Inspection on 13/02/08 for Guild House

This inspection was carried out on 13th February 2008.

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

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

Other inspections for this house

Guild House 10/02/09

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Guild House 2a Denmark Road Gloucester Glos GL1 3HW Lead Inspector Mr Adam Parker Key Unannounced Inspection 09:40 13 & 15th February 2008 th 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 Guild House DS0000016453.V354799.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. Guild House DS0000016453.V354799.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Guild House Address 2a Denmark Road Gloucester Glos GL1 3HW 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) 01452 525098 01452 380245 The Gloucester Charities Trust Miss Moya Doreen Neighbour Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Guild House DS0000016453.V354799.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. When two people wish to occupy room 12 they are offered an additional single bedroom, which they can use as a sitting room if they wish. 9th October 2007 Date of last inspection Brief Description of the Service: 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 intimate 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. 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 and has many homely features to enhance the environment. There is level access to the attractive garden area. Guild House is approximately one mile from the 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 fees range from £426 to £547 (a double room). Some personal items are charged extra; the individual prices are readily available in the home. Guild House DS0000016453.V354799.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. The inspection visit was carried out by one inspector over two days in February 2008. The registered manager of the home was present for the both days of 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 three people using the care centre 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. What the service does well: What has improved since the last inspection? Despite the lack of clear care plans there has been an improvement in other documentation relating to care practices. Self-medication by residents is now addressed through risk assessments and plans have been produced to guide staff in giving medication prescribed on an ‘as required’ basis. The homes abuse policy has been updated to include clear guidelines for staff to follow. Guild House DS0000016453.V354799.R01.S.doc Version 5.2 Page 6 Recruitment is now based on robust procedures. There have been some improvements in staff training although there is still some further progress to be made in this area. There has been progress in introducing a formal quality assurance system at the home. Checks on the hot water system in relation to any risk from Legionella are now being carried out. 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. The summary of this inspection report can be made available in other formats on request. Guild House DS0000016453.V354799.R01.S.doc Version 5.2 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 Guild House DS0000016453.V354799.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s 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 resident’s care needs to ensure that the home is able to meet their needs. These processes are undertaken prior to the resident’s admission. Where residents had been discharged from hospital to the home relevant information had been obtained from the hospital. The registered manger stated that no one is admitted to the home without an assessment and that all residents are admitted on a months trial basis Guild House DS0000016453.V354799.R01.S.doc Version 5.2 Page 9 The home does not provide intermediate care and so Standard 6 does not apply. Guild House DS0000016453.V354799.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans must be developed in order to guide staff in meeting residents’ personal and health care needs, although their privacy and dignity is being upheld. EVIDENCE: Guidance to staff in addressing specific care needs for each resident in the form of care plans remains very limited. In one example, a resident suffered regular falls and although there was mention in the care records about falls, which had occurred recently there were no clear instructions to staff in the preventative measures required or any action that may be needed following a fall. Areas of the care documentation designated for care plans tended to include descriptions of incidents and desired outcomes from care giving as opposed to actual plans of care. One care plan stated, “We need to make ……more comfortable” Although there was no actual plan of how this may be achieved. Guild House DS0000016453.V354799.R01.S.doc Version 5.2 Page 11 There was recorded evidence of residents receiving input for health needs from health care professionals such as chiropodists, general practitioners and specialist nurses. Risk assessments had been completed for pressure sores, falls and nutrition. There were records of personal care given to residents such as baths although these were not always being recorded in the designated area of the resident’s file. A record of weight is kept. Following examination of the Medication Administration Records and discussion with the management team a number of protocols were produced for residents who were prescribed medication on an ‘as required’ basis. There were no gaps seen in the recording of administration on the Medication Administration Records (MAR) and hand written directions had been signed by the staff member making the entry and signed by another staff member checking the entry. A record was being kept of storage temperatures of medication kept in the refrigerator although there were gaps in this such as in November where no readings had been kept. In addition the current recording sheet was missing during the inspection visit. There had been no monitoring of the storage temperatures of all other medication kept and this needs to be done to ensure that the home is storing residents’ medication at the correct temperature. Some topical medication, eye drops and liquid medication had been dated on opening although others had not. This should be carried out for all such medication as an indication of the expiry date. A number of risk assessments had been completed for residents who were keeping and administering their own medication. Residents confirmed that staff knocked on doors before entering. One resident described staff as “very polite and friendly”. Guild House DS0000016453.V354799.