Inspection on 03/07/07 for Guardian Care Centre

This inspection was carried out on 3rd July 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 26/09/06

Guardian Care Centre 27/02/06

Guardian Care Centre 30/08/05

Guardian Care Centre 01/03/05

Guardian Care Centre 12/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 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 Key Unannounced Inspection 3rd July 2007 09:30 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.V345015.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. 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.V345015.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Guardian Care Centre Address Longton Road Trentham Stoke-on-Trent Staffordshire ST4 8FF 01782 644800 01782 644950 ms@guardiancare.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Nightingale Group Limited - The Guardian Care Centre Mrs. Margaret Elizabeth Sexton Care Home 143 Category(ies) of Dementia - over 65 years of age (40), Physical registration, with number disability (64), Physical disability over 65 years of places of age (39) Guardian Care Centre DS0000026946.V345015.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 143 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. 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 20 PD aged 18 - 65 . 26th September 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. 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 Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 5 floor) currently provides twenty-two beds for young adults with physical and/or learning disability. Court Walk (ground floor) currently provides twenty-two beds for young physically disabled people and young physically disabled people with complex nursing care needs. The two floors are connected by a passenger lift. Accommodation is provided in mainly single rooms. All of the rooms have en-suite facilities. Both floors have their own dining room and communal areas and there are sufficient and appropriately adapted washing and bathing facilities. There is a central kitchen situated in Selwyn House and there are satellite kitchens to both floors in New House. Mayfield Unit is a new twenty-bedded unit. This is a very modern, state of the art unit, which can accommodate up to twenty residents with critical care needs between the ages of 18 - 65 years. All bedrooms are spacious and with en-suite facilities. There is a large communal room, a snoozlan and a hydrotherapy pool. There is a new large laundry room and staff facilities attached to Mayfield Unit, which were built at the same time and replaced the existing laundry and staff room. The fees charged by Guardian Care Centre range from £250.00 - £4,555.00 per week. Extras not included in the above are toiletries, hairdressing, newspapers and some trips out. This information was provided by the administration department of the home on 17/10/06. Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this unannounced inspection over two days. At the end of the inspection visit verbal feedback was given to the Registered Manager of the home where positive outcomes were identified and areas were highlighted where improvements were required. There were no immediate requirements left at the time. As this was a key inspection, all the key standards were examined and outcomes for the people who live at the home were assessed. The following methods were used to gather evidence – Direct Observation of the delivery of care Short Observational Framework Inspection on Garden View Unit. Discussions with the people who live at the home Discussions with a visitor to the home Discussions with staff and managers Examination of documentation and records Tour of the units Most of the key standards were fully met and for those standards only partly met – requirements and recommendations have been made and included at the end of this report. This inspection assessment was a combination of good, excellent and poor outcomes – making many of the outcome scores as adequate overall. The reasons for this have been outlined below. What the service does well: “Staff are excellent- cannot fault them they see to all my needs. All the staff are helpful and friendly.” “I rely on the staff a lot and get a lot of help from them.” In respect of food – “I get a lot of salads because I like salads”. The above were comments received from two of the people who live in New House. “I just want people out there to know that this home is here and what excellent care my relative received in New House”. Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 7 The above was a comment received from a visitor who had recently lost a close relative at the home and who had returned to visit the other residents and staff in the unit. The complex care needs of individuals accommodated in New House and Mayfield units are very well met by the staff at the home. Pre-admission assessment is thorough and ensures that everything is in place to receive and meet the needs of the individual. Care is very much person centred and all the activities of daily living are centred on the individual and his or her specific needs. The staffing ratio on these units is good with 1:1 and 2:1, and on occasions, as seen at the time of the visit – 3:1 where required. Therapeutic activities are provided on these units according to the needs and abilities of the individuals and the home has the benefit from having a new hydrotherapy pool and snoozlan room. The new unit – Mayfield provides a new state of the art unit with very modern facilities and equipment. Highly specialised equipment is provided for individuals as and when required in order to maximise their independence and provide them with comfort. Residents enjoy regular trips out to local places of interest and the home has the benefit of a minibus. There is a good GP support for the home – with one GP providing services for all the residents in the home. There is a good staff training and development programme with a training manager who plans and oversees the programme. There is good management support for the home with a Care Director (Registered Manager) who has been in place for over 5 years. Each unit has its own manager and supporting deputy managers. What has improved since the last inspection? What they could do better: The culture of the dementia care unit – Garden View is such