CARE HOMES FOR OLDER PEOPLE
Guild House 2a Denmark Road Gloucester GL1 3HW Lead Inspector
Kathryn Silvey Announced 29 June 2005 10:00am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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 D51_D03_S16453_Guild House_V228712_290605_Stage4_AI.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Guild House Address 2a Denmark Road Gloucester GL1 3HW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01452 525098 The Gloucester Charities Trust Mrs Ann Wilson Care Home 41 Category(ies) of OP Old Age (41) registration, with number of places Guild House D51_D03_S16453_Guild House_V228712_290605_Stage4_AI.doc Version 1.30 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. . Date of last inspection 9 February 2005 Brief Description of the Service: Guild House has undergone a major refurbishment over the last few years. The original home has been extended and enlarged to include an additional second floor. Communal areas are spacious and doorways can easily 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. All toilets are assisted and there are sufficient communal toilets on the ground floor. Each floor has a small kitchenette for the service users use. All floors can be accessed by the passenger lift. The home has a new call bell system and security facilities.There are many adaptations in the home, which meet the needs of the service users accommodated. The home is furnished to a high standard and has many homely features to enhance the environment.There is level access to the attractive garden area. The home 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. Guild House D51_D03_S16453_Guild House_V228712_290605_Stage4_AI.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection, which was completed in 8 hrs. Forty service users were accommodated and some were seen and spoken to individually during the inspection. Most were able to answer questions and offer comments about life in the home. Several service users were given the new information leaflet provided by the Commission ‘Is the care you get the care you need’, and leaflets were left for the manager to distribute to the rest of the service users not seen. One visitor was spoken to, commenting about the staff and home. The communal areas were seen and some bedrooms. A sample of records and procedures were looked at, and the new manager, care co-ordinator catering manager, three care staff and the activities organiser were spoken to. The previous registered manager had been in post for less than a year and the new manager had only recently been appointed. The manager agreed that the outstanding requirements from 2002 regarding The Statement of Purpose and the Service User Guide will be completed in order to prevent formal action from being taken. What the service does well:
The healthcare records were well written and there was evidence that multidisciplinary professionals supported service users. Most service users spoken to said they were well cared for and found the staff courteous and helpful. The home has a committed activities organiser and many events, activities and trips are organised, including a recent holiday to Wales for seven service users. The service users spoken to were pleased with all the events they were able to join in with and felt their needs were well provided for. Service users have a say in what happens in the home, the minutes of their meetings supported this and service users spoken agreed that they are able to do what they wish. The service users spoken to knew who to complain to and said the manager dealt with their concerns. A visitor spoken to said the home was excellent and that the friend they were visiting was very happy living here. Guild House D51_D03_S16453_Guild House_V228712_290605_Stage4_AI.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
The registered providers must ensure that service users have information about the home as required by the regulations and to ensure that an informed choice can be made before admission, and all service users already accommodated receive relevant information. A recorded assessment of all service users must be completed prior to admission to ensure the staff can meet their needs, and plans can be made for their admission to the home. The care plans and supporting records require some careful organisation and additions to ensure the care staff have clear actions to follow, and that the service users identified needs are well met. Risk assessments should be completed for trips out and holidays with service users. The manager should ensure that a comprehensive protection from abuse policy is recorded and known by all staff. Concerns/complaints dealt with by the manager should be recorded. A review of staffing levels must be completed to ensure that care staff have sufficient time to meet the service users needs. Two service users spoken to said the staff took too long to answer the call bell. Guild House D51_D03_S16453_Guild House_V228712_290605_Stage4_AI.doc Version 1.30 Page 7 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. Guild House D51_D03_S16453_Guild House_V228712_290605_Stage4_AI.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection Guild House D51_D03_S16453_Guild House_V228712_290605_Stage4_AI.doc Version 1.30 Page 9 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 standard(s) 1, 2 & 3 There was a lack of information about the home available to the service users, including up to date terms and condition/contract. There were incomplete pre-admission assessment records for service users, which would ensure all their needs could be met in the home. EVIDENCE: After looking at the Statement of Purpose and the planned Service Users Guide with the manager it was evident that both require updating. The homes term and conditions had not been reviewed as planned, this must be completed as part of the Service User Guide information. Not one of the service users accommodated had received a Service User Guide. No pre-admission assessments were found, only evidence of a simple letter to prospective service users to say the previous manager deemed them suitable for residential care. A blank example of a pre-admission assessment was found, which the new manager agreed to use as it was comprehensive and appropriate. The only pre-admission information found was a questionnaire, which was mainly to establish their financial position.
