Inspection on 06/12/05 for Gordena Care Homes

This inspection was carried out on 6th December 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gordena Care Homes 07/08/07

Gordena Care Homes 23/02/07

Gordena Care Homes 18/05/06

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Gordena Care Homes 16 Overnhill Road Downend South Glos BS16 5DN Lead Inspector Paula Cordell Announced Inspection 09:30 6 and 7 December 2005 th th Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 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 Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 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 Adults 18-65. 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. Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Gordena Care Homes Address 16 Overnhill Road Downend South Glos BS16 5DN 0117 9574966 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) Mrs Sarah Louise Howick Mr Simon Gordon Parker Mrs Judith Ann Parker Care Home 9 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (2) of places Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 9 persons (male and female) aged 19 years and over who have a learning disability. May accommodate one named person with a learning disability who has dementia. This will revert to the original certificate once the person leaves the home. Not applicable Date of last inspection Brief Description of the Service: Gordena Homes was registered with the Commission for Social Care Inspection in July 2005. The home is registered to provide personal care and accommodation to nine people with a learning disability aged 19 years and over. In addition the registration includes one named person who has dementia in addition to their learning disability. Gordena Homes is a large semi-detached Victorian property that is situated in a well established residential area. The road links with Staple Hill and Downend, both areas being within walking distance. Both areas have good public facilities and a regular bus service into Bristol. Communal/shared areas in the home are located on the first and top floors. This home would be only suitable to individuals who are fully ambulant and can use stairs. The kitchen, dining room and one bathroom plus the manager’s office is situated on the top floor. The middle floor has one lounge, a further three bedrooms and a bathroom. The laundry, shower room and five bedrooms are situated on the ground floor. There is a conservatory, which is available for the smokers of the household. There is a small garden at the rear of the property mainly grassed with surrounding shrubs. Gordena Homes is a family business owned by Mr Parker and Mrs Howick. The registered manager is Ms J Parker. Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was Gordena Homes’ first inspection since registration in July 2005. The home was bought as a going concern from an existing provider. The purpose of the visit was to establish if the home is meeting the National Minimum Standards and the requirements of the Care Standards Act 2000 and review the quality of the care provision for the individuals living in the home. The inspection was conducted over two days for a total of 12 hours. This inspection employed key elements of the national inspection methodology with the objectives of focusing on outcomes for the residents. This is evidenced through evaluation of core standards and verification through a surveying and case tracking approach, in which the views of residents and staff were sought. The inspector met with the registered provider Ms Howick, the registered manager Mrs Parker, five of the nine residents and three members of staff. An opportunity was taken to view the home and a number of the records relating to the management of the home and plans of care for three of the residents. What the service does well: What has improved since the last inspection? What they could do better: There are a number of requirements and recommendations from this visit to ensure compliance with the legislation and maintain the safety of the residents living in Gordena Homes. This was the home’s first inspection since the purchase in July 2005. Whilst there was evidence that the home was establishing new working systems for Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 6 recording and the planning of care and ensuring safe systems of working there was still much work to be done. Residents must have a plan of care that records in sufficient detail their support needs and how this is being met. The home would benefit from a review of the present recording systems to enable information to be more accessible and filed in logical sequence. Residents would benefit from the information available to them to make a decision to be expanded to ensure compliance to the legislation and to enable them to make an informed decision on whether to move to the home including the statement of purpose and a contract of care. As part of the process the home must review the assessment policy and the assessment tool to ensure that it reflects the service provided at Gordena Homes, which will assist in ensuring that the home only admits individuals whose needs they can clearly meet. Residents must be assured that there are robust practices in the administration, recording and storage of medication and that there is a clear policy to guide staff. Residents would be better protected if staff attended a course on their protection and the procedures were reviewed in light of current legislation, including the policy on abuse and the use of restraint. Residents would benefit from clear records being maintained including inventories of their belongings. Residents must be protected by a risk assessment that clearly details all areas of risks and how these are being minimised without compromising their independence. These should include risks in the home and the community. Residents would benefit from staff receiving training specific to the needs of the individuals living in the home with evidence supporting this attendance. Residents and staff would benefit from the policies and procedures being reviewed to ensure compliance to the legislation and to ensure they reflect the service provision at Gordena Homes. 