Inspection on 27/02/09 for Gold Hill Residential Home

This inspection was carried out on 27th February 2009.

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

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

Gold Hill Residential Home 24/09/08

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 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Gold Hill Residential Home 5 Avenue Road Malvern Worcestershire WR14 3AL Lead Inspector Emily White Key Unannounced Inspection 27th February 2009 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 Gold Hill Residential Home DS0000018654.V374380.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.V374380.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 Mr Raymond Dennis Howard 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.V374380.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 within the following categories: physical disability over the age of 65code 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. 24th September 2008 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.V374380.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 1 star. This means the people who use this service experience adequate quality outcomes. 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. We visited the service during the week for a whole day. We met the new 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. What the service does well: People using the service have good access to activities inside and outside the home. People have good contact with their families and other visitors. Meals are nutritious, varied and served at times to suit different people. People using the service tell us that they enjoy the food. The service respects peoples privacy, dignity, autonomy and choice. People are given the chance to give their opinions about the running of the service. People using the service know how to complain and know that their complaints will be listened to. People are supported by the right numbers of staff who are well trained to do their jobs. Staff are enthusiastic and caring in their jobs. Gold Hill Residential Home DS0000018654.V374380.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The manager must be registered to manage the service, so people can feel confident their service is in reliable and capable hands. Improvements to the care planning and reviews should be completed so that people using the service receive a personalised but consistent level of support. The service must ensure that people are kept safe by updating manual handling assessments as peoples needs change. The service must improve its infection control practices so that people using the service are confident they are not put at risk. Improvements to the house should be completed and consideration be given to improving the environment for the benefit of people with cognitive and sensory impairments. Gold Hill Residential Home DS0000018654.V374380.R01.S.doc Version 5.2 Page 7 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.V374380.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.V374380.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): 1, 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 so they know that the home can meet their care needs. EVIDENCE: Following the last key inspection a recommendation was made that the statement of purpose be updated to provide an accurate reflection of the service provided. During our visit we saw that the guide to the service and the statement of purpose were updated by the manager in January 2009. The information reflects the National Minimum Standards and the service provided. In the entrance to the house we note that the statement of purpose, service guide, previous inspection report, fire safety and mental capacity act information are all in the hall and easily accessible for visitors. The hall table Gold Hill Residential Home DS0000018654.V374380.R01.S.doc Version 5.2 Page 10 also has a visitors book, and information leaflets, and comments cards for visitors. Following the last key inspection a recommendation was also made that the service should improve the information in their assessments, so that people can be confident the service will; meet their needs. The Annual Quality Assurance Assessment tells us that a new assessment form is being completed. We looked at the information gathered about a new person to the service, which shows that the old form is used. However the information gathered about the person is detailed and is used to inform that persons care plan. Example comments include: X has some difficulty word finding due to diagnosis of dementia and X has a good appetite, little and often meals preferred. The assessment form includes all of the topics in the National Minimum Standards including personal care, mobility, sleep, mental well being, medications, and family. We also note that the assessment from the local health authority or social services is used to help gather more information about the person before they move. The Annual Quality Assurance Assessment tells us that the service plans to improve by ensuring that information from outside agencies is collected in a timely manner, and improving their pre- admission care plans and evaluations through training for staff. Gold Hill Residential Home DS0000018654.V374380.