Inspection on 27/09/06 for Gorselands

This inspection was carried out on 27th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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

Gorselands 07/01/06

Gorselands 16/05/05

Gorselands 17/11/04

Gorselands 25/08/04

Gorselands 02/02/04

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

CARE HOMES FOR OLDER PEOPLE Gorselands Gorselands 45 The Avenue Clevedon North Somerset BS21 7DZ Lead Inspector Juanita Glass Unannounced Inspection 09:30 27th September 2006 and 7th November X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Gorselands DS0000008097.V312750.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Gorselands DS0000008097.V312750.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gorselands Address Gorselands 45 The Avenue Clevedon North Somerset BS21 7DZ 01275 872315 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) laspiller@aol.com Mr Lawson Anthony Spiller Mrs Lesley Karen Spiller Mr Lawson Anthony Spiller Care Home 30 Category(ies) of Dementia (30), Dementia - over 65 years of age registration, with number (30) of places Gorselands DS0000008097.V312750.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 30 persons aged 6O years and over suffering with Dementia. 7th January 2006 Date of last inspection Brief Description of the Service: Gorselands is registered to provide accommodation and personal care for up to 30 older people who are suffering from dementia. The property is set in a residential area of Clevedon near to the coast. The house provides accommodation on three floors and is set in attractively maintained and sheltered gardens, which are secure. There is a passenger lift to all floors. Mr and Mrs Spiller have owned Gorselands for many years and have recently extended the property to include three new en-suite rooms. The current fee was not available. Gorselands DS0000008097.V312750.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two days. A total of 10 hours were spent talking to residents and staff, and looking at care records, staff personnel files, records maintained in the home and the environment. Comments made by residents highlighted the individual approach to care adopted in the home. Residents would come to the office throughout the day, either with a request or just to chat. They were never turned away. Residents spoken to said they were very happy and despite the levels of dementia they remembered staff and spoke fondly of them. This was especially evident when they spoke about Mr Lawson the owner. At least five of the seven residents spoken to said they looked forward to his visits when they could go on trips or he would play music to them. The atmosphere in the home is relaxed and cheerful. Staff have a close rapport with residents which was evident throughout the day. One resident stated, well this is my home now. Id rather be in my own but if I have to be somewhere Im glad Im here. One relative was really impressed with the results of craft sessions, and was pleased to find her mother could still be creative despite her level of dementia. What the service does well: What has improved since the last inspection? What they could do better: No requirements were made following this inspection. Gorselands DS0000008097.V312750.R01.S.doc Version 5.2 Page 6 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. Gorselands DS0000008097.V312750.R01.S.doc Version 5.2 Page 7 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 Gorselands DS0000008097.V312750.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, and 5. 6 does not apply Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken and the manager has confirmed that they can meet the needs of the individual. Prospective residents are given the opportunity to visit the home. Each resident is provided with a statement of terms and conditions prior to moving into the home. This sets out in detail what is included in the fees and the roles and responsibilities of the provider. EVIDENCE: Following a referral or enquiry the manager carries out a full assessment of a prospective residents needs. She will visit to them either in hospital or in their own home. Care records examined all contained concise assessments, these were backed up by social services or hospital care plans. Prospective residents are invited to visit the home prior to admission. A relative or representative usually carries this out. The prospective resident may be invited to attend the Gorselands DS0000008097.V312750.R01.S.doc Version 5.2 Page 9 home for day-care, which assists their move into a care home. Residents spoken to during this inspection were unable to comment on the admission process. All care records contained signed contracts or statements of terms and conditions. Gorselands DS0000008097.V312750.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Gorselands has a strong ethos of involving residents in all aspects of their life. All residents have a robust care plan, which reflects Person centred care. Staff actively promote residents’ rights of access to health and remedial services. The home has a clear medication policy, procedure and practice guidance. Staff have access to written information and understand their role and responsibilities. Resident’s privacy and dignity is respected when staff are delivering health and personal care, this is a key principle of the homes aims and objectives. EVIDENCE: The care records for five residents were reviewed during this inspection. The manager has revised the way in which care plans are written. Care plans now reflect the Person centred approach that forms the basis of the care provided by staff at Gorselands. A programme of training in the new approach to writing care plans has been planned. Staff now make a daily entry in care records for all residents. This includes a record of activities followed by Gorselands DS0000008097.V312750.R01.S.doc Version 5.2 Page 11 residents during the day. Care records reviewed reflected the residents’ needs and gave staff clear guidance and direction. Staff spoken to show an awareness of the individual needs of the residents in their care. Care records also showed that residents were supported in attending healthcare appointments. They evidenced appointments with the chiropodist, dentist and optician as well as appointments at various clinics. A review of the medication records revealed no errors and staff were observed to administer medication within current guidelines. Following discussions with the manager a PRN (as required) protocol had been put into place for individual residents. These now identified ways in which using PRN medication can be avoided. Such as a walk in the garden or a cup of tea when a resident is becoming agitated or unsettled. The home also encourages the use of natural foods to prevent constipation rather than resorting to PRN aperients. Residents spoken to said that staff are always nice and polite. Staff are observed to talk to residents in a respectful manner maintaining some personal dignity. Gorselands DS0000008097.V312750.