 3 2 3 x x 2 STAFFING Standard No Score 27 3 28 4 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 2 3 x x x 2 x x Gloucester House Nursing Home H56-H06 S26173 Gloucester House V226956 240505 Stage 4.doc Version 1.30 Page 21 NO 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. 2. 3. Standard 1 16 36 Regulation 4 and 5 22(6) 26 Requirement The Statement of Purpose and Service User Guide must be available in relevant formats. The homes complaints procedure must be available in suitable formats. Monthly written reports of the Responsible Individuals visits to the home must be submitted to the Commission. A programme of carpet cleaning and replacement must be instigated. Timescale for action 31/08/05 31/08/05 15/06/05 4. 19 23 31/08/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 7 Good Practice Recommendations Care plans must evidence they have been completed with input from residents and/or their representative; care plans must be complete of all assessed needs and problems, and social and biographical details Clinical risk assessments and forms must be available and complete, including nutrition and missing person forms Medication charts must state the name of the person authorising and changing administration details; precise H56-H06 S26173 Gloucester House V226956 240505 Stage 4.doc Version 1.30 Page 22 2. 3. 8 9 Gloucester House Nursing Home 4. 5. 6. 7. 8. 9 11 22 26 31 medication administration details must be recorded; records of known allergies must be kept up to date Sharps must not be re-sheathed Details of residents wishes and preferences in respect of death and dying and last rites, must be obtained and recorded Appropriate facilities, including signage, must be in place to residents with sight impairments. The standard of cleaning must be improved The Manager must successfully complete the management qualification. Gloucester House Nursing Home H56-H06 S26173 Gloucester House V226956 240505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone, Kent, ME16 9NT 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 Gloucester House Nursing Home H56-H06 S26173 Gloucester House V226956 240505 Stage 4.doc Version 1.30 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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