Inspection on 20/07/06 for Guardian House Nursing & Residential Home

This inspection was carried out on 20th July 2006.

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

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

Other inspections for this house

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

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

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

Guardian House Nursing &... 13/09/05

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. 2nd Inspector Mrs Lynne Gammon Key Unannounced Inspection 20 July 2006 10:30 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.V296577.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 House Nursing & Residential Home DS0000026947.V296577.R01.S.doc Version 5.2 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 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.V296577.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th February 2006 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, and 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. The fees in this home range from £406.00 to £829.00 at the time of this report. This can be broken down to include part funding by the County Council (Social Services) and free nursing care. Contribution from residents will be different, depending on how much funding they receive. There are additional charges for hairdressing. Guardian House Nursing & Residential Home DS0000026947.V296577.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Following inspection planning, this unannounced key inspection visit was carried out by two inspectors and took four hours to complete. The following methods of gathering evidence were used – Direct observation Examination of records Discussions with staff, visitors and residents Discussions with the acting manager Tour of the home Inspectors arrived at about 10.30am and were greeted by a few of the residents who were sitting outside enjoying the summer weather. The acting manager was on duty as the nurse in charge and was administering medication at the time. Inspectors were made to feel welcome by staff, residents and visitors. All the key minimum standards were examined during this inspection and inspectors gave verbal feedback to the acting manager at the end of the inspection visit. This included one immediate requirement. Other requirements and recommendations were made as a result of this visit and have been included at the end of this report. There were some very mixed comments received from residents and their representatives about the care they receive in the home. These included – “Not being mobile I have to be turned regularly in bed. This does not always happen.” “The staff do not listen to what I say. Sometimes they are available and sometimes not.” Discussions were held with several residents. One of the residents was receiving day care three times per week and she was pleased with the personal care afforded to her by the staff in the home. A relative stated that “someone is always available.” There were some disappointing comments about the social activities provided in the home. These included – Guardian House Nursing & Residential Home DS0000026947.V296577.R01.S.doc Version 5.2 Page 6 “Not as frequent as they were when mother first went into the home – always something going on then – the home has gone down bank and is not the same place.” “More could be done – residents might like to paint or make something around the tables – like they do in day care centres – play cards or dominos etc.” “Before there was plenty of entertainment now hardly anything. I was told on my first visit that there would be a variety of things for them to do each week plus trips out, what happened?” In relation to the staff at the home comments included – “Ten out of ten for all the staff.” “Whatever you ask for they will do.” “I do not expect them to come to my wife when they are busy but as soon as they are free they are there for you.” “The staff are very pleasant and sociable.” “The staff are very helpful at all times and someone is always available.” “Problems happen when different staff are on duty. I feel they should be informed about the residents – the ones who want to go the toilet but might not be able to communicate too well are left sitting wet and it is very upsetting.” “The home is a happy one – the staff are very good.” “Sometimes short of staff.” “The staff do their best but there is just not enough of them at one time.” In relation to the presentation of the home “Went through a period of neglect not as clean as it first was but the condition is starting to pick up again.” “The home is very clean. The domestic staff do an excellent job and need telling so.” “The home told me that they hoped to get more comfortable chairs but they have not been able to get any. A lot of things need to be replaced urgently at the home, even some of the buzzers when broken are not replaced for quite a while because they do not have any replacements.” In relation to the food and meals – “There is not enough variety in the food and at times some of the food is too difficult for the residents to handle because of the lack of adapted utensils. The tables that are used by the chairs for residents to eat off do not balance properly so most of the time everything spills onto them. Plus there are not enough dining tables for everyone.” Staff training and supervision was found to be very good. The acting manager has yet to be Registered with the CSCI. Guardian House Nursing & Residential Home DS0000026947.V296577.R01.S.doc Version 5.2 Page 7 The home caters for elderly residents of either sex and with general nursing needs. Physical disabilities are catered for and aids and adaptations are supplied to help