Inspection on 01/06/05 for Goffs Park Nursing Home

This inspection was carried out on 1st June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Goffs Park Nursing Home 18/07/07

Goffs Park Nursing Home 03/01/07

Goffs Park Nursing Home 25/05/06

Goffs Park Nursing Home 03/10/05

Goffs Park Nursing Home 16/11/04

Goffs Park Nursing Home 01/06/04

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

CARE HOMES FOR OLDER PEOPLE Goffs Park Nursing Home 39 Goffs Park Road Crawley West Sussex RH11 8AX Lead Inspector Helen Tomlinson Announced Wednesday 1 June 2005, 09:00, V221505 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Goffs Park Nursing Home H60-H11 S24146 Goffs Park Nursing Home V221505 010605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Goffs Park Nursing Home Address 39 Goffs Park Road, Crawley, West Sussex,RH11 8AX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01293 524942 Goffs Park Care Homes Limited Mrs Elizabeth Bannister Care Home (CRH) 39 Category(ies) of Old age, not falling within any other category registration, with number (OP), (39) of places Goffs Park Nursing Home H60-H11 S24146 Goffs Park Nursing Home V221505 010605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1 A maximum of 39 persons in the category OP (Old age not falling within any other category) to be accommodated at any one time. Date of last inspection 16 November 2004 Brief Description of the Service: Goffs Park is a care home which is registered for up to 39 people aged 65 years and over. It provides nursing care. The care home is a converted large detached house, situated in a residential area of Crawley, close to the town centre. Accommodation is provided on 3 floors, which can be accessed using a passenger lift. There are 27 single and 4 double rooms. 1 of the double bedrooms on the third floor was being used as a communal lounge, in order to provide additional lounge space for the residents. There is one other medium sized lounge on the ground floor. This is also used as the dining room at meal times. There are large, well kept grounds which are accessible to residents in suitable weather. The service is privately owned by Mr. R. Lallchand and the registered manager is Mrs E. Bannister, who is responsible for the day to day running of the home. Goffs Park Nursing Home H60-H11 S24146 Goffs Park Nursing Home V221505 010605 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection. It was carried out by Mr D. Bannier and Miss H. Tomlinson who arrived at the premises at 9am. They were present in the home for 8 hours. During the inspection 12 residents, 3 visitors and 4 members of staff were spoken with. The registered manager was in discussion with the inspectors throughout the day. Care practices were observed and records examined, with particular attention paid to the care of 3 residents. A tour of the premises took place and many of the residents were spoken with in their own bedrooms. The registered individual, Mr Lallchand, was unfortunately unable to attend due to illness. Feedback regarding the outcome of the inspection was given to Mr Lallchand, in person, on 14th June 2005. 2 complaints had been received by the Commission since the last inspection. What the service does well: What has improved since the last inspection? At the time of the inspection work was ongoing to refurbish many of the bedrooms. New carpets were being laid and new furniture provided. Where this work had been completed the environment was improved. Goffs Park Nursing Home H60-H11 S24146 Goffs Park Nursing Home V221505 010605 Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Goffs Park Nursing Home H60-H11 S24146 Goffs Park Nursing Home V221505 010605 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Goffs Park Nursing Home H60-H11 S24146 Goffs Park Nursing Home V221505 010605 Stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4. Residents were assessed, before moving into the home, to make sure their needs could be met at Goffs Park. Their suitability for the home had not been confirmed to the residents or the relatives before they became accommodated. Residents said they felt the staff were providing care which met their needs. For those with high dependency needs the practices and staff training did not ensure all their health needs were adequately met. Goffs Park Nursing Home H60-H11 S24146 Goffs Park Nursing Home V221505 010605 Stage 4.doc Version 1.20 Page 9 EVIDENCE: The files seen had assessments recorded which had been completed by the registered manager before the resident was admitted to the home. Assessments from hospital had also been obtained when appropriate. No letters to residents or relatives were seen to confirm the home could meet their needs. 