Inspection on 04/08/05 for Gotton Manor Care Home

This inspection was carried out on 4th August 2005.

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 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

Gotton Manor Care Home 20/06/08

Gotton Manor Care Home 19/10/06

Gotton Manor Care Home 01/03/06

Gotton Manor Care Home 10/12/04

Gotton Manor Care Home 17/06/04

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

CARE HOMES FOR OLDER PEOPLE Gotton Manor Care Home West Monkton Taunton Somerset TA2 8LL Lead Inspector Barbara Ludlow Announced 4th August 2005 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. Gotton Manor Care Home D53 - D02 S3261 Gotton Manor V231095 040805 Stage 2.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Gotton Manor Care Home Address West Monkton Taunton Somerset TA2 8LL 01823 413118 01823 412943 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) Grandcross Limited (wholly owned subsidary of Four Seasons Health Care Ltd) Mrs Susan Yvonne Stephens Care Home with Nursing 60 Category(ies) of Old Age (60) registration, with number of places Gotton Manor Care Home D53 - D02 S3261 Gotton Manor V231095 040805 Stage 2.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 27 places for older persons of either sex, not less than 60 years of age, who require general nursing care. 2. Up to 6 places for personal care, for persons not less than 65 years of age. 3. Up to 27 places for person over the age of 65 who require personal care. Date of last inspection 10th December 2004 Brief Description of the Service: Gotton Manor Care Home is registered for 60 service users, providing nursing care for 30 people over the age of 60 and personal care for 30 people over the age of 65.The providers are Four Seasons Health Care Ltd, the Registered Manager is Ms Susan Stephens. The home is situated in the countryside, near the village of West Monkton, about 4 miles from the centre of Taunton. It is split into two sites, The Coach House and Gotton Manor. The Coach House caters for 27 people requiring personal care only. A variation has been made to the registration of Gotton Manor, which now caters for 27 people requiring nursing care and 6 requiring personal care. There are extensive grounds, with attractive views, which are accessible to service users. Both sites share a kitchen and laundry facility. A ramp is available for wheelchair users to enter the sites. Passenger lifts and a stair lift are available to access all areas. There is a call system throughout. Locks are provided to each bedroom door. There are dining areas and large lounges available. Gotton Manor Care Home D53 - D02 S3261 Gotton Manor V231095 040805 Stage 2.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was well received and was carried out by two inspectors from CSCI. The homes manager Mrs s Stephens was on duty and the Head of Care for the residential wing, both were available throughout the inspection period to assist with the process. The pre inspection information had been completed to a good standard and was sent in to CSCI before the inspection. Feedback forms had been received from five service users and two from families/ carers. This feedback was very positive comment included ‘excellent care home’ and ‘kind and wonderful staff’. A tour of the premises was made and service users and staff were met and spoken with. Services users expressed their satisfaction with the care and the service they receive at the home. Staff confirmed that they receive training and support to carry out their duties. Records were sampled for, staff recruitment and training and the safety checks for maintenance and servicing of equipment. Care plans were sampled for individual service users. Accident records, complaint records and financial records were also seen. Overall this was a positive inspection. The inspectors would like to thank staff and service users for their help and contribution to the inspection process. A new service user contract is due to be issued; this meant that not all service users had a contract. What the service does well: Gotton Manor and the Coach House offer both nursing and residential care on the same site. The home is set in large well kept grounds with patio areas that can be accessed by service users. One service user was seen on the patio, others sat close to opened patio doors enjoying the sunshine. The care records are well maintained; care planning is up to date and detailed. Gotton Manor Care Home D53 - D02 S3261 Gotton Manor V231095 040805 Stage 2.doc Version 1.40 Page 6 Servicing records and financial records are well maintained. Any issues raised with the manager receive prompt attention, one service user confirmed this having brought matters to the Managers attention and received a proactive, timely and helpful response. 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. Gotton Manor Care Home D53 - D02 S3261 Gotton Manor V231095 040805 Stage 2.doc Version 1.40 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 Gotton Manor Care Home D53 - D02 S3261 Gotton Manor V231095 040805 Stage 2.doc Version 1.40 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) 1,2,3,4,5. NMS 6 is not applicable. The home provides information for service users and their families / carers, with the exception of the latest contract, adequate information is available for service users to make an informed choice of care home service. Pre admission assessment is carried out to ensure that a service users care needs can be met. EVIDENCE: The homes current CSCI Certificate of Registration was on display. The home has a Statement of Purpose and Service user Guide. One relative confirmed that they had been given information to help their decision-making and had been shown the homes last inspection report. The homes administrator confirmed that the company is reviewing the contract and that not all service users had contracts. Care plans were sampled and the homes Manager confirmed that preadmission assessments are undertaken to ensure that care needs can be met. Gotton Manor Care Home D53 - D02 S3261 Gotton Manor V231095 040805 Stage 2.doc Version 1.40 Page 9 Day care is offered, currently to one person only. The home has six bedrooms in the nursing wing that are used for more