Inspection on 07/12/05 for Guild House

This inspection was carried out on 7th December 2005.

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

The inspector 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 13/02/08

Guild House 09/10/07

Guild House 14/11/06

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 Mrs Kate Silvey Unannounced Inspection 7th December 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Guild House DS0000016453.V271414.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Guild House DS0000016453.V271414.R01.S.doc Version 5.0 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 The Gloucester Charities Trust To be appointed Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Guild House DS0000016453.V271414.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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. Manager to complete NVQ 4 in Care Management within a 3 year period from date of registration as manager. 29th June 2005 Date of last inspection 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. There are assisted 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 DS0000016453.V271414.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection over seven hours. Fifteen standards were inspected to complete the year. These included care planning, medication management, the quality of food provided, the environment to include health and safety issues, staff training and recruitment. Four service users care plans were looked at in detail and the service users were spoken to at length, including a relative, to monitor the standard of care provided. Several other service users were spoken to generally and many were seen during lunchtime. Records were checked and the manager, senior carer on duty and the administration staff helped with the inspection process. What the service does well: What has improved since the last inspection? Guild House DS0000016453.V271414.R01.S.doc Version 5.0 Page 6 The Trust has produced a new draft terms and conditions for the service users, which only requires minor amendments. However, this has been outstanding for some time and now must be finalised for use to protect and inform the service users. The manager has a new format to use for service users pre-admission assessments, however, the records must contain sufficient information when completed. The care plan recording had improved but further precise information must be included. Suitable adaptations have been provided in the conservatory to include chairs and coffee tables to meet the need of the service users. An additional Gazebo had been provided in the garden to create more shade on hot days, and new fencing and gates to the front of the home provides more security. Recruitment practices had improved, protecting the vulnerable service users accommodated. Staff fire training and fire safety in the home had improved and all the fire officer’s recommendations had been met. The manager has made improvements to the home, which continues to protect the heath, safety and wellbeing of the service users, in particular regarding the prevention of Legionella. What they could do better: The home requires an up to date Statement of Purpose and Service User Guide, this has been outstanding for some time and the inspector was informed it would be completed by the end of January 2006. There was a shortfall in knowledge regarding medication and protocols should be written for some service users who require further support. The local CSCI pharmacist will review the medication management. The use of pet names for service users and inappropriate terms of endearment should be avoided. Nutritional assessments should be completed for all service users, however, it was noted that service users are regularly weighed to identify any problems. There is a need to ensure that quality assurance is adequately managed. Service users views should be sought when changes are planned in the home to ensure that their home meets their needs at all times. Guild House DS0000016453.V271414.R01.S.doc Version 5.0 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 DS0000016453.V271414.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Guild House DS0000016453.V271414.R01.S.doc Version 5.0 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 the following standard(s): 1, 2,3 Prospective service users and service users already admitted did not have adequate information about the home and facilities provided. The Trust has produced a suitable new draft contract for service users, which requires minor amendments. Service users pre-admission assessments did not have sufficient information. EVIDENCE: An example of the new draft contract for service users was given to the inspector. It appeared to be user friendly and clearly sets out the Trusts terms and conditions. However, item 16 requires qualification regarding risk assessments for service users leaving the home The manager confirmed that the new Statement of Purpose and Service User Guide will be finalised on 12 January and ready by the end of January 2006, which will ensure that prospective service users have sufficient information to Guild House DS0000016453.V271414.R01.S.doc Version 5.0 Page 10 make an informed choice before admission to the home. A copy will be sent to the Commission, non-compliance with this will result in enforcement action. When a service user makes an initial enquiry to the home a Customer Service Log is completed. The service user is then invited to the home for a pre-admission assessment, or an experienced staff member will visit the service user to complete the record. An example was seen of a recent pre-admission assessment. The information recorded was insufficient. It was discussed with the manager how improvements could be made to ensure that the home was able to completely identify service users needs. Guild House DS0000016453.V271414.