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): 7, 8, 9, 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are treated with respect for their privacy and dignity and are supported by staff in a kind and sensitive way. There has been some improvement to care records and medications administration which needs to be continued so that all people using the service can be confident they are receiving the same level of support. EVIDENCE: Following the last key inspection a requirement was made that care plans must be updated and reviewed so staff have good information about how to support people using the service. The improvement plan for the service tells us that that peoples care plans have a new format to make them easier to use, staff have a handover report at the change of each shift and four staff have had training on care planning and risk assessment. We spoke to the deputy manager and senior in charge of these new arrangements. One senior staff member has responsibility for setting up the new care files, which has not been completed yet. The Annual Quality Gold Hill Residential Home DS0000018654.V374380.R01.S.doc Version 5.2 Page 12 Assurance Assessment tells us that the service is aiming to make the support they provide more personal. There is a residents care book, which is to be kept in the persons room and will give information on care preferences, a personal calendar, pictures, photographs, hobbies and interests. These have not yet been set up although we were able to see a blank copy. All monthly reviews of care files are being recorded with a documented date and whether changes are made. Staff tell us this is a paper exercise and the family or person is not involved at present. The manager tells us that the priority is to update the main care plan, then they will set up a key worker system using the residents books which will help the junior care staff keep in touch with peoples care needs. These improvements should take place as a matter of priority so that all care files are up to date and all people using the service can be confident they are receiving the same standard of care. We looked at the care files of four people using the service, and met or observed them during the day. We can see from someone who is new to the service that the care plan is completed within the week after they move in, and that time is taken to make sure all the details are in the care plan. The plans include a brief life story, and look at topics such as personal care, psychological and social needs, mobility, medication and nutrition. The plans set out the issue, the expected outcome and specific care needs for that person. Care files also contain a daily plan for peoples preferred routine for example times for meals. Plans also contain risk assessments related to peoples specific needs such as mobility, diabetes, smoking and falling. All plans also have assessments for nutrition, continence, mouth and foot care and medication. Information is clearly written in a way that promotes privacy, dignity and choice for example X can and likes to choose her clothes daily, she will need guidance with this. The plans also look at peoples social needs, and cognitive ability with guidance for staff on speech, anxiety, and use of cutlery and cups for example. Comments include staff to take time to find out what X is saying and have patience. We met a group of six people after their residents meeting who say that their opinions are listened to now when they didn’t used to be. One person said its got a lot better but there is still a long way to go. We observed some good staff interactions that respected peoples dignity, particularly in relation to sensitive areas such as using the toilet. One person with insulin dependent diabetes has instructions in their file for staff to observe for hypoglycaemia, and a flowchart for the treatment and identification of hypoglycaemia, which is good practice. Nine staff members have attended diabetes training at the end of 2008. However we note that one person with diet controlled diabetes did not have this highlighted under the nutrition section of their plan. This information was elsewhere in the plan, and clearly highlighted in the kitchen. We spoke to several staff members who are aware of this persons needs. While we could not identify a poor outcome Gold Hill Residential Home DS0000018654.V374380.R01.S.doc Version 5.2 Page 13 for this person, care should be taken that all relevant information is entered into all sections of peoples plan to prevent oversight and mistakes. We looked at the care file for someone who is highly dependent. Although their plan had not been changed to the new version, some parts of their plan had been updated following the last inspection. We note clear instructions for turning in bed, use of fluid monitoring charts, and a cream administration chart that is being completed. The plan gives guidance for district nurse visits, and monitoring for skin soreness. The deputy manager now completes a monthly audit of people at risk from pressure sores. However we note that this person has had an appropriate risk assessment for bed rails, and two staff are able to assist them without a hoist, but the manual handling assessment does not refer to these issues and is therefore out of date. A further requirement was made following the last inspection that staff must be aware of the personal and health care needs of people and care must be given in a reliable and consistent way. The improvement plan for the service tells us that documentation, handover information, training and supervision will be improved to achieve this. In general staff say there have been great improvements to information sharing. Senior staff record in the care files and there are three hand overs per day at every shift change where seniors tell junior staff about significant events. Staff are ware that a new weekly meeting is being set up to go through care plans. Seniors will discuss with others what is in selected care plans and junior staff can contribute to the care planning. We note that peoples daily records are detailed and it is easy to see that peoples care is being given as their care plan describes. Professional records show appropriate visits by the doctor and other health professionals, and whether medications are newly prescribed. Where relevant to their care peoples behaviour is monitored using a separate recording sheet. We spoke to four staff who are able to describe peoples needs well and show understanding of areas such as dementia and diabetes. Some staff tell us they have had recent training in these areas. People using the service also tell us that their care has improved and seems more reliable. Following the last key inspection a requirement was made that 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 improvement plan for the service tells us that staff will have medications training and regular audits will be carried out. We saw that there is a medications hand over book for every shift change and the deputy manager audits the medications once a month. We audited three peoples loose medications and one pack for someone who is known to refuse medications. All of these are stored, administered and signed for appropriately. However one person on short term medications had not been given the same medications as signed for. The service must take care that short term medications such as antibiotics are taken as prescribed. Gold Hill Residential Home DS0000018654.V374380.