CARE HOMES FOR OLDER PEOPLE
Goatacre Manor Care Centre Goatacre Lane Goatacre Wiltshire SN11 9JA Lead Inspector
Tim Goadby Key Unannounced Inspection 12th, 18th & 24th May 2006 09:30 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 Goatacre Manor Care Centre DS0000015911.V297154.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. Goatacre Manor Care Centre DS0000015911.V297154.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Goatacre Manor Care Centre Address Goatacre Lane Goatacre Wiltshire SN11 9JA 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) 01249 760464/454 01249 760252 Mr John O`Dea Mrs Margaret O`Dea Mrs Kathryn Jane Swainson Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42), Physical disability (3), Terminally ill (3) of places Goatacre Manor Care Centre DS0000015911.V297154.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. No more than 3 persons in receipt of terminal care at any one time No more than 3 physically disabled residents in the age range 18 - 64 years at any one time No more than 42 persons over the age of 65 years requiring nursing care 11th November 2005 Date of last inspection Brief Description of the Service: Goatacre Manor Care Centre provides accommodation, and care with nursing, for up to 42 service users. The majority of these will be people aged 65 and over. The service may also care for up to three adults in the 18 to 64 age range, if they need care due to a physical disability, or because of a terminal illness. Both short and long-term placements can be offered. The home is privately owned. It is in the small village of Goatacre, near Lyneham, Wiltshire. The market towns of Calne and Wootton Bassett are within a few minutes drive. The larger town of Swindon is also only a short distance away. This offers a full range of amenities. The home consists of an original property with an added purpose built extension. Service user accommodation spreads over two floors. There is a lift that operates between these. There are 28 single bedrooms, and seven which may be shared. En-suite toilets and handbasins are provided in the majority of these. There are four bathrooms, and two showers. There are two main lounge and dining areas, both on the ground floor. The home has wheelchair accessible corridors, bedrooms and communal rooms. Grab rails are provided in corridors, bathrooms and toilets. Lifting aids and equipment are available. Externally there are pleasant, accessible gardens and adequate parking spaces. Fees charged to service users range between £525 per week, which is a rate only available for people not in receipt of any nursing care; and a maximum figure of £760 per week, which is for people with high nursing care needs who are also occupying larger rooms. Information for service users is displayed in the entrance hall, and is also available on request. People are informed about CSCI inspection reports on the home, and are often directed to the Commission’s website, which is an increasingly popular way to access these.
Goatacre Manor Care Centre DS0000015911.V297154.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This Key inspection was completed in May 2006. The evidence gathered included pre-inspection information supplied by the service; and a review of regulatory contact since the previous main inspection in November 2005. The latter included additional inspection visits in January and February 2006, including one conducted jointly with the Health and Safety Executive. These visits were chiefly concerned with the heating and hot water arrangements for the home. Surveys were provided for service users and their families, but only one response was received. The home has left the relevant forms on display, so that people can contact the CSCI with feedback at any time. Two visits then took place to the home. The first of these was unannounced. The second, a few days later, was by appointment, to view a range of records. This fieldwork section of the inspection included the following: observation of care practices; sampling of records, with case tracking; discussions with service users, staff and management; sampling a meal; and a tour of the premises. A final visit then took place to meet with the registered persons and give feedback. What the service does well:
The home demonstrates good practice in the majority of areas inspected. Service users can be confident that their needs are fully assessed, from the pre-admission stage onwards. Care is regularly monitored and reviewed. Other relevant health professionals are involved when necessary. A wide range of health care needs are supported, with the home providing a valuable local resource which is able to cater for people with complex needs and high levels of dependency. Staffing levels are good, and reflect the identified care needs of the home’s residents. This means that there are enough people on duty to support service users when they need help. Goatacre Manor provides a pleasant and comfortable environment for service users to live in. The home is in an attractive situation. Internally, it is well furnished and maintained. There is an ongoing programme of refurbishments and improvements. Goatacre Manor Care Centre DS0000015911.V297154.R01.S.doc Version 5.2 Page 6 Food provided in the home has been seen to be of consistently good quality over a number of inspections. Choice is available. Special dietary needs can be catered for. Practice in this area enhances quality of life for service users. Visitors are made welcome, and are a regular feature of life in the home. Contact for service users with their family and friends is positively promoted, ensuring that key relationships can be maintained. Staff display appropriate attitudes towards service users, with warm, friendly, respectful interactions being observed. This creates an open and positive atmosphere from which service users can benefit. Staff themselves appreciate the support received from colleagues, and speak of how much they enjoy working at the home. Service users benefit from the support of a skilled and knowledgeable staff team. Systems are in place to ensure that all staff undertake a range of relevant training. This includes all mandatory topics, and also a variety of areas which are directly relevant to the care needs of the home’s occupants. Employees have the opportunity to take courses in areas they are particularly interested in, and to develop expertise which they can then pass on to other colleagues. Over 50 of the home’s care staff have achieved a nationally recognised qualification which supports their work with service users. Feedback from the relative of one service was positive about the care provided at Goatacre Manor. They were satisfied with all areas of service delivery, and commented particularly on the care and support shown by staff to both the service user and their family. What has improved since the last inspection?