that outcomes for the people who live on this unit are poor. This is in contrast to the other four units throughout the home, which offer good and excellent outcomes. Improvements are required in the following areas – Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 8 Some of the staff on the unit did not appear to possess the necessary skills and expertise to meet the needs of the people living there. Staff must receive recognised certificated training in Dementia Care and other mental health related illnesses. It was observed that there were insufficient numbers of staff on the unit, staff also commented that they were too busy to give drinks and talk to residents More care staff must be provided on the unit in order that the basic needs of the people who live there, (both physical and emotional needs) can be met. Residents on Garden View unit must be offered drinks on a regular basis and choices in their beverages throughout the day. The choices must include cups of tea and/or coffee and drinks as preferred. A Short Observational Framework Inspection (SOFI) identified that this was still not happening. The CSCI are concerned that this requirement has still not been addressed after the last two inspections have identified this as an issue. The Provider must address this within the timescale of this report. Care practices must be reviewed on this unit and made more person centred, taking into account individuals’ wishes and feelings, and be less task orientated. Autonomy must be promoted for individuals living on Garden View unit so that, despite having limited capacity, individuals are enabled to make choices and their preferences are upheld. Again the above was observed during the SOFI and individual dignity was compromised. In respect of the environment Garden View lacks stimulation and must be further improved by redecoration and adaptation of the unit in order to meet the specific dementia care needs of the people who live there including help with orientation. Garden View must review and improve its policy on the treatment and prevention of pressure sores. They must seek advice from nurse specialists as and when required. Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 9 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 10 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.V345015.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,3 and 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives are provided with sufficient information about the home in order to be able to make an informed decision about moving in. Individuals can be assured that, once in the home, their assessed needs will be met. On Garden View unit care practices need to be reviewed and staff knowledge and skills improved in order to ensure that individual assessed needs are fully met on a continual basis. Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 12 EVIDENCE: The service had a Statement of Purpose and a service user guide. These reflected the differences in each unit. These provided suitable information for people to know what the service offered. Examination of a sample of files on two of the units (Garden View and Garden Walk) showed that prior to admission an assessment was completed. In cases where people were supported by the local authority this included an assessment both by the service and the local authority. The assessment covered the necessary areas. There was one person with an ethnic minority background and discussion with staff confirmed that the service had taken account of that person’s culture and prior to admission they had discussed their requirements with the person concerned and with their family to make sure that they were able to meet their cultural/ religious needs. The service was overall able to meet the needs of the people that lived there. Within Garden Walk staff were fully aware of people’s needs and had received the necessary training to provide people with the support they needed. People we spoke to were very positive about the care they received and about the attitude of the staff. In Garden View, the EMI unit, the care was very task orientated with little interaction between staff and the people that live there, leading to people’s emotional needs being over looked. There was no evidence of person centred care being provided and when raised staff were unaware of what this meant. Therefore staff would benefit from having training in current dementia care practice to ensure that all the needs of people were being met. Discussions with unit managers on New House and Mayfield identified that it was extremely important to “get it right” and the initial assessment of needs was paramount to agreeing funding and meeting the complex nursing and care needs of the individuals accommodated there. Examination of a sample of individual plans from Mayfield and Court Walk confirmed that pre-admission assessments were undertaken by trained staff and were very comprehensive, sometimes consisting of several visits to assess the individual concerned. There was also evidence of information sharing with other professionals involved in the multi-disciplinary team. Assessments on these units are conducted professionally and sensitively and involve the individual and their family or representative wherever possible. Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complex care, continuing care and individual health care needs are very well planned, met and delivered with dignity and respect. On Garden View unit care practices must be reviewed and made more person centred and less task orientated. EVIDENCE: A random sample of individual plans was examined on Mayfield, Court Walk, Garden Walk and Garden View units. Plans on Mayfield and Court Walk were comprehensive and had been developed from an initial assessment of need. Individual risk assessments had been developed and these plans were very Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 14 person centred with diverse needs identified and care plans in place to meet them. Plans on Garden View needed to be more personalised and were a list of activities people could not do rather than identifying people’s strengths, abilities and preferences and needs. Plans did not include a full social history and there were no effective plans for people that show aggression looking at possible reasons for it and how to work with the person. At