1 visitor stated she had received no documentation from the home prior to her relative being accommodated. Residents who were able to communicate with the inspectors said they were happy at the home and the staff did all they could to make sure they were well cared for. Observation of care practices and records for the more dependant residents showed that not all health needs were being adequately met by staff. Not all staff had received training appropriate for the work they were doing and some training was out of date e.g. moving and handling. This resulted in incorrect techniques being used by staff. Staff training is more thoroughly discussed later in the report. Goffs Park Nursing Home H60-H11 S24146 Goffs Park Nursing Home V221505 010605 Stage 4.doc Version 1.20 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 and 9 The plans of care seen were not up to date, contained conflicting information and had not been reviewed in line with the changing condition of the resident. The health care needs of the more dependant residents were not being fully or appropriately met in some instances. Some practices did not safeguard the residents from risk of harm. The procedures for the administration of medication did not always meet the guidance of the Nursing and Midwifery Council although all medication was administered by a qualified nurse. EVIDENCE: 3 care plans were examined. These contained a lot of information regarding the resident. This information was confusing with conflicting information about the same problem being present. For one recently admitted resident there were 3 different comments about the same problem. The plan of care recorded reflected one of these comments. This resulted in no clear direction given to staff and inconsistencies in the care provided. There was no system for reviewing the plan of care. This led to the resident’s needs and condition not being re-assessed and the plan of care not being up to date. Goffs Park Nursing Home H60-H11 S24146 Goffs Park Nursing Home V221505 010605 Stage 4.doc Version 1.20 Page 11 The lack of re-assessment and accurate care planning was particularly concerning with regard to health care needs. Pressure area risk assessments were present for all residents. There was no care plan following this for the prevention of pressure sore development. Care plans were present for the management of sores once occurred. These were not updated as required and for 1 resident had not been reviewed since August 2004 despite a deterioration and the development of sores. There were no continence assessments on the files examined despite the residents being incontinent. There were no plans of care regarding this and the incorrect use of aids was seen to take place. Nutritional risk assessments had been completed. These had not been reviewed and there was no plan of care despite 1 resident having lost over 2 stone in weight and being significantly frail. Some intake and output charts were in the residents bedrooms. On 2 occasions these had not been correctly completed and indicated long periods when the resident had no fluids. A lifting risk assessment was present. This had not been reviewed and did not give clear information to the care staff. There was no information regarding the specific equipment to be used for each resident and incorrect moving and handling techniques took place. The majority of the residents had bed rails in place. This had not been done on a risk assessment basis, most had no protectors present and many were incorrectly fitted on the bed. An immediate requirement notice was issued that the registered manager ensured the use of these rails was appropriate and safe. This required urgent action to rectify a problem that was a serious welfare issue which put residents at risk of harm. The examination of the records for the administration of medication showed some incorrect practices had taken place. These included using 1 resident’s medication for another resident. Although it was the same medication for both residents this practice does not comply with the nurses code of practice. The name had been changed on the label of prescribed creams and medication had been stopped without consulting the prescribing person. All the above practices are against the Nursing and Midwifery Council code of practice. There were 3 medication trolleys in the home, 2 were securely stored, 1 was not. All other medication was correctly and securely stored. It was discussed with the registered manager that the parental feeds must be kept in a cool place and not in the residents bedrooms. Policies and procedures with regard to medication were present in the home. Goffs Park Nursing Home H60-H11 S24146 Goffs Park Nursing Home V221505 010605 Stage 4.doc Version 1.20 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 The food served at Goffs Park was appropriate to meet the varied needs of the residents accommodated. The lack of dining space does not allow for a sociable mealtime to take place or for the residents to choose where to eat their meals. EVIDENCE: The residents who were able commented favourably about the food served. They said the meals were varied and there was plenty provided. On the day of the inspection the main meal was nutritious and appealingly served. There was no choice of main meal at lunchtime. Residents were not aware of the meals to be served that day. There is no specific dining space provided. Residents either ate their meal at a portable table in the lounge or in their own bedrooms. 