ambulant service users for personal care only and are contracted by Social Services. Gotton Manor Care Home D53 - D02 S3261 Gotton Manor V231095 040805 Stage 2.doc Version 1.40 Page 10 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 Care plans were up to date and reviewed appropriately. These care plans demonstrated input from community health care professionals. Medications are well managed; the exception was one Oxygen cylinder that was not in a portable cage for safe storage and handling. Service users are treated with respect and dignity. EVIDENCE: Service users were seen and twenty-five were spoken with during the tour of the premises, both in the communal areas of the home and in the privacy of their rooms. Service user questionnaires were sent to the home and five were returned. The feedback was positive and included ‘kind and helpful’, ‘well looked after’ and ‘very well cared for’. All service users spoke positively about the care and service they received at the home. The inspectors heard one comment of the call bell not always answered promptly delaying access to the toilet; this was fed back to the Manager at the inspection. Gotton Manor Care Home D53 - D02 S3261 Gotton Manor V231095 040805 Stage 2.doc Version 1.40 Page 11 One pressure sore was identified and the care planning for this was satisfactory. MAR charts were examined and were completed to a good standard. During the tour of the premises one oxygen cylinder was seen to be freestanding, oxygen cylinders should be secured at all times to reduce the hazard from them toppling over and injuring someone or becoming damaged. Gotton Manor Care Home D53 - D02 S3261 Gotton Manor V231095 040805 Stage 2.doc Version 1.40 Page 12 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 There is dedicated activity staff time and a range of activities is offered at Gotton Manor and the Coach House. These activities are well publicised. Visitors and service users confirmed that visitors are made welcome. It was evident that service users can exercise choice and control in their daily lives. The meals served looked appetising, there was a choice of menu offered and the meals were nicely served by care staff. EVIDENCE: The home has dedicated activities staff and is currently recruiting a volunteer. The activity programmes are well advertised around the home and are sent around to service users. These programmes are headed, Daily Activities, Weekly Activities and Excursion Programme. The home has a mobile shop (trolley) every Wednesday. Care staff are paid to attend some outings to ensure sufficient assistance is available for example where a visit requires one to one support. Staff also attend outings in their own time to offer their support to the service users, this is commendable. Gotton Manor Care Home D53 - D02 S3261 Gotton Manor V231095 040805 Stage 2.doc Version 1.40 Page 13 Staff received praise from service users and visitors, they were described as ‘kind and wonderful’ and ‘kind and helpful’. Service users asked confirmed that they can choose whether or not they join in with activities. Service users who are unable to participate in the group activities are seen on a one to basis within the weekly activity schedule. Newspapers can be delivered at cost; two persons were spoken with who have a regular daily paper delivered. Visitors confirmed that they feel welcome at the home and see their relatives / friends in both the communal areas and in private, if the service user wishes. Service users expressed their confirmation of being able to choose how they spend their time and retain their independence. One service user takes a walk into the gardens once or twice a day. Meals were observed being served in both the Manor and the Coach House, mealtimes were unhurried social occasions. There was a choice of main meal and dessert, drinks were served. Assistance where needed was given sensitively and on a one to one basis. The cook in charge on the inspection day was providing cover from the sister home in Taunton, and knew this home well. All kitchen temperature records were well maintained and the kitchen was clean and tidy. The service users in the coach house have dining tables with flower arrangements on plastic wipe clean table covers and use coloured plastic beakers for their drinks at lunchtime. The use of plastic beakers was for safety reasons; the strong colours of the beakers gave a ‘picnic’ feel to the occasion. Service users commented that the food was ‘good’; that there was ‘enough’ another said ‘nice food, lovely desserts’. The long gap between teatime one day and breakfast the next day. The vulnerability this creates for service users who are very dependent was raised with the home, this matter received attention and milky drinks are now offered to all service users at 8pm each day. Gotton Manor Care Home D53 - D02 S3261 Gotton Manor V231095 040805 Stage 2.doc Version 1.40 Page 14 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. The home investigates all complaints in line with company policy. Service user safety is paramount. Recruitment practice is good and offers protection to the service users at the home. EVIDENCE: Staff files were sampled and good recruitment practice was confirmed. The staff notice board carries information for staff about the company Whistle blowing policy and about POVA. There has been one referral made to the POVA list. There have been no complaints made to the home since the last inspection. One issue were raised with CSCI and an unannounced visit was made, the home cooperated fully and the inspector was able to confirm good practice. One service user asked confirmed that they had been able to make a postal vote at the last inspection. Advocacy services can be arranged if required via Age Concern. Gotton Manor Care Home D53 - D02 S3261 Gotton Manor V231095 040805 Stage 2.doc Version 1.40 Page 15 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. This home has maintenance staff and has an ongoing programme of redecoration and refurbishment. The home is kept clean and tidy. The bedrooms are comfortable and can be personalised. The home is equipped to meet the assessed needs of service users; there are sufficient assisted bathing and toilet facilities. Communal rooms are