Inspection on 13/09/05 for Guardian House Nursing & Residential Home

This inspection was carried out on 13th September 2005.

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

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

Other inspections for this house

Guardian House Nursing &... 10/03/09

Guardian House Nursing &... 17/12/07

Guardian House Nursing &... 20/07/06

Guardian House Nursing &... 11/02/06

Guardian House Nursing &... 29/01/05

Guardian House Nursing &... 23/06/04

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

CARE HOMES FOR OLDER PEOPLE Guardian House Nursing & Residential Home Cobden Street Dresden Stoke-on-trent Staffordshire ST3 4EL Lead Inspector Mrs Yvonne Allen Announced Inspection 13th September 2005 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 House Nursing & Residential Home DS0000026947.V249682.R01.S.doc Version 5.0 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 House Nursing & Residential Home DS0000026947.V249682.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Guardian House Nursing & Residential Home Address Cobden Street Dresden Stoke-on-trent Staffordshire ST3 4EL 01782 598330 01782 644950 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) Guardian Care Nursing The Nightingale Group Mrs J Wood Care Home 24 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (24), of places Physical disability over 65 years of age (3) Guardian House Nursing & Residential Home DS0000026947.V249682.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th January 2005 Brief Description of the Service: Guardian House is a purpose built home that provides nursing care for up to 24 older people. It is part of the Nightingale Group Ltd, Guardian Care Centre, Longton Road, Trentham, Stoke on Trent. Guardian House is situated in Dresden, a residential area between Trentham and Longton and is close to local amenities. The home is set back from the main road and has its own small garden for service users to enjoy. There is a small car park to the side of the home that is accessed from the drive. Accommodation is provided on two floors that are accessible by stairs or passenger lift. There are 16 rooms and four companion rooms available and 30 have en-suite facilities. The home has a large open plan lounge that has three distinct areas, one social area where service users can enjoy participating in activities, a quieter sitting area and the dining area. There is a designated smoking area for service users. The home has adapted bathing and toileting facilities on both floors. Catering and laundry facilities are provided at the home. Guardian House Nursing & Residential Home DS0000026947.V249682.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was carried out over four hours by one inspector. A tour of the home was conducted where the inspector chatted to residents, visitors and staff. Relevant paperwork and documentation were examined and verbal feedback was given to the registered manager at the end of the inspection. Not all of the standards were assessed during this visit. Those not looked at on this occasion will be assessed during the next inspection. The Commission received four comment cards back from residents and four from visitors. What the service does well: The home provides a comfortable, safe environment for the residents who live there. Staff morale is high resulting in an enthusiastic workforce that works positively with residents to improve their quality of life. There was good multidisciplinary working in evidence ensuring that the health care needs of individuals were well met. The staff have a very good understanding of the support required by the residents and this was evident from the positive relationships, which have been formed between the staff and residents. There was a very good staff training and development programme in place at the home and staff were supported with their training needs. Management of the home is very effective and the manager is supported well by her senior staff in providing clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. Comments received from relatives included “I always find the staff very helpful and caring…they all seem happy which I find important.” Also, “I visit every day and the staff are very helpful….thanks to everyone.” Guardian House Nursing & Residential Home DS0000026947.V249682.R01.S.doc Version 5.0 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 House Nursing & Residential Home DS0000026947.V249682.R01.S.doc Version 5.0 Page 7 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 House Nursing & Residential Home DS0000026947.V249682.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 5 Residents and their families could be assured that the home they were entering into would be able to meet their identified needs. EVIDENCE: Each resident undergoes an assessment of needs before being offered a place at the home. These were usually carried out by the registered manager and records were seen contained in individual care plans. The manager stated that if, in her professional opinion, she felt that the home would be unable to meet the needs of an individual, then she would not offer a placement. Individuals funded by other bodies such as the Health Authority or Social Services also had an assessment in place by them. These were also seen contained in care plans. A further assessment was usually undertaken following six weeks after admission to ensure that the home was meeting individual needs. Guardian House Nursing & Residential Home DS0000026947.V249682.R01.S.doc Version 5.0 Page 9 Residents and their families are encouraged to visit the home prior to admission and meet with other residents and staff. Discussions with some of the residents identified that they felt that their individual needs were being met by the home on a continual basis. All of the visitors spoken to confirmed that they were happy with the services provided to their relative in the home. Evidence contained within individual care plans identified that assessed needs were being met on a continual basis. Guardian House Nursing & Residential Home DS0000026947.V249682.