Inspection on 21/08/08 for Guardian Care Centre

This inspection was carried out on 21st August 2008.

CSCI found this care home to be providing an Adequate service.

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 13/10/09

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 29/01/2009.

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, Jane Capron Unannounced Inspection 21st August 2008 09:00 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.V370708.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.V370708.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 Mrs. Margaret Elizabeth Sexton 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.V370708.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 3rd July 2007 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. 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. Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 5 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 new twenty-bedded unit. This is a very 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 ensuite facilities. There is a large communal room, a snoozlan 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 £250.00 - £4,555.00 per week. Extras not included in the above are toiletries, hairdressing, newspapers and some trips out. Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The inspection process commenced several weeks prior to the visit. The visit to the home took 2 days to complete. On the first day there were three inspectors present and on the second day there were two. 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. The Provider sent us a separate AQAA for each of the units throughout the home. These gave us limited information about the services offered. Several weeks prior to the inspection visit we sent a number of surveys to be completed by people who live in the home, relatives and staff members. Many of these were returned to us and comments from them have been included in this report. All of the Key minimum standards were assessed and for each outcome a judgement has been made, based on the evidence gathered. These judgements tell us what it is like for the people who live in this home. The ways in which in we gathered evidence to make our judgements were as follows – We looked at any information we had received about the home since the last Key Inspection. This included any compliments, complaints and Safeguarding referrals we had received. We spoke with the people who live in the home. We spoke with the staff who work at the home. Discussions were held with the Registered Manager and unit managers. We examined relevant paperwork and documentation at the home. We walked around the home and we visited all the units except Court View as this was closed to visitors due to the recent outbreak of gastroenteritis. We sat and observed over a 2-hour period how staff interact with and care for the people who live at the home. This is called a Short Observational Fieldwork Inspection (SOFI). We did this on Court Walk and Garden View. At the end of the inspection visit we discussed our findings with the registered manager. Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 7 What the service does well: This is what people told us they felt the home does well – “I feel that the cleanliness of the home is excellent. The home is kept very spick and span. Meals seem to be very good.” “I find everybody very caring.” “All our family feel welcome. It’s like our second home. There is a real homely feel. The staff are always pleasant and in good humour. I don’t feel the need to be with my relative every minute of the day as I know he is very well cared for and his needs are pre emptied.” Staff tell us – “The home cares for the clients individually and respects the needs of each client. A hard working team that support each other well.” “Put people first, making sure each individual’s needs are met to the best of our ability.” “It gives a caring, happy, professional home for the people we care for. Has good hygiene, organised rooms, activities etc. We all work well together as a unit including the unit manager.” “Provide quality care to the client, meet their personal needs, support them with their personal interests”. The needs of people accommodated on New House, Mayfield and Garden Walk are met very 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 wherever needed. This ranges from specialist mattresses to ventilators. The provision of the hydrotherapy pool and snoozlan room on Mayfield unit is an asset for the home to have and provides diversional therapy for several people, not just those accommodated on Mayfield unit. The home is committed to staff training and development and the programme is delivered very well. Staff feel very well supported with their training needs. Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better: This is what people told us they felt the home could do better – “A smiley face and more tender loving care. Staff don’t seem to want to speak to you. I only know the names of 2 staff after about 3 years.” “The only thing I will make a comment on is that I personally feel that they could do with more staff. When the staff go to a meeting, which they do frequently. I realise they are required for training purposes but it seems to leave a skeleton staff especially at weekends.” “Provide a higher level of staff to patient ratio and encourage staff to stay. There seems to be a very regular staff turnover.” This is what staff say - “Be more organised when it comes to shortness of staff.” The delivery of care to people accommodated on Garden View unit needs to be further improved in order to ensure that this is person centred. Care is currently delivered in a task-orientated way. The unit is too big as it stands and does not lend itself to meeting individual care needs. It is recommended that the unit be divided up into smaller units each with its own staff team. The staffing ratio also needs to be higher on this unit, and new staff need to be more closely supervised to ensure that the complex mental health needs of people can be met effectively and that care can be delivered holistically. Also it cannot be guaranteed that people living on this unit have their personal choices and preferences upheld. This is in respect of all the activities of daily life in the home, included choices of meals and beverages. Risk assessments in the care plans on Court Walk must accurately reflect the needs of the person and be updated when necessary. This is to ensure that people’s needs are accurately reflected and can be met. Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 9 Care plans on Garden View unit must be made more individual and person centred. Medication on Court Walk must be stored within the temperature range recommended by the manufacturer to ensure that medication does not loose potency or become contaminated. The records of the receipt, administration and disposal of all medicines for the people who use the service must be robust and accurate. All medication must be administered as prescribed to ensure that people are kept safe and healthcare needs are met. Further efforts should be made to ensure that people have the opportunities to engage in activities of their choice. The comments and responses in suggestions book could be dated in order to be able to audit responses for quality assurance purposes. Referrals under safeguarding should be made in a timely manner in order to protect people. Information regarding the details of the referral and outcome should be made available for inspection purposes. 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.V370708.R01.S.doc Version 5.2 Page 10 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.V370708.R01.S.doc Version 5.2 Page 11 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 assessed standards 1, 2 and 3. Standard 6 is not applicable for this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are given enough information about the home in order for them to be able to make an informed decision about moving in. Admissions are not made to the home until a full needs assessment has been undertaken and only take place if the service is confident that staff have the skills, ability and qualifications to meet the assessed needs of the person wishing to live there. Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 12 EVIDENCE: In their AQAA the Providers told us – “We provide infromation to enable indvidiuals to make a choice. When placed with us cleints are happy with our service”. All of the people we spoke with felt that they were given enough information about the home in order to be able to make an informed decision about moving in. All of the surveys we received back from the people who live at the home were positive and indicated that they had received enough information before moving in. The comments we received from people included – “My parents received the information so I could decide if it was the right place for me.” We were shown samples of contracts laying out the terms and conditions between the home and the individuals. Where people are funded this is between the home and funding bodies. We looked at several records of pre-admission assessments. These were detailed and documented individual needs, choices and preferences. There was a lack of recording in respect of individual social histories. It is recommended that social histories are completed at the time or soon after admission to the home. We spoke with 2 staff members about their knowledge of the needs of particular individual people on their units. One was a care assistant and one was a unit manager – and both were very aware of these individual needs. The care assistant was also able to demonstrate how to respond to changing circumstances such as managing challenging behaviours. She confirmed that she has received the training for this. Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 13 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): We assessed standards 6,7,8,9,10,16,18.19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home meets the personal and healthcare needs of younger adults, elderly people and people with continuing and critical care needs very well. The care of elderly people with mental health needs is not based on their individual needs. People requiring this care do not receive personal and healthcare support using a person centred approach. Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 14 EVIDENCE: In their AQAA the Providers told us – “We offer a comprehensive package of care. All clients have care plans to prove that we do well.” This is what the people who live at the home, and their representatives told us – “The basic needs outlined in the care plan are adhered to but due to staffing levels my mother’s immediate needs can be put on hold eg toileting, soiling, changing until staff are available.” “The staff are extremely efficient at passing on information, contacting other services and agencies on my relative’s behalf. They are prompt in answering queries/questions.” “My relative has severe mental illness and it is very difficult for new staff or when they are not used to dealing with highly dependant people. They give only basic care instead of an holistic type of care giving.” “The staff encouraged me to join my relative’s wheelchair assessment and they worked very hard to get his wheelchair repaired, keeping us informed every step of the way.” “I have confidence in the staff. I have never felt unsafe”. “I feel looked after and safe.” “I could not get anywhere better”. “Staff are kind”. “I can have a bath or a shower”. One lady told us that she likes having her own toilet so that her privacy is maintained. She said that staff treat her well and respect her privacy and dignity. She said that the Doctor comes if she was not well. The chiropodist comes and the optician comes every 12 months. We looked at a random selection of care plans. The overall standard of care planning is good, although this varies on different units. Personal, nursing and health care needs are assessed and plans put into place to meet these needs. Risk assessments are developed and people are encouraged to maintain their independence and take negotiated risks. Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 15 The management of people with critical and continuing care needs is excellent. On Garden View unit care plans have been developed and improvements have been made but plans are not person centred enough and do not always reflect individual choices, preferences and abilities. On Court Walk unit risk assessments are in place for all and evidence that they are reviewed but the dates of reviews are not always met. One person has a risk assessment for safety while in bed and has bed rails in place. An accident happened where the person climbed over the bed rails and was found on the floor with no injuries. However the risk assessment had not been changed, to reflect the additional risk. The involvement of people or their representatives in the reviews of care plans is inconsistent, being evident is some plans and not in others. The health care needs of people are managed by visits from local health care services included GPs. Staff actively seek access to healthcare professionals when it is required and there were good records of these visits. People have the aids and equipment they need and these are well maintained to support them. On New House and Mayfield units staff are trained and competent in health care matters particularly in the care of people using the service who remain immobile for long periods of time including people requiring critical care or with continuing care needs. The home arranges training on health care topics that relate to the health care needs of these people. Staff members on these units are very alert to changes in mood, behaviour and general wellbeing and fully understand how they should respond and take action. We carried out a period of observation on Garden View unit over a 2-hour period. Staff supervision was satisfactory – there was always a member of staff present in the lounge area. Basic care needs were attended to but in a task orientated way. 2 staff members were observed standing over people to feed them drinks – one was even dipping a biscuit in a person’s tea prior to feeding him with it. We were informed afterwards that this staff member was very new – but no one was showing her what to do. She had been left with the drinks trolley to give out morning drinks and did not know the people using the service by name or what they preferred to drink – she asked each one the same thing – “Tea or juice?” Not many could answer so they were given whatever she chose for them. There were no instructions written on the trolley about who prefers what to drink, takes milk or sugar. Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 16 We met a relative who told us that his mother’s basic care needs were met and that she always appeared well cared for but that he does not get involved with the care plan and did not know for definite who the manager of the unit was. He also said that the cup of tea offered was put on for our benefit and that they normally just had juice given out. His mother said, “Its very pleasant here tonight –and nice to have a cup of tea for a change.” On the whole – this unit has made some progress with the improvement of care standards and people are having regular drinks and basic care needs are being met. However care is delivered in a task orientated way and does not represent an individualised person centred approach to people with dementia and mental health care needs. We saw good records relating to the cultural needs of a person. We saw evidence of involvement of the relatives and clear instructions for staff to follow. Some irregularities with medication were found on New House and a requirement has been made as a result of this inspection. The issues are in respect of homely remedies and incorrect records of administration. A requirement has been made to improve this area. The medication process was found to be satisfactory on Garden View and Mayfield units. Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 17 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): Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 18 All the standards were assessed for this outcome area. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally staff are aware of the need to support people to develop their skills, including social, emotional, communication, and independent living skills. Some people using the service are consulted or listened to regarding their choice of daily activity, but this process could be improved. The food in the home is of satisfactory quality and meets the dietary and cultural needs of people who use the service. People cannot always be guaranteed a choice of meals and drinks or that meals will be served at the correct temperature. EVIDENCE: In their AQAA the Providers told us – “We have a designated team to administer social activites. Programmes, notices and individual care plans.” Comments from relatives included – “I just feel that my father could do with more involvement in activities as he is hard of hearing and is in a wheelchair. All he seems to do is sleep most of the time and I think a little more activity would do him good. He does have a hearing aid but staff do not put it in for him. I put it in for him when I visit.” “They all have their own identities and interests which stimulate my relative – e.g. music, TV, crystal healing etc.” “It was a priority for us that our relative was somewhere with other young people (both staff and residents). It’s a joy to come in and hear the staff singing along to his music! The Eucharist Minister attends every Sunday.” We visited Garden View unit and looked at a random sample of care plans. Plans were not individualised and therefore did not identify the activities and interests of people. Staff reported that they were starting to develop life story histories but few had been completed. The activity person was present on the unit during the morning doing hand massages and manicures. Staff reported that activities took place “as and when”. The activity co-ordinator visits the unit about twice a week and at other times the care staff try to organise Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 19 activities. Staff did tell us that every so often a couple of people had the chance to go out but sometimes they could not accommodate this as it was not planned in advance and a staff member had go from the unit which was not possible. The service has a reminiscences room and a leaflet on the wall indicated that reminiscence equipment was available. However the records and information from staff told us that this was rarely used and currently one person that wanted to spend time alone was using the reminiscence room as a lounge. Records seen did show that the service had put on a ‘European Day’ during July 2008. Staff reported that people can have their hair done, most people enjoy it that musical entertainers regularly come in and someone brings a dog in. Some people have also been making jewellery and done some painting- examples were displayed along the corridor walls. Overall the unit does not routinely have planned activities and the activities do not seem to reflect the interests of the people living there. We also visited Garden Walk unit where individualised plans are in place identifying people’s interests and areas they wished to pursue. These were observed during afternoon - in one lounge a person living there was leading some music and care staff were dancing with people. In the dining room a number of people were being supported by to make jewellery by a care staff member. One person told us that she had made a necklace a previous week and another person showed the bracelet he had made for his wife. Staff and people living there reported that they had good activities including musical entertainment, a gardening club, a visiting library and the hairdresser comes every day. One person told us that he went out quite often to the pub. There were daily newspapers available. The Unit had done a ‘European Day’ where different foods had been on offer and staff had dressed up. Neither unit had regular religious services although a priest visited those people of the Roman Catholic faith that wished it. In Garden View there are no care plans showing people’s spiritual needs although on the assessments some people were identified as being, “C of E”. During the day we saw a number of visitors and in Garden View several people came to in regularly to support their relative to have their lunch. People can visit at any time and we observed that some relatives were regular visitors having positive and relaxed relationships with staff. People we spoke to in Garden Walk were positive about the unit – they could eat their meals in their rooms or in the dining room, they could choose to join in with activities or not as they wished. A person told us that he liked to go to bed early and could do so. He also said that he liked to get up at 8am and that suited him and that he was always brought a cup of tea in bed before he got up. Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 20 On Garden View records showed us that the unit involved advocates to support people to make choices about their lives. The bedrooms we saw on each unit contained personal belongings and small items of furniture they had brought with them. A daily menu is provided where there is a choice for each meal. Comments from people on Garden Walk included, “The food is excellent and there is a choice provided”, and, “The food is not bad at all.” A person who lives at the home told us that there is a menu to choose from and that for tea rather than having sandwiches she always chooses the soup. She said that drinks were provided throughout the day. On Garden View there was no choice provided, although staff reported this was not usual. It seems that if someone wants something specific this can be requested as one person always had a jacket potato and this was provided. We observed that the soft diet was nicely presented. Staff told us that the kitchen decide on how many of each meal to send up rather than staff. Also the pudding on the menu was jam sponge but apple pie arrived. There were yoghurts and fruit available but some of the fruit appeared old - oranges were brown skinned and