The home’s newly appointed manager, Mrs Jane Swainson, has completed the process of registration with the CSCI. She was previously the deputy manager of the home, and represents a point of continuity and stability for the service. Her knowledge, skills and experience make her a suitable person to uphold the welfare of service users. The home has updated relevant information relating to abuse and adult protection. There is now a clear link between the service’s own procedures and the multi-agency process that operates within Wiltshire. In addition, there has been a focus on providing all staff with training to develop their awareness of this topic. These steps should enhance the protection available to service users. Six care plans were sampled at this inspection. These contained information on the areas of support that service users may need. An omission highlighted at the previous visit, which related to continence care for one person, had been addressed.
Goatacre Manor Care Centre DS0000015911.V297154.R01.S.doc Version 5.2 Page 7 A problem with the kitchen floor has been remedied by repairing the affected area. This means that the surface can be kept hygienically clean. A door to the laundry room which had had its glass panel removed, compromising fire safety in the building, has been repaired. What they could do better:
There are three outstanding unmet requirements from recent inspections. Two of these relate to key health and safety topics, which remain in need of attention to ensure that service users are not placed at risk of harm. Firstly, action is required on hot water and radiator surface temperatures. Risk levels have reduced from those found in November 2005, because most heating has been turned off, and the home’s boiler system has been struggling to generate an effective hot water supply. But service users have still been placed at risk in some areas, by a failure to take effective steps to manage risk whilst planning ahead for a major project to completely renew the plumbing and heating system. Progress needs to be made on all these linked areas, to ensure that service users’ safety is upheld, and that their care needs can be met. Frail people who come into contact with hot surfaces can quickly come to very serious harm. Equally, failure to have enough hot water available at all times can limit the ability to carry out important personal care and hygiene. Secondly, the use of bed sides with any service user must be supported by a documented risk assessment, addressing all relevant issues; and by evidence of consent. Sampled files showed that this has still not been fully achieved in all cases. The other outstanding requirement is for implementation of a quality assurance (QA) system. Work is ongoing towards this, but no evidence has yet been generated. An annual development plan must be produced as the outcome of a suitable quality audit, so that service users can be confident that their views underpin a process of continuous improvement for the service. This inspection identified some deficits which the home’s management had not been aware of. There had been some failures in internal communication, and in audit trails. These highlight the importance of having an effective QA system. Records must be available to show that a robust recruitment process takes place for all staff. This will demonstrate that there is appropriate protection for service users. Such evidence was not available in one sampled file at this visit.
Goatacre Manor Care Centre DS0000015911.V297154.R01.S.doc Version 5.2 Page 8 Some good practice recommendations were also made. Attention should be given to developing the content and quality of care plans to a consistently high level. The sample viewed during this inspection varied in the amount of information and detail contained, meaning that some service users were not benefiting as much as others. The home’s activities programme could be developed further, to broaden the range of what is offered, and give more attention to including all service users in some way. The home is already taking steps towards this, by seeking to recruit an additional staff member to lead on this area, and to provide suitable training. Fire drills are carried out by means of each weekly alarm system test, which also serves as a mini practice. Care should be taken to keep a record of which employees are present, so that it can be shown that each person participates at least once in every three month period. 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. Goatacre Manor Care Centre DS0000015911.V297154.R01.S.doc Version 5.2 Page 9 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 Goatacre Manor Care Centre DS0000015911.V297154.R01.S.doc Version 5.2 Page 10 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): 3 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Prospective service users have their needs assessed before a decision is made to offer them a place in the home. Standard 6 is not applicable to this service. EVIDENCE: The home’s senior nursing staff undertake assessments of potential service users. This is done in person, where possible; or by telephone, if the prospective admission lives some distance away. The initial assessment is recorded on a form devised for this purpose. When applicable, relevant information is also obtained from other sources. Sampled files at this inspection show that the assessment process is carried out in detail, and fully recorded.
