Inspection on 26/09/06 for Guardian Care Centre

This inspection was carried out on 26th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 21/08/08

Guardian Care Centre 03/07/07

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 08/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Guardian Care Centre Longton Road Trentham Stoke-on-Trent Staffordshire ST4 8FF Lead Inspector Mrs Y Allen. Mrs S Mullin Mrs W Jones Mrs W Grainger Key Unnanounced Inspection 26 September 2006 10:00 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.V313580.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.V313580.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 133 Category(ies) of Dementia - over 65 years of age (40), Physical registration, with number disability (44), Physical disability over 65 years of places of age (54) Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Maximum number of persons to be admitted to Guardian Care Centre are 133. Maximum number of persons to be admitted to New House are 44 with physical disability (PD) aged 18 - 65 years on admission. 12 persons may have an associated mental disorder (MD). 12 persons, aged 30 - 65 years on admission, may have early onset dementia (DE). 6 persons may have a learning disability (LD). 1 named individual may be 68 years of age on admission. Admittance of one `named service user` aged 60 years with central nervous system disorder to the New House Unit. Maximum number of persons to be admitted to Selwyn House are 79 aged 65 years and above on admission. 40 persons may be admitted to Garden View with dementia DE(E). 39 persons may be admitted to Garden Walk OP, PD(E). 4 persons may be admitted to Garden Walk with a terminal illness (TI). Within Garden Walk, up to 6 persons who require nursing care may have dementia needs. Maximum number of persons to be admitted to Mayfield Unit are ten PD aged 18 - 65 . Admission of one named service user aged 67 years of age to Mayfield Unit 27th February 2006 3. 4. 5. Date of last inspection 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 and 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.V313580.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 the first part of a twenty-bedded unit. This is a very modern, state of the art unit, which can accommodate up to ten residents 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 room. The second part of this unit was almost complete at the time of the inspection and the provider had applied to the CSCI for registration. 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. This information was provided by the administration department of the home on 17/10/06. Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was carried out by four inspectors and the field visit took 6 hours to complete. All the key standards were assessed relating to older persons and younger adults. Evidence was gathered using the following methods – Tour of all the units including the kitchen and laundry areas. Discussions held with staff members and Care Director. Discussions held with residents and visitors. Examination of records and documents and case tracking of individual residents. Discussion with the GP. At the end of the field visit verbal feedback was given to the Care Director. There were no immediate requirements left. Other requirements and recommendations were made and are included at the end of this report. The following written comments were received from representatives of residents accommodated at the home however it was not documented which units of the home these comments pertain to – “Excellent care, approachable staff, willing to listen to any concerns.” “Very impressed and satisfied by the standard of care given to my mother. Staff are always pleasant and helpful.” “Mr… has only been in the care home for a short time but all of his family are delighted with the care and attention that he receives on a daily basis.” “My wife is having excellent care. The staff are excellent and cannot do enough –always smiling in difficult circumstances and always tell me about my wife. Cannot speak too highly of them.” “I go to see my relative every day and we are more than well looked after with cups of tea and sometimes biscuits. I personally cannot fault the care and attention given to my relative and the way others are cared for.” “Staff do listen if we are unhappy about something, they will amend it if possible or come to some arrangement for both parties.” “Our relative is happy at Guardian care. She is looked after by all the staff from management right down the scale. So we are content and have peace of mind knowing she is well cared for and safe.” Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 7 “My relative is on a non-gluten diet and the home caters for this always.” “Appears a very well run home. Staff always helpful and happy. My relative is being cared for to a much higher standard than when he was in hospital and appears happy, contented and settled for the first time in nearly a year.” “The staff and the care workers always take very good care of my relative they are always helpful and kind. We would not know how we would cope without them.” “We have tried to explain the severity of our relative’s medical issues but feel like it is ignored and treated in an ignorant manner.” With reference to activities – “ very few. There are no on going day-to-day activities. There is only 1 activities organiser for 3 homes.” With reference to making a complaint – “never been given information about this procedure. I am afraid to complain too much for fear that they say they can’t cope with our relative anymore.” With reference to the cleanliness of the home – “could be a lot cleaner. Cot sides never cleaned unless the home has an inspection approaching. The home never smells clean – when you enter a room it smells terrible.” Inspectors