the last inspection there were no assessments in place on Garden View for the use of chairs that could restrict people. This had now been addressed. Assessments were in pace that included the views of the GP. Care plans on Mayfield and Court Walk showed that sexuality was recognised and documented as was allowing the expression of verbal and physical aggression. There was one person on Garden Walk with needs relating to their religion/ culture. Although discussions with the staff confirmed they were meeting these needs there was no plan in place to provide all staff with the necessary information about their needs. On New House and Mayfield units communication is enabled as much as possible and the provision of specialist equipment to aid communication was evidenced. There was an holistic approach to the provision of care and managers and staff are very sensitive to the needs of all the individuals accommodated there. It was observed that some individuals required 1:1 care, some 2:1 and, for one individual, 3:1. The culture of Mayfield and New House units was such that encouraged all individuals to reach their full potential and individual plans focussed on the strengths and abilities of individuals rather than weaknesses and disabilities. The Care planning system was in the process of change – from hard copies to a computerised system. This was seen to be working well with adherence to data protection. All staff delivering care were able to input information according to rank and hard copies could easily be printed out for individuals and/or their representatives. There was abundant evidence of access to, and the involvement of, other healthcare professionals as and when required and there was a very effective GP support service for the home. All individuals were encouraged to use the services of this GP, but could keep their own GP if this was agreed. Two residents were spoken to at length on Court Walk about their care in the home. One lady received regular respite care whilst the other lady was a permanent resident at the home. Both residents were complimentary about the home and the following comments were received – “Staff are excellent- cannot fault them they see to all my needs. All the staff are helpful and friendly.” “I rely on the staff a lot and get a lot of help from them.” In respect of food – “I get a lot of salads because I like salads”. Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 15 In most units staff were observed speaking to individuals with dignity and respect throughout the visit. When asked if her dignity was respected by the staff in the home one of the residents stated “ dignity is very much upheld”. However on Garden View there was little interaction observed. A short observational inspection took place and during the two hour period of observation there were very instances of staff talking with people apart from a few words when undertaking care tasks. Staff confirmed that they felt that they had little time to talk to people. The lunchtime medication round was observed in Mayfield unit. The administration of medication certainly met the diverse needs of individuals – from following a gentleman around the unit – who took his medication orally whilst on the move – to administration of medication to a service user via a PEG. Medication Administration Record charts had been completed as required and at the time of the inspection there were no individuals on controlled medication. The week following the inspection visit concerns were raised to the CSCI by the Tissue Viability Nurse Specialist based at the local hospital regarding the admission of a resident from Garden View. There is a requirement for the policy on the prevention and treatment of pressure sores on Garden View to be reviewed and improved and for all staff delivering care on this unit to receive training in this area. Advice from specialist healthcare professionals must be sought wherever possible. Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who live at this home are generally enabled to make choices wherever possible about their lifestyles with the exception being on Garden View unit. There is a need to review and improve this outcome for the people who live on this unit in order to ensure that, despite having limited capacity, autonomy and choices are promoted for individuals. EVIDENCE: Discussions with the Activities Supervisor identified that there are planned therapeutic activities for individuals on each unit although they stated that there were limited activities taking place on Garden View and few people (1 or 2 at a time) from Garden View and Garden Walk were able to access activities out of the service. Planned activities were evidenced on Mayfield – where an individual was observed enjoying a session in the Spa therapy pool. A risk assessment had been carried out prior to him using the pool and this was Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 17 evaluated regularly. There were three members of staff accompanying him – one in the water supporting him and two staff standing next to the pool. The hoist was used to transfer him from his chair into the pool and he had floating supports under his neck and head. He was obviously enjoying his session and the staff were very attentive to his needs. Another individual was observed enjoying a session in the Snoozlan room. Again she had undergone a risk assessment and this was contained in her care plan. A member of staff stayed with her constantly and was massaging her hands – which the young lady appeared to be enjoying. As described by the activities supervisor – not all activities of this type are suitable for all individuals and not all would benefit – but for those who do – these facilities are a great advantage for the home to have. There are regular trips out arranged to various places of interest. Albeit only a small number of individuals can be escorted at each trip. The deputy manager of New House explained that individuals are assessed as to their requirements for stimulation and some are identified as needing “extra” stimulation. The inspector was shown an activities book, which is completed, on a daily basis by the staff. Although the units are secure, visitors are welcome at any time and were observed coming and going on Mayfield and New House. There was a good rapport noted between staff and family members. Some