Guild House D51_D03_S16453_Guild House_V228712_290605_Stage4_AI.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 The care plan system requires some updating to adequately provide staff with the information they need and to ensure the records are complete. The healthcare needs were generally well met with evidence of some good multidisciplinary support. EVIDENCE: Three care plans were looked at in detail. The care plans seen had a lot of information, however, actions to meet the required needs were not specific or detailed enough and were sometimes more of a review. There was no evidence of a night care plan. A monthly dependency profile was completed. Regular monthly reviews were not always evident, however, the keyworker had written a monthly social review. Risk assessments were recorded and a care plan was written for identified risks. A service user at risk from a poor dietary intake had no record of intake and no support from a dietician. A highly dependent service user had very good records to ensure that while in bed pressure care was appropriate and fluid intake was recorded.
Guild House D51_D03_S16453_Guild House_V228712_290605_Stage4_AI.doc Version 1.30 Page 11 Daily records were recorded but could be more meaningful to address care plan actions, some records had not been completed for 5 or 6 days. The care plans seen were not signed. Personal profiles were unavailable although the care co-ordinator stated that they had been completed. Healthcare professional visits were well recorded. Most service users spoken with stated they were well cared for, however, one service user had an issue with the length of time staff took to answer the call bell. Accident records did not reflect the same number of accidents recorded in the daily records. Guild House D51_D03_S16453_Guild House_V228712_290605_Stage4_AI.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 The service users have a varied activities programme, which meets their individual lifestyle needs. The home should complete risk assessments for some activities. EVIDENCE: A weekly activities timetable was displayed by the homes’ full-time activities co-ordinator, however, trips out are advertised well in advance. Service users told the inspector of the many activities they enjoyed, skittles, darts, Gloucester Organ Club, boat trips, the scrabble league, spelling tests, ‘Countdown’ quizzes and supermarket trips to name a few. The service users are also active in fund raising for their chosen charity each year The activities organiser completes each service users social care record daily. New service users are asked what activities they enjoy and every effort is made to meet their needs. Life histories were not recorded to help plan and use for reminiscence, but lots of information is gathered informally about the service users during conversations. It was recommended that, with the service users consent, personal histories are recorded about them for all staff to be able to recognise what interests the service users.
Guild House D51_D03_S16453_Guild House_V228712_290605_Stage4_AI.doc Version 1.30 Page 13 A ‘loop system’ has been installed in the dining room to enable the service users with hearing impairment to enjoy entertainment. Service users had recently returned from a holiday to Wales, which they enjoyed. Risk assessments are not completed for trips away from the home, it is recommended that this information is recorded prior to any trips to ensure the service users safety and provide sufficient staff. The record of a service users meeting was seen and it was evident that they have a say in what happens in the home, and are supported by the staff and manager. Guild House D51_D03_S16453_Guild House_V228712_290605_Stage4_AI.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The manager deals with complaint/concerns to the service users satisfaction, however, they should have their own copy of the complaints procedure and records should be kept. The home lacks the appropriate procedures to ensure that any suspicion of abuse is dealt with appropriately. EVIDENCE: The complaints procedure was seen and was available, however, none of the service users had their own copy. The service users spoken to knew who to complain to and said the manager usually dealt with their concerns satisfactorily. The complaints folder in the manager’s office did not have a record of any concerns raised by the service users. The manager stated that the concerns dealt with were not recorded anywhere. It was recommended that concerns, the outcome and action taken be recorded. The staff spoken to had read the homes policy for protecting the service users from abuse and knew about ‘whistle blowing’, which would be to contact the manager. The manager stated that staff share problems with her, and felt sure that they would tell her of any suspected abuse of a service user. The policy seen had the different types of abuse detailed but only Croners policy was found for actions to take when abuse was suspected. There was no procedure specific to the home.
