Inspection on 01/06/06 for Gosmore Nursing & Care Centre

This inspection was carried out on 1st June 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

Gosmore Nursing & Care Centre 21/11/07

Gosmore Nursing & Care Centre 11/01/07

Gosmore Nursing & Care Centre 12/10/05

Gosmore Nursing & Care Centre 18/04/05

Gosmore Nursing & Care Centre 11/11/04

Gosmore Nursing & Care Centre 22/05/04

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

CARE HOMES FOR OLDER PEOPLE Gosmore Nursing & Care Centre Hitchin Road Gosmore Hertfordshire SG4 7QH Lead Inspector Alison Jessop Unannounced Inspection 1st June 2006 10:00 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 Gosmore Nursing & Care Centre DS0000019395.V298115.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. Gosmore Nursing & Care Centre DS0000019395.V298115.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gosmore Nursing & Care Centre Address Hitchin Road Gosmore Hertfordshire SG4 7QH 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) 01462 454 925 01462 953 991 gosmore@fshc.co.uk Tamhealth Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Care Home 70 Category(ies) of Old age, not falling within any other category registration, with number (70), Physical disability over 65 years of age of places (25), Terminally ill (1) Gosmore Nursing & Care Centre DS0000019395.V298115.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. This home may accommodate 70 older people in need of nursing care. This home may accommodate 25 older people with physical disability who require personal care. The home may accommodate two named service users whose primary diagnosis is dementia. The registered person must notify the commission if the two named person are no longer accommodated at the home. Date of last inspection 12th October 2005 Brief Description of the Service: Gosmore is a care home providing personal and nursing care and accommodation for 70 older people. It is owned and managed by Tamhealth Limited, which is a member of the Four Seasons Health Care group. The home is set in extensive grounds on the outskirts of Hitchin, a short drive from the main shopping centre and the local amenities. Stevenage is five miles away from the home. Gosmore Nursing Home was opened in 1999 and accommodation for service users is offered in both the original and newer wings of the building. The majority of the homes bedrooms are for single accommodation but there are some double rooms. Twenty-seven of the rooms have en- suite facilities. The home is set in attractive grounds that are level and can be accessed by the service users. The current accommodation charges range from £526 to £763 per week. Gosmore Nursing & Care Centre DS0000019395.V298115.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Three Regulatory Inspectors carried out this unannounced inspection over one day. Time was spent talking to service users, staff and visitors. Records were observed in relation to service users care, statutory records were also scrutinised. A meeting was held with the manager of the home who has recently returned from maternity leave. What the service does well: What has improved since the last inspection? What they could do better: Although a needs assessment is carried out prior to service users being accepted, this appears to be a paper filling exercise. A lot of information has not been completed and consideration of the skills and abilities of staff appears not to have been taken into account. Gosmore Nursing & Care Centre DS0000019395.V298115.R01.S.doc Version 5.2 Page 6 Staff record health care issues within individuals’ care plans but there is little or no evidence that regular health monitoring takes place. Few staff have experience or training to meet the care needs of the residents who have dementia. Training, development and supervision of staff is inconsistent and staff lack leadership. Although care plans are available, information cannot be easily traced. Risk assessments identify risks but not how to minimise them. Health care monitoring charts such as fluid, weight and turning charts have not been regularly completed. Throughout the inspection a number of service users did not have access to call bells. The home is due to undergo a complete refurbishment and meetings are currently being held to plan designs. The work is due to commence is September. 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. Gosmore Nursing & Care Centre DS0000019395.V298115.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gosmore Nursing & Care Centre DS0000019395.V298115.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Applications for admission to the home are agreed without any reference to or consideration of the skills, ability or knowledge of the staff that will be caring for them. EVIDENCE: Although a needs assessment is carried out prior to service users being accepted, this appears to be a paper filling exercise. A lot of information has not been completed and consideration of the skills and abilities of staff appears not to have been taken into account. A number of service users have been admitted to the home who have dementia care needs, and although their primary need is nursing care, there was little evidence to suggest that their dementia care needs had been considered. Two service users have been admitted to the home whose primary diagnosis is dementia. A variation of registration category has been submitted to the home on request by the Commission for Social Care Inspection. Gosmore Nursing & Care Centre DS0000019395.V298115.R01.S.doc Version 5.2 Page 9 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 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Health care is reactive rather than proactive, ongoing monitoring of health is poor. Staff record health care issues within individuals’ care plans but there is little or no evidence that regular health monitoring takes place. Few staff have experience or training to meet the care needs of the residents who have dementia. EVIDENCE: Throughout the inspection some sensitive and caring interactions with service users were observed. However one disturbing incident was observed between one member of staff and a service user, further information is reported in standard 18 of this report. On arrival at the home a number of service users were observed in the conservatory, enjoying a range of activities. Feedback from service users about the care they receive was generally positive. One service user said ‘the staff are very kind to me and are always willing to spare a moment to answer my questions.’ Gosmore Nursing & Care Centre DS0000019395.V298115.R01.S.doc Version 5.2 Page 10 Although care plans are available, information cannot be easily traced. Risk assessments identify risks but not how to minimise them. Health care monitoring charts such as fluid, weight and turning charts have not been regularly completed and those that had results were not being actioned. One service user had lost a considerable amount of weight however an action plan had not been identified. One service user was observed sitting in her chair on the hoist sling. When staff were questioned about this they stated that it was easier for staff, they later retracted the statement and said that they were following the service users instructions. An observation was made during the inspection that one carer referred to service users as lads or girls. A more dignified and age appropriate approach must be adopted. During the morning the optician was visiting the home and service users were seen in one of the small lounges. Service users were left in a line outside the room whilst they waiting for their appointment. Feedback was gained from a relative who said that her fathers clothes had returned from the laundry and trousers had been put on her father with a damp waist band, this had happened on a couple of occasions. The manager stated that there had been a problem with the tumble dryer but that this has recently been rectified. Procedures relating to medication were inspected and some requirements have been made. Amounts of PRN medication did not reconcile and reasons for nonadministration had not been recorded. This requirement was made at the two previous inspections. Individual blood testing equipment is being used however one lancet was not named. The home destroys its own medication however a procedure was not available on how risks in relation to this new system are minimised. Gosmore Nursing & Care Centre DS0000019395.V298115.R01.S.doc Version 5.2 Page 11 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy the flexibility of meal arrangements and enjoyed being able to eat in their own room if they wished. Residents are given the opportunity to take part in a variety of activities and social interaction between service users and staff was cheerful. EVIDENCE: Throughout the day of the inspection service users were observed enjoying various activities. A group of service users sat in a private lounge and were enjoying a quiz. A new activity co-ordinator has been employed and will be implementing themed activities, which will begin with the world cup. A number of relatives and friends were visiting the home on the day of the inspection. A series of residents/relatives meetings have been held and a food committee has been set up, which will assist menu planning. A number of service users appeared to spend the day in their bedrooms and although there was a TV, these were not being used appropriately. One service users television was placed by the side of his chair and was playing very loudly. Gosmore Nursing & Care Centre DS0000019395.V298115.R01.S.doc Version 5.2 Page 12 Food served looked appetising and service users said that food is served hot. Pureed food was served in separate portions and a dignified approach was taken for those service users requiring assistance with meals. Gosmore Nursing & Care Centre DS0000019395.V298115.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Links within external agencies (CSCI, police adult protection teams) are weak with little evidence of the service being open or proactive in the area of protection. The outcomes from referrals are poorly managed with issues not always satisfactorily resolved. EVIDENCE: During the visit, the inspector overheard a conversation, where a carer spoke to a service user quite sharply. This was passed to the manager of the home to deal with following the Protection of Vulnerable Adults Procedure. No contact was made by the home with Adult Care Services or the service users family and the procedure was not followed. A number of complaints have been received from relatives since the previous inspection report. Although relatives were responded to within reasonable timescales, there was no record of evidence to suggest that these had been fully resolved. Gosmore Nursing & Care Centre DS0000019395.V298115.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Many areas of the home look run down, decoration looks tired and areas of the home look unclean. The quality outcome in this area will improve when the refurbishment of the home is completed. EVIDENCE: The home is due to undergo a complete refurbishment and meetings are currently being held to plan designs. The work is due to commence is September and most service users and relatives were aware of this. Requirements made during the previous inspection report have not been met, and will not be met until the refurbishment is complete. Many areas of the home looked unclean and attention to detail is not considered, feedback from relatives in relation to this was negative with one relative stating ‘the fire door was closed one day as there was a fire drill, the carpet was so dusty, I don’t think anyone had cleaned behind there at all.’ Gosmore Nursing & Care Centre DS0000019395.V298115.R01.S.doc Version 5.2 Page 15 Throughout the inspection a number of service users did not have access to call bells and due to the layout of the home it is imperative that service users are able to use these, particularly as long periods of time passed when the inspector did not observe any staff presence near bedrooms. Many of the hallways, outside bedrooms were cluttered with equipment such as hoists, wheelchairs and weighing scales, not only is this an unsafe practice, it gave the area’s a clinical atmosphere. Bars of soap, bottles of bubble bath and shampoo were observed in communal bathrooms. These must be stored in individual’s rooms in order to reduce the risk of infection. Gosmore Nursing & Care Centre DS0000019395.V298115.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Training provided is very limited, with areas not being identified and not targeted at relevant individuals. Records pertaining to recruitment are inconsistent. EVIDENCE: Although there was a full staff complement on the day of the inspection staff working on the first floor units appeared to be very busy, particularly around the lunchtime period as a high number of service users require assistance. One relative stated ‘there is a poor staff presence, they appear to be so busy.’ It was noted by the inspector that care staff have to go down to the kitchen to collect meals and also return the food trolley, a better use of care workers time could be allocated to caring for service users, whilst kitchen staff attend to trolleys. Records pertaining to recruitment of staff were inconsistent and references were difficult to trace. This was also the case with staff training records. Although some training had been carried out, a training plan is required to ensure that all staff receive mandatory and specialist training. Very few staff have undertaken dementia training, this must be a priority as this is a condition of the variation of the homes registration. Seven staff are currently completing an NVQ qualification. Gosmore Nursing & Care Centre DS0000019395.V298115.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Training, development and supervision of staff is inconsistent and staff lack leadership. Quality assurance systems are in place however the results of surveys carried out have not yet been received. EVIDENCE: The current manager has resigned and a new manager has been appointed to start in July. A number of residents and relatives meetings have been held following a collective complaint from relatives. The regional manager has attended the meetings, which continue to be held every two months and feedback from relatives has been positive. One relative said that things have improved. A food committee meeting has also been arranged where service users and Gosmore Nursing & Care Centre DS0000019395.V298115.R01.S.doc Version 5.2 Page 18 relatives can discuss their food preferences. A food survey is currently being carried out and the results of this will help to determine the menu. Several cupboards accessible. were found unlocked and cleaning chemicals were A window restrictor had been taken off the window in one of the bedrooms causing a risk to health and safety. A regular audit of windows must be carried out. Access was also available to the maintenance workshop and although it is unlikely that service users would be able to access this, it is advised that a safety gate is fitted at the bottom of the stairs. Gosmore Nursing & Care Centre DS0000019395.V298115.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 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 2 2 X X 2 X X X 1 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 2 X 2 Gosmore Nursing & Care Centre DS0000019395.V298115.R01.S.doc Version 5.2 Page 20 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. 2. Standard OP4 Regulation 12(1)(b) 12(1)(a) Requirement The registered person must ensure that the home has the capacity to meet people’s needs. Care plans must reflect how service users’ needs are met and how potential risks are monitored and managed. Health care monitoring records must be fully completed and any action taken to maintain and improve health must be fully recorded. Medication amounts did not reconcile. The symbol to reflect that medication is being refused was being used but not reason is recorded. This requirement was made at the previous inspection. A procedure relating to the safe disposal of medicines must be available in the home at all times. A risk assessment must be submitted to CSCI in relation to the safe disposal of medication. Lancets allocated to individual service users must be named. The privacy and dignity of all service users must be observed. DS0000019395.V298115.R01.S.doc Timescale for action 30/06/06 30/06/06 OP7 3. OP8 12(1)(a)& (b) 30/06/06 4. OP9 13(2) 30/06/06 5. 6. OP9 OP10 13(2) 12(4)(a) 30/06/06 30/06/06 Gosmore Nursing & Care Centre Version 5.2 Page 21 7. OP16 8. OP18 9. OP19 Service users must be referred to in an age appropriate manner. Service users must not be left sitting on hoist slings. Private appointments such as optical visits must be carried out in an area which will offer privacy to service users. 22(3) All complaints must be fully 30/06/06 investigated and records must be maintained for inspection purposes. 13(5)&(6) Service users must be protected 30/06/06 12(1)(a) from abuse. All allegations must be dealt with following the Protection of Vulnerable Adults procedure. Carried forward from previous inspection report. 30/04/07 23(2)a,b,c Furnishings must be in good &d condition. Chairs must be cleaned or replaced and all parts of the house kept in a good state of repair. A maintenance plan must be submitted to the Commission detailing plans for improvements to the home and the completion date. Particular attention is required to regulate the heat in the conservatory and the cleanliness of carpeting. Previous timescale of 31/05/05 and 30/11/05 not met. 23(2)(l) 13(4)(c) Suitable storage areas must be used for equipment such as hoists, wheelchairs etc. Call bells must be accessible to service users and extension leads must be fitted where necessary. Previous timescale of 31/05/05 not met. All areas of the home must be clean. Toiletries must be maintained in individual bedrooms in accordance with universal infection control procedures. DS0000019395.V298115.R01.S.doc 10. 11. OP22 OP22 30/06/06 30/06/06 12. 13. OP26 OP26 23(2)(d) 13 (3) 30/06/06 30/06/06 Gosmore Nursing & Care Centre Version 5.2 Page 22 14. OP27 18(1)(a) 15. OP28 18(1)(c) (i) 19(1)(a) schedule 2 18(1)(c) (i) 16. OP29 17. OP30 18. 19. OP38 13(4)(a) (b)&(c) 13(4)(a) (b)&(c) OP38 Staffing levels must be continually reviewed in order to meet the changing needs of service users. A list of staff that have completed or are currently completing NVQ must be submitted to CSCI. The registered person must not employ any person until all documents specified in schedule 2 have been obtained and verified. A training plan must be submitted to CSCI for all staff working in the home. All care staff must receive dementia training. All cleaning chemicals must be stored safely in accordance with COSHH. A regular audit of windows must be carried out to ensure that all windows are restricted. 30/06/06 01/10/06 30/06/06 01/10/06 30/06/06 30/06/06 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 OP3 OP38 Good Practice Recommendations Needs assessments should be fully completed and information should be gathered from other sources prior to making a decision about a person’s suitability. It is recommended that a safety gate is installed at the foot of the staircase leading to the maintenance room. Gosmore Nursing & Care Centre DS0000019395.V298115.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 Gosmore Nursing & Care Centre DS0000019395.V298115.R01.S.doc Version 5.2 Page 24 - 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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