Inspection on 12/10/05 for Gosmore Nursing & Care Centre

This inspection was carried out on 12th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 11/01/07

Gosmore Nursing & Care Centre 01/06/06

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 Angela Dalton Unannounced Inspection 12th October 2005 10:30 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.V258623.R01.S.doc Version 5.0 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.V258623.R01.S.doc Version 5.0 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 Ltd, a wholly owned subsidiary of Four Seasons Health Care 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.V258623.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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. 18th April 2005 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. Accommodation for service users is offered in both the original and newer wings of the building. The majority of the home’s bedrooms are for single accommodation but there are some double rooms. Twentyseven 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. Gosmore Nursing & Care Centre DS0000019395.V258623.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two Inspectors conducted this unannounced inspection on 12th October 2005 between 10.30am and 3.30pm. The findings were disappointing and several requirements have been made. The manager is currently on maternity leave and the deputy manager is being assisted by another home manager to manage the home during this period. Four immediate requirements were made during the course of inspection. Some requirements made at the previous inspection remain unmet. What the service does well: What has improved since the last inspection? Temperatures are being recorded in the medication storage area but no action is being taken when the temperatures are noted to be high. Copies of prescriptions are being kept to evidence that the home is in receipt of them rather than the previous practice of the prescriptions going directly from the GP to the pharmacist. A Criminal Record Bureau disclosure has been received for the hairdresser who works unsupervised with Service Users. Staff were seen to knock prior to entering Service Users rooms. Gosmore Nursing & Care Centre DS0000019395.V258623.R01.S.doc Version 5.0 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. Gosmore Nursing & Care Centre DS0000019395.V258623.R01.S.doc Version 5.0 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.V258623.R01.S.doc Version 5.0 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): These standards were not inspected on this occasion. EVIDENCE: Gosmore Nursing & Care Centre DS0000019395.V258623.R01.S.doc Version 5.0 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): 7,9,10 Service users’ dignity is not observed. The medication system does not ensure the protection of service users. EVIDENCE: Care plans have a wealth of information, but as identified in the previous inspection it is difficult to find current information. The staff have evidently had time to make necessary improvements to the documentation. Expansion of current information is needed to ensure that individual needs are met. One service user complained that they were often hungry and portions of meals were too small. A care plan relating to nutrition was in place but no records were being kept to monitor intake and the frequency of food offered. The care plan prescribed the offer of regular snacks. Medication was inspected and a requirement has been made to address the following: Action must be taken to ensure that medication is stored at a safe temperature. For a period of several weeks over the summer medication was stored at temperatures up to 34ºC as opposed to the recommended 25ºC. Directions on the Medication Administration Record Sheet had been scored out and changed by staff but there was no evidence to reflect that these were the instructions from the GP. Handwritten instructions on the Medication Administration Record Sheet had Gosmore Nursing & Care Centre DS0000019395.V258623.R01.S.doc Version 5.0 Page 10 not been signed. Medication amounts did not reconcile when checked for the altered medication and a dose signed for had been scored out. Medication appeared to have been given but not signed for as there were gaps on the MAR sheets. 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. One dose of medication had not been given as the home has run out. This is not acceptable. The medication system requires review to ensure that the issues are dealt with. An immediate requirement was made to ensure equipment used for blood tests is not shared. Dignity of service users is not upheld. Service users stated that they do not always get their own clothes returned from the laundry. Staff were noted not to interact with Service Users but as stated before there were some outstanding members of staff but they were in the minority. An Inspector overheard one member of staff whilst in the dining room saying ‘I suppose we’ll have to talk to them now they’re all down’. A Service User was shouting abuse and was ignored by staff. Wheelchairs were unclean. Some staff were seen to walk through the conservatory without acknowledging Service Users. Radio one was playing loudly in a small lounge and when an Inspector asked if there was an alternative, one tape was played from a small selection. A Service User said ‘not this again’ and walked out. There were