Inspection on 06/06/06 for Gloucester House Nursing Home

This inspection was carried out on 6th June 2006.

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

Other inspections for this house

Gloucester House Nursing Home 19/04/07

Gloucester House Nursing Home 03/11/05

Gloucester House Nursing Home 25/05/05

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 Mrs Ann Block Key Unannounced Inspection 6th June 2006 09:25 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 Gloucester House Nursing Home DS0000026173.V296152.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. Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gloucester House Nursing Home Address Lansdowne Road Sevenoaks Kent TN13 3XU 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) 01732 741488 01732 741664 gloucester@agecare.org.uk AgeCare, The Royal Surgical Aid Society Mrs Philippa Jane Saunders Care Home 54 Category(ies) of Old age, not falling within any other category registration, with number (54), Physical disability (10), Terminally ill (10) of places Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd November 2005 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 six 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 is 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 amenities 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. Current fees range from £570.00 for a shared room and from £822.46 to £865.00 for a single room. Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key inspection was carried out by Ann Block, regulatory inspector, including an unannounced site visit to the home between 9.23am and 6.22pm on Tuesday 6th June 2006. During the site visit residents, the manager and staff agreed to speak with the inspector both privately and in groups. Four residents were case tracked which included talking with the resident where possible, talking with staff involved in their care, looking at associated records and observing practice. A tour of part of the home was made. As part of the key inspection process comment cards are provided. At the time of writing this report, responses were received from 11 residents, 10 relatives and friends and 9 health and social care professionals. Where appropriate evidence for judgements about the quality of service includes responses from this survey. Judgements may also include using evidence from previous inspections where outcomes remain the same. Feedback was provided to the manager during and at the end of the site visit. Comments included: From residents: ‘Very good and friendly staff always ready to help’ ‘I chose the home because it came highly recommended’ ‘During the 3½ years I have been a resident at GH I have been very happy’ From relatives: ‘He has received attention to his needs beyond the usual responsibility of nursing/care staff. I have nothing but praise for the way he gets attention.’ ‘I feel Gloucester House give a high standard of care.’ From health and social care professionals: ‘I have always found the home to be excellent’. Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 6 ‘The home communicates very clearly to me their needs and seeks advice on a professional level’. What the service does well: What has improved since the last inspection? What they could do better: Residents’ satisfaction in having a good quality environment would be enhanced by implementing plans for upgrading, refurbishing and replacement of areas which need attention. Residents confidence that staff have the qualities to work with them would be enhanced when all staff have criminal records bureau checks, recruitment is properly carried out and evidenced, proper records are held of training and recruitment and supervision is carried out at least 6 times a year for care staff. Residents would be more secure that Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 7 staff have the information to work with them when care plans contain good detail of personal, social and spiritual care and the daily record evidences how this has been achieved. That medication has been administered correctly will be better managed when the system for staff administering prescribed creams is reviewed. Residents’ safety will be better achieved when doors which need to be locked are kept locked. Evidence that residents’ monies are well managed will be better achieved when records are more accountable. Residents and others will know that any complaints or niggles about the service are listened to and actioned when there is evidence of how and whether this has been achieved. 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 DS0000026173.V296152.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 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 the following standard(s): 1,2,3,4,5 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can make a choice whether Gloucester House will be suitable for them through a sound admission process. EVIDENCE: Residents have written and taped information to help them make a judgement whether the home will be suitable. A number of residents said that family had arranged the moving in process. One resident said her son had looked round a number of homes and after considering them all decided that Gloucester House would be the most suitable. Another said that her daughter in law had visited Gloucester House and knew immediately because of its friendliness and welcome that the home would be suitable, the resident agreed that the right choice had been made for her. It was evident that generally the home could meet the needs of those accommodated there. The manager is aware of the category of registration Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 10 and ensures that action is taken where the home can no longer meet need. It is planned for a variation of condition of registration is applied for in respect of named individuals who come outside the current registration category but whose needs remain met in the home. Privately funded residents have a contract which gives basic information on what residents can expect to receive for the fee they pay and sets out terms and conditions of occupancy. It is planned to provide funded clients with a similar agreement. At present copies of the contract between the proprietor and the funder are held on residents’ files. Residents spoke of meeting the manager before they were admitted, they remembered being asked questions, including their likes and dislikes. Residents’ files held copies of the initial assessment which contained evidence from a range of sources including mental and physical health assessments. The manager and senior staff are competent in carrying out assessments using their experience and training to make judgements whether the home would be suitable. The home was able to send a Polish speaking member of staff out as part of a recent assessment to communicate with a potential resident whose first language is Polish. Few residents felt they had been in a position to visit the home before admission and as mentioned left the arrangements to family. Visits by prospective residents or their family are welcomed, there are opportunities to meet other residents and view the available room. Residents are offered a trial period where they can judge whether the home is right for them. Intermediate or rehabilitative care is not offered. Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 11 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): 7,8,9,10 & 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have their care and health needs set out in a plan of care however expanding this to include better detail of social and spiritual needs would improve this process. EVIDENCE: Each resident has a care plan, where possible this will be discussed with the resident concerned or their family. The plan in most cases includes the basic information necessary to plan the individual’s care and is well structured with information clear and accessible. There remains a deficit in the identifying and recording of personal history, social, recreational and spiritual detail. The plan includes some risk assessments, including those in response to accidents or untoward incidents. When developing the plan the home has complied where possible with relevant clinical and social care guidelines. Evidence of updating information and changing actions appears on care plans. Daily records are made which record some activities of daily living. The records don’t reliably link to areas of specific need such as monitoring a Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 12 persons whereabouts or how improved nutrition would be promoted as indicated in the overall care plan . Residents have access to health care services that meet their assessed needs both within the home and in the local community. Care plans have a section to record interventions from other professionals. Those seen included reference to optical, dental and chiropody services. A separate physiotherapy report and intervention is maintained. The majority of residents use the same visiting medical officer who staff said was very good and committed to providing older people with a good quality of life. Where a resident has moved locally they may remain with their own GP. Residents spoke highly of the ‘home’s’ GP. Residents’ health is monitored and appropriate action taken. The home seeks professional advice on health care issues, acts upon it and generally is able to provide the aids and equipment recommended. There is evidence in the care plan of health care treatment and intervention, and a record of general health care information including weight monitoring and nutritional information. In some cases outcomes from these interventions are reflected in action to take, this should routinely be recorded in the care plan. As is often found, staff are better able to provide verbal updates to condition and need than is recorded. The home has a medication policy which is accessible to staff. Medication records are generally up to date for each resident and medicines received, administered and disposed of are recorded. There are suitable facilities to store medication and to dispense them from. Following advice given at a pharmacy inspection in November the registered person is working towards improvement. There needs to be clearer systems for accountability for prescribed creams as discussed with the deputy manager. Nursing staff are supported to undertake relevant training and to work towards PREP requirements. Where care staff administer prescribed creams there needs to be evidence of competency. Staff are aware of the need to treat residents with respect and to consider dignity when delivering personal care. This was very well evidenced during the inspection. Residents said they appreciate the qualities of the permanent staff. The home arranges for residents to enjoy the privacy of their own rooms and provides fixed screens in shared rooms. Residents are happy with the way that most staff deliver their care and respect their dignity. The home has policies and procedures, which inform staff how they should handle dying and death. Residents said the home was caring and discreet in supporting residents during their last stages. Staff and residents said the home had many commendations about the care they give at this time. The wishes of residents about terminal care and arrangements after death are not Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 13 always recorded, but staff are able to give an account of the arrangements. The manager is planning to implement end of life pathway plans. Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 14 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): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a setting which recognises them as individuals with the right to exercise control over their lives, who they see, what they eat and what activities they want to do. EVIDENCE: The routines of the home are planned around the residents’ needs and wishes. Systems enable the service to be flexible and changed to meet individual wishes. Residents said they were encouraged to live as life as close as possible to they had been used to at home. The home encourages residents to take control of their life and be actively involved in the running of the home. This involvement comes from meetings, one to one chats with senior staff and advocates. Residents said they feel comfortable in talking to staff and knew they would be listened to. They commented that senior staff were very approachable. Some felt that at times it was more difficult to find someone to talk to at weekends. The home takes residents feedback seriously and makes changes where possible. Staff listen to residents and make considerable effort to provide a flexible service, which enables them to enjoy a better quality of life. Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 15 An activities coordinator is employed who works 7 hours each weekday. The activities coordinator demonstrated a commitment to providing activities for older people including activities familiar to the group such as bingo, looking at ways a former hobby could be continued and encouraging new ideas. There is as strong emphasis on artwork, excellent pictures painted by residents are displayed around the home. An art exhibition is planned. Residents make cards which are sold for fundraising for future projects. Given the number of residents it is more difficult to spend one to one time with all those who need it, where time allows care staff provide such interactions. A minibus and driver are available and can be used for appointments or outings. A comment was made by two residents that they felt there were not enough outings. In contrast another commented that ‘there is always something arranged and I’m always reminded about activities when they are about to happen’. Family and friends feel welcome and know they can visit the home at any time. Staff always make time to talk to visitors and share information with the agreement of the resident. The design of the home provides seating areas within the communal areas of the home where residents can entertain their visitors, in addition to the privacy of their own room. It is clear that the home encourages individuals and groups from the community to visit the home, residents spoke of enjoying visits from pupils from Sevenoaks School. Residents individuality is well supported, they said they are encouraged to maintain independence but will be assisted in areas where they needs help. Residents are encouraged to take responsibility for their own financial affairs and to use their money as they wish. Residents have the opportunity to bring personal items with them to the home and are encouraged to keep personal effects which are important to them in their own room. The home believes that residents should always be aware of any information held and written by the home, and have the right to read any documents they wish and staff promote this. Residents said they were are of their care plan but weren’t interested in reading them as they trusted staff to know what to do. The inspector was able to join a group of residents for lunch and to observe preparation of a variety of foods for supper. Food and mealtimes are taken seriously by residents and staff. Much of a recent residents meeting was spent discussing new proposals for serving the lunch which would give residents more active choice at the time the meal was served and may resolve some of the niggles mentioned by residents. An experienced cook is responsible for providing quality nutritional meals that meet the cultural and dietary needs of the residents as recorded in the care plan, this is not supported by required documentation as referred to later in the report. The cook understands the preferences of residents and aims to offer old favourites and for people to try more unfamiliar food. Residents thought the standard of food was good Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 16 although one missed bread and dripping. Care staff are sensitive to the needs of those residents who find it difficult to eat and discretely give assistance with feeding. They are aware of the importance of ensuring residents are unhurried and comfortable with the process. Residents have a main dining room on the ground floor with additional dining areas on each wing. Tables are set attractively with the necessary cutlery and aids to help individuals during their meal. A number of residents choose to eat in their rooms. Residents spoke of having breakfast in their rooms and of the lovely bacon and eggs they had that morning. There are facilities for staff and visitors to make a drink with serveries on each floor, staff take round the drink trolley between meals. Drinks are readily available in bedrooms and the lounges. Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 17 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): 16,17 &18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have access to people who listen to any concerns and who will take action. Records do not reliably record how or whether this has been achieved. EVIDENCE: The service has a complaints procedure that gives the process of the complaint, relevant contacts and timescales. The complaints procedure is available within the home. Residents and others associated with the provision understand how to make a complaint. There is no formal system to record complaints which ensures that each element of a complaint has been properly investigated and responded to, or that action taken has resolved the problem. This may have led to a residents comment that ‘I know how to make a complaint but they don’t take any notice half the time’. ‘Niggles’ or minor complaints are recorded in a notebook held at reception, this has potential to compromise confidentiality but usually only refers to non-personal issues. These, and complaints made on an ad hoc basis, are not recorded in a manner which could be used as part of a quality assurance system. On a more positive note residents said they have plenty of opportunities to voice opinions about the home and know they will be listened to. There is a good understanding of the duty of care and of maintaining the safety of residents. There are local and AgeCare policies and procedures regarding protection of residents, including access to the Kent & Medway Joint Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 18 Working Protocol. Local policies are satisfactory, reviewed and updated. Within the policy it is clear when incidents need external input and who to refer the incident to as has been evidenced in practice. Links with external agencies are satisfactory and include CSCI, police and adult protection teams. All relevant staff demonstrate an awareness of the content of the policy and know what immediate action to take and when and who to refer any incident on to. The outcomes from any referral are satisfactorily managed, with issues resolved in collaboration with other professionals. Residents feel safe and supported. The home’s aims and objectives include the rights of residents. Residents are supported to live as independently as possible, exercising their rights to make choices and decisions with assistance when needed. Those who wish to place an election vote are supported to do so. The service policies refer to the rights of the resident in their placement. Staff are aware of the policies and work to them. Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have a satisfactory environment in which to live but which has areas needing updating and refurbishment. EVIDENCE: The service provides a homely environment. It has a rolling programme to improve the decoration, fixtures and fittings, but occasionally there is slippage of timescales due it is said to budget restrictions. The manager and AgeCare are aware of the need for refurbishment but priority had to be given to replacing the lift control and repairs to the heating system. There are a number of single rooms, a few double rooms, all of which have ensuite facilities. Those residents who are in shared rooms were aware when they chose the home that they would have to share. Residents can personalise their rooms and choose where they sit in the range of communal areas. Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 20 Residents say they are comfortable, the home is clean, warm, well lit and there is usually sufficient hot water. Residents said, with some relief, that the heating had worked effectively last winter but mentioned noisy valves on radiators which were being investigated. In addition to en-suite facilities there are communal toilets near the lounges and dining room, plus a toilet for visitors. Staff have their own rest area. There are a number of assisted baths including an adjustable height bath and Parker bath. Bathrooms are functional rather than attractive and at the time of the site visit were being used for storage of hoists and other equipment. Each wing has a sluice facility all of which had minimal odour at the time of the site visit. The home is generally clean and tidy, the appearance rather spoilt by areas of substandard décor, poorly presented balconies leading from the upper lounges, and two small lounges being used for storage. Residents spoke of good relationships with the domestic allocated to their wing and how she had a programme of deep cleaning and cleaning of curtains, a resident on another wing commented that ‘my bedroom could do with being cleaned more thoroughly’. At weekends one domestic is employed who does essential cleaning. There is an awareness of practices to ensure residents safety around the home with notices advising of risk areas. Given the needs of some residents accommodated, doors which state ‘fire door keep locked’ should be locked and the door to the laundry should also be locked to prevent risk to those residents who are confused but ambulant. Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 21 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): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are cared for by a staff team who understand and anticipate residents’ needs and wishes. Residents would be better protected by improvements to the recruitment procedure. EVIDENCE: Residents are generally satisfied that the care they receive meets their needs, but there are some times when no one is available to immediately help them. Some comments were made that call bells could take up to 25 minutes to be answered. The manager agreed this was not acceptable and would use the printout system to check where such situations were occurring. Staffing rotas try to take into account the times of high and low activity, residents and staff felt there was a good ratio of staff to residents with normally adequate time to provide health and personal care and support. They felt that deficits usually occurred at times when there were higher dependency needs. There is acceptable use of any agency staff, residents said this has been better recently as the home is fully staffed. There is a vacancy for an evening support cook, a member of care staff was covering but said this was on additional hours. The service recognises the importance of training, and delivers where possible a programme that meets any statutory requirements. Residents feel that staff are trained and able to deliver their care needs. Training records showed that Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 22 qualified staff have opportunities to update their skills, care staff are encouraged to undertake NVQ training with 70 of staff now qualified to NVQ level 2 or above. Most staff are clear regarding their role and what is expected of them. Residents said that staff working with them know what they are meant to do, and that they are generally able to meet their needs. They were less sure that the same could be said of agency staff. There was evidence of some excellent interactions between staff and residents, particularly where residents present challenges. Senior staff felt this was in part due to the personality of staff involved but also to training they had undertaken. References were however made to inappropriate communication by a minority of staff, the manager was aware of how communication by an individual may be perceived and will monitor the situation. The service has a recruitment procedure that is adequate and generally meets the regulations and the national minimum standards although at a basic level. The structuring of the recruitment system is lax and doesn’t fully evidence that all steps have been taken to ensure staff are competent and safe to work with older people. Following the last inspection criminal records bureau checks have been made for all staff, the home is waiting for one certificate to be returned. There is good awareness of the use of POVA (protection of vulnerable adults) procedures Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 23 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): 31,32,33,34,35,36,37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a needs led and safe service, which is run in their best interests by a manager and staff who are committed to providing a good quality of life for older people. Attention to record keeping and staff supervision would support good practice in providing skilled care for older people. The quality of the environment will be improved when money is available for upgrading and refurbishment. EVIDENCE: The manager is qualified or has the necessary experience to run the home. She has now completed her management qualification. The manager makes sure progress is made towards national minimum standards for older people. The manager trains and develops staff who are competent to care for older Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 24 people. The service is planned to be user focused, and works in partnership with family of residents and professionals. The home has a statement of purpose that sets out the aims and objectives of the service. The manager has developed systems that monitor practice and compliance with the homes plans, policies and procedures. Regular residents and staff meetings are held and a combined relatives/relatives and friends meeting in planned for later in June. Feedback about the service is taken seriously and incorporated in future planning. The registered person is aware of the need to plan the business activity of the home, and manage the finances and resources to deliver the business plan. The service provider takes responsibility for the home’s accounts and business development. There