hard and an apple was extremely soft, (the staff member disposed of them). Staff we spoke to said that some people regularly had fruit but we did not see anyone eating any. We saw that people were given a drink during the morning although this was limited to “tea or juice”. We did see a cake had been sent up to have with the afternoon drink. The tea provided was sandwiches, sausage rolls, soup and cakes. The Unit had some food - biscuits and toast, which could be eaten throughout the night. On Garden View meals were taken both in the dining room and in two of the lounges. A high number of people needed help with eating. This meant that some people needed to wait for sometime before having their meal and we observed meals being left on a trolley for up to 25 minutes - with the top meal being uncovered. There was one person of Caribbean heritage and his wife confirmed that he would not want alternative food and was happy with the meals provided. On Court Walk we saw records of “one to one” hours in individual books, this means that relatives can look at them to get an idea of what their relative has been doing. We looked at 3 records, which demonstrated that a person had only received his full “one to one” session of 4 hours once in 15 days. Another person had received his full 2 hrs, 6 days out of 13. A third person had received their full 2 hrs 6 out of 16 days. The activities co-ordinator stated that she is introducing a swimming club, cinema club, luncheon club, and a craft club. She said, “I believe it’s important that people have an opportunity to socialise with others they wouldn’t usually Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 21 mix with.” “I want to get people out as often as I can.” “I do what I think is appropriate, it’s important they have new experiences, the jewellery making has gone down really well.” We spoke with a care worker who told us that a person she looks after, “enjoys going out - he doesn’t mind where, he’s been out today with the activities coordinator.” We saw this person’s bedroom, which displayed family photographs and evidence of his working and personal life. We spoke with another care worker who said, “ This person enjoys rough and tumble and having fun, he has very limited communication and not sure what he understands.” “I took him to a football match last season at Stoke City he enjoyed that. He likes sensory stuff and used to go to hydrotherapy but doesn’t go any more, I think it might be because of the cost. He hasn’t been for about 6 months.” We saw this person’s room, which was pleasant and contains items that reflect his interests as described by the care worker, a music centre, light rope for sensory stimulation, and football memorabilia. We spoke with another person at length. She is very happy with her care and the staff team. She knows who her key worker and co-workers are and gave a positive account of her time at Guardian Care. During the period of observation (SOFI) issues relating to practice were observed. One staff member gave a person her meal without asking her what she wanted, speaking to her or telling her what the choice was. One member of staff put a person’s apron on without speaking to her. Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 22 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): Standards 16,18,22 and 23 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be assured that complaints and concerns will be listened to and taken seriously. Staff are generally aware of the procedures for recognising and reporting abuse. EVIDENCE: In their AQAA the Providers told us –“ We investigate any complaint urgently. POVA training is mandatory.” Comments from people told us – “I would speak to the carer or nurse if I had any concerns.” Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 23 Comments from relatives included – “Not had any concerns – we keep contact on a daily basis.” “Mother cannot make complaints due to lack of capacity but if I have asked for anything they have always complied.” We have received some concerns about the home since the last inspection but not an extreme number, given the size the home. Those concerns have been referred back to the Provider and have been investigated by them – we have been sent copies of their investigations. People have not contacted us again after this, which we hope indicates their satisfaction with the outcome. Each unit has a suggestions book. In New House 4 comments were noted and there was evidence of action taken by the manager to address the concerns. Comments and responses were not dated and we recommend that these are included for monitoring purposes. It was reported to us that this unit hasn’t received any formal written complaints but have been involved with one safeguarding referral. Social Services were concerned that the home did not follow the local safeguarding policy in the first instance but that this was delayed while the home commenced their own investigations. Staff members spoken to included a care assistant and Deputy Manager on Garden View, and the Unit Manager on Mayfield Unit –all confirmed that staff have training in Protection Of Vulnerable Adults (POVA) and that they are aware of the local policies for safeguarding referrals. Examination of 6 staff training files identified that instructions are given in respect of how to safeguard the people using the service during staff induction training and that further training is given in this area. Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 24 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): Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 25 Standards 19,24,26 and 30 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. New House and Mayfield units provide a physical environment that is appropriate to the specific needs of the people who live there. The wellmaintained environment provides specialist aids and equipment to meet specific needs. The lay out and design of the units allows for small clusters of people to live together in a non-institutional environment. The units on Selwyn House are large and, particularly on Garden View in respect of meeting mental health care needs, do not encourage person centred care. EVIDENCE: In their AQAA the Provider told us – “ We provide a clean and tidy environment. There is an environment refurbishment programme in place.” Comments from people using the service and relatives included – “The home is always spotless and clean.” “I feel that the cleanlines of the home is excellent. The home is kept vey spick and span” We did receive a concern prior to the inspection about the poor state of hygiene of a bedroom of a person moving into the home in the Garden View unit. When the relative took the person in to the home the bedroom had not been cleaned from the previous resident. The bed was dirty and the sheets were soiled. The room was also poorly presented. The home admitted that this was an oversight. We visited 3 further bedrooms on Garden View unit. Two of the three bedrooms were unsatisfactory. The beds were poorly made with crumbs in one of the beds – we were informed that this had just been made up. The layout of Garden View unit does not encourage small groups living or privacy. There is one large dining room, one large lounge with most people in, a smaller lounge and a reminiscence room used by one person. The unit is very big and does not lend itself to individualised care. This unit would be better made into smaller separate units. Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 26 Carpets along corridor areas on this unit are badly stained. The unit had been redecorated since the last inspection with vibrant stimulating colours along the corridors and pictorial signage to help with orientation. This has helped to improve the look of the environment for people who live on this unit. On Garden Walk there is similar accommodation. The lounge and dining room are well decorated and nicely maintained. Bedrooms are clean, well furnished and decorated. Both units were clean and tidy apart from the bedrooms mentioned on Garden View. The home has had a recent outbreak of Diarrhoea and Vomiting and has worked with the Health Protection Community Support to address this. At the time of this visit, Court View on New House was still closed to visitors. All units have domestic assistants on duty throughout the week and cleaning schedules in place. We spoke with people that live at the home who said, “They clean the toilets everyday”, and, “We have clean towels everyday”. We discussed infection control with the staff and they were aware of the need to wear protective gloves and aprons and the importance of hand washing after undertaking personal care tasks and before serving food. We saw bedrooms on Court View, which were pleasant, and had items that reflect the person’s interest as described by the care worker, music centre, light rope for sensory stimulation, and football memorabilia. Mayfield unit was very clean and well presented. Bedrooms are very personalised and adapted to individual needs, some with very specialist state of the art equipment. Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 27 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): All the standards in this outcome were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff receive relevant training that is focussed on delivering improved outcomes for the people using the service. The home puts a high level of importance on training and staff report that they are supported through training to meet the individual needs of people in a person centred way. Staffing ratios need to be improved and made more consistent on Garden View and new staff require more supervision in order to ensure that individual needs are met on this unit. EVIDENCE: Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 28 In their AQAA the Providers told us –“ We maintain staffing levels and the retention of experienced staff”. Comments from people using the service and relatives included – “The staff are extremely efficient”, and, “It is very reassuring that we see all staff receiving regular training.” “I find everybody very caring.” “I feel that some staff, (not all), could be a little more pleasant. Sometimes I don’t get a smile or a “Hello” which doesn’t cost much but makes things better.” Some of the relatives expressed concerns about the level of staff provided at the home. “At times there appears to be insufficient staff.” This has been raised by 4 relatives in surveys we received prior to the inspection visit. At the time of this visit, there were 34 people living on Garden Walk; 2 qualified staff plus 5 care staff were on duty throughout the day. We were told that this number increases to 6 or 7 care assistants if the unit is full. At night there is 1 nurse and 2 carers (3 if full). There is a Domestic Assistant on duty 8-5pm- seven days a week. We saw that the staff were able to meet people’s needs. A person who lives on the unit told us that when the buzzer is pressed staff come quickly and another person said, “I can’t fault the staff”. At the time of this visit, there were 2 nurses and 7 care staff plus 2 new care staff who had gone for induction training on Garden View. Staff reported that staffing had improved but effectively was reduced when 2 of the staff were new. In Garden Walk unit, in New House there were 8 care support workers and 2 nurses on duty. On nights there is 1 nurse and 3 care staff. Records show that although these levels are reported to be the norm there are occasions when there are less staff. Staff training records were provided and we interviewed 2 staff on this unit. One staff member confirmed that had she had completed NVQ level 2 training and had received mandatory training including safeguarding. She is the allocated co-worker of a person living on the unit and gave an account of how the individual’s needs were being met. Discussions with her confirmed regular staff meetings and supervision sessions are held. She felt that sometimes there could be more staff. Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 29 Another staff member said that monthly staff meetings and bi-monthly supervision sessions are held. She confirmed that her training is up to date and that she feels supported by the management team. She was aware of what to do if she was concerned about the welfare and well being of the people using the service and she gave a good account of how the complex needs of one person are met. Observation (SOFI) of care practices on Garden View indicated that there should be more staff around who are aware of individual needs. This unit does not work well as one large unit and is task driven. Peoples’ needs would be better met with a higher staffing ratio. We looked at 6 staff files to check the Home’s recruitment practices. All of these contained evidence that the required checks had been made and 2 written references obtained for each prospective member of staff. Staff training records were also checked on Garden View. Mandatory training had been completed, followed by regular updates. The home keeps a mandatory training matrix, a copy of which was given to us for the staff on each of the units. There is very good evidence of staff training at the home – particularly in critical care and continuing care. One of the managers said that she feels very supported with her training needs and has completed the Acute Care Module and Mentorship to degree level. She told us that regular staff meetings are held and that the manager listens to suggestions. The deputy manager on Garden View requires further training in dementia care and training in managing challenging behaviours. A staff member we spoke to on Garden View told us that there have been staffing problems on Garden View unit and that, at times, “Staffing has been dangerously low.” We were told, “Two weekends ago there was 1 nurse on duty and 1 of the carers was pregnant and last Saturday there were only 4 carers on duty. There are 4 new starters on duty today but 2 have gone for training. Staff do not stay long on this unit. New staff are not inducted properly or helped and therefore leave. We didn’t finish breakfast until 11.15am and then its lunch at 12.30pm. There were only 3 night staff on duty last night. One resident went missing for 2 hours. The Police were called out but then he was found in another person’s bedroom.” Examination of the off duty identified that, on several occasions, staffing had been inadequate for Garden View unit over the last few weeks. Discussions with the unit manager confirmed that there has been a problem with the retention of staff and that they are in the process of recruitment and have new staff starting. However many of these new staff are unqualified carers with Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 30 little or no experience in care and no dementia and mental health experience. These staff members need time, training and support before they can be counted as an effective member of the team, able to care for the people living in the home properly. Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 31 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.V370708.R01.S.doc Version 5.2 Page 32 Standards 31,33,35,37,39,and 42 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally the home is well managed and run in the best interests of the people who live there. EVIDENCE: In their AQAA the Providers told us –“ All employees have POVA & CRB checks before starting employment. All staff have an enhanced CRB.” The Registered Manager has been in her current position for over 6 years and is supported by the unit managers. Each unit manager has the necessary skills and experience to run the unit and all keep updated with training requirements. All of the managers told us that they feel supported in their role and with their training needs. They spoke of the Registered Manager as being, “very supportive and approachable”. The manager on Mayfield unit explained that she had recently completed the Acute Care Module and Mentorship to degree level. When we visited Garden View unit one of the visiting relatives told us that he did not know who the manager was but guessed it was, “the lady in the black uniform”. Another visitor knew the manager well and was chatting to her when she came in to the louunge. This should be addressed and the manager should make herself known to all the people on her unit including their representatives. Also, it has been identified that, although there have been improvements made to this unit, (Garden View), since the last Key inspection, the manager will need to focus on further development to ensure that care is less task orientated and delivered with a more person centred approach. The provision of staff needs to be better managed to ensure that there are consistently enough staff to meet the needs of the people accommodated on the unit. Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 33 The supervision of new staff needs to be better managed on this unit to ensure that staff turnover is diminished and that staff have all the necessary skills to meet individual needs. There is a Quality Assurance programme in place at this home. Auditing of different areas throughout the home is on going. Improvements are recommended in this area to help ensure that services are continually assessed and improved. More involvement of the people who live at the home is recommended including obtaining the views of the people and their representatives. There are regular staff meetings at the home. Staff told us about these and we saw the minutes of recent meetings. Staff members told us that their views are listened to and any suggestions they have for improvement are taken seriously. It is recommended that more regular meetings are held for the people using the service, where they and their representatives can express their views, opinions and suggestions towards the running of the home. We discussed the management of personal allowances with the Registered Manager. The procedure for this has not changed since the last inspection and clear audit trails can be followed if required. People are able to access their money as and when they wish. The administrator has overall responsibility for maintaining these records. We looked at some Health and Safety records in the home. These are accurrate and up to date. Maintenance of equipment has been carried out as required including the fire safety equipment. The required checks are carried out, for example hot water temperature testing. Each person has individual risk assessments contained in his or her plan of care, so that they can be supported safely. The Environmental Health Department visits the main kitchen and leaves a report. The last report received was satisfactory and the recommendations have been addressed. The Fire Safety Officer also visits the home and leaves a report with the manager. The Officer also sends us a copy of his report. Examination of staff training records and discussions with staff identify that staff receive regular training sessions in mandatory Health and Safety training such as manual handling, fire safety and first aid. Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 34 Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 35 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 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 ENVIRONMENT Standard No Score 19 3 20 x 21 x 22 x 23 x 24 x 25 x 26 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 x 33 2 34 x 35 3 36 x 37 x 38 3 Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 36 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. Standard OP7 Regulation 15(1) and (2) Requirement Risk assessments in care plans must accurately reflect the needs of the person and be updated when necessary. This is to ensure that people’s needs are accurately reflected and can be met safely. Care plans on Garden View unit must be made more individual and person centred. Medication must be stored within the temperature range recommended by the manufacturer to ensure that medication does not loose potency or become contaminated. The records of the receipt, administration and disposal of all medicines for the people who use the service must be robust and accurate. All medication must be administered as prescribed to ensure that people are kept safe and their healthcare needs met. Staffing ratios need to be improved and made more consistent on Garden View in order to ensure that individual DS0000026946.V370708.R01.S.doc Timescale for action 28/10/08 2. OP9 13(2) 28/10/08 3. OP9 13 (2) 28/10/08 4. OP9 13 (2) 28/10/08 5. OP27 18(1)(a) 28/10/08 Guardian Care Centre Version 5.2 Page 37 needs are met on this unit. 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. 3. Refer to Standard OP12 OP33 OP18 Good Practice Recommendations Further efforts should be made to ensure that people have the opportunities to engage in activities of their choice. The comments and responses in suggestions book should be dated in order to be able to audit responses for quality assurance purposes. Referrals under safeguarding should be made in a timely manner in order to protect people. Information regarding the details of the referral and outcome should be made available for inspection purposes. New staff should be more closely supervised on Garden View unit to help ensure that they feel more confident, less likely to leave, and also to help them recognise the individual needs of the people who live at the home. People should be offered a choice of meals and beverages throughout the day. More attention is needed to ensuring this happens on Garden View unit. Also attention should be given to ensuring personal preferences are upheld on this unit. Local safeguarding procedures should always be followed within the given timescales in order to help protect people living at the home. Improvements are recommended to Quality Assurance to help ensure that services are continually assessed and improved. More involvement of people who live at the home is recommended including obtaining the views of the people and their representatives. It is recommended that Garden View unit be divided up into smaller units in order to be better able to meet the individual needs of the people who live there. 4. OP36 5 OP14 6 7 OP18 OP33 8 OP19 Guardian Care Centre DS0000026946.V370708.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. 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