7 residents required full assistance to have their meals and drinks. This meant that staff were isolated with specific residents at meal time and there was no supervision of the other residents during this period. Goffs Park Nursing Home H60-H11 S24146 Goffs Park Nursing Home V221505 010605 Stage 4.doc Version 1.20 Page 13 A soft diet and diabetic diet was provided. Liquidised food was appealingly served. No hot drinks were offered during the course of the morning. Cold drinks were available, but residents did not have the choice of a cup of tea or coffee during the morning period. 1 resident who was able said they could go to the kitchen and ask for a cup of tea anytime. Goffs Park Nursing Home H60-H11 S24146 Goffs Park Nursing Home V221505 010605 Stage 4.doc Version 1.20 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 There was a written complaints procedure which had been followed in the event of complaints made. EVIDENCE: 2 complaints had been received regarding Goffs Park since the last inspection. 1 of these had been recorded but was not yet resolved to the satisfaction of all parties. A complaints procedure which contained the correct information was present in the resident’s guide. A complaints procedure displayed in the hall of the home did not contain the correct information. Goffs Park Nursing Home H60-H11 S24146 Goffs Park Nursing Home V221505 010605 Stage 4.doc Version 1.20 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,22,26 The home provided a homely environment for the residents accommodated. The maintenance work which was ongoing will improve the home. The home was clean and pleasant. The layout of the building creates some difficulties in making sure all residents are adequately supervised. There was a lack of communal space, especially for dining purposes. Equipment was provided to meet the needs of the residents although this was not always correctly used. Goffs Park Nursing Home H60-H11 S24146 Goffs Park Nursing Home V221505 010605 Stage 4.doc Version 1.20 Page 16 EVIDENCE: Goffs Park is a detached, converted house and as such the layout is small corridors, on 3 floors, with bedrooms off them. Whilst this was said to be an attraction to some visitors and residents spoken with, it also presented some difficulties in ensuring the highly dependant residents were adequately supervised. At the time of this inspection maintenance work was ongoing to improve the environment of the home. New carpets had been laid in the corridors and lounge of the home. This was being done in some bedrooms. New bedroom furniture was being provided. 1 resident spoken with said they welcomed the improvements. The home was clean and free from offensive odour. Residents were seen to have personal possessions in their rooms. Specialist equipment was provided to meet the needs of the residents. 3 hoists were available. It was discussed with the registered manager that it was not clear which equipment would be used for which residents e.g. the sling to be used with the hoist. Other moving and handling equipment was present and a belt was seen to be used although the use of this was incorrect. When touring the building there were several issues seen with the nurse call system. For several immobile residents the call bell was out of reach, for 1 resident the bell was switched off, 1 had no call bell present and 1 had loose and disconnected wiring. These issues were highlighted to the staff at the time. Pressure relieving equipment was in place. Pressure relieving cushions and various types of pressure relieving mattresses were in use. 1 of these was found to be deflated and providing no protection for the resident. This was corrected at the time. Since the removal of some pressure mattresses by the Primary Care Trust the provider had purchased some for the use of residents in the home. These were used on a risk assessment basis. The staff were seen to wear plastic aprons and gloves were available. Linen bags and clinical waste bags were in use. 2 sluices were available. Goffs Park Nursing Home H60-H11 S24146 Goffs Park Nursing Home V221505 010605 Stage 4.doc Version 1.20 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30 The dependency levels of the residents and the layout of the building had not been taken into account in the use of staff in the home. This left vulnerable residents isolated. The recruitment procedures did not include all checks to ensure the person was fit to work with vulnerable adults. Not all staff had received training for the work they were to perform. EVIDENCE: The duty rota seen showed that a Registered nurse was on duty at all times. The rota accurately reflected the staff on duty that day. At the time of the inspection the number of staff on duty was adequate for the number of residents accommodated. The deployment of these staff members meant that not all floors of the home had staff present at all times. Since the majority of residents spend their day in their room this left vulnerable residents without supervision for long periods. It was discussed that the deployment of staff in the home should be reviewed. Goffs Park Nursing Home H60-H11 S24146 Goffs Park Nursing Home V221505 010605 Stage 4.doc Version 1.20 Page 18 The recruitment