Inspection on 13/10/09 for Guardian Care Centre

This inspection was carried out on 13th October 2009.

CQC 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 CQC 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

Guardian Care Centre 02/02/10

Guardian Care Centre 29/01/10

Guardian Care Centre 21/08/08

Guardian Care Centre 03/07/07

Guardian Care Centre 26/09/06

Guardian Care Centre 27/02/06

Guardian Care Centre 30/08/05

Guardian Care Centre 01/03/05

Guardian Care Centre 12/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Guardian Care Centre Longton Road Trentham Stoke On Trent Staffordshire ST4 8FF Lead Inspector Yvonne Allen. Wendy Jones, Linda Clowes, Joy Key Unannounced Inspection 09:30 13th October 2009 X10029.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 Guardian Care Centre DS0000026946.V377402.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 and Care Homes for Adults 18 – 65*. 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. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Guardian Care Centre Address Longton Road Trentham Stoke On Trent Staffordshire ST4 8FF 01782 644800 01782 644950 ms@guardiancare.co.uk 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) Nightingale Group Limited - The Guardian Care Centre Care Home 143 Category(ies) of Dementia (143), Mental disorder, excluding registration, with number learning disability or dementia (143), Old age, of places not falling within any other category (143), Physical disability (143) Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 143 Dementia (DE) 143 Physical Disability (PD) 143 Mental disorder (MD) 143 The maximum number of service users to be accommodated is 143. 2. Date of last inspection 21st August 2008 Brief Description of the Service: Guardian Care Centre comprises of three modern purpose built buildings, New House, Selwyn House and Mayfield Unit. It is situated in the suburban area of Trentham, Stoke on Trent and is within easy walking distance of local bus services and has good access to road networks. The home offers ample parking space and enjoys accessible gardens and its own protected private patio garden. Selwyn House is a modern purpose built two storey units providing nursing care for seventy-nine older people. Garden View (first floor) provides forty beds for elderly mentally ill persons aged 60 years and over. Garden Walk (ground floor) provides thirty-nine beds for frail elderly people also aged sixty years and over. The two floors are connected by a shaft lift. Accommodation is provided in mainly single rooms with 95 having en-suite facilities. Both floors have their own dining room and communal areas and there are sufficient and appropriately adapted washing and bathing facilities. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 5 New House is a modern purpose built two-storey unit providing nursing care for up to forty-four people - young physically disabled adults over the age of eighteen years and younger people with learning disability. Court View (first floor) currently provides twenty-two beds for young adults with physical and/or learning disability. Court Walk (ground floor) currently provides twenty-two beds for young physically disabled people and young physically disabled people with complex nursing care needs. The two floors are connected by a passenger lift. Accommodation is provided in mainly single rooms. All of the rooms have en-suite facilities. Both floors have their own dining room and communal areas and there are sufficient and appropriately adapted washing and bathing facilities. There is a central kitchen situated in Selwyn House and there are satellite kitchens to both floors in New House. Mayfield Unit is a recently constructed twenty-bedded unit. This is a modern, state of the art unit, which can accommodate up to twenty people with critical care needs between the ages of 18 - 65 years. All bedrooms are spacious and with en-suite facilities. There is a large communal room partitioned into two lounges, a sensory room and a hydrotherapy pool. There is a new large laundry room and staff facilities attached to Mayfield Unit, which were built at the same time and replaced the existing laundry and staff room. The fees charged by Guardian Care Centre range from £391.00 to £5,232.00 per person per week. These should be discussed with the Registered Manager in the first instance, as fees are very much dependent on individual needs and available funding. Extras not included in the above are toiletries, hairdressing, newspapers and some trips out. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this service is 1 STAR. This means that the people using this service experience ADEQUATE quality outcomes. We, the commission, carried out this unannounced Key Inspection visit on 13th October 2009. This inspection visit was undertaken by four inspectors and took one day. The inspection process was commenced prior to the visit and included surveys completed by people who live in the home, relatives and staff. All of the Key minimum standards were assessed and for each outcome a judgement has been made, based on the evidence gathered. These judgments tell us what it is like for the people who live in the home. Prior to the inspection visit the Providers had completed a self-assessment tool, which is known as the Annual Quality Assurance Assessment (AQAA). Completion of the AQAA is a legal requirement and it enables the service to under-take a self assessment, which focuses on how well outcomes are met for people using the service. It was completed to a good standard and gave detailed information about the services offered. Information from the AQAA was used to plan the inspection visit and references to it have been included in this report. The ways in which we gathered evidence to make our judgments were as follows - We looked at any information we had received about the service since the last Key Inspection. We spoke with people who live in the home. We spoke with the staff who work at the home. We examined relevant records and documentation in the home. We walked around the home and visited all of the units. We observed staff interaction with people they care for. We completed a Short Observational Framework Inspection (SOFI). SOFI is designed to give us an opportunity to record our observations during the inspection of care homes where people have dementia, severe learning disabilities or general difficulties with communication. It can enable us to look closely at practice issues and observations; it is used illustratively alongside other evidence. SOFI offers first hand experience of sitting alongside people who use the service for a couple of hours in a communal space within the care home. It gives an insight into their general well being during this time, and also into the staff interaction with the people who use the service. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 7 Observations were made of interaction between staff and people who use the service around non-personal care tasks, at lunchtime and during the Short Observational Framework Inspection (SOFI.) Since we carried out our last inspection the service has had a change in manager. Throughout this inspection report we refer to the new manager as the “acting manager”. This means that the Provider has applied with us for registration for the manager but that he is not yet registered with us. At the end of the inspection visit we discussed our findings with the acting manager. What the service does well: These are the following comments we received from people who live in the home and their representatives – “The staff are nice, kind and helpful” “A million times better than the hospitals” “The small things that are important. They always have time to support him with things” “Considerate caring staff” “Generally staff are very good and always willing to help and do a good job” One to one care ensure that my relative is “comfortable, kept clean and she says that she likes it here” The service cares for people with continuing and complex personal, nursing and health care needs well. The needs of people with complex care are met well. Care is person centred and delivered as per their care plan. Families feel involved in the care of their loved ones and are made to feel welcome. Staff have the knowledge, expertise and skills to meet the critical and continuing care needs of this client group. Rooms are very personalised on Mayfield and New house and very much adapted to meet the needs of individuals. Specialist equipment is provided as required and is centred on personal need. This ranges from specialist mattresses to ventilators and communication aids. Equipment is provided to help individual people to maximise their independence and communication skills and to provide support and comfort. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better: There are concerns about the way the service manages the health and safety of people living in the home. This will need to be reviewed and improved in order to ensure that people are kept safe. These are comments received from people who live at the home and/or their representatives “Hoisting is a bit hit and miss and against care plan agreement” “The wheelchairs that are used are never cleaned or maintained and most do not have footrests, and the ones that do are rarely used”. During our tour of the home, we identified that on two of the units, Garden View and Garden Walk, wheelchairs were being used without footrests. On two occasions we had to intervene because of the potential risk to the person using the wheelchairs. We did not directly observe any unclean wheelchairs and the service does have a wheelchair cleaning programme in place. We observed poor manual handling practices used in one of the units and no risk assessments for some of the people who live there. . There is concern about safeguarding vulnerable people – “Need more doors within units so that residents don’t go into other peoples’ rooms” Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 9 “They could stop the males form going into the females’ rooms at night. Females with dementia have no way of objecting or complaining” There is concern about the lack of person centred activities for people living in the home – “More activities needed for elderly residents” “Could provide more activities for elderly residents” “I had expected more choice of activities, trips out and son on. This has not happened and I am disappointed that the centre does not have a vehicle big enough to take my relatives’ chair so that he cannot take part in any organised trips out in any event.” We observed that most people would benefit from some quality time being spent with them to improve their quality of life and to preserve their dignity. There was concern about the number of staff provided at the home – “Need a few more staff on sometimes” “They care very much for patients with limited staff” We observed that there is insufficient staff to meet the needs of people on Garden View unit. The service must undertake an urgent review of staffing in the Garden View unit to ensure that it is always fully staffed and peoples’ needs are met with a person centred approach. There is some concern about the meals provided by the service – “Could provide better food” “Food improvement please – the food could be improved, family sometimes have to bring in food if it has been particularly bad for a few days”. “The only complaint is the standard of the meals, both in terms of choice and quality. The meals are often dry and unappealing and smothered with thick tasteless gravy. The pureed diet is totally unacceptable and indeed inedible. The fork mash diet is a little better but still much poorer than the diet in hospital. My relative has lost over 1kg since coming here. This area must be improved.” There is concern about medication practices within the service – We identified several areas in need of improvement in respect of medication and have made four good practice recommendations to ensure that people receive their medication safely. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 10 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. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 11 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 12 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at all of the above key standards for this outcome. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People undergo a full assessment of their needs prior to being offered a place at the home. People are given sufficient information about the service in order for them to be able to make a decision. EVIDENCE: Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 13 In their AQAA the Providers tell us – “We have a complete and thorough pre admission process; we always offer prospective residents and relatives the opportunity to visit. We complete pre admission assessments and as such we meet every resident prior to admission and provide them with relevant information in the form of brochures. This has now been enhanced further by the introduction of a Lead Senior Nurse to work on the detail, quality and standard approach of assessments across all units within the home”. We discussed the pre admission assessment process with the manager and unit manager. They told us that this process has changed since the last Key inspection, in that the service now employs a senior nurse to carry out these assessments across all of the units. The nurse then involves the manager and unit manager in discussions and, for people with a complicated medical history, either the manager or unit manager will accompany the nurse on the assessment. The unit manager told us that they will only agree to admit a person if they are satisfied that their assessed needs can be met by the service. For some people the pre admission assessment can be a long process involving various health care professionals. People and their representatives are encouraged to visit the home for as many times as they wish and are given information about the home in order to help them make a decision. We saw pre admission assessment details contained in care plans. These were comprehensive and people told us, on surveys, that they had been involved in the admission process. We spoke with a unit manager about the admission process for a person who had, until recently, been living at the home. The person’s representative had telephoned us to raise her concerns about the service’s inability to meet the needs of her relative efficiently. She was concerned that staff did not always understand his needs and were not sufficiently trained to meet them. During the discussion with the unit manager it was identified that when this person was assessed in hospital he was very poorly and, at that stage, staff at the home were trained and equipped to meet his needs. However, as this person recovered and became well again it was evident that this was not the correct care setting for him and that his needs were not being met fully at the home. The manager told us that he and the staff had recognised this and that, after many discussions with the relative; he had planned a review of this person’s needs with a view to finding an alternative placement for him. This had not been necessary as the person had moved back to his original care setting. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 15 We looked at all of the above key standards for this outcome. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have their personal and nursing needs assessed, monitored and met by the service and people with critical and continuing care have their needs met well by the service in a person centred way. However it cannot be guaranteed that the needs of people living on the dementia care unit will be met in a person centred way or that peoples’ dignity will be maintained. The medication process needs to be reviewed and improved in order to ensure that medication is delivered safely to people. EVIDENCE: In their AQAA, the Providers tell us – “We value our residents as individuals. We are aware of the importance of communication and person centred care and we promote the core principles of care to ensure that all our practices are underpinned and informed by the principles of respect, dignity, choice and independence for individuals”. They say that “We encourage and support individuals wherever possible to make decisions based on the experience of their needs and enhanced by appropriate professional support and guidance. We feel that this is evidence that our practice is experiencing a shift of values from professionals knowing best to professionals supporting and empowering individuals to be in control of how their needs are met”. They tell us that they “Ensure that all personal care is delivered by kind, caring, skilled and experienced staff. All care staff are given the opportunity to complete common induction standards and NVQ training”. They tell us that they “have registered nurses based on all units; we also enable access to specialised nursing services and we have an excellent relationship with the GP who covers our home”. They say that they “cover all activities of daily living with individual person centred, electronic care plans” which are regularly reviewed. They tell us that “All referrals to specialist areas such as community psychiatric nurses, tissue viability nurses speech and language therapists, occupational therapists, dieticians etc are made and coordinated via our retained GP”. They also say that they “have a good supply of specialised equipment including dynamic and static pressure relieving mattresses”. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 16 We visited most of the units throughout the home to look at how the service meets the health and personal care needs of people who live there. When we visited the dementia care unit we carried out a Short Observational Framework Inspection (SOFI), as described in the summary of the report. During this period of time we identified the following – It was very noisy on this unit and the music was playing non stop. This meant that people could not make a choice about whether they wanted to listen to the music or not. Many people were continually passing though the lounge, this was not conducive to meeting the needs of people with dementia. Generally staff contact with the four people we observed on the SOFI was good but was task orientated. Staff interactions included being cheeky towards people, ignoring people, (talking over the person), and making fun of people (one staff member in particular). One staff member in particular took the time to engage with one person. Most people looked very dishevelled and in various forms of dress. Peoples’ finger nails were very dirty. One lady sitting in a recliner chair had her incontinence pad showing. Staff did attempt to preserve her dignity by covering her legs with her dress but this did not resolve the issue. Some people were wandering around in just socks with a potential for slipping on the laminate floor. One ladys stockings were below her knees, and she sat almost bent double in the chair for long periods, staff did ask if she was “ok” and attempted to make her more comfortable but she resumed this position. One lady had a table with the instructions on the table of table to be in front of her at all times when she is in the lounge. Staff told me that the family had brought this table and instructed on its use to stop her from falling. This person’s care plan did not record any assessment of this or consent for use. It is therefore recommended that an assessment be carried out for this including a Deprivation Of Liberty Safeguarding referral. We looked at the way the service manages medication. When we looked at the controlled drugs cabinet and register on Garden View we identified the following – Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 17 That controlled drug “patches” had been stored incorrectly and not as per instructions on each packet. On Garden View unit we observed the staff nurse administering medication after lunch. It was noted that an Insulin phial stored in the fridge was not in its original package so staff were unable to establish prescribing instructions for this. Also another type of Insulin in pen form was being stored in the fridge. Staff should check with the supplying pharmacy in order to obtain advice on the correct administration and storage of the Insulin. There were no protocols in place for PRN (as and when needed) medication. We asked staff to find these protocols and they were unable to do so. We looked at how the service meets the health and personal care needs of people on Court View unit. We saw that people have a care plan in place to address physical health care needs and also social and emotional needs. Records show that monthly evaluations of care plans are taking place. We saw one care plan that stated that the person is “at risk of malnutrition and dehydration and requires at least 1.5 litres of fluid each day”. We asked for evidence that the service is monitoring the fluid and dietary intake of this person. We were told that they kept the records in the unit kitchen. The staff nurse was unable to produce these. The records on the computer also include medical and health care appointments; there is good evidence that the person has regular input to meet his changing health care needs. Although a recent record of a social worker visit hadn’t been transferred to the computer records. We looked at a care plan regarding the person’s emotional state; this said that the person is “Good pleasant, happy.” We looked at two care plans regarding anxiety and maintaining a safe environment. The anxiety care plans stated that the person can become anxious, and that staff were to support him at these times. He is prescribed 1 tablet of Diazepam 2mgs to be administered up to 4 times per day at these times. We checked the medication records to confirm this prescription, but we could not see a protocol for the use of this medication. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 18 The plans said the person can become physically aggressive at times, staff are to support and reassure him and if necessary to maintain his safety appropriate moving and handling “CPI” techniques. We looked at the medication administration records (MAR) for this person. Staff are signing on every occasion that medication is administered, there are no unexplained gaps on the MAR. We tried to complete an audit trail of medication. For regular prescriptions such as medication that is prescribed daily, the MAR contains evidence of the date and quantity of medication received into the home. However, for as required (PRN) medication, there was no record of the quantities of medication stored in the home. This information may have been recorded on older MAR but the staff nurse didn’t know where these are kept. We looked at the medication storage facilities, these looked to be appropriate. In one cupboard we saw a tube of Fucidine cream in its original box, that had the label ripped, which means that we could not tell who the cream was prescribed for. There is a suitable controlled drug cupboard for storing this medication and a controlled drug register to record the amount of controlled medication kept in the home. We looked at bottles of Nitrazepam 2.5mg/5mls where the quantity of liquid we measured in the bottles did not tally up with the amount recorded in the book. We spoke to the staff nurse about this, he stated. “The night staff usually record the medication received in the home, I understand they didn’t have time to record the quantity of controlled medication we received last night.” The service has a Homely remedy policy and procedure and maintains a list of homely remedies it has in stock that have been agreed with the GP. In addition a stock list of each of the remedies is maintained. We randomly sampled the stock levels of Paracetamol 500mg tablets the record stated that there should be 84 tablets in stock. The quantity we found and agreed with the staff nurse came to 75, indicating 9 had not been accounted for. The service has a medication fridge for medication that needs to be stored at lower than room temperature. We saw that staff are recording the ambient temperature of the fridge daily. However, staff are not maintaining a record of the maximum and minimum temperatures as shown on the thermometer. We noted that the maximum temperature was 21degrees centigrade which exceeds the recommended maximum temperature of 8 degrees centigrade. The staff nurse stated that there is no need to store any of the current medication prescribed for people on Court View. We saw that one person’s eye drops are being stored unnecessarily in the fridge. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 19 Comments we received from people and their representatives about the care they receive on Garden View unit are as follows – “Very clean, they look after my relative very well but she needs a hair cut and has been waiting ages”. A person, who visit very regularly, was fairly satisfied with the care but would like to look after their partner at their home, has spoke with social worker and has accessed the advocacy service. Another visitor is quite satisfied with the care but doesnt get much conversation from her relative “She sleeps most of the time”. Most residents on this unit have some degree of cognitive impairment and as such not able to fully comment on their care. Some said they were ok when asked. On Garden Walk we received the following comments from a visitor – “Oh its very good here, the staff look after mum very well” We spoke to six people living on this unit and they all confirmed that they are happy with the services provided to them. Other comments include – “General day to day care is excellent in terms of washing, dressing, feeding etc”. “As far as I am concerned the staff take very good care of my relative and always contact me if there is any serious change to his health and welfare”. “Mayfield provides good quality care. Staff interact well with clients and have a good understanding of their needs and how to handle difficult individuals. Relatives and friends are made to feel welcome”. “They are handling my relative’s challenging behaviour needs well”. Prior to our inspection visit a Social Worker had raised some concerns about the care of a person living on Mayfield Unit. These concerns had been surrounding this person’s recent hospital admission. The specific issues of concern were that the Social worker had not been informed that the person had been admitted to hospital and also that the person had become “dehydrated” despite receiving 1:1 care. We looked at this person’s care in detail, especially around the time of her hospital admission. We also spoke with her immediate family. Generally, this person’s care plan records were well maintained. However, it was identified that records of daily food and fluid intake for the days leading up to her hospital admission had not been fully completed. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 20 From these records of food and fluid intake, we are unable to ascertain whether this person did receive adequate nutrition and fluid intake. Staff did refer the person to the General Practitioner; she was commenced on a course of antibiotics prior to her hospital admission. Staff failed to contact the person’s Social Worker to inform her about the hospital admission. The unit manager told us that this had been an oversight and should not have happened. From examination of the person’s care plan we saw that a Deprivation Of Liberty Safeguarding referral had been made in respect of this person, by the home and this had been returned as not necessary. Advice from the Dietician and Speech And Language Therapist (SALT) had been sought. The person had received diabetic retinopathy screening and regular physiotherapy. On Mayfield Unit we looked at another care plan of a young person whom we had met at the last inspection. This person has a “Do Not Attempt Resuscitation” (DNAR) care plan in place. This is reviewed every three months by the multidisciplinary team and the person himself is involved in this. We saw that “SALT” has been involved a number of times with this person’s care. The person has a Violence and aggression flowchart in place. We noted a dying care plan which has been introduced in May of this year. This person requires 2:1 care during day and 1:1 at night. We observed him walking around the unit with 2 carers. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 21 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at all of the above key standards for this outcome. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Life in the home is made flexible and varied but it cannot always be guaranteed that social and therapeutic needs of people will be delivered as planned. People are somewhat dissatisfied with the current menus and presentation of meals served in the home. It cannot be guaranteed that people are given choices about meals. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 22 EVIDENCE: In their AQAA the Providers tell us that they “have a dedicated diversional therapy manager who has a team of coordinators.” They also tell us “Our aim is to provide services that match the expectations of our residents by involving them wherever possible in choosing their own activities, social and community contacts”. They tell us “We have newspapers delivered and have resources such as books and games”. Also “We have regular visits from representatives from a local church and we have an extended communion service delivered every Sunday”. The service employs a full-time Activities Co-ordinator whom we spoke with on the day. She arranges a full Monthly Activities Programme covering a wide range of activities for all the units at Guardian Care. These include craft activities, gardening, cookery, pop mobility sessions and trips to local places of interest for people who are able to attend communal activities. The Activities co-ordinator also arranges visits from various religious denominations to meet the needs of people who use the service. The Social Diary includes the use of the Sensory Room/Spa which was not fully functional on the day of our visit. When we looked at individual care plans we identified that people who had been assessed as benefiting from use of the spa had not been using it. Designated care assistants receive activities training in order that they can provide individual training on the units in which they work. We spoke to care assistants who had received such training and found that due to pressure of work for their substantive posts they felt there was little time left for them to provide individual or small group activities in the individual units as often as it was needed. They also admitted that they found this situation stressful as they felt guilty that they did not have the time to do this properly. We have, therefore, as part of this report, asked the service to undertake a review of how individual person-centred activities can be best delivered. We saw that records of family visits are maintained and we observed visitors coming and going throughout the day of our visit. Lunchtime could not be viewed as a pleasing experience for the people we observed on the dementia care unit. Small tables were placed in front of the person and the meal was served to them. Staff did inform people what was on their plate. One lady was offered an alternative dessert. None of the four people were offered the opportunity to go to the toilet or to wash their hands before or after dinner. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 23 We looked at the care plan relating to the social needs of the person on Court View unit. This stated that the person may be at risk of social deprivation and needs support in this area. A record also stated that he should receive a weekly aromatherapy session. Additional information said that he should receive one hour 1:1 therapy per day. We looked at the records kept by the service which evidence that the person receives 1:1 therapy for an hour per day. We saw that staff are signing to confirm that he has received this input, and then making an additional record in an activity book. We also saw a separate record of the outings he has been involved in. The records of activity did not evidence what type of input the person receives on a 1:1 basis, they usually give non specific information such as, “has had a good day, he has been in a good mood, enjoyed his meals and spent a lot of time in his bedroom”. We looked at the records of outings and saw that the person had been on four outings during 2009. In separate records on the computer we found a record that documented that the person had listened to a singer/entertainer in the home. We couldn’t see a record of aromatherapy sessions. The staff nurse said that the aroma therapist recorded these. Two people living on Mayfield unit had been assessed for use of the hydrotherapy pool. However these people had not used this facility very often. The Social Worker of one person was concerned about this. When we spoke with this person’s family they told us that they are satisfied with the care their relative receives at the home, but they also would like to see her use the hydro-pool from time to time. We observed staff interacting well with this person. She was receiving 1:1 care and the staff members were trying to encourage the person to eat her lunch but the person was not interested in it. We also saw staff helping with activities with this person as she enjoys drawing. We observed another person being helped to eat his lunch and this was a soft diet which was portioned separately. We went to speak to a person as he was being supported by a carer to eat his evening meal. She told us that the person “doesn’t have any problem, he enjoys his food and very rarely refuses anything, he has to have a pureed diet, which he enjoys, we just have to make sure he doesn’t eat too quickly.” We asked the person if he was enjoying his evening meal, he smiled and nodded intimating that he was. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 24 On Garden Walk unit the tables were attractively set up ready for the next meal. We spoke with the Cook about the menus and meals served in the home. She explained that there is an alternative to the main meal daily. However this is not made clear to people living in the home and is not documented on the menus. It is recommended that alternatives to the main menus be made available to people living in the home. We have received the following comments in relation to the activities and meals served in the home – “Could provide better food” “Food improvement please – the food could be improved, family sometimes have to bring in food if it has been particularly bad for a few days”. “Could provide more activities for elderly residents” “The only complaint is the standard of the meals, both in terms of choice and quality. The meals are often dry and unappealing and smothered with thick tasteless gravy. The pureed diet is totally unacceptable and indeed inedible. The fork mash diet is a little better but still much poorer than the diet in hospital. My relative has lost over 1kg since coming here. This area must be improved.” “I had expected more choice of activities, trips out and son on. This has not happened and I am disappointed that the centre does not have a vehicle big enough to take my relatives’ chair so that he cannot take part in any organised trips out in any event.” We were informed that the service has received a visit from the local Environmental Health department since our last inspection. The Cook told us that this was a “good” visit and that there were only a few recommendations made which have now been addressed. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 25 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at all of the above key standards for this outcome. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live at this home can be assured that any concerns they have will be listened to and taken seriously. Whilst staff awareness of the Protection Of Vulnerable Adults is improving, precautions are not always taken to ensure that people living in the home are protected from harm or abuse. EVIDENCE: In their AQAA the Providers tell us that they “deal with all concerns and complaints at an early stage so that clients or relatives do not feel the need to take their concerns higher”. They also say that they have “a clear and prominently displayed complaints procedure, and qualified staff have well developed communication skills”. They tell us that they “have a detailed policy on both protection and abuse and whistle blowing”. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 26 They say that “All staff who enrol on the common induction training receive further training on protection and abuse and are given a copy of our whistle blowing policy”. They say that they have “an open and honest management structure with unit managers in each unit who maintain a high profile and uphold the organisational precept concerning zero tolerance of abuse or neglect”. They also tell us that they “foster an atmosphere where residents, staff, visitors and any additional significant others are encouraged to report poor practice, discuss concerns and lodge complaints if needed”. As previously outlined in this report, we, the commission have received two complaints about the service, both of which have been about the care of people living on Mayfield unit and both received very recently before this inspection. The service has a complaints procedure in place which is clear to follow and is displayed on all the units and contained in the Service User Guide. The acting manager explained that concerns are usually dealt with by the individual unit managers with more serious complaints being referred to him. The acting manager does keep a log of complaints which reflects how he addresses complaints formally as per the procedure. We required the service to improve the way in which it deals with the Protection Of Vulnerable Adults (POVA). This is now obviously improving and the acting manager explained how this is developing through staff training and better management of Safeguarding referrals. Through his previous work experience the acting manager is familiar with local Safeguarding procedures and he attends relevant meetings to update his knowledge about this area. However people who have relatives living on the dementia care (Garden View) unit have concerns about the protection of their relatives – “Need more doors locked on the units to keep residents in their own area so not going into other peoples’ rooms (vulnerable people).” “They could stop the males from going into the females rooms at night. Females with dementia have no way of objecting or complaining”. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 27 Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 28 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at all of the above key standards for this outcome. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most of the units are clean and adapted to meet the needs of people but Garden View dementia care unit is not maintained to the same standard. EVIDENCE: Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 29 In their AQQA the Providers tell us – “We feel that we are very lucky as far as the resources and the environment we have. All units are now the subject of rolling programmes of decoration and refurbishment. The Operations Director and Care Director carry out regular environmental inspections and formulate specific action plans for any areas which need attention, the plans are actioned by the estates manager using a team comprised of maintenance and decorating personnel, housekeeping and cleaning services, plumber and electrician”. They also say that “A high proportion of our bedrooms have electrically profiling beds where this equipment has been identified as being beneficial for specific clients, where this is not the case, the furniture in resident’s rooms is in a more homely style”. “Where possible, residents are encouraged to bring in pieces of their own furniture or belongings. All equipment and fittings are maintained and serviced according to current legislation. All ground floor units have direct access to well kept and maintained outdoor areas”. We walked around the units and looked in the communal rooms and some of the bedrooms. Mayfield unit is modern having recently been built. It has two phases, each with ten generous bedrooms, and all with ensuite facilities. There is a large communal area in the middle. This has now been portioned off to make two smaller communal areas, which is better suited to the needs of the people living there. There is a kitchen for staff to prepare snacks and drinks for people and there is another specially adapted kitchen for people who live in the home to use for cooking and preparing their own meals if they wish to. There are appropriate and specially adapted toilet and bathing facilities provided. There is a hydro therapy pool and a sensory room provided. The unit was clean and well presented. Bedrooms have been adapted to meet the needs of people living there. We noted the provision of specialist equipment throughout. Garden Walk unit was clean and well presented with no mal odours. There is a marked difference between the other units and Garden View in the standard of décor. There was an unpleasant odour on entry to the unit which became worse as the day progressed. Bedroom doors are locked when people are out of their rooms, preventing them from going to their rooms if they wish. Bedrooms on this unit are quite sparse. There were some personal possessions in rooms, but not many. There was an assortment of chairs in the lounges. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 30 There is a team of domestic staff who work at the home and there is a domestic assistant employed on Garden View unit from 8am to 5pm daily. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 31 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at all of the above key standards for this outcome. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are carefully selected to work for the service and are trained to meet the general care needs of people living in the home. It cannot be guaranteed, however, that staff are provided in sufficient numbers or have the particular skills to meet specific needs of people. EVIDENCE: In their AQAA the Providers tell us “We have focused on the recruitment of quality staff through having designated, regular open days. We have also set in place a robust system of interviewing and checking procedures which complies with all requirements as far as CRB and POVA checks are concerned” Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 32 They also tell us that they “have an extensive staff training programme with a dedicated training officer and trained trainers on all units”. They say that “A complete and accurate matrix of all staff training is maintained by the training manager”. Also –“We are aiming to enrol all new starters on a common induction training course if they have not already completed and are trying various ways of achieving this. We also aim to provide NVQ training for all staff, and we are currently able to provide staff trained to NVQ level 2, level 3 and level 4”. We spoke with the Senior Nurse who is also the Training Manager for the 279 staff team at Guardian Care. We asked the training manager to confirm how many staff were trained in learning disabilities but he was unable to give us a definitive answer. He gave us an up to date copy of the raining Matrix which shows that eight care assistants out of 16 have had autism training. In-house trainers deliver moving and handling and infection control training. The training matrix shows that the majority of moving and handling training is up to date except for Infection Control with only 45 staff members having received this. 18 staff members have received dementia care training. There are no issues of concern identified with Induction Training – all staff spoken with confirmed that they had received this and the training matrix shows staff receiving this. At the time of this visit there were thirty-nine people living in Garden View. There were two nurses and eight care assistants on duty. Two care assistants are providing one-to-one care for two people which leaves six care assistants for the remainder. The majority of staff, including nurses, work eleven hour shifts from 8am to 7pm. Three care staff were off sick on the day of the visit and care assistants were covering from another unit. One of the care staff providing one-to-one care had not been on the unit before and did not know the person. However, she was coping well and the person who receives the service