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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 was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users have their abilities, needs and goals reflected in their individual plans. They would benefit from all such plans achieving a consistent degree of quality and detail. Service users are supported to address their personal and health care needs effectively. Service users are protected by the home’s policies and procedures for dealing with medicines. Service users have their privacy and dignity respected. Issues of ageing, illness, death and bereavement are recognised, and service users are given support to deal with these sensitive topics. Goatacre Manor Care Centre DS0000015911.V297154.R01.S.doc Version 5.2 Page 12 EVIDENCE: Sampled care plans contain necessary information regarding service users’ health and personal care needs. Further developments should promote greater consistency in their quality and content. For instance, some plans give clear detail about the support to be given to service users, by breaking this down into specific steps. Others are less well set out, so that guidance for staff is general and open to various interpretations. Evidence of health care support is good. There is assessment of all relevant areas, and this is kept under regular review. Identified risks are linked to suitable plans of care. Key indicators of health are monitored and recorded. The actions of the home’s own nursing and care team are clearly shown. It is also apparent that there is regular input from GPs and other relevant health professionals. Reviews and evaluations of care show progress being made by service users in overcoming some health problems, and in effective management of long term issues. Medication is managed safely. Administration of drugs to service users is performed by nursing staff, and was seen to be carried out appropriately. Records are maintained in line with required criteria. Medication is booked into the home, and a record is also kept of medicines which are disposed of. Individual medication charts show what drugs have been administered to each service user, and also any reasons for non-administration. One member of staff has lead responsibility for the ordering of prescriptions. The home has links with a number of local GP surgeries, and there is evidence of reviews of medication for individual service users. Staff provide personal care to users sensitively and respectfully. There is warm and friendly interaction amongst people. Intimate care tasks are always carried out with due regard for privacy. Staff ensure that they gain the permission of service users, and then take them to their own room, or another suitable location. Service users’ spiritual needs are highlighted in their records. Church services are held in the home. People with particular religious views are enabled to express these in line with their own preferences. Issues regarding end of life care are clearly addressed in care plans. Service users’ own wishes about care at this time are documented and observed. Sampled records show appropriate support during the final days of life, including frequent input from GPs. The home’s approach to palliative care is supported by links with a local hospice.
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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 was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are supported to exercise choice and control in their daily lives. Service users are provided with a range of activities and opportunities, but would benefit from further development of practice in this area. Service users are able to maintain and develop appropriate relationships with family and friends. Service users are offered healthy, nutritious and enjoyable meals, in line with individual needs and preferences. EVIDENCE: The home employs one person, who works for three sessions each week, to lead on activities. It is planned to recruit another person to help develop practice in this area. Information has been accessed from Age Concern on ideas for training for activities co-ordinators. Goatacre Manor Care Centre DS0000015911.V297154.R01.S.doc Version 5.2 Page 14 Trips out for groups of service users, enabled by hiring a specially adapted coach, are held at least twice a year. A Christmas shopping trip to Bristol was the most recent such outing. Later in 2006 a trip to Bristol Zoo is planned. At Goatacre Manor itself, a weekly programme of activities is drawn up. The sessions provided include carpet bowls, bingo, quizzes, art and craft, and cooking. Relevant celebrations are marked, and outside entertainment is also brought into the home on some other occasions. It is planned to hold a garden party during the coming summer months. As well as small group activities, staff also spend time in one to one conversation with service users. Naturally occurring situations when people may need support, such as when having a drink, are used to engage in interaction, and provide a good point of social contact. The majority of service users spend time in communal areas, and are therefore able to be involved to varying degrees in the daily life of the home. There are no restrictions on visiting, unless requested by the service user. Most people have some contact with family or friends. Visitors come and go regularly. People can choose whether to receive guests in communal areas, or in their own rooms. Arrangements for meals continue to be good. As at previous inspections, a sampled meal was tasty and well presented. Portion sizes are appropriate to the needs of individuals. The home has