Inspection on 11/01/07 for Gosmore Nursing & Care Centre

This inspection was carried out on 11th January 2007.

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

Other inspections for this house

Gosmore Nursing & Care Centre 21/11/07

Gosmore Nursing & Care Centre 01/06/06

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 11th January 2007 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.V326557.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.V326557.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 453 991 gosmore@fshc.co.uk Tamhealth Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Manager post vacant 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) Gosmore Nursing & Care Centre DS0000019395.V326557.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 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. This home may accommodate one named service user who has a diagnosis of dementia. This condition will be revoked should the service user permanently leave the home. 1st November 2006 Date of last inspection 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. There are three lounges on the ground floor, one being a large conservatory. There is a large dining area and hairdressing room, which is also used to carry out other domiciliary appointments. The home is set in attractive grounds and can be accessed by service users. The current accommodation charges range from £526 to £763 per week. Gosmore Nursing & Care Centre DS0000019395.V326557.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two Regulatory Inspectors carried this key unannounced inspection out over one day. Time was spent talking to service users and staff. The environment was inspected and records scrutinised. Feedback was also gained from a visiting General Practitioner. The manager was available throughout the inspection to answer questions. The outcome of the inspection was very positive and all previous requirements had been met. The home currently has 36 service users, therefore a further random inspection may be required when the home is at full capacity. What the service does well: What has improved since the last inspection? A lot of work has been done to review care plans although this is still in progress. General health care and monitoring appears to be more thorough and service users said they have confidence in the staff providing their care. A new bank chef has been recruited who is very enthusiastic about the new menu. Service users confirmed that the food has improved. Food served was hot and tasty and looked appealing. Homemade cake is now served each day. The environment has been beautifully decorated with new furniture adding a homely feel. Service users are very pleased with the décor. The home looked clean in most areas however further work is required in the bathrooms. Gosmore Nursing & Care Centre DS0000019395.V326557.R01.S.doc Version 5.2 Page 6 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. Gosmore Nursing & Care Centre DS0000019395.V326557.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.V326557.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken, ensuring that so far as possible service users needs can be met. EVIDENCE: The staff management team carries out a comprehensive needs assessment prior to admission. The team consider the application and a decision is made. Introductory visits to the home are encouraged. The home does not provide intermediate care. Gosmore Nursing & Care Centre DS0000019395.V326557.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have individual health care plans that give a comprehensive overview of their general health and acts as an indicator to changing health needs. The home arranges for health professionals to visit residents in the home and provides facilities to carry out treatment. Service users looked comfortable, well cared for and feel confident and relaxed about the care they receive. EVIDENCE: A lot of work has been carried out to update and review care plans, which now contain comprehensive information and instructions. Staff must ensure that information no longer relevant to service users current needs is removed from the current care plan. Health care monitoring records such as food and fluid intake and bed care had been fully completed. Gosmore Nursing & Care Centre DS0000019395.V326557.R01.S.doc Version 5.2 Page 10 One new service user has recently been admitted to the home with a grade 5 pressure sore. No other service users in the home have pressure sores Monitoring of pressure sores and bruising are now being satisfactorily recorded and input from district nurses is being utilised. Staff have received some practcal training from a continence nurse on catheter care. More training is being provided in the future. Procedures relating to medication are generally satisfactory. However, some gaps on medication administration records were observed. Gosmore Nursing & Care Centre DS0000019395.V326557.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. 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. Sufficient staff resources are provided to allow time for activities and stimulation, and family and friends feel welcome and know they can visit the home at any time. The atmosphere in the dining room at lunchtime was vibrant and staff encouraged service users requiring support with meals to eat independently. EVIDENCE: A new activity co-ordinator has been appointed who spends 24 hours a week organising and facilitating activities with service users. Over the Christmas period a busy programme of activities was available including a Christmas party, visit to the local school to watch the nativity, entertainment and a competition to make Christmas decorations. Service users stated that they had a very enjoyable Christmas at Gosmore. Unlike previous inspections a high number of service users were observed enjoying their lunch in the beautifully refurbished dining room and conservatory rather than in their bedrooms. Gosmore Nursing & Care Centre DS0000019395.V326557.R01.S.doc Version 5.2 Page 12 Feedback about the meals was very good. A new bank chef has been employed who is enthusiastic about the new menu. The lunch on the day of the inspection was pork chops with potato and vegetables or vegetarian casserole. The food was nicely presented and was hot and tasty. Gosmore Nursing & Care Centre DS0000019395.V326557.