is suitable business insurance with details of cover for residents’ property included in the service users guide. Monthly visits are made by a representative of the organisation with reports of the visit supplied to the commission. Notifications of incidents and accidents affecting the wellbeing of residents are properly recorded and notified to the appropriate authorities. Residents have the opportunity to manage their own money if they wish, and facilities are provided to help keep it safe, including lockable space in individual rooms. A number of resident spoken with said their family dealt with monies on their behalf. Where the home manages money on residents’ behalf a system is in place to record transactions and accounts for spending. The business manager will support those residents who need help with finances. Records are held with evidence of expenditure made on a residents behalf maintained, the system for audit trail of such expenditure could be made clearer. The home does not act as an agent or appointee to residents. Record keeping standards vary with some records seen evidencing accountability for monitoring residents’ wellbeing. Records which are required but which were either not held in sufficient detail or not available for inspection include a record of food provided, especially where there are nutritional concerns, a photograph of each resident and member of staff, a full record of each complaint and all records pertaining to staff including records of training and induction. The manager and deputy share staff supervision and peer support between them. It is recognised that this has implications for the frequency of sessions with most staff receiving one to one supervision twice yearly. The manager plans to train other senior staff in the process to meet the standard of formal supervision being carried out at least 6 times a year. The pre inspection questionnaire recorded that servicing and maintenance of services and supplies are carried out in a timely fashion promoting the safety of residents. Following problems with the lift a new control panel was fitted Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 25 and work was undertaken on the heating system. This has restricted monies being available for desperately needed upgrading to some areas of the home including floors, paintwork, alterations and repairs to the kitchen as recommended by the Environmental Health Officer. Staff were able to detail the procedures in the event of fire. Good working practices were observed to reduce the risks of cross infection and meet relevant legislation. Safety posters were displayed in the appropriate places. Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 26 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 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 3 18 3 1 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 2 2 1 3 Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 27 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. 1. Standard OP19 Regulation 23 Requirement A programme of carpet cleaning and or replacement must be instigated. This requirement is repeated from the inspection of 3/11/05. Budget plans submitted to Age Care include an amount for ongoing refurbishment and replacement. An improvement plan of how this will be achieved is required by 30 September 2006 2. OP29 19 All care staff must be subject to criminal record bureau checks This requirement is repeated from the inspection of 3/11/05 – all but one member of staff has been criminal record bureau checked, an application has been made in respect of the remaining person. All records as required by regulation and listed in Schedules 2,3 & 4 must be held and available for inspection at all times, this will include: • A photograph or each DS0000026173.V296152.R01.S.doc Timescale for action 30/09/06 31/07/06 3. OP16 OP37 17 19 31/07/06 Gloucester House Nursing Home Version 5.2 Page 28 • • • service user A recent photograph of each member of staff and copies of proof of identity A record of food provided for service users in sufficient detail to enable any person inspecting then record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of any special diets prepared for individual service users. A record of all complaints made by service users or representatives or relatives of service users or by person working at he care home about the operation of the care home, and the action taken by the registered person in respect of any such complaint. A copy of any record in relation to a person’s employment to include induction and training records. • 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 OP7 Good Practice Recommendations Care plans should be complete of all known wishes and needs, including personal hygiene, oral hygiene. This recommendation is repeated from the inspection of Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 29 3/11/05. 2. OP7 Care records should include information on residents’ social and occupational interests. This recommendation is repeated from the inspection of 3/11/05. The daily record should record how interventions specified in the body of the care plan are being achieved There should be clearer systems to audit trail prescribed creams, including staff competency to administer them. Residents’ wishes and preferences in respect of later stages of life, death and dying and last rites must be obtained and recorded. This recommendation is repeated from the inspection of 3/11/05. Bedroom and bathroom doors must be repaired and kept in a good decorative state. This recommendation is repeated from the inspection of 3/11/05. Doors which state fire door keep locked should be locked. The door to the laundry should also be locked to prevent risk to those residents who are confused but ambulant. The system for recruiting staff should evidence that necessary action has been taken to ensure staff are competent and safe to care for older people. Such evidence will include access to records of induction training. 9 OP35 Clear procedures must be in place in respect of management of residents personal monies and the safe keeping of personal possessions. This recommendation is repeated from the inspection of 3/11/05. 10 OP36.2 All care staff should receive formal supervision at least 6 times a year. 3. 4. 5. OP7 OP9.4 OP11 6. OP19 7. 8. OP19 OP29 Gloucester House Nursing Home DS0000026173.V296152.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone 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 DS0000026173.V296152.R01.S.doc Version 5.2 Page 31 - 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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