a menu, based on a four week rotation. Dishes provided are varied and nutritious. There is a focus on the use of fresh ingredients. Choice is available. If people do not wish to have the main option, an alternative dish will be prepared in line with their request. Special dietary needs can be catered for. This includes caring for service users who need to use special equipment. Goatacre Manor Care Centre DS0000015911.V297154.R01.S.doc Version 5.2 Page 15 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 & 18 Quality in this outcome area was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are safeguarded by the home’s policies and procedures for complaints and protection. EVIDENCE: A suitable complaints procedure is in place. It is prominently displayed in the entrance hallway, and includes contact details for the CSCI. No formal complaints about the home have been received over the period since the last inspection. The service is devising a system for logging any informal issues or concerns which are brought up, and showing how these are resolved. There is also a suggestion box which can be used by anyone wishing to make comments. Suitable procedures are also in place regarding abuse and adult protection, and there is information about local multi-agency processes for responding to any concerns. All staff are receiving training to develop their awareness of this topic. It is included as a key element of the home’s induction process. The home’s manager has also attended a more detailed course. Goatacre Manor Care Centre DS0000015911.V297154.R01.S.doc Version 5.2 Page 16 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): 19, 25 & 26 Quality in this outcome area was adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users live in a comfortable and clean environment, suitable to their needs. The current system for providing the home with heating and hot water is failing to meet all of service users’ safety and care needs. EVIDENCE: Goatacre Manor’s service user accommodation is spread over two floors. The main communal areas are on the ground floor. There are large, accessible grounds. Car parking space is available at the front of the home. Care has been taken to create a homely environment. Furniture, fixtures and fittings are of a good standard. The property appears to be well maintained. There is an ongoing refurbishment programme.
Goatacre Manor Care Centre DS0000015911.V297154.R01.S.doc Version 5.2 Page 17 Office space is mainly found on the first floor. The matron’s office is currently situated upstairs, but it is hoped to provide one on the ground floor, making the matron more readily accessible to service users and visitors. It is also hoped to create a more suitable nurses’ station. At present, a small area off the entrance hallway is utilised. This has limited space. It is also away from the main parts of the building where service users spend their time. Both of these issues are due to be addressed by a plan to extend the property. But there is no date set for this work as yet. Adaptations and equipment, such as grab rails and toilet seat raisers, have been provided where necessary. Assisted baths are also available. All beds are of a hospital type. Individual service users have also been provided with adapted seating and adjustable tables. Staff receive manual handling training, which includes instruction in how to use the various equipment available. The home was clean and hygienic in all areas seen during the inspection. The kitchen floor has been repaired in areas that were of concern. There is now an effective seal in all places again. The area has been cleaned thoroughly. Although some discolouration is still noticeable in places, this appears to be a cosmetic issue, and not to present any hygiene risk. The system for heating and hot water is not working reliably, and is scheduled for replacement in summer 2006. Hot water is provided by an oil fired boiler. Problems are being experienced with this being able to provide a sufficient supply to all parts of the building at all times of day. It is difficult to regulate the system to ensure an appropriate temperature at each of the outlets which is supplied. At previous inspections there have been concerns that the hot water temperature at some hand basins was above safe levels. Conversely, the issue now is that a supply of hot water is not always available. The home’s two electric showers can heat water to a suitable temperature, so these can be used whenever required. Baths have not always been possible, when water temperature has been too low. The problem has eased now that the heating can be turned off, but the situation remains in need of further attention. The plan is to replace the current boiler system during the summer months, so that the new one is ready by autumn. The home is investigating various options, and is soon to take a decision on how to proceed. This proposal also links to directly to the need to address concerns regarding risks from hot surfaces, such as radiators and pipework. This issue is discussed in more detail in the ‘Management and Administration’ section of this report. Goatacre Manor Care Centre DS0000015911.V297154.R01.S.doc Version 5.2 Page 18 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 was good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are supported by suitable numbers of appropriately trained staff. The home is unable to provide full evidence that appropriate recruitment processes are in place, to ensure the protection of service users. EVIDENCE: Goatacre Manor is registered to provide nursing care, so qualified nursing staff must be on duty at all