maintain independence. The staff have received training in dementia awareness and are able to accommodate a few residents with these needs, not falling under mental health nursing category. Although spiritual needs are assessed, the home does not hold regular Church services of any denomination but the inspector was informed that clergy visit on an individual basis. What the service does well: What has improved since the last inspection? What they could do better: The Providers will need to ensure that the comments, contained in this report from residents and their families are taken seriously and acted upon. Comments indicate that the level of care and social activities provided in this home are not as good as they used to be. Guardian House Nursing & Residential Home DS0000026947.V296577.R01.S.doc Version 5.2 Page 8 Some of the care practices observed during the visit were disappointing especially in relation to lack of supervision for residents at mealtimes and some aspects of health and safety. These will need to be addressed by the providers. The provision of staffing numbers will also need to be addressed and staff must be provided according to the overall occupancy and dependency level of the residents accommodated. The provision of only 2 night staff gives rise for concern, especially as all the residents accommodated have nursing needs. Also the staffing levels appears to dip around mealtimes – at lunchtime there are only 4 staff including the nurse and the same until 5pm when tea is served. The cook leaves at 4pm meaning that a member of the care staff will need to be deployed to the kitchen in order to make drinks and complete food preparations. If residents start to take their evening meal before 5pm then this would leave only 2 care staff on the floor. This will be adding to the problem of supervision at mealtimes. The dining routine needs to be reviewed, as not all the residents are able to sit in the dining room. There are insufficient numbers of tables and chairs for this to happen meaning that a number of residents have to eat in the lounge where they spend all day. An over bed table is provided for this and the residents are in easy chairs. This is not conducive to enjoyable dining and it was obvious that some residents were struggling to eat in this position. An audit is recommended of food and meals provided to include the views of residents and/or their representatives. The environment was looking worn and tired in places and there is a need to implement the redecoration/refurbishment programme without further delay. The Providers will also need to review their maintenance support for the home, as this was as and when required with no definite hours dedicated to the home. The comments received and the observation of the home confirmed that this would need to be improved upon. The system for the recording of the outcome of complaints will need to improve with documentation being available in the home as to the summary and outcome of each complaint received. The CSCI telephone number will also need to be attached to the complaints procedure. The frequency of fire drills for night staff must be increased, as this was insufficient. There were very good records seen for day staff. All information relating to recruitment must be available for inspection at the home. This was in relation to 2 written references, which needed to be faxed through from Guardian Care Centre for staff employed at this home. Guardian House Nursing & Residential Home DS0000026947.V296577.R01.S.doc Version 5.2 Page 9 The CSCI must receive an application in respect of Registered Manager for the home. This has been ongoing for some time now and a time limit of 3 months has been agreed. The dates of care plan reviews must be specific and documented as day, month and year as these are legal documents. The issues identified with medication must be addressed. 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.V296577.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 House Nursing & Residential Home DS0000026947.V296577.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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 service users undergo an assessment of needs but cannot always be guaranteed that the home will meet their assessed needs fully. EVIDENCE: Examination of care plans identified that pre admission assessments were being carried out prior to individuals being offered placements at the home. Discussions with the acting manager confirmed that it is her responsibility to carry out these assessments and that, in her absence, then the other senior nurse would do this. She went on to explain how the assessment works and that, placements are only offered to those residents whom she feels can have their needs met by the home. Examples were also seen of pre admission assessments carried out by Social Workers. Guardian House Nursing & Residential Home DS0000026947.V296577.R01.S.doc Version 5.2 Page 12 As highlighted throughout this report, there were some outcomes, which the home was failing to meet and not all residents’ individual needs were being met fully. These included a lack of help and assistance to eat their meals; a lack of social and therapeutic activities and some aspects of relating to personal care were weak. Guardian House Nursing & Residential Home DS0000026947.V296577.