Guild House D51_D03_S16453_Guild House_V228712_290605_Stage4_AI.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) none EVIDENCE: Guild House D51_D03_S16453_Guild House_V228712_290605_Stage4_AI.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Staff moral had improved recently and the new manager has implemented some changes to maintain continuity for the service users. Staff were appropriately trained to meet service users needs. A review of staffing levels must be recorded and acted upon to ensure need can be met. EVIDENCE: Several care staff were spoken with, two were experienced and one had completed NVQ level 2 training and was just finishing NVQ level 3. One carer had only been employed for four months and had no previous experience but had completed induction training and already started NVQ level 2 training. The staff had completed other required training e.g. first aid, fire training, food hygiene, dementia care and manual handling. The staff said their training needs were met at the home and they felt they could approach the manager should they want further training. A list of the staffs’ qualifications were seen, there are 32 care staff, 16 have or are currently working towards NVQ level 2 and three have complete the NVQ level 3 qualification. The manager had produced a list of staff care hours totalling 940 per week. The rotas were being changed and a copy will be sent to the Commission. There was no evidence of a staffing level review to highlight any shortfalls, this was discussed with the manger and will be required for the inspector to see at the next inspection.
Guild House D51_D03_S16453_Guild House_V228712_290605_Stage4_AI.doc Version 1.30 Page 17 Staff felt rushed at times as there are three floors and some service users were highly dependant. The service users told the inspector and the manager that staff took too long to answer call bell, sometimes more than 20 minutes. The manager produced data from the call bell system that identified that the service users were correct and the manager could identify when this was happening. The new manager stated there had been a lot of staff sickness and absences, this had now reduced and staff moral had improved. Guild House D51_D03_S16453_Guild House_V228712_290605_Stage4_AI.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 The new manager had already made some positive changes and was respected by the staff and service users. The new manager is not registered with CSCI yet and must forward the application as required. EVIDENCE: The new acting manager has had a lot of experience in other care settings and it was evident that staff respect her and that the service users liked her. She is implementing some gradual changes in the home working with the senior care staff and the service users. The staff spoken with felt the changes were positive. The manager had provided fans and portable air conditioning units for the service users on the top floor where high temperatures had recently been experienced. The service users spoken with were pleased with the improved conditions and the manager hoped to install air conditioning in the future. An application had not been received by the Commission for the manager to become registered.
Guild House D51_D03_S16453_Guild House_V228712_290605_Stage4_AI.doc Version 1.30 Page 19 The manager was currently looking at fire safety and health and safety issues in the home. Guild House D51_D03_S16453_Guild House_V228712_290605_Stage4_AI.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 2 x x x x x x x Guild House D51_D03_S16453_Guild House_V228712_290605_Stage4_AI.doc Version 1.30 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4&5 Requirement The registered persons must make amendments to the Statement of Purpose and Service Users Guide, send a copy to the Commission and give service users the guide. (This was required at the last inspection for 09/02/05) The registered persons must make amendments to the homes terms and conditions, and send a copy to the Commission. (This was required at the last inspection for 09/02/05) The registered persons must ensure that a pre-admission assessment is recorded for all service users by competent care home staff. The registered persons must ensure that the care records are complete and regularly reviwed. The registered persons must ensure risk assessments are completed for trips out and holidays for service users. The registered persons must ensure that concerns/complaints by the service users, and the actions taken are recorded. The registered persons must Timescale for action 30/09/05 2. 2 5.1(b) 30/09/05 3. 3 14 31/08/05 4. 5. 7 12 15 15 31/08/05 31/08/05 6. 16 17.2 31/08/05 7. 18 13.6 30/09/05
Page 22 Guild House D51_D03_S16453_Guild House_V228712_290605_Stage4_AI.doc Version 1.30 8. 27 18 9. 31 8.1 ensure the policy for protection of vulnerable adults from abuse is clear and comprehensive. The registered persons must complete a staffing level review to ensure service users needs are met in a dignified manner. The registered providers must appoint a registered manager and send an application to the Commission. 30/09/05 30/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 12 Good Practice Recommendations Personal histories should be completed with the service users consent as an additional aid for care staff to idenify interests and preferred lifestyle. Guild House D51_D03_S16453_Guild House_V228712_290605_Stage4_AI.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester GL3 4AB 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 Guild House D51_D03_S16453_Guild House_V228712_290605_Stage4_AI.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!
