Inspection on 31/05/06 for Gorway House

This inspection was carried out on 31st May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Gorway House 09/12/09

Gorway House 01/04/09

Gorway House 06/10/08

Gorway House 14/08/07

Gorway House 21/05/07

Gorway House 02/11/06

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Gorway House 40 Gorway Road Highgate Walsall West Midlands WS1 3BG Lead Inspector Mrs Maggie Bennett Key Unannounced Inspection 31st May 2006 08:50 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.V294126.R01.S.doc Version 5.1 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.V294126.R01.S.doc Version 5.1 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.V294126.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th October 2005 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. The fees is £350.00 to £450.00 per week. Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over one and a half days, commencing on 31st May 2006. At the time of the inspection the Registered Manager, Mrs. Jennifer Beale, was on holiday. The Manager, Mrs. Susan Allen, assisted throughout the inspection and the Registered Provider, Mrs. Pamela Brown, was also present during some of the visit. All of the Key National Minimum Standards were inspected on this occasion. It was found that of the 46 statutory requirements made at the last inspection, 19 had either been met or were in the process of being met. A further 14 statutory requirements were made following this visit. There were 18 service users living at Gorway at the time of the visit. During the course of the inspection the care plans and files of a random sample of service users were seen and “case tracked” in order to inspect the home’s assessment processes, care planning systems and quality of care delivered. A random sample of staff files were also seen to check compliance with Staffing Standards and Regulations. Other documentation was seen so that the home’s health and safety procedures could be assessed. Discussion took place with a number of service users. Only one visiting relative was available during the visit. A tour took place of the building. Staff were observed during their duties and discussion also took place with 2 members of staff and with the management of the home. What the service does well: What has improved since the last inspection? Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 6 The systems with regard to the administration of medication have improved and the home has moved to a Monitored Dosage System. Both the management of the home and the staff feel that this is a much more “professional” system and that the concerns expressed by the Pharmacist Inspector, following his visit in November 2005, have now been addressed. This inspection found that, despite a clear improvement in a number of areas, there were still some shortfalls, which are noted below. Menus are now produced and a choice is advertised. Several service users spoken to, however, do not seem to be aware that there is a choice (see below). Some of the statutory requirements made with regard to the kitchen and kitchen records have now been met. A probe has been provided and the temperature of cooked meats is taken. A record is now maintained of fridge and freezer temperatures and a new fridge has been purchased. Several of the statutory requirements made with regard to the building have been met and more improvements are planned. A number of staff have achieved their NVQ2 qualification and more have been enrolled to commence the training. Several staff have also attended Adult Protection Training. Although in its early stages, the home have begun to introduce supervision sessions for staff and some staff have been requested to complete self appraisals. There is evidence that the home have begun to look at its policies and procedures and to bring them into line with current requirements. What they could do better: The home’s assessment procedures, although improved in some areas, remain unsatisfactory. There is evidence that several people may have been admitted to the home, who could be inappropriately placed. The manager has undertaken to obtain up to date professional assessments on all these people and to consult with the Commission following receipt of the assessments. Staff have not received sufficient training in the needs of people with dementia. There has been no real improvement in the care planning systems at the home and no evidence that service users are involved in their care planning. Care plans do not contain enough information about service users’ healthcare needs, including pressure sore risk assessments, falls risk assessments and nutritional screening. There is no evidence that care plans are regularly reviewed. It is acknowledged that there is an improvement in medication administration, but some poor practice was observed during the inspection (see Standard 9 for further details). Although the management of the home and the staff feel that sufficient social care activities are provided, this is not the perception of the service users. They said: “Not seen any”. “No activities here…..” “Not enough activities – I would like more stimulation.” Several service users do not feel that there are choices at mealtimes and they need to be more enabled to participate in menu planning. Several of the environmental issues raised at the last inspection, including the majority of the requirements of the Fire Officer, have been met, but some remain outstanding and are long overdue. There must be sufficient staff employed on the afternoon shifts (this is sometimes only 2). Recruitment records had improved but the standard is still not met as not all staff files contained 2 written references and application Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 7 forms did not supply a full employment history. 2 application forms had been written in pencil. There is still no staff training and development plan. There is no record of a proper induction for new staff. The home has not yet produced a quality assurance and quality monitoring system and to date there is no written evidence that service users’ views of the home are sought and acted upon. Evidence of the regular servicing of the hoists must be available, as must written evidence that the temperature of the water at outlets accessible to service users is regularly tested. 