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. Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Residents had some information to enable them to make a decision on whether to move to Gordena Homes. This must be expanded to ensure that it meets with the legislation including contracts. There was a lack of processes to support the home in ensuring the smooth transition for new residents in the form of an assessment tool and a policy, which was relevant to Gordena Homes to guide the prospective resident and the staff. EVIDENCE: The home has a statement of purpose and a service user guide, which requires some additions to ensure that it complies with the legislation. Areas of inclusion are the home’s complaints procedure, terms of conditions of service, fees charged and the process for referral and admissions to the home. The service user guide focussed on the environment and should be expanded to include the facilities and the service that individuals can expect. The guide was available in an accessible format and photographs had been included to make the information more understandable for the intended audience. This is good practice. The provider and the manager stated that the statement of purpose and the service user guide has not been sent to the relatives or representatives. This was echoed in the two returned relative questionnaires, which stated that they had not been given a copy of the complaints procedure. Good practice would Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 9 be to give copies of the statement of purpose/service user guide to residents and their relatives or their representatives. The home has one vacancy. The manager stated that they had not been involved in an admission of a new resident, as the previous provider had undertaken this. However they were able to articulate the process including an assessment of need to ensure the home was able to meet the individual’s care needs and the involvement of the existing residents to ensure compatibility. The manager stated that they would obtain the assessment and care plan drawn up by the placing authority for a prospective resident. A copy of the home’s planned assessment tool was seen however, this concentrated on the physical needs rather than social, psychological, and emotional needs, which would be more compatible to supporting an individual with a learning disability. The manager was advised to review and ensure that all areas as detailed in standard 2 of the National Minimum Standards on assessment were in place. The home had an admissions policy but this reflected the service provided to individuals with mental health needs. This must be adapted and reflect the service provided at Gordena Homes. Contracts were seen for the previous provider. The manager stated that the home is in the process of liaising with placing authorities on the fees charged for each individual and has only recently received this information. All residents or their representative must have a contract of care. Contracts of care must be in an accessible format to ensure they are appropriate to the intended audience. Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 Residents were evidently involved in the planning of their care. Care information would benefit from more organisation to ensure it is accessible. Care plans lacked evidence of a formal review to demonstrate how the home was meeting the changing needs of the residents. EVIDENCE: Whilst there was information in the home detailing the care service provided to the individuals, including a plan of care, information for supporting individuals when challenging, risk assessments and health care management, this was all disjointed and held in a variety of different places in the office. It took staff a while to find the information and it was difficult for the inspector to gain a true picture of how the home was supporting the individuals. Some care plans had insufficient information, to show all of the actions staff needed to take, to support the residents to meet their needs and to show how specific care needs had been met. The manager stated that the plans of care had been re-written and developed since the change of provider. However, much of the information lacked a date Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 11 and a signature. This meant it was difficult to determine whether care plans were being reviewed at the appropriate intervals (at least six monthly). Risk assessments were in place but had not been reviewed since August 2003. Risk assessments covered a wide range of activities both in the home and the community. A resident stated that they were involved and consulted in the planning of their care. Examples were given on activities and personal care. Residents were complimentary about the increased involvement under the new ownership. Two residents told the inspector that they had recently changed rooms to enable a person to have a single bedroom due to their changing needs. Both of the individuals stated the new provider had discussed with them the changes and both had been happy to share. One individual’s care folder contained a communication dictionary describing how the individual made choices and to enable staff to read clearly what the individuals body language meant to ensure a consistent approach. This is good practice. The manager stated that they were planning to re-introduce individual program plan meetings (IPP) to ensure more resident involvement. This would be good practice. Residents confirmed regular meetings were held to discuss the running of the home including consultation on the change of management of the home, activities, holidays and menu planning. During these meetings opportunities were taken to consult with residents on whether they were happy with the present service provided and for them to make suggestions for improvements. From these discussions it was evident that the residents were the focus of the service provided. The home does not have a policy on confidentiality which can be shared with other professionals and guide both residents and staff. However, conversations of a confidential nature were conducted in the office with the door closed. Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Whilst it was evident that the residents were supported to choose their daily activities and each had a combination of college courses and day centre placements, this must be extended to ensure that leisure and social activities are tailored to the individual. Records did not clearly describe the social opportunities open to residents. Residents were supported to maintain contact with friends and family. Residents described more involvement in the running of the home and how they could chose how to spend their day. EVIDENCE: Residents were keen to share with the inspector their new day care plans. All but one of the residents in the past attended a day centre, which was provided by the previous provider. Residents stated that now they attend college or a combination of day centres and one individual attends a local City Farm, another did voluntary work in a bakery one day per week. In addition arts and craft activities and cooking is completed in the home. One resident confirmed that they make cakes on a regular basis and they enjoy this. Daily records lacked any real depth to determine how the home was enabling and supporting individuals to be active and occupied. Whilst it was evident that the individuals were going shopping there was a lack of other activities offered. Residents Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 13 stated that they go shopping and go for walks but there were insufficient records to determine a full extent of the activities that individuals were attending. Two individuals had been identified to go swimming but there were no records confirming the activity had taken place. On the day of the inspection a small group of individuals went to a local park for a walk and a cup of tea. Staff stated that residents are offered a daily outing and some of the residents go out in the community independently. Staff stated that there was sufficient staff on duty during the day but in the evenings there was only two staff, which made it difficult to support individual or small group activities in the community. From talking with staff it was evident that trips to the pub or outings were tailored to the whole of the house, staff stated that this is often through the choice of the individuals. However, staff were talking positively about the introduction of each resident being allocated an amount of time with their key worker on a weekly basis to plan and complete an activity of their choice which could include shopping or going to the pub or the cinema. This would be good practice. Residents were keen to share information about Christmas Parties and shopping trips to purchase presents for friends and relatives. The home had been decorated festively and it was evident residents were looking forward to spending Christmas in the home or with relatives. Residents are involved in contract work where individuals complete work at home. Residents confirmed their enjoyment in the activities. However, the money was paid into a central account and used for social activities. Residents should be consulted to ensure that this is satisfactory to all concerned and the system is equitable. The manager stated that residents were consulted on activities and holidays. It was decided that a holiday this year was not possible due to the change of provider and that residents have only recently had access to their finances as these were with the previous provider until September 2005. Residents confirmed the consultation process and stated places that they wanted to go next year. The provider stated that the residents were keen to try different holidays than that offered under the previous management, which was an annual trip to Brean. Holidays included hotels or destinations that included a plane trip. This will be followed up at the next inspection. The home supported individuals to maintain contact with relatives and provided opportunities to socialise outside the home. Residents described good relationships with relatives. Birthdays and special events were celebrated. Residents described good relationships with friends from college and their day centres. The manager, provider and residents consulted confirmed that the routines of the home were resident led. However guidelines for the sleep in staff stated Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 14 that all residents were to be in bed by 9pm. The manager and staff stated that residents often stay up later and residents confirmed that they chose when to go to bed. This documentation should be amended to ensure that it reflects individual choice. Residents were making full use of their home including their private space and the communal lounges. The kitchen was locked when staff were not present, however it was evident that individuals were encouraged to use the kitchen supported by staff. Individual risk assessments confirmed that supervision was required in the kitchen. Menus were not assessed on this occasion. Residents stated that they enjoyed the food in the home and the weekly take away on a Saturday night. The kitchen was well stocked with a combination of convenience food and fresh vegetables and fruit. Staff stated that fruit is available with every meal. Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 Resident’s personal care needs were being met, however a review of the levels of independence should be undertaken. Resident’s health care needs were not clearly being met. Residents were not protected by policies and procedures in the safe administration of medication. EVIDENCE: As already mentioned information on care was not held centrally and was difficult to fully assess that residents care needs were being met. There was a lack of information relating to health care appointments. The manager stated that this was not written in the personal diary, however one persons entry included “visit to doctor”. There was no documentation to be found on the outcome of the visit or follow up on the medical record. One care plan made reference to health monitoring due to their diabetes there was no reference in the plan of care or other documentation that this was being done. The home is in the process of drawing up Health Action Plans in response to the Valuing People White Paper. This is good practice but further work is required