Inspection on 24/08/09 for Gorsefield Residential Home

This inspection was carried out on 24th August 2009.

CQC found this care home to be providing an Poor 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

Gorsefield Residential Home 09/09/08

Gorsefield Residential Home 10/09/07

Gorsefield Residential Home 29/09/06

Gorsefield Residential Home 22/02/06

Gorsefield Residential Home 17/08/05

Gorsefield Residential Home 30/03/05

Gorsefield Residential Home 03/11/04

Gorsefield Residential Home 25/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Gorsefield Residential Home 306 High Lane Burslem Stoke on Trent Staffordshire ST6 9EA Lead Inspector Peter Dawson Key Unannounced Inspection 24th August 2009 09:00 DS0000008233.V377337.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gorsefield Residential Home Address 306 High Lane Burslem Stoke on Trent Staffordshire ST6 9EA 01782 577237 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) Mr David John Hood Mrs C Bhalla, Mrs Janet Hood Manager post vacant Care Home 17 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (17), of places Physical disability over 65 years of age (5) Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 17 Physical disability - over 65 years of age (PD(E)) 5 Dementia - over 65 years of age (DE(E)) 8 The maximum number of service users who can be accommodated is: 17 9th September 2008 2. Date of last inspection Brief Description of the Service: Gorsefield is situated on the main road in High Lane, close to Burslem and directly on a bus route allowing easy access for visitors. The home is a large detached property which has been extended and provides good spacious accommodation. The building and location are quite impressive, well presented and well maintained. There are attractive gardens to the front and rear with good parking facilities. Accommodation is on 2 floors with shaft lift access to the first floor. On the ground floor there are 2 lounges, separate dining room, kitchen and 5 single bedrooms, there is an assisted bathing facility also on this floor. On the first floor there are 10 bedrooms, 2 are shared rooms and have en-suite facilities, some with shower. On this floor there are 2 bathrooms, one has an assisted facility. There are separate toilets, office and storage facilities. There is a small lounge/recessed area with kitchenette, allowing space to receive visitors. The home has registration to provide accommodation for up to 17 older people 5 of whom may have a physical disability and 8 may have dementia care needs. There is presently no registration for people with mental health needs. Current weekly fees can be obtained by contacting the service direct. Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 5 Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes The last Key unannounced inspection of this service was on 9th September 2008. This unannounced Key Inspection was carried out on one day by one inspector from 08:30 – 17:00. The National Minimum Standards for Older People were used as the basis of assessment of the service. The service completed the AQAA (Annual Quality Assurance Assessment) prior to the inspection. This is a legally required self-assessment every service has to complete annually. This contains information about what the service think they do well, what progress they have made over the past year, what they think they could do better and their plans for improving the service over the next year. This was completed by the Acting Manager who had no previous experience of completing this document. The information was brief and without detail or depth to indicate the level of service provided and plans for the future. During the inspection most people were seen and many spoken with separately and together. We were also able to speak with 4 visiting relatives who expressed their views about the service. Comments were favourable from those spoken with and no complaints or concerns expressed. We also spoke with staff on duty, including care, catering and housekeeping staff and all showed a commitment to people using the service. We were able to visit all the communal areas and spoke with people in depth who were sitting in the two lounge areas. We also saw a sample of bedrooms and the external garden areas. Records inspected included: Care plans, risk assessments, daily notes, and medication records, staffing rosters and staff records. There were 16 people in residence at Gorsefield at the time of this inspection, this included 2 people on respite care. The only vacancy was in a shared room and the Acting Manager said that this room was likely to remain as a single room. Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 7 What the service does well: Staff have good awareness of healthcare needs and swiftly refer to health care professionals if there are concerns about health matters. Good working relationships exist between staff and GP (General Practitioner) and District Nurse. This was demonstrated in an observed visit by the GP during the inspection who had been called to see 3 people. The GP had said, when seen on the previous inspection, that staff were helpful and cooperative and made appropriate early referrals where there were any concerns about health. A person who has been cared for in bed for 3 years (recently deceased) had been cared for during a period of deterioration with oversight from the District Nursing Service who had complimented staff upon their diligence, cooperation and good care. The person was totally dependent and the Nursing Service had reduced the regularity of visits as a result of their confidence in the home’s