were made to feel welcome by all the staff and residents in the home. The Care Managers of Garden Walk, Garden View and Mayfield Unit were present at the time as was the Care Director. This is a large busy home with visitors and visiting professionals coming and going throughout the day. The inspection was carried out with as little intrusion to daily routines as possible. The GP from the local surgery was visiting the home at the time of the inspection and he invited the inspector to the surgery to speak with him. This home excels in some areas as highlighted in the report and, on some units the home could be classed as a centre of excellence. However, there are areas of weaknesses, which have also been highlighted, and this has a bearing on the overall scoring of the standards in the report. The providers must provide the CSCI with an improvement plan highlighting how these areas will be improved upon. Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 8 What the service does well: What has improved since the last inspection? What they could do better: Some of the working practices on Garden View unit need to be reviewed and the delivery of care on this unit needs to be improved upon. There needs to be evidence, on the above unit, that autonomy and individual choices are upheld and promoted for this very vulnerable client group. A policy must be developed for the use of Kirton type chairs and the use of these chairs should be avoided wherever possible. Individual residents must be aided to mobilise on a regular basis and staff should be provided in sufficient numbers in order to do this. The management approach on this unit needs to be reviewed and there needs to be good working relationships with other outside professionals. The staff recruitment procedure has areas of weakness where improvements are needed. This has been raised at previous inspections. All staff must receive regular mandatory training and supervision and this must be documented. NVQ training should be developed further in order for the home to achieve the minimum standard for this. Some catering procedures are in need of improvement and attention must be paid to maintenance of cleanliness within this area. Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 9 The serving of meals in relation to soft liquidised diets must be improved upon and, on Garden View, the dining procedure requires reviewing. Attention is required in relation to some health and safety and maintenance issues around the home. Some of the carpets are in need of replacement. Individual plans must contain regular reviews as indicated and, wherever possible these must involve participation by the resident and/or his representative. 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. Guardian Care Centre DS0000026946.V313580.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.V313580.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 to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents, representatives and placement officers are provided with sufficient information about the home and residents undergo a thorough assessment of their needs prior to admission. EVIDENCE: The initial assessment is generally carried out by the funding authority, once this is done, the home looks at the referral and if they feel they can possibly meet the prospective residents needs they will then go out and meet them their own environment and complete their own full assessment. Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 12 The Pre admission assessments on the seven care plans seen during the inspection were very comprehensive and meet the criteria specified in standard 2.3. A selection of three care plans were examined on New House and four from Selwyn House during the inspection and the care provision of those residents was tracked. It was identified that the care plans seen were developed well. There was a full initial assessment, which identified individual problems/needs, and care plans had been developed in respect of these and all residents had working care plans in place. Evaluations had been documented in the care plan and referred to in the daily report. There were clear daily entries when there were incidents of aggression or violence and action plans and risk assessments had been formulated and implemented to manage those clearly identified problems. There was evidence of regular reviews for all care planning activities. The information in the care records demonstrated that social workers and health professional are regularly consulted about the ongoing requirements of residents and there was evidence that professional advice was recorded and acted upon. Where significant changes in care needs had been determined, multi disciplinary meetings/reviews are undertaken to ensure that these issues are appropriately addressed. Weights were regularly recorded in the care plan. Regular audits of care plans were undertaken by unit managers and were seen in the file on one resident case tracked. Each care plan seen had a copy of specimen signatures of staff at the front of the file, so it was easy to cross reference which member of staff completed entries. Care staff when questioned were very knowledgeable about individual disabilities. Senior staff were seen to be very diligent in deploying and directing junior members of staff. On Garden Walk the manager showed the inspector how she assesses individual risk by taking her laptop out with her when she carries out preadmission assessment of needs for individuals. These assessments were very thorough and is a very pro-active approach to ensuring that individual needs will be met by the home. Guardian Care Centre DS0000026946.V313580.