comfortable. The Nursing wing has well appointed dining and sitting rooms. The Coach House communal areas are well used and look worn. EVIDENCE: A tour of the home was made. A number of deficits were brought to the attention of the manager in feedback at the end of the inspection. Gotton Manor Care Home D53 - D02 S3261 Gotton Manor V231095 040805 Stage 2.doc Version 1.40 Page 16 Service users comments supported their appreciation of their surroundings, such as ‘lovely house’. Bedrooms and corridors have received attention, with redecoration, re carpeting and some have new furniture. One sluice and the staff toilet require foot operated flip top bins rather than open top bins to promote control of cross infection and the reduce risks. Service users asked confirmed that the laundry service was good; one service user said there laundry was ‘returned quickly and put away’. Gotton Manor Care Home D53 - D02 S3261 Gotton Manor V231095 040805 Stage 2.doc Version 1.40 Page 17 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 staff were seen to be on duty at the time of this inspection. Staff are recruited and the company policies and procedures ensure safe practice. Staff are given induction and training to enable them to offer care services to the client group, Older People. EVIDENCE: Staff on duty were seen and spoken with, all felt supported in their duties. Staff personnel files were examined, these supported good recruitment practice. There is ongoing training to meet the statutory and ongoing training needs of a skill mixed staff group. Staff are supervised and records are kept. There was sufficient staff seen on duty and on the duty rotas to provide care. There are a number of vacant staff hours at present and recruitment to these hours is in progress. The staff room has been changed to allow staff to have quieter breaks. There is a Registered Nurse on duty at all times in the Care Home. Although registered as one care home, the residential care in the Coach House is led by a Care Manager who reports directly to the homes Registered Manager, Mrs Stephens. Gotton Manor Care Home D53 - D02 S3261 Gotton Manor V231095 040805 Stage 2.doc Version 1.40 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 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) 31,32,33,34,35,36,37,38. The home has an experienced Registered Manager and is well run. Service users confirmed that the care they receive is good. The home has company policies and procedures to promote good practice and protect service users from harm. The home has an administrator to who deals with all service users accounts. Health and safety matters are treated responsibly; a numbers of items are identified for attention at this inspection. EVIDENCE: Mrs S Stephens manages the home very well. Pre inspection preparation was carried out and documents to support this inspection were forwarded to CSCI. Gotton Manor Care Home D53 - D02 S3261 Gotton Manor V231095 040805 Stage 2.doc Version 1.40 Page 19 The Managers office has been moved since the last inspection and the old office is now for use by the nursing and care staff. The company has policies and procedures to protect service users from harm. Service users have meetings and are able to raise any concerns, one service user confirmed that any issues coming to the attention of the Manager are dealt with quickly and effectively, with follow up to ensure the service user is happy with the outcome. Accidents are recorded and analysed, if falls are identified then a falls risk assessment is carried out. Accident records were appropriately recorded and stored. Records seen at this inspection were appropriately maintained and stored. Equipment servicing was up to date. Chemicals were safely stored. Fire safety records were seen, fire extinguishers were serviced in March 2005, and the fire alarm, emergency lights had been serviced. Weekly fire alarm checks are carried out. One fire door to the sluice room would not close fully and was identified for attention. One sash window was identified that required attention to prevent the risk of entrapment when opening or closing it. The hot water delivered to two baths was measured at 48 degrees Celsius; this requires being no more than 44 degrees Celsius to be at a safe limit. Hot water fail-safe devices must be fitted to hot water bath outlets and be adjusted to a safe limit of no more than 44 degrees Celsius. The Manager described problems maintaining water temperatures at a safe limit, and was advised that where fluctuations are anticipated, hot water warning signage should be displayed. Gotton Manor Care Home D53 - D02 S3261 Gotton Manor V231095 040805 Stage 2.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 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 3 3 3 3 3 3 3 2 Gotton Manor Care Home D53 - D02 S3261 Gotton Manor V231095 040805 Stage 2.doc Version 1.40 Page 21 NO 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. 2. Standard OP 9 OP38 Regulation 13(2) 13(4)(i) Requirement Timescale for action 28.09.05 3. 4. OP38 OP38 23(4)(a) 13(4)(i) Oxygen cylinders must be stored securely to prevent the risks from one toppling over. Bath hot water outlets must 28.09.05 have fail safe devices set to a safe limit ( 44oC) and carry hot water warning signage where a fluctuation in temperature has been identified as a risk. The sluice door, a fire door, must 28.09.05 be adjusted to ensure it closes fully. Sash windows that require 28.09.05 blocks to hold them open must all have a hold open device that reduces the risk of entrapment when adjusting the window opening. 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 OP 2 OP26/38 Good Practice Recommendations The new service user contract should be introduced as soon as it is available. Foot operated flip top bins must be used in communal D53 - D02 S3261 Gotton Manor V231095 040805 Stage 2.doc Version 1.40 Page 22 Gotton Manor Care Home staff areas identified, the toilet and sluice, to reduce the risk of cross infection. Gotton Manor Care Home D53 - D02 S3261 Gotton Manor V231095 040805 Stage 2.doc Version 1.40 Page 23 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL 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. 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