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The care plans had improved but further precise recording was required to ensure all needs are identified, and actions are recorded and reviewed regularly. Healthcare professionals meet the service users health care needs. Although the medication was well organised there were shortfalls in knowledge that could put service users at risk. The service users spoken to felt they were treated with respect but staff should avoided using pet names and inappropriate terms of endearment. EVIDENCE: Several care plans were seen and service users were spoken to. Some service users were unaware of their care plans. Generally there was an improvement in the care plan recording, however, the records were muddled. Reviews were sometimes written where the actions Guild House DS0000016453.V271414.R01.S.doc Version 5.0 Page 12 should be and actions were not specific enough to meet the problem or need identified. However, there was evidence of good care being provided and the service users spoken to all felt well cared for. An accident record had not been completed for a service user who fell out of bed and sustained a fracture. A service user with epilepsy did not have an individual protocol in their care plan. One service user supported by a Macmillan nurse required a care plan for pain control to ensure all staff knew the medication regime. It was evident that healthcare professionals support the service users as clear records were kept of their visits. Daily records were meaningful, however, there was no clear record of activities completed. The manager had recently appointed a new activities coordinator to start in January 2006. The medication management was checked and the senior carer orders medications appropriately using the doctors repeat prescriptions. The supplying pharmacy is in Portsmouth. A monitored dosage system is used for administration and there was a procedure from the supplying pharmacy on how to administer the system. The medication procedure for the home could not be located but should be kept with the medication. No homely remedies were in use for the service users. External medication was stored separately to internal medication. The senior carer stated that all self-medicating service users had secure storage. The manager needs to ensure that the Royal Pharmaceutical Guidance is available for the staff to refer to, which can be taken from their web site. The home also requires a new British National Formulary. Anti-coagulant therapy was administered and recorded appropriately. A service user with insulin dependent diabetese did not have a clear protocol for managing the blood glucose levels. However, some instructions had been recorded from the doctor and diabetic nurse. The senior carer stated the diabetic nurse was calling the following day and her advice would be sought regarding a protocol. The senior care stated that some care staff had received training regarding the care of service users with diabetese. The medication records were generally well recorded and the medication was safely stored. However, there was some confusion about controlled drugs storage and recording, including the changing needs for one service user who required analgesia as directed by the Macmillan nurse and the doctor. Guild House DS0000016453.V271414.R01.S.doc Version 5.0 Page 13 The manager was informed that the CSCI local pharmacist would visit the home to complete an audit and advise staff to ensure that medication was managed appropriately. Medication training for care staff will also be reviewed. All the service users spoken to said they were treated with respect by the staff and their dignity was preserved at all times. Evidence was seen by the inspector of appropriate courtesy to service users, however, pet names and inappropriate terms of endearment should be avoided. Guild House DS0000016453.V271414.R01.S.doc Version 5.0 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,14,15 The service users maintain contact with their families, friends and the community through the facilities provided and activities organised in the home. The service users are supported to maintain choice and control over their lives. The home provides a good standard of varied and balanced meals in sufficient quantities to cater for all dietary needs. EVIDENCE: The service users enjoy Holy Communion in the home monthly, and have many visits out in the community. The activities notice board has been duplicated to help more service users know what is happening in the home. It was recommended that an activities programme be given to all service users to aid those who are unable to see the notice boards readily. One service user commented that the day centre attended fortnightly was “wonderful”. Another service users had recently gone shopping with a carer. It was evident from talking to the service users that they have considerable choice over how they spend their day. The staff support their wishes and they feel able to make comments to the manager if they are concerned about anything. Guild House DS0000016453.V271414.R01.S.doc Version 5.0 Page 15 Visitors are welcomed in the home and one spoken to was pleased that there were no restrictions other than the service users preferences. Most service users have their own telephone to keep in contact with their families. The catering manager was spoken to and informed the inspector of any changes in the homes catering facilities. It was evident that the service users wishes regarding food are taken seriously and implemented. The catering manager has a communications book where staff can ensure that wishes are noted and acted upon. Each morning the catering staff ascertains the service users food choices for the day. The lunchtime activity was observed in the dining room, and care staff were seen sensitively helping service users who required some assistance with their food. Some service users chose to eat in their own rooms. The drinks machine in the dining room ensures that service users can have a drink at anytime during the day. A service user with diabetese was pleased with the variety of desserts provided, however, there was no evidence of referral to the dietician as the doctor was currently managing her needs Nutritional assessments had not been completed. All the service users spoke to said the food was good and that they had a sufficient quantity and choice each day. Guild House DS0000016453.V271414.R01.S.doc Version 5.0 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Not inspected this time. Guild House DS0000016453.V271414.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 26 The home was well maintained. The home had decreased the communal area for service users. The staff maintain a clean environment for the service users. EVIDENCE: The communal areas and the service users bedrooms seen were pleasant and well maintained. Twenty new armchairs and eight coffee tables had recently been purchased to ensure service users had the correct height for manoeuvring. Another Gazebo had been provided in the garden, and new fencing and gates to the front parking area making it more secure for service users. One service user was disappointed that the small lounge with a television had been recently converted to an office. This was discussed with the manager Guild House DS0000016453.V271414.R01.S.doc Version 5.0 Page 18 and an alternative office area must be provided to ensure the home maintains adequate lounge/dining facilities for fortyone service users. The home was clean and free from offensive odours. However, the manager was seeking a new fulltime domestic, as there was currently a shortfall. A carer was completing extra domestic hours to maintain the homes clean environment. The service users spoken to were pleased with the cleanliness of their rooms. Guild House DS0000016453.V271414.