to ensure that these are accessible to staff and there is a need for clear guidelines on what should and must be recorded. A resident stated that the home is good at arranging doctor, dentist and optician appointments. Whilst information was limited there was sufficient Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 16 evidence to say that residents were attending appointments at regular intervals in respect of the dentist and the opticians. The manager stated that all residents are supervised with bathing to minimise risks. This should be reviewed to ensure that whilst ensuring the individuals safety it does not curtail their independence or right to privacy. Each person had a personal care statement detailing how their would like to be supported and their level of independence. All residents were dressed reflecting their individuality. Personal care was delivered behind a closed door ensuring the privacy of the individual. It was evident that the home was accessing support from other professionals including psychology, psychiatrists and the community learning disability team. The home has a policy on the administration of medication, but this focused on the administration and lacked information about ordering, disposal and what to do in the event of an error. The inspector has sent guidance to assist with this process to ensure compliance with the Royal Pharmaceutical Guidelines. A random check of the medication highlighted two concerns in that two individuals were being administered as and when required medication as a daily medication. The manager contacted the pharmacist and the prescribing doctor immediately to resolve the issue. The home must send a regulation 37 notification the outcome to enable the Commission for Social Care Inspection to monitor the situation. There were no stock records to enable a full audit of the medication. The manager stated that the system is new and has been in operation for the last two months. The pharmacist has arranged training but this has been cancelled on two occasions. Three staff have completed a distance learning package on medication, which was assessed by an external assessor. The manager stated that staff only administer medication once they have worked in the home for three months and have been assessed as competent. A member of staff confirmed this. Presently only four staff have been assessed as competent which is the manager, provider, deputy and one carer. It was noted that one of these members of staff were always working in the home. Medication is stored in a locked cupboard along with food. The manager has requested a new cabinet from the pharmacist. This will be followed up at the next inspection. The communal rooms are situated on the first and second floor of the home. This means the home must complete regular assessments on the care needs of the individuals who are getting older in respect of their mobility to ensure their safety. Risk assessments were seen in respect of the stairs and mobility. These must be kept under review. The last review was September 2003. Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 17 There was no documentation in respect of the resident’s wishes in respect of their death or in the event of requiring palliative care. One of the residents has dementia. The home is in the process of organising training to ensure that staff have the skills to support the individual. The care plan must reflect the changing needs of the individual and how the staff are supporting the individual with their condition. Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Residents were confident that the home would listen and action any concerns they have. However, the complaints and abuse policy failed to demonstrate that these were based on current good practice. There was a lack of staff training in abuse however this was planned for 2006. EVIDENCE: The home has a complaints procedure, which makes reference to the Association of Residential Care as a second level of complaint. There was no mention of timescales and no mention of the role or contact details of the Commission for Social Care Inspection should individuals continue to be unhappy. This requires updating to ensure it reflects current practice of the home. Residents were able to describe what they would do if they were unhappy and would direct concerns to the provider or the manager. Two completed relative questionnaires stated that they were not aware of the complaints procedure. A copy of the complaint procedure must be sent to relatives. The home has a policy for protection of vulnerable adults. This must be reviewed to ensure compliance with the Department of Health ‘No Secrets’ and the local authority’s policy on protection ensuring a multi-agency approach. A copy of the local authority’s policy on ‘No Secrets’ was in place. The manager and a member of staff were aware of their responsibilities in reporting all allegations of abuse and what constituted abuse. A whistle blowing policy was in place. The home is a family run business. However, from talking with the provider, the manager and staff there were no worries about voicing concerns about challenging practices. The inspector was Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 19 given healthy examples where staff were challenging their own practices and that of others to the benefit of the residents. The manager was able to provide evidence that all staff would be attending training in abuse and an external course was planned for February 2006. This will be followed up at the next inspection. In addition the provider was in the process of arranging for all staff employed in the home to complete the Learning Disability Award Framework foundation and induction. As part of the award there was a section on ensuring the safety of vulnerable adults. This would be good practice. There were guidelines for dealing with the levels of aggression for each individual. These were about positively diffusing situations. The manager stated that physical aggression is rare and restraint has been not been used in the last few years. The home completes a report on incidents of aggression and the action taken. The records were clear and contained sufficient detail. The policy on restraint requires