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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. The health care needs of individuals was monitored and maintained by the staff in the home and other healthcare professionals. Some aspects of personal care and health and safety were in need of improvement and not all basic care needs were met on a continuous basis. EVIDENCE: A random selection of three care plans was examined and three residents were case tracked to identify if care was being delivered as per plan. The plans were overall of a good standard, were consistent and had been evaluated monthly. However the content of monthly evaluations was minimal and the actual date of entry of these was not included – only the month. This was discussed with the acting manager and a requirement has been made for a proper date to be inserted in future. Guardian House Nursing & Residential Home DS0000026947.V296577.R01.S.doc Version 5.2 Page 14 Most of the comment cards from residents and visitors implied that they some were satisfied with the overall care provided by the home but that there were some were not. Comments from residents included – “Not being mobile I have to be turned regularly in bed. This does not always happen.” Discussions were held with several residents. One of the residents was receiving day care three times per week and she was pleased with the personal care afforded to her by the staff in the home. Another resident who was sitting in the reception area was one of the residents being case tracked. She was well presented and dressed appropriately and had had her hair recently washed and set and her spectacles had been cleaned. This lady had a drink of juice at hand, which she managed by herself. There were a number of visitors present at the time of the inspection and the inspectors spoke with them about the care their relative was receiving in the home. Comments and opinions were mixed. The relatives of a resident in the home stated that they were very happy with the care their relative was receiving. They stated that they can visit anytime and that their relative always appears well cared for and that the staff are friendly and approachable. One of the residents commented, “The staff do not listen to what I say. Sometimes they are available and sometimes not – nobody cares.” A relative who was visiting at the time, stated that she thought that her mother was giving up. This lady had developed pressure sores and the nurses in the home were treating these. There was documentation in place to confirm this. One of the relatives spoken to was not happy with the care afforded to her relative or from what she had seen, to other residents in the home. She stated that her mother had had her own wheelchair but that she had not seen this for some time now. The inspector then observed two care staff moving this lady into a wheelchair in order to go to the toilet. This wheelchair belonged to another resident in the home as it had the resident’s name on the side of the wheelchair. Also the chair only had one footrest in place. The technique used to transfer this lady into the wheelchair under her arms was wrong and was a moving and handling technique, which is no longer, approved or deemed safe. Comments from professional staff said; “Sadly staff turnover makes it hard to form lasting relationships with the Guardian Team”. They also went on to say they were satisfied with the overall care provided to residents in the home. Comments from other professionals confirmed that they was satisfied with the overall care afforded to the residents in the home. Guardian House Nursing & Residential Home DS0000026947.V296577.R01.S.doc Version 5.2 Page 15 The inspector observed the acting manager administering the lunchtime medication to the three residents being case tracked. The inspector had two concerns as follows – Medication was dispensed from the medication trolley, which was stored in the drugs room, and the trolley was not moved into the room where the residents were seated. Although the acting manager explained that there were only a few residents receiving medication at lunchtime, this is bad practice and could lead to errors in medication administration. Also, on one of the Medication Administration Record charts medication had been omitted and the reason for omission had not been documented. This was regular and not “as required” medication. It was difficult to identify whether dignity was upheld for the residents by the staff in the home, as the comments received were so very mixed. Also inspectors witnessed examples of good and bad practice in relation to personal care. It is reasonable to confirm that, as a general rule, residents are treated with dignity and respect by the staff in the home but sometimes this fails and there are areas for improvement. Guardian House Nursing & Residential Home DS0000026947.V296577.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home was failing to meet the social and therapeutic needs of individual residents accommodated. Dining facilities within the home were not conducive to ensuring that this was a pleasant experience for individuals and there was room for improvement to the menus. EVIDENCE: The acting manager explained that senior care staff are responsible for organising activities for residents plus there is a diversional therapist who works at the home for 5 hours per week and has been working on producing an activities programme for the home. The acting manager confirmed that there are no Church services held in the home but that individual spiritual needs are met and that residents are visited by members of their own Church should they want this. A visitor was sitting with one of the residents being case tracked. They stated that there are very little activities for the residents. A couple of weeks ago his Guardian House Nursing & Residential Home DS0000026947.V296577.R01.S.doc Version 5.2 Page 17 relative had gone out into the garden to attend the barbeque organised by the home but that was the first time in over a year that she had been outside. Another resident had difficulty in communicating but was able to show how much she had enjoyed the recent