Inspection on 24/09/08 for Gold Hill Residential Home

This inspection was carried out on 24th September 2008.

CSCI found this care home to be providing an Poor service.

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

Gold Hill Residential Home 27/02/09

Gold Hill Residential Home 30/04/07

Gold Hill Residential Home 15/12/06

Gold Hill Residential Home 21/04/06

Gold Hill Residential Home 29/11/05

Gold Hill Residential Home 29/07/05

Gold Hill Residential Home 14/03/05

Gold Hill Residential Home 18/08/04

Gold Hill Residential Home 26/03/04

Gold Hill Residential Home 15/12/03

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

CARE HOMES FOR OLDER PEOPLE Gold Hill Residential Home 5 Avenue Road Malvern Worcestershire WR14 3AL Lead Inspector Andrew Spearing-Brown Unannounced Inspection 09:10 24 September 7 and 8 October 2008 th th th 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 Gold Hill Residential Home DS0000018654.V372285.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. Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gold Hill Residential Home Address 5 Avenue Road Malvern Worcestershire WR14 3AL 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) 01684 574000 Manor Care Limited Vacant Care Home 40 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (40), of places Physical disability over 65 years of age (40) Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: care home only - code PC; to service users of the following gender: either; whose primary care needs on admission to the home are within the following categories: physical disability over the age of 65-code PD(E) 40; old age, not falling within any other category code OP 40; Dementia over the age of 65 - Code DE(E) 20. The maximum number of service users who can be accommodated is 40. Key inspection 30th April, 1st and 2nd May 2007 Thematic inspection 26th September 2007 2. Date of last inspection Brief Description of the Service: Gold Hill is a large building occupying a corner position within close proximity to the centre of Malvern, which has all of the amenities usually associated with a small town. The home is registered to provide personal care for a maximum of 40 older people. The people using the service are accommodated in 24 single bedrooms and 8 double bedrooms on four levels i.e. lower ground, ground, first and second floor. Sixteen of the single bedrooms and 7 of the double bedrooms have an en suite facility. Several of the bedrooms enjoy attractive views of the Malvern Hills and the surrounding area. The home has a small, two-person passenger lift. Communal areas consist of two lounges on the ground floor and a dining room on the lower ground floor. The dining room has an adjoining conservatory that is used as a designated smoking area. There are car-parking facilities at the front of the premises. The train station is about a 10 minute walk from the home. A copy of the Service Users’ Guide was available in the entrance area of the home. This document stated that ‘the fees currently fall within the range of £353.00 and £430.00 per week per person. Fees will be agreed prior to admission, depending on facilities offered and following a care needs assessment’. For up to date information the reader may wish to contact the provider directly. Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. We, the Commission, carried out this key inspection without any prior notice. A key inspection is one in which we look at all the aspects of the service that are most important to people using it. This key inspection took place during three separate visits to the home during September and October 2008 involving one regulation inspector. Before this inspection the registered manager completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. The AQAA was poorly completed and failed to give us the information we needed. During the inspection we were told that the registered manager had resigned and left Gold Hill in July 2008. We sent the care home a number of questionnaires for people using the service and members of staff to complete. We received 9 questionnaires back from people using the service but we noted that they were completed on behalf of people by the deputy manager. In addition, we received 7 questionnaires back from members of staff. During the inspection, discussions were held with the owners representative, the project manager, the deputy manager, a number of staff members and some people using the service. We had a look around the home and the grounds. We also observed what was happening in the home. In addition, we viewed the care documents regarding some people using the service such as care plans, risk assessments and daily records. We also viewed medication records and some staff records. This inspection takes into account information we have received since the last inspection as well as the visits to the home. Following the previous key inspection (April 2007) we carried out a thematic inspection during September 2007 as part of a study conducted by the Commission regarding privacy and dignity. What the service does well: Information about the home is available for people to refer to. This information could help people decide whether they wish to reside at Gold Hill. Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 6 People living in the home are able to personalise their rooms with items that are familiar to them so that they live in surroundings which they prefer. Activities are provided including some for those who are able to use community resources such as the local swimming pool. The number of hours available for activities is about to be increased with the employment of a second coordinator. Comments received about the food available within the home are good. One person using the service told us that the staff are very good, helpful if you want anything. The number of staff who have completed an NVQ (National Vocational Qualification) meets the National Minimum Standard. We found that staff have either received necessary training or were about to embark upon training. Staff showed a respect for peoples privacy and dignity and were seen to be warm and caring towards people using the service. What has improved since the last inspection? What they could do better: Some amendments to the information available to people are necessary so that people are fully aware of the service available to them. Assessments of care needs need to be more detailed in order that people can be assured that their needs can be met. Care plans need to fully reflect people’s current health and personal care needs so that staff are aware of what they need to do to support people in a reliable, consistent and safe way. Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 7 Medication needs to be managed more carefully so that people always receive treatment as it has been prescribed. As a result of our concerns we left an immediate requirement and asked the registered provider to respond in writing upon the action they intended to take. We saw some critical written comments made by some relatives regarding the service provided. The comments had not been seen as concerns or complaints and no record existed of the action taken to resolve the matters. Suitable systems need to be in place to ensure that peoples comments (however they are made) are listened to and acted upon in order to make improvements to the service provided. The way in which the premises are monitored for risks and necessary maintenance should be improved so that needs can be identified promptly and addressed with due priority. The way in which the registered provider monitors the management of Gold Hill needs to be more effective to ensure that the quality of the service is maintained and develops in a way that reflects the needs and preferences of people using the service. 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. The summary of this inspection report can be made available in other formats on request. Gold Hill Residential Home DS0000018654.V372285.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 Gold Hill Residential Home DS0000018654.V372285.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3. Standard 6 is not applicable. Quality in this outcome area is adequate Information about the home is available to help people make a choice about whether they would like to live there. Peoples needs are assessed before they move in to ensure that the home can meet their individual care needs but lack the detail necessary to support a comprehensive care plan. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of both the Statement of Purpose and the Service Users Guide were available in the entrance foyer of the home. The Statement of Purpose was dated September 2008 and stated that ‘At Gold Hill it is our primary objective to provide care to all Service Users to the highest standard.’ Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 10 The document contained details of the staff including the recently appointed Project Manager. Some information within the document was however incorrect such as the statement of the hours worked by activity coordinators, a statement about staff supervision and a statement about the frequency of in house church services. The exact fees charged were not given within the Statement of Purpose however it did make the following statement: We are committed to providing value for money within our comprehensive service. The fees charged are dependant on the type of care package and needs of the individual service user. The current rules can be complicated and specific advice is available from the Home Manager. Details what is included and what is not included within the fees. The Service Users Guide gave further information regarding fees as follows: Fees are reviewed in April each year. The fees currently fall within the range of £353.00 and £430.00 per week per person. Fees will be agreed prior to admission, depending on facilities offered and following a care needs assessment. We viewed the pre admission assessment of the most recently admitted person residing within the home. We enquired about when the assessment was carried out as it was dated the same day as the actual admission. We were told that this was a mistake and that the assessment had taken place prior to the admission. The information on the assessment was brief and needed to be more detailed to give sufficient detail to form the basis of an initial care plan. We also viewed a copy of an assessment prepared by Worcestershire Adult Services regarding the person due to be admitted into the home. This however gave some information that conflicted with the brief assessment carried out on behalf of the home, for example dietary care needs. Gold Hill does not provide intermediate care and we are not aware of any plans to do so in the future. Gold Hill Residential Home DS0000018654.V372285.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is poor People are treated with respect for their privacy and dignity and are supported by staff in a kind and sensitive way. However, care records do not provide staff with sufficient and correct information about people’s health and personal care needs to ensure that people receive the support and treatment they require. People do not always receive prescribed medication and treatments correctly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a Statement of Purpose which includes a ‘Service Users Charter’. This makes a number of statements regarding privacy and dignity including that people using the service ‘will be treated with dignity during any intervention’ and ‘will be respected for their individuality and views and be encouraged to express themselves as individuals.’ Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 12 When we carried out a thematic inspected in September 2007 we noted that care plans stated that people using the service had received a copy of the home’s Service Users’ Guide. We also noted that the vast majority of care staff and management consulted were aware of the homes Privacy and Dignity Policy. Staff were able to give examples of how they would put these principles in to practice such as using towels to cover people when bathing them. From our observations and limited discussions with people using the service at that time we concluded that people’s privacy and dignity was respected. People appeared to be well supported by the staff to choose clothing appropriate for the weather conditions and to reflect individual’s culture, gender and personal preferences. We did bring to the attention of the person in charge a couple of people who needed clothing either changing or adjusting. Within a questionnaire sent to a number of people using the service we asked whether people believed they received the care and support they needed. The responses were completed on behalf of people using the service. However, five people replied always three replied usually and one replied sometimes. When asked if staff listen and act upon