Inspection on 10/02/09 for Guild House

This inspection was carried out on 10th February 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Guild House 13/02/08

Guild House 09/10/07

Guild House 14/11/06

Guild House 07/12/05

Guild House 29/06/05

Guild House 09/02/05

Guild House 21/09/04

Guild House 24/03/04

Guild House 30/12/03

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Guild House 2a Denmark Road Gloucester Glos GL1 3HW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Adam Parker     Date: 1 0 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Guild House 2a Denmark Road Gloucester Glos GL1 3HW 01452525098 01452380245 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Gloucester Charities Trust Name of registered manager (if applicable) Miss Moya Doreen Neighbour Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 41 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Guild House is an attractive property, which has been sympathetically converted and extended to provide accommodation for older people who require personal care. Communal areas are spacious and doorways provide adequate space to accommodate wheelchair users. The communal rooms consist of a large dining room, one television lounge and a large lounge/conservatory on the ground floor. There are also further seating areas on each landing, which provide quiet places to relax. The accommodation consists of forty-one spacious single bedrooms on three floors. Care Homes for Older People Page 4 of 26 care home 41 Over 65 41 0 Brief description of the care home Couples who wish to share can also be accommodated. All rooms have a large en-suite with either a bath or a shower. Each floor also has an assisted communal bathroom. There are assisted communal toilets on the ground floor. Each floor has a small kitchenette for the residents use. All floors can be accessed by the passenger lift. The home has a call bell system and security facilities. The property is furnished to a high standard. There is level access to the attractive garden area. Guild House is approximately one mile from Gloucester city centre. Buses pass nearby to both the city and to Cheltenham. A church is next to the home and a small park is within walking distance. The provider supplies information about the home, including access to the most recent CSCI report to anyone who has expressed an interest. The details are maintained in a file, which is displayed in the front hall of the home. Current fee levels were not checked at this inspection. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection visit was carried out by one inspector on one day in February 2009. The registered manager of the home was present for the inspection visit, as well as two management facilitators. A tour of the premises was conducted and examination of residents care files. In addition staff recruitment and training was looked at as well as documents relating to the management and safe running of the home. Samples of records were selected for inspection against a number of outcome areas as a case tracking exercise. During the inspection visit four residents were spoken to, to gain their views of the service. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Care Homes for Older People Page 6 of 26 Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes admission procedure ensures that all residents are admitted on the basis of a full assessment of their needs, so that they can receive the care that they require. Evidence: Records seen in the residents care files showed that careful assessments are undertaken of each prospective residents care needs to ensure that the home is able to meet their needs. These processes are undertaken prior to the residents admission. Where residents had been funded by the local authority then copies of their care plan describing the residents needs had been obtained before the person was admitted to the home. All residents are admitted on a months trial basis The home does not provide intermediate care and so Standard 6 does not apply. Care Homes for Older People Page 10 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home works well to meet residents health and personal care needs and upholds their privacy and dignity, although some improvements are still needed in the recording of medication administration and with storage arrangements. Evidence: Since the previous inspection the home had developed care plans that although brief in content, described the actions that staff would carry out to meet the residents needs. One care plan also described input from a Physiotherapist as well as how staff actions would meet the needs of the resident. At the time of the inspection visit the home was in the process of transferring all residents care plans and associated risk assessments to a new format. Risk assessments had been completed for pressure area care, moving and handling and nutrition. A falls risk assessment in use indicated that a review should be carried out in the event of a fall and this had been carried out for one resident. A mental health risk assessment had been completed for one resident who had a history of Care Homes for Older People Page 11 of 26 Evidence: depression. There was recorded evidence of residents receiving input for their health needs from visiting professionals such as GPs and community nurses. A chiropodist was visiting the home during the inspection visit. Two residents spoke of how they were able to have their usual chiropodist visit them in the home as opposed to the one who visits the home on a monthly basis. One resident commented We could not have better care. Medication storage and administration arrangements were looked at. Since the previous inspection the home had obtained a motorised medication trolley. Medication storage temperatures were being monitored in both the refrigerator and with general storage. Records kept showed that appropriate storage temperatures were being maintained. The recording of the administration of controlled medication was in order and recorded administration times showed that medication was being given at time intervals suitable for effective pain management. The cabinet for storing controlled medication was checked and was not in line with current legal requirements. The home should make the necessary improvements so that any controlled medication can be stored correctly. Medication administration records (MAR) were checked, generally medication administration had been signed for where it had been given although there were a few gaps noted such as for two residents on the 4th and 5th February 2009. This was discussed with a staff member who had responsibility for overseeing