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. Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 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.V294126.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 4. Standard 6 is not applicable. The overall outcome for this group of standards is judged to be poor. Prospective service users are not provided with all the information they need in order to make an informed choice about whether to move to Gorway. Although the home do obtain assessment information on prospective service users, their own assessment lacks detail and prospective service users cannot be assured that the home is able to meet their needs. The home have admitted a number of people outside of their category of registration and cannot provide the evidence to verify that it can meet these people’s needs. Staff have not received sufficient training in the needs of people with dementia and mental health needs. EVIDENCE: A random sample of service users files were seen during the inspection. At the last inspection the home were required to provide service users with a letter detailing the current level of fees and information on any annual increase in fees. This was in the process of being developed at the time of the inspection and has not, therefore, been provided. The Registered Person states that Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 10 there has been no increase for privately funded service users since the last inspection. All service users who are funded by the Local Authority receive a letter from Social Services with details of their contribution towards their fees. The files of 2 recently admitted service users were seen in order to inspect the homes assessment procedures. It was found that full assessment information had been received from the service users social workers, although in one case this was not received until the day the person was admitted. It is essential that this information is received prior to the person’s admission. In one case the home had carried out their own brief assessment and their notes were detailed in the file. In the second case the home did not appear to have carried out their own assessment prior to the person being admitted. It is strongly recommended that a representative of the home visits any prospective service user in their own home (or in hospital) prior to them being admitted. The home must ensure that the assessment information contains details of all the elements listed in Standard 3.3 of the National Minimum Standards. Otherwise there is a danger that service users could be admitted without an assurance that the home can meet their needs. Following assessment, the Registered Manager must write to the prospective service user stating that the home the home is able to meet their needs. From information seen in care plans, it appeared that the home had admitted some service users with a diagnosed dementia and others with diagnosed depressive illnesses. One person had been admitted on Section 117 of the Mental Health Act and another had been placed on a Guardianship Order (Section 7 of the Mental Health Act). The home is not currently registered to care for people within these categories. If the home is able to provide evidence that it can meet these peoples needs an application for a Variation to change the Homes Category must be submitted. The number of people admitted to the home with a diagnosed mental health need is the cause of some concern and the home was advised that no further service users with dementia or mental health needs must be admitted until this situation has been discussed and resolved with the Commission for Social Care Inspection. The Registered Manager undertook to obtain up to date assessments from the social workers of the service users in question. Copies of these are to be forwarded to the Commission. Some staff have taken part in a day’s training in Dementia Care. It was agreed with the manager in charge that this training was not of sufficient depth and did not equip staff with the knowledge they needed to care for people with dementia. If the home is to continue to care for people with dementia, staff must take part in suitable training. The manager undertook to take steps to obtain such training. Staff have not received any training in the needs of people with mental health needs, such as depressive illnesses. They have, however, received advice from the Consultant Psychiatrist and Community Psychiatric Nurse. It was Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 11 observed during the inspection that staff were having some difficulties coping with the needs of a service user who had episodes of extreme agitation. They were, however, observed to be very patient and considerate. As with training in dementia care, training in the needs of people with mental health problems must also be obtained. Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. The overall outcome for this group of Standards is judged to be poor. There has been very little improvement in care planning since the last inspection and there is no clear or consistent system in place to adequately provide staff with the information they need to satisfactorily meet service users’ needs. The systems for the administration of medication have improved, but there remain some shortfalls, which need to be addressed in order to ensure that service users’ medication needs are met. Service users feel that they are treated with respect, with their right to privacy upheld. EVIDENCE: The files of four service users were looked at during the inspection. The Care Plans seen lacked any detail and gave no indication of the persons social and health care needs and how these were to be met. There is nothing to indicate that people have been involved in their care planning, as care plans are not signed by service users or their relatives. There is no evidence of monthly reviews. There were, however, some copies of social work review meetings. Risk assessments were not available on all files. Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 13 Care Plans at present are basically a tick box, the box being ticked when the person has had a bath, haircut, nails done, etc. There is very little about the person. On some care plans there were some brief details about social interests, hobbies, etc. but no indication as to whether these needs and aspirations could be met. One person had been discharged to the home on Section 117 of the Mental Health Act, but there was nothing to indicate whether this person was subject to the Care Programme Approach and how these requirements were being met. One risk assessment was seen, but it was inadequate. The person was described as having a recurrent depressive disorder, but the risk assessment did not identify any concerns. As stated in the National Minimum Standards, care plans are: “…the yardstick for judging whether appropriate care is delivered to the individual resident.” The care plan must be a “dynamic document, which will change as regular assessment of the resident reveals changing needs.” Care plans must set out individual needs, how these needs are to be met, ideally in the words of the service user, and must contain regular evaluations. Unfortunately there seems to have been very little improvement in this area since the last inspection. During the inspection it was clear that the Manager and staff on duty had a good awareness of the service users day to day healthcare needs. Frequent telephone calls were made during the day requesting GP visits and healthcare needs were discussed with service users. The home have set up a file detailing visits from Doctors, nurses and other healthcare professionals as well as any outpatient appointments. This, however, tends to be retrospective and does not contain any planning with regard to healthcare needs. There are no pressure sore risk assessments. Even if no service users currently have pressure sores, a risk assessment must still be carried out. Although some service users are receiving visits from community psychiatric nurses, consultant psychiatrists, etc., these visits and the interventions received are not detailed in their care plans. For example, one service user has been seen by the Consultant Psychiatrist and Community Psychiatric Nurse and verbal advice had been given, but none of this was recorded in the person’s care plan. There was no evidence of nutritional screening. There are no falls risk assessments on files. As with care plans, staff are able to give a good account of service users needs, but this is in their heads only and is not documented. It is strongly recommended that the health care needs and plans of individuals are kept within their care plans, rather than altogether in one file. It was observed that a service user was moved by staff putting their arms under the service users armpits (see Standard 38 re. moving and handling training). This practice must not be used. There have clearly been improvements in medication administration since the visit of the Pharmacy Inspector in November 2005. The policy and procedure for the handling of medicines has now been devised. The home must now provide evidence that staff who administer medication have read and Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 14 understood this document. The home have changed to a monitored dosage system and staff spoken to feel that this system is now working well. Currently there are no service users who administer their own medication (apart from some inhalers). The home are aware that should anyone wish to do so, they must undertake a risk assessment and regularly monitor the service users capability to manage their medication. Medicines arriving at the home are now routinely checked for accuracy. This check must be recorded and dated on the MAR chart. Returned medication is also clearly recorded and signed for. The home has ceased the practice of secondary dispensing and all medication is dispensed from the original container. A sample of the medication and MAR charts was carried out and there were no discrepancies. There were some eye drops in the trolley, which were not labelled and there was no note as to when they had been opened. During the inspection it was noted that a tot of medication was placed bedside the lunch of a service user for her to take at her convenience. The member of staff did not observe the service user taking the medication and later recorded them all the medication as having been taken. The taking of medicines must be observed and each tablet signed for immediately after administration. One service user had been prescribed promazine 5ml. x 3 daily as required. Staff said that the CPN had stated that this could be given x 4 daily if needed. The CPN had not, however, confirmed this is writing on the MAR chart. The home must not increase the numbers of dosages given on a verbal communication. There must be written confirmation before this is done. During the inspection the home contacted the CPN who undertook to speak with the service users GP and alter the prescription accordingly. Currently there are no medicines needing refrigeration, but a secure container has been purchased should this occur in future. A number of staff have taken part in the accredited medication training and more are scheduled to do so. It remains a requirement that the home introduce a competency-monitoring programme to ensure that staff handle and administer medication safely and accurately. It is further recommended that a controlled drugs cabinet is purchased, along with a controlled drugs register and that appropriate training on its completion is undertaken. The majority of service users have their own rooms at Gorway and for these people all personal care giving takes place in private. One shared room is currently occupied by 2 people who wish to share. Service users spoken to during the inspection confirmed that their privacy was respected at the home. Staff were observed to treat service users with respect, always knocking on doors before entering rooms. The homes induction training for new starters is not clearly documented (see Standard 30) and it is not possible to verify that new workers are trained in how to treat service users with respect. Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. The overall outcome for this group of standards is judged to be poor. The home have produced a weekly programme of activities, but several service users are unaware of this and some feel that there is very little to do during the day. There are no restrictions on visits and service users spoken to feel that their rights to autonomy and to make choices are upheld. Although menus are now produced, the majority of service users said that they were not aware of what they were having for lunch, or that there was a choice. There is no provision for service users with special dietary needs. EVIDENCE: The majority of service users spoken to did not feel that there were sufficient social care activities at the home. Some of their comments are as follows: Not that I know of. It doesnt bother me. Not seen any. No activities here. There are not many chaps here. Not enough activities - would like more stimulation. Not keen on activities, but there are plenty of books. We dont do a lot in the daytime, sometimes we have a walk. I used to like to sew. After breakfast I want to start doing jobs and going to the shops. Im not living. Staff felt that it was difficult to motivate people and that you cant force people. Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 16 A large number of service users are taken out regularly by their relatives. There is some evidence that activities have been discussed with the service users at their meetings and there is an itinerary of activities posted on the notice board. These include Keep Fit once a week, board games, manicures and the mobile library. A representative from a local Church visits on a weekly basis. There are occasional trips out - The local Rotary Club provide 2 trips a year and there is usually a visit to the Lights at the Arboretum. There are plans to have a Garden Party this year. There does appear to be a discrepancy with what the home feel they are providing and the perception of the service users. It was recommended to the manager that a staff member be given particular responsibility for looking at social activities and for holding discussions with the service users about what they would like to do. It does seem that more imagination is needed in this area. Service users confirm that they are able to see their visitors at any reasonable time and that there are no restrictions on visits. There is a visiting policy and all service users and their relatives are given a copy of this. The home must ensure that an up to date Statement of Purpose and Service Users Guide is developed and that these documents contain all those details required by Regulation (including details with regard to visits and involvement of relatives and of the service users’ rights of access to their personal records). Service users also confirmed that they are able to make choices at the home, although some felt that they had to get up in time for breakfast, otherwise they would miss it. The manager stated that this was not the case and that if service users wanted to sleep in late in the mornings, then this choice was respected. This was confirmed, as during the course of the inspection one service user did sleep in late and was able to have a bath and then breakfast at his convenience. Several service users handle their own financial affairs. The home is recommended to obtain written details of the local Age Concern Advocacy scheme, so that this information is available in the event of service users needing this service. Care plans do not contain sufficient detail with regard to dietary needs, likes and dislikes. Although a menu is published, which details an alternative, several service users did not think that there was an alternative. One person did say, however, They get me something else if I dont like the food. On the menu for that day was meat pie, but the cook said the butcher didnt turn up because it was Bank Holiday. She therefore served fish and chips, which was mostly appreciated, apart from one person who said that the peas were hard. Rice pudding was stated on the menu, but fruit sponge was given instead. Some service users said that they had been notified that morning that they would be having fish and chips. As far as possible, the home must adhere to the published menu and ensure that there is always a distinct alternative Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 17 available. The majority of the service users said that they were happy with the food. Food is pretty good, we cant grumble. Yes - very nice. Quite good. One person, who formerly lived in India, said he thought the food was good and that he was quite happy with European food. He said that on Saturdays they sometimes had a curry, but that these were not authentic. It is recommended that this person be asked if he would like to discuss recipe suggestions with the cook. Three full meals a day are offered and tea and snacks are served in the intervening time. It is anticipated that service users will take their snacks in the dining room. The cook said that a cooked breakfast was offered each day, although there was no bacon in evidence during the inspection. She said it wouldnt always be bacon, sometimes eggs on toast. There are 2 service users who are diabetic. The cook said that there was no special provision for them and that they have what the others have. The home must provide appropriate food for those service users who are diabetic. Staff were observed to be attentive during the meal time and to be discreetly helping those service users who needed help. There was evidence that fridge and freezer temperatures are now taken regularly. The temperature of cooked food is also taken, the probe was seen, along with antiseptic wipes. Some out of date tinned foods were found in the store store, which were disposed of by the manager. The home must improve its stock control system. Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The overall outcome for this group of standards is judged to be adequate. Service users spoken to during the inspection felt that if they had a complaint the management of the home would listen to them and take action. Although the home do have an Adult Protection Policy in place this needs to be updated so that it is in line with the local Social Services Policy and Procedure and contains all the relevant telephone numbers. Several staff have attended Adult Protection Training and this has increased their knowledge of potential abuse and helps to protect service users. EVIDENCE: The home have a Complaints Policy and Procedure in place and a copy is available on the notice board. Of those service users spoken to, most felt that if they had a concern they would discuss this with the management of the home. They also felt that they would be listened to. I would speak to J., S. or Mrs. B. Mrs. B. makes sure I have what I want when I want it. If anything cropped up I would speak. Any of the staff will sort your problems out. The home does not have a book in which to record complaints. None have been made since the last inspection. It is recommended that in addition to a complaints book, the home also have in place a comments book, which can be placed in a convenient place (perhaps in the Hall?) for service users and their visitors. The home have in place a policy and procedure with regard to Adult Protection. The home must ensure that this policy is in line with the Adult Protection Policy Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 19 and Procedure produced by Walsall Social Services. They also need to ensure that they have the Protection of Vulnerable Adults guidance and that staff are familiar with this guidance, including their responsibilities with regard to “Whistleblowing”. The home must have to hand essential telephone numbers, such as the Adult Protection Unit, Social Services, Emergency Duty Team, CSCI. Several staff have taken part in Domestic Violence training and more are booked on the next training course. Staff spoken to felt clear that they would have no hesitation in reporting any suspected incidents of abuse. Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24, 25 and 26. The overall outcome for this group of standards is judged to be adequate. Gorway is an attractive and generally well-maintained home, with pleasant gardens to the front and rear of the property. Service users feel they live in a comfortable and clean home. There continue to be some outstanding issues, which must be met in order to ensure a safe environment for the service users. EVIDENCE: At present the home does not have a programme of routine maintenance and renewal of the fabric and dedcoration of the premises. This must be produced and a copy forwarded to the Commission. There are attractive gardens to the rear of the property, which are kept in good order. Several of the requirements made with regard to the building at the last inspection have now been met or are in the process of being met. Fire Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 21 resisting doors in the premises are gradually being upgraded and fitted with smoke seals as well as intumescent strips. Automatic door closures have been fitted to several doors. Work to the doors is still underway and is not yet fully complete. It was noted at the inspection that several doors were wedged open. This practice must cease. If, for the convenience of the service user, it is desirable that the door should be open, an automatic closure device must be fitted. A suitable key in a breakable box has now been supplied so that the exit gate from the garden can be opened in an emergency. It is understood that quotes are currently being obtained for re-decoration of the exterior paintwork. Following the requirement made at the last inspection some easy chairs have been replaced and others cleaned. The carpet has been removed in the smaller lounge and there is now a wood block floor in this room. New light fittings have been provided. Several of the bedrooms have an en suite toilet and wash hand basin. In addition there are separate toilets and bathrooms. Attention is needed to the following areas: Room 1 – the bush outside the window needs cutting back as it is making the room very dark; several rooms do not contain lockable storage space; in a number of cases there were no chains on plugs to wash hand basins and in some cases no plugs at all; one bedroom had an odour and it is recommended that consideration is given to providing washable floor covering. Risk assessments have not yet been carried out with regard to service users having keys to their rooms and keys to a lockable facility within their rooms. All radiators must be guarded or have guaranteed low temperature surfaces (Several radiators in communal areas and some bedrooms are not covered). At the time of the inspection the premises were clean and free of any offensive odours. Service users spoken to said the home was always clean. There is a suitable laundry in the home. Although liquid soap was available, there were no paper towels and these must be provided. The bin in the laundry must have a lid. The washing machine has a sluice facility. It is recommended that “Dissolvo” bags are used for foul laundry. It was noted that there was some bar soap in the communal bathrooms and this must be removed. There was also some unlabelled conotrane cream in one toilet. Service users’ individual creams must be kept either in the medication cupboard, or, if they self administer, in their own rooms. Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The overall outcome for this group of Standards is judged to be poor. Staffing levels are adequate during morning shifts, but not on all afternoons. The home needs to demonstrate, through its assessments (including risk assessments) that the current ratios are sufficient to meet the needs of its service users. NVQ training has improved and staff are rightly pleased with their achievements. Despite an improvement in recruitment procedures, staff records are poor and do not meet the requirements. New staff do not receive proper induction training. Staff do not have an individual training and development assessment and profile. Service users spoken to felt that the staff worked hard and looked after them well. EVIDENCE: At the time of the inspection there were 18 service users living at Gorway and rotas showed that during the morning shift (8.00 a.m. to 4.00 p.m.) there is one senior carer and two other carers on duty. During the afternoon shift (4.00 p.m. to 8.00 p.m.) there are occasions when there are only 2 care staff on duty (although a manager is available to assist). It was noted during the inspection that 2 service users were needing the assistance of 2 carers. It is, therefore, a requirement that there are always 3 care staff during daytime shifts. Overnight there are 2 waking carers. There is a cook on duty from 8.00 a.m. to 2.00 p.m. and cleaners are employed every day except Sunday. In addition there is a person employed to carry out laundry duties. During the inspection it was noted that the large lounge was unattended for a good part of Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 23 the afternoon. The manager stated that the service users in this lounge did not require constant supervision and that those in need of more assistance usually sat in the front lounge. As stated in Standard 7 above, all service users must have their dependency levels assessed and these assessments must be available within their care plans. The home must be able to provide evidence that staff levels are appropriate to the assessed needs of the service users. 