Inspection on 21/11/07 for Gosmore Nursing & Care Centre

This inspection was carried out on 21st November 2007.

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

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 21st November 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.V355381.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.V355381.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) Mrs Valerie Ellen O`Brien 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.V355381.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. 11th January 2007 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 £550 to £800 per week. The Service User Guide, Statement of Purpose and previous CSCI Inspection report can be obtained from the manager of the home. Gosmore Nursing & Care Centre DS0000019395.V355381.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Regulatory Inspector and an expert unannounced inspection out over one day. by experience carried this On the day of the inspection there were 52 service users in residence. The expert by experience looked at the environment and gained feedback from the residents, visiting relatives and staff. They were asked to assess what life is like for the people who live there. The inspector also spoke with residents and spent time looking at care records, observing care practice and gaining feedback from the manager and her staff team. Information was taken from the Annual Quality Assurance Assessment which is a self assessment completed by the manager of the service. What the service does well: Gosmore is a large home and the environment has been refurbished in such a way as to make it a homely, comfortable atmosphere. The home has been tastefully refurbished and the décor and soft furnishings offer a tranquil environment to the residents. Residents are looked after very well. Comments from residents include ‘the staff are very helpful,’ and ‘they really take good care of me, the girls are lovely.’ One relative stated ‘we find the nurses and carers are very kind, caring and very pleasant and friendly.’ Another stated ‘the staff are always friendly and cheerful to the residents and relatives. In the nine months my husband has been in Gosmore, I have never once seen exasperation expressed.’ The expert by experience said ‘although it is difficult to have a homely feel in such a large place, there is definitely a happy, friendly atmosphere and visitors are welcome at any time. Spouses have been invited for Sunday lunch. A lot of hard work has obviously been put into this home to make it what it is.’ Food and fluids are plentiful and the menus have been reviewed following consultation with residents and relatives. The food on the day was hot, tasty and attractively served. There is a wide range of activities available and the activity co-ordinator has provided residents with a programme of activities and events over the Christmas and New Year period. Gosmore Nursing & Care Centre DS0000019395.V355381.R01.S.doc Version 5.2 Page 6 The manager has an open door policy, is very approachable and has implemented many new procedures. Complaints are thoroughly investigated and any concerns followed up immediately. What has improved since the last inspection? 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.V355381.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.V355381.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): 3&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 individual needs can be met. EVIDENCE: The registered manager or her deputy carry out a comprehensive needs assessment prior to agreeing admission and ensure that any specialist equipment is in place prior to admission to the home. The manager stated that they are currently organising a small gift for new arrivals to help them to feel welcome. Gosmore Nursing & Care Centre DS0000019395.V355381.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. Personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each resident’s plan; they give a comprehensive overview of their health needs and act as an indicator of changes in health requirements. EVIDENCE: Several care plans were inspected and three service users were case tracked. This means that the inspector looked at each aspect of their care including health and social care, medication, care plans and other records and specialist equipment used. All files have been reviewed since the previous inspection and contain only information relevant to current care needs. The care plans describe in detail individual needs and preferences. Records relating to risk management and nursing needs are reviewed regularly and regular monitoring of residents health and food and fluid intake is recorded. Gosmore Nursing & Care Centre DS0000019395.V355381.R01.S.doc Version 5.2 Page 10 Generally all residents looked well cared for. Comments from residents about their care included ‘the care staff are helpful and friendly, they look after me very well.’ One relative stated ‘we find the nurses and care staff very helpful and they appear to have my husbands welfare at heart.’ Another relative said ‘we haven’t had concerns about the care and they have responded quickly when mum has been ill.’ Two residents in the home have pressure sores. One of whom was admitted with the sores. Pressure care and prevention in the home is good and specialist equipment is available such as air mattresses and cushions. Recording of prevention and treatment is thorough. On the day of the inspection one care worker went off sick and the two nurses on the unit were completing medication training, therefore several residents were waiting to be assisted to wash and dress at 11am. One particular lady was in bed and looked uncomfortable as her arm was swollen, she did not appear to be very happy. The call bell was out of reach and when checked by the inspector this was not working. Once transferred to the lounge area for lunch the lady said she was much more comfortable. Procedures relating to medication are adequately maintained. One resident approached the inspector and said that she had not been given her medication for two days. When this was investigated it appears that the medication has not been available in the home. The nurse stated that the GP is aware and that all procedures have been followed to monitor her health and wellbeing. Residents appear to be treated with dignity and respect. One resident said ‘the staff are very kind to me, they listen to me and that makes a difference.’ Gosmore Nursing & Care Centre DS0000019395.V355381.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 or offered assistance immediately to those requiring some help. EVIDENCE: On the day of the inspection various activities were taking place. In the small lounge residents were observed playing bingo, one resident was enjoying colouring pictures in the conservatory, another painting and knitting. The expert by experience stated in her report that the activity co-ordinator had boundless energy. The home has regular fund raising events and hand made Gosmore Nursing & Care Centre DS0000019395.V355381.R01.S.doc Version 5.2 Page 12 cards have been produced which will be sold in order to raise funds for further activities and other charitable causes such as the local hospice appeal. A Christmas activity plan was observed on display in resident’s bedrooms. The home welcomes visitors at any time and relatives who responded said ‘the nurses and carers are most welcoming and make as much time as possible for my husband and me to spend as much time together. Many examples of how residents are helped to exercise choice and control over their lives were observed. Resident’s choices and preferences are also noted in the care plans. Feedback from residents about the food was very good. One residents said ‘its not bad’, he was later observed scraping his plate clean. Some of the relatives were not so positive about the food however the manager explained that the usual chef had left and was not replaced by another permanent chef for several weeks. The food served was piping hot, well cooked and attractively served. The expert by experience stated ‘it was lovely to see linen serviettes and flower arrangements on the tables and the serviettes were quite large and looked more dignified than bibs that are so often used.’ The atmosphere in the dining room was vibrant and the manager stated that following consultation with residents and relatives there is likely to be two sittings at lunchtime. Throughout the day it was observed that there was plenty of food and drinks available around the home. Gosmore Nursing & Care Centre DS0000019395.V355381.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 manager welcomes concerns and complaints so that the service can continually improve; she has an open door policy. Residents can expect that as far as possible they are safeguarded from abuse. EVIDENCE: The service has received six complaints since the previous inspection. None of the complaints have been upheld and one safeguarding referral was made. The manager took precautions to protect the residents during this period of time. All complaints were dealt with within the timescale on the complaints procedure. One relative stated ‘when a complaint was made all the correct procedures were followed and I was kept informed of all that had transpired.’ Staff have received training on safeguarding adults and the local procedure is available at all times. The company has a whistle blowing line that they can report to. One referral has been made to the Protection of Vulnerable Adults List (POVA). Gosmore Nursing & Care Centre DS0000019395.V355381.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 home provides a comfortable, safe environment to the people who live there. The rooms are attractively decorated and offer a tranquil, homely atmosphere. The soft furnishings are tastefully arranged and the dining area is a vibrant, atmospheric place to enjoy meals. EVIDENCE: The refurbishment of the home is almost complete. The communal areas have been decorated. One relative stated ‘the refurbishment has made the home much more attractive and welcoming.’ Many of the bedrooms have been refurbished and new furniture has been provided. Some of the rooms have flat screen TV’s and spacious en-suite bathrooms. Gosmore Nursing & Care Centre DS0000019395.V355381.R01.S.doc Version 5.2 Page 15 A couple of the main bathrooms have been refurbished however there is still more work to be done in this area and many of the bathrooms remain in need of some attention. Some of the bedrooms also require refurbishing with new carpets required. One room had a large stain on the carpet and there was an unpleasant odour in the room. The conservatory offers a light, airy place for residents to enjoy the garden within the comfort of a warm atmosphere. One resident said she enjoys watching the birds in the garden from the window. All areas of the home were clean and tidy and apart from one bedroom no malodours were detected. Gosmore Nursing & Care Centre DS0000019395.V355381.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. The recruitment and selection procedure safeguards the residents and protects them from abuse. The staffing levels appear at most times to be appropriate to meet the needs of the residents. However on occasions there have been low staffing levels. EVIDENCE: On the day of the inspection the staffing levels on the first floor unit were low. One resident stated ‘sometimes there are not enough staff and it’s hard to find anyone to help, mainly at weekends.’ One relative who responded stated ‘staffing levels are sometimes a stretch and agency staff are sometimes brought in, but they don’t always know what to do.’ The manager stated that five care staff have completed an NVQ level 2, two have completed level 3 and five more are currently completing NVQ qualifications. Induction programmes take place and new staff are provided with a mentor. The home has implemented a named nurse and key worker Gosmore Nursing & Care Centre DS0000019395.V355381.R01.S.doc Version 5.2 Page 17 system. This ensures that individual’s needs are met and residents are more closely monitored. Procedures relating to recruitment are adequately maintained, thus protecting residents from abuse. Thorough checks are carried out applicants before working in the home. Staff had completed a lot of training. The mandatory training programme has been reviewed and it was evident by observing care practice that staff have current good practice knowledge and skills. Gosmore Nursing & Care Centre DS0000019395.V355381.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 committed to proving a good quality, responsive service and is reported to be approachable by residents, relatives and staff. EVIDENCE: The manager of the home has registered with the Commission for Social Care Inspection. She ensures that she spends time with the residents continually gaining feedback in order to be able to further improve the service provided. One relative stated ‘the manager is very approachable and I feel I can discuss any concerns or issues with her.’ One relative did however state ‘weekends could do with a senior member of staff who knows what is going on and to be available to ask questions.’ Gosmore Nursing & Care Centre DS0000019395.V355381.R01.S.doc Version 5.2 Page 19 There is a quality assurance system within the home and the manager stated that there are residents and relatives meetings where everyone can raise issues or ideas. There was due to be a meeting in the home that evening. Four Seasons also operate a Team Auditing Process. This is a self-assessment where each aspect of the service is quality reviewed. The outcome of the most recent review was that 71 of areas were met. Financial procedures in the home are maintained centrally and residents have individual accounts on the computer system. Residents are able to ask for money at anytime and regular statements can be provided to residents and/or relatives. Health and safety procedures in the home appeared to be adequately maintained. Gosmore Nursing & Care Centre DS0000019395.V355381.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 3 8 3 9 3 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 2 X X 2 X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Gosmore Nursing & Care Centre DS0000019395.V355381.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP19 Regulation 23(2)(b) Requirement To continue to improve the environment for service users the redecoration of bathrooms and remaining bedrooms must be completed. Lime scale must be removed from baths and bathrooms must be kept tidy. Carried forward from inspection report dated 11/01/07. To ensure service users needs are met in a timely manner all bells must be accessible to service users and must be in full working order at all times. Suitable staffing numbers must be available in order to meet service users needs at all times. Timescale for action 21/09/08 2. OP22 13 (4)(c) & 23 (2) (c) 18(1)(a) 21/12/07 3. OP27 21/12/07 Gosmore Nursing & Care Centre DS0000019395.V355381.R01.S.doc Version 5.2 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Gosmore Nursing & Care Centre DS0000019395.V355381.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Inspection Team 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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