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The policies and procedures regarding the safeguarding of residents are of a high quality and are regularly reviewed and updated. The service is clear when incidents need external input and who to refer the incident to. EVIDENCE: No complaints have been received by the home since the previous inspection and all previous complaints have been fully resolved. The manager stated that several verbal compliments had been received recently. The Commission for Social Care Inspection has not received any complaints about the home since the previous inspection and all previous complaints have been fully examined with no further action required. Gosmore Nursing & Care Centre DS0000019395.V326557.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The refurbishment of the home has transformed its appearance and communal areas of the home provide a clean, comfortable and homely atmosphere. New equipment ensures the safety and comfort of service users. EVIDENCE: The majority of the home has undergone extensive refurbishment. The entrance to the home is beautifully decorated proving a welcoming atmosphere. Both lounges including the conservatory have been refurbished and are tastefully decorated again offering a homely environment. The hallways on each unit have also been redecorated and pictures and ornaments give these areas a more homely feel. Although some bedrooms have been completely refurbished, many of the bedrooms are on a rolling programme for Gosmore Nursing & Care Centre DS0000019395.V326557.R01.S.doc Version 5.2 Page 15 redecoration. Bathrooms have not been completely refurbished however one specialist bath has been installed. Bathrooms generally continue to look scruffy and items such as net pants and cardboard boxes were found on shelving or floors. The majority of the home looked very clean and attention to detail had been given. Some baths were heavily stained with lime scale, which looks unsightly. Feedback from service users in relation to the refurbishment was very positive. A daily audit of call bells is now carried out to ensure that these are in working order and some new call bell equipment has been ordered. New hoists, profiling beds, bed rails, weighing scales and linen have been purchased. Hot water was available in all those rooms tested and clean bed linen is now stored on each unit. Gosmore Nursing & Care Centre DS0000019395.V326557.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service recognises the importance of training, and delivers where possible a programme that meets any statutory requirements. There are still some areas requiring attention. The service is also able to recognise when additional training is needed, and attempts to plan over time to provide this training. EVIDENCE: The staff team appeared to be more enthusiastic about their work, and appear to take great pride in the service and in the home. Although a training programme is in place, evidence of training received by staff was unavailable. The manager stated that a lot of training is planned in the near future. A copy of the training plan shoukd be sent to CSCI. Staff spoken to were very positive about the new manager and stated that they now receive regular supervision. Two staff are due to attend a ‘train the trainer’ course in moving and handling. They will then be able to offer training to staff in the future. A robust recruitment policy and procedure is in place to ensure the safety of the residents and records pertaining to recruitment are satisfactory. Gosmore Nursing & Care Centre DS0000019395.V326557.R01.S.doc Version 5.2 Page 17 Gosmore Nursing & Care Centre DS0000019395.V326557.R01.S.doc Version 5.2 Page 18 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): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is regarded highly by all staff in the home and residents spoken to were complimentary. Statutory records were available for inspection and had been maintained in accordance with legislation. EVIDENCE: The manager has been in post for three months and has implemented a lot of changes, which appear to have improved operations within the home. The manager stated that she would submit an application for registration in the near future. Gosmore Nursing & Care Centre DS0000019395.V326557.R01.S.doc Version 5.2 Page 19 Four Seasons Health Care had carried out a quality audit in August. Questionnaires were sent to relatives and other visitors to the home and a report was collated. A copy of the report must be submitted to CSCI. A relatives meeting is planned where they will get the opportunity to meet the management team and offer feedback. A food committee meeting is also held involving residents and relatives. Procedures relating to service users money were satisfactorily maintained. Gosmore Nursing & Care Centre DS0000019395.V326557.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 3 Gosmore Nursing & Care Centre DS0000019395.V326557.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(2)(b) Timescale for action Information no longer relevant to 31/01/07 service users care needs must be removed from the current care plan. There must not be any gaps on 31/01/07 Medication Administration Records. Redecoration of bathrooms and 31/03/07 remaining bedrooms must be completed. Lime scale must be removed from baths and bathrooms must be kept tidy. All care staff must receive 31/03/07 appropriate training. Evidence of staff training should be submitted to CSCI. A copy of the most recent quality 31/03/07 audit report must be submitted to CSCI. Requirement 2. 3. OP9 OP19 13(2) 23(2)(b) 4. OP30 18(1)(c) (i) 24(2) 5. OP33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Gosmore Nursing & Care Centre DS0000019395.V326557.R01.S.doc Version 5.2 Page 22 No. Refer to Standard Good Practice Recommendations Gosmore Nursing & Care Centre DS0000019395.V326557.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hertfordshire Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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