times. They are supported by carers. Levels vary slightly, depending on the service user occupancy. Ratios of staff to service user tend to be high, reflecting the dependency levels of the people living in the home. At the time of this inspection there were 29 service users in residence. For this number, morning shifts consist of two nurses and five or six carers. In the afternoon there is one nurse and four carers. Overnight cover is provided by three waking staff, one of whom is a nurse. Goatacre Manor Care Centre DS0000015911.V297154.R01.S.doc Version 5.2 Page 19 Staff are deployed to various sections of the home. A nurse oversees each group. A senior carer will allocate carers to service users. Carers usually work in pairs, because most residents need two people for support with personal care. People may also be assigned to work one to one, if an individual has specific needs. Staff work across the different parts of the home, so they get to know all of the service users. Some qualified nurses are recruited from overseas. Where necessary, they undertake adaptation training so that their qualification is recognised in the UK. Such nurses work as carers until this process has been completed. The home generally enjoys stable staffing, with relatively low turnover. The core team is well established. Relief and agency workers are used as necessary. The home also employs people for various other key tasks. These include activities, administration, catering, cleaning, and maintenance. The home has a member of the nursing team who acts as training coordinator. She ensures that all staff attend all necessary courses, and that refresher sessions are provided when these become due. Both nurses and carers undertake various training, appropriate to their roles. Induction of new staff involves working through a booklet, which links to relevant national training standards for the social care workforce. New starters are allocated a senior carer as a mentor. The home has more than 50 of care workers with National Vocational Qualifications (NVQs) in care at Level 2 or above. Most of the assessing for NVQs is done by the external training provider which Goatacre Manor uses for this, but there are also some trained NVQ assessors amongst the home’s own team. Staff who spoke with the inspector confirmed the range of training which they undertake. This includes practical instructions in the use of equipment, alongside courses and in-house sessions on various relevant topics. Training opportunities are displayed on a noticeboard in the home, and staff can put their name forward for any they are interested in. People also have the opportunity to develop particular areas of expertise. For instance, carers can become approved manual handling trainers, who can then give instruction to other colleagues. Staff also confirm that meetings are held, usually once a month. Everyone has the chance to contribute agenda items. Minutes are kept, so that anyone who can’t attend is able to read about what was discussed. Goatacre Manor Care Centre DS0000015911.V297154.R01.S.doc Version 5.2 Page 20 Recruitment is carried out appropriately, but records need to be stored so that they are readily available for inspection. Sampled files at this visit were complete in most cases. The exception was for an employee recruited from overseas. This person’s file did not have written references; documentary evidence of relevant qualifications and training; full employment history; a statement regarding the person’s health; or evidence of a work permit. The reason given was that this information had been forwarded to the body which registers nurses, as the employee is a qualified nurse in their own country who now wishes to undertake adaptation training so that they can practise in the United Kingdom. Goatacre Manor Care Centre DS0000015911.V297154.R01.S.doc Version 5.2 Page 21 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, 33, 35 & 38 Quality in this outcome area was adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The registered manager is suitably qualified, competent and experienced, so that service users benefit from a well run home. Quality assurance measures need to be implemented, to ensure the home is conducted and developed in line with service users’ needs and preferences. Service users’ financial interests are safeguarded by the systems operated. Service users are placed at risk by significant deficits in practices relating to their health and safety. EVIDENCE: Goatacre Manor Care Centre DS0000015911.V297154.R01.S.doc Version 5.2 Page 22 Since the previous inspection, the home’s newly appointed manager, Mrs Jane Swainson, has successfully completed the process of registration with the CSCI. Mrs Swainson has worked at Goatacre Manor for a number of years, and was deputy matron prior to the retirement of the previous manager. Staff confirmed that they find the manager and senior colleagues approachable and helpful. Goatacre Manor has not yet fully implemented a quality assurance (QA) system. The approach currently taken is based on existing systems, such as the one devised by the Registered Nursing Home Association. The new manager is hoping to institute a review of a range of policies and procedures, to tailor them more directly to the home. Her intention is to link this to the development of a QA system. Various audits already take place on a range of topics. Feedback is also obtained from service users, visitors and others in a number of ways. But no evidence is yet available to demonstrate how these sources are collated, to produce a quality audit report, and a service development plan. This area will become