CARE HOME ADULTS 18-65
Gordon House Belmont Grove Liverpool Merseyside L6 4EH Lead Inspector
June Beaver Unannounced Inspection 27th November 2006 11 am Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 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 Gordon House DS0000025106.V306716.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 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. Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Gordon House Address Belmont Grove Liverpool Merseyside L6 4EH 0151 260 9022 0151 260 9022 gordonhouse@c-i-c.co.uk www.c-i-c.co.uk. Community Integrated Care 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) David George Bruce Sara Elin Taylor Care Home 20 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (20) of places Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Residents between ages 16 and 64 years 18 MD residents between ages 16 and 64 years (PC) and 3 named male residents 65 years MD/E (PC) 4th November 2005 Date of last inspection Brief Description of the Service: The care home is managed by Community Integrated Care (CIC) and consists of a single storey building which houses 20 residents with long term enduring mental health illness. All residents have their own bedroom. Shared communal spaces include a well-maintained garden. The residents are encouraged to follow a lifestyle in accordance with their own choices and preferences. Two experienced psychiatric nurses manage the home. Psychiatrists, GPs, community psychiatric nurses, social workers and family support all residents in the home. The residents are encouraged to take up paid jobs, attend daycentres, or follow educational programmes. Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced site visit to the premises which lasted approximately six hours and was part of a key inspection. During the visit three service users were spoken to as well as five members of staff. One of the Manager’s had completed a pre-inspection annual quality assurance self-assessment document prior to the visit and the information it contained was verified on the day by looking at the records and documentation available at the home. There were some requirements and recommendations made which relate to documentation and training. What the service does well:
The service users are supported by staff who treated each service user in a friendly but respectful way. The home encourages family and friends to keep in contact with service users and many of them go home at weekends and visitors welcome at the home at any time. The home is clean and warm and offers a safe environment for service users to live in. There is an on-going programme of activities, which is individualised to service users own personal choice and hobbies, and there are some group activities when all the service users choose to get together. One of the service users spoken to during the visit talked about the Christmas Concert he and other service users were putting on for the staff and visitors, another service user was going late night Christmas shopping in the city centre and another service user was in the lounge talking to his visitor. Staff appeared to be aware of service users likes and dislikes and how they prefer to spend the day. Service users spoken to confirmed this and stated that the staff are “sound” and “you can ask them to come with you to the shops or they will give you a lift if you need one”. The menus/meals are planned in advanced however service users do have a choice if they do not like the planned meal.. One service user stated that “he would get some money from the staff and go and buy something to cook if he didn’t want the meal or alternative on offer”. The home has a rehabilitation kitchen where service users can cook a meal for themselves or visitors. Staff spoken to during the visit confirmed this and said “service users often cook a meal for some of the others or visitors, however they usually leave the washing up to staff!”. There is an “open door” policy and service users are free to come and go as they wish. Some service users need staff support to use the local community
Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 Page 6 services and facilities and this is generally discussed on admission and a plan of action drawn up. The Manager stated that the home has a very good relationship with the local G.P.’s surgery and Community Mental Health Team and this was supported by the survey forms returned to this office. One member of the health professionals team who visits the home said “staff are always very supportive to mental health professionals in respect of their clients and also make contact if there are any problems. I have placed there and I am very satisfied with the service” Other survey forms completed by either G.P.’s or psychiatric nurses ticked all the “yes” (satisfied) boxes. . What has improved since the last inspection? What they could do better: 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. Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 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 Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 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 and 5. Quality in this outcome area is good. This judgement has been made using all available evidence including a visit to the service. The Statement of Purpose and service user guide contained sufficient information to enable service users and their families to make an informed choice regarding the suitability of the service. EVIDENCE: The Statement of Purpose and Service User Guide is very detailed and informative and gives prospective service users and/or their relatives a good overview of the home, the accommodation, the staff and qualifications, the meals, social activities, contact numbers for the registered owners and what to do if there are any concerns/complaints about the service. The service does not take referrals directly as they usually come via the Community Care Schemes run by the Primary Care Trust who will provide a full medical and social history. A senior member of staff will also carry out a pre-admission assessment to make sure it can meet the prospective service user’s needs in full. The preadmission information is used to form an initial care plan which is reviewed shortly after admission. Service users are offered the opportunity of test driving the home prior to commitment and can visit the service as often as they need before making up Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 Page 9 their mind whether it is the right place for them or not. Many of the service users are able to move on to independent living after a period of rehabilitation Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 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 and 9. Quality in this outcome area is good. This judgement has been made using all available evidence including a visit to the service. The staff in the care home encourage service users to try to live an independent life which includes making decisions and taking responsible risks EVIDENCE: Two service users care files were case tracked and found to contain a good deal of information on service users mental and physical health and social care needs. All service users have an individual care plans which are drawn up on admission to the home and reviewed by the senior nurses on a monthly basis to ensure they are still appropriate. There is an “open door” policy and service users are free to come and go as they wish. Some service users need staff support to use the local community services and facilities and this is generally discussed on admission and a plan of action drawn up. The Manager stated that the home has a very good relationship with the local G.P.’s surgery and Community Mental Health Team.
Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 Page 11 Daily health records and risk assessments are also kept for each service user which include any specific issues such as accidents or incidents and any visits from GPs or specialist nurses. These records help staff to make sure all aspects of service users health and welfare are looked after. Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 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): 12,13,15,16 and 17. Quality outcome in this area is good. This judgement has been made using all available evidence including a visit to the service. The home provides service users with support and encourages them to take part in the local community and to pursue appropriate leisure facilities and employment. EVIDENCE: All service users have a care plan which is drawn up by the senior nurses and the service user. The care plans contain a lot of useful information and there was evidence that they are reviewed regularly and re-written if treatment is changed. The care plans also contain personal risk assessments agreed by the service user for matters such as going out or going on leave, taking tablets out of the home and managing their own money. Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 Page 13 Some service users are encouraged to take up therapeutic employment and one service user has a job at the home which he states “he enjoys as he likes to feel useful and keep busy”. The service users are encouraged to attend the weekly “activities planner” meetings when they will have the opportunity to discuss and plan the following week’s activity. One of the service users spoken to during the visit talked about the Christmas Concert he and other service users were putting on for the staff and visitors, another service user was going late night Christmas shopping in the city centre and another service user was in the lounge talking to his visitor. The service has a designated activities budget and the use of a mini-bus. The Manager stated that the staff are very good at challenging discriminatory behaviour and are offered training on induction and further study days on how to handle equality and diversity. All service users are entered on the electoral roll and can exercise their right to vote either in person with staff support if needed, or by postal voting. The service users can access a local advocacy service and the manager states that the Primary Care Trust are also considering setting up an independent advocacy service also. The home has also encouraged service users to use the Income Maximising Officer from the Citizens Advice Bureau about finances. The kitchen looked very clean and was equipped with modern cooking equipment and facilities. The menus are planned in advance however if the service user doesn’t want the planned meal they are able to have something else instead. One service user stated that “he would get some money from the staff and go and buy something to cook if he didn’t want the meal on offer”. The home has a rehabilitation kitchen where service users can cook a meal for themselves or visitors. Staff spoken to during the visit confirmed this and said “service users often cook a meal for some of the others or visitors, however they usually leave the washing up to staff!”. There is tea and coffee available throughout the day for service users and visitors to help themselves, and there is a nicely furnished communal dining area where service users eat and socialise. Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 Page 14 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 and 20. Quality in this outcome area is good. This judgement has been made using all available evidence including a visit to the service. The home supports service users mental and physical health care needs in an appropriate way and will seek advice from other professionals when needed. EVIDENCE: Through discussion with staff it was evident that service users wishes were taken into consideration as far as possible when planning day to day events. Staff appeared to be aware of service users likes and dislikes and how they prefer to spend the day. Service users spoken to confirmed this and stated that the staff are “sound” and “you can ask them to come with you to the shops or they will give you a lift if you need one”. Evidence that staff ensure that the service users health care needs were met was provided in the care files. Each visit from a member of the multidisciplinary team such as G.P. or a community psychiatric nurse was recorded with an outcome. Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 Page 15 Medication practices were generally satisfactory, however the staff need to make sure that they record the time of PRN medication on the record sheet so that other staff know when it was last given to prevent it being given too soon and putting the service user at risk. One service user is being supported to take responsibility for his own tablets by staff who observe how it is done with a view to him taking full charge in the near future. Another service user made comments on a “have your say” survey form about having to return to the home for a tablet. This was explored during the visit and the matter has now been resolved to the service user’s satisfaction. Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 Page 16 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 and 23. Quality in this outcome area is good. This judgement has been made using all available evidence including a visit to the service. There is a robust complaints procedure in operation, which makes sure that service users and their families’ complaints, or concerns are listened to. The home provides staff with training in adult protection procedures to make sure service users are not put at risk of harm or abuse. EVIDENCE: Through discussion with staff and reviewing the self assessment record it was evident that there had been no complaints since the last inspection. There is a comprehensive complaints procedure in operation at the home which helps service users and their families feel confident that their concerns will be listened to and staff will try and resolve matters. There is a training programme in operation at the home that includes Adult Protection issues and all staff have attended this as part of their induction and on-going training to make sure the service users are not put at risk of any harm or abuse. Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 Page 17 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 and 30. Quality outcome in this area is adequate. This judgement has been made using all available evidence including a visit to the service. The service users live in comfortable clean surroundings. The home is modern and bright, accessible to local amenities and equipped with modern furniture and furnishings. EVIDENCE: The premises were clean and tidy and generally well maintained, however the communal toilets and bathrooms need refurbishment as they were shabby, bare and the flooring was worn and badly stained. There is no central heating in the communal bath/shower rooms, they are heated by a small electric fan type heater fixed high up on one of the walls. They do not appear to provide a lot of heat and do not create a warm homely atmosphere in which to take a relaxing bath. Service users have personalised their rooms and are able to choose their own colour scheme. One service user is in the process of re-decorating his room and said he was able to choose the paint and do some of the work himself.
Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 Page 18 There are designated smoking areas and staff were observed reminding service users to respect this in a non-confrontational way. On the day of the visit the heater in the main smoking lounge was broken and the room was cold. This needs to be mended as soon as possible for the service users comfort. The communal lounges and dining room were nicely decorated and furnished with modern furniture. There is a well equipped rehabilitation kitchen to help service users learn cooking skills including preparation with help from staff. Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 Page 19 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): 32,34 and 35. Quality outcome in this area is good. This judgement has been made using all available evidence including a visit to the service. The service has a robust recruitment procedure and employs sufficient numbers of staff to ensure the service users health and welfare needs are met in a safe manner. EVIDENCE: An inspection of the rota indicated that there is a steady stable workforce with no vacancies.. The present staffing levels ensure service user needs are met and that their lifestyles and social activities are promoted. Through reviewing the staff files it was evident that there is a good recruitment procedure operating at the home. Staff files contained the information required to make sure service users are looked after by appropriately vetted staff. The recruitment process includes criminal record bureau and protection of vulnerable adult checks. The home provides staff with a wide range of appropriate training which includes NVQ training (National Vocational Qualification) to level 2 & 3. All staff are given regularly one to one supervision and a record kept of each session.
Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 Page 20 There appeared to be a very good rapport between service users and all levels of staff. A completed visitor’s survey form stated “All the staff are very pleasant and helpful from the manager to the cleaners. I am very satisfied in every way”. Another survey form completed by a social worker who places people in Gordon House stated that “staff are always very supportive to mental health professionals in respect of their clients and also make contact if there are any problems. I have placed there and I am very satisfied with the service”. Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 Page 21 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): 37,39 and 42. Quality in this outcome area is good. This judgement has been made using all available evidence and by visiting the service. The Manager is competent and has the skills necessary to manage the home in an efficient manner whilst developing good working relationships with staff, visitors and the service users. EVIDENCE: The Manager has worked at the home since 1988 and is one of two registered managers for the service. He is a registered mental nurse with many years experience in the national health service and private sector. He has completed the Registered Manager’s Award and takes part in regular training updates and specific training relating to mental health conditions. . Staff spoken to during the inspection spoke highly of the style of management in evidence at the home and stated that the Manager was very supportive.
Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 Page 22 Service users appeared to have a very good rapport with the Manager and frequently called at the office during the visit for a chat or to ask a question. Service users spoken to on the day of the visit also spoke highly about the Manager and staff. There was evidence that staff meetings take place giving staff the opportunity to raise any matters regarding the running of the home and there was evidence that service users’ and their families were sent questionnaires asking them for their opinion on the standards at the home. The service users and professional visitors survey forms returned to the Commission were complimentary about the running of the home and the staff. The service is supported by a Service Manager who visits monthly and send a copy of her audits to the Commission for Social Care Inspection. The certificates of worthiness required by registration for gas, fire equipment, electrics. Portable appliances, water temperature, hoist and lifts were available and up to date Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 Page 23 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 Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 2 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 x 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x x 3 3 x x 3 x Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 Page 24 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13 Requirement The registered person must ensure that entries of PRN medication contain the time of administration. The registered person must ensure that there is adequate heating in the smokers lounge. The registered person is required to upgrade the communal toilets and bathrooms and provide suitable heating. Timescale for action 15/12/06 2 3 YA24 23 23 31/12/06 31/03/07 YA27 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 YA27 Good Practice Recommendations It is recommended that a planned programme of refurbishment for the homes communal toilets and bathrooms be commenced. Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Gordon House DS0000025106.V306716.R01.S.doc Version 5.2 Page 26 - 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!