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a varied activities programme, good social contact and a variety of meals planned through consultation about their preferences. EVIDENCE: The home has an activities coordinator and a range of activities are on offer to residents. Information about planned activities is displayed on the notice boards for the residents’ information. There are close links with the church that is situated next to the home and residents also attend a church in another part of the city that organises a number of activities. Residents also go out of the home on some evenings to attend an ‘organ club’ where musical entertainment is provided. The home has its own minibus and residents spoke positively about trips out of the home. In addition services are also held at the chapel adjacent to another care home operated by the provider nearby. One resident spoken to said that there was “A lot of entertainment and plenty to do.” The home has a policy of allowing open visiting and a number of visitors were observed during the inspection visit. At times some resident’s relatives stay for lunch although the registered Guild House DS0000016453.V354799.R01.S.doc Version 5.2 Page 13 manager gave examples how in the past the effect of visitors in the home is monitored in the interests of all residents. 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. It was noted that although a vegetarian choice is always available there was no recording of alternative meals provided at lunchtime. However breakfast and supper choices were being recorded. One resident described the food as “excellent” and reported how she had gained weight since being in the home. In addition she described how she was able to have exactly the same type of breakfast she had enjoyed while living at home. Another resident described the meals as “nice and varied”. A recommendation at the previous inspection for a comments book to be placed in the dining room for residents to comment on meals has been adopted. On examination there were some very positive comments about the meals. During one day of the inspection visit residents were observed enjoying soup as a starter during lunchtime. Guild House DS0000016453.V354799.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is generally available if any resident or their representative should wish to make a complaint and this coupled with more staff training should ensure that residents are protected from abuse. EVIDENCE: The home has a register for recording complaints. One resident in particular had raised a number of complaints and correspondence relating to these was held on file. All recent complaints had come from two residents and the management of these was evidently on ongoing situation. 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. Residents meetings are held where concerns may be aired and these are encouraged. One resident spoken to felt that they would benefit from a large print version of the complaints procedure due to eyesight problems. Following a requirement at the previous inspection the policy for responding to an allegation of abuse in the home has been amended to add further guidance for staff. However it is recommended that contact with the adult protection unit of the local authority should also be included. Information about the protection of vulnerable adults is included in the staff handbook given to all staff. As well as covering such issues in NVQ training, Guild House DS0000016453.V354799.R01.S.doc Version 5.2 Page 15 additional training has been provided for a number of staff and more was planned on the weekend following the inspection. Guild House DS0000016453.V354799.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are accommodated in a very comfortable clean property that is well maintained and furnished 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. The communal lounge and dining area were attractively presented, there is also a small ‘quiet lounge’ without a television which it was reported is used for such activities as card games. Sensory equipment was being stored in here ready for installation in a sensory room on the second floor. 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. Guild House DS0000016453.V354799.R01.S.doc Version 5.2 Page 17 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 surfaces and although the walls were generally washable there was one small area that needed attention in respect of flaking plaster. Hand washing facilities were available in the laundry and alcohol gel hand rub dispensers are situated in a number of locations in corridors. Guild House DS0000016453.V354799.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient staff are deployed and training is undertaken in a number of areas to meet residents needs with robust recruitment practices in place. 