Inspection on 30/08/05 for Guardian Care Centre

This inspection was carried out on 30th August 2005.

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

The inspector 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 03/07/07

Guardian Care Centre 26/09/06

Guardian Care Centre 27/02/06

Guardian Care Centre 01/03/05

Guardian Care Centre 12/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Guardian Care Centre Longton Road Stoke on Trent Staffordshire ST4 8FF Lead Inspector Yvonne Allen Announced 30 August 2005 th 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Guardian Care Centre Address Longton Road Trentham Stoke on Trent Staffordshire ST4 8FF 01782 644800 01782 644950 Telephone number Fax number Email 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 Ltd Mrs Margaret Elizabeth Sexton Care Home 123 40 39 44 Category(ies) of Dementia - over 65 registration, with number Physical Dis - over 65 of places Physical Disability Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Maximum number of persons to be admitted to Guardian Care Centre are 123. Maximum number of persons to be admitted to New House are 44 with physical disability aged 18-65 years on admission. Maximum number of persons to be admitted to Selwyn House are 79 aged 65 years and above on admission. Within Garden Walk, up to six persons who require nursing care may have dementia needs. Date of last inspection 1st March 2005 Brief Description of the Service: Guardian Care Centre comprises of two modern purpose built buildings, New House and Selwyn House. 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 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 Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was carried out over two days by two inspectors. The first day started at 10am and finished at 8pm and the second day started at 10am and finished at 2pm. Verbal feedback was given to the Care Director at the end of the second day. The inspectors toured all four units and met staff, residents and some visitors. Fifteen comment cards had been received back from residents and ten from relatives. No one had asked to speak to the inspectors. Comment cards were also received back from General Practitioners and a placement officer from social services. Relevant records and documentation were examined. What the service does well: The home provides high standards of nursing and personal care in a purpose built environment, which has been suitably adapted to meet individual needs. The care afforded to young physically disabled residents, some of whom have very complex and challenging needs, is excellent. Throughout all the units staff were seen to be caring, sensitive to the needs of residents and professional. Care plans were found to be thorough and the plans provide staff with the information they need to satisfactorily meet the needs of the residents. The health needs of residents were well met with evidence of good multi disciplinary working taking place on a regular basis. The staff have a very good understanding of residents’ support needs and this was evident from the positive relationships, which have been formed between the staff and residents. Personal support is offered in such a way as to protect residents’ privacy, dignity and independence. Staff are well trained and there is a good deal of financial input from the company into staff training. Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4, 5. The home provides up to date detailed information to prospective residents and their carers to enable them to make an informed decision about moving into the home. Information contained in the homes Statement of Purpose and Residents Guide about services provided was readily available to those who needed it. All four units of the home have comprehensive pre admission assessment procedures in place and demonstrate, that the needs of residents were being frequently assessed, reviewed and appropriately met. Residents could expect maximum effort from staff to enhance and enrich their quality of life. Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 9 EVIDENCE: The company ensure that all their prospective residents have a very detailed pre admission assessment, undertaken by suitably qualified and trained nurses. This procedure is well supported by comprehensive written records, samples of which have been examined and found to be satisfactory. Needs are identified and a plan of care is established, which is developed further as the period of assessment reveals more information of individual needs and how these are to be effectively met. All funded residents undergo a 6 weekly review with the relevant members of the multi disciplinary team present, along with the families. Discussions are held with the emphasis on whether the home are meeting the needs of the individual resident and what, if any steps need to be put in to place to optimise levels of dependence and improve quality of life. During this inspection the dependency of residents was thoroughly discussed. On Court Walk very experienced senior nursing staff were caring for highly dependant brain-injured residents, with very complex and demanding physical needs. Some residents remained in a persistent vegetative state, unable to undertake the simplest of tasks themselves and fully dependent on staff. On Court View staff were supporting, supervising and caring for profoundly disabled residents suffering from brain injuries, early dementias, multiple sclerosis and learning disabilities. Many of the residents required one to one care where staff never left their side during an agreed amount of time, which could account for the full 24 hours per day. Staff were rotated when on duty to alleviate/minimise stress, which may occur, by the resident or member of staff during such close supervision. Pre admission visits are encouraged to the home and generally admissions are initially based on a mutual ‘trial’ foundation and this is clearly verified in the Statement of Purpose. Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service Users, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10, 11. Care planning throughout all units was of a very high standard. The identified individual health and personal care needs were being very well addressed, which ultimately improves resident’s physical and mental abilities. The home had comprehensive policies and procedures in place for the management and administration of residents’ medication. Residents could expect prescribed medication to be administered in line with their Doctors directions and in a safe and professional manner. All residents were treated with respect and their right to privacy was being up held. Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 11 EVIDENCE: A sample of care plans were examined during this inspection and a high standard of care planning was being achieved. This examination of several care records confirmed a thorough approach was taken and all care requirements were identified. Discussions with staff and residents confirmed that good standards of health and personal care were provided throughout Guardian Care nursing home. The individual files of the four residents that were being tracked for inspection purposes were looked at in depth. Each showed that their care needs relating to health, personal and social care had been appropriately recorded. The care plans have individual sheets for addressing the various aspects of need covering the holistic care required by the individual resident and these were completed in every case. Records showed that the care plans are reviewed on a monthly basis. The care plans have sections to record all health professional appointments, such as GP visits, District Nurse, chiropody, dental, ophthalmic etc. These were complete in every instance. The daily contact sheets also recorded how each person was each day, and there was an audit trail to show if someone was not well that the GP had been contacted. Discussions with the residents (those who could comment) evidenced that they consider that their health needs are well met by the home. During these discussions a general practitioner visited the home and was engaged in conversation with an inspector. The doctor was very complimentary about the home and how the staff prepare well for his two weekly surgery visits to the home. There was evidence in the care plans that the needs of the resident and the requirements for his visit were promptly recorded in the care plan. The home is reminded to complete all entries in black ink, in line with NMC requirements to ensure that all information can be photocopied to a good standard. Additionally, all entries should be accompanied with time the entry was made. Due to the high dependency of residents, none self medicate, with the exception of one lady on the general unit who uses her inhaler when required and the nursing staff supervises this activity. Oxygen is used continually and all units that used oxygen had cylinders stored appropriately. Controlled drugs were securely stored and registers tallied with stock levels. Clinical rooms seen were very clean and orderly. An examination of medication stock, records and signatures confirmed a very complete style, which conforms to NMC requirements. Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 12 The storage of medication was not found to be fully satisfactory, in that the EMI unit clinical room reached temperatures in excess of 25.C, which can have a deteriorating effect on some medication, which needs to be stored below that temperature. Following discussions with the unit manager steps are currently being taken to address this issue. Throughout the period of the inspection, in was pleasing to witness several very positive interactions between staff and residents, which confirmed that residents of Guardian Care are treated with respect and afforded privacy. The Inspector observed residents being consulted about a variety of things and staff were demonstrating patience and sensitivity. Extensive discussions with staff of different levels also confirmed a positive and respectful manner. Staff commented on the home and its ethos and stated ‘The one to one care provided to those residents who required it, was very good’ ‘It is good to be able to spend time with residents getting to know about them and their likes and dislikes’ ‘ we all work as a team and are happy in our work, everyone here is close’. Consultation with residents and visitors to the home equally conveyed a feeling of mutual respect that exists between residents and staff. Throughout the day staff were observed to be knocking on bedroom doors before entering and promoting privacy when assisting residents in a variety of other personal care situations. Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with asssistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15. The whole ethos of the environment provides a varied range of recreational activities and opportunities. Contact with families is actively promoted. Residents are consulted and encouraged to make choices that determine personal routines and activities for daily life. Residents experienced a lifestyle where they moved freely in and around the home. The quality of meals continues to be of a good standard and offer a broad choice and selection of food. Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 14 EVIDENCE: During this inspection the inspector had the opportunity to sit and meet with several residents and relatives. All of the residents engaged in conversation (who were able to comment) stated that they enjoyed their lifestyle in the home and that they could make their own choices about how they conducted their day. In a group discussion with staff, it was determined that residents got up in the morning when they wanted, that breakfast was flexible anytime up until 10am, and that they all went to bed at different times depending on their preference. Residents have keys to their doors on request. Some residents went out to day centres regularly, others went on home leave and annual holidays with their relatives. There is a range of activities provided, including mobility exercise sessions, bingo, and several types of musical sessions such as a sing along to entertainers. A sheet showing the activities was displayed on the units. All spoken with confirmed that they could receive visitors at any time. A visitor told the inspector that she was always made most welcome. Residents and visitors could choose to sit in the lounge with others or go to the bedroom of the resident for some privacy. From observations made during this inspection, it was pleasing to see that residents are appropriately consulted and encouraged to make choices in their day-to-day lives. As well as observing direct examples of this, discussions with residents and relatives also confirmed this good practice. The Inspector observed the cooked lunch and tea that was provided on the day of this inspection. Both meals looked appetising and were well presented. Copies of menus were available throughout the home, which confirmed a good variety and choice of meals. Comments from several residents confirmed their satisfaction with the quality, quantity and choice of meals provided. Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 15 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The excellent knowledge and understanding of adult protection issues possessed by the staff provides a safe environment in which residents are protected from abuse. EVIDENCE: There were complaints procedures displayed on each unit. These were accessible and clear. The managers on each unit deal with concerns as they arise and the Care Director deals with official complaints. Records of the investigations area maintained along with the outcome and any action taken. The CSCI had not received any complaints directly since the last inspection. One of the visitors spoken to stated that some concerns she had had when her relative was admitted to the home had been dealt with quickly and efficiently. The staff receive training in the protection of vulnerable adults during their induction and again as part of NVQ training. When questioned, staff were aware of the policy on the reporting of abuse. Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 16 Individual and generic risk assessments are in place to help protect residents from harm including self-harm. Evidence was contained in care places indicating that residents are encouraged to maintain their mobility and to take measured risks that allowed them to maintain their independence wherever possible. In New House risk assessments ensure that residents are allowed free movement throughout their environment often on a 1 to 1 basis with care staff. Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 17 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 and 26. The standard of the environment within this home is good, providing residents with an attractive an homely place to live. EVIDENCE: The inspector conducted a tour of all four units, visiting all communal areas, and a selection of bedrooms. Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 18 The environments were clean, pleasant and well presented. Redecoration and refurbishment was on a rolling programme and there was evidence of this during the tour of the home. In new house bedrooms had been very well adapted to suit the needs of individuals. Most of these rooms had been personalised by families. There was highly specialised equipment in use to help with direct care, aid mobility and help maintain individual comfort. The attention to detail in relation to maintaining resident comfort was commendable. Nothing was too much trouble for the staff and, in the words of a staff member, “what the resident needed the resident was provided with”. Bedrooms were prepared for residents before they were admitted to the units. The manager stated that often more than one visit is made to assess the resident’s needs prior to admission in order to ensure that all necessary equipment is in place. Residents were also observed enjoying the summer sunshine in the courtyard garden area. Over in Selwyn House bedrooms had also been adapted to the needs of individuals but equipment used here was less specialised as individual needs were different. Bedrooms appeared personalised with residents and families having brought in personal effects from home. In Garden Walk some of the ensuite rooms are in need of the erection of shelving. Toiletries were observed stored in baskets on the floor next to toilets. In Court View in bedroom number 11 there was a top drawer missing from the set of drawers and this needs replacing. Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 19 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30. The home has sufficient numbers of well-trained care staff to meet the needs of the residents. Care staff training is given a high priority. Not all maintenance work is carried out promptly and this may have a negative effect on the welfare of residents. The standard of vetting and recruitment practices is poor with appropriate checks not being carried out and potentially leaving residents at risk. EVIDENCE: Domestic and laundry cover was determined and adequately addressed the needs of the residents and environment over a seven-day period. However, although it was determined that the home were providing sufficient maintenance hours, not all of the homes requirements for remedial work had Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 20 been completed. Each unit has its own maintenance book where staff entered any work that needed to be undertaken. The inspector looked at these logs and it was determined that several requirements made had not been completed and some dated back to July. The home are required to review the maintenance workload so that all work identified is completed. Staff training was discussed at length with all disciplines of staff. The staff spoken to were very