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28,29,30 The staff are adequately trained and competent to ensure the service users are in safe hands, however, there is a shortfall with regard to medication knowledge, addressed at Standard 9. The homes recruitment practices protect the vulnerable service users accommodated. EVIDENCE: Staffing levels were discussed with the manager but not looked at in detail at this inspection. There had been an unrecorded review by the manager who had looked at deployment of staff and systems. However, dependency levels were less and the manager agreed to record any details for the next inspection. The home has developed a room for staff training purposes and each staff member has an individual folder with current qualification achieved recorded. The records were not looked at in detail this time, however at the last inspection the pre-inspection questionnaire indicated that there are 32 care staff, 16 have or are currently working towards NVQ level 2 and three have completed the NVQ level 3 qualification. A senior carer is currently completing a health and safety course. Guild House DS0000016453.V271414.R01.S.doc Version 5.0 Page 20 Since the last inspection staff have attended two training sessions on the use of hoists, three for manual handling, four in ‘What is Care’ and theoretical and practical fire training, which included a fire drill. A sample of the recruitment records for a new carer was seen. POVAFirst had been requested and all other requirements were in place. The manager stated that all staff have the required level of CRB check. Guild House DS0000016453.V271414.R01.S.doc Version 5.0 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35,38 The home does not have procedures to ensure an effective quality assurance system. Service users are protected from financial abuse. The manager has made improvements in the home, which continues to protect the health, safety and welfare of the service users. EVIDENCE: The service users had quality questionnaires in 2004 to identify areas for improvement. However, service users are not always consulted about changes in the home. Guild House DS0000016453.V271414.R01.S.doc Version 5.0 Page 22 A service users meeting was recently held and the minutes were being typed for all to see. Areas identified at meetings for improvements in the home or dissatisfaction are normally dealt with. The manager was unsure until the minutes of the meeting were seen what remains outstanding. Two random service users financial records were seen and both were correct and well recorded. The monies were securely stored. The fire safety officer and Environmental Health officer had visited the home since the last inspection. There was evidence of fire safety compliance, and an outside agency had completed fire risk assessments. The fire safety records were complete. The manager is addressing the EHO recommendation, which includes compliance regarding the prevention of Legionella. All service users rooms have ensuite showers, which require specific maintenance to prevent disease. Guild House DS0000016453.V271414.R01.S.doc Version 5.0 Page 23 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 2 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 x 3 2 X X X X X 3 STAFFING Standard No Score 27 X 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X 3 Guild House DS0000016453.V271414.R01.S.doc Version 5.0 Page 24 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 OP1 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 two inspection for 09/02/05 & 30/09/05) The registered persons must make minor amendments to the homes draft terms and conditions, and send a copy to the Commission. (This was required at the last two inspection for 09/02/05& 30/09/05) The registered persons must ensure that pre-admission assessments record sufficient detail. The registered persons must ensure that all care plans are detailed and regularly reviewed after consultation with service users or their representative. The registered persons must ensure that all accidents are recorded appropriately to DS0000016453.V271414.R01.S.doc Timescale for action 14/12/05 2. OP2 5.1(b) 14/12/05 3. OP3 14 14/02/06 4. OP7 15 14/02/06 5. OP7 17 14/12/05 Guild House Version 5.0 Page 25 6. 7. OP9 OP12 13.2 15 8. OP18 13.6 9. OP20 23.2 10. OP31 8.1 11. OP33 24 identify preventative measures. The registered persons must ensure that medication is managed safely. The registered persons must ensure risk assessments are completed for trips out and holidays for service users. (This was previously required on 31/08/05) The registered persons must ensure the policy for protection of vulnerable adults from abuse is clear and comprehensive. (This was previously required on 30/09/06) The registered persons must ensure that the communal facilities meet the requirements for 41 service users. The registered persons must appoint a registered manager and send an application to the Commission.( This was previously required on 30/09/05) The registered persons must have an comprehensive quality assurance system. 14/12/05 14/02/06 14/02/06 14/02/06 14/02/06 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP7 OP9 OP10 OP13 Good Practice Recommendations The service users activities should be recorded. The home should have the Royal Pharmaceutical Guidance and an up-to-date BNF. Staff should not use ‘pet’ names for service users, unless agreed by them, or use inappropriate forms of endearment. The activities programme should be in a format that all services users can have a copy of for information. DS0000016453.V271414.R01.S.doc Version 5.0 Page 26 Guild House 5 6 OP15 OP27 The manager should ensure all service users have a nutritional assessment. The manager should record any staffing reviews undertaken. Guild House DS0000016453.V271414.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Gloucester Office 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 DS0000016453.V271414.R01.S.doc Version 5.0 Page 28 - 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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