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 to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10, (older adults) and 6,18,19,20 (younger adults) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Personal and individual health care needs are planned, reviewed and monitored on all the units throughout the home. There is a need for a review and improvement plan in relation to Garden View unit. EVIDENCE: Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 14 New House is split in to two floors, the ground floor accommodating very profoundly disabled residents. The vast majority of these residents are unable to communicate or actively take part in recreational activities. However the home provides therapeutic sessions including hydrotherapy, reflexology and sensory stimulatory sessions during the week. The care staff report that no resident on this floor was well enough to attend day care services. On the first floor of New House, some residents are more able to communicate and the unit manager confirmed that they have opportunities to attend a range of recreational events. There was some type of activity planned on a daily basis for each person, which had been agreed as part of the Person Centred Planning approach. Following discussion with a male resident and from observation, it was confirmed that in house activity is organised based on individual needs. On New House daily routines are developed with residents best interests at heart. The majority of residents are unable to make any decisions for themselves in this regard and staff are sensitive to that. For those residents who can decide on their daily routines these are accommodated and recorded in to their care plans. On Garden View and garden Walk staff were observed helping residents to eat their lunchtime meal. Another resident spoken to commented that she was happy with her meals and the care provided. On Garden View individual care plans examined documented that each time they are reviewed then this should be done with the individual’s representative. Whilst there was evidence that this had been done in some care plans, in one of the plans examined this had not taken place since 10/09/05. A lack of communication between staff and relatives had been an area of concern raised with the inspector. Some healthcare professionals had raised concerns about the above unit and that it can be difficult to arrange reviews and meetings sometimes. Some healthcare professionals had mentioned their concerns about the number of “Kirton” chairs used on this unit as restraint. This was observed on the day of the visit. Examination of care plans revealed that there had been a risk assessment carried out prior to the use of these chairs for all the individuals and discussions had taken place with representatives and healthcare professionals at review meetings. However, there was more of this type of chair being used on this unit than seen on other similar units and this gave the inspector rise for concern. Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 15 The CSCI does not recommend the use of this type of chair. Providers must address this and, as required for supervision of residents, more staff must be provided on this unit. These types of chair must only be used in the most pressing and concerning of cases and as a last resort following a multi disciplinary team meeting and agreement. A policy for the use of Kirton type chairs, which takes the above into account, must be implemented by the providers and a copy of this given to the CSCI. On all the units throughout the home, staff were observed treating residents with dignity and respect. Contact with significant others is encouraged by the home and facilitated for where possible. Visitors are able to meet their relatives in the lounges or bedrooms. Staff were observed on Garden View and Garden Walk helping some residents with mobility and to maintain independence using a Zimmer frame. On New House one Resident spoken to during the inspection confirmed that staff treated him with respect and he felt that his privacy and dignity was maintained at all times. On all units, residents receive additional, specialist support and advice as needed from physiotherapists, occupational therapist and speech therapists. Suitable equipment is provided where required. There was evidence of residents visiting GPs and other professionals including optician, chiropodist, dentist and hospital appointments. All visits either in or outside the home were clearly recorded. Care staff stated that they maintained a good working relationship with all members of the multi disciplinary team. The individual needs of personal hygiene requirements were very clear. On New House all care planning as far as possible was agreed with the residents (and families if agreed by residents) reviewed regularly with the goal of encouraging full independence where possible. The receipt, storage, administration and disposal of medication was examined on the ground floor of New House and on both floors in Selwyn House and this was found to be in compliance with requirements. Medication Administration Record sheets were examined and these had been completed as required. The GP raised some concerns about local policies in relation to medication in a home of this size and he has been discussing this with the PCT. Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 (older persons) and 11,12,13,14,15 and 17 (younger adults) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. On most of the units throughout the home residents are helped to exercise choice and control over their daily lives. However there is a requirement for this area to be reviewed, further developed and improved on Garden View unit. EVIDENCE: Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 17 The home provides a mini bus with ramped access for residents who require wheelchairs or who have mobility difficulties. This is regularly used to visit local areas of interest and other outings. All residents on New House are provided with opportunities to develop effective social, emotional and communication channels. The philosophy of the unit continues to encourage all resident’s to maintain and develop optimum levels of skill and independence. No residents were attending any educational sessions due to the current levels of disabilities. It was identified by conversation with staff and a resident that residents are actively encouraged to maintain relationships with friends and family outside the home. On Garden View unit, from observation on the day of the visit, and through comments received from relatives of previous residents of the home (four in total) – who have since moved to other homes, it was identified that there is a need for improvement in the way the unit is run. Garden View accommodates individuals with mental health needs (elderly). It was noted that there is a definite routine to the unit, which appeared to be geared around staff shifts rather than the meeting needs of individual residents. Inspectors were informed by these relatives, and existing staff, that a number of residents are got up early in the morning – about 15-20 of the 40 accommodated, well before 8am, then taken to the lounge, then taken to the dining room for breakfast, then back to the lounge. Investigation of a complaint during 2005 had identified that this had been an issue. On the day of the visit, residents were taken to sit in the dining room at 11.30am to wait for lunch, which did not arrive until 12.30-1pm. The lunchtime routine was inefficient, with meals left on the side going cold after being sent up from the kitchen in the dumb waiter. There were no homely touches to the dining room and the dining experience was somewhat institutionalised. The only drinks seen being served at lunchtime were cold juices. Two residents were spoken to whilst they were dining and one stated that he would have preferred a cup of tea with his meal. Staff spoken to commented that the serving of hot drinks is not encouraged. One reason given for this was that “It causes them to urinate more at night”. Very few residents accommodated on this unit are able to express their wishes and preferences and staff need to rely on history taken from the family and friends. There was very little evidence that personal choices and preferences in respect of food and drinks were being upheld on this unit. Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 18 There was a list in the dining room but this was documenting mainly allergies, with few preferences. This was something, which had been of concern to the relatives mentioned above. Working practices need to be reviewed on this unit. On New House one resident case tracked was a Muslim lady who had sustained severe injuries after a road traffic accident. She was now in a persistent vegetative state and needed full 24 nursing care. The resident and her family are very religious and the care staff are diligent in ensuring her cultural and spiritual needs are met. The lady is not fully immersed in water she is suspended on a soft platform above the bath and jugs of water of poured over her to bathe her. This water is infused with Holy water the family bring back to the UK from Saudi Arabia. Additionally she wears religious artefacts at all times in keeping with her faith. The family visit and the staff support them with time to pray together. Following interviews with staff, they all satisfactorily described how they would support service users with their personal care needs while ensuring their privacy and dignity. Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 (older persons) and 22 and 23 (younger adults) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The policy for raising concerns and complaints was clear and accessible. Staff are given POVA training and residents are protected by the local policies but the recruitment procedure needs to be tightened up in order to ensure that only suitable staff work at the home thus protecting vulnerable residents. EVIDENCE: The home had a comprehensive complaints procedure in place in the lobby of the home. The staff assured the inspector that all complaints/concerns are recorded along with any remedial action put in to place to resolve issues. There had been two complaints dealt with by the CSCI since the last inspection, neither of which had been upheld. Both were in reference to Garden View Unit. The home ensures that the legal rights of residents are protected and maintained whilst they are accommodated in the home. Some residents had Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 20 used advocacy services in the past and staff confirmed that these services were easily accessible should the need arise. Discussions took place with staff regarding measures taken to protect residents from all forms of abuse. POVA training had been delivered to all those spoken to. The staff were very proactive in enabling residents to live their lives free from fear of abuse and were clear about the correct procedures to be employed, should any abuse be suspected. Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 (older persons) and 24 and 30 (younger adults) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals live in a home, which has been adapted to meet their needs and is pleasantly presented in most areas. However there are areas in need of improvement and some catering procedures require reviewing. EVIDENCE: Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 22 Selwyn House is separated into two floors each offering alternative care to diverse groups of residents. Within the house is the main kitchen off the dining room from Garden Walk. A number of concerns were identified and discussed at feedback and with the catering staff. A large quantity of the food had been prepared in advance for the following day. Three omelettes had been prepared ready for evening meal on the day of the inspection. Pureed food was served in a most unattractive manner combined in a bowl. Food served as soft or liquidised should be served as separate portions – i.e. – of vegetables, meat, so as to be more attractively presented for residents. The fridge/freezer in the kitchen had a split seal, the inspector was told that management had been made aware of this and the issue was to be addressed. The potatoes in the outdoor shed should be raised off the ground to prevent any infestation. One of the freezers contained two foil wrapped food items where the packing was split and freezer burn could occur if left. For the majority of the fridge freezers and fridges the seals were in an unacceptable hygienic condition, this was pointed out to the catering team. The inspector identified that not all the dining rooms had the niceties of homeliness of either tablecloths and or placemats. This formed part of the feed back discussion. Garden Walk A sample of the bedrooms and bathing facilities were seen, the door for bedroom 16 needed adjusting to ensure that it was effective in the event of a fire. Bedrooms had been adapted to meet individual needs and contained personal possessions. The bathroom near to bedroom 14 had a loose toilet seat which was a potential hazard. The bath mat in the bath, had faeces adhered to it and this was pointed out to the person in charge. Garden View The seal in the dining room fridge was split and needed replacement. The sample of bedrooms identified a well-maintained environment. The decoration however in bedroom 34 was in need of reviewing, and the bed head was detached from the bed posing a potential hazard. On checking the maintenance record there was no evidence of the broken emergency nurse call cord in the en suite in bedroom 6. This was discussed Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 23 with the handyman who was on site. Issues relating to repairs should be identified on the monthly audit of the units and reported. A bathroom registered for the use of residents was identified as being used for the storage of hoists. This would be a potential hazard for residents using the toilet in the facility. An alternative area should be found for storage. Within a cupboard in the unit was a box of Latex gloves; it is inadvisable to use this type of equipment due to a high risk of an allergic reaction. Staff on duty confirmed that they used them for the taking of bloods. The manager in charge of the unit could not evidence a risk assessment for the staff or individuals receiving treatment by staff wearing the gloves. The trained nurse agreed not to use the gloves again. If this equipment is to be used as normal practice then all the staff and all the residents should have individually written risk assessments. In New House – A sample tour of the unit identified that residents had space to wander freely around their home. Some residents remained in their bedrooms. The room used for respite was clinical in its design and offered no homely touches on the walls. It is recommended that this room be reviewed, as while in use it is someone’s home. The tiles in the shower room would benefit from steam cleaning and repairing the cracked one near the base. Carpets in corridors were stained and aged especially near to the communal lounge. The inspector was told that they were to be replaced. In the event that this was to take any length of time then the carpets require an industrial clean. Bedrooms evidenced many personal possessions; the decorating programme was on going. Bedroom 12 evidenced broken plaster around the door. The inspector was told that the maintenance person repairs the surround when necessary. It was suggested that a metal surround fixed around the frame would prevent the breaking up of the plaster. This was part of the feed back discussions. Mayfield CourtThis recently opened unit was exceptional in its design and facilities. At the time of the inspection the unit had five residents. With one to one care to meet the complex needs of the residents. This area had a hot tub, snooselem with waterbed. Residents appeared relaxed and comfortable. Across the unit the standards of hygiene achieved by the housekeeping staff should be commended. Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 (older persons) and 32,33,34 and 35 (younger adults) The outcome for this standard was good. This judgement has been made using available evidence including a visit to this service. Staff training is very good at this home although the standard required level of NVQ training had not been met and residents are cared for by a skilled and competent workforce. EVIDENCE: The care staff work 8 – 8 for the day shift and 8 – 8 for the night shift. New House – On the ground floor unit there were 22 residents and at the time of the inspection there were 4 qualified nurses and 9 care staff. (A further rostered member of care staff was off sick) Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 25 On the upstairs unit there were 19 residents and two qualified nurses and 11 care staff on duty at the time of the inspection. A sample of staff rota’s showed staffing levels were supplied in adequate numbers to meet the needs of service users. The figures for the period 20/08/06 and the 10/09/06 showed total weekly hours for care staff equated to between 3815.30 and 4022.00. Qualified staff hours for the same period equated to between 1331.50 and 1196.00 per week. Agency hours were also used to ensure levels were satisfactory, although the manager stated that the number of hours had reduced recently. Court Walk. Provided 3 qualified staff per shift throughout the waking day and according to the records between 10 and 7 care staff. Night staffing included 1 or 2 qualified nurses, and 