staff in providing a high standard of care. Positive comments from people using the service included, “I am very happy here, the staff are wonderful”. “We know that if there is anything we want, it will be provided for us”. Relatives seen said, “I am more than happy with my Mother’s care, although she is deteriorating I want her to stay here, I know that they can provide the care she needs”. A relative explained that there are 3 children who visit his mother, each on 2 days per week and at varying times, he said that the home and care is, “excellent”. We saw a well presented environment with good standards of hygiene and infection control. Odour management is good. There is a high level of satisfaction with food provision, 4 people said that the food was good, with varied menus and choice of dish. Food is well-presented in a pleasant dining setting. What has improved since the last inspection? Three mattresses were replaced following an immediate requirement of the last inspection. The home has complied with a previous requirement to ensure that all external doors are alarmed to alert staff in the event of people wishing to leave. This related to a person who had been recently admitted and stated her intention, with actions, of leaving the building. Checks on this inspection confirmed that all doors are now alarmed, increasing safety for all people using the service. All staff have been provided with training in Safeguarding Vulnerable Adults, following a recommendation at the last inspection. This means that staff are all now aware of the procedures to be followed if they suspect people may be abused. Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 8 Some improvements have been made in providing activities for people. This has been mainly in improving the garden area where people confirm they have been able to spend time together and enjoyed some new activities. More entertainers are now arranged internally, people saying that they enjoy the music and singing. Internal activities need to be provided to meet the occupational and recreational needs of people using the service. People previously told us that they were “bored” and two people said during this inspection that more activities are needed to occupy them. What they could do better: The home must appoint a competent person to manage the home and application made to us for approval of a Registered Manager. In the interim period it is vital that the Acting Manager is given adequate supernumerary time to adjust to her new role and undertake effective management of the home. As stated above, activities within the home now need to be extended to provide occupation and purpose for people during the winter months. The home must ensure that potentially harmful substances, such as cleaning fluids, must be securely stored in a locked facility and not left in places that people have access to. This will ensure their safety. It is important that two written references are obtained prior to employment and evidence of POVA (Protection of Vulnerable Adults) or CRB (Criminal Record Bureau) checks must be available in the home for inspection. The service must ensure that people using the service are supported safely by suitable staff. The Statement of Purpose/Service Users Guide should be updated and made readily available in the home for people using the service and visitors. Care plans require updating to provide clear instructions to staff that will enable them to meet people’s needs. An urgent referral should be made for the re-assessment of a person whose needs have changed and can no longer be met by the home. A health care record for each person providing a chronological record of interventions by Health Care Professionals is recommended, this will ensure that important information is readily available at all times and particularly in an emergency. Medication records should be improved with an ongoing count of medication that will ensure all medication can be accounted for in the home at any time and can be audited. It is also important to ensure prescribed creams are administered correctly. Care plans should record the reason for prescription and how, where and when they should be applied. Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 9 The complaints procedure should be available in the home at all times for people using the service and visitors. The provision of a shower facility would improve the bathing options for people and would meet their needs. Training in the Mental Capacity Act and Deprivation of Liberty Safeguards would give staff the necessary information in relation to this important legislation. Footplates should always be used on wheelchairs to ensure people’s safety. Those not wishing to use them should be risk assessed and asked to sign a disclaimer following the assessment if necessary. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 10 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 Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the home should be updated and readily available so that people have the information to make an informed decision about admission. EVIDENCE: The home has a statement of purpose/service users guide that has previously been given to all people admitted to the home. On this visit the Acting Manager was unable to find the documents. They need to be updated to reflect the change in management and other changes. There is an assessment tool used when people are seen and assessed prior to admission. There have been no new admissions since the Registered Manager Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 12 left the home in May this year. Records seen prior to that date included a satisfactory assessment. Standard assessment profiles are provided prior to admission by the Social Worker involved. People have told us previously that they have visited the home prior to admission when they can make a judgement, without pressure, about the suitability of the home for them. Contracts are provided by the funding local authorities. People funding their own care are provided with a contact directly with the home. These were not sampled on this inspection. Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Updated care plans and changes to the medication system will ensure that people’s personal and healthcare needs are known and met. EVIDENCE: Care plans are dated and need review and updating, to provide current information to meet people’s needs. Since the Registered Manager left in May the Acting Manager has not had time to update and review care plans. Time must be allocated and this matter addressed. We saw dated information such as walks with 4 wheel trolley but the person now uses a wheelchair, this was not recorded in the care plan. A person now has dialysis 3 times per week at the hospital - this was not recorded on the care plan. Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 14 There have previously been 2 parts to the care plan - one a summary of daily needs, the other additional information in the office on the first floor that noone accesses. It is suggested that this information could be merged to provide essentially one document, readily available with the current information that staff need to meet the person’s needs. The review, updating and merging of this information is very important to ensure people’s current needs are all documented and known by staff meeting their care needs. Social care needs are not recorded or known. This is important information in supporting the social, recreational and pastoral care needs of people. We looked at the care being provided for a person with deteriorating health, weight loss and poor food intake - although fluids are being taken adequately. The home felt there was no need to initiate a fluid intake chart at this stage. During the inspection we discussed some concerns with the visiting GP who will pursue the provision of food supplements. The home is trying to monitor closely the needs of this person. Her visiting relative was later seen and said he was very satisfied with the care being provided for her. He felt the care at Gorsefield was excellent and did not wish her to move to another setting as this was her home. The family visit every day and say they are kept informed of their Mother’s progress. They are fully aware of her currently deteriorating health. We observed a positive and open dialogue between staff and the visiting GP who had been asked to see 3 people on his visit. We were told that a person has a DNAR (Do Not Attempt to Resuscitate) election, signed by him and the family. Current rules of the Primary Care Trust, (PCT) are that only DNAR elections on the prescribed red forms signed by the GP or other doctor will be accepted by PCT staff. This was also referred to the visiting GP who will take steps to provide the correct documentation in accordance with the person’s wishes. It was difficult to identify in this and other instances when people had been seen by the GP and other healthcare professionals. It is recommended that a health care record sheet should be established for each person, giving a chronological record, for easy reference, of all interventions by health professionals. We discussed the care needs of a person presenting difficult behaviours and more recently acute problems relating to elimination. The person spends most of the day in bed and is resistant to personal care. A request for reassessment by the Care Management team some months ago has not been actioned. The Acting Manager was advised to make a further urgent referral for reassessment as the home feel they can no longer meet his needs. We inspected the medication system. We have recently received an anonymous complaint relating to staff not being trained in medication Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 15 administration and medication being given from a large tray and people not having the appropriate medication. We found that senior staff only administer medication and have had training. There was a medication training update course arranged on the day of this unannounced inspection. Medication is administered from a trolley that is transported around the home but locked securely when unattended. Some shortfalls were identified in the medication system: Analgesic medication prescribed for a person 1 or 2 tablets four times per day was not being given. The Medication Administration Record, (MAR) showed that none had been received during the current medication cycle and none had been given. This medication is not PRN (as required) and must be reviewed with the GP. The prescriber’s instructions must always be followed. It was agreed that it is difficult to assess whether the person in question is in pain and able to express this. In relation to another person prescribed anti-depressant medication, the MAR had been signed but the medication not given. 