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’. The home has made very good progress in ensuring that the care staff are trained towards the National Vocational Qualification (NVQ), Level 2 or Level 3 in care; 69 have already achieved the qualification. Records for recently recruited members of staff were examined. All the required information and documentation had been obtained including an employment history against which any gaps in employment could be explored. Checks against the Protection of Vulnerable Adults list were being made as well as with the Criminal Records Bureau. Guild House DS0000016453.V354799.R01.S.doc Version 5.2 Page 19 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 have received training in a number of areas relevant to the needs of people using the service, which include the use of a nutritional assessment tool, catering in care homes and activities training. Guild House DS0000016453.V354799.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Further development of quality assurance systems and safety checks including a review of the fire risk assessment should ensure the home is being run safely and in the best interests of the residents. EVIDENCE: The registered manager has a background in social care and many years experience in working with older people. She has recently carried out training in recruitment, protecting vulnerable adults and fire warden training. Since the previous inspection more quality assurance systems have been developed in the home. These have used questionnaires from residents, visitors, staff and visiting health care professionals to gain views on the Guild House DS0000016453.V354799.R01.S.doc Version 5.2 Page 21 performance of the home. Although the system was still developing and some collation of information was needed, some changes to the service were reported in response to issues raised on questionnaires In addition monthly visits are carried out by the registered provider in line with regulation 26, copies of these have been forwarded to the Commission. Despite these measures there are two repeated statutory requirements in this inspection report. 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 their records although a valuable item was being held with no record kept. Secure storage is available in the home. Training is provided for staff in safe working practices such areas as fire safety, infection control, food hygiene, moving and handling, first aid and health and safety. A small number had not received fire safety training and the registered manager reported that this was being followed up. It was also reported that some staff had not attended health and safety and first aid training although these had been planned there had been little interest in attending and the training had not gone ahead. Some catering staff were also due food hygiene updates. The storage of cleaning materials was looked at and these were securely stored with no decanting from large to small containers evident. Training in handling hazardous substances was being planned. The Fire Risk Assessment was reviewed in March but the Fire Officer assessed it as inadequate in July 2007. The home is now seeking advice in reviewing the document correctly although the review is still to be completed. Central heating boilers had been serviced during 2007. The electrical wiring in the home has been checked as well as portable electrical appliances. In addition there was evidence of servicing of hoists and the lift. Records were being kept of weekly checks on water temperatures and where these had been found to be too high remedial action had been taken. Following a requirement at the previous inspection monthly checks were being carried out in respect of any Legionella risk with an outside specialist. Window restrictors are fitted on all windows; regular checks should be made on these particularly those on the upper floors to ensure they are functioning. Accidents are recorded and subject to audit. Since the previous inspection there has been an improvement in security arrangements in the home. Guild House DS0000016453.V354799.R01.S.doc Version 5.2 Page 22 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 Guild House DS0000016453.V354799.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 (1 and 2). Requirement Timescale for action 30/04/08 2 OP15 3 OP35 17 (2) Schedule 4 Paragraph 13 17 (2) Schedule 4 Paragraph 9 The registered person must ensure that all care plans contain sufficient detail in the care needs of each resident. This is particularly in relation to pressure area care and reducing the risk of falls. This requirement has been repeated from the previous inspection. When an alternative meal is 30/04/08 provided for a resident this must be recorded in detail. This will ensure that a check can be made on dietary intake. Where valuables are held on 30/04/08 behalf of residents a record must be made as specified in Schedule 4. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Guild House DS0000016453.V354799.R01.S.doc Version 5.2 Page 24 No. 1 2 3 4 5 6 Refer to Standard OP9 OP9 OP16 OP18 OP38 OP38 Good Practice Recommendations The temperature in the medication storage room should be monitored and recorded to check that residents’ medication is being kept at the correct temperature. All bottles of eye drops, liquid medication and topical medication should be dated on opening as an indication of the expiry date. Review the needs of residents in respect of accessing the complaints procedure and consider producing the procedure in other formats such as large print. Reference to making contact with the adult protection unit of the local authority must be made in the homes ‘Abuse Policy’. Regular checks should be made with records kept on the functioning of window restrictors. The Fire Risk Assessment should be reviewed and updated in line with the Fire Safety Officer’s instructions. Guild House DS0000016453.V354799.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Guild House DS0000016453.V354799.R01.S.doc Version 5.2 Page 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. 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