LPs but nothing to play them on. Staff reported that there was a CD player but no-one knew where it was as the Activities Co-ordinator was on Annual Leave. Some Service Users bedrooms were dirty. One Service User’s oxygen and nebuliser masks were dirty. All these issues must be addressed. Not all bedrooms are lockable and a recommendation stands from the previous inspection. Gosmore Nursing & Care Centre DS0000019395.V258623.R01.S.doc Version 5.0 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): 12,15 Activities do not meet Service Users expectations. The importance of mealtimes is not recognised with relation to dignity and choice. EVIDENCE: Very few activities appeared to be occurring in the absence of the activities coordinator. The deputy manager reported that a member of staff had been allocated this role but staff spoken to had no awareness of this. Some Service users had a manicure during the inspection. Staff were busy and Service Users were often left without staff and there was no way for them to be alerted if Service Users needed help. There is apparently a mobile call bell but the staff appeared unaware of this. Service users sat in the smaller lounges had no way of attracting staff attention. The cook has recently started work at the home. Service users commented that the quality of food had deteriorated. Lunch was sampled and although the meat was found to be tender the vegetables were overcooked and bitter. The meal was unseasoned and those service users who could not make their needs known were not offered seasoning. Pureed food was served but staff were observed to mix the portions together. Service users who did not eat in the dining room were observed to eat off trays and they struggled with them. A suitable alternative must be made available. Food is not served to service users hot, as heated trolleys are not available for Gosmore Nursing & Care Centre DS0000019395.V258623.R01.S.doc Version 5.0 Page 12 transporting food to areas outside of the dining room. Tea and coffee was served to some service users at 11.45am and then lunch was served at 12.15pm, which may affect service users’ appetites. One staff was observed to stand over a service user to assist them drinking a cup of tea rather than sitting next to them. In one quiet lounge there was a jug of juice but no glasses. In another area there was no jug or glasses. Service users were only offered one cup of tea and readily accepted the offer of another when an Inspector enquired. Biscuits are served on the saucer of the teacup to service users as opposed to giving a choice. Service Users commented that there had been no fruit on offer within the home since the previous cook left. Service Users reported that residents’ meetings had ceased since the previous registered manager had left and that food was regularly discussed at these forums. Gosmore Nursing & Care Centre DS0000019395.V258623.R01.S.doc Version 5.0 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): 18 Service users are not protected from abuse. EVIDENCE: Staff were observed to transfer a Service User by an unsafe manoeuvre on more than on occasion. Although staff have all received moving and handling training they are not ensuring Service Users safety. Gosmore Nursing & Care Centre DS0000019395.V258623.R01.S.doc Version 5.0 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): 19,22,23,26 The home is not safe, clean and comfortable. EVIDENCE: The home was dirty. Toilets and baths were stained and had a build up of limescale. Carpets are stained and are in need of replacement. A bathroom was being used to store a wheelchair, commode and Zimmer frame. Domestic staff levels are clearly inadequate to keep the home clean (it was odour free). The staff room is unclean and an unpleasant area for staff to relax. Furniture is worn and stained. A maintenance plan has been again requested. A recommendation has again been made for the home to decommission the use of the room as a bedroom due to its unsuitability. Staff and service users reported that the Conservatory continues to be unusable in the hot weather as it is unbearable to sit in. This must be rectified as it is used as a lounge. Not all bedrooms are lockable and a recommendation remains. A requirement has again been made to ensure that call bells are accessible by Service Users as they are unable to ask for assistance in communal areas due to the lack of call bells. Call bells were tied up out of reach in some bathrooms Gosmore Nursing & Care Centre DS0000019395.V258623.R01.S.doc Version 5.0 Page 15 and some service users are unable to call for help when in their rooms due to the lack of extension leads. Staff were observed wheeling soiled laundry through the conservatory and dining room. This practise must cease. Gosmore Nursing & Care Centre DS0000019395.V258623.R01.S.doc Version 5.0 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): 28,29 The home is inadequately staffed. EVIDENCE: Staff numbers are not adequate. Staff are putting themselves and Service Users at risk as they are working alone with hoists in part of the home. Staff reported that they felt this was unsafe practise. Morale is clearly affected by staff working at reduced levels. Staff are working more overtime to ensure staff cover is available. A copy of rotas worked has been required. The deputy manager is having to spend more time in the office and her hours are not covered by the rota. This must be