8 staff have successfully completed the NVQ2 qualification. More staff have been enrolled to commence the qualification in the near future. Two staff are to undertake NVQ3. This is good progress and although the home did not achieve 50 of its staff qualified to NVQ2 by 2005, there is a commitment to ensure that staff are appropriately trained. The home does not employ any Agency staff. There has been some improvement in recruitment procedures, but there are still shortfalls and this Standard is not met. The files of 5 members of staff were inspected. 2 of these staff were relatively recently appointed (in October 2005). All files contained an application form, but in most cases the form was not completed in all areas. 2 staff had not completed the section requesting names of referees. 3 had done, but there were no written references on file. None of the application forms gave a full employment history. The Rehabilitation of Offenders Declaration was completed. 2 of the application forms had been written in pencil. Satisfactory CRB checks were available on all files. Not all staff files contained copies of their contracts and job descriptions. Staff files must contain all those records required by Regulation. There is no staff training and development programme, only a list of training staff have undertaken. The home must produce a written programme, with projected dates. All staff must have an individual training and development assessment and profile. Files of recently recruited staff do not contain a record of induction training to Skills for Care specifications. All new staff must receive induction training to Skills for Care specifications within 6 weeks of commencing employment. All staff now receive at least 3 paid days training per year. Service users say: Staff are overworked and underpaid - theyre really good staff. Theyre good to you here - theyre kind and feed you well. They tell you when its your turn to have a bath. They look after you well. Theyre pretty good. They are kind and thats what you want. Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. The overall outcome for this group of Standards is judged to be poor. The managers are now taking part in the Registered Managers’ Award training and, although still in its infancy, there is evidence that a programme of staff supervision is also being developed. This represents some progress and will be of benefit to the service users. There has been very little progress on the development of a quality assurance system and there is, therefore, no evidence that the views of service users and their representatives are sought and acted upon. Apart from hairdressing money, the home does not look after the finances of any of the service users. There has been some improvement in health and safety checks and procedures, although further improvement is needed in order to ensure that service users and staff are fully protected. Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 25 EVIDENCE: The Registered Manager and Manager are currently undertaking the Registered Managers’ Award. Following completion of this they will undertake the care modules of NVQ4. Although they have not met the target of March 2005, progress is being made and it is hoped that this aspect of Standard 31 will be met in the near future. Both managers are very experienced and have worked at the home since its opening. The Registered Manager has lead responsibility for all the day-to-day operations and care practice, whilst the Manager has lead responsibility for all aspects of staffing and wages. There has been very little progress on the provision of a quality assurance system and there is still no annual development plan for the home. The Manager states that questionnaires are to be sent out to service users, relatives and other stakeholders. Service users spoken to feel that their views are listened to, but there is no written evidence that they are regularly consulted. There is evidence that policies and procedures are being developed and updated. There are still no formal systems in place for the monitoring of practice in the home. The home does not look after any monies on behalf of service users. This is either done by the service user themselves or on their behalf by their relatives. The only financial transactions that take place are when the home pays for hairdressing and this money is reimbursed to the home by relatives. There are secure facilities in place for the safekeeping of any monies or valuables. There is evidence that the home have begun to look at providing supervision for its staff. There were supervision records on 2 files seen and the Manager was clear of the homes responsibilities in this area. There was also evidence of staff having been asked to carry out a self-appraisal. From the staff records seen certificates on files showed that there has been some improvement in the provision of training in the mandatory health and safety areas of fire safety, food hygiene, moving and handling and first aid. All staff must also take part in infection control training. As stated in the standards on Staffing the home must produce a training matrix, with an up to date picture of the training completed by staff and projected dates for new and refresher training. It was concerning to note during the inspection that 2 staff used an inappropriate method of moving a service user. The home must ensure that staff receive regular moving and handling training and that they only use approved techniques. Practice in this area must be monitored by the Managers. Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 26 Records seen showed that a fire alarm test takes place each week, the emergency lights are tested monthly and a fire drill takes place every six months. The home must produce a Fire Risk Assessment. The Registered Manager must take part in the Managers Fire Training course held by the West Midlands Fire Service. There was evidence of a gas safety check in November 2005, a 5-year electrical check and of the regular servicing of the lift. There is no record of the Arjo bath hoists being serviced and this must be provided. The home must provide written evidence of water safety checks, including checks for legionella. The temperature of the water at outlets accessible to service users must be checked each week and this must be recorded. There are window restrictors on all first floor windows. The home now has an appropriate accident book. There is a first aid box in the kitchen. A food probe and antiseptic wipes are now provided. Fridge and freezer temperatures are taken and recorded. The Registered Manager must forward to the Commission the homes written statement of the policy, organisation and arrangements for maintaining safe working practices. Copies of risk assessments for safe working practice topics must also be forwarded. Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 X X X 2 2 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 28 Are there any outstanding requirements from the last inspection? Yes. 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 OP2 Regulation 5(1)(b) Requirement Timescale for action 31/07/06 2. OP3 14(1) Ensure an annual letter with a statement of the annual increase or the current level of fee must be issued to the service user and a copy kept on file. 2.2 Timescales of 30/04/05 and 30/11/05 not met. This letter is currently being developed. 30/06/06 New service users must only be admitted on the basis of a proper assessment. A copy of this assessment must be received by the home prior to the person’s admission. Following assessment the Registered Manager must write to the prospective service user confirming that, having regard to the assessment, the home is able to meet the person’s needs. The registered person and the 30/06/06 registered manager must consult with the Commission for Social Care Inspection if they wish to accommodate someone who has specific needs that are outside the category of their registration. The home has admitted service users with both a diagnosed DS0000020811.V294126.R01.S.doc Version 5.1 3. OP4 12(1) Gorway House Page 29 4. OP4 18(1)(c)(i ) 15(2) 5. OP7 6. OP7 15(2) 7. OP7 13(4) 8. OP7 15(2) 9. OP8 12-1-16-1 10. OP8 14(1) dementia and a diagnosed mental health need. Up to date social work assessments must be obtained for all these people. (Previous timescale of 30/11/05 not met). Staff must receive appropriate training in the needs of service users with dementia and mental health needs. Ensure the care plans have the signature of the service user/ relatives and involve them in drawing up their care plan. 7.6 Timescales of 30/04/05 and 31/12/05 not met. Ensure residents Care Plans are developed to set out in detail the action which needs to be taken by the care staff to ensure that all aspects of the health, personal and social care needs of the resident are met. (Previous timescale of 31/12/05 not met). All care plans must include a risk assessment, with particular attention to the prevention of falls. The service user’s plan must be reviewed by care staff in the home at least once a month, updated to reflect changing needs and current objectives for health and personal care, are actioned. The registered manager must produce a risk assessment for pressure sores to be completed by care staff in the home and held with the care plan for the resident and reviewed on a continuing basis. (Previous timescale of 31/12/05 not met). Ensure a weight chart is completed regularly and kept on the service users’ files. DS0000020811.V294126.R01.S.doc 31/07/06 30/06/06 31/07/06 31/07/06 30/06/06 31/07/06 31/07/06 Gorway House Version 5.1 Page 30 11. OP8 14(1)(2) 12. OP9 13(2) 13. OP9 13(1) 14. OP9 17(1)(a) 15. 16. OP9 OP9 13(2) 13(2) 17. OP9 13(2) (Previous timescale of 31/12/05 not met). Nutritional screening must be undertaken on admission and subsequently on a periodic basis, a record maintained of nutrition, including weight gain or loss, and appropriate action taken. The home must provide written evidence that staff have read and understood the policy and procedure with regard to medication. The registered person and registered manager must ensure that a risk assessment is completed for those service users that wish to administer their own medication. (This must be done for service users who administer their own creams and inhalers). (Previous timescale of 31/12/05 not met). Records must be kept of all medicines received, administered and leaving the home or disposed of to ensure that there is no mishandling. The MAR chart must be completed to confirm the quantities received. The date of opening of eye drops must be written on the container. The person administering medication must observe the service user taking the medication and sign the administration sheet immediately afterwards. “Tots” of medication must not be left for service users to take unsupervised. The home must not accept verbal instructions with regard to “as required” medication. If Consultants or Community Psychiatric Nurses wish to change medication, they must DS0000020811.V294126.R01.S.doc 31/07/06 30/06/06 31/07/06 30/06/06 31/05/06 31/05/06 31/05/06 Gorway House Version 5.1 Page 31 18. OP9 13(2) 19. OP12 16(2)(m)( n) 20. OP15 17(2) 4 (13) 21. 