barbeque and sitting in the garden. Many of the comments included in the comment cards suggested that there were insufficient therapeutic activities provided for residents at the home. Examination of care plans identified that documentation of activities was poor. Some of the comments made in relation to activities read – “Not as frequent as they were when mother first went into the home – always something going on then – the home has gone down bank and is not the same place.” “More could be done – residents might like to paint or make something around the tables – like they do in day care centres – play cards or dominos etc.” “Before there was plenty of entertainment now hardly anything. I was told on my first visit that there would be a variety of things for them to do each week plus trips out, what happened?” Residents were observed eating their lunchtime meal of fish and chips. Comments received from one of the visitors included – “There is not enough variety in the food and at times some of the food is too difficult for the residents to handle because of the lack of adapted utensils. The tables that are used by the chairs for residents to eat off do not balance properly so most of the time everything spills onto them. Plus there are not enough dining tables for everyone. The inspector confirmed this. There were insufficient dining tables and chairs for the number of residents accommodated in the home. Therefore a number of residents stayed sitting in their lounge chairs and had over bed tables from which to eat their meals. This was not conducive to dining and some of the residents were obviously struggling to eat their meals in this position. It was also observed that one of the residents who was involved in the case tracking was fed via tube and was left sitting next to residents who were eating meals. It was felt that this was inappropriate and must have only added to the individual’s ordeal of not being able to eat solid food. It is a requirement of this report that enough dining tables and chairs be provided for all the residents accommodated in the home and that residents are encouraged to take their meals in the dining room or their own bedroom. The inspector observed one lady who was suffering with Parkinson’s disease really struggling to feed herself with the fish and chips served to her. The fish had not been cut up for her but also she was unable to handle the cutlery and needed specialised adapted cutlery and crockery. Some of the other residents were seen struggling to feed themselves with the utensils available to them. A requirement has been made to supply specialised adapted cutlery and crockery for individuals who need them following an assessment by the Occupational Therapist. Guardian House Nursing & Residential Home DS0000026947.V296577.R01.S.doc Version 5.2 Page 18 It was also observed that soft liquidised diet was mashed together and not placed into separate portions of meat, vegetables, etc. Served in this way, the meal did not appear appetising and it is recommended that soft diets be served as separate portions the same as normal diets. The inspector visited the kitchen and spoke with the head cook. Menus were worked on a four weekly rota and appeared to be varied and nutritional. However, it was felt, in light of comments received, that these would benefit from being reviewed and an audit including obtaining the views of residents and their representatives should be carried out. It was identified that most of the vegetables served to residents are of the frozen variety and that fresh vegetables are served on a Sunday. It is recommended that more fresh vegetables and more fresh fruit be served to residents throughout each week, as these are tastier than the frozen variety. For most of the residents and relatives spoken to food was a very important issue and meals were something that they looked forward to. The taste and quality of food served to them was a priority. A comment from a resident read – “A regular cook would help! There is not enough brown bread, fresh fruit and yoghurts etc.” “It is difficult to eat because of my hands. I rarely get any help.” Although personal choices and preferences were laid down in individual care plans, through case tracking it was identified that autonomy could not always be guaranteed. Due to the staff being very busy at all times, there was little time to pay attention to detail or to ensure that individual preferences were upheld. The home catered for diverse needs of individual residents. There were aids and adaptations provided for the less mobile and staff had received training in dementia awareness to help meet the needs of residents with these needs. Discussions with the acting manager, however, identified that there was a need to monitor whether spiritual needs were being met on a regular basis. Guardian House Nursing & Residential Home DS0000026947.V296577.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their representatives can be assured that the systems in place at the home will help protect them from harm. There was evidence that concerns are listened to and dealt with but the documentation of these will need to be improved in order to evidence that they have been dealt with as per procedure. EVIDENCE: There was a complaints procedure displayed in the entrance to the home. This included the address details of the local CSCI office but did not contain the telephone number. There is a requirement for this to be included. There was a complaint/concerns log kept in the home, which the acting manager had completed. The care plan of one of the residents involved in case tracking had documented that a complaint had been made by the representative of the resident and that this had been referred to the Care Director. Examination