files for 3 members of staff were examined. The necessary checks had not been carried out for 2 of these staff. There was no evidence that the correct checks regarding the Protection of Vulnerable Adults had been done. There was no reference from the last employer for 1, there was no reason for leaving the last employment for 1 and there was no full employment history for either. For 1 staff member their documentation for eligibility to legally work in the UK was not present on file. This has been received by the Commission following the inspection. The registered manager was reminded of her responsibility regarding employment and ensuring all staff employed are fit for the work they are to perform. Staff training records were kept. These showed that some people required up dated training for moving and handling. There was no record of the induction training provided although 1 member of staff told inspectors of the thorough training they had undertaken. In house training had been provided for specific issues such as continence and parental feeding. As discussed throughout the report some practices seen indicated that staff required more training and supervision regarding the day to day tasks they perform. Goffs Park Nursing Home H60-H11 S24146 Goffs Park Nursing Home V221505 010605 Stage 4.doc Version 1.20 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 The records seen were not always up to date or had been reviewed appropriately. Not all information regarding the residents was stored so as to protect their confidentiality. EVIDENCE: Not all records seen for individual resident’s care were kept up to date. Daily records were kept but these did not always correspond with the plans of care or assessments. This was misleading for staff caring for the residents. The individual records for residents were securely stored. The communal diary contained information of a confidential nature with regard to individual residents and was kept in the entrance hall of the home. Goffs Park Nursing Home H60-H11 S24146 Goffs Park Nursing Home V221505 010605 Stage 4.doc Version 1.20 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x x x x x x 2 x Goffs Park Nursing Home H60-H11 S24146 Goffs Park Nursing Home V221505 010605 Stage 4.doc Version 1.20 Page 21 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 4 and 30 18(1)(c ) (i) 15(1)(b) 14(2) Persons employed to work at the care home must receive training appropriate to the work they are to perform. The registered person shall keep the residents plans under review. The assessment of residents needs must be kept under review and revised with any change of circumstance. The health care needs of the resident must met with particular attention to pressure area care, nutrition and continence. Unnecessary risks to the health or safety of residents are identified and eliminated. All residents must have an assessment for the use of bed rails and all bed rails must be safely used. The registered person shall make arrangements for the safe administration and recording of medicines in the care home. The registered person shall ensure there is adequate sitting, recreational and dining space provided from the residents private accommodation. 31/8/05 Standard Regulation Requirement Timescale for action 3. 4. 7 8 31/7/05 31/7/05 5. 8 12(1)(a) 30/6/05 6. 8 13(4)(c ) 9/6/05 7. 9 13(2) 30/6/05 8. 15 23(2)(g) 31/12/05 Goffs Park Nursing Home H60-H11 S24146 Goffs Park Nursing Home V221505 010605 Stage 4.doc Version 1.20 Page 22 9. 22 13(5) 10. 22 13(4)(c ) 11. 29 19 and Schedule 2. 12. 37 17 The registered person shall make suitable arrangements to provide a safe system for the moving and handling of residents. Unnecessary risks to residents are reduced. All residents must have access to a working call bell at all times. The registered person must ensure all people employed to work at the care home are fit to do so. All information in Schedule 2 should be obtained for all members of staff prior to employment. All records in Schedules 1,2,3 and 4 must be kept. All records must be up to date and securely stored. 30/6/05 30/6/05 30/6/05 31/7/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard 9 15 16 27 3 Good Practice Recommendations All parental feeds should be kept, as per manufacturers instruction, in a cool place. Hot drinks should be made available to all residents during the day. The complaint procedure on display in the home should be amended. The use of staff in the home should be reviewed to ensure all residents are adequately supervised at all times. The registered person must confirm in writing to the resident that the home is suitable to meet their needs in respect of health and welfare. Goffs Park Nursing Home H60-H11 S24146 Goffs Park Nursing Home V221505 010605 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection 2nd Floor, Ridgeworth House, Liverpool Gardens Worthing West Sussex BN11 1RY 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 Goffs Park Nursing Home H60-H11 S24146 Goffs Park Nursing Home V221505 010605 Stage 4.doc Version 1.20 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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