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 have a choice to meet their dietary needs or preferences. EVIDENCE: The Annual Quality Assurance Assessment tells us that the service provides a full and active programme of activities. There are two activities coordinators who work Monday to Friday and have 46 hours to spend with people using the service. Examples of their work include setting up a personal life history, holding regular residents meetings and taking people out on trips. The service has access to the local community bus two or three days a week and offers swimming, Thai Chi, pub lunches, garden centres, coffee mornings, and various clubs. Unfortunately we were unable to see written examples of the coordinators work as they had finished for the day, however the manager tells us that individual records of activities and community contact for people are being kept separately from people’s care files. Gold Hill Residential Home DS0000018654.V374380.R01.S.doc Version 5.2 Page 15 Activities on the board in the hall show a trip to a garden centre, coffee mornings, bingo, arts and crafts, and films. It would be good practice for the service to make this more clear and accessible for all people using the service. Our observations during the day showed that the television is on for much of the time in both lounges, with some people watching and some asleep. The smoking lounge is used by several people during the day who appear to get on well. There were no scheduled activities for the afternoon of our visit as a residents meeting took place, which involved six residents, both activity coordinators and the deputy manager. We were invited to sit in on the residents meeting. This covered the actions from the last meeting and discussion about a new newsletter for the service which would give people dates for activities and have contributions from residents. The meeting also discussed activities such as swimming, hydrotherapy, purchase of skittles and bowls for the garden, as well as bowling, a butterfly farm trip and in house shopping. We met with six people using the service after their meeting who say there are more activities; people can go out on trips in small groups if they wish, and lots of activities in house such as bingo, entertainers and folk musicians. We are able to see from peoples care plans that choice is respected and offered in all areas where people are able. The residents meeting showed choice being offered and peoples opinions being listened to. We also observed staff supporting peoples choices over lunch, and people getting up at different times in the morning and sitting where and with whom they choose throughout the day. Development of the residents book will help the service provide a more individual service which will assist in promoting autonomy and choice for people using the service. We sat with people in the dining room during their lunch. We saw that people are treated as described in their plans, for example with their meal sizes and company of others. We observed good, patient staff interactions particularly with people with communication difficulties, and note that staff offer choices for puddings and drinks. People using the service tell us that the food is good with lots of choice for all the meals of the day. We went to the kitchen and met the staff. There is a four weekly rota for meals which chows choice and variety. Breakfast is served from 8-10.30 which recognised peoples flexible waking times, and people can have a cooked breakfast. We saw that there is an accurate notice in the kitchen for all people who have special requirements such as diabetes or soft food. Gold Hill Residential Home DS0000018654.V374380.R01.S.doc Version 5.2 Page 16 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): 16, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements have been made so that people are aware of how to complain about the service and staff have an awareness of their responsibilities regarding the protection of people against abuse. These improvements should be maintained for the safety of people using the service. EVIDENCE: The last key inspection identified some concerns about the way complaints are handled. We saw that a complaints log is being kept. Issues include a complaint from a resident about the porridge, staff incidents, and an accident with a resident which needed to be investigated. All areas of complaint are taken seriously and appropriately documented and investigated. We also saw that the manager has written a reply to all families who raised concerns in their annual surveys, detailing what will be done about the issues raised. The Annual Quality Assurance Assessment tells us that the manager has set up comment slips in the hall for all visitors to use, and there are monthly meetings with staff, people using the service and relatives. All staff has been given a copy of the whistle-blowing policy. The service notifies us of any incidents affecting the welfare of people using the service, and current recruitment practices are safe and appropriate. We spoke to four staff about their knowledge of keeping people safe and they all understand the processes set up by the service and who to turn to if there Gold Hill Residential Home DS0000018654.V374380.R01.S.doc Version 5.2 Page 17 is a concern. Most staff have had training in the protection of vulnerable adults in the past six months, provided by an in house trainer. Gold Hill Residential Home DS0000018654.V374380.R01.S.doc Version 5.2 Page 18 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): 19, 