CARE HOMES FOR OLDER PEOPLE
Gorway House 40 Gorway Road Highgate Walsall West Midlands WS1 3BG Lead Inspector
Mrs Wendy Grainger Key Unannounced Inspection 14th August 2007 09:00 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 Gorway House DS0000020811.V348315.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. Gorway House DS0000020811.V348315.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 Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Gorway House DS0000020811.V348315.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One named service user to be admitted in the category of DE(E). Date of last inspection 21st May 2007 Brief Description of the Service: Gorway house is a two storey detached property situated on a quiet residential area of Walsall. There are 24 single rooms and two doubles, the majority having en suite facilities. There are two large lounges and a separate dining room. To the rear is a very pleasant garden. Within the home are two lounges one used more frequently for any social events. The dining room is central to the home and off the kitchen area. Car parking is located at the front of the home. From the information provided by the care manager the current fees range from £350.00 to £400.00 per week. Additional costs would include hairdressing, personal newspapers, private chiropody and toiletries. Gorway House DS0000020811.V348315.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Mrs W D Grainger Inspector carried out this second key inspection on the 14 August 2007. I was assisted by the provider and one of the care managers the inspection was completed in the day. The provider and management had agreed the previous report. This inspection included a sample tour of the home, observations of the staff practices, discussions with staff and eight of the people who use the service. Documents, records, and reports, medication, staff training were examined. At the time of this inspection there were 22 people who use the service at Gorway House. What the service does well: It was planned to continue with the “potted history section” developed for the care plans as evidenced in one plan. This section will provide a further insight into the person past life style and interests. Staff were observed to work as a team addressing the people who use the service needs in a sensitive manner. Staff on the day were prepared to change their work routine, using skills to benefit the people who use the service and to assist with the inspection while the manager was training. From the information provided by the managers and from records available the home had made a commitment to the mandatory training sessions following the previous inspection. The new format of the care plans had improved the manner in which information was recorded; there remains some modification to be considered in the eating & drinking section as discussed with the manager. Eight people who use the service were spoken with one person had been in the home since the beginning of the year told the inspector “they look after me so well” she thanked the provider for her “kindness and care you all give me”
Gorway House DS0000020811.V348315.R01.S.doc Version 5.2 Page 6 Individuals’ life styles were recognised and respected. One person sustained his life style upon entering the home he was informing the staff that he was going out to enjoy his swimming session; this person continued to drive his car. People who use the service were provided with a comfortable and homely environment. The family of the recently admitted resident confirmed that they were sent a letter to confirm the placement and that “they were very satisfied with the home and the placement” At the commencement of the inspection the senior carer conducted a sample tour of the home with the inspector. The building was odour free and a credit to the housekeeping staff. What has improved since the last inspection?
There had been a commitment by the managers and provider to ensure that the staff had the mandatory training required to do their job. The required firework requested by the Fire Officer had been completed. There had been a review of the care plan format, areas changed and where necessary additional information added. The final radiators had been protected. Three of the staff spoken with at the time of the inspection confirmed that they received supervision in regard to their training and development needs. There had been following the previous inspection a commitment by the managers to ensure that new residents were provided with the appropriate information on admission. No person was admitted to the home without a full assessment of his or her needs. The Statement of Purpose was given on admission; a person who had recently been admitted to the home confirmed this. Gorway House DS0000020811.V348315.R01.S.doc Version 5.2 Page 7 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. Gorway House DS0000020811.V348315.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.V348315.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good Standards 1,3,4 were reviewed. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose was displayed and provided on admission to any person. The document contained information to enable people to make an informed choice about the facilities provided. No person was admitted to the home without a full assessment of his or her needs. A competent experienced member of the management team completed this practice to ensure that the home could meet the individuals nees. EVIDENCE: The Commission had been provided with the current Statement of Purpose prior to this inspection, the only comment made was the font could be more suitable for people that had a visual impairment. The document contained
Gorway House DS0000020811.V348315.R01.S.doc Version 5.2 Page 10 information that had enabled the new persons family to make a decision about placing their relative at Gorway A family confirmed that they had been given this document when their mother had been admitted. They also confirmed that one member of their family had received a letter confirming the assessment and placement. The care plan for the recently admitted person identified by her signature that she had been part of the planned care. This plan had a particularly detailed “potted history” of the resident, completed by the family. This format is to be cascaded down to other plans with the help of families and friends. Gorway House DS0000020811.V348315.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is adequate Standards 7,8,9,10 were reviewed. This judgement has been made using available evidence including a visit to this service. Arrangements were in place for the continued health care from other professional agencies. The medication system used by the staff when administering medication to individuals was satisfactory; records evidenced for this practice were not always current. The staffs on duty were observed in their work practices, respect and kindness was evidenced. The planned care records had developed; there were areas that required further consideration to their content. EVIDENCE:
Gorway House DS0000020811.V348315.R01.S.doc Version 5.2 Page 12 Two of the planned care documents were tracked through the inspection, each one had been compiled with the assistance of the person or their family; this was evidenced from the signatures on file. The risk assessments for these two people had developed and consideration taken into account of all aspects of the individuals life style. The section on these and other plans seen but not tracked identified that each person had collective details for eating and drinking. When explored the manager agreed that this needed to be reviewed. The provider was advised that extremely personal details in one of the care plans tracked should ideally be kept elsewhere. The provider agreed and removed the documents to store in the safe. The tracking included medication and accommodation; each one was satisfactory Each of the residents seen and spoken with were well presented, mobile and able to participate in their chosen life style, one resident during the day wandered freely around the home; another person demonstrated challenging behaviours in lounge later in the afternoon. The staff on duty handled the situation confidently and with respect shown to the person. Of the eight residents spoken with each one was very satisfied with the home the care and food they receive. “its nice here I can do what I want” “ the staff are good its nice to know they are here at night” “ the owner is very kind” Arrangements from the evidence made available identified that medical and other professional agencies visited the home. The medication system was observed to be satisfactory. At the commencement of the inspection the inspector identified areas where certain members of the night staff had failed to sign the Medication record or use the directions provided. This was discussed with the manager who has since contacted the Commission to inform them that further training was provided for the person responsible. It is important that when staff commence the use of a medication with a stated expiry date that the date is recorded. The home had not completed the PRN “as and when” protocol yet. For the people that choose to self administer their medication the risk assessment needs to be current and reviewed on a regular basis. The staff and management were observed to work as a team supporting and enabling individuals to continue with their life style. From the observations made on the day staff demonstrated sound care practices. Gorway House DS0000020811.V348315.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is adequate Standards 12,14,15 were reviewed. This judgement has been made using available evidence including a visit to this service. There was no evidence on the day of the planned menus and balanced diet provided. Visitors were welcome to the home at any time except meal times. The social aspect of the home was being developed from individuals expressed interests. EVIDENCE: At the time of the inspection the home had a college work experience person for one week. She played cards today and then proposed to read poems to the residents in the afternoon. When spoken with she told the inspector she was enjoying her week and willinginly answered resident’s questions about her self and her customs.
Gorway House DS0000020811.V348315.R01.S.doc Version 5.2 Page 14 People who use the service confirmed that they did exercises, they had enjoyed the quiz and the service earlier in June. One resident in particular likes to feed the birds daily, one person remains mobile and owns his own car; this person went swimming today. Ladies confirmed that they would like to go out more but for some this would be difficult. Families call and take their relative out. The menus to confirm that a balanced diet was prepared were not in the home they had been re-moved and were in the process of being reviewed. It is important that the Commission is able to view menus. These should always be kept at the home so there is evidence of what meals are served. The meal of the day was roast pork, stuffing, potatoes roast and boiled, vegetables and or fish. The inspector observed the meal, which was well presented and that individuals had chosen the alternative. The meal was followed by apple crumble and custard. No special diets were required at the time of this inspection. It is important that the required temperatures were completed at all times. Records identified that the weekend catering staff failed to record food temperatures. Positive comments from residents spoken with in respect of the lunch were given to the inspector “ the food is always good” “I can have something different” “ its always nice” Gorway House DS0000020811.V348315.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The homes complaint procedure was available to any person visiting or living at Gorway. Staff initially received training, which was on going, ensured that the people who use the service were protected from abuse EVIDENCE: The complaints process was displayed on the notice board and accessible to visitors, staff and people who use the service. The manager is to change the details of the Commission address to meet the recent changes of offices. From evidence in the records and future training plans some staff continued with training for the protection of vulnerable adults in their care. Two of the staff spoken with during the day confirmed they were aware of the whistle blowing policy and the protection of adults they would not hesitate to use it if they had concerns. During the time at the home three of the people who use the service told the inspector that they were aware of who to speak to in if they had a complaint. There was observed awareness of who the service provider was. One person who used the service told the inspector that she come in each day to see us.