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Sufficient staff resources are provided in the home to allow time for activities and stimulation. Maintaining independence and enabling residents to make their own decisions about how they wish to live is a key objective of the home. Residents enjoy the flexibility of mealtime arrangements; the cook is familiar with the dietary requirements of individual residents. EVIDENCE: Residents take part in a varied programme of activities, which are suitable to their personal abilities, likes and dislikes. The activities organiser keeps a record of individual residents participation. She also finds out from residents and relatives what their personal likes and dislikes are and what past hobbies they took part in. Residents especially enjoyed craft sessions when they make birthday cards for family members or pictures to put in their rooms. Residents were preparing to make calendars for the New Year and theyd also made a birthday card for the Queen. One relative was very happy with the wedding card made for a grand daughters wedding. One popular activity was cake Gorselands DS0000008097.V312750.R01.S.doc Version 5.2 Page 13 making when everybody enjoyed the results. Residents also go out for regular trips in the minibus, or a walk with staff. Residents have access to wellmaintained and secure gardens where they can wander safely. One resident commented on the lovely gardens and scenery, whilst others were observed exercising personal choice throughout the day. Care plans identify personal preferences so staff are aware when residents prefer to go to bed or get up in the morning. There are no restrictions on visiting and residents can entertain their guests in one of the various lounges or the privacy of their own room. The cook showed an awareness of residents personal likes and dislikes and of any dietary needs that they had. Menus showed evidence of wholesome and nutritional meals being provided. Residents spoken to just after lunch all said mealtimes were always a pleasure. The meal provided on both days of the inspection was well presented with fresh vegetables and a choice of menu. The mealtime was conducted in an unhurried and dignified manner. Gorselands DS0000008097.V312750.R01.S.doc Version 5.2 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. The home has a clear complaints procedure and is available within the home. Policies and procedures regarding protection of residents are satisfactory and are reviewed and updated. All staff demonstrate an awareness of the content of the policy. EVIDENCE: The home has a clear and robust complaints policy and procedure, which gives timescales and directs relatives and residents to the Commission for Social Care Inspection. No complaints have been received since the last inspection the complaints folder was available to read. Residents spoken to said if they wanted to raise concerns they would go straight to Lawson (Mr Spiller) The Policies and Procedures for the Protection of Vulnerable Adults and whistle blowing were very clear and concise. Staff spoken to were aware of the issues surrounding adult protection and knew where they could find guidance in the office. The home also had a copy of the North Somerset inter-agency policy and procedure Gorselands DS0000008097.V312750.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is excellent. This judgment has been made using available evidence including a visit to this service. Residents are encouraged to treat Gorselands as their own home. Gorselands provides a very well maintained, safe, comfortable and attractive home. EVIDENCE: Gorselands is a well decorated and well maintained home. The decor lighting and furnishing is all to a high standard. Residents have a choice of communal areas and private rooms meet or exceed the floor space stipulated in the National Minimum Standards. The garden has been landscaped and provides a level paved area for walking. There are also well-maintained lawns, raised flowerbeds and covered areas for residents to enjoy. One resident commented on the pleasure she got from looking out of her bedroom window onto pleasant and well-maintained gardens. Gorselands DS0000008097.V312750.R01.S.doc Version 5.2 Page 16 The home maintains a high standard of cleanliness and was free of offensive odours on the day of the inspection. Staff are aware of infection control guidelines and the homes policies and procedures. The manager has contact details to obtain any specialist advice should it be required. Gorselands DS0000008097.V312750.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Rotas show that staffing levels and skill mix is appropriate to the needs of the resident group, Staff have all received training relevant to dementia care and the resident group within the home. The service has a good recruitment procedure that supports the protection of vulnerable adults. EVIDENCE: Staff rotas showed that there are adequate numbers of staff to meet the needs of residents the in in the home. The manager confirmed that extra staff can be used as and when required. Either to support the activities organiser or to support residents with higher care needs. Staff confirmed that they did not feel pressurised through staff shortage or lack of of knowledge when caring for the resident group in the home. All staff have received training specific to dementia care and using a person centred approach. Recruitment records showed that all the required checks were being carried out prior to new staff commencing work in the home. Staff also had job descriptions that identified their roles and responsibilities within the team. The manager has introduced a key worker system and progress in this area will be Gorselands DS0000008097.V312750.R01.S.doc Version 5.2 Page 18 reviewed at the next inspection. Staff spoken to said they understood their roles and responsibilities and supported the key worker system. All mandatory training was up-to-date and additional training was booked or advertised for staff to attend. Staff are encouraged to attend any training that is relevant to the needs of the resident group. Staff spoken to said they felt management supported them in obtaining further knowledge. Gorselands DS0000008097.V312750.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The manager is open and approachable and has all the relevant qualifications to run a care home. The home has a clear quality assurance system, which the manager is currently revising. The home does not handle residents’ personal finances. The home insures the health and safety of the residents through staff training and clear and concise policies and procedures. EVIDENCE: Staff and residents spoken to said they felt that they could approach the manager and the owner at any time. The manager has successfully obtained registration with the Commission for Social Care Inspection. Staff spoken to Gorselands DS0000008097.V312750.R01.S.doc Version 5.2 Page 20 felt well supported and confirmed that the manager works alongside them carrying out practical supervision with staff on a regular basis. This enables her to identify areas in need of development or recognise areas of good practice. During the inspection the manager was observed to have a friendly and easy rapport with the residents. Residents commented on how nice and friendly the manager was. An annual quality assurance is carried out in the home. This involves residents and relatives in commenting on the running of the home. The manager is currently revising the content of the questionnaire and intends including staff and outside agencies in the next quality assures processing. Progress in this area will be reviewed at the next inspection. Health and safety in the home was satisfactory. The fire log was reviewed and showed that staff had received fire-training updates throughout the year. Fire drills involve both day and night staff. All checks had been carried out in line with current guidelines. A full fire risk assessment has been carried out and is available in the fire log file. Service records were all up-to-date and available for inspection. Insurance details were displayed in the entrance hall. Generic and working risk assessments have been reviewed and these include the use of sharp objects in the kitchen. Gorselands DS0000008097.V312750.R01.S.doc Version 5.2 Page 21 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 X 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Gorselands DS0000008097.V312750.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Gorselands DS0000008097.V312750.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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. 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