enthusiastic and complimentary about the training programmes available in the home. NVQ training is ongoing throughout the home. The staff files provided evidence that induction and foundation training to National Training Organisation standards is provided, together with all mandatory training. Courses for moving and handling, basic first aid, fire safety and COSHH are regularly undertaken throughout all units in the home. However, several of the kitchen staff do not hold a basic food hygiene certificate and this needs to be addressed in the near future. A requirement was made to this effect. Observations of staff on duty throughout the inspection confirmed that care staff were competent and caring in their conduct and as far as possible they promoted a safe environment for residents to live in. A selection of employee files were examined in relation to the recruitment procedure. Out of 7 files examined, 2 had only one written reference in place, 3 had no written references in place and 2 had the required two references in place. Another file seen contained no written references and an unacceptable CRB check. This was very alarming and was discussed with the Care Director at length. This had been a previous requirement at the last inspection and the recruitment procedure at this home must be tightened up and addressed without delay. Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s polies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 33, 35 and 38 (Older People) and Standards 23, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 36, 37 and 38 The manager is supported well by her senior staff in providing clear leadership throughout the home. Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 22 Some further development is required in certain areas to ensure that all senior staff are fully aware of their roles and responsibilities. EVIDENCE: The home is well managed by a registered manager who is known as Care Director. Each unit then has a manager who, in turn, is supported by senior nurses. Each manager has the skills and expertise to care for the residents on their unit. The staff members spoken to were complimentary about their managers and stated that they felt very well supported and that the managers were accessible and approachable. Staff meetings are arranged and minutes of these were seen. Staff felt that their views were listened to and they felt included in the running of the units. The other managers and nurses were very knowledgeable and kept clinically updated and attended various relevant study sessions and courses. The manager of Garden Walk had recently completed a diploma in health and safety. The Care Director also kept up to date clinically and had recently completed the RMA. Formal staff supervision was not in place as per standard 36 and requires further development and attention. This was discussed with the Care Director. On the whole records were maintained in accordance with Data Protection requirements. However, it was observed that care plans were not as secure as they should be on Court View and it is recommended that these are stored in a more secure setting. Equipment used at the home had been maintained and serviced as required. The required testing and recording of hot water, fire alarms and emergency lighting had been carried out. Mandatory staff training had taken place with records maintained. Fire drills were recorded but there were concerns in relation to the lack of drills recorded for night staff. These need stepping up to at least four drills per year for each member of night staff and two per year for day staff. Accident books were maintained on each unit and these were examined. The current system for auditing of accidents was unsatisfactory and this needs reviewing so that each manager is aware of their responsibilities in relation to these. Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 23 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 3 2 3 3 4 4 4 5 3 6 N/A HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 3 3 2 4 3 2 3 3 Score Standard No 7 8 9 10 11 Score 4 4 3 4 3 Standard No 27 28 29 30 2 3 1 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 3 x 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 3 33 x 34 x 35 x 36 2 37 3 38 2 Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 38 Regulation 18(1)(i) Requirement All staff preparing food must receive external training in basic food hygiene and HACCP. Current certificates must be available for inspection when required. All identified maintenance work must be completed promptly to ensure the health and safety of residents in the care home. Shelving must be installed in ensuite rooms for storage of personal toiletries The top drawer in bedroom 11 in Court View needs replacing The recruitment procedure must be made more robust. There must be two written references in place for each employee. Unsatisfactory CRB checks must be investigated and risk assessed. PREVIOUS REQUIREMENT. More frequent fire drills are required for night staff Accidents must be audited on a regular basis and records maintained Formal staff supervision must be Timescale for action By 30/10/05 2. 27 18(1)(a) Immediate and on going By 30/10/05 By 30/10/05 Immediate and on going 3. 4. 5. 21 24 29 23(2)(m) 23(2) 19 schedule 2 6. 7. 8. 38 38 36 23(4)(e) 13(4) 18 (2) Immediate and on going Immediate and on going Immediate Page 25 Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 documented and on going RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 37 38 38 Good Practice Recommendations That care plans are stored more securely on Court View That Latex gloves are replaced by a substitute glove to avoid sensitivity That more maintenance hours be provided at the home Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Guardian Care Centre E51-E09 s26946 Guardian Care Centre v241226 300805 Stage 4.doc Version 1.40 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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