CARE HOMES FOR OLDER PEOPLE
Guysfield Residential Home Willian Road Willian, Letchworth Hertfordshire SG6 2AB Lead Inspector
Neil Fernando Unannounced 19 May 2005 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. Guysfield Residential Home I52-I02 S19399 Guysfield v225612 190505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Guysfield Residential Home Address Willian Road, Willian, Letchworth, Hertfordshire SG6 2AB 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) 01462 684441 Guysfield House Limited Karen Darlington CRH PC 50 Category(ies) of DE(E) - Dementia over 65 - 8 places registration, with number OP - Old Age - 50 places of places Guysfield Residential Home I52-I02 S19399 Guysfield v225612 190505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Dementia - over 65 years of age (8), Old age, not falling within any other category. Date of last inspection 07 October 2004 Brief Description of the Service: Guysfield is a large Victorian house, which has been 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 a thirty minutes walk of Letchworth town centre. The accommodation comprises of forty-eight single bedrooms with an en suite wash hand basin and toilet facilities and 1 double bedroom, located on each of the three floors. There are two passenger lifts, which serve all three floors. Three lounges, one conservatory and two dining rooms are on the ground floor. The main kitchen, laundry facilities and the Manager’s office are also available. There is ample car parking space to the front of the property and a large garden to the sides. Guysfield Residential Home I52-I02 S19399 Guysfield v225612 190505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the first inspection for the year 2005/6 under the National Minimum Standards for Care Homes for Older People and the Care Homes Regulations 2001. The last inspection (Unannounced) was carried out on 7.10.04. Guysfield is a residential care home, which is owned and managed by Guysfield House Limited. The establishment is registered to accommodate up to 50 people over 65 years of age of both genders, including 8 persons who have dementia. On the day of the inspection, there were 46 service users in residence. The unannounced inspection took place over one afternoon/evening in May 2005. It found that a significant majority of the standards assessed on this occasion meet the National Minimum Standards. 12 service users, 1 visiting professional and 11 members of staff including the Regional Manager and Registered Manager were spoken to, in order to seek their views regarding the quality of life at Guysfield Home. In the main, evidence available suggests that the care for service users has been maintained to a good standard. What the service does well:
The potential service users, their relatives and significant others have excellent opportunity to visit and assess for themselves the facilities offered at this home. The process for assessing and identifying the needs of any service user prior to being offered a place remains satisfactory. The care planning and review process ensures that the needs/requirements of the service user are identified and addressed, and unmet needs closely monitored. Information gathered from discussions with service users, staff members, a visiting Doctor, examination of records and observation of care practice suggests that the quality of care being offered to the resident group is good. Service users appeared to be treated with dignity and respect, and their privacy, upheld. Social and recreational activities facilitated for more able service users are suitable to their needs. A good variety of nutritious food is served in a comfortable setting. All residents are clear that they are consulted and have an input to menu planning. Information gained suggests that the quality, quantity and variety of food served are of a high standard. Guysfield Residential Home I52-I02 S19399 Guysfield v225612 190505 Stage 4.doc Version 1.30 Page 6 The home has excellent reputation for maintaining links with the local community. Contact with family and friends are actively encouraged and supported. The home is clean and comfortable, and continues to generate a warm and homely atmosphere. There is good evidence to demonstrate that service users are actively encouraged to make it their home, through inclusion in decision-making process and encouragement to personalise their room. Service users are being proactively empowered to raise any concern/complaint they may have, if they are dissatisfied with any aspect of the service offered to them. The protection systems including staff recruitment are adequately robust to ensure the safety of service users. The staffing levels remain satisfactory. In the main, the registered Manager is competent to manage this establishment. What has improved since