Inspection on 27/02/06 for Guardian Care Centre

This inspection was carried out on 27th February 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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 26/09/06

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 HOMES FOR OLDER PEOPLE Guardian Care Centre Longton Road Trentham Stoke-on-Trent Staffordshire ST4 8FF Lead Inspector Mrs Yvonne Allen, Mrs Sue Mullin and Mrs Lynne Unannounced Inspection 27 February 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 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.ukl 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.V284882.R01.S.doc Version 5.1 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). 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. 30th August 2005 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. Of those thirty nine beds up to four can be used for palliative care. 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 units 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 Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 5 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. A large laundry facility is situated on the ground floor at ‘Holly Lodge’. ‘Holly Lodge’ is situated to the side of New House and also houses staff facilities. Mayfield Unit is a ten bedded unit which has only very recently opened. 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. Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over six hours by three inspectors. Inspectors toured all the units except Mayfield, which had only been registered by the CSCI very recently. Relevant records and documentation were examined and inspectors held discussions with residents, staff and visitors. Discussions were held with the Registered Manager and feedback was given at the end of the inspection. Not all of the standards were assessed during this visit, but those not assessed or fully met last time were examined. There were some requirements and recommendations made as a result of this inspection. What the service does well: This was a positive inspection with all of the previous requirements and recommendations met from the previous inspection. The planning and delivery of personal and nursing care is very good and care is delivered in a respectful and dignified manner. The health care needs of individuals are well met with evidence of good multi disciplinary working. This also includes the complex and continuing care needs of individuals and the home excels in this area. The staff team are dedicated and skilled and, although staff training was not assessed at this visit, it was evident that the home provides excellent staff training. The home is also recognised for this locally and regularly takes student nurse placements and adaptation of overseas nurses. The environment is purpose built and has been adapted to meet individual needs. The home was found to be well presented and the standards of cleanliness and hygiene were excellent. Specialist equipment and adaptations were provided wherever needed to help individual residents attain and maintain as much independence as possible. Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 7 What has improved since the last inspection? What they could do better: The medication process will need to be tightened up to ensure that errors are avoided and that any such errors are reported to the CSCI and representatives of the individual resident involved. It was felt that the employment of a dedicated activities co-ordinator would enhance the programme of therapeutic activities throughout the units. This is a very large home accommodating a number of residents with very differing needs and warrants a co-ordinator linked to each unit. The CSCI had received three complaints directly since the last inspection and it was felt that some of these could have been avoided if addressed by the unit managers at an early stage. The process of how concerns and complaints are dealt with should be reviewed by the home. Although staff training is very good at the home there were a couple of areas for improvement and this was in relation to POVA training and evidence of staff fire drills. Fire drills could be evidenced more effectively on a matrix system. Formal staff supervision was taking place and staff spoken to confirmed this, but the sessions should include the topics highlighted under standard 36 of the minimum standards for older persons. There was a quality assurance programme in place at the home but little evidence of what action has been taken to address weaknesses highlighted. Please contact the provider for advice of actions taken in response to this Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 8 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.V284882.R01.S.doc Version 5.1 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4 Residents could be assured that their needs would be met at the home by a skilled and dedicated staff team. EVIDENCE: The EMI unit was able to meet the needs of the current residents. The staff had received training in dementia care as well as a range of general care practices. Specialist healthcare staff were involved to provide advice and support and included community nurses specialising in dementia care. Discussions with staff demonstrated that staff were aware of the needs of the residents and how these needs were to be addressed. Staff, spoken to, had an awareness of issues relating to dementia care. The critical and continuing care needs of residents in New House were catered for extremely well by the staff who work there. Staff were found to be very knowledgeable, professional and dedicated. Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 The planned personal, nursing and health care of individuals are well met by the staff at the home and there was evidence of good multi disciplinary working taking place on a regular basis. Care is delivered in a dignified and respectful manner. The medication process will need to be tightened up in order to ensure that residents are fully protected. EVIDENCE: Samples of resident plans were examined during the inspection. Those seen were comprehensively developed identifying the health and personal care needs of the residents and showing the action to be taken and the expected outcomes. The home had long and short terms care plans in place. There was evidence of ongoing health monitoring through regular assessments of tissue viability, nutrition and continence. Care plans and nursing interventions were adjusted to meet changed needs. Records showed that the elements of the care plans were being regularly evaluated. Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 12 Files showed that risk assessments were completed in respect of mobility and falls and for the safe movement of residents in the event of fire. Staff reported that relatives were involved in the care planning and review process. There was evidence in most care plans that relatives were contacted when there was any change in the physical/mental condition of residents. All residents had access to a GP and medical examinations took place in residents’ bedrooms. The units involved the GPs as necessary and undertook regular clinical assessments to identify individual nursing interventions. The home clearly identified the health care needs of each resident and plans were in place to meet their needs. Residents were assessed to identify those at risk of developing pressure sores and appropriate interventions were in place with the necessary records and monitoring taking place. The staff informed the inspector that any residents who were receiving residential care were supported by the District Nursing services. The home had the necessary equipment and practices in place to promote tissue viability and to aide prevention and the home involved the specialist tissue viability nurse to provide advice and support. Each resident had a risk of cot side entrapment and night staff completed any risk assessments associated with a potential for sleep deprivation. Records showed that the continence needs of residents had been assessed and plans were in place to respond to their individual needs. The home monitored the psychological needs of the residents and involved specialist mental health staff when required Fall risk assessments were in place and residents were seen to have appropriate good fitting footwear. The units undertook nutritional assessments and where it was felt necessary a nutritional care plan was put in place. This was being monitored. Fluid and food intake was where required. Residents were being weighed at least monthly and records were being kept to explain the reasons why when this had not been able to be undertaken. The medication process was inspected on Garden walk. The unit had a clinical room where the medication was kept. The unit had a fridge for medication and this was kept at an appropriate temperature and was defrosted regularly. There were correct storage facilities available for keeping controlled drugs and there was a controlled drugs register that when checked by the inspector was found to have been completed in line with NMC requirements. A qualified nurse administers all medication and a sample of medication administration records was checked and these showed that medication was Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 13 being administered appropriately. Any gaps in the records identified the reason why medication had not been administered for example refused. The home had in place a sample of nurse’s signatures that corresponded with those on the medication records. Photographs of residents were also in place. The unit had several oxygen cylinders with at least four that had been awaiting collection for some months which need to be collected with some urgency, as they could pose a fire safety hazard. The cylinders were chained to the wall and correctly stored. There was some uncertainty of drug disposal and the inspector was given conflicting information. There were no containers for disposal of medications seen in the home in line with the new regulations. The pharmacy that deliver the medication to the nursing home appear to be collecting returns but this was not in line with new regulations brought into line in July 2005. Two residents were admitted on the same day and at some point a week or so after their admission, one resident was given the other’s medication by mistake. The GP and pharmacy were informed but not the residents relatives or CSCI. The unit manager stated that both residents would have had photos in place at the time but she did not really know why the mistake had happened, as the drugs were quite different. The Christian names were similar although not the same. The GP asked the care staff to be aware of side effects such as diarrhoea, which she did in fact suffer from and this was documented in her care notes. More robust measures must be taken to ensure mistakes like this do not recur and relatives and the CSCI should always be informed of such untoward events. Observation showed that the staff respected the privacy of the residents and that they were treated with respect. Staff interacted with residents in a relaxed and positive manner. Staff explained to residents any actions they were taking and were caring in their attitude towards them. Issue such as incontinence were dealt with discreetly and privately. Changes of clothes due to spillages were dealt with a relaxed manner. Observation and discussions with staff confirmed that the residents wore their own clothes and all the residents were suitable dressed and their clothes were of a good standard and appeared well kept and laundered. Visitors were able to visit at any reasonable time and could see a relative in their bedroom or in one of the lounges. Staff stated that visitors would take their relative in the garden in the warm weather One inspector engaged several members of staff in conversation about aspects of the care home and this is what they stated, ‘We always like to have a laugh Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 14 with the residents, we offer them good care and look after them well.’ ‘We all get on well together and work as one big team’. In New House two individual service user’s care plans were examined and were very well written, detailed and comprehensive and reflected the current needs of the service users. The documentation seen and a discussion with service users, relatives and staff confirmed that health and personal care needs were being well met. All aspects of daily living were contained within the care plans and reviewed monthly. Risk assessments were also completed and reviewed monthly. Records also evidenced visits to the home by other health professionals as required. The medication procedure on New House was examined and the administration, storage and disposal of all drugs were in order. MAR charts were examined and had been completed in line with NMC requirements. The storage and administration of controlled medication was examined and stocks in the bottles were checked and tallied with the register stock levels. All residents had a current photograph in place on the MAR sheets and a list of staff specimen signatures was in place for the on-going protection of the service users. Observation of staff and their interaction with the service users confirmed that there was a respectful regard for service users. Service users stated that staff treated them with dignity and respected their need for privacy when required. Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Residents are supported to make choices in relation to the routines of the day and dietary preferences. The delivery of social and therapeutic activities in a home of this size would be aided and enhanced by the employment of dedicated activity co-ordinators on each unit. EVIDENCE: The routines within the unit were quite flexible to meet the needs of the residents. Residents were able to get up at a time of their choosing and could go to bed when they wished. A number of residents had disturbed sleeping patterns and the unit was able to respond to residents who got up a number of times in the night. Meals were provided within a time framework although breakfast could be served over quite a lengthy period. Residents were able to access their bedrooms during the day and those that were able were free to move around the unit and to use any of the communal rooms. There were organised activities arranged by the activity coordinator for the whole site. The units did not have a designated activity staff member that spent regular time five days a week. Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 16 The inspector spoke to several residents on the nursing unit downstairs who reported a lack of schedule that was flexible to respond to the needs and moods of the residents. The care staff were designated in an ad hoc manner to provide an in unit activity programme which did not appear to have any structure One resident described how she wanted to be able to do some painting or other activities including craftwork and chair physical activity sessions. There were 10 – 11 residents whom staff confirmed liked to read the daily newspapers and would join in more activities on the general unit downstairs. The examination of the care records showed that the unit obtained information from relatives over residents’ interests but there was only a little evidence that the activities they undertook in the unit were recorded. The home provided a varied menu operating four-weekly. A hot breakfast as well as cereals, porridge and toast were provided for those residents that wished it. Breakfast was served over a fairly flexible period and it was recommended that some food, toast for example, be available for those residents that get up early. The main meal was provided at lunchtime with soup and sandwiches being provided in the early evening. A dessert was provided with both meals. Yoghurts were available for every meal. A choice of main meal was always provided and the home could respond to particular requests such as omelettes. The home ensured that there were adequate snacks available between meals for supper and during the night if needed. The home also provided fresh fruit. Nutritional assessments were completed and residents weight was being monitored. The home provided for special diets such as low fat and diabetic and was providing soft and pureed foods. The daily menus were displayed and meals were observed being served on the ground floor unit. Staff were observed assisting residents with eating, which was undertaken in a sensitive manner. When staff were asked about their opinion of the food served in the home they reported ‘The kitchen staff tell us, if they wouldn’t eat it they wouldn’t serve it’. ‘For breakfast the kitchen serves lovely fresh omelettes; they are spot on – with tomatoes served on top. ‘Even those residents who require a liquidised diet get a full English breakfast’ ‘we eat the food here and it is good, last Sunday there was a lovely roast dinner with fresh vegetables and all the trimmings’. Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 17 Service users likes and dislikes were recorded in the care plans. Outings were arranged for service users to Trentham Gardens, shopping trips, the local public house etc. For those service users who were bed bound, records and observation evidenced that a range of therapies were used to stimulate and motivate service users. Records showed that strenuous efforts had been made to meet the social, religious and cultural needs of a service user from an ethnic minority group in consultation with the family. On New House the inspector observed lunch being served and the food appeared to be attractively presented and well balanced. The upstairs dining room was bright, modern and clean providing a pleasant environment for service users to enjoy their meals. The dining room downstairs was also pleasant and on the day of the inspection, birthday banners were hanging in the dining room for two service users who were celebrating a birthday on that day. Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 The complaints procedure was accessible but the number of complaints referred directly to the CSCI would suggest that these might be reduced if they were dealt with more effectively as concerns at an early stage. The legal rights of individual residents are upheld wherever possible. EVIDENCE: The home supported residents to have their legal rights upheld. Residents were able to consult with their legal representatives in private. Postal votes were available and the home reported election cards being delivered to the home yearly. Staff supported residents to vote at the local polling station if mobility access was available at those polling stations. Residents were able to access advocates if necessary. The home supported residents to receive their mail unopened and have private access to telephones. The home offered a free service to residents from the homes cordless phones if necessary or the use of a pay phone in the small lounge. Two residents have their own landline installed and several others had their own mobile phones. The Unit Manager confirmed that service users were asked if they wished to have a postal vote or required a lift to the electoral polling station when national and local elections were in progress. She also confirmed that each year, information regarding those living in the home was updated and sent to the local authority in order for the service users to be added to the electoral register and therefore, eligible to vote. Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 19 There was a clear and accessible complaints procedure in place at the home. Since the last inspection the CSCI have received three complaints directly. The home has a Vulnerable Adults policy as well as a Whistle blowing policy and staff are made aware of this on induction. It is recommended that, in order to ensure that all staff members are aware of the local VA policy, more staff training in this area be organised. Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 Residents live in a comfortable environment, which is safe, clean and well presented and has been adapted to suit individual needs. EVIDENCE: The units were generally well decorated and maintained. The home had a programme for maintenance and for the refurbishment of bedrooms. All the bedrooms seen in the units were of a good standard and were light and airy. The units had suitable communal areas. Each unit was divided into two distinct adjoining areas and each area had two lounges and a dining room. Furnishings and the decoration in the lounges was suitable and was quite homely. The dining rooms provided ample space for the residents and each one had sufficient tables/chairs. The EMI unit was on the first floor and this meant that any access to the garden had to be supervised by staff. Staff confirmed that in warm weather residents did on occasions go into the garden. Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 21 The units had adequate toilet and bathing facilities and all bedrooms had en suite toilet facilities. The units had sufficient bathrooms level access shower rooms. All bath and shower rooms had toilet facilities. In addition the unit had adequate separate toilets. All these facilities were lockable. All seen were clean, and had soap and paper towels. The units had the necessary adaptations corridors had grab rails throughout and toilets were fitted with handrails and frames. Wheelchair accessibility was provided. The units had suitable equipment to aid safe moving and handling, which included mobile hoists. The units had fully operational nurse call systems. The home had two vertical lifts enabling residents to access both floors of the home. The home has a new mechanical bed on loan, which is proving to be very popular, and they are hoping to be able to provide more in the future. All the bedrooms had washbasin facilities. Bedrooms were provided with wardrobes, chest of drawers and at least one chair. Bedrooms had appropriate lighting with one over the bed and were suitably furnished and decorated. Most bedrooms were carpeted but some had non-slip vinyl flooring. Observation showed that rooms were personalised with a range of pictures, ornaments and flowers. Residents were able to bring in small items of furniture and personal possessions The units were suitably heated and there was adequate lighting provided. Bedrooms were suitably ventilated. All bedrooms were centrally heated with radiators having individual controls fitted. Radiators did not pose a risk to the residents. Water tested in the rooms was at a suitable temperature. All areas seen on the inspection were observed to be clean and tidy throughout. A discussion with the domestic staff member confirmed that cleaning schedules were in place and that these were being adhered to. The home had extra cleaning schedules in place to respond to unpleasant odours by way of a male member of staff who would clean the floors of rooms with any malodours The units had procedures in place for the control of infection and hand washing facilities were available to staff throughout. The unit had an ample supply of aprons and gloves, which did not cause irritation to the skin. A tour of the units in New House evidenced that they were well maintained and accessible for the service users. Externally, an enclosed patio area provided a safe and enjoyable area for the service users, which included a greenhouse used to grow seedlings, tomatoes etc, a fountain, bird table, seating etc. Staff confirmed that this area was used extensively in the summer for barbeques. Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 22 Inside the home there was a separate smoking room and an activities room, which was sometimes used for the children of service users when visiting their parent. In addition to this, two computers were situated next to the activities room for use by the service users, one of which had Internet connection. Communal areas were satisfactory and furnishings were domestic in character and bright and clean. Specialist equipment was provided and included specialist hospital beds, chairs, a Jacuzzi bath, and environmental controls for nurse call to promote independence. The bedrooms were clean and homely with satisfactory fittings and furnishings. Service users had many of their own possessions in their rooms and each room contained restricted wardrobes and smoke alarms for the safety of the service users. However, in some bedrooms, the radiators were far too hot and it is a requirement of this report that the heating system be checked to ensure guaranteed low temperature surfaces for the safety of the service users. There was a rolling programme of redecoration and refurbishment at the home and records were seen of improvements, which had taken place since the last inspection and those planned for this year. The Estates Manager oversaw this programme. Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29 Staff are carefully selected to work at the care home and residents’ needs are met by the numbers and skill mix of staff. EVIDENCE: At the time of the inspection there were 38 residents receiving general nursing care on Garden Walk. There were no vacancies as one double is only used as a single and the unit considers itself full at 38 occupancy. It was identified that one resident receives one to one nursing for two hours each morning and afternoon. However, it was disappointing to note that of the three full time employed care staff, including an adaptation nurse and a care supervisor interviewed, no one was able to inform the inspector why she needed this extra amount of care input. This was later discussed during the feedback with the care manager, who stated that she would follow this up. The unit has a senior nurse manager who has one supernumerary shift a week to complete her management duties. The shifts were either; 7.00am – 1.00pm or 8.00am – 2.00pm – with 1 qualified nurse and 7 care staff 7.00am – 7.00pm or 8.00am – 8.00pm – with 1 qualified nurse and 7 care staff Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 24 Night shifts were 7.00pm – 7.00am – with 1 qualified nurse and 3 care staff On the day of the inspection there was also a student nurse who was supernumerary and on a learning module from University of North Staffs. A domestic staff