what people say, eight out of nine people said yes. Everybody residing at Gold Hill had a care plan in place. However, we found that the registered persons had not complied with a previous requirement on care planning and, as a consequence, there were some potentially poor outcomes for people using the service. As the home is not registered as a care home with nursing, and therefore does not have trained nursing staff directly employed, people needing such a service are seen by community nursing services. On the first day of this inspection we were told that nobody had any pressures sores. We were told that one person was seeing community nurses due to having a skin tear. On viewing one person’s care plan and other documentation, we found that they were receiving regular visits from the nursing service because of an ongoing problem regarding pressure ulcers and a poorly toe. Although staff at the home did not have to directly treat these wounds, they were nevertheless involved in the overall care package and therefore needed suitable guidance. The care plan made no reference to these care needs; a document on skin condition stated has no pressure sores’ and he nutrition assessment under condition of skin stated Pressure areas intact, when this was clearly not the situation. We were unable to establish what creams were currently in use and where they were to be applied due to conflicting information within the records and from what staff told us when we discussed this with them. The same person received medication for constipation but the information about the medication in use differed between the care plan and the medication records. We observed that an entry in notes about this person, written by a community Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 13 nurse, highlighted some poor practices and incorrect care regimes at the home resulting in poor outcomes for the person concerned. We noted that another person also had some cream, which was prescribed and opened during January 2008. Staff had not been and were not applying this cream as prescribed, but we noted that the instructions on the tub stated that it should be discarded 3 months after opening. This cream was therefore 5 months out of date. The records of another person made reference to a GP prescribing cream but made no mention to what cream it was. No short term care plan was set up in relation to this care need leaving a care plan saying ‘skin intact in good condition staff to observe for changes in skin condition report any changes / discomfort to senior in charge when this was apparently not the case. We identified two people living within the home who were diabetic. We were concerned about the information in care documentation regarding these people, especially when a senior carer did not know that one of these people was diabetic. The written records for the other person stated Diabetic (Diet controlled). The person did, however, have medication prescribed for diabetes. Other than a brief mention of this, there was no care plan to guide staff about the person’s care needs in relation to diabetes. We observed that care plans and risk assessments had been reviewed but only the month when the review occurred was recorded and not the date. In addition, although care plans were reviewed regularly they did not always capture the most up to date information as highlighted earlier. As part of this inspection we assessed the management of medication within the home. On examining the current months Medication Administration Record (MAR) sheets we found gaps whereby staff had either failed to sign that medication was given or enter a code to indicate why it was omitted. This included one course of antibiotics where a gap was evident on the evening of the 23rd of September. We were able to audit the medication remaining and conclude that the dose was not given. Another gap was noted for lunch time on the 24th September. We viewed the MAR sheet regarding another antibiotic. The sheet stated ‘course complete’. The number of signatures on the MAR sheet did not add up to the total number of tablets prescribed and 2 tablets remained in a blister pack ready to be returned to the pharmacy. As a result of these concerns we issued an immediate requirement. Following our immediate requirement we received a response from the project manager in relation to the management and administration of medication. The response indicated the action taken to prevent this situation arising again Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 14 We saw examples of poorly completed MAR sheets in relation to the application of creams. The frequency of application was not transferred correctly from one months sheet to the next and it was unclear whether the treatment was to continue or cease. When these were compared to the care records described above regarding creams, they left us unsure as to what the currently prescribed treatment was. We saw some good practices in relation to medication management, for example photographs were in place to aid recognition. In addition, the records showed No known allergies when that was the case. We saw guidance for staff regarding one person, saying that the individual concerned should not have grapefruit juice due to one particular prescribed tablet. We saw evidence of some forthcoming distance learning training regarding medication. We will assess the level of training undertaken by staff when we next visit Gold Hill. Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. Quality in this outcome area is good People who use the service are supported to engage in community activities of their choice. Activities are also provided within the home for people who may be less able. The meals provided are good and people are afforded a choice to meet their dietary needs or preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We were informed that, at the time of this inspection, Gold Hill had 1 full time (30 hours per week) activities coordinator. We were also informed that a second part time person (16 - 20 hours per week) was to commence working in the home once the necessary documentation and checks were completed. Information about the activities scheduled to take place was on display. We were told by people using the service that they enjoy some of the activities available to them. Activities listed included: • Crafts in the dining room DS0000018654.V372285.R01.S.doc Version 5.2 Page 16 Gold Hill Residential Home • • • • • Sing along Coffee morning