Inspection on 18/04/05 for Gosmore Nursing & Care Centre

This inspection was carried out on 18th April 2005.

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 01/06/06

Gosmore Nursing & Care Centre 12/10/05

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 Home Hitchin Road Gosmore Hertfordshire SG4 7QH Lead Inspector Angela Dalton Unannounced 18.04.05 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 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 Home I52_s19395_Gosmore_v221251_180405 stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Gosmore Nursing Home Address Hitchin Road Gosmore Hertfordshire SG4 7QH 01462 454925 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Tamhealth Limited Care Home 70 Category(ies) of OP Old Age 70 registration, with number PD (E) Physical disability - over 65 25 of places Gosmore Nursing Home I52_s19395_Gosmore_v221251_180405 stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 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. Date of last inspection 11.11.04 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 home’s 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. Gosmore Nursing Home I52_s19395_Gosmore_v221251_180405 stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 18th April 2005 and was conducted by two inspectors. The majority of the inspection was spent talking to service users, relatives and staff. Records were examined and care plans inspected. The inspectors discussed their findings with both the home manager and deputy. It was the home manager’s first day back after a period of leave and the deputy is relatively new in post. The activities organiser was interacting with service users on the day of inspection. She has recently taken on the role and has plans on how to expand her provision. What the service does well: What has improved since the last inspection? The majority of requirements made at the previous inspection had been met. Gosmore Nursing Home I52_s19395_Gosmore_v221251_180405 stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Gosmore Nursing Home I52_s19395_Gosmore_v221251_180405 stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Gosmore Nursing Home I52_s19395_Gosmore_v221251_180405 stage 4.doc Version 1.20 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 standard(s) 1, 2, 3, 4, Service users are equipped to make an informed choice about where they live and have their assessed needs met to ensure that the home can provide appropriate care and support. EVIDENCE: Service users and relatives confirmed that they had received information about the home either prior to admission or on arrival to the home in the form of a service user guide. One service user is in the process of moving rooms and was aware that this would result in the issue of a new contract. All care plans are based on a needs assessment and a copy was on individual files. A senior member of staff is responsible for conducting assessments. A recommendation has been made to improve the provisions for service users with sensory needs regarding activities to ensure more involvement and independence. Standard 6 is not appropriate, as the home does not provide intermediate care. Gosmore Nursing Home I52_s19395_Gosmore_v221251_180405 stage 4.doc Version 1.20 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 standard(s) 7, 8, 9, 10,11 The home provides a good standard of care but key documentation needs attention. Care plans could be set out better to enable staff to ensure continuity of care to individual service users. EVIDENCE: Care plans were comprehensive but it is recommended that they are better organised as information is not collated and it was difficult to find current detail. Risk assessments identified the risk but fail to expand in detail how the risk is managed and the action that should be taken if an identified risk occurs. As a nursing home qualified nurses are employed and health needs are met. Service users confirmed improvements in their health since admission. Some staff were observed to enter bedrooms without knocking and assisting without interaction. A recommendation has been made. Death and dying wishes are not recorded in care plans although there is the documentation in place to acquire this information. A requirement has been made regarding medication, as there were gaps on the sheets and two systems running concurrently. Gosmore Nursing Home I52_s19395_Gosmore_v221251_180405 stage 4.doc Version 1.20 Page 10 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 standard(s) 12, 13, 14, 15 The lifestyle service users experience within the home has the potential to make their expectations with regard to personal interests, meals and contact with friends and family. EVIDENCE: Service users were complimentary about meals but commented that meals and hot drinks were not always hot on arrival to bedrooms. Dessert is served separately to ensure it is kept at the correct temperature. Menus are on display. There are several lounges to enable service users to meet with family or friends away from their bedroom. Religious services take place monthly. An Activities Co-ordinator is employed for twenty–four hours a week. However a proportion of service users who spoke with the inspectors stated that there were no activities. It is recommended that the activities co-ordinator audits service users’ preferences and sees service users who cannot travel to the lounge. Staff hold regular quiz nights with service users. Gosmore Nursing Home I52_s19395_Gosmore_v221251_180405 stage 4.doc Version 1.20 Page 11 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 standard(s) 16, 17, 18 Service users are protected from abuse and able to make complaints within a robust complaints procedure. EVIDENCE: The home has a robust complaints procedure and this was inspected during the inspection. Records showed complaints received and action taken. The complaints policy is on display within the home and service users and relatives were aware of how to make a complaint. Prior to the inspection a complaint had been made which was investigated as part of the inspection. It will not be substantiated. Staff were aware of the Whistle Blowing policy within the home. Gosmore Nursing Home I52_s19395_Gosmore_v221251_180405 stage 4.doc Version 1.20 Page 12 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 standard(s) 19, 20, 21, 22, 23, 24, 25, 26 Service users live in clean, comfortable, safe surroundings suitable for their needs. EVIDENCE: The home was clean and odour free. The conservatory was uncomfortably warm and the manager stated that there are plans to provide fans and blinds to address this. A requirement has been made to submit a copy of the maintenance plan to the Commission. One bedroom is adjacent to the manager’s office and overlooks the conservatory (therefore receiving no natural ventilation) and is small