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Care is well planned and delivered in a way so as to promote privacy and dignity for individuals. Individual health care needs are well met with evidence of good multi disciplinary working taking place on a regular basis. EVIDENCE: A random selection of individual care plans was examined. The standard of care planning was found to be consistent and thorough. Individual risk assessments had been developed from an initial assessment of needs. Shortterm care plans were also in place for the management of acute episodes. The plans had been regularly evaluated on a monthly basis. Individual healthcare needs were assessed and monitored and there was good evidence of multidisciplinary working. The manager confirmed that there was good GP support at the home and that there was a community matron based at the health centre who is on hand to give advice, especially in relation to tissue viability issues. During the inspection the physiotherapist was seen working with one of the residents and was discussing ways forward with the programme of rehabilitation. The residents have access to NHS chiropody and Guardian House Nursing & Residential Home DS0000026947.V249682.R01.S.doc Version 5.0 Page 11 there is a dentist who will come to the home when needed. The Optician visits on a regular basis and sees all new residents and others on an annual basis. The home also utilise the services provided by the local Cottage Hospital and can ring them for advice. There was evidence contained in care place of good nutritional assessments and monitoring with the involvement of the dietician and the gastro department. Referrals to hospital were evident where this had been required. Monthly assessments of health status were evident. The administration of the lunchtime mediation round was observed. The MAR charts had been completed as required. Medication was stored and administered as required. The nurse administering the medication appeared competent and confident and, when questioned by the inspector, it was obvious that she had the required knowledge and skills. Care staff were observed delivering care in a way which maintained privacy and dignity for individual residents. The residents spoken to confirmed that staff were always respectful toward them. There was a good rapport and banter noted between staff and residents. This was also observed between staff and visitors. Some residents chose to spend more time in the privacy of their own bedrooms, watching TV or just enjoying their own company. Some preferred to take their meals in their own rooms and their preferences were respected by the staff. Guardian House Nursing & Residential Home DS0000026947.V249682.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15 Residents have the opportunity of engaging in therapeutic activities suited to their capabilities. The meals in this home are good offering both choice and variety and catering for special dietary needs. EVIDENCE: On the day of the inspection there was an entertainer visiting the home during the afternoon. Almost all of the residents were observed enjoying this show in the lounge. Residents spoken to confirmed that entertainers visit the home on a regular basis. Residents had enjoyed a game of bingo in the lounge during the morning where staff were observed helping residents to play. There was a programme of activities and entertainment. This was overseen by two members of care staff who had the responsibility of organising activities Guardian House Nursing & Residential Home DS0000026947.V249682.R01.S.doc Version 5.0 Page 13 All the residents spoken to were complimentary about the quality of the food provided at the home. There was a choice at each mealtime, evident on the menus, and special diets were catered for. The lunchtime meal was observed as being appetising and residents who needed help with eating their meal were having assistance from care staff. Guardian House Nursing & Residential Home DS0000026947.V249682.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Residents and their families could be assured that any concerns or complaints they had would be listened to, taken seriously and acted upon. The systems adopted by the home help to ensure that residents are protected from harm and abuse. EVIDENCE: There was a clear and accessible complaints procedure displayed in the home. The manager had received two complaints in the last twelve months. These were recorded and had been investigated as per procedure. The CSCI had received one complaint directly which had been investigated and not upheld. Two of the visitors spoken to at the time of the inspection stated that they would know who to go to if they had any concerns and another visitor stated that some concerns he had had in the past had soon been rectified by the manager and staff in the home. Several staff members were spoken to during the inspection. The senior care assistant on duty was interviewed and was asked about his knowledge of the procedure for POVA. His knowledge of this was good and other staff members were also aware of who they would report to in such circumstances. Guardian House Nursing & Residential Home DS0000026947.V249682.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 The standard of the environment within this home needs some improvement but does provide a comfortable, safe and homely place for the residents to live. EVIDENCE: A tour of the home was conducted where all the communal areas, the kitchen, laundry and a selection of bedrooms were inspected. The home provided a comfortable environment for the residents, which had been adapted to suit individual needs. Bedrooms were arranged to suit the preferences of the resident and also to help with care and nursing needs. There was evidence of the use of pressure relieving equipment, mobile hoists, aids and adaptations, toilet frames and raised toilet seats, grab rails and passenger lift. Baths had also been adapted. Heating, lighting and ventilation was adequate. Guardian House Nursing & Residential Home DS0000026947.V249682.R01.S.doc Version 5.0 Page 16 The décor was looking a little worn and tired in places and it is required that the programme of redecoration and refurbishment is stepped up. It was noted that, in bedroom 19, there was, what appeared to be, a burn mark in the carpet. This carpet needs replacing. Bedroom number 3 also required a new carpet. Some of the flooring in the toilets was badly marked and these require new flooring. The above issues were discussed with the registered manager at the time of the inspection. There was a large lawned area adjacent to the car park outside and this provided an attractive setting for residents to enjoy the summer sun. The inspector was shown photographs of a recent barbeque event during which a gazebo was erected. The residents commented on how they had enjoyed this. There was also seating areas around the side of the home. There was adequate communal space provided with a large lounge and separate dining area. There was also a quiet area, which contained a water feature, where residents and their visitors could relax. The home was clean and hygienic throughout. Guardian House Nursing & Residential Home DS0000026947.V249682.