22. OP15 OP18 12(1)(a) 12(1)(a) 23. OP19 23(2) write on and signed the MAR chart and must also request a new prescription from the G.P. The home must introduce a competency-monitoring programme to ensure that staff handle and administer medication safely and accurately. (Previous timescale of 31/01/06 not met). The Registered Manager must consult with service users about their social interests and make arrangements for a varied programme of both in house and outside activities. Service users’ wishes and participation with regard to social care activities must be recorded in their care plans. Provide evidence of consultation with residents regarding dietary needs and preferences for all mealtimes and produce menus detailing the choice of foods available. (Service users’ likes and dislikes and nutritional needs must be recorded on their care plans). (Menus must be an accurate record of the food to be served). Previous timescale of 28/10/05 not met. Special diets must be provided for service users with specialist needs, such as diabetics. The home must ensure that their Adult Protection Policy and Procedure is in line with that produced by Walsall Social Services. It must include essential telephone numbers. A programme of routine maintenance and renewal of the fabric and decoration of the premises must be produced and a copy forwarded to the Commission. DS0000020811.V294126.R01.S.doc 30/06/06 31/07/06 30/06/06 30/06/06 31/07/06 31/07/06 Gorway House Version 5.1 Page 32 24. OP19 23 25. OP24 23(1)(m) 26. OP19 16(2)(c) 27. 28. OP25 OP26 13(4) 13(3) 29. OP27 18(1)(a) 30. OP28 18(1) Ensure all of the fire resisting doors in the premises are upgraded so that they have smoke seals fitted as well as intumescent strips. Place risk assessments on case files or in the care plans regarding the provision of keys to the door locks and drawer locks of service users rooms. National Minimum Standards 24.6 & 24.7. Previous timescales of 28/02/05 and 31/12/05 not met. The home must ensure that all those areas listed in the section on the Environment as needing attention in individual rooms are attended to. All radiators must be guarded or have guaranteed low temperature surfaces. Paper towels must be provided in the laundry. The bin in the laundry must have a lid. Bar soap must not be left in communal bathrooms. Service users’ individual creams must be kept either in the medication cupboard or in their own rooms (if they selfadminister). Sufficient staff must be employed on all shifts. The ratios of care staff to service users must be determined according to the assessed needs of service users. The home must ensure that 50 of care staff within the home achieves NVQ level 2 or equivalent by 2005. 28.1 Timescales of 31/03/05 and 31/03/06 not met. It is recognised, however, that there has been an improvement in this DS0000020811.V294126.R01.S.doc 31/08/06 31/07/06 31/07/06 31/08/06 17/06/06 30/06/06 31/08/06 Gorway House Version 5.1 Page 33 31. OP29 19(1) 32. OP29 24(1) 33. OP30 24(1) 34. OP30 18(1) 35. OP31 9(2)(b)(i) 36. OP33 24 area. The registered person and registered manager must ensure the recruitment policy is operated on a thorough procedure based on equal opportunities and ensuring the protection of service users. Application forms must be full completed. 2 satisfactory written references must be obtained prior to appointing new staff. Application forms must contain a full employment history. Staff files must contain all those records required by Regulation. (Previous timescale of 31/11/05 not met). The registered person and registered manager must ensure all staff receive contracts and job descriptions with copies to be held on file. (Previous timescale of 31/12/05 not met). The registered person and registered manager must provide a training plan and development programme for all staff. (Previous timescale of 31/12/05 not met). The registered person and registered manager must ensure all new staff receive induction training to NTO specification within the first six weeks of appointment to their posts. (Previous timescale of 31/12/05 not met). Registered managers must have a qualification at level 4NVQ in management and care or equivalent by 2005. 31.2. Previous timescale of 31/03/05 not met. Provide evidence of continuous self monitoring, involving service DS0000020811.V294126.R01.S.doc 30/06/06 31/07/06 31/07/06 31/07/06 31/08/06 31/08/06 Page 34 Gorway House Version 5.1 37. OP36 18(2) 38. OP36 18(2) 39. OP38 13(4) 40. OP38 13(4) 41. OP38 13(4) users and an annual internal audit 33.3 Provide evidence of feedback from service users and relatives 33.6 Timescale of 30/04/05 not met. Provide the Commission for Social Care Inspection with a copy of a year plan of supervision sessions for all staff. Previous timescales of 30/03/05 and 30/11/05 not met. Provide formal supervision for the staff at least six times a year with written records dated and signed by staff. 36.2 Timescales of 28/02/04 and 31/01/06 not met. Ensure the maintenance checks and certificates are completed by a competent person and made available for the Hoists. Timescales of 30/04/05 and 31/12/05 not met. Water temperatures at outlets accessible to service users must be tested each week and recorded. The registered manager must attend the Fire Prevention Training provided by the West Midlands Fire Department. (Previous timescales of 31/08/05 and 31/03/06 not met). 30/06/06 31/07/06 30/06/06 31/05/06 31/07/06 Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 35 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. Refer to Standard OP9 OP12 Good Practice Recommendations The manager should monitor the administration of medication as part of the quality assurance self monitoring and annual audit. It is recommended that consideration is given to requesting a staff member take responsibility for consulting service users and organising social care activities. It is recommended that a Key worker system is introduced and that monthly and six monthly review meetings involving service users and their families are regularly held. Service users’ meetings, during which menu choices, activities and other events are discussed, should be regularly held. It is recommended that, in addition to a book for recording Complaints, the home supply a “Comments” Books for service users and their visitors. The external decoration of the home should be completed during the summer as planned. It is strongly recommended that residents are encouraged and assisted to hold residents’ meetings. 3. OP14 4. 5. 6. OP16 OP19 OP33 Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 36 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Gorway House DS0000020811.V294126.R01.S.doc Version 5.1 Page 37 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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