11 tablets had been received at the start of the medication cycle and 18 recorded as given. The Acting Manager said that there was no other stock and it had must have been signed for but not given. She will pursue this with the relevant staff. Medication received is recorded on MAR sheets but where there is a back up stock, this is not added. It is important to record a diminishing number/amount of medication on the MAR sheets so that the system can be audited. We had some concerns about the recording of cream application. Although prescribed creams were recorded on MAR sheets there were no recorded details about which cream should be used, where, how and when. We saw in a care plan for the same person creamed feet and groin needs creaming. There were no instructions about which cream was used and for which part of the body. Care plans (or MAR sheets) should contain clear information for staff. Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Continued efforts to extend the range of activities will provide more stimulation for people and improve quality of life. EVIDENCE: This outcome area was judged poor on the last key inspection. There was no structured activity, people said that they were “bored” and staff admitted that activities were not provided, mainly due to lack of staff time. Since that time efforts have been made to improve the activities available in the home. Poor garden furniture has been replaced with more comfortable seating. Large games have been purchased and during the summer many people have enjoyed being outside in the pleasant secluded garden and engaging in games or talking together or with staff. People said that this is an improvement. The Acting Manager showed us craft materials that had been bought with plans to engage and encourage people in small groups to create cards and small gifts and be occupied whilst engaging with others. There was previously an overGorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 17 use of the TV, identified in the last inspection report. There is a large lounge with TV and the smaller “quiet” lounge also has a TV, which was switched on at the start of the inspection with only one person in the room who did not wish to watch. Later several people were seen in the lounge two people said they do not like to watch TV and the other two were asleep. It is important to provide an area away from the compulsory TV where people can relax and talk perhaps with background music. Many people have TV in their bedrooms and therefore have an alternative. Entertainment provided from external sources has been changed after consultation with people using the service. There are now several entertainers who visit and people said that they enjoyed this. There is still light exercise to music. Regular visits are made by clergy and people said that they enjoyed this and that it meets their religious needs. The lack of activity and stimulation has been mentioned in earlier reports, the reasons given were that there are only 2 care staff on duty throughout the day and personal care commitments mean that there is little staff time available to engage in activities. An example at the moment is: the cook finishes at 1pm, the two care staff have to prepare and serve tea, leaving little time to spend with people on an individual basis. There have been no external visits this year and whilst moves have been made to improve activities there is still some way to go. Food provision is good. People spoken with were unanimous about this saying the choice, quantity and quality of food is good and that they are always given choices. Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A readily available, clear complaints procedure will ensure people know the procedures for reporting complaints and give them confidence that they can complain about any aspect of the service. EVIDENCE: The complaints procedure was not available in the home. The Acting Manager was unable to find a copy and will ensure that a copy is promptly provided and posted in an area of the home easily accessible by people using the service and visitors. The home has not received any complaints since the last inspection and none have been received by us. A recommendation of the last report to provide training for all staff in Safeguarding procedures has been actioned. Most people attended a course in February this year and this was confirmed in discussion with staff. A copy of the former Adult Protection Procedures (now Safeguarding) was available in the reception area but dated 2001. A current copy of the Safeguarding procedures must be obtained and readily available to staff. Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 19 One referral has been made to the Safeguarding team, relating to the handling of a person using the service. Staff were suspended and an investigation carried out under the Safeguarding procedures. There was no evidence to prove the allegations and staff were re-instated. The home understands the importance of referring these matters to the Safeguarding Team of the local authority. Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in safe, comfortable, well maintained environment and enjoy the good facilities provided. EVIDENCE: A requirement was made at the time of the last key inspection that remaining external doors should be alarmed to alert staff in the event of people wishing to leave. This related specifically to a person who had been admitted to the home, stated her intention of leaving and had made attempts to do so. On this visit we were able to see that all external doors had been alarmed and staff alerted to anyone leaving the building. This has increased safety for people in the home. Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 21 A requirement was also made to replace 3 mattresses immediately, following complaints from people in the home. It was also required that an audit of all mattresses in the home should be carried out. The 3 mattresses were replaced, but it is not known if the audit was carried out – the Manager has now left the home and the provider was on holiday. The provider is asked to inform us of the result of the audit when he returns. There have been improvements and replacements to the home since the last inspection: New garden furniture has been purchased, all chairs in the main lounge replaced and the room redecorated. We were told that chairs for the smaller lounge have been ordered and the room will be redecorated. Inspection of the communal areas and some bedrooms confirmed that the presentation of the home is satisfactory and there are ongoing replacements and redecoration. The garden areas are well established and maintained providing a pleasant, private area that people can enjoy. We found a tin of very strong cleaning fluid in the laundry area that was unlocked and accessible by people in the home. All substances that may be harmful to health must be stored securely to protect people using the service and a requirement is made to ensure this. There is an assisted bathroom on each floor but the first floor bathroom is rarely used. There are no shower facilities and a recommendation of the last report to consider this option is repeated in this report. This would provide an alternative bathing choice and be particularly helpful to people with high personal hygiene and dependency needs. Bedrooms seen were well furnished and personalised, reflecting individuality. Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment procedures do not provide protection for the people using the service. EVIDENCE: The home is staffed to the minimum level with 2 Carers on duty throughout the day and one waking night carer and someone sleeping in the building and on call. There is always a senior carer on duty. Additional staffing hours are needed at peak times of care, staff being busy at these times as well as answering telephone calls, receiving visitors and engaging with visiting healthcare professionals. This has been highlighted in previous reports. There is little time for staff to engage individually with people in a meaningful way that is not task-centred. It was reassuring to be told that a person the home have been caring for in bed for the past 2-3 years was supported by staff to the end of her life. Having no relatives/visitors staff ensured that the person was not alone in the final days of their life. Additional staffing hours were used for this purpose. Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 23 There is low staff turnover and a high degree of commitment to people in this home. We observed good engagement and sensitive interventions by staff when people needed reassurance and support. Staff training has continued. There has been training this year in Safeguarding, Moving and Handling, Food Hygiene and Health and Safety. Medication training was planned on the day of the inspection and Fire Training is currently being arranged. Dementia care training is arranged for 1st September 2009. It was difficult to extract training information for each person from the many training records and a staff training matrix is recommended for easy monitoring of staff training needs. NVQ training continues – more than 50 of care staff had trained to NVQ standards at the time of the last inspection and two more have completed the course. Some staff have undertaken NVQ 3 training also. There has been no training in the Mental Capacity Act and the Deprivation of Liberties Safeguards. The Mental Capacity Act came into force 2 years ago and is important training for staff in assessing the capacity of people using the service. Deprivation of Liberty Safeguards came into force on the 1st April this year. Training is important so that staff understand and move to assess and ensure people’s rights are protected. This should be arranged as soon as possible. We looked at 2 staff files but the records were incomplete. The provider was away on holiday and it was not possible to access the information we needed. It was clear in one instance that only 1 written reference had been obtained prior to employment, there was a Criminal Records Bureau (Police) check in one file but the staffing rota showed the person had been working prior to that date. No Protection of Vulnerable Adults (POVA) check was on file and it was not possible to ascertain if this had been obtained prior to employment. Staff must not work with people using the service until a satisfactory POVA check has been received. The two application forms seen had not been signed and in one instance no declaration made and signed by the staff member indicating whether there were previous convictions. Information to confirm the start dates for the two members of staff was not available. It is important that two references and either a POVA or CRB check are obtained for all staff prior to employment. Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current management arrangements and processes do not protect the best interests, health, safety and welfare of the people using the service. EVIDENCE: The Registered Manager left the home in May. She had considerable experience of managing a home for older people. The providers have appointed a senior carer as the Acting Manager. She told us during this inspection that this arrangement is for 12 months only, although we have not been approached by the providers to confirm this arrangement. Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 25 The providers are legally obliged to tell us about the management arrangements. 