Inspection on 01/04/09 for Gorway House

This inspection was carried out on 1st April 2009.

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

Gorway House 09/12/09

Gorway House 06/10/08

Gorway House 14/08/07

Gorway House 21/05/07

Gorway House 02/11/06

Gorway House 31/05/06

Gorway House 20/10/05

Gorway House 24/05/05

Gorway House 26/11/04

Gorway House 27/09/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Gorway House 40 Gorway Road Highgate Walsall West Midlands WS1 3BG Lead Inspector Dawn Evans Unannounced Inspection 1st April 2009 10:15 DS0000020811.V374412.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. Gorway House DS0000020811.V374412.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 Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gorway House Address 40 Gorway Road Highgate Walsall West Midlands WS1 3BG 01922 615515 01922 725059 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Pamela Brown Mrs Jennifer Beale Mrs Susan Allen Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Gorway House DS0000020811.V374412.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: 2. Old age, not falling within any other category (OP) 28 The maximum number of service users who can be accommodated is: 28 6th October 2008 Date of last inspection Brief Description of the Service: Gorway House is a residential home located in Walsall, West Midlands. The two-storey detached property is located in quiet residential area and provides accommodation for 28 older people. The home provides 24 single and two shared rooms; the majority of rooms are equipped with en suite toilet. The property comprises of two large lounges and a separate dining room. A well-maintained garden is situated at the rear of the property. Ample car parking is located at the front of the home. Staffing is provided on a 24-hour basis ensuring people have the support and assistance they need to promote their independence and welfare. Fees charged for the service provided at Gorway House was not made available; the reader is advised to contact the home directly for this information. Gorway House DS0000020811.V374412.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. The unannounced key inspection of Gorway House was undertaken in two days. The inspection methods used to establish the quality of care and the effectiveness of the management of the home, involved looking at care records, talking to people who use the service and staff. We, the Care Quality Commission looked around the home to ensure it was suitable and safe to meet people’s needs. Information from the service Annual Quality Assurance Assessment (AQAA) is also included in this report. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. We sent surveys to the service to distrubute to people who use the service and staff members. This would enable us to obtain people’s views on quality standards within the home. These surveys were not returned to us. The service has two registered managers; both were present on the days of our visit. What the service does well: The service’s staff recruitment practices ensure people are suitable to work within the home ensuring people’s safety and welfare. Daily routines ensure people are able to live a lifestyle of their choice and continue to pursue any religious interests promoting their rights and individuality. Sufficient numbers of staff ensure people are supported in a manner that maintains their welfare and social needs. Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Efforts had been made to improve information contained within care plans. However, there were shortfalls in providing details about people’s diagnosed health conditions. This may compromise the quality of care provided to people to ensure their health. People are not involved in their care planning to ensure the care they receive will meet their expectations of promoting their choice and rights. Where possible people should be encouraged to be involved in their care planning ensuring the support they receive reflects their choice and best interest. Risk assessments were not in place for everyone. This could have a negative impact on the support provided to ensure people’s health and safety in activities undertaken within the home and in the community. Measures should be taken to ensure a risk assessment is in place for all people who use the service. For example, social activities undertaken outside the home, where people’s health condition may compromise their safety. A risk assessment may promote their independence whilst ensuring their welfare. Records looked at and discussions with the registered manager confirmed the service have received two complaints. One complaint was not addressed in a timely manner. It took several months for the investigation to be concluded. There was no evidence of the complainant or the person accessing the service being involved in decision making to ensure their choice and rights. Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 7 Action should be taken to ensure complaints are addressed promptly to ensure people’s rights and protection. We requested an improvement plan. An improvement tells us what the service will be doing to improve quality outcomes for people and so ensure their assessed needs are met. The improvement plan was not sent to us when requested. It also failed to provide sufficient information about how standards would be improved to ensure people’s welfare. Action must be taken to ensure future requests for an improvement plan is completed and returned to us by the date identified, showing what measures will be taken, by whom and when, to improve quality outcomes for people. Information obtained from the services quality assurance surveys was not used to improve quality standards within the home. Measures should be taken to ensure information collated from quality assurance questionnaires are used to improve the service promoting good outcomes for people. 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. Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 8 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 Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3 and 6 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 have access to relevant information enabling them to establish the service’s suitability to meet their assessed needs and so promote their health and best interest. Written contracts ensure people are aware of the service they will receive and their legal rights and so guarantee their welfare. The undertaking of a needs assessment ensure people can be confident their care and social needs will be met to support their rights and independence. Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 10 EVIDENCE: The service AQAA showed people who use the service had access to the home’s Statement of Purpose. This document told people about the service and facilities provided. For example, the management structure, staff qualifications, accommodation available within the home, access to healthcare services amongst other things. This means people who wish to use the service are provided with information they need, enabling them to establish the service’s suitability to meet their assessed care and social needs. The registered manager said efforts would be made to ensure this document is available in various formats, such as large print, different languages, Braille and audio if requested. This should promote people’s understanding. The registered manager told us a copy of the Statement of Purpose is located in each bedroom. People spoken to also confirmed this. We received a concern about the content of the service’s contract. The contract tells people what is included in the fees, the method of payment, the period of termination and the room to be occupied. The contract provided relevant information about the service and facilities they will receive. However, consideration should be given to provide more specific information about the methods of payments. For example, if the home is unable to continue to provide a service to a person. The contract needs to show whether the person would be reimbursed for fees paid in advance. Records showed and discussions with people confirmed they were given a contract. These were signed and dated by the person or their representative. This showed people were aware of the service they will receive to ensure their best interest. Discussions with the registered manager confirmed a needs assessment is undertaken before people are offered a placement. A needs assessment enables the service to establish people’s care needs and the level of support they require to promote their independence and safety. One person had recently been admitted to the home, they confirmed being involved in the assessment process. A copy of their needs assessment was also seen on file. This should ensure the care people receive reflects their choice and individuality. The information obtained from this assessment is used to develop a care plan. A care plan provides staff with guidance on how to meet people’s assessed needs. Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 11 The registered manager confirmed the service does not provide intermediate care. Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 12 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): 7, 8, 9 and 10 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. People cannot be confident care plans will tell staff how to meet their care needs to ensure they receive the support required to promote their health and wellbeing. Systems and practices for the management of people’s medicines may place them at risk and have a negative impact on their health and safety. Staff practices and approach ensure people’s privacy and dignity are respected ensuring their rights are upheld. EVIDENCE: Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 13 Information contained within the service AQAA and discussions with the registered manager confirmed people have a care plan. A care plan should provide details of how to meet people’s care and social needs, so promoting their health and social welfare. Although efforts have been made to improve the information held in the care plans, there were a number of shortfalls which may compromise people’s health. For example, we looked at one medication administration record; this is a record of people’s prescribed medication. Medication listed in this record indicated the person might have a diagnosed health condition. Although the care plan did not show this information, the registered manager confirmed this diagnosis and said this information was recorded elsewhere. We looked at these records, which showed the person’s doctor had requested a routine health check to be undertaken within one month of the last medical appointment. Records showed this was not undertaken for four months. This means the person cannot be confident their healthcare needs will be met. Information relating to people’s diagnosed health condition must be included within their care plan. This should ensure staff members know how to meet the person’s needs and so promote their health and safety. We looked at another care plan, which showed the person’s health diagnosis and the assistance required to promote their health and independence. Records also showed they had access to a healthcare specialist to monitor their health condition. Although care records promoted the person’s health and independence, the registered manager confirmed they were no risk assessment in place to ensure the person’s safety whilst doing so. The registered manager also acknowledged the person’s diagnosed health condition and the social activities they undertook could compromise the person’s and other people’s safety. Action must be taken to ensure a risk assessment is carried out with the person using the service and/or if appropriate their representative. This should help to promote people’s independence and ensure their safety. We looked at two other care plans, which provided adequate information relating to people’s assessed care needs and the support required to promote their best interest. Care plans were reviewed on a monthly basis to reflect people’s changing care needs. The service AQAA showed people or their representative were involved in their care planning. We looked at four care records, which did not evidence Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 14 this, and the registered manager was unable to confirm people’s involvement. Only one of three people spoken to was aware of their care plan. This means the care they receive may not ensure their choice, rights and independence. Information contained within care records showed people have access to healthcare services, such as General Practitioner, Dentist, Optician and Chiropodist. People spoken to also confirmed this. The pharmacist inspector visited Gorway House on the 1st April 2009 as part of the key inspection to fully assess the