Gorway House DS0000020811.V348315.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good Standards 19 20 23 24 25 26 were reviewed. This judgement has been made using available evidence including a visit to this service. The management provides a pleasant comfortable environment where people who use the service can relax, accessing various parts of the home and gardens easily. Gorway housekeeping staff maintained high standards of hygiene throughout the home. Gorway House DS0000020811.V348315.R01.S.doc Version 5.2 Page 17 EVIDENCE: Located in a quiet area and near to local shops and a college Gorway House stands in its own tranquil grounds. The owners plan to re-arrange the gardens next year making them even more accessible to the people who use the service. Raised flower beds were in the plans giving an option to those residents that like gardens. At the time of the visit a ramp was being constructed from one of the side doors making access and egress to the garden easier. The owners and management provided a comfortable establishment where people who use the service can walk about freely. The housekeeping staff continued to ensure that high standards of hygiene were maintained. A same tour of the home evidenced that personal possessions in bedrooms were encouraged; this was confirmed by people who use the service spoken with “its nice having my things here” “ we were told that we could bring in things for mum” The inspector was told that the night staff were the people responsible for ensuring that the bathrooms and toilets had sufficient toilet rolls for the day. This was brought to the attention of the management in the previous inspection report, there remains a possibility of cross contamination with the practice followed by the night staff. The night staff needs to be aware of the possibility of a potential cross contamination in certain areas. Following the previous inspection the provider had continued and completed the protection of the radiators to ensure the safety of the people who use the service. Gorway House DS0000020811.V348315.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good, Standards 27 28 29 30 were reviewed This judgement has been made using available evidence including a visit to this service. People who use the service have their needs met by staff with experience and skills. The home had developed procedures further to ensure that the recruitment process protected people who use the service. EVIDENCE: The owner and managers had made a commitment to the training of staff following the recent inspection. The evidence from the records confirmed training was on going and planned until December. At the time of the inspection a day’s first aid training was taking place; one of the managers also participated in the training. There were staff on duty in number sufficient to meet the needs of all the people who use the service. Two of the staff on duty were spoken with they confirmed that they were aware that certain checks had to be made prior to
Gorway House DS0000020811.V348315.R01.S.doc Version 5.2 Page 19 them being employed. They confirmed supervision with management and the amount of training that was planned. It was hoped that four more of the staff would sign for the National Vocational Qualification later in the year. The senior carer had recently completed her NVQ Level III. The staff records evidenced were in general satisfactory, one person had been at the home since 1997 no references had been obtained at that time the provider and the person on duty at the time agreed to provide a character reference. One new night care person’s references and a health check prior to employment were pending. The provider employed new staff on a trial period followed by an appraisal and discussion. A permanent contract of employment would then be issued. The home maintained evidence of any criminal police check available to the Commission. Gorway House DS0000020811.V348315.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good Standards 31 33 35 38 were reviewed. This judgement has been made using available evidence including a visit to this service. There had been some development with the quality assurance of the service provided. The home operated for the best interest of the people who use the service. Records provided ensured that the health, safety and finances of the people who use the service were protected. EVIDENCE:
Gorway House DS0000020811.V348315.R01.S.doc Version 5.2 Page 21 The managers continued with their Registered Managers Award and hope to complete it later in the year. The manager on duty shared with the inspector that she had enjoyed the exercise but it did take a lot of personal time commitment. Following the recent inspection the managers have sourght feedback from people who use the service and where possible relatives. Comments during the day and from visitors were positive, “ I am so pleased that mum is here” “ the manager moved mum when we had a problem with her upstairs its given us more peace of mind” “we had a meeting soon after mum came here to see if everything was OK” “ I can go out to the shops if I want” The managers were to further develop the surveys to include other agencies. A sample of the finances held on behalf and in agreement with the individual residents were checked and found satisfactory. The manager had developed a new finance sheet for monies received and debited; this will make records simpler for the staff responsible. The inspector evidenced records of contractual servicing from the previous annual quality assurance assessment, and last inspection, which remained current. Fire records continued to be current and plans for more staff to complete fire instruction and a drill were evidenced to be in place. Gorway House DS0000020811.V348315.R01.S.doc Version 5.2 Page 22 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 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 3 3 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 3 X 2 X 3 X X 3 Gorway House DS0000020811.V348315.R01.S.doc Version 5.2 Page 23 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 OP15 Regulation 16 (i) Requirement The registered person shall ensure that menus were maintained at all times at the home so there is evidence of what meals are served. When medication is administered to people who use the service it must be clearly recorded, to ensure that people receive the correct levels of medication Timescale for action 10/09/07 2. OP9 13 (2) 10/09/07 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 2 3 Refer to Standard OP7 OP26 OP33 Good Practice Recommendations To review the section in the care plans for eating and drinking to ensure that they reflect individuals needs. To educate the staff where necessary in the potential cross contamination and the need for infection control by not leaving exposed toilet rolls in the bathing/ toilet facilities. A system should be implemented to take into account the views of stakeholders using the service.
DS0000020811.V348315.R01.S.doc Version 5.2 Page 24 Gorway House Gorway House DS0000020811.V348315.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Birmingham Local Office 1st Floor Ladywood House 45-46 Stephenston Street Birmingham B2 4UZ 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
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