Inspection on 13/12/06 for Guysfield Residential Home

This inspection was carried out on 13th December 2006.

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

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

Other inspections for this house

Guysfield Residential Home 06/04/09

Guysfield Residential Home 07/04/08

Guysfield Residential Home 26/04/07

Guysfield Residential Home 26/10/05

Guysfield Residential Home 19/05/05

Guysfield Residential Home 07/10/04

Guysfield Residential Home 22/06/04

Guysfield Residential Home 17/12/03

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Guysfield Residential Home Willian Road Willian Letchworth Hertfordshire SG6 2AB Lead Inspector Claire Farrier Key Unannounced Inspection 10:00 13 and 14th December 2006 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 Guysfield Residential Home DS0000019399.V322222.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. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Guysfield Residential Home Address Willian Road Willian Letchworth Hertfordshire SG6 2AB 01462 684441 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) Guysfield House Limited Manager post vacant Care Home 50 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (50) of places Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th October 2005 Brief Description of the Service: Guysfield was originally a large Victorian house, subsequently sympathetically converted and extended to provide residential care for elderly people. It is situated in the quiet village of Willian, within a few minutes walk of the village amenities and about two miles from Letchworth town centre. The accommodation comprises forty-eight single bedrooms and one double bedroom, all with en-suite sink and toilet facilities, located on three floors. There are two passenger lifts, which serve all three floors. Three lounges, a large central conservatory and two dining rooms are on the ground floor as well as the main kitchen, laundry facilities and the managers office. There is ample car parking space to the front of the property and a large garden to the sides. The Statement of Purpose and Service Users Guide provide information about the home for referring social workers and prospective clients. The current charges range from £450 to £650 per week. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two inspectors over one day, with a return visit on the following day. The focus of this inspection was to assess all the key standards. Some additional standards were also assessed. The majority of time was spent talking to residents and staff, and discussions were held with the home’s acting manager and the company’s area manager. Some time was also spent looking at records, care plans and staff files, and the inspectors made a tour of the premises. Questionnaires about life in the home were given to residents before the inspection took place, and five were completed and returned to CSCI. One immediate requirement was left regarding a health and safety risk. An appropriate response has been received from the provider. What the service does well: What has improved since the last inspection? The last key inspection was in October 2005, and only one requirement was made concerning the recording of medication. An inspection was carried out in August 2006, but the report was not completed. An immediate requirement was made during this inspection concerning the recording of medication, and the company returned an action plan to address the issues. Following these two inspections the recording of medication has improved. The policies and procedures for administering medication in the home are basically sound, and the recording of the medication administered every day is appropriate. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 6 Issues from the company’s clinical and property services audits of the home have been addressed. A lot of work has been put into updating the care plans and assessments. All of those that were seen have been written in the last few months. However, these documents do not provide adequate information on the health and personal care needs of each resident. A new cleaning schedule is in place, and a senior housekeeper has been employed. The residents spoken to were particularly complimentary about the improvement in cleanliness in the home. A new training company has been engaged to provide basic training for the staff, and a clear training matrix is in place to enable updates of mandatory training to be tracked effectively. Regular residents’ meetings take place. What they could do better: The home has been without a registered manager for ten months. There is no deputy manager and there are insufficient senior staff to ensure that there is a team leader on duty at all times in the home, Some staff, including senior staff, are working excessively long hours and long shifts, which has an impact on staff morale and may affect the wellbeing of the residents. As noted above, the formats for both assessments and care plans are not used appropriately in order to ensure that the staff have the information that they need to provide a good quality of care for the residents. The assessments seen are at best poor, and in some cases inadequate. A lot of work has been put into writing the care plans, but many are a standard care plan with just the name of the person changed. There is no indication that the care plans address the person’s individual needs, and there is no evidence that the residents are consulted or have any input into their care plans. The home is registered to provide care for people with dementia, but there is no evidence of specific facilities for people with dementia. There is no environmental differentiation, such as colour coding or pictorial cues to assist orientation. There is no evidence of specific activities such as reminiscence or facilities for sensory stimulation. Most of the staff who were spoken to said that they have had no training in dementia care. The evidence of health care provision, and in particular of the assessment and management of pressure area care, is poor. Some information on a resident’s needs for moving and handling was inadequate. As noted above, the recording of medication has improved, but the storage facilities are inadequate, and the temperatures of the medication stores are not monitored effectively. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 7 An immediate requirement was made to replace the stair carpet in the original building that was threadbare and loose, and caused an immediate risk of tripping. Risk assessments are needed for shared equipment, such as reclining chairs, and for individual activities that are identified on each resident’s care plan. 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. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 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 Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The assessments of the needs of the residents do not provide sufficient information on residents’ care needs to enable the needs to be met. The staff have the skills and experience to meet the residents’ care needs. However the home does not provide sufficient facilities and expertise to provide a good service for residents with dementia. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 10 EVIDENCE: An assessment is carried out before any resident is admitted to the home. The assessments in the files that were inspected provide very brief details of the person’s needs. The format provided by the company should provide full details of each person’s needs, and indicate clearly whether they can be met in the home, and how they should be met. This information would provide a good basis for the care plan. However in the examples seen, the assessment form was completed as a checklist, and there were very few, and in some cases, no further details or comments. A clinical audit of the home by the company in September 2006 also noted that pre-admission assessments need to be more detailed. No action has so far been taken to address this. Staff members were observed to have a good relationship with the residents. They have the skills and experience to meet the residents’ care needs. However there is no evidence of specific facilities for people with dementia. There is no environmental differentiation, such as colour coding or pictorial cues to assist orientation. There is no evidence of specific activities such as reminiscence or facilities for sensory stimulation. There is only basic training available for staff in the needs of people with dementia, and the staff showed little understanding of individual methods of communication and perception. The care plans seen do not address the needs for dementia care adequately (See Health and Personal Care). The home does not accept residents who have challenging behaviour associated with dementia, but specific facilities for dementia care must be provided in order to meet the conditions of registration. Poor recording of pressure area care indicates that there may be a lack of understanding of how to meet the needs of people who are at risk of pressure sores (see Health and Personal Care). Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care plans do not provide adequate information on the health and personal care needs of each resident. They are not used by the care staff to enable them to provide a good quality of care. The care plans do not adequately address the needs of people with dementia, and appropriate risk assessments are not in place to ensure that any potential risks to the health and safety of residents are identified and addressed. There is inadequate recording and monitoring of health care for identified health needs, such as pressure area care. The home has generally good procedures for administering and recording medication safely, but inadequate storage and insufficient staff means that there is a risk of errors in administration. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 12 EVIDENCE: Detailed case tracking was carried out through the files of six residents. The care plan format follows Ropers Activities of Daily Living, which is a medically orientated model. The care plans include sections on medical and personal care needs. The section on activities and quality life is titled Recreational Therapy, and other sections include Restricted Mobility, Physical Aggression and Management of Pain. The focus of this approach is on management of problems, not encouraging and enabling the resident to maintain their individuality and independence. Each care plan is written by hand, and the format includes the needs, goals, and the input needed to meet the goals. A lot of work has been put into writing the care plans, but there is no evidence that they are a useful tool for the staff to be able to provide a good quality of care for the residents. However not all the care plans are completed appropriately, and many are a standard care plan with just the name of the person changed. There is no indication that the care plans address the person’s individual needs, and there is no evidence that the residents are consulted or have any input into their care plans. The Ropers format and the mechanical way that they are written does not provide a person centred approach to care, with each resident at the centre of the care that is planned for them, and a holistic approach to their needs for a life in a residential setting. The staff spoken to confirmed that the care plans do not provide them with the information that they need to provide a good quality of care for the residents. One care worker said that they check the care plan only to confirm whether two people are needed to assist the resident with their care. Another care worker said that they have never seen a care plan. The residents spoken to said that the staff are sensitive in the help they provide with personal care. One resident’s questionnaire included the comment, “I only have to ask and I get all the help I need.” During the inspection the staff were observed to have a good relationship with the residents, and to treat them with respect. However staff were observed to take the scales to a resident seated in the conservatory, which is also the main entrance hall to the home, and to weigh them there in full view of other residents and any visitors to the home. It was explained that this resident prefers this, rather than being disturbed to go to their room to be weighed in private. However there are other ways to ensure that personal procedures such as monitoring weight are carried out in private, for example by weighing residents when they have a bath or in the morning or evening when they are having other personal care provided in their room. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 13 Good procedures were observed for transferring frail residents into the dining room at lunchtime, including the use of handling belts, hoists and wheelchairs. The staff spoken to confirmed that they have all had a recent update of training in moving and handling, and they have sufficient equipment to enable them to assist the residents appropriately. However the care plan for one resident who was observed had insufficient information on the procedures needed for her physical needs, and the procedures that were followed were not those that were written in the care plan. The care plans seen contained no risk assessments that relate to each resident’s needs. The only risk assessment seen was one for prevention of heat stroke, which was a standard risk assessment copied for each person. Risk assessments are an essential ingredient in the care plan package, and should detail the risks that are assessed for any activity, and how those risks can be best managed to enable the resident to maintain independence and choice. There is insufficient information in the care plans on the specific needs of people with dementia (See Choice of Home). One resident’s care plan states, “Likes to walk around the home collecting bits and pieces.” There are no guidelines or risk assessment for managing this behaviour. A referral was made for a psychiatric assessment in July 2006 for deterioration, but the reviews of the care plan constantly report “No change”. The standard care plan for Memory Loss and Confusion is “Observe X’s behaviour for any changes. Keep a daily routine which X can get used to and use signs and pictures to remind X of where he/she is.” There are no further details of individual needs, and no indication in any care plan that any behaviour is monitored, or that there are any signs or pictures available for use when required. The care plans contain assessments for health needs, including assessments for moving and handling, the risk of falls, and pressure areas. The assessments used have a scoring format, but most have no explanation of what the score means. For example, the Braden Scale for pressure sores is used in the home. There is no explanation of what the scores on this scale indicate. Each care plan seen includes a care plan for skin integrity, but these are standard care plans, including, “Encourage to mobilise, if skin breaks down inform a senior.” There is no individualised care plan for each person’s specific needs. The care plans were seen for two residents who have a pressure sore or ulcer. The care plans do not address their individual needs, and there is no tool for monitoring the progress of the pressure sores, and no body chart or photographs to indicate the extent and type of pressure sore. The district nurse visits regularly to dress pressure areas and ulcers, but no records were seen of these visits, and the nursing notes on the care given and progress of the treatment were not seen in the care plans. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 14 An inspection was carried out in August 2006, but the report was not completed. An immediate requirement was made during this inspection concerning the recording of medication, and the company returned an action plan to address the issues. Following these two inspections the recording of medication has improved. The policies and procedures for administering medication in the home are basically sound, and the recording of the medication administered every day is appropriate. However the medication storage is very badly managed. Medication is stored in two shallow cupboards. Some medication is supplied in monitored dosage blister packs, but a large amount of medication is supplied in the original containers. The containers are all dated when they are opened, and the amount of medication received has been recorded appropriately on the MAR (medication administration record) charts. However the blister pack system provides a method of supplying and administering medication that should enable care staff to administer correct doses with a minimal risk of error. All medications that are not contra-indicated for supply in a blister pack should be supplied in that way. The storage in the home is not appropriate for the number of medications supplied out of blister packs, and the current practice causes an unacceptable risk of maladministration. Controlled medication is stored and recorded appropriately. A chart for recording the temperature of the medication storage cupboards was seen on the office wall, with the instruction to “report to management if the temperature is measured above 25 degrees.” On the two days before this inspection, the temperature for one trolley was recorded as 28°C, but there was no indication that this had been reported, or that any action had been taken to address the situation. Medication stored at inappropriate temperatures may become clinically ineffective. The senior care workers administer the medication, but during the medication round that was observed, they were constantly interrupted. This may lead to an event that may affect the safety of service users from a maladministration of medication. There are insufficient numbers of senior staff trained to administer medication in the home. (See Management.) Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 15 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): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Families and friends are welcomed into the home, and family members are consulted about the resident’s care. Wholesome and varied meals are provided within the home, offering a well-balanced and nutritious diet for the residents. The service of meals provided to residents in the small dining room is poor. Residents maintain their independence by making choices about the food and how they spend their days. There is a range of stimulating activities to suit the needs of most of the residents, but there are insufficient activities for people with dementia. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 16 EVIDENCE: A new activities co-ordinator has been appointed since the last inspection. The activity programme is displayed in several places in the home, and includes activities such as poetry, nail care, bingo, film club and ball therapy. Comments in the inspection questionnaires included, “I like the Bingo, the bean bag games, and most of the varied activities.” “I love the activities, especially the bingo, and the discussions.” On the afternoon of the inspection a quiz took place in the conservatory. The conservatory is a large room, and there is constant activity there from people passing through and coming and going through the front door. Some of the group taking part in the quiz found it hard to hear, but on the other hand several people sitting in other areas of the conservatory also joined in answering some of the questions. It was explained that activities usually take place in one of the smaller lounges, but on this occasion some of those who were taking part did not want to move to another room. There are no specific activities for residents with dementia, but the activities co-ordinator tries to talk to everyone and involve them as far as possible. Some one to one activities take place, such as nail care. The activities co-ordinator has had no training for providing activities, and she would benefit from training in providing specific dementia care activities (see Choice of Home). The home is situated on the outskirts of Willian, and there are no local community facilities within easy reach. It is planned to arrange some outings for residents when the weather improves next year. There is a regular communion service in the home for those who wish to take part. Visitors are welcome at any reasonable time and may be entertained in any of the communal areas or in service users’ bedrooms according to individual preference. The residents who were spoken to during the inspection and who returned questionnaires said that they are able to express their opinions and wishes about their life in the home. Comments in the questionnaires included, “They are very good like that”, “They could be better at listening to what you say”, and “Most of the staff are kind and helpful. They are so busy that they are not always available. They try very hard to sort out any problems I have.” There are regular residents meetings in the home. The activities co-ordinator chairs the monthly residents’ meeting. An average of 15 residents attend the meeting and give their views and opinions, and the activities co-ordinator talks to as many residents individually as possible, to ask their views on activities and outings. It was reported that the named key workers have time set aside for each resident, for example to check their toiletries, write birthday cards and chat, and they encourage the residents to express their views. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 17 All the questionnaires from residents stated that the food provided is usually good. One stated that the meals are excellent. The residents spoken to during the inspection said that they enjoy the meals that are provided, and they look forward to meal times. The menu provides a varied and balanced choice of meals. Hot and cold drinks are served throughout the day and staff said that snacks are available outside mealtimes on request. There are two dining rooms in the home, one for the more able residents and a smaller one for residents who are frailer and may need some assistance. In the larger dining room lunch was served plated to the residents, and extra gravy was offered to those who wished. Individual drinks were poured from behind the serving area and taken to the residents. Consideration could be given to providing jugs of drink and gravy, and possibly dishes of vegetables, on the tables so that the residents who are able to do so can serve themselves. In the smaller dining room the meals were served over a longer period, with the result that some people were eating long before the others. As in the large dining room, additional gravy was offered, but not until the meal was nearly finished. Salt and pepper were available on only one table, and seasoning was not offered to anyone who was assisted with their meal. There were insufficient staff in the small dining room to ensure that the residents had a good standard of service and assistance during the meal. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 18 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): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a comprehensive complaints procedure in place, and residents and their relatives are confident that any complaints will be properly investigated. Appropriate polices and procedures are in place to ensure that the residents are protected form the risk of abuse. EVIDENCE: The home has a satisfactory complaints procedure in place. Residents and their relatives are encouraged to make their concerns and complaints known. All complaints are recorded appropriately, and the records include the process of investigation and the response to the complainant. All the residents who took part in the inspection said that they know how to make a complaint, and they know who to speak to if they are unhappy. The home has comprehensive procedures for prevention of abuse. Training in safeguarding vulnerable adults has been provided for all the staff, and the staff spoken to were aware of their responsibilities for whistle blowing. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 19 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): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally well maintained and provides a comfortable environment for the residents. Individual and communal facilities are appropriate for the residents’ needs. There was a noticeable offensive odour in one area, which causes an unpleasant environment for the residents. Immediate action is required to make the stair carpet safe, and risk assessments are needed for the electrically operated reclining chairs in the lounges. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 20 EVIDENCE: Guysfield is a large Victorian house with a newer extension built in the same style. The two wings are joined by a large conservatory that is both the entrance hall and the main seating area for the home. The accommodation comprises forty-nine single bedrooms and one double bedroom, all with ensuite sink and toilet facilities, located on three floors. There are two passenger lifts, which serve all three floors. A senior housekeeper has recently been appointed, and the good standard of cleanliness throughout the home was noted. Several residents commented on the cleanliness, and most of the residents who completed questionnaires stated that the home is always fresh and clean. However there was a noticeable odour in one bedroom. Appropriate procedures are in place for the control of hygiene. But there is no facility for the staff to wash their hands in the laundry. There is a rolling programme for maintenance and refurbishment in the home. Several beds have been replaced, and all are due to be replaced. One resident commented on how pleased she is with her comfortable new bed. The bathrooms are also being refurbished, and it was noted that the baths in the bathrooms on wing 1 are stained, and need replacing. Two bathrooms are currently out of use due to the refurbishment. However some additional repairs and maintenance are needed immediately. The gutters that can be seen from the windows of the upper floors were full of leaves, and need to be cleared. The stair carpets on the stairs in the original part of the home are threadbare in places. There is tape over some patches on stair treads that is unsightly and could cause a risk of slipping or tripping. There is loose carpet on several steps near the top of the first flight of stairs from the ground floor, which presents a serious risk of tripping. A property audit carried out by the company in September noted that a washing machine had been out of order for six weeks. This has now been replaced, but on this inspection the dishwasher was not working. An additional bedroom has been created on the top floor, and a variation to the conditions of the home has been agreed for its use. The room is not yet in use, and it is not safe to use until the windows are replaced (see Management and Administration). It was reported that this work will be completed before a resident is admitted, and it is also planned to install an en-suite toilet in the bedroom. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 21 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): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff numbers in the home are sufficient to ensure that all the residents’ needs are met, but some work very long hours. Training in essential skills is available for the staff, but there is insufficient training in specific needs such as dementia care and pressure area care. The induction training programme does not comply with the induction standards required by Skills for Care. The recruitment procedures make sure that, as far as possible, the residents are supported and protected in the home, but there are some gaps in the information that is required to be kept. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 22 EVIDENCE: The staffing rotas for two weeks were seen, which showed that there are seven care staff and a team leader on duty throughout the day, and three care staff on duty at night. Some staff work very long shifts of twelve hours. Two of the night staff have worked excessively long hours, one 72 hours in a week, and one 60 hours. None of the day staff have worked over 48 hours, but several have the maximum working time of 48 hours as their contracted hours. The number of hours worked and the length of the shifts is contrary to the Working Time Directives. The staff team comprises 18 care workers and 2 team leaders. This number of staff means that the average working week is 46 hours. There are sufficient staff working in the home on each shift to meet the needs of the residents, but the home does not employ sufficient staff to ensure that the terms of the Working Time Directive are met. The excessively long hours and long shifts required of the care staff could cause a risk to the welfare of the residents. All the members of the care staff and domestic staff spoken to during the inspection were enthusiastic about their work in the home. The company provides a comprehensive training programme that covers all the statutory training, and the training matrix that was seen showed that all the staff have attended essential health and safety training and training in prevention of abuse. Other training is available for the specific needs of the residents. The staff who were spoken to said that they have had no training in dementia care. Seven care staff attended a half day training course in basic dementia care on the day before the inspection, and it was reported that the aim is for all the care staff to undertake an intermediate training course to ensure that they have the skills and knowledge to meet the needs of the residents. All the care staff must have an appropriate training in dementia care, and it is recommended that senior staff should take a certificated training course. Training in pressure area care is available, but the poor recording of pressure area care (see Health and Personal Care) indicates that there is insufficient training provided on this subject. The company has an induction training programme that is based on Ropers Activities of Daily Living. This does not comply with the induction standards required by Skills for Care. All the care staff are encouraged to undertake NVQ qualifications, and there is an expectation that new staff will register for the qualification. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 23 The home has robust policies and procedures for recruitment. Three staff files were seen for recently recruited members of staff. They contained most of the required information, including satisfactory references, evidence of identity and confirmation of good health. The files included evidence of a satisfactory POVA first clearance that was received before the person started work in the home, but no CRB (Criminal Record Bureau) disclosures. It was reported that staff do not work unsupervised until a satisfactory CRB disclosure has been received. Evidence of satisfactory CRB disclosures must be maintained in the home, and must be available for inspection when required. The file of one member of staff contained no evidence of their immigration status or work permit. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 24 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): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Appropriate records are maintained for the effective management of the home and monitoring of health and safety procedures, and appropriate procedures are in place to ensure that the personal money of the residents is looked after and recorded appropriately. However, the practices in some areas must be addressed to ensure that there is no risk to the health and safety of the residents. An effective quality assurance system is required, to ensure that views of the residents and their families underpin all self-monitoring, review and development of the home. The management structure in the home is insufficient to carry out the aims and objectives of the home’s Statement of Purpose, and to ensure that systems are in place to meet the needs of the residents. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 25 EVIDENCE: The registered manager of the home left Guysfield in February 2006, and the acting manager was the home’s administrator. She was assistant manager of another home for several years. She has completed the RMA (Registered Managers Award) qualification, and she is working towards NVQ level 4 in care. An application has not yet been submitted for registration, and the home has been without a registered manager for ten months. On the day of the inspection the Area Manager was in the home to supervise and support the acting manager, and she provided much of the information contained in this report on the plans for training, staffing structure and refurbishments in the home. There is no deputy manager. There are two team leaders, and it is planned to appoint a third. The team leaders will take on some of the responsibilities of the deputy manager role, including staff supervision and organising key working, and monitoring medication and care plans. Currently there are insufficient senior staff to ensure that there is a team leader on duty at all times in the home, and on occasions, particularly at weekends, a care worker may be required to act as the senior in charge of the home. Some staff, including senior staff, are working excessively long hours and long shifts (see Staffing), which has an impact on staff morale and may affect the wellbeing of the residents. The area manager makes monthly monitoring visits to the home. It was reported that a new quality assurance policy is being developed. This will include annual questionnaires for residents, relatives, staff and visiting professionals, which will be collated and analysed by an external body. The company carries out regular audits in the home. Clinical and environmental audits were completed in September 2006, with resulting action plans. Many of the actions from the audits have been completed, but some have not been addressed, for example to improve the pre-admission assessments (see Choice of Home). Some health and safety concerns which were observed during this inspection (see below) were not noted in the audits. The company produces an annual business plan for the home, with action plans for immediate action, and medium term and long term actions. The system of quality assurance that was discussed should provide a robust system that meets the requirements of the National Minimum Standards and the Care Home Regulations. However as it is not yet in place, a requirement has been made. The arrangements for management of residents’ money were inspected and appeared to be accurate. Money is stored safely and adequate records are maintained in order to protect service users from financial abuse. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 26 The home maintains appropriate records for the health and safety of the residents and staff in the home, and staff follow the home’s policies and procedures. Fire records are up to date, and all the staff take part in regular fire training and fire drills. Three health and safety concerns were noted during this inspection. 1. The stair carpets on the stairs in the original part of the home are threadbare in places. There is tape over some patches on stair treads that is unsightly and could cause a risk of slipping or tripping. There is loose carpet on several steps near the top of the first flight of stairs from the ground floor, which presents a serious risk of tripping. (See Environment.) 2. There are electrically operated reclining chairs in two lounges, which were seen to be enjoyed by the residents. However there is no risk assessment in place to ensure that the chairs are operated safely and do not cause any risk to the safety of the residents. The risk assesment should include the rationale for use and how staff will be trained in the operation of the specific chair. 3. An additional bedroom has been created on the top floor, and a variation to the conditions of the home has been agreed for its use (see Environment). This was the first time that this room has been seen since the variation was agreed. The room is not yet in use, and it is not safe to use until the windows are replaced. The windows currently open onto a stone balcony, which is unsafe for any potential resident. The windows must be replaced with windows that have a restricted opening and do not provide access to the balcony. It was reported that this work will be completed before a resident is admitted. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 27 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 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement The assessments of the needs of the residents do not provide sufficient information on residents’ care needs to enable the needs to be met. A comprehensive assessment must be completed before any resident is admitted to the home, that provides appropriate and adequate information to enable the staff to meet all the person’s assessed needs. There is no evidence of specific facilities for people with dementia. The registered person must ensure that the home provides specific facilities for dementia care in order to meet the conditions of registration. Timescale for action 14/03/07 2. OP4 12(1) 14/03/07 Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 29 3. OP7 12(2) & (3) 15 The care plans do not provide 14/03/07 adequate information on the health and personal care needs of each resident. They are not used by the care staff to enable them to provide a good quality of care. There is no evidence of the involvement of service users in decisions about their care. The registered person must ensure that all care plans provide adequate and appropriate information on all the resident’s needs, and that recording in care plans is relevant and informative. Service