way the home was managing medicine on behalf of the people who used the service. In summary the medicines management systems within the home were found to be deficient and were potentially placing some people at risk. We found the home had a practice of recording the receipt of medicines coming into the home. On close examination of this practice we found that the home had not accurately recorded the receipt of some medication and in some cases had not recorded the receipt at all. We also found that medication, which had been carried over from the previous month had not been accounted for in the records and therefore as a consequence the home could not demonstrate that these medicines had been administered correctly and appropriately. We found a number of issues with the administration of medicines and the administration records. We found by comparing the administration records with the Monitored Dosage System (MDS) being used in the home that the medicines contained within this system were being administered as intended by their doctor. We however found that medicines not contained within this system were not always being administered. We found evidence of where members of staff had signed the Medicine Administration Record (MAR) charts but had not administered the medication. One example of this was where a quantity of 14 antibiotic tablets had come into the home but the administration records showed that 18 tablets had been administered. We also found that 28 tablets used in the treatment of calcium and vitamin D deficiency had been received by the home. The administration records showed that five of these tablets had been administered so we expected to find 23 tablets remaining but we found 25 tablets. We also found that a quantity of 20 antibiotic tablets had been booked in. The administration records showed that 21 tablets had been administered and when examining the box that they had been dispensed into we also found one tablet still in the box. We found that one person living in the home had been prescribed a number of inhalers two of which had the directions “as directed” and “as directed when required”. We found that both of these inhalers were being administered on a regular basis but we found no written evidence that the administration taking place had been clarified with the doctor. We also found that the MAR chart did not show what doses of the inhalers were being administered at each administration time. Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 15 We found that one of the members of staff regularly examined the MAR charts to check that there were no signature gaps in the administration records. We were told that if she did find a gap then the member of staff who had been on duty at the time would be contacted and asked to return to the home to sign the chart to confirm that the medication had been given. The member of staff also confirmed that no record of these incidents was made. The member of staff was informed that this practice placed the integrity of all of the MAR charts into doubt. The home needed an audit system that identified and recorded the errors and also recorded the outcomes without the need to retrospectively sign the MAR charts. On examining the MDS system we found that an analgesic tablet had been taken from a blister a week before it should have been. A member of staff explained that a tablet had been dropped and in order to meet the administration requirements this tablet had been remove and administered. We found no record of this incident to explain the missing tablet. We also found the dropped tablet had been disposed of in the household waste. This tablet should have been returned to the pharmacy for proper disposal. We also found that the home had not made any record of the tablets disposal and this led to the discovery that the home did not record the return of any medication to the pharmacy. We found that one person in the home was self-administering their own indigestion remedy, which had been prescribed by the doctor. We found that the manager was not aware of this situation and as a consequence there was no risk assessment in place to safeguard the person themselves and other people in the home. We observed a number of administrations of medication during the day. We found some of the practices place the people living in the home at risk. During the lunchtime round we observed the practice of the member of staff placing the medication pot next to the person the medication was intended for and leaving it for them to take. The staff member then went back to the trolley and signed the MAR chart before the medication had been taken. This practice could lead to other people around the dining table inadvertently taking the medication. We also observed later on in the day a staff member preparing medication for two people at the same time. The medication for one person was placed into one medication pot and the medication for the second person into another pot. The staff member signed the MAR charts for both people and then took both pots off around the home to administer to the two people. This practice again could lead to medication being administered to the wrong person. The walking around the home with medication not secure could also lead to other people living in the home and visitors especially children obtaining the medication in the pots. We discovered from the manager that all of the staff who were administering medication had received training on the safe handling of medicines but had not Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 16 undergone any assessments to determine whether the theory was being put into practice. We found that medication requiring cold storage conditions was being stored in the kitchen fridge. We found that the medication in the fridge was easily accessible as the fridge was not lockable nor was the medication being stored in a locked container within the fridge. We also found that the practice of recording the fridge temperature on a daily basis was not happening. We also found that the home did not have a maximum and minimum thermometer so they were unable to measure the maximum and minimum temperatures on a daily basis to ensure that the fridge temperature was maintained at between two and eight degrees centigrade. We found that the home did not have any Controlled Drugs on the premises at the time of the inspection. The manager said that the doctor of one of the people living in the home had requested, on the day of the inspection, that a Controlled Drug be resumed. The Controlled Drug that was to be resumed would require storage in a Controlled Drugs cabinet and it was noted that the home did not have one. The manager was informed of the need for a Controlled Drugs cabinet and her comment was that she would speak to the doctor to see if he could prescribe an alternative, which would not need the additional storage requirements. The service AQAA stated, “All staff understand that service users need to feel they are treated with respect and their rights to privacy is upheld.” One person said, “The staff do respect my privacy, when they help me to have a bath they try their best to cover me with towels, to preserve my privacy and dignity.” We observed staff knocking on bedroom doors before entering. The registered manager said the majority of bedroom doors were fitted with a security lock. This should promote the individual’s right to privacy. Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 17 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): 12, 13, 14 and 15 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 are able to live a lifestyle of their choice reflecting their social interests and religious preferences. Contact with family and friends promote people’s rights and choice. People are offered a choice of meals to reflect their dietary needs, likes and dislikes promoting their health. EVIDENCE: Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 18 The service AQAA stated, “We try to maintain a lifestyle that matches their expectations and preferences and one that encourages their social, creational, cultural and religious beliefs.” We observed the daily routine to be relaxed with people engaging in pastimes of their choice. For example we saw one person in the garden, people watching the television, some were entertaining guests and others preferred the privacy of their own room. This demonstrated people’s daily routine and choice was valued. Care records included details of people’s religious needs. People and staff members confirmed religious services were carried out at the home. This should ensure people’s religious interests are maintained and their rights to practice are respected. We saw a social activity programme displayed in the home showing the availability of the following events: religious services, art and craft, card making, hairdressing, nail care, jewellery parties, keep fit, walks, amongst others. People spoken to confirmed they had access to various activities to promote their social interests. The service AQAA shows, relatives and friends are encouraged to maintain contact. People spoken to confirmed they were able to maintain contact with their family and friends who were able to visit at anytime. We observed people were able to entertain their guests within the communal areas or within the privacy of their own room. One person said, “My daughter visits me nearly every day.” We saw people were able to personalise their bedrooms to reflect their choice and individuality. Staff said people have access to a self-advocacy service (Age Concern). This is an independent service providing people with additional support. We spoke to two people who were not aware of this service. Information about this service was not contained within the service’s Statement of Purpose. Access to this service may assist in promoting people’s rights and best interest. Prior to the inspection visit we received two complaints about the lack of choice and the quantity of meals provided. Discussions with staff and the menus we looked at showed three meals were provided on a daily basis with drinks available throughout the day. Staff told us and care records confirmed the need for a special diet for people with a diagnosed health condition. Although the menus did not reflect this, staff confirmed their knowledge of people’s dietary needs and one care record contained a monitoring sheet of a person’s daily dietary intake and a body Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 19 weight chart. This enabled staff to monitor the person’s diet and body weight, to ensure their health. Menus showed people were offered an alternative choice. However, this only consisted of fish fingers, fish cakes or faggots. The registered manager confirmed the menus would be reviewed to provide more choice of meals to ensure people’s nutritional needs; likes and dislikes are catered for. Meals offered to people on the day of our visit appeared appealing, wholesome and nutritional. One person said, “There are some things I don’t like but I eat the majority of the meals.” “I like their shepherds pie.” Another person said, “The food is very good, there is usually two things to choose from.” “I like fish more than meat and they sort that out for me.” Discussions with staff confirmed no one required a special diet due to cultural or religious needs but every effort would be made for future dietary requirements. Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 20 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): 16 and 18 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. People have access to the service’s complaints procedure, enabling them to share their concerns. However, they cannot be confident their complaints will be listened to or addressed in a timely manner to ensure their rights. Policies adopted by the home protect people from the risk of abuse. EVIDENCE: The service AQAA stated, “We have a good complaints procedure in place and that having these procedures we are protecting the service users legal rights.” We saw people had access to the home’s complaint procedure; this information was located within the communal areas of the home. This showed people were able to share their concerns to promote their rights and protection. One person said, “I would tell my daughter or social worker if I had any complaints.” Another person confirmed, “I would tell the staff.” Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 21 We have received two complaints for the service; the AQAA did not accurately reflect this information, it told us they had not received any complaints. We looked at these complaints, which showed one complaint was not addressed in a timely manner. It took several months for the investigation to be concluded. There was no evidence of the complainant or the person accessing the service being involved in decision making to ensure their choice and rights. Another complaint showed the home had not informed us of an incident that may have had an adverse affect on people’s safety. The home must inform us of any incidents/events that may affect people’s welfare. This shows the service does not always listen to or take complaints seriously to maintain people’s rights and ensure their safety. We received a concern from Social Services about the approach and attitude of some of the staff. Comments made to us during the inspection by the registered provider (owner) were considered disrespectful to people who use the service and did not promote equality or respect diversity. Consideration should be given in providing equality and diversity training to staff. This may enable staff to recognise discriminative practises and the impact this may have on quality outcomes for people who use the service and so promote better practices. The service had a written safeguarding policy in place, this told staff how to recognise abuse and what action should be taken, to protect people from potential harm. The registered manager said she was in the process of arranging safeguarding and Mental Capacity Act training. This should enhance staff skills and knowledge on how to protect people from harm. The registered manager said they had not received any safeguarding referrals. A safeguarding referral is where there is an allegation of potential abuse or people’s safety being compromised. Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 22 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): 19 and 26 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. The environment and facilities meet people’s needs and ensure their safety, independence and comfort. Good hygiene standards promote people’s health and safety. EVIDENCE: Gorway House is situated in a quiet residential area in Walsall, West Midlands. The two-storey property offers single and shared bedrooms located on both the ground and first floor level. A number of bedrooms are equipped with en suite toilets. Bathrooms were fitted with appropriate equipment and adaptations, Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 23 such as grab rails and an assisted hoist. This should enhance people’s independence and safety. Ramp access was also available at the front of the property enabling people with reduced mobility to access the home safely. A passenger lift ensures people had access to all the facilities within the home. Two lounges, a separate dining room, kitchen and a laundry were situated on the ground floor. People also had access to a well-maintained garden. The service AQAA told us, “Our housekeeping staff are very thorough and maintain high levels of hygiene throughout the home.” The cleanliness of the home was well maintained. We looked at a report from an Infection Control Advisor, which showed a scoring of 82.9 . Good hygiene standards should ensure people’s comfort and safety. People spoken to confirmed the home was always clean and tidy. Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 24 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): 27, 28, 29 and 30 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. Sufficient numbers of appropriately skilled staff ensure people’s needs are met. Staff recruitment practices ensure people are protected from potential abuse. EVIDENCE: The home is registered to provide a service for 28 people; the registered manager confirmed 21 people were in residence on the day of our visit. We looked at staff working rotas and discussions with staff confirmed two or three staff were provided per shift. One person who uses the service said, “The staff respond to my buzzer (nurse call alarm) quickly.” This means people’s needs are responded to promptly ensuring their wellbeing. The service AQAA shows 14 out of 21 staff had obtained the National Vocational Qualification level 2/3 in Care. This should ensure staff have the skills to support people in maintaining their health and social needs. Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 25 The service AQAA stated, “We have a good recruitment and selection process.” We looked at three staff personnel files, which showed staff recruitment practices had improved. For example, files contained evidence that all the necessary security checks, such as a Criminal Record Bureau (CRB) disclosure and checks against the Protection of Vulnerable Adults (PoVA 1st) register were carried out before people were employed to work at the home. Staff members spoken to also confirmed they had received these safety checks prior to commencing employment with the service. We looked at training records, which showed each staff had a training plan, this showed their training needs and also training they had undertaken. Records showed and discussions with staff confirmed they had received the following training: Health and Safety, Adult Protection, Fire Awareness, Medication Management amongst others. This mean staff should be suitably skilled to meet people’s care needs safely. Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 26 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): 31, 33, 35 and 38 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 management of the service does not always ensure good quality outcomes for people or promote their welfare and rights. People can be confident their finances will be well managed to protect them from abuse. EVIDENCE: The service has two registered managers both of whom have several years experience in social care and have completed the Registered Managers Award. Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 27 This training should influence practices that promote people’s interest, health and safety. We have received two complaints about the service of which both raised concerns about the manager’s professional conduct and manner. Discussions with the registered manager confirmed this may be due to the inappropriate management of complaints received by the service. For example, we looked at a response to a complaint. Information shared with the complainant did not respond directly to the areas of concern this resulted in a break down of their professional relationship. The complainant contacted us to share their concerns. The registered manager said she had enrolled to undertake a ‘Customer Relationship’ course. This should enhance communication and management skills and ensure the service is managed more effectively. The service AQAA states, “We have started a quality assurance structure and system and are constantly striving to improve this.” The registered manager said quality assurance surveys are distributed to people, General Practitioner, District Nurses etc. We looked at these questionnaires, which asked questions about staff approach, social activities, menus amongst other things. Discussions with the registered manager and records we looked at did not show how the information obtained from these surveys was used to improve services for people. Information collated from these questionnaires should be used to improve the quality outcomes for people. The previous inspection report identified the quality rating for the service as 0 star. This means the people who use this service experienced poor quality outcomes. We asked for an improvement plan to be completed. An improvement tell us what the service will be doing to improve quality outcomes for people and so ensure their needs are met. The improvement plan was not submitted within the identified timescale. On the day of our visit the registered manager confirmed they had not completed the plan. The improvement plan was given to us on the second day of our visit. An improvement plan must be received within 28 days of the request and failure to do so may result in enforcement action being taken. The improvement plan did not provide details on how shortfalls in the service would be improved to enhance people’s quality of life. For example, insufficient safety standards in medication practices, the improvement plan states, “Constant assessment to improve medication administration.” Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 28 The plan does not show whether staff will have regular competence assessments to ensure they have the skills and understanding to administer medicines safely to guarantee people’s health and safety. Timescales were not given to identify when action would be taken to address the shortfalls and so ensure people’s welfare. Prior to the inspection we sent surveys to the people who use the service and to the staff to enable them to tell us about the quality of the service provided. The registered manager confirmed they had received the surveys but was not entirely sure whether they had been distributed to people as requested. This did not give everyone the opportunity to share their views with us. The service AQAA was sent to us within the identified timescale. It provided adequate information about the service offered and contingency plans to improve quality standards. The service maintains limited amount of cash in safekeeping for some people, records of transactions and balances were maintained. This should ensure people’s finances are managed to protect them from financial abuse. Servicing records of appliances were maintained. Measures need to be taken to ensure moving and handling equipment is serviced on a six monthly basis to promote safety standards. Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 29 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 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 2 X 2 X 3 X X 3 Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 30 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 OP8 Regulation 13(1)(b) Requirement All requests for referrals to a healthcare clinician must be carried out in a timely manner and in accordance with any instruction from a health care professional. So that people’s health care needs can be met and people are not placed at risk of harm. Accurate, complete and up to date records must be kept of all medication received, administered, taken out of the home when residents are on leave and disposed of to ensure that medication is accounted for, is available and is given as prescribed. Appropriate information relating to medication must be kept, for example, in risk assessments and care plans to ensure that staff know how to use and monitor all medication including “as directed”, “when required” and self administered medication so that all medication is administered safely, correctly and as intended by the prescriber, to meet individual DS0000020811.V374412.R01.S.doc Timescale for action 01/06/09 2. OP9 13(2) 22/05/09 3. OP9 13 (2) 22/05/09 Gorway House Version 5.2 Page 31 health needs. 4. OP9 13(2) To ensure that staff are suitably qualified, experienced and competent to safely administer medication before they administer medication to the people using the service. 22/05/09 5. OP9 13(2) 6. OP9 13(2) To make arrangements to ensure 22/05/09 that medication is stored securely at the correct temperature recommended by the manufacturer. To make arrangements to ensure 01/07/09 that controlled drugs are stored securely in accordance with the requirements of the Misuse of Drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulations 1973 and in accordance with the guidelines from the Royal Pharmaceutical Society of Great Britain. 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 OP2 Good Practice Recommendations The service contract provided to people should be reviewed to show if people would be reimbursed fees paid in advance, if the home is no longer able to provide a service to them. People should be encouraged to be actively involved in their care planning. This will ensure their care reflects their choice and rights. To ensure people have access to a self-advocacy service. This should ensure people have additional independent support promoting their best interest. Consideration should be given in providing staff with equality and diversity training. This should promote anti DS0000020811.V374412.R01.S.doc Version 5.2 Page 32 2. 3. 4. OP7 OP14 OP16 Gorway House 5. 6. 7. 8. OP16 OP16 OP19 OP33 discriminative practices and so promote people’s rights. Complaints/concerns should be listened to and addressed to ensure people rights and protection. Any events/incidents that may have an adverse affect on people’s welfare should be reported to the Care Quality Commission. Moving and handling equipment should be serviced on a six monthly basis to ensure the equipment is safe to use. Information collated from quality assurance questionnaires should be used to improve quality outcomes for people who use the service. Gorway House DS0000020811.V374412.R01.S.doc Version 5.2 Page 33 Care Quality Commission West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway, Birmingham B1 2DT 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. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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