reviewing to ensure compliance to the Department of Health’s guidelines on using restraint. A copy of the guidance was sent to the home directly after the inspection. There was no current staff training on dealing with challenging situations. This must be addressed to ensure staff have the skills and the competence to effectively support the individuals living in the home. Finances were checked at random for two of the residents. The amounts corresponded with the records and receipts were seen along with two signatures supporting the expenditure. This is good practice. The manager stated that the provider is the appointee for all the residents and new bank accounts have been opened in the name of the resident re Gordena Homes. The accountant stated that there have been difficulties during the purchase of the home when the previous provider did not send all information relating to the residents finances. This was requested on the day of the inspection and bank statements were sent across. The home was in the process of reconciling their records with previous statements. A further request to the previous provider was being made for the receipts of expenditure. Without the day-today receipts during this period it was difficult for the inspector and the accountant to fully account for the finances during the change of ownership. The provider was made aware of the procedure to follow should any discrepancies appear. Due to the changeover of provider the fees have not been paid to the new provider and residents benefits have not been received. This is in the process of being resolved including residents paying back loans to the provider for day-to-day expenses. Clear records were seen of the loans. Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Residents live in a homely, clean and comfortable environment, which is meeting the needs of the residents. The home is not suitable for individuals who have mobility needs. EVIDENCE: The home is a large Victorian house spread over three floors. There is ground floor accommodation, however the lounge is situated on the first floor and the kitchen and the dining room are on the second floor. There is no passenger lift, which makes the home unsuitable for people with high mobility needs. There is access to local shops and facilities within walking distance. There are six single bedrooms and one double bedroom. An opportunity was taken to speak to the individuals who were sharing the bedroom and both were happy to do so. There was no screening in place to ensure privacy. The provider stated that they were exploring options for this, which would include consultation with the two residents. One of the lights in the hallway was not working and the manager provided evidence that this was being addressed along with the electrical appliance testing. A letter was seen confirming this. Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 21 The provider stated that there are plans to refurbish the home to move the kitchen and lounge facilities to the ground floor within the next twelve months. No plans were available at the time of the inspection. This would be seen as good practice. However, the home must keep the Commission for Social Care Inspection informed to ensure that the home continues to meet the environmental standards and monitor the effects on the residents living at Gordena Homes. All of the bedrooms were seen. These were personalised to suit the individual’s personalities. A concern was raised that the two of the bedroom windows opened directly on to the conservatory where residents smoke. There was a risk of passive smoking and this limited the view for those individuals. It was noted that there was no lockable storage for some of the residents to store their valuables. Communal areas were homely and being used by the residents as they chose. The home was clean and free from odour. Cleaning schedules were seen. Care staff are responsible for the cleaning of the home along with the residents. A resident confirmed that they assisted and were happy to do so especially with their bedrooms. Residents were keen to show the inspector their own personal space. Emergency lighting was seen throughout the home and these were checked daily. The manager stated that they were in the process of contacting the fire brigade to request a full inspection of the building. This demonstrated a proactive approach to ensuring the safety of the individuals. There were no radiator guards throughout the home and water temperatures exceeded 43°c. There were no risk assessments in place to demonstrate that residents were safeguarded against risks of scalds. A risk assessment must be in place for each radiator in relation to the residents living in the home. Where a risk has been identified the home must take appropriate action. The home has adequate bathrooms to meet the care needs of the residents. There are two bathrooms and a shower room with one separate toilet. These contained adequate hand washing facilities. There was a range of comfortable and accessible shared spaces including an area for residents to smoke. Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 Residents are protected by a thorough recruitment procedure. Whilst staff are supported, more formal structures should be put in place along with a comprehensive training plan for individuals. The home has only recently been taken over, it was evident that systems were still being set up to ensure that staff were trained and competent and supported in their role. The manager was aware of her legal responsibilities and good practice. The inspector looks forward to reviewing this at the next inspection. Consideration must be taken to ensure that there is adequate staff working in the home to support residents to have opportunities to go out socialising in the evenings EVIDENCE: The residents are supported by a core group of staff. There are three staff during the day and two staff in the evenings with one member of staff sleeping in. As already mentioned the reduction of staff in the evenings means that there are a lack of social opportunities for the individuals living in the home. The home employs three staff under the age of 21 years of age. The duty rota provided evidence that these staff are not left in charge of the home or complete sleep in duties unsupervised. A member of staff stated that they have to work five sleep in duties with senior staff prior to being left in charge of the home as part of the induction process. This is good practice. Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 23 There were guidelines for staff and clear responsibilities in relation to their daily role in the home. Staff meetings were happening every month to discuss issues and roles within the home. The manager described the changes that have been implemented in the home since the change of ownership. Whilst this was acknowledged as being a slow process it was evident that the manager and the owner wanted to make significant changes both to the environment and the delivery of care. Residents were aware of the change of ownership and spoke positively about the increased involvement. The manager has been in negotiations with a local training provider and is in the process of introducing the Learning Disability Award Framework for all staff. The plan is for this to be in place for February 2006 a letter was seen confirming this. This would be good practice. In addition all staff will attend dementia and protection of vulnerable adults training. This will be followed up at the next inspection. Individual training records for staff were not in place and the manager stated that these are with the previous provider. This must be addressed to provide evidence that staff are undertaking periodic training at least 5 days per annum (pro-rata for part-time staff) relevant to the care needs of the residents and their individual roles. It was evident from talking with the new provider and the manager that the home is working towards 50 of the workforce having an NVQ. The manager has completed their NVQ 4 in care and management and has achieved the Registered Manager’s Award. The deputy and the provider are planning to complete this course. In addition a carer has an NVQ 2 in care and two further staff will be enrolling to complete. This would mean that a total of four staff out of seven would have an NVQ in care. Inductions were in place but in one case there was no staff signature supporting that this had been undertaken. Recruitment records were in place to demonstrate that residents are safeguarded. This included references, a completed application, proof of identification and a criminal record check. The home must develop formal supervision and review of an individual carers performance. The manager stated that they were planning to attend training along with the deputy to enable them to fulfil this role. Since the change of ownership only two staff have received a formal one to one supervision session. The manager stated that they were planning to introduce formal supervision for all staff on a six weekly basis. A member of staff stated that they felt supported in their role as carer and that the provider and the manager were approachable. In conclusion the home has only recently been taken over, it was evident that systems were still being set up to ensure that staff were trained and competent and supported in their role. The manager was aware of her legal Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 24 responsibilities and good practice. The inspector looks forward to reviewing this at the next inspection. Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,40,41,42,43 The home has been through a period of change including ownership. Whilst there is much to be done it was evident that there was a commitment from the manager and the provider to improve service provision. Residents must be protected from scalds in the form of risk assessments or safe water temperatures and radiator covers. EVIDENCE: Gordena Homes was previously known as Nightingale Care Homes and has recently been purchased by Ms Howick and her brother Mr Parker. They have recently attended an interview with the Commission for Social Care Inspection to become the registered providers. The business is a family concern. The registered manager is Mrs Judith Parker. Mrs Parker has managed the home for the past two years under the previous owners. Staff spoke positively about the support from both the manager and the provider and had been informed and involved about the changes that they want to put in place. Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 26 The manager stated that under the previous management many of the day-today management responsibilities were undertaken by the previous provider for example budgeting, staff training, staffing arrangements and development planning and her new role has been a real learning curve. The provider and the manager were keen to review the direction of the home to ensure that residents have more involvement and care is tailored to the individual. Changes have been made in the planning of care and daily activities. Both the provider and the manager acknowledge that there is still much to be done. An opportunity was taken to read many of the policies that are required under the Care Homes Regulations. Many of these did not reflect the practices in the home or the service provided. A total review of the policies is advised using the National Minimum Standards as guidance, which refers providers to other guidance and legislation. The home should ensure that these policies are accessible to staff, the manager and the provider. Records have been discussed throughout the report. Whilst the home is reviewing the recording of information this must be logical and accessible. There were no inventories for residents’ belongings and no training records for staff. Residents’ daily records lacked what was happening in practice as staff were led to believe that nothing personal could be documented. This must reflect the day-to-day wellbeing and the support given to the individual and include episodes of challenging behaviour and attendance of appointments or make reference to where this is documented. A tour of the building was undertaken. There were no radiator guards or control on water outlets. There were no risk assessments in place demonstrating that this had been assessed to ensure the safety of individuals. This must be undertaken and where a risk is identified the provider must take appropriate action. The provider stated that since the purchase of the home window restrictors have been put on all windows and radiator guards will be purchased and installed in high-risk areas. Fire records were seen and found to be in good order including training, fire drills and checks on the equipment. In addition there was a fire risk assessment. There was a risk assessment for the safe storage of cleaning products and some data sheets on specific chemicals. The manager stated that they would be contacting other companies to ensure that all chemicals brought into the home have a Data Sheet. Electrical equipment lacked a sticker to say that this had been tested. A letter was shown to the inspector demonstrating that this was being completed during the week of the inspection. Evidence was seen that the previous provider had checked this within the last twelve months. Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 27 Budgets were discussed with the accountant who was in the process of developing a profit and loss record. This was not seen on this occasion as the business has only been in operation since July 2005 and a true cost was still being obtained. It was evident from discussions with the provider and the manager they were planning to meet with placing authorities to ensure the charges reflect the true costs. The home was clearly displaying the certificate of insurance and registration. These were satisfactory and reflected the nature of the business. Since taking over the business the provider stated that they have increased the insurance cover in response to a request from the placing authority. Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 2 x 3 2 Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 2 12 3 13 2 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 2 3 2 3 2 2 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Gordena Care Homes Score 2 2 2 2 Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 2 2 X DS0000064848.V260208.R01.S.doc Version 5.0 Page 29 Not applicable Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 14 (1) Requirement The home must develop an assessment of need for prospective residents that reflects the needs of an individual with learning disabilities. Care plans to be kept under review at least six monthly and more frequently for residents who are getting older. Risk assessments to be kept under review and reflect the activities and needs of the individual. For residents to have a contract of care which is signed by the individual or their representative. Consideration should be taken to ensure that this is accessible. Expand on the statement of purpose to ensure that it contains all information specified in schedule 1. A copy to be sent to the Commission for Social Care Inspection. To maintain a record of how the home is meeting the health care needs of the residents. The home must review the medication procedure to ensure DS0000064848.V260208.R01.S.doc Timescale for action 07/01/06 2 YA6 15 (2) (b) 07/02/06 3 YA9 13 (4) 07/02/06 4 YA5 5 (1) (a) (b) (c) 07/02/06 5 YA1 4 Shc 1 07/02/06 6 7 YA19 YA20 12 (1) (a) 13 (2) 07/12/05 07/02/06 Gordena Care Homes Version 5.0 Page 30 8 9 YA20 YA20 18 (1) (c) (i) 13 (2) 10 YA20 13 (2) 12 (1) (a) 11 YA20 13 (2) Sch 3.3 (i) 18 (1) (c) (i) 13 (6) 12 13 YA35 YA23 14 YA23 13 (6) (7) 15 YA33 18 (1) (a) 16 YA42 13 (4) 17 YA22 22 compliance with the Royal Pharmaceutical Society Guidelines. For all staff to have medication training. To ensure the medication is stored as per the Royal Pharmaceutical Society Guidelines. To review the administration of medication for two individuals who are receiving as and when required medication on a daily basis with immediate effect. The outcome to be sent to the CSCI in the form of a regulation 37 notification. For the home to maintain a record of all medication entering the home to enable an audit to be completed. Staff must complete an induction within six weeks of employment. All staff to attend a course on vulnerable adults and supporting individuals who exhibit challenging behaviour. The policy on restraint and protection must be reviewed to ensure compliance to legislation and guidance. (No Secrets and the Department of Health’s Guidelines on restraint for people with learning disabilities). Review staffing to ensure that residents have opportunities to go out in the evenings as detailed in the statement of purpose. For the home to assess the need for safe water temperatures and radiator guards in respect of the individuals living in the home, where a risk is identified prompt action is to be taken. The Policy on complaints must be reviewed to ensure it reflects the home’s structure and DS0000064848.V260208.R01.S.doc 07/02/06 07/01/06 07/12/05 07/12/05 07/01/06 07/05/06 07/03/06 07/01/06 07/01/06 07/02/06 Gordena Care Homes Version 5.0 Page 31 includes timescales and the contact details for the CSCI. Copies must be given to residents and their representatives. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 Refer to Standard YA12 YA20 YA6 YA41 YA23 YA40 Good Practice Recommendations To review the payment of the contract work undertaken by residents to ensure equitable. To record residents wishes in the event of their death seeking views of the residents and their representatives where relevant. To review the logical sequence of recording and storing of resident information to ensure it is accessible. To develop an inventory of residents belongings. To record how the home is supporting residents with their finances including who is acting as the appointee. Review all policies to ensure they reflect the structure of the home and the care needs of the residents as per Appendix 2 of the National Minimum Standards for Care Homes. For each staff member to have an individual training record of courses attended. Including copies of certificates. Ensure that all care documentation is dated and signed. To obtain Data Sheets in respect of COSSH and copies to be held in the home. 7 8 9 YA35 YA6 YA43 Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 Page 32 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Gordena Care Homes DS0000064848.V260208.R01.S.doc Version 5.0 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!