medication practices. Any gaps in the recording of medication administration should be investigated to check whether residents have been receiving their correct doses of medication. Written protocols were in place to guide staff in administering medication prescribed on an as required basis. Handwritten directions on the MAR had generally been signed by two members of staff which should indicate that the written directions have been checked for accuracy. Some residents in the home were administering their own medication and this had been subject to a risk assessment. Two residents spoken to had no problems with the administration of their medication. Residents confirmed that staff knocked on doors before entering and were polite to them. Consent forms had been completed for staff who may need to be checked at night by the night staff. There are no shared rooms at the home apart from those shared by a married couple. Care Homes for Older People Page 12 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a varied activities programme, good social contact outside of the home and a variety of meals planned through consultation about their preferences. Evidence: The home has a dedicated activities coordinator and also receives input from another activities coordinator who covers other services operated by the registered provider. Information about planned activities is displayed on the notice boards for the residents information. The home had recently obtained a DVD projector and had recorded various outings and activities in the home which were viewed during the inspection visit. A range of activities are on offer in the home such as arts and crafts, music and movement, raffles, bingo, coffee mornings and quizzes. Musical entertainers also visit the home including a choir. There are close links with the church that is situated next to the home with residents attending mid week services and the church making occasional use of the homes garden. Children from a playgroup based at the church also visit the home. Residents also attend a church in the city that organises a number of activities. One resident was also attending another church with the involvement of a relative. In addition services are also held at the chapel adjacent to another care home operated by the provider nearby. Christian Holy Communion is held in the home on a Care Homes for Older People Page 13 of 26 Evidence: monthly basis. The home has taken account of residents preferences about activities and at their request, residents no longer attend an organ club where musical entertainment was provided. Two residents are involved in providing activities in the home with one resident playing the organ and another running a classical music group. The home has its own minibus and trips out of the home are organised with one destination being the Chew Valley lakes near Bristol. Other trips out have been made to the cinema and the theatre. Residents also have the opportunity to go on holiday to a hotel. One resident spoken to said that there was always something going on. another resident chose not to join in with bingo as was their preference but praised the wonderful activities coordinator. The home has a policy of allowing open visiting and a number of visitors were observed during the inspection visit. Information about advocacy services is available in the home. Residents are able to personalise their individual rooms with a number of items including furniture. The home has a four weekly menu. A number of residents spoken to confirmed that they were offered a choice of meals and one particularly praised the choices at supper time. It was noted that a vegetarian option was available and where this had been provided a record was being kept. One resident described the food as wonderful and another as five Star. Another resident described the meals as good although one resident was less positive and their comments were discussed with the registered manager. A book for residents to record comments about the meals was still in use as it had been at the previous inspection. Care Homes for Older People Page 14 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available if any resident or their representative should wish to make a complaint and the homes approach to staff training should ensure that residents are protected from abuse. Evidence: The homes AQAA document completed in December 2008 stated that the home had not received any complaints in the previous twelve months. There was an on going situation with one resident who had continuously expressed dissatisfaction with the service provided that we were aware of through contact with the registered provider. Information about how to make a complaint is available in the entrance to the home along with other information about the service. All residents are given a copy of the service users guide that contains the complaints procedure as well as being given a separate copy. A large print version of the complaints procedure was also available. Residents meetings had been held where concerns could be raised. In relation to residents legal rights, the home has information on the Mental Capacity Act 2005 and training had been planned. The home has information available about local advocacy services that could be used by residents. A number of staff had completed training in protecting vulnerable adults although it Care Homes for Older People Page 15 of 26 Evidence: was reported that 16 staff had not received this training. The majority of these were recently recruited staff and training had been booked. All night staff had completed the relevant training. The homes AQAA document indicated that there had been no safeguarding referrals or investigations made in the twelve months prior to its completion in December 2008.The homes abuse policy makes reference to making contact with the local authority adult protection unit and there is a copy of the No secrets guidance about safeguarding adults available for staff. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are accommodated in a very comfortable clean environment that is well maintained, furnished and improved to suit their needs. Evidence: A tour of the premises was undertaken. All areas of the home inspected were found to be clean, well maintained and decorated and smelled fresh throughout. Since the previous inspection the entrance hall had been redesigned to provide a reception area. The communal lounge and dining area were attractively presented. Since the previous inspection a small television lounge had been developed with a wall mounted television and video and DVD players. There was also a new sensory room which had been completed since the previous inspection visit and this was equipped with a variety of sensory equipment which may be suitable as an activity for any resident who developed dementia. The entrance hall contained information about the home including photographs of the staff team. The garden is easily accessible by residents and contains a variety of seating. Residents rooms were comfortable, well decorated and contained various degrees of personalisation with some enjoying views of the surrounding area. The laundry had washable floor and wall surfaces and was clean and tidy. Hand Care Homes for Older People Page 17 of 26 Evidence: washing facilities were available in the laundry and alcohol gel hand rub dispensers are situated in a number of locations in corridors. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff are deployed and training is provided in a number of areas to meet residents needs. However an improvement in the recruitment procedures would more fully protect residents. Evidence: Staffing in the home is arranged so that on a typical weekday as well as management and administrative staff there are six carers and one senior carer in the morning with four carers and one senior in the afternoon. Other staff consist of three cleaners, a laundry worker, and three kitchen staff. At night there are two care staff and one senior carer with another senior member of staff on call. It was reported that changes to staffing arrangements were being considered. The home had made good progress in ensuring that the care staff are trained towards the National Vocational Qualification (NVQ), Level 2 or Level 3 in Health and Social Care with over 50 having achieved the qualification and others working towards it. Records for recently recruited members of staff were examined. In all of the examples looked at application forms had been received that contained employment histories although with some dates of employment had been given in years only. It was reported that this was due to the use of old forms and the new forms introduced Care Homes for Older People Page 19 of 26 Evidence: allowed for more information to be included in this area. Accurate employment dates are needed to explore any possible gaps in employment. One staff member recruited had not given the reason for leaving a previous employment in a care setting and there was no evidence that this had been explored at interview. In addition a second reference had not been obtained. Criminal Records Bureau checks and and checks against the Protection of Vulnerable Adults register had been made before empolyment started. The home has a document for induction training that covers the common induction standards for social care in England. An example of this document was seen being completed for one member of staff. Staff had received training in a number of areas relevant to the needs of people using the service, which included care planning and dementia training. All residents spoken to during the inspection visit praised the staff. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed with a developing quality assurance assurance system in operation and safety checks to ensure that the home is run in the best interests of residents. Evidence: The registered manager has a background in social care and many years experience in working with older people. Since the previous inspection she has carried out training in protecting vulnerable adults and fire safety and was due to commence training in dementia. Residents spoken to during the inspection visit praised the registered manager and the way that the home was managed. As part of its quality assurance the home had made use of questionnaires from residents, visitors, staff and visiting health care professionals to gain views on the performance of the home. There were plans to carry out a specific survey of the residents views of the meals provided. Responses to questionnaires should be Care Homes for Older People Page 21 of 26 Evidence: compiled in a report as a way of measuring the performance of the service in meeting the needs of residents. A number of audits had been carried out on accidents, health and safety within the home. Good examples were reported of how the home had responded to the views of a number of residents as to the arrangements of their individual rooms and how these had been improved to meet their needs. In addition monthly visits are carried out by the registered provider in line with regulation 26. However these were not stored in the home at the time of the inspection visit. Copies of these reports must be kept in the home for reference by the registered manager and inspectors. The arrangements for looking after residents money was looked at and were satisfactory with records kept. A check on the money held for one resident showed this to be accurate in relation to the record kept. No valuables were being looked after for residents at the time of the inspection visit. Staff have received training in fire safety, infection control, food hygiene, moving and handling, health and safety and first aid. The home has ensured the servicing and maintenance of electrical systems and appliances as well as hoists and the lift. Regular checks are made and recorded on hot water temperatures and records showed that temperatures had been maintained at appropriate levels. A specialist consultant had carried out work to reduce the risk of Legionella in the home with a risk assessment completed and water testing carried out. A good system of checks was in place on windows, window restrictors and patio doors in the interests of residents safety. Cleaning materials had been stored securely with correct labels in use for any decanting from large to small containers. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 Before a person starts work in the home, all the information and documentation specified in Schedule 2 of the Care Homes regulations 2001 must be obtained. This is to ensure that residents are protected through robust recruitment procedures. 30/06/2009 2 33 17 Reports of visits made under 30/06/2009 regulation 26 of the Care Homes Regulations must be kept in the care home. This is so that they are available to the registered manager and for any inspection. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 26 1 9 The storage arrangements for any controlled medication should ensure that these are in line with current legal requirements for care homes. Audit the medication administration records and investigate any areas where medication administration has not been recorded. The responses to quality questionnaires should be compiled in a report. 2 9 3 33 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!