was engaged in conversation and it was determined that one domestic is employed for a full day on each of the units over a seven day period. This level on ancillary staff was acceptable to the CSCI and all areas of the home seen were clean and hygienic. The domestic went on to inform the inspector that she had adequate good quality supplies available to her at all times. COSHH was discussed and fully understood by the employee; data sheets were available on each unit. This lady had only been employed in the home for three months but stated that ‘ the staff here have been very helpful and friendly towards me- I am not treated a just a cleaner’. On Garden View at the time of the inspection there were 36 residents suffering with forms of dementia requiring 24 hour nursing care, which included one in hospital. There were four vacancies. The above shift pattern is the same and the unit also has a senior nurse manager, who has one supernumerary shift a week to complete his management duties. Care staffing levels and skill mix were found to be satisfactory on both units. A care assistant accompanied the inspector around the EMI unit and was very enthusiastic about the teamwork on the unit. She explained that she had been welcomed into the home and encouraged to use her own initiative. She spoke highly if the unit manager and explained that all the staff work together for one goal to meet the residents needs. Training was high on the homes agenda and this member of the care staff confirmed that she was urged to learn more about dementia care and felt valued by the company. On New House staffing rotas evidenced that the numbers and skills of staff were appropriate to meet the needs of the service users. On the day of the inspection there was the unit manager plus three registered nurses, one care supervisor and eight care assistants plus two adaptation nurses on Court Walk and two registered nurses, two care supervisors, six care assistants and three adaptation nurses. Most of these staff worked from 8.00 a.m. to 8.00 p.m. and these staffing levels were deemed sufficient to meet the needs of the service users living in the home at that time. The staff recruitment procedure was assessed and six employee files were examined. These all related to staff that had recently been recruited to work at the home. Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 25 All these files contained CRB and POVA checks and contained two written references. All but two contained proof of identification. The two, which did not fully meet the requirements, were highlighted during feedback. Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34, 35, 36 and 38 The home is run in the best interests of the residents. Audits undertaken will need to evidence what action has been taken to address the weaknesses highlighted in systems. EVIDENCE: The process of quality assurance was assessed. There were examples seen of various audits, which had been carried out over recent months. These included audits of care plans, medication and accidents. It is recommended that this process be developed further to include seeking the views of residents. It is also recommended that audits contain evidence of the action taken as a result of the auditing. There were examples seen of where action was needed Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 27 in order to address weaknesses but there was no evidence of what action had been taken. Company financial viability was discussed with the registered manager and the inspector saw the statistical analysis of occupancy for the home. The home was also in the process of expanding with one new unit recently built and another adjoining unit in the process of being built. The inspector did not have any concerns regarding financial viability of the company at the time of the inspection. The administration of residents’ finances was assessed and records were found to be in order. Receipts were maintained so as to allow for audit trails to be carried out. Monies and valuables could be handed in for safekeeping. Residents also had a lockable facility in their bedrooms. The system for staff supervision was examined. There was evidence that formal supervision was taking place on a regular basis. Staff spoken to also confirmed that they were having supervision. It is recommended that the content of the supervision be reviewed and developed to include the information outlined under standard 36 of the minimum standards for older people. The arrangements in place for staff mandatory training were examined. There was evidence that this was taking place on a continuous basis and staff spoken to confirmed that they received regular update sessions in mandatory training. There were records of staff having received training in fire safety, first aid, COSHH, food safety awareness, infection control and moving and handling. There were records of fire drills having taken place for both day and night staff but it was difficult to identify how many fire drills each staff member had taken part in per year. It is recommended that a matrix be maintained for fire drills so that this can be more easily identified. Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 4 3 3 3 4 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 3 3 3 x 3 Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 29 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 OP9 Regulation 13(2) Requirement More robust measures must be taken to ensure that medication errors this do not recur and relatives and the CSCI should always be informed of such untoward events Timescale for action 28/03/06 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 Refer to Standard OP12 OP16 Good Practice Recommendations It is recommended that an activities co-ordinator be appointed to each unit. It is recommended that concerns be dealt with more effectively by the home at an early stage. This may help to prevent them becoming complaints sent directly to the CSCI later. Audits carried out should display what action has been taken as a result of highlighting weaknesses in systems. The formal staff supervision procedure should include the information outlined under standard 36. The number of fire drills attended by individual staff members should be made clearer for inspection purposes. DS0000026946.V284882.R01.S.doc Version 5.1 Page 30 3 4 5 OP33 OP36 OP38 Guardian Care Centre 6 OP18 More POVA training for staff should be organised. Guardian Care Centre DS0000026946.V284882.R01.S.doc Version 5.1 Page 31 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. 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