12 months is too long a period for interim management arrangements. The Acting Manager is trying to acquaint herself with the procedures and information necessary for her to continue to manage the home effectively. Unfortunately she is still on the staffing rota and does not have supernumerary time to take over the management responsibilities. She has had 3 days in the past 3 months where she has specifically been able to allocate time to take on these duties. She did say that the provider has told her to arrange additional staffing to give her specific time for management duties but this has not happened. It was clear from this inspection that considerable work needs to be done to update the care planning system and to review and update other information systems including the Statement of Purpose, complaints procedure and staff recruitment and records. The Acting Manager at this time needs several days to acquaint her with the management duties of the home and be able to move towards providing supervision and staff meetings and other aspects of management presently not being addressed. There are no residents’ meetings or quality assurance processes in place at this time. It is important to provide people with the opportunity of expressing their views about the standards and quality of service and this also needs to be planned and addressed. Individual risk assessments as part of the care planning process also require review and updating. We were made aware of two areas of potential risk to people using the service: A harmful substance found in the laundry area to which people in the home have access - this must be removed and kept securely as part of the COSHH (Control of Substances Harmful to Health) requirements. Any substance presenting potential risk should be recorded in the COSHH assessment and kept in secure place in the home. We saw a person being transported in a wheelchair without footrests. This presents considerable risk of accident to the person. We were told that the person refuses to have the footrests. A risk assessment must be completed in relation to this practice and refusal by the person to use footrests accompanied by a disclaimer signed by the person. We received a completed AQAA (Annual Quality Assurance Assessment) prior to the inspection. The AQAA is a legally required self-assessment document containing information about what the service think they do well, what progress they have made over the past year, what they think they could do better and their plans for improving the service over the next 12 months. This was completed by the Acting Manager who has no previous experience of completing this document. The information was brief and without detail or depth to indicate the level of service provided. In relation to plans for the next 12 months there were no recorded plans in 6 of the 7 outcome areas. Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 26 The providers must ensure that a competent person is appointed to run the care home and allocate supernumerary time to ensure the efficient management and operation of the home in the meantime. It is the providers’ responsibility to support the Acting Manager in her new role and ensure that she has the necessary time, skills and resources to manage the home effectively. The providers should plan to have a registered manager in the home as soon as possible. Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 2 18 3 2 3 2 3 3 3 2 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 2 X X 1 1 2 Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 28 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 OP38 Regulation 13(4)(a) Requirement Timescale for action 31/08/09 2 OP29 Schedule 2(5) 8 3 OP31 Substances harmful to health must be securely stored to ensure the safety of people using the service. Two written references must be 31/08/09 obtained prior to employment and evidence of POVA or CRB checks must be available. A person must be appointed to 30/09/09 manage the home. Interim management arrangements should ensure the Acting Manager has the necessary time, skill and resources to effectively manage the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The Statement of Purpose and Service Users Guide must be updated and copies readily available in the home for people using the service and visitors. DS0000008233.V377337.R01.S.doc Version 5.2 Page 29 Gorsefield Residential Home 2 3 4 5 6 OP7 OP8 OP8 OP9 OP9 `7 8 9 10 OP16 OP21 OP30 OP38 Care plans must be updated to provide clear guidance/instruction to staff to enable them to meet people’s needs. Make urgent referral for reassessment of the needs of person identified whose needs cannot be met by the home. Provide a healthcare record for each person providing a chronological record of interventions by Health Care Professionals. An ongoing cumulative count of medication is required to ensue that all medication can be accounted for and audited. Clear instructions must be provided to ensure prescribed creams are administered correctly. Care plans should record the reason the product is prescribed and how, where and when they should be applied. The complaints procedure must be readily available in the home for people using the service and visitors. Consider the provision of a shower facility to meet the needs of people using the service. Training should be provided for staff in the Mental Capacity Act and Deprivation of Liberty Safeguarding. Footplates should be always used on wheelchairs to ensure peoples safety. Those not wishing to use footplates should be asked to sign a disclaimer after a risk assessment is completed. Gorsefield Residential Home DS0000008233.V377337.R01.S.doc Version 5.2 Page 30 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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