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some improvements have been made to the environment and there is a programme of maintenance in place. However significant works are still outstanding and must be addressed to improve quality and safety for people using the service and staff. EVIDENCE: Previous key inspections have identified significant areas of work to be done in the house, particularly in relation to the laundry and kitchen areas. The service has been able to obtain quotes but has not yet started this work, which has been outstanding for some time. The last key inspection recommended that the service create a maintenance plan for works to be done. This has been completed and shows that although some areas have improved there are still areas which need to be addressed. These include the flooring in the kitchen and laundry, damp in the laundry, a broken lift, improvements to all rooms such as new furniture, bedside lamps, redecorating, visible pipe work, some Gold Hill Residential Home DS0000018654.V374380.R01.S.doc Version 5.2 Page 19 work to bathrooms, new furniture for the lounge, and broken sash windows which were identified at the last inspection. We note that some improvements have been made for example, the dining room lighting has been replaced, and the dining room has been redecorated with new pictures and table decorations. There is now a television for the smoking area, and we could see that some areas have been repainted such as a hallway and some upstairs bedrooms. There is a new shower room on the ground floor. However we also note that the other bedrooms on the other floors have very old furniture and decoration, and the ensuite bathrooms are very old. The stair carpets are old and stained throughout. In addition, having the smoking room in the conservatory next to the dining room means that cigarette smoke is very evident during meals and other residents are not able to enjoy a conservatory during the summer months. The service should also consider the decoration and signage of the building, which should be provided to assist the needs of a range of people using the service, particularly those with hearing impairment, visual impairment, learning disabilities or dementia or other cognitive impairment. The Annual Quality Assurance Assessment tells us that the service has employed another full time cleaner and 33 staff members have had training in infection control. Despite this we note that the floor outside the kitchen and dining room was not clean, there were flannels or towels in communal areas, an upstairs bathroom sink was not clean, and there was soap missing in the upstairs bathroom and toilet throughout the day. The manager tells us that one of these rooms is not in use however the door was open and available to walk into. Staff records show recent in house infection control training however the service must be able to demonstrate good hygiene and infection control practices in operation in the house. Gold Hill Residential Home DS0000018654.V374380.R01.S.doc Version 5.2 Page 20 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): 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 enough 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. EVIDENCE: The Annual Quality Assurance Assessment tells us that there are enough staff on duty to meet peoples needs and the service does not use agency staff, which is good practice. There are three day time shifts and a night shift. There are always three waking staff working at night and four staff during the day which includes senior staff. In addition there is always a deputy manager on during the week and at weekends. There are also enough domestic and kitchen staff to meet peoples needs. Rotas show us that sickness and leave is covered appropriately. The Annual Quality Assurance Assessment tells us that ten staff members have achieved the NVQ level 2, and six staff are taking the course. Two staff members have achieved NVQ level 3 and eight staff are taking the course. The staff training matrix confirms this. Gold Hill Residential Home DS0000018654.V374380.R01.S.doc Version 5.2 Page 21 We spoke to four staff members including two senior staff. They tell us they have had access to a lot of training recently and the manager is very supportive of training. Several of the staff have completed distance learning certificates from Warwickshire College in dementia awareness, equality and diversity and palliative care. Staff show enthusiasm for learning new skills and are able to speak about what they have learned. A new staff member has had induction and shadowing, and tells us she feels confident working with people with diabetes, dementia and significant physical needs. The training matrix and staff files also show that staff have had mandatory training in infection control, fire safety, moving and handing, food hygiene and health and safety. Staff have also had recent training in medications and protection of vulnerable adults. Much of the training is provided in house by the provider organisation; however we note that there has been some training input from the local authority. Some of this training includes supervision training, recording skills, deprivation of liberty standards and tissue viability. We looked at two staff files which show that current recruitment practices are appropriate and safe. However since the inspection the service notified us of an incident involving a staff member. This has raised concerns about past recruitment practices and we have advised the service to conduct an audit of all staff recruitment files to make sure that background checks have been done and people using the service are not put at risk. Gold Hill Residential Home DS0000018654.V374380.R01.S.doc Version 5.2 Page 22 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): 31, 33, 34, 35, 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The new manager has made some improvements. Further improvements are necessary to make sure 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. EVIDENCE: The Annual Quality Assurance Assessment tells us that the manager and two deputy managers have