addressed. Minimum staff levels are used and staff often work below agreed minimum levels. A protocol must be devised to ensure that the home is adequately staffed. Currently the home has to seek approval from head office to use additional staff and if none can be found the home is short staffed. Gosmore Nursing & Care Centre DS0000019395.V258623.R01.S.doc Version 5.0 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): 32, 38 The health and safety of service users and visitors to the home is not assured. EVIDENCE: The manager has not yet been registered and their application will be revisited on return from maternity leave. Some of the issues identified in the Inspection (such as staff ratios) have obviously been developing over some months. The home is being managed by the deputy manager and on two days by a visiting manager from another home. As stated earlier the deputy must ensure that their hours are covered as they are counted on the rota. Health and safety requires attention within the home and an Immediate Requirement was made during the inspection as door wedges were being used and this practise must cease. Risk assessments must be in place for service users who have items that may pose potential risks in their room such as kettles or lighters (which one service user has). The lift doors are difficult to close in one side of the Gosmore Nursing & Care Centre DS0000019395.V258623.R01.S.doc Version 5.0 Page 18 home. This must be addressed. The door to the loft does not lock. The staff accommodation area is also accessible and COSHH items were in the kitchen. Gosmore Nursing & Care Centre DS0000019395.V258623.R01.S.doc Version 5.0 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 X X 2 2 X X 1 STAFFING Standard No Score 27 1 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 x X X X X 1 Gosmore Nursing & Care Centre DS0000019395.V258623.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? 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 12(1)(a) Requirement Timescale for action 30/11/05 2 OP9 13(2) Care plans must reflect how service users’ needs are met and how potential risks are monitored and managed. E.g. nutritional requirements, possession of a kettle and lighter. 31/10/05 The following must be addressed: Action must be taken to ensure that medication is stored at a safe temperature. For a period of several weeks over the summer medication was stored at temperatures up to 34ºC as opposed to the recommended 25ºC. Directions on the Medication Administration Record Sheet had been scored out and changed by staff but there was no evidence to reflect that these were the instructions from the GP. Handwritten instructions on the Medication Administration Record Sheet had not been signed. Medication amounts did not reconcile when checked for the altered medication and a dose signed for had been scored out. Medication appeared to have been given but DS0000019395.V258623.R01.S.doc Version 5.0 Gosmore Nursing & Care Centre Page 21 3 4 OP9 OP10 5 OP15 6 OP18 7 OP19 8 OP22 9 OP26 not signed for as there were gaps on the MAR sheets. 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. One dose of medication had not been given as the home has run out. 13(2) Lancets must be allocated to individual Service Users and not shared. 12(4)(a) The privacy and dignity and dignity of all service users must be observed.There are several occasions during this inspection where it has not been afforded a high priority. 16(2)(g) Issues relating to food and (h)&(i) mealtimes must be dealt with: mealtimes must be a dignified occasion recognising the individual requirements of service users. 13(5)&(6) Service users must be protected 12(1)(a) from abuse. Poor moving and handling was observed during the inspection. 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 not met. 13(4)(c) Call bells must be accessible to service users and extension leads must be fitted where necessary. Previous timescale of 31/05/05 not met 23(2)(d) The home must be clean. A DS0000019395.V258623.R01.S.doc 12/10/05 31/10/05 31/10/05 12/10/05 30/11/05 31/10/05 30/11/05 Page 22 Gosmore Nursing & Care Centre Version 5.0 10 OP26 13(3) 11 OP31OP27 18(1)(a) 12 OP38 13(4)(a) (b)&(c) professional thorough clean of the home is strongly advised. Soiled laundry must be tranferred in line with infection control procedures and not through communal areas of the home. Staffing levels must be adequate to meet the needs of service users. The safety of service users and staff must be assured by ensuring the adequate deployment of staff within the home. Copies of the previous six months worked rotas must be sent to the Commission. A copy of the worked rota must be sent to the Commission at the end of every month. The health and safety issues identified in Standard 38 must be addressed. The health and safety of Service Users, staff and visitors must be assured. 12/10/05 14/10/05 31/10/05 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 OP24 OP23 Good Practice Recommendations Bedrooms should be lockable. Bedroom number 30 should be decommissioned by the home due to the lack of natural ventilation, proximity to the manager’s office and lack of privacy. Gosmore Nursing & Care Centre DS0000019395.V258623.R01.S.doc Version 5.0 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.V258623.R01.S.doc Version 5.0 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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