family members take their loved ones out, returning later on in the day. There was one visitor who had returned to visit another individual having recently lost her husband at the home. She arrived with a birthday present for the resident and was eager to speak with the inspector. She wanted it to be known how pleased she had been with the care afforded to her husband whilst he was ill. Spiritual and religious needs are assessed and documented and it was noted that – one of the bedrooms on Mayfield depicted that the individual accommodated there was of the Roman Catholic faith. When this was explored further it was confirmed that the Priest visits this individual on a regular basis. There was evidence that autonomy; individual choices and preferences are promoted on New House and Mayfield. Two residents were spoken to at length on New House – one an individual who comes into the home for regular respite, and the other –a permanent resident. Both ladies confirmed that they were happy with the services provided by the home and felt that the staff were very caring and friendly. They both confirmed that they were able to make choices about daily routines – and had their preferences upheld. One of the ladies stated that she only liked salads – and that these were provided in many different varieties. The other lady liked to smoke – and was observed going out into the garden to do so. On Garden Walk there was evidence throughout the unit of activities that had taken place. There were photos on the walls of trips out and of activities in the Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 18 unit. There had been trips to Trentham Gardens, to watch football, to the pub and one person went swimming. However the number of people that could access these trips was limited to one or two at a time. Discussions with people that live at the unit confirmed that they were living the lifestyle they liked. One person told us that they would recommend the service. One person told us that they liked watching the soaps and they were able to do this. Another person told us that they visited all the other units where they had made friends. This person also told us that they watched videos, listened to music and helped in the garden. People had the choice to have their spiritual needs met and there were a number of priests/ vicars visiting the service. The service was meeting the cultural needs of one person. On Garden View there were less activities available. People were able to have their hair done regularly. There were a few opportunities for people to go out on trips. People also took part in activities organised across the service. There had been a BBQ and a firework display. Looking through diary records showed that there tended to be only two activities recorded – sing-along and reminiscence. When staff were asked about this they said that these were what was available on those days and not that the person had actually taken part. The activity coordinator said that they did not spend much time on the unit and that each unit had a co-ordinator to organise activities. During the period of the inspection there were no activities provided and staff spoken to said they did not have much time to support people undertake activities. The TV was on in both lounges throughout the day although there did not appear to be anyone that was watching. On Garden Walk and Garden View there was evidence of regular visitors and a visitor spoke to said that they always felt welcomed. On Garden View several people visited to assist their relative to have their lunch. The service had a central kitchen that provided meals to all the units. People told us they liked the meals. Comments included: ‘Lovely food, always a choice’ and ‘food good’. The service always provided a range of meals with two main choices always available. However there were always other meals available and the chef reported that he would try to accommodate any specific wishes of people. Each unit had its own kitchen area and had supplies of drinks; bread, jam and cereals etc. so drinks and snacks were available throughout the day and night. One person we spoke to on Garden Walk said that they got up early and they could always have a drink when they got up. On Garden View there was no drink provided between breakfast and lunch and on the day we visited no drink was provided during the afternoon either. Staff we spoke to said that it was usual for there to be no drink in the morning but that they had not had time to provide one during the afternoon. They said that people had two at teatime. Staff did report that the choices of drinks were restricted as the manager wanted people to have water or squash rather than hot drinks. Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 19 The service provided the main meal at lunchtime and a lighter meal for example sandwiches and jacket potato at teatime. The service provided for people that needed a soft diet, a puréed or a liquidised diet. However the liquidised meal we saw did not look appetising, as all the separate foods had been liquidised together. The service was able to provide for a person with a diet related to their culture. On Garden View we observed staff supporting people to eat. Due to the difficulties some people had, there were no tablecloths and no knives and forks set out. A number of people ate in the lounge. Lunchtime was a busy period as we were told that 19 people needed feeding or needed encouragement to eat. This meant that people had to have meals at different times and many people were sitting in the dining room for a long time before they could have a meal as the staff were supporting other people. Observation showed that in most cases people were fed sensitively but we were told by a relative and by staff that there were times when one staff member had to feed two people at the same time. We would recommend that Garden View review how it organises its mealtimes to ensure that people do not have to sit for long periods before they eat and that when people need to be fed this task is carried out with dignity and with each person individually. On Garden Walk lunchtimes appeared to be well organised. There were two sittings. This enabled people to be able to eat together and to have the support they needed. Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home can be assured that any concerns they have about the home will be listened to and taken seriously. People can be assured that they will be in safe hands in the home. EVIDENCE: There was a clear complaints procedure in place displayed on each unit. Each unit manager deals with concerns on a regular basis and complaints are usually referred to the RM (care director). The visitor, who was spoken to at length, confirmed that the staff on New House “soon sorted out any concerns” she had about her husband’s care. The staff members spoken to were all aware of what constitutes abuse and explained the procedure for dealing with this and reporting it. Staff training is provided in this area. Staff undergo checks including criminal records checks prior to being offered employment at the home. Examination of one staff file identified the need to provide written evidence that risk assessments have been carried out by the Registered Manager in Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 21 relation to CRB results and the decision to employ. This was discussed with the manager at the time who confirmed that she had done this and the written records were secure. Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a clean, comfortable, safe environment that has been adapted to meet their needs with highly specialist equipment where required. Garden View could be further improved by adaptation of the unit to meet the specific dementia care needs of the people who live there. EVIDENCE: Mayfield is still very new and is ultra modern in appearance and facilities. There is a feeling of space to this unit with wide corridors – with bedrooms off and large communal areas. There are lots of windows creating light and space. Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 23 The unit consists of two separate mirror units – which meet in the centre and have shared communal rooms. The unit was very clean and well presented. Bedrooms were all single with ensuite facilities and had been personalised and adapted to meet individual needs and preferences. New House was clean and well presented and bedrooms had been personalised by individuals and their families. The units were now showing some signs of wear and tear and are in need of redecoration and refurbishment in areas. We were informed that the units were included on the redecoration programme with some work having already been done. On New House and Mayfield units it was observed that the units were adapted and highly specialist equipment and beds were provided in order to meet the exact needs of individuals. A sample of accommodation on both Garden View and Garden Walk were looked at. Both units were well decorated and clean and tidy. The units had one double room that in one unit was used for a couple. Bedrooms were of a good size and had mostly been personalised. All were ensuite. People we spoke to said they liked their bedrooms. Garden View had some signs in large print showing where communal rooms, for example bathrooms and toilets were sited. However there was significantly more this unit could do to aid people that live there to be oriented to the environment. For example the introduction of pictorial signs and methods such as different colours or picture boxes to individualise bedroom doors to try and help people know which is their bedroom. There is a large central kitchen housed over in Selwyn House and a recently constructed large laundry area housed alongside Mayfield unit. Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are carefully selected to work at the home and, have the skills and competencies to meet the needs of the individuals accommodated there. There is a need to review and improve the numbers and skills of staff provided on Garden View Unit. EVIDENCE: We spoke to a number of staff during the inspection. Staff on Garden View generally stated that they had received all the Health and Safety training and had received training in safeguarding people and dementia care. However when we spoke to them knowledge of current dementia care practices was limited and the nurse stated that she had not received any training in dementia care. On Garden View there were 2 nurses on duty although one of these was on duty to do paperwork and to update care files. In addition there were 6/7 care staff during the day. There were however times when there had been 5 staff on duty. At night there was 1 qualified nurse and 3 care staff. Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 25 A short observational framework inspection on Garden View identified that there appeared insufficient staff to meet the needs of the service users accommodated there – drinks were not administered as required. Staff confirmed that they felt that they had little time to talk to people. Staff we spoke to also said that it was usual for there to be no drink in the morning but that they had not had time to provide one during the afternoon. On Garden Walk there were 2 qualified nurses during the day and 5 care staff. Night staff included 1 qualified nurse and 3 care staff. Both Mayfield and New House were well staffed with a good skill mix of qualified nurses and care staff. These staff possessed the knowledge and skills needed to care for the residents accommodated in these units. All staff had received the required training in order to meet the very complex care needs of individuals in the home. Mayfield and New house units were both staffed according to the needs of the individuals accommodated. It was observed that this was sometimes 1:1, 2:1 and, for one resident – 3:1. The staff on these units had the necessary skills and expertise to care for the residents - often with demanding and /or highly complex care needs. There is a well-organised and effective staff training and development programme in place at the home and there is a training manager to implement and oversee this. At the time of the inspection visit the training manager was off sick. A random sample of staff training records was examined. Discussions with staff members on Mayfield and New House confirmed that they receive support with their training needs and training sessions and courses are facilitated for them. The Providers have told us that 80 of care staff are trained to NVQ level 2 or above and 20 are working toward this qualification. The Providers also told us that 100 of catering staff and 90 of care staff have received training in safe food handling and all staff have received training in infection control. A random sample of staff files was examined where it was identified that the required checks on employees had been carried out prior to employment. Two written references were in place, together with proof of identification and Criminal Records Bureau (CRB) checks. Qualifications had been assessed together with Personal Identification Numbers (PIN) of nurses against NMC records. Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 26 Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The units in this home are well managed and people benefit from the style, ethos and leadership with the exception of Garden View, which needs to review and improve in this area so that the unit is run in the best interests of the people who live there. EVIDENCE: Discussions were held with the managers of New House and Garden Walk. Unfortunately the manager of garden View had left the home as we arrived for the inspection visit. Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 28 The manager of Mayfield unit was off on sick leave at the time. Deputy managers also supported the unit managers and we met those on Court Walk and Court View. Both of these managers had an excellent knowledge of their clients and were very helpful in providing information for the inspection. The managers were, in turn, supported by the Registered Manager (RM) who was also known as the Care Director. She was not on duty on the first day of the inspection but was present on the second day and the results of the inspection were discussed with her during feedback. The managers spoken to all commented that they felt supported by the RM and that she ran an open door policy. Regular managers’ meetings were held with the RM and minutes were seen. The home has benefited from the continuity of the RM who has held this position for over 5 years. The home had a quality assurance programme in place, which assessed all the key areas on a regular basis. The deputy manager on Court Walk showed us how the new computerised system of care planning would lend itself to quality auditing. It is recommended that the results of quality audits are displayed including showing the actions taken by the home to address areas of weakness and how the views of the residents have been included. It is also recommended that quality auditing is reviewed on Garden View and made more effective in order to improve the delivery of care and services for the people who live on this unit. The maintenance of personal allowances was examined. The home’s administrator has overall responsibility for this and discussions were held with her about the system. She explained to us how this works and how people who live in the home are able to access their monies when they need/want to. It was identified that some of the units keep a small amount of monies – such as change from shopping and so on. It was also noted that this money is not monitored and this was highlighted to the administrator who agreed that she should be checking this on a regular basis. Records relating to the maintenance of health and safety were examined. These were found to be in order showing that equipment used in the home is tested and serviced as required. Also staff receive updates in mandatory training regularly and this is recorded. Fire safety requirements are adhered to and a recent inspection by the fire safety officer highlighted this, with a requirement, which the Provider was addressing. Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 29 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 3 x 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x 3 x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 x 3 x x 3 Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes 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 OP30 Regulation 18(1)(c)(i ) Requirement The staff on Garden View unit delivering care must receive recognised certificated training in Dementia Care and other mental health related illnesses. More care staff must be provided on Garden View Unit in order that the basic needs of the people who live there, (both physical and emotional needs) can be met. Service users on Garden View unit must be offered choices in their beverages throughout the day. The choices must include cups of tea and/or coffee as preferred. PREVIOUS TIMESCALES OF 30/11/06 and 26/02/07 NOT MET. On Garden View unit care practices must be reviewed and made more person centred, taking into account individuals’ wishes and feelings, and less task orientated. Autonomy must be promoted for individuals living on Garden View unit so that, despite having limited capacity, individuals are DS0000026946.V345015.R01.S.doc Timescale for action 20/11/07 2. OP27 18(1)(a) 20/08/07 3. OP15 16(2)(i) 20/08/07 4. OP7 12(3) 20/08/07 5 OP14 12(2) 20/08/07 Guardian Care Centre Version 5.2 Page 31 6 OP19 23(1)(a) 7 OP8 12(1)(a) 13(1)(b) enabled to make choices and preferences are upheld. Garden View must be further improved by decoration and adaptation of the unit in order to meet the specific dementia care needs of the people who live there. Garden View must review the policy on the prevention and treatment of pressure sores and take advice as necessary. 20/11/07 20/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP33 Good Practice Recommendations It is recommended that the results of quality audits be displayed including showing the actions taken by the home to address areas of weakness and how the views of the residents have been included. It is also recommended that quality auditing is reviewed on Garden View and made more effective in order to improve the delivery of care and services for the people who live on this unit. The dining facilities should be improved on Garden View to make this more conducive to dining and to promote dignity. PREVIOUS RECOMMENDATION Regular monitoring checks should be carried out on monies kept on units (personal allowances). 2. OP15 3 OP35 Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Stafford Local Office Dyson Court Staffordshire Technology Park Beaconside STAFFORD ST18 0ES National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Guardian Care Centre DS0000026946.V345015.R01.S.doc Version 5.2 Page 33 - 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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