of the complaint log confirmed this but did not contain a copy of the outcome of the complaint and whether or not the complaint had been dealt with within the set timescale of 28 days. It is required that all parts of a complaint are kept together and are available for inspection. Guardian House Nursing & Residential Home DS0000026947.V296577.R01.S.doc Version 5.2 Page 20 Comments concerning raising concerns and complaints received from residents and their representatives were mixed with some stating that they knew who to go to and were satisfied and others that they did not know who to approach and that they have raised concerns before which have not been dealt with satisfactorily. Staff spoken to were aware of the procedure relating to Vulnerable Adults and stated that they would report any concerns to the acting manager in the first instance. Staff training is given in this area during induction and later as a separate area. Guardian House Nursing & Residential Home DS0000026947.V296577.R01.S.doc Version 5.2 Page 21 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was found to be clean but is in need of redecoration, refurbishment and a better level of maintenance support. EVIDENCE: Comments received from some of the residents and their representatives prior to the inspection visit indicated that maintenance support for the home was lacking and that there were areas in need of improvement. During the tour of the home this was found to be upheld. All communal areas, kitchen, laundry and most of the bedrooms were inspected. Some of the windows in the lounge were blown where the double glazed seals had gone. This caused a fog effect and obstructed views through the windows. There is a requirement for these to be made good. Guardian House Nursing & Residential Home DS0000026947.V296577.R01.S.doc Version 5.2 Page 22 Overall the home was found to be very clean and residents and relatives had confirmed this in their questionnaires. The laundry was found to be adequate but there was a query over whether the home was using alginate bags in order to reduce handling of contaminated linen and avoid cross infection. None of these could be seen at the time but the acting manager assured the inspectors that they were used. The toilet located close to the laundry room was clean but the flooring was in need of replacement. The toilet located close to the Oxygen storage room was in need of new flooring and the hot water in this room was found to be very hot and exceeding the required 43 degrees centigrade. An immediate requirement was left to address this and the CSCI received confirmation that this had been done within 24 hours. Overall the bedrooms were homely and very clean. Some of the bedrooms were looking tired and in need of redecoration and refurbishment. The toilet in bedroom 86 was starting to look worn and needs replacing in the near future. The emergency buzzer was tested and the response was very quick. The garden was pleasant and accessible to residents. The inspector visited the kitchen and this was found to be clean and hygienic at the time. The inspectors were provided with a redecoration/refurbishment programme for 2006. However, very little had been actioned on this plan and half the year has gone. This was discussed with the acting manager and a requirement has been made for this to be completed within the year. Comments from residents and relatives in relation to the environment are as follows – “Went through a period of neglect not as clean as it first was but the condition is starting to pick up again.” “The home is very clean. The domestic staff do an excellent job and need telling so.” “The home told me that they hoped to get more comfortable chairs but they have not been able to get any. A lot of things need to be replaced urgently at the home, even some of the buzzers when broken are not replaced for quite a while because they do not have any replacements.” The following comments were received from a representative of a resident – Guardian House Nursing & Residential Home DS0000026947.V296577.R01.S.doc Version 5.2 Page 23 “The lift is always breaking down and it takes hours for someone to come and fix it. The other week most of the residents had to sleep downstairs all night because it was broken down.” “A few months ago I was told that there was going to be a meeting with someone who runs the home to discuss any problems and I and at least two other people took time off work to be there but no one showed up. There has been no other meeting date made since. When I first went to visit the home before my relative was admitted I thought that it was perfect. Small and well run, but the way things have changed I just cannot believe it The maintenance log was examined and it was identified that jobs requested had been attended to. Discussions with the acting manager identified that there were no dedicated maintenance hours for this home but that the maintenance person was available on request and was based at the Guardian Care Centre. It did not appear, from the tour of the environment and listening to residents/ relatives’ comments that this system was working efficiently for the home. It is a recommendation of this report that this is reviewed in order to help eradicate some of the problems identified and to ensure that the home and equipment used in the home, is maintained to a satisfactory standard. Guardian House Nursing & Residential Home DS0000026947.V296577.