particularly important, as it is anticipated that there will soon be a statutory requirement for all registered care services to have evidence of such an approach. One of the home’s administrative staff is responsible for any involvement that the service has with service users’ money. Most have their affairs managed by relatives, or legal representatives. Often these people live some distance away. Goatacre Manor provides a facility that enables more convenient access to cash for service users. Money can be paid into a residents’ account that the home maintains with a local bank. This does not accrue any interest. There is also a rigorous system of checks to prove appropriate operation of the account. Each individual resident can only have funds drawn on their behalf if they are in credit. Monies are not pooled in the sense that an individual could be in deficit. Care home regulations mean it is generally not permitted for services to pay money belonging to users into an account, other than one in their own name. But this rule does not apply if the money is paid in respect of services provided by the home. It has been agreed that the arrangement at Goatacre Manor falls under this latter category. Therefore, it is appropriate for it to continue. The service provides clear information about this facility, to assist people in deciding whether they wish to make use of it. Where possible, service users are enabled to retain some control over amounts of their own money. It is recognised that this is an important way of people maintaining a sense of independence and self-esteem. Health and safety risk assessments are in place, addressing all areas of the building, and key topics such as hazardous substances and infection control. A review schedule ensures that each one is looked at annually. There are
Goatacre Manor Care Centre DS0000015911.V297154.R01.S.doc Version 5.2 Page 23 systems for recording and reporting any problems that are noted. The home has its own maintenance team, who can give prompt attention to a range of tasks. Staff also receive regular training and updates on various health and safety issues. The fire log book shows that all required checks and instructions are recorded as being carried out, and up to date. Training is provided each quarter, as required. The system has been devised so that a range of topics are covered, using a variety of approaches. Each weekly test of the fire alarm system is used as a mini practice, with any staff on duty reporting to the fire panel as an assembly point. Records should ensure that each employee is captured by this exercise at least once in every three month period. Accidents and incidents occurring in the home are recorded. A monthly audit is carried out to identify any trends and suitable action points. There are unresolved safety issues regarding hot surfaces. This was identified as a significant concern at the inspection of November 2005. Immediate requirements were issued at the close of that visit. An additional inspection visit took place in January 2006 to follow up on these, at which progress was found to be slower than required. A joint visit then took place with the Health & Safety Executive (HSE) in February 2006. At the close of this an improvement notice was issued by the HSE. In response to this, the home undertook to begin a phased programme of covering radiators and pipework, in line with assessed priorities. However, this has not been instigated, and the reasons for this change of decision have not been documented. Hot surfaces should not exceed 43°C. Although the majority of heating in the building is now turned off for the summer, three radiators have still been recorded as consistently well above this level, and without suitable risk management procedures in place. During this inspection these specific radiators were checked. Two were no longer turned on, but the other was found to be very hot. The home’s own records indicate that it had consistently been operating at over 50°C, up to a highest recorded figure of 57.4°C. Although no temperature reading was taken during the inspection, the maximum time a hand could be held comfortably against the surface was three seconds. It was clear that any frail person falling against this radiator for even a short period of time would be likely to sustain serious harm. This radiator was in the bedroom of a service user assessed as being at a known high risk of falling. The radiator was screened off with furniture and had a blanket placed over it, but these temporary measures cannot be considered suitable to guarantee safety. There was no documented risk assessment about the issues arising from this particular radiator. Nor was it clear why it was being left on, with no apparent action to address the
Goatacre Manor Care Centre DS0000015911.V297154.R01.S.doc Version 5.2 Page 24 consistently unsafe high temperature. The problem had been recorded but not reported within the home, and not picked up by any audit system. Once the matter was drawn to the attention of the registered persons, the radiator was turned off. Immediate risks from hot surfaces have therefore been removed for now. But progress on this issue has been insufficient to date, and much more effective action is needed in the coming months, to ensure that the risk is no longer present when heating needs to be turned on again later in the year. Since this key inspection finished, the CSCI has carried out another joint visit with the HSE regarding this issue. The home still needs to ensure that full risk assessments are in place for all hot surfaces which are accessible to service users. The only current reference