looked calm and relaxed. It was a lovely autumn day and the two people receiving one-to-one were taken to Trentham Gardens in their wheelchairs for several hours and returned at teatime. The rest of the unit was very busy and all staff were also very busy. One person spends all their time in their room and needs regular checks and attention. A high proportion of people need varying degrees of assistance with all aspects of their lives including toileting, eating and drinking. Several people needed wheelchairs to mobilise. We saw two being moved with wheelchairs that did not have footrests in place, thus putting people at risk of injury. We have highlighted this further on in the report. The vast majority of people on this unit have continence needs and there was a strong smell of urine in the lounge area on the day. The floor was a hard surface and appeared clean and dry. A domestic is deployed on the unit daily from 8am to 5pm to ensure that the environment is clean. The deployment of Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 33 more care assistants would enable them to attend to personal care needs more frequently. The lounge was noisy with loud music. Several people were shouting out. Three ladies were slumped in chairs with clothing dishevelled for some considerable time. This clearly affects their dignity and privacy. A SOFI exercise was carried to monitor interactions between the staff team and people who use the service. We spoke with a number of staff including two Care Shift Leaders (Seniors). The two Care Shift Leaders had worked in the unit for some time. Both were well trained, having NVQ level 2 or 3 in Care and were up to date with all mandatory training. The training matrix provided, showed us that not all staff on this unit have received dementia care training. There is a need for all staff delivering care on this unit to receive dementia care training in order to be able to meet the needs of the people living there. The training matrix tells us that there is a trained trainer for Infection Control on this unit and that three care staff have received Infection Control Training. We spoke with four staff who were positive about their work on the unit and said they liked the longer shifts. If they were on one-to-one they would swap with a colleague half way through the shift. Staff also confirmed that there were good changeover sessions that informed them of the latest situation with each person on the unit. Everyone said that it was a busy unit but they liked it that way. Two people told us that they could do with more staff. All said they were well supported by colleagues and the nurse managers. They confirmed they received mandatory training and supervision. Regular staff meetings are held. The nurses confirmed that they were well supported by managers. As staff were very busy we were only able to speak to one for a few minutes for a private interview. We spoke with the others whilst they were working (making drinks or serving food) so that we did not impact on their workload. The rotas for Garden View show that during the day there are two nurses, one care shift leader and ten care assistants rostered. On the day of our visit, the unit was two care assistants short and the rotas show that there are often one or two people on holiday or training. This situation needs to be addressed to ensure that this unit is fully staffed at all times. We have made a requirement that a staffing review is carried out to ensure that sufficient staffing is deployed on the unit to meet the needs of the people who use the service. We have made a recommendation of this report that all care staff who work on Garden View unit receive dementia care awareness and mental health awareness training. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 34 We looked at the files of four staff in detail to monitor recruitment practices. We are satisfied that the service is taking up all appropriate checks such as references and Police checks to ensure that staff are fit to work with vulnerable people. We found evidence that staff have attended a thorough Induction Training course that included such mandatory training as moving and handling, health and safety, fire safety and food hygiene. They have moved on to take further specialist training such as non-violent intervention and bedrail safety. The service has a nurse who takes the lead on provision and management of Staff Training. Staff we spoke with told us that they received relevant training and time off to do this. We saw that staff supervision was being provided by line managers and staff we spoke with confirmed this. The service must undertake an urgent review of staffing in the Garden View unit to ensure that it is always fully staffed. The review must take into account the needs of people who use the service (particularly where the provision of one-to-one care removes staff from the overall staffing ratio); routine staff absences such as attending training, annual leave, sickness absence. This will ensure that people who use the service receive the good quality person centred care they need and that their dignity and privacy is upheld. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 35 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 36 We looked at all of the above key standards for this outcome. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally run in the best interests of the people who live there. However, the system for reviewing the quality of care and services does not always identify areas in need of improvement. Also the moving and handling practices adopted by the service cannot always guarantee the safety of people. EVIDENCE: In their AQAA the Providers tell us “Our care centre has a well defined and fully accountable management structure. The directors maintain a close involvement and the dedicated Care Director is also the registered person with a full time position at the centre, enabling him to be fully involved in the day to day activity and running of the facility” They tell us that “The Care Director also chairs weekly managers meetings where all unit managers and heads of departments are invited and are enabled to provide feedback or receive constructive criticism”. They say that “All staff receive induction and relevant training”. They say that “Policies and procedures are regularly reviewed and updated as required and are made available to all staff members on a generic login which forms part of the documentation used within the centre”. They also tell us that “All units have suggestion books for feedback and relatives and residents are frequently invited to provide informal feedback on all aspects of the organisation and structure”. As outlined in the report summary there has been a change in manger at this service since we carried out the last Key Inspection. The Provider has applied to us, the commission, for the new manager, Mr Robert Stanway, to become Registered Manager for the service. The Provider refers to the manager as “Care Director”. Mr Stanway has many years experience including management of nursing and commissioning of Care. During our discussions with him, it was identified that Mr Stanway has ideas to bring about positive changes at the home in order to help improve the care and services people receive there. The service has a Quality Assurance programme in place which is being developed further by the manager. This will need to be reviewed in order to ensure that the programme identifies areas in need of improvement, such as those identified by us, the commission, during this inspection visit. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 37 The Quality Assurance programme does include carrying out regular audits of many areas and obtaining the views of people living in the home. The service provides a secure facility for people who wish to leave small amounts of monies and valuables. The service also keeps records for the maintenance of personal allowances. These records allow for audit trails to be carried out at any time and demonstrate that the process is robust and transparent. People are encouraged to manage their own finances wherever they are able and wish to do so. Often this is with the help of their next of kin or an advocate. The service has a Health and Safety Policy in place and the manager works with all staff to ensure that the service is safe for the people who live there and the staff who work there. We saw that records relating to the servicing and maintenance of equipment were in place including the records for ensuring fire safety at the home. During our tour of the home, however, we identified that on two of the units, Garden View and Garden Walk, wheelchairs were being used without footrests. On two occasions we had to intervene because of the potential risk to the person using the wheelchairs. It is recommended that the wheelchair policy is enforced at the service and staff are made aware of the importance of proper wheelchair use in order to ensure that people are kept safe whist using these. On Garden View unit we observed staff using the underarm method for transferring people from area to area. We looked at risk assessments for two of these people we had observed being moved in this way. We looked at “Maintaining a safe environment” (generally for action in event of emergency) and “Mobility” (at risk of falls). There was no risk assessment for moving and handling for these people. We looked at the care plan for a person living on Court View unit around mobility. We saw that the plans state “is unsteady on his feet at times and has been provided with a cocoon bed to reduce the chance of injury”. We saw that this bed is essentially a purpose built soft sided bed on the floor; the sides can be fixed in an up right position at night to prevent the chance of the individual rolling out. During the day the sides can be undone and the individual is able to leave the bed. However because the bed has no legs, staff need to use a hoist to lift the individual up from it. We spoke to the carer sitting with this person and she said, that the person “shuffles to the edge of the bed, then we can use the hoist to lift him.” We could not see, from the records that a manual handling risk assessment has been completed. Staff could not produce this. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 38 There are, therefore, obvious concerns about the way the service manages the health and safety of people living in the home. This will need to be urgently reviewed and improved in order to ensure that people are moved and handled safely. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 39 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 x 2 x 3 3 4 2 5 x 6 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 ENVIRONMENT Standard No Score 19 2 20 x 21 x 22 x 23 x 24 x 25 x 26 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 x 33 2 34 x 35 3 36 x 37 x 38 2 Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 40 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 OP38 Regulation 13(5) Requirement Timescale for action 08/01/10 2 OP38 12(1)(a) 13(4)(c) 3 OP27 18(1)(a) The service must undertake risk assessments for manual handling and hoisting people in order to ensure that people are safely managed. Footrests must be used on all 08/01/10 occasions when transporting people who use the service in wheelchairs. This will ensure that they are not placed at unnecessary risk of harm from poor practice. The service must undertake 08/01/10 an urgent review of staffing in the Garden View unit to ensure that it is always fully staffed. The review must take into account the needs of people who use the service, particularly where the provision of one-to-one care removes staff from the overall staffing ratio. Also routine staff absences must be allowed for. This will ensure that people who use the service receive the good quality person centred care they need and that their dignity and privacy is upheld. DS0000026946.V377402.R01.S.doc Version 5.2 Page 41 Guardian Care Centre 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 Refer to Standard OP18 Good Practice Recommendations It is recommended that a risk assessment be carried out for the person we referred to, accommodated on Garden View unit who has a table placed in front of her whilst she is sitting in a chair. This should include a Deprivation Of Liberty Safeguarding referral. The service should ensure that care plans are up to date, are carried out as per plan, and maintain records of dietary and fluid intake where these are an identified need. This is to help ensure that the nutritional needs of people are monitored and met. The service should ensure that where CPI techniques have been agreed as an appropriate method of managing a person’s behaviour, then the care records indicate specifically the techniques that are appropriate to use. This is so that people are managed appropriately and safely. The service should ensure that people have regular opportunities to engage in meaningful activities both in and out of the home. This is to ensure that the social and therapeutic needs of people are met. The service should be measuring and recording the maximum and minimum temperatures of the medication fridge on a daily basis. The fridge should be maintained at between 2 and 8 degrees centigrade. This will ensure that medication is stored safely and at the correct temperature. The service should ensure that records of medication are accurate so that an audit trail can be carried out. The service should ensure that the labels on medication packaging are legible in order to ensure that medication is administered to the individual for whom it is prescribed. The service should ensure that where medication is prescribed as required (PRN) there are clear instructions (protocols) for staff to follow, which states under which circumstances the medication is to be administered. This is so that staff are able to use the medication correctly, safely and under the right circumstances. The service should ensure that all staff in the service DS0000026946.V377402.R01.S.doc Version 5.2 Page 42 2 OP8 3 OP38 4 OP12 5 OP9 6 7 8 OP9 OP9 OP9 9 OP30 Guardian Care Centre 10 OP33 receive training relevant to the needs of people whey are asked to support. In this instance, we recommend that all staff deployed on Garden View Unit receive dementia care awareness, mental health awareness and other such training to enable them to provide a sensitive and personcentred service to people who are living in this unit. The Quality Assurance programme should be reviewed so that this picks up areas in need of improvement as those which we, the commission, have identified during this visit. Guardian Care Centre DS0000026946.V377402.R01.S.doc Version 5.2 Page 43 Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Fax: 03000 616171 Email: enquiries@cqc.org.uk Web: www.cqc.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. 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