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff Training and supervision is good. Staff have the required skills and competencies but, at times, are not provided in sufficient numbers to meet the needs of the residents in the home and this will need to be reviewed. EVIDENCE: Comments received from relatives and residents in relation to the staff at the home include – “Ten out of ten for all the staff.” “Whatever you ask for they will do.” “I do not expect them to come to my wife when they are busy but as soon as they are free they are there for you.” “The staff are very pleasant and sociable.” “The staff are very helpful at all times and someone is always available.” “Problems happen when different staff are on duty. I feel they should be informed about the residents – the ones who want to go the toilet but might not be able to communicate too well are left sitting wet and it is very upsetting.” “The home is a happy one – the staff are very good.” “Sometimes short of staff.” “The staff do their best but there is just not enough of them at one time.” Guardian House Nursing & Residential Home DS0000026947.V296577.R01.S.doc Version 5.2 Page 25 At the time of the inspection visit there were 20 residents accommodated in the home. All were receiving general nursing care and 2 of these had dementia care needs also. The acting manager was on duty working as the trained nurse and 4 care assistants supported her until 12 midday. Then from 12 midday until 5pm there were three care staff and from 5pm until 10pm there were four care staff again. During the night from 10pm until 7 am there was one nurse and 1 care assistant on duty. Inspectors had some concerns about the above arrangements in light of observations at the time of the inspection, comments from some of the residents and their families and comments from some staff members. There did not appear to be enough staff on duty over meal times where residents did not receive all the assistance they required in order to eat their meals. Comments cards received from some of the families and residents indicated that there was not always enough staff on duty to attend to the needs of the residents in the home. Discussions with residents and visitors at the time of the visit confirmed the above. A discussion held between the inspector and a member of the care staff team at the time of the visit highlighted that she was concerned about the number of staff supplied at nighttime. Inspectors identified that, should the occupancy increase any more than 20 residents, then there would need to be a second care assistant employed during the night time, making a total of 3 staff on duty. Dependency levels of residents will also affect the number of staff required. Overall dependency levels of residents accommodated in the home at any given time must be assessed on a regular basis and staff provided accordingly. There was a domestic assistant employed daily from 8am until 4pm who was also responsible for the laundry. In the kitchen there was a cook employed daily from 8am until 4pm. Administration for the home was undertaken by secretarial staff at the Guardian Care centre. Maintenance support for the home was provided by the Guardian Care centre. The inspector was informed that maintenance work required at the home was documented and attended to weekly by the maintenance staff. There were no designated maintenance hours supplied to the home but support was given on an as and when required basis. Observation of the environment identified that this arrangement was not efficient and dedicated maintenance hours should be provided at the home. Guardian House Nursing & Residential Home DS0000026947.V296577.R01.S.doc Version 5.2 Page 26 Discussions with staff members identified that staff training and support is offered by the home. One staff member who spoke with the inspector stated that she had received Moving and Handling and Fire Safety training, dementia training and had just completed her NVQ level 2 in direct care. Another staff member spoken with stated that she enjoyed working at the home and stated that the induction had been good and that the staff training was good. It is recommended that the home increase the number of care staff who are trained to NVQ level 2 and above as, at 30 this was falling short of the 50 target relating this minimum standard. The inspector explored the homes’ recruitment and selection procedure during the visit. 2 employee files were examined and both contained the following – Application forms. Criminal Records Bureau and Protection of Vulnerable Adults checks. Evidence of Induction. Evidence of Supervision. Evidence of training and development. Work permit. Proof of identification. Nursing and Midwifery Council number. There was, however, only one written reference for both employees. It was later identified that the second reference was contained in files at the main office at Guardian Care Centre and a copy of these were forwarded to the inspector. It is required that all information relating to the individual regarding recruitment are kept together and available for inspection at the home. Guardian House Nursing & Residential Home DS0000026947.V296577.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some aspects of overall management of the home are good, especially in relation to staff training and supervision. However other areas highlighted throughout this report are in need of improvement, especially in relation to aspects of the delivery of care and service users outcome. There is still no Registered Manager for the home and this will need to be addressed within the timescale agreed. EVIDENCE: Inspectors met with the acting manager and discussed Manager Registration for the home. The applicant had applied for registration with the CSCI over the last few months but this had been returned due to inappropriate references and no CRB. The acting manager stated that she intended to resend her Guardian House Nursing & Residential Home DS0000026947.V296577.R01.S.doc Version 5.2 Page 28 application following amendments to references and