to radiators in risk assessments is as one element of an overall assessment of a room. This simply considers whether the appliance is in a good state of repair and is securely fitted. Individual documented risk assessments for each location also need to take into account environmental factors, such as position; and relevant service user factors, such as the needs and preferences of a room’s occupant. Where issues of concern are identified, a suitable risk management plan must be put in place. In the longer term, action must be taken to resolve any systemic problems which are contributing to the current unsafe situation. The home’s intention is to replace the boiler and balance the system, so that a suitable maximum temperature is guaranteed. However, advice from the HSE is that a system that controls the temperature at source must also have safeguards to ensure that, if the thermostat failed, radiators and pipework can’t become dangerously hot where service users may access them. Boxing potentially hot surfaces in, or providing guaranteed low surface temperature appliances, are possible ways of providing these extra safeguards. The home anticipates that some pipework and radiators will need replacing as part of the boiler replacement project, due to increased water pressure. But it is not yet possible to be certain which areas will need this. Safety issues relating to hot water temperatures are not currently an issue for the home. But they have been in the past, and attention will also need to be given to this area once the boiler system has been renewed. Again, the intention is that the temperature will be regulated to a safe level from its central distribution point. But this does have the potential to fail. Also, the home intends to run water at higher temperatures for a short period overnight, as a ‘purging’ of the system to control the risk of harmful bacteria developing. Therefore, outlets where individual service users are assessed as being at risk may need thermostatic mixer valves fitting. Goatacre Manor Care Centre DS0000015911.V297154.R01.S.doc Version 5.2 Page 25 The use of bed sides is practised with a number of service users living at the home. This is not always supported by sufficient evidence of appropriate risk assessment, or of relevant consent. Sampled files showed that the issue is addressed. However, all but one of these lacked appropriate detail about how and why bed sides were being used for the particular individual. Evidence of consent was not available in one case. Goatacre Manor Care Centre DS0000015911.V297154.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 2 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 X 2 X 3 X X 1 Goatacre Manor Care Centre DS0000015911.V297154.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 OP25 Regulation 12-1 13-4 23-2j,p Requirement The persons registered must provide a written action plan to the CSCI. This must set out the steps they will take to provide heating, and a water supply, that meet the relevant environmental health and safety requirements and the needs of service users. Action plan updates must then be provided to the CSCI at intervals of not greater than four weeks, until all required steps have been completed. COMMENT: The home’s intention is to identify a suitable programme of works, commission these, and have them completed not later than September 2006. See also Requirement No 6. 3 OP29 7;9;19 Sch2 Staff records must contain evidence that all required recruitment checks are carried out. Statutorily required records must be available for inspection in the home at all times.
DS0000015911.V297154.R01.S.doc Timescale for action 07/07/06 2 OP25 12-1 13-4 23-2j,p 04/08/06 24/05/06 Goatacre Manor Care Centre Version 5.2 Page 28 3 OP29 17-2,3b Sch4-6 24 This part of Regulations also applies to the above Requirement. The persons registered must devise and implement an effective quality assurance system. (Timescale of 31/12/05 not met) COMMENT: The timescale relates to production of an annual development plan, as evidence of an outcome from various quality audits. 24/05/06 4 OP33 31/07/06 5 OP38 12-1,2,3 13-7,8 The persons registered must ensure that documented risk assessments, and written evidence of consent, are in place for any use of bed sides. (Timescale from 26/05/05 not met) There must be a documented risk assessment, and risk management plan, for all potential risks to service users from heating and hot water. COMMENT: The risk management plan for uncovered radiators and exposed hot pipes, devised by the home in February 2006, has not been followed. The reasons for this change have not been documented. 07/07/06 6 OP38 13-4 07/07/06 7 OP38 13-4 Risk assessment and risk 04/08/06 management plan updates must then be carried out at intervals of not greater than four weeks, until all required steps have been completed. Goatacre Manor Care Centre DS0000015911.V297154.R01.S.doc Version 5.2 Page 29 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 Attention should be given to care planning systems in the home, to ensure that all service users benefit from the level of detail and information that is contained within the best examples seen at inspection. The home should continue with its proposed steps to develop the programme and range of activities offered. Care should be taken to ensure there is an effective record which demonstrates that all staff have taken part in a fire safety practice at least once in every three month period. 2 3 OP12 OP38 Goatacre Manor Care Centre DS0000015911.V297154.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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