at church Swimming at the local pool Tai Chi Trip on mini bus People spoke about going out to Tai Chi and to the swimming pool; both of these took place while we were visiting. Although we did not witness any activities taking place within the lounges during this inspection other than watching television the above programme does include such events. Within the questionnaires that we sent to some people using the service we asked whether activities are arranged by the home that you can take part in? Three people responded always while five answered usually one person did not respond to this question. However a number of additional comments were also made about activities within the questionnaires including: Happy with reading books provided by the library Enjoy trips out Enjoy singing afternoon No outside bodies visit to enhance the range of activities available. We were informed that occasional entertainment is provided. Risk assessments are carried out prior to activities taking place outside of the home such as trips to garden centres. These do however need to be improved and made more individual in areas which are potentially more risky such as swimming. We saw evidence that efforts are made to ensure that people have the opportunity to attend Holy Communion within the home and attend a local church for a coffee morning. At the time of this inspection we were told that there was nobody residing in the home from any other religions. It was therefore evident that the home makes efforts to assist people in their religious observance as well as maintain links with the local community. Although we did not speak to any visitors during our inspection we are not aware of any restrictions placed upon visiting. We joined a small group of people at lunch time. The menu was displayed on a notice board in the dining room. The meal was served by care staff to people and the whole experience was relaxed and unhurried. The meal was hot, nicely presented and tasty. People chatted to us while eating the meal and confirmed that the food provided is good. We saw staff assisting people as necessary in a discreet and sensitive manner. Comments within the questionnaire regarding food provided included: Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 17 Enjoy all meals, given choice of meals Enjoy puddings Very good meals, offered a choice Would like fish and chips brought in from the chippy Good choice of meals given Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is adequate People are aware of how to complain about the service but they cannot be sure that all their comments will be sufficiently acted upon. Staff have an awareness of their responsibilities regarding the protection of people against abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information regarding the homes complaints procedure was available behind the reception desk in the main foyer of the home. The information upon this procedure was correct regarding the address of the commission. We did note however that the address within the most recently produced Statement of Purpose was incorrect and gave the address of the former locals office. Since the last key inspection we have received one anonymous complaint regarding the service provided at Gold Hill. We asked the registered provider to carry out an investigation into the matters put to us. We received a written response from the company which told us that an investigation had taken place. We were told that other than this complaint the service has not received any during 2008. Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 19 However, we found some comments sent to the home on two separate questionnaires as part of their internal quality survey. We were concerned by the comments made upon these two forms and the lack of evidence to demonstrate that the matters raised were taken seriously and regarded as complaints. The deputy manager believed that the matters were resolved, but we were not able to evidence this or whether the people who raised the issues were happy with the response. Polices and procedures were in place and available in relation to safeguarding (adult protection). We spoke to one member of staff about the action s/he would take in the event of becoming aware of a safeguarding incident. The response was sufficient to demonstrate an awareness of the procedure to be followed. Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 Quality in this outcome area is poor. People using the service are not provided with a safe and well-maintained place in which to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Gold Hill residential care home provides accommodation for 40 people. The home was generally clean and tidy but some redecoration and other environmental improvements were still necessary. As part of this inspection we viewed the outside of the home and the grounds, communal areas of the home and a small number of bedrooms. We made a number of observations. Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 21 On arriving at the home we noted that some weeds or overgrown plants were on both sides of the driveway. The outside of the home had rubble which needed to be moved. We were informed that action took place following our initial visit to the home. At the time of the previous key inspection we mentioned some similar concerns in relation to the garden and the need to have some rubbish removed. We were informed that some parts of the exterior have been painted since our last visit. However, we observed that some parts to one side of the home and some windows were in need of attention to improve the appearance of the home. When in the basement area we noticed a range of things. A lockable door was found to be unlocked. Within the small cupboard was an emersion heater. One pipe was cold, one was warm and one was hot. The pipe to the top of the heater was very hot and could potentially have scalded somebody who was unable to remove their hand quickly. We were told that a member of staff must have just opened it. However, when we checked this out, we were told that some contractors had gone off with the key. It therefore seemed likely that the door had been left unlocked for a few days. A shower room has been refurbished. The area was small but housed a toilet, a wash hand basin and a shower. Liquid soap and paper towels were available but a bar of soap was seen on the wash hand basin and this compromised these infection control arrangements. We viewed the laundry room. The walls in this room