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 29 Staff are carefully selected to work at the care home and residents are safeguarded from harm or abuse by this process. The number and skill mix of staff provided will need reviewing in relation to the provision of maintenance and domestic hours. Residents and their families can be assured that the staff posses the relevant knowledge and skills to care for them. EVIDENCE: At the time of the inspection the home was fully occupied with 24 residents all in receipt of nursing care. The staffing rota was examined and the numbers of staff provided corresponded with the minimum requirements of the existing staffing notice. The manager usually worked supernumery but covered some shifts on the floor occasionally. She was supported by a deputy manager who worked on the floor. There was always a qualified nurse on duty throughout each 24 hour period. From 7am-2pm four care assistants were employed including a senior care assistant. From 2pm-5pm three care staff were employed and from 5pm7pm there were four care staff on duty. On night duty there was one qualified nurse and one care assistant plus there was a care assistant working a twilight shift until 10 or 11pm. Guardian House Nursing & Residential Home DS0000026947.V249682.R01.S.doc Version 5.0 Page 18 The provision of maintenance services gave some rise for concern as there was only provision one day per week plus as and when required. This was inadequate and maintenance hours provided at the home required increasing. The kitchen was adequately staffed from 7am-8pm. The domestic assistant also worked in the laundry daily from 7am-4pm or sometimes 5pm. The provision of domestic hours requires reviewing. It is a recommendation that a full time domestic assistant is employed as well as a part time laundry assistant. Administration is provided by Guardian Care centre. At the time of the inspection there were no staffing vacancies and very little use of agency staff. The staff training and development programme was very effective. The registered manager of the home was also the staff-training manager for Guardian Care Centre. The training programme was examined and found to be comprehensive and extensive for both mandatory and non-mandatory training. NVQ training was on going and the home had reached the 50 target level for NVQ levels 2 or above. The senior care assistant stated that he would very much like to do NVQ level 3 training as he had gained level 2 a few years previous. This was discussed with the manager who stated that she would be putting him, along with others, forward to do this training. Eight of the care staff held a current first aid certificate at the time of the inspection. The staff members spoken to all felt that their training needs were very well supported by the manager. The home is to be commended for its staff training and development programme. There was a robust staff recruitment procedure in place at the home. Three employee files were examined and these were found to contain the required information, references and police checks. Guardian House Nursing & Residential Home DS0000026947.V249682.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 36, 37 and 38 EVIDENCE: Discussions with the manager revealed that she had completed NVQ level 4 training in management. She had also undergone NVQ assessor update training and had almost completed 7407 teaching certificate. She had attended various study days in order to maintain her PREP requirements. The manager stated that she would also be commencing a palliative care course in September. Guardian House Nursing & Residential Home DS0000026947.V249682.R01.S.doc Version 5.0 Page 20 Staff members spoken to were very complimentary about the manager and the support afforded to them. They stated that she was approachable and that, as well as staff meetings, they were also able to talk to her in private on a one to one basis. Residents were also given the opportunity to air their views at residents’ meetings or, as they commented, they could have a word in private at any time. A visitor spoken to also confirmed this, and it was observed that there was a good rapport between the manager, staff, residents and visitors. Staff members confirmed that they received regular formal supervision sessions and the inspector observed that these had been documented. The records of maintenance were examined in relation to the servicing and maintenance of equipment in the home. These were found to be up to date and in order. The recording of hot water temperature testing for baths and showers had not been documented as having taken place monthly and this will need to be commenced. Accidents had been recorded as required and had been audited on a regular basis. There was a current Gas Safety test certificate in place, PAT testing had been done, A test certificate was in place for compliance with Legionella. Mandatory staff training updates had taken place including fire safety and fire drills, moving and handling, COSHH, infection control, food safety and others. Guardian House Nursing & Residential Home DS0000026947.V249682.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 3 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 x x x 3 3 2 Guardian House Nursing & Residential Home DS0000026947.V249682.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 4 Standard 19 19 19 27 Regulation 23(2)(b) 23(2)(b) 23(2)(b) 18(1)(a) Requirement The carpets must be replaced in bedrooms 19 and 3. The flooring must be replaced in the toilets identified The programme of redecoration and refurbishment in the home must be stepped up The number of maintenance hours provided at the home must be increased Timescale for action 20/12/05 20/12/05 20/12/05 20/12/05 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 27 Good Practice Recommendations The number of domestic staff hours provided at the home should be reviewed with a view to increasing these Guardian House Nursing & Residential Home DS0000026947.V249682.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Guardian House Nursing & Residential Home DS0000026947.V249682.R01.S.doc Version 5.0 Page 24 - 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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