was just waiting to receive her CRB. It is required that an application in respect of Registered Manager for this home be received by the CSCI within 3 months of this inspection. The acting manager stated that she was supported by a deputy manager and other trained nurses. Senior care supervisors are also employed on each shift wherever possible to oversee the care. The Company carries clinical audits out 6 monthly at the home. The inspector examined the latest audit, which was carried out in May of this year. This assessed all areas of the services delivered and included obtaining the views of residents in the home. As outlined under standard 15, it is recommended that an audit of meals and food be undertaken to include the views of residents and their representatives. Staff are appropriately supervised in the home and the inspector saw written evidence of regular formal staff supervision. The recording and content of these sessions was very good. Health and safety was addressed within the home. Up to date records were seen of the following – Hot water temperature testing Maintenance and testing of fire equipment including weekly fire alarm testing and emergency lights testing. Servicing equipment including that of hoists. The certificate for up to date servicing of the lift was unavailable for inspection and could not be produced. This must be produced to the CSCI within one month of this report. Gas safety certificate was seen. Certificate for legionnella compliance was seen. Certificate for insurance, which included public liability insurance was displayed. Staff had received regular update training sessions in mandatory health and safety training. Regular fire drills had been carried out for day staff but night staff had not received these as required and this must be addressed with more fire drills organised for night staff. Guardian House Nursing & Residential Home DS0000026947.V296577.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 x x 3 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 3 x x 3 x 2 Guardian House Nursing & Residential Home DS0000026947.V296577.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP38 Regulation 13(4) Requirement The wheelchair policy must be adhered to at all times for the safety of both individual residents and staff. Staff must only assist residents to move using the correct moving and handling techniques as outlined in individual care plans. Medication must only be dispensed directly from source with the MAR chart at hand to confirm identification of the individual. Where “o” is identified on the MAR chart the reason for omission of medication must be defined. The provider must improve the provision of social and therapeutic activities for the residents in the home and these must be evidenced. Individual residents must be assessed and provided with suitable adapted cutlery and crockery in order to help them to feed themselves The provider must ensure that DS0000026947.V296577.R01.S.doc Timescale for action 28/08/06 2 OP38 13(5) 28/08/06 3 OP9 13(2) 28/08/06 4 OP9 13(2) 28/08/06 5 OP12 16(2)(m)( n) 28/08/06 6 OP15 16(2)(g) 28/08/06 7 OP15 12(1)(b) 28/08/06 Page 31 Guardian House Nursing & Residential Home Version 5.2 8 OP15 23(2)(g) 9 OP38 23(4)(e) 10 OP38 23(2)(c) 11 OP31 8 and 9 12 13 OP29 OP27 19 and schedule 2 18(1)(a) 14 15 OP19 OP16 23(2)(b) 22(8) 16 OP16 22(7)(a) individual residents receive the help and support they require in order to eat their meals The provider must ensure that adequate dining facilities are provided for all the residents in relation to the provision of more dining tables and chairs and that individuals are encouraged to eat in the dining room or individual bedrooms. The frequency of fire drills must be increased for night staff in order to ensure that all staff have the required training. The CSCI must be provided with a certificate to confirm that the passenger lift has been serviced within the last 12 months. The CSCI must receive an application in respect of Registered Manager for the home. All information relating to recruitment must be available for inspection at the home. Staff must be provided in sufficient numbers in order to meet the needs of the residents accommodated in the home. The redecoration/refurbishment programme must be completed for 2006 by the end of the year. It is required that all parts of a complaint are available for inspection by the CSCI and that the outcome and summary of the complaint is documented. The telephone number of the local CSCI office must be included on the complaints’ procedure. 28/08/06 28/08/06 28/08/06 20/10/06 28/08/06 28/08/06 31/12/06 28/08/06 28/08/06 Guardian House Nursing & Residential Home DS0000026947.V296577.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 4 5 6 Refer to Standard OP15 OP33 OP19 OP15 OP28 OP7 Good Practice Recommendations It is recommended that soft diets be served as separate portions the same as normal diets. It is recommended that an audit of meals be carried out to include the views of the residents and/or their representatives. It is recommended that the system for maintenance support for this home is reviewed and changed in order to offer a better service in this area. It is recommended that the home provide more fresh fruit and fresh vegetables with meals. It is recommended that NVQ training is stepped up in order to achieve the standard of 50 . 15(2) The dates of care plan reviews must be specific and documented as day, month and year. 28/08/06 Guardian House Nursing & Residential Home DS0000026947.V296577.R01.S.doc Version 5.2 Page 33 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.V296577.R01.S.doc Version 5.2 Page 34 - 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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