had recent training in supervision, care planning and risk assessments. We discussed the improvement plan for the service with the manager and she tells us she intends to apply to be the registered manager which she believes will help with leadership and direction of the service. The manager is also completing the NVQ level 4 in leadership and management and intends to complete it this year. It is clear from our visit that many areas Gold Hill Residential Home DS0000018654.V374380.R01.S.doc Version 5.2 Page 23 in the service have been improved and requirements from the last inspection have been met. However significant areas for improvement remain. We note that the Annual Quality Assurance Assessment was not informative enough in the section relating to health and personal care. The manager does not have a background in care and for these reasons must invest time into ensuring the improvements in this area are completed in a timely way. Following the last key inspection a requirement was made that the service must maintain a system for reviewing and improving the quality of care provided, including using the opinions of people using the service. The manager and deputies carry out monthly audits of wound and pressure care, accident audits which link to the accident book, a kitchen audit, a domestic audit, a maintenance audit and medications audit. There are monthly residents meetings for which minutes are taken and demonstrate actions that are being taken. Family meetings are advertised every month but as yet no one has attended. However the manager has written to everyone who sent a survey and will be sending out annual surveys to relatives again this year. It would be good practice for the manager to use this information to create an annual development plan for the service. A requirement was also made following the last inspection that staff must receive regular formal supervision so that they are sufficiently monitored to ensure peoples care needs are met. The manager has set up a separate supervision matrix for 2009 which shows that regular supervisions are happening. Staff files show minutes taken of supervision meetings which have happened recently. Staff tell us they have regular meetings with managers. During our visit we saw notices on staff boards for staff meetings which are held regularly, for seniors, health and safety, and domestic staff. Following the last key inspection two requirements were made for the service to liaise with the local fire service to ensure policies and procedures in place are in line with the Fire Safety Order, and to establish and maintain a system to ensure that people using the service are safe from potential risk or injury from environmental factors within the home. The Annual Quality Assurance Assessment tells us that the manager has formed a Health and Safety committee formed to monitor and address any areas of potential risk to the home. We note that the fire risk assessment is up to date following a meeting with the fire officer, environmental risk assessments are up to date, the manager has a checklist for equipment safety checks, and an accident report book is kept. We note that improvements have been made to the storage of and access to peoples money. The service has purchased a safe, all transactions require double signatures, and peoples financial details are stored in a locked cabinet. Gold Hill Residential Home DS0000018654.V374380.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 3 17 x 18 3 1 x 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 3 3 3 x x 3 Gold Hill Residential Home DS0000018654.V374380.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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 13 (5) Requirement Timescale for action 27/04/09 2. OP22 23 (1) (a) and (2) (a) (b) 3. OP31 Care Standards Act 2000 Section 11 (1) The service must make sure that there is safe system for moving and handling people who use the service, which includes an up to date moving and handling risk assessment. This is to make sure people who use the service are kept safe while receiving support. The service must prioritise the 27/05/09 structural work identified on its maintenance plan to make sure that the building supports the comfort and well being of people using the service. This refers in particular to the kitchen, conservatory, laundry and sash windows. The manager must apply to the 27/05/09 Commission be registered to manage this service. Gold Hill Residential Home DS0000018654.V374380.R01.S.doc Version 5.2 Page 26 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 OP1 Good Practice Recommendations The service should consider ways that it can make information about the service more accessible for people with different needs and impairments, so that all people interested in using the service are well informed. Improvements to the system of care planning should take place as a matter of priority so that all care files are up to date and all people using the service can be confident they are receiving the same standard of care. The management should undertake a regular audit of care plans to ensure that all relevant information is entered into all sections of peoples plan, to prevent oversight and mistakes. The service should make sure that short term medications such as antibiotics are taken as prescribed. The service should be able to demonstrate that it is able to minimise the risk of spread of infection and protect people using the service. The service should conduct an audit of all staff recruitment files to make sure that background checks have been done and people using the service are not put at risk. It would be good practice for the manager to use information gathered from people using the service and other audits to create an annual development plan for the service. 2. OP7 3. OP7 4. 5. 6. OP9 OP26 OP29 7. OP33 Gold Hill Residential Home DS0000018654.V374380.R01.S.doc Version 5.2 Page 27 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.V374380.R01.S.doc Version 5.2 Page 28 - 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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