in size. A recommendation has been made for the home to decommission the use of the room as a bedroom. One of the Inspectors noted whilst using the lift that the door did not close immediately. Although the maintenance schedule reflected that the lift is maintained the manager agreed to monitor this. Aids and adaptations were in place and available to those who need them. Call bells were in place but extensions must be provided to service users to enable them to summon assistance whilst sat away from their bed or if the position of the bed does not facilitate easy Gosmore Nursing Home I52_s19395_Gosmore_v221251_180405 stage 4.doc Version 1.20 Page 13 access. Not all rooms were lockable and not all rooms have a lockable space. A recommendation has been made. A requirement is made under Standard 42 regarding low surface radiators and for evidence of a Legionella check if appropriate. Appropriate hand washing facilities and infection control measures are in place. Gosmore Nursing Home I52_s19395_Gosmore_v221251_180405 stage 4.doc Version 1.20 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 Sufficient numbers of trained and competent staff meet service users’ needs. EVIDENCE: It was the manager’s first day back to work following annual leave on the day of inspection. The deputy manager was the nurse on duty and has been in post for less than a month. There was no induction protocol in place for her and a requirement has been made to evidence the recruitment checks that have taken place prior to appointment. Service users confirmed that staff attended to their needs within an acceptable timescale. A member of kitchen staff has transferred to work as a carer and a requirement has been made to evidence how suitability for the role was assessed. The home has a high number of staff who have achieved their NVQ awards. Training is afforded a high priority within the home but there is no way of tracking individual training achievements and when renewal dates are due. A recommendation has been made. Five personnel files were inspected and a requirement has been made for a photograph of staff to be obtained. Gosmore Nursing Home I52_s19395_Gosmore_v221251_180405 stage 4.doc Version 1.20 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 36, 37, 38 The home is competently managed assuring the safety and welfare of service users. EVIDENCE: Supervision of staff takes place regularly and records reflected this. Fire records were also inspected, as were care plans, complaints and medication records. A valid certificate of insurance cover for legal liabilities is posted in the manager’s office. Records of all financial transactions are kept at the head office and the Regional Accountant carries out a quarterly audit of the home’s financial situation. The administrator manages service users’ monies. The home manager has not yet registered with the Commission for Social Care Inspection and a requirement has been made for her to do so. She plans to commence the Registered Manager’s Award in the near future. Service users confirmed that there were meetings arranged and their views were also sought by questionnaire. A requirement is made regarding low surface radiators not Gosmore Nursing Home I52_s19395_Gosmore_v221251_180405 stage 4.doc Version 1.20 Page 16 being in place in the conservatory. Evidence is also required whether a Legionella check if appropriate within the home. Door wedges must not be used and this is also a Requirement. A risk assessment must be conducted on the adjustable bed that is in use. Some call bell wires and the wire of the hoist charger were repaired with electricians tape and a requirement has been made to ensure that those appliances are safe. Gosmore Nursing Home I52_s19395_Gosmore_v221251_180405 stage 4.doc Version 1.20 Page 17 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 2 3 3 2 2 2 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 2 3 3 3 3 3 3 2 Gosmore Nursing Home I52_s19395_Gosmore_v221251_180405 stage 4.doc Version 1.20 Page 18 yes 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 OP9 Regulation 13(2) Requirement a) A thermometer must be provided in the first floor treatment room where medicines are stored. b) Prescriptions must be seen by the care home prior to sending to the chemist. This requirement has been brought forward from the previous inspection. Medication quantities must reconcile and supplies returned to the pharmacist if new system is implemented. Medication given must be signed for, and if not given, a reason recorded. 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. Call bells must be accessible to service users and extension leads must be fitted where necessary. Evidence to reflect the suitability of internally promoted or transferred staff must be in place Timescale for action 31/05/05 2. OP9 13(2) 31/05/05 3. OP19 23(2) (a)(b)(c) & (d) 31/05/05 4. OP22 13(4)(c) 31/05/05 5. OP29 19 (1) Schedule 2 31/05/05 Gosmore Nursing Home I52_s19395_Gosmore_v221251_180405 stage 4.doc Version 1.20 Page 19 6. 7. OP31 OP38 8(1)(a) 13(4)(a) and forwarded to the Commission. A CRB check must be applied for the homes hairdresser. An application to register the manager with the Commission must be received by CSCI. Risks to service users must be reduced: Radiators that are not low surface temperature in the conservatory must be made safe or removed. The electric adjustable bed must be risk assessed. The manager must check if a Legionella check is appropriate within thehome and inotify the Commission of the outcome. The suitablity of wires that are covered by electricians tape must be checked. 30/06/05 31/05/05 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 OP2 OP12 OP7 Good Practice Recommendations The Activies Co-ordinator should audit activities with Service Users to ensure that they are appropriate to their needs and choices. Care Plans should be organised to reflect care provided to current needs as information is not currently kept together and is difficult to find. Risk Assessments should reflect how and identified risk is managed and dealt with if encountered. Staff should knock prior to entering a service users room. Food and hot drinks should be delivered to service users at a hot temperature. Bedroom number 30 should be decommissioned by the home due to the lack of natural ventilation, proximity to the managers office and lack of privacy. Bedrooms should be locakable and lockable space provided in each room. 3. 4. 5. 6. OP10 OP15 OP23 OP24 Gosmore Nursing Home I52_s19395_Gosmore_v221251_180405 stage 4.doc Version 1.20 Page 20 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City Herts 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 Home I52_s19395_Gosmore_v221251_180405 stage 4.doc Version 1.20 Page 21 - 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. 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