4 care staff. Court View. Provided 2 qualified staff throughout the waking day and 8 care staff. Night staffing included 1 qualified nurse and 4 care staff. Garden Walk. Provided 2 qualified nurses up until 5pm and 1 from that time and 5 care staff. Night staff included 1 qualified and 3 care staff. Garden View. Provided 1 qualified nurse, with additional support provided by the manager of the unit and 6 care staff. Night staffing included 1 qualified and 3 care staff. Mayfield. Provided 2 qualified staff throughout the waking day, with 6 care staff. Night staff included 1 qualified and 5 care staff. Records showed that additional staff could be rostered on at peak times, dependent on service user need. The service recruits additional ancillary staff including domestic (318.75) per week approximately, laundry (183.75) per week approximately and catering (237.00) per week approximately. The number of NVQ level 2 trained care staff or equivalent was less than the 50 required by the minimum standards, with a total of 49 care staff trained or had an equivalent qualification out of a team of 169. Another 22 staff had enrolled or were undertaking both the level 3 and 2 training. 4 out of the 5administration/office staff had achieved NVQ level 2, and domestic staff had an NVQ. Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 26 A new induction programme had been introduced and appeared to be very comprehensive, feedback from new staff confirmed that they were happy with the introduction to the home. 8 staff were interviewed and confirmed that they were up to date with mandatory training. A sample of 13 staff recruitment files were checked the majority of records required by the Care Homes Regulation 2001 were included in the files. All had application forms that detailed individuals previous work history, 9 had two written references, 2 had 1 references and 2 did not have any references, although it was accepted that the 2 staff had recently been employed and the information available showed that reference requests had been sent. In one example it was recommended that a reference be sought from the individuals last employer in the care field. All files had letters of engagement, contracts, next of kin details, dates of employment, hours to be worked, health declarations, 8 had photographs, and 7 did not. POVA checks had been undertaken on the majority of staff. There was some detail of staff training in the files seen. The training manager confirmed that each member of new staff had the GSCC code of practice and conduct in their induction pack. The main areas of concern relating to recruitment included: Standard Criminal Records Bureau checks had been requested and received for staff. The guidance for all staff who provide care and support for children and vulnerable adults is for an enhanced check to be carried out. This will also be a requirement of this report. Some time was spent with the training manager for the service, who also had senior nurse responsibility for the new Critical Care Unit. She showed how a 3 monthly rolling training programme had been introduced with a range of topics and interests, to promote staff knowledge and expertise. To ensure that night staff were involved as much as possible some of the sessions took place in the late evening. An example of the training schedule for the period from September to November 2006, included Basic Food Awareness, Bed Rails Safety and Risk Assessment, Professional Values, Diversity and Human Rights, Abuse and Protection, Dementia and Challenging Behaviour, Sex and Sexuality, Palliative Care and Breaking Bad News. The induction programme follows a 12-week period, in which staff are expected to have undertaken a range of training, evaluation of the induction is also carried out by the training manager to determine that staff had completed all the component parts. If necessary the induction period can be extended. The training manager gave examples of assistance provided to staff who may Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 27 require additional support. The induction package also includes test sheets and a reflection comments sheet. It was reported that if a new employee successfully completes the induction programme they were nominated for a foundation programme or NVQ training. Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 28 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 (older persons) and 37, 39 and 42 (younger adults) The outcome for this standard was adequate. This judgement has been made using available evidence including a visit to this service. The overall management of this very large home was satisfactory and the home was run in the best interests of the residents who live there with a need for a review of this on Garden View Unit. EVIDENCE: Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 29 From discussion with the staff interviewed during this visit there appeared to be anomalies in the delivery of individual supervision. Some staff reported that they had received a regular 1:1 supervision session and 2 appraisal sessions per year. Others stated that their supervision had not been very frequent and in one example it was reported that the opportunity to receive a supervision session had not occurred. There was also discussion with the training manager about qualified staff receiving clinical supervision. She confirmed that staff were supported to participate in this and were provided with training opportunities to promote professional development. The service routinely undertakes checks of qualified nurses professional registration with the Nursing and Midwifery Council. Each unit had its own Manager as well as the Care Director (Registered manager) for the home. Management of units appeared to be satisfactory with a need for a review of Garden View unit as outlined in