users must be enabled and encouraged to make decisions about their care. Appropriate risk assessments are 31/03/07 not in place to ensure that any potential risks to the health and safety of individual residents are identified and addressed. Appropriate and adequate risk assessments must be put in place for each resident for situations in which there is any risk of harm or injury to themselves or others. Recording of pressure area care is inadequate, and does not provide staff with the information that they need to provide a good quality of care. The registered person must liaise with the district nurses to ensure that appropriate care plans and recording are in place for all the residents’ health care needs, and in particular for the management of pressure area care. 4. OP7 13(4) 5. OP8 12(1)(a) 31/03/07 Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 30 6. OP9 13(2) The home has generally good procedures for administering and recording medication safely, but inadequate storage and insufficient staff means that there is a risk of errors in administration. All medication must be administered and recorded in accordance with the Royal Pharmaceutical Society guidelines and the home’s policy and procedures. The temperature of cupboards used for storing medication was recorded as over 25°C. The temperature of all areas used to store medication must be regulated to below 25ºC. A resident was weighed in the conservatory, in full view of other residents and any visitors to the home. Staff must respect the service users’ privacy and dignity at all times. The service of meals provided to residents in the small dining room is poor. The registered person must ensure that meals are provided to all the residents with equal care and attention. In particular, additional support must be available as required for residents who need assistance at mealtimes. 14/03/07 7. OP9 13(2) 28/02/07 8. OP10 12(4)(a) 31/01/07 9. OP15 12(4)(a) 28/02/07 Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 31 10. OP19 OP38 13(4)(a) 23(2)(b) The stair carpets are worn in many places, and must be replaced without undue delay, in order to ensure that there is no risk to the safety of residents and staff. Immediate measures must be taken to ensure that the stair carpets are safe. The gutters that could be seen from the windows of the upper floors were full of leaves. The registered person must ensure that the premises are maintained in a good state of repair at all times. There is no facility for the staff to wash their hands in the laundry. 14/12/06 11. OP19 23(2)(b) 31/01/07 12. OP26 12(1)(a) 16(2)(j) 31/01/07 13. OP26 16(2)(k) The registered person must ensure that liquid hand wash and paper towels must be available for staff in order to prevent the risk of spreading infection. There was a noticeable odour in 31/01/07 one bedroom. Measures must be put in place to identify and keep the home free from offensive odours. The staffing rotas show that many staff work very long hours and long shifts. The registered person must ensure that sufficient staff are employed in the home in order to comply with the Working Time Regulations. 14. OP27 18(1)(a) 14/03/07 Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 32 15. OP29 19(1)(b) There was no evidence of satisfactory CRB disclosures, and there was no evidence of work permit or immigration status for one member of staff. The registered person must ensure that no-one starts work in the home without satisfactory evidence of their fitness and their right to work. All staff in the home must have appropriate specialised training in meeting the needs of people with dementia. An appropriate certified training should be considered for senior staff. The induction training programme does not comply with the induction standards required by Skills for Care. All new members of staff must complete a comprehensive induction training programme that meets the Skills for Care requirements. The home has been without a registered manager for ten months. 31/01/07 16. OP30 12(1)(b), 18(1)(c) (i) 14/03/07 17. OP30 18(1)(c) (i) 14/03/07 18. OP31 8(1) 9 31/03/07 19. OP31 18(1)(a) An application for registration for the acting manager must be submitted without further delay. There is no deputy manager, and 14/03/07 only two senior staff to take dayto-day responsibilities in the home. The registered person must ensure that the management structure in the home is sufficient to carry out the aims and objectives of the home’s Statement of Purpose, and to ensure that systems are in place to meet the needs of the residents. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 33 20. OP35 24 There is no structured system for 14/03/07 monitoring the quality of the care provided by the home. A system for monitoring the quality of care must be established, that focuses on the consultation with the service users and other involved people, and provides feedback on the process and the results of the consultation. There are electrically operated reclining chairs in two lounges. 21. OP38 13(4)(a) & (b) 31/01/07 22. OP38 13(4)(a) & (c) The registered person must ensure that risk assessments are place to ensure that the reclining chairs are operated safely and do not cause any risk to the safety of the residents. 31/01/07 The additional bedroom on the top floor is not yet in use, and it is not safe to use until the windows are replaced. The registered person must ensure that the windows of the additional top floor bedroom are replaced with windows that have a restricted opening and do not provide access to the balcony. This room must not be occupied by a resident until the windows have been made safe. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 34 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 OP12 OP15 Good Practice Recommendations It is recommended that suitable training should be provided for the activities organiser in providing activities for people with dementia. It is recommended that consideration is given to providing jugs of drink and gravy, and possibly dishes of vegetables, on the tables so that the residents who are able to do so can serve themselves. Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Guysfield Residential Home DS0000019399.V322222.R01.S.doc Version 5.2 Page 36 - 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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