appeared damp. Following the last inspection we made a requirement saying that The laundry floor and wall finishes must be impermeable and readily cleanable. We gave a compliance date of June 2007 for this to happen. It was therefore disappointing that, 16 months after the date for compliance, this work had not taken place. We were however informed that quotes were recently requested for the work to be undertaken and for this reason we did not taken any further enforcement action. We were informed that it is now expected that this work will be done in the foreseeable future. We were further informed that they were awaiting baskets to come to place peoples individual items into. Laundered clothing was at the time of our visit being placed into large green bins which could easily lead to clothing going back to the wrong room. Equipment within the laundry seemed to be suitable for purpose with all three washing machines having a sluice facility. The dining room has a wooden floor. On our first visit of this inspection we noted that the walls were bare as reported within our previous inspection report. By the time we concluded this inspection the project manager had purchased some pictures. The lighting in the dining room remains as previously reported however we were informed that quotes were to be sought in order to change the current arrangements. The corner of the dining room has a damp patch where the paint has flaked off. One of the double doors, which are fire doors, did not close properly into the rebate. This matter was Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 22 brought to the attention of the owners representative and reported to us that suitable action took place within 24 hours of us noticing this defect. Smoking is permitted in the conservatory which is off the dining room. The smell of smoke leaks into the dining room, which could be offensive to some people as well as infringing peoples rights to be in a smoke free environment especially when eating. On the ground floor Gold Hill offers two lounges for sitting and relaxing in as well as a corridor area with some sitting provided. Both the lounge areas were warm and comfortable looking although one seemed to be seldom used. We were told that the carpet in the Red Lounge is new. The corridor area had 4 comfortable ‘dining room style’ chairs and a coffee table. The carpet in this area of the home is new. The walls needed painting as they were stained in places. The walls had 7 faded pictures on display. The area was lit by 2 bulbs only 1 of which had a shade. People are able to personalise their rooms as they wish but we saw a wardrobe in one bedroom which was not secured to the wall and needed wedges underneath it due to the uneven floor. This item of furniture, which could of potentially toppled over and cause injury, was reported to of been secured within 24 hours of our visit. Despite us previously reporting that pipe work was to be boxed in, we saw some in this bedroom which was not covered. The carpet on the second floor corridor was ill fitting in places. These could also present as a risk to peoples safety. On the first and second floors we noted a number of issues which were cause for concern in relation to health and safety matters. A fuse cupboard was found to be open but immediate action was taken. We noted a fire door which did not close correctly and again immediate action was taken. However, we are concerned that it required our inspection to bring about action which should already have been identified by staff working in the home. On viewing the fire escape we noted that it had weeds growing between the steps which could be a slipping hazard in the event of an evacuation. We were later informed that action took place regarding the weeds around the fire escape within 24 hours of bring it to the attention of the project manager. Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. Quality in this outcome area is good People can have confidence in the staff at the home because checks have been done to make sure they are suitable to care for them. There are sufficient staff to support people and arrangements are made to provide training for staff so that they understand people’s needs. Staff are kind and sensitive in their approach to people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff rota was seen and showed the name and role of each person employed. As well as care assistants, other staff were also on duty when we visited the home such as domestics, a laundry assistant and catering staff. At the time of this inspection a total of 21 carers were employed at Gold Hill. We saw a box containing a number of NVQ (National Vocational Training) certificates. We also viewed a training matrix which indicated a higher number of staff hold this qualification. From the matrix we established that a total of 10 carers hold a level 2 qualification and 1 person has a level 3. Therefore the home has just met the National Minimum Standard as they have 50 of staff with this qualification. In addition to the above staff, further carers have Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 24 commenced this training; therefore the home should be able to exceed this standard in the future. We viewed the training matrix and noted a number of gaps within it. It was however evident that training was due to take place shortly after this inspection and it was envisaged that the people identified as needing the training would be attending. While we were at the service a date was arranged for infection control training to take place. We viewed the staff files of two employees who have over recent months commenced work at Gold Hill. The first one we viewed contained some documentation which suggested that the person had commenced work prior to references and a PoVA (Protection of Vulnerable Adults) first check. It was however highly likely that the date on these two documents was incorrect and that the correct procedures had taken place. The second file contained the required documentation and evidence that sufficient checks had taken place. Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 37. Quality in this outcome area is poor. People using the service cannot be assured that their best interests and safety are paramount at all times. The management of Gold Hill needs to be more effective in ensuring that the quality of the service is continually maintained and that it develops in a way that reflects the needs and preferences of people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In July of this year the registered manager, who had been in post for about 15 months, resigned. We were not told about this at the time. During our inspection we were informed about the alternative management arrangements Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 26 that had been made and how these had subsequently changed. The deputy manager had, for a while, acted as manager. However, a Project Manager had recently come to Gold Hill with the brief to improve the service prior to an inspection. Evidence recorded elsewhere in this report indicates that the management of the home has not been effective enough to ensure that people using the service are safe and receive the care that they need. For example, improvements to care planning that we had previously required have not been made and people are at risk of not receiving appropriate healthcare treatment or their medication, as prescribed. Other findings support this view of the management. Prior to the inspection we requested the completion of an AQAA (Annual Quality Assurance Assessment). This document was returned to us, by the former manager, within the timescale given. The AQAA should tell us how well the home thinks they are performing and should give us information about the home, staff and people who live there, improvements and plans for further improvements. However, the AQAA returned to us was brief and gave us little information about the home. There was a lack of understanding regarding the purpose of the AQAA. It failed to give us evidence of where the home believes it is doing well and gave us no information regarding the views of people using the service or equality and diversity matters. Within the ‘Management and Administration’ section, the AQAA did not acknowledge any areas where the home could do better. Arrangements were in place for keeping the safe keeping of money on behalf of people using the service. The records of a small number of people were viewed and we found that the amount recorded balanced with the cash held. We were however concerned about a number of security arrangements which were brought to the attention of senior people within the home. We were assured that systems would be changed to ensure the money was held more safely. We viewed records regarding formal staff supervision. These were found to be poor and gave very little evidence of meaningful supervision since January 2008. We saw a small number of written records but these did not give any indication regarding actions taken following concerns or issues raised by staff members with their supervisor. The project manager devised a supervision training matrix following our visit. More positively we saw evidence that the Project Manager had held meetings with different groups or sections of staff such as carers or domestic /laundry/kitchen staff. While we were in the home the fire alarm sounded. The vast majority of staff evacuated the building while a couple of staff made efforts to establish the cause of the alarm sounding. Nobody gave any reassurance to people using the service who were left within the building. One person became visibly Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 27 distressed and was banging on the door to get out of the building. Our concerns were brought to the attention of senior staff within the home and Hereford and Worcester Fire Authority as we believed the arrangements within the home needed to be reviewed to ensure that evacuation procedures in the event of a potential fire are appropriate and are properly understood by the staff. Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 28 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 2 X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 1 X 1 Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15 Requirement All care plans must describe how the needs of people using the service, in respect of their health and welfare, are to be met. Care plans must be reviewed to ensure that staff are provided with up to date guidance about how to meet peoples needs and a system put in place to ensure that this is done as needed. This requirement replaces one previously unmet with time scales dating back to 30/06/06. 2 OP8 12 (1) Staff must be aware of the 31/12/08 personal and health care needs of people and care must be given in a reliable and consistent way. This is to ensure that people are supported to maintain their health and comfort. Timescale for action 31/12/08 Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 30 3 OP9 13 (2) Medication must be stored, administered and recorded accurately and safely at all times in order to safeguard people and ensure that they receive treatments as prescribed. The laundry floor and wall finishes must be impermeable and readily cleanable. This requirement with a timescale of 30/06/07 was not met and is repeated. 24/09/08 4 OP26 23 31/12/08 5 OP36 18 Care staff, including the deputy manager, must receive regular formal supervision so that they are sufficiently monitored to ensure the care needs of people using the service are met. This requirement replaces one previously unmet with time scales dating back to 30/06/06. 31/12/08 6 OP33 24 1 (a) (b) 3 Maintain a system for reviewing and improving at appropriate intervals the quality of care provided. Incorporate within the quality assurance system a means of consultation with people using the service and their representatives which then acts upon and responds to comments received. Liaise with the local fire service to ensure policies and procedures in place are in line with the Fire Safety Order Establish and maintain system to ensure that people using the service are safe from potential risk or injury from environmental DS0000018654.V372285.R01.S.doc 31/01/09 7 OP38 23 (4) (A) 31/12/08 8 OP38 13 15/12/08 Gold Hill Residential Home Version 5.2 Page 31 factors within the home. 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 Refer to Standard OP1 OP3 Good Practice Recommendations The statement of purpose should be an accurate reflection of the service provided. Systems should be in place to ensure that a full assessment of care needs is carried out prior to an admission into the home. Establish a plan with a schedule of work to improve the environment in which people are residing. 3 OP19 Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Gold Hill Residential Home DS0000018654.V372285.R01.S.doc Version 5.2 Page 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!