this report. Each unit had their own record for the required testing of the fire system coupled with fire drill and training. A fire risk assessment was completed annually and was identified as current. Garden Walk & Garden View records evidenced that staff had been involved in training including the night staff and kitchen staff. There was evidence that records were not current for the month of June at Selwyn and New House when one week in the month (3 rd June) tests were not recorded. In the event that the person responsible is on annual leave then alternative arrangements should be in place. At Mayfield Unit there were a number of weeks where records were incomplete. May, June July and August. There was no written evidence of the night staff taking part in a fire drill for this unit. This was part of the feed back discussions. Records evidenced that the emergency lights were tested as required. The Care Director produced written evidence to confirm that quality auditing is carried out at the home. This auditing also involves obtaining the views of the residents and/or their representatives. Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 30 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 x 5 x 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 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 3 28 3 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 2 33 3 34 x 35 x 36 2 37 x 38 2 Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No 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 OP29 Regulation 19 schedule 2 para 7 Requirement Recruitment practice must include obtaining an Enhanced Criminal Records Bureau Check. The registered person must ensure and evidence that enhanced disclosures have been applied for, for all staff. Two written references must be sought and included in the individual staff file. The registered person must provide evidence that all staff have received mandatory training. Liquidised food must be more attractively presented. The refrigerator seals identified in the report as being split must be made good and kept in a hygienic condition. An alternative method should be considered other than using foil to keep food wrapped whilst stored in the fridge or more regular checks made. Potatoes should be stored off the floor to prevent any infestation contaminating them. The use of Latex gloves is DS0000026946.V313580.R01.S.doc Timescale for action 26/11/06 2 3 OP29 OP38 19 schedule 2 para 3 18 26/11/06 26/11/06 4 5 OP15 OP26 16 (i) 16 (j) 01/11/06 26/10/06 6 OP26 16(g) 31/10/06 7 OP38 13(4)(c) 31/10/06 Page 32 Guardian Care Centre Version 5.2 8 OP19 9 OP38 10 OP7 11 OP8 inadvisable unless the home can demonstrate that full risk assessments have been carried out on each resident in the home and staff members. Bath mats used should be maintained in an appropriately hygienic manner. The carpets referred to in the report were aged and needed replacing. In the event this the time scale is prolonged then industrial cleaning may help. 23(2)(b)(d) Potential hazards to residents were identified with a loose toilet seat, broken nurse call system in one en suite, a detached bed head. No entries in the maintenance book had identified these potential hazards to the appropriate person. The monthly audit of the home must identify these issues including the action taken to address them. 23(4)(c, v, The registered person must e) ensure by means of a fire drill and practices that all the persons working at the home are aware of the procedure to be followed in the event of a fire, including the procedure for saving life. This must be documented. 15(2)(b) The registered person shall ensure that individual plans are kept under review, and, wherever possible, this is carried out with the resident or their representative. 13(7)(8) A policy must be developed for the use of Kirton type chairs and these chairs only used in exceptional circumstances. Where individual residents are able to mobilise but need assistance from staff then staff DS0000026946.V313580.R01.S.doc 26/10/06 26/10/06 30/11/06 30/11/06 Guardian Care Centre Version 5.2 Page 33 12 OP14 12(2) 13 OP15 16(2)(i) and 16(4) 14 OP15 16(2)(i) 15 OP36 18(2)(a) should be provided in sufficient numbers in order to facilitate this. Working practices must be reviewed on Garden View and there must be evidence of the promotion of autonomy and choices for residents in relation to the routines of the day. Residents must be given a choice and their preferences upheld in relation to meals and drinks, the serving of tea and coffee throughout the day must be included in this choice. The procedure for dining must be improved upon in Garden View unit so as to ensure that residents receive their food at the correct temperature. Individual staff supervision must be undertaken at least 6 times per year for all staff and documented. 30/11/06 30/11/06 30/11/06 30/11/06 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 4 Refer to Standard OP28 OP33 OP15 OP32 Good Practice Recommendations The levels of NVQ trained staff should be improved to ensure that 50 of the workforce have the qualification or equivalent. Staff meetings should be held regularly for all levels of staff and documented. The dining experience should be made more congenial and enjoyable for residents on Selwyn House. The manager on Garden View will need to ensure that relationships with outside professionals are maintained and that the unit is run transparently and in the best interests of the residents. More activity co-ordinators should be provided for a home of this size DS0000026946.V313580.R01.S.doc Version 5.2 Page 34 5 OP12 Guardian Care Centre Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Guardian Care Centre DS0000026946.V313580.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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