Inspection on 03/07/08 for Gorselands

This inspection was carried out on 3rd July 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Gorselands 31/07/07

Gorselands 01/08/06

Gorselands 07/02/06

Gorselands 31/10/05

Gorselands 27/01/05

Gorselands 15/04/04

Gorselands 28/10/03

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Gorselands 25 Sandringham Road Hunstanton Norfolk PE36 5DP Lead Inspector Alan Buttery Unannounced Inspection 3rd July 2008 11:00 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 DS0000037280.V368754.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 DS0000037280.V368754.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gorselands Address 25 Sandringham Road Hunstanton Norfolk PE36 5DP 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) 01485 532580 RSIVA91@hotmail.com Cieves Limited Sally Ann Parton Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Gorselands DS0000037280.V368754.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st July 2007 Brief Description of the Service: Gorselands is a care home providing personal care and accommodation for up to twenty-one older people. The home is privately owned by Cieves Limited. Gorselands is located in the seaside town of Hunstanton and is adjacent to all facilities. It is a large detached property and provides accommodation on the ground and first floors. There are 17 single rooms and two double rooms. Eight of the bedrooms have en suite toilets. A shaft lift allows easy access to the first floor There is a large paved car parking area at the front of the home. The gardens, which are well maintained, have a range of ornamental flowers and a fountain feature. The garden at the rear of the home is suitable for wheel chair users. Mrs Siva confirmed that the current fees are between £358:00 and £420:00. There are additional charges for items such as hairdressing, private chiropody and personal items. Currently, these charges are advised verbally at the time of the initial enquiry and are not put in writing until the terms of residence is provided. Gorselands DS0000037280.V368754.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality Rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced visit, and during our visit we looked at the key minimum standards for older people. The manager of the service was available during our visit to provide the information and documentation required, and we were joined during the inspection by the proprietor. The service provides care to up to 21 older people, with a mixture of private and local authority funding arrangements. They currently have an empty room, but hope to have a new resident moving in shortly. What the service does well: Gorselands offers a well-managed and homely service for the people living there, and have improved the administration and record keeping since our last visit. The staff team have all received suitable training to undertake the care and support of the people living in the home. The manager felt that the staff team are very supportive, and always prepared to do a little extra to help the people they care for. People living in the home are offered choice in all areas of their lives, and a range of activities and events are available to them. The home has a good relationship with the local health professionals Gorselands DS0000037280.V368754.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Gorselands DS0000037280.V368754.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 DS0000037280.V368754.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3, 5 and 6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Procedures are in place to ensure that people who move into the home can be confident that their health and social care needs have been assessed and can be met by the service. EVIDENCE: Before anyone moves into the home, a full assessment of need is carried out, usually by the manager of the service, and this is usually done during a visit to the person wishing to move to the home. Where this is not possible, or the person is in hospital, information will be gathered from the person’s family, and where professionals are involved, they will be asked to contribute to the assessment. Gorselands DS0000037280.V368754.R01.S.doc Version 5.2 Page 9 The service also tries to ensure that anyone thinking about moving to the home has the opportunity to visit, and spend some time in the home, ensuring that they are happy with the environment of the home and the facilities on offer. Once the assessment has been completed, and the service has ensured that the needs of the person can be met, arrangements are made for a date to move in, and initial care plans are written and risk assessments undertaken Gorselands DS0000037280.V368754.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Although individual plans are in place, they must show how both health and social care needs are met, and be reviewed more regularly to ensure that any changes are noted. Procedures are in place to ensure medication support is provided safely. EVIDENCE: Once the person has moved into the home, their initial care plan is reviewed as more information about the person is obtained, to take into account likes and dislikes, and although it is expected that the care plans cover both health and social care needs, there was little evidence in the three files examined of any planning around social activities. For example, one ladies assessment stated that she ‘likes to sew’ but there was no corresponding care plan to show how staff assist her in this activity. Another indicated somebody enjoyed gardening and dancing but this was not recorded anywhere in her individual plan. Gorselands DS0000037280.V368754.R01.S.doc Version 5.2 Page 11 It is also important that the individual plans are reviewed in accordance with the standards, and on the files examined during our visit, there was no evidence that this was happening, for example some of the care plans we looked at had not been reviewed between February and June. One of the files we looked at contained a food and fluid chart, which was being used to monitor the intake following a stroke, but this not supported by an appropriate care plan, whilst another noted regular chiropody visits were required, but did not have a record of them happening. However it was pleasing to see how a record of falls had been analysed, and the reasons behind one of the residents having a series of fall identified and acted on. Procedures are in place to ensure medication is properly managed, and staff who administer medication have all received suitable training. The service use the Boots monitored dosage system, and Boots also provide training to staff an a pharmacy audit. There is not currently anyone in the home who wishes to manage his or her own medication. During our visit, staff were seen talking to people who live in the home, and assisting them with lunch, and were treating the people with respect. Gorselands DS0000037280.V368754.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Although a range of activities are available, more individual detail would show how a persons likes and dislikes are being met. EVIDENCE: A variety of events and activities are arranged for people living in the home including entertainment, a recent family party for all the residents and families, Christmas lunch for all the family, occasional trips out. However, as mentioned earlier individual plans do not demonstrate what the people living in the home would like to do, and this is something that the proprietor of the home will be considering in the coming weeks. A varied menu is provided, with a choice of main meals on a daily basis, and the dining room offers suitable facilities for the people in the home. One of the resident’s of the home recently celebrated their 100th birthday, and was visited by the mayor of Hunstanton, who commented in a letter to the manager that the home had ‘impressed’ him and that ‘for such a large house, ….…it still very much like a family home’ Gorselands DS0000037280.V368754.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Procedures are in place to ensure that any concerns or complaints, or allegations of abuse are appropriately dealt with. EVIDENCE: The homes complaints procedure, which is detailed in the current service users guide, has now been revised, and is available to everyone living in the home. The CSCI has not received any complaints. The service follows the local authority safeguarding adult procedures, and ensures that all staff receive regular adult protection training. There have been no issues of a safeguarding nature in the last year. Gorselands DS0000037280.V368754.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Although providing appropriate accommodation, the home needs to be more confident that all areas of the home are safe for both residents and staff EVIDENCE: During our visit, we looked around the home. People living in the home are able to bring personal items with them, and many of the rooms that we were able top see had an individual touch. In general, the home was clean and tidy on the day of our visit, and there were no unpleasant odours. The premises are in a good state of repair and as mentioned earlier offer accommodation of a domestic nature to the people living there. Gorselands DS0000037280.V368754.R01.S.doc Version 5.2 Page 15 The home has two staircases, and the one at the rear of the building is steep, and potentially poses a health and safety risk, should one of the people living in the home fall. It was therefore requested that a risk assessment be undertaken to ensure that anyone who may be able to use the stairs could do so safely, or alternatively fit a gate to the top and bottom to prevent access. The current arrangement of a notice pinned to the wall at the bottom of the stairs saying that people living in the home should not use the staircase is unacceptable. Gorselands DS0000037280.V368754.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. A well trained and competent staff team are available to meet the needs of people living in the home but a review of staffing is needed to demonstrate that sufficient care staff are available at all times of the day. EVIDENCE: The home is in a large building over two floors, and at present there are 3 staff members working during the morning but only two in the afternoons, with one member of night staff and a back up carer who sleeps on the premises at night but is available to call upon if needed. It is unclear whether this provides sufficient staff to cover the needs of the people living there safely, and the proprietor agreed during our visit to submit a detailed review of staffing to the commission. Staff records that were examined during our visit showed that the required information is in place, and details of the training received by staff was also seen confirming that the required mandatory training is in place. Gorselands DS0000037280.V368754.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is well run, and the views of people living in the home taken into account. EVIDENCE: The registered manager of the home has the necessary experience and skills and has already introduced a number of changes, and improved the administration within the home. Staff are now receiving regular supervision, although to date no formal appraisals have taken place, but the proprietors should also ensure that the manager also receives formal supervision. A quality assurance process is now in place, and the type of questions used was discussed with the manager and proprietor, to try and obtain more information from people living in the home by using a more open style of question. Gorselands DS0000037280.V368754.R01.S.doc Version 5.2 Page 18 The service does not handle any money for people living in the home, but does have procedures in place to ensure they have access to funds should the need arise. Procedures are in place to ensure all health and safety issues are dealt with and staff receive training in matters relating to health and safety. However issues raised earlier in the report about the safety of the rear staircase and staffing levels need to be addressed. Gorselands DS0000037280.V368754.R01.S.doc Version 5.2 Page 19 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 X 3 X 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 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 2 Gorselands DS0000037280.V368754.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Individual care plans must show the involvement of the person they relate to, and evidence of regular review, and cover all aspects of their health and social care needs to ensure identified needs are being met Individual plans must show how social needs are identified and met to ensure people living in the home do have opportunities to lead an active varied lifestyle of their choosing Risk assessments must be in place to demonstrate the safety of all areas of the home. The service must provide a detailed review of staffing to show how they meet the needs of the people living in the home Procedures must be in place to ensure the health and safety of people living in the home Timescale for action 30/09/08 2. OP12 15(1) 30/09/08 3. 4. OP19 OP27 13(4)(a) 18(1)(a) 30/09/08 30/09/08 5. OP38 13(4)(a) 30/09/08 Gorselands DS0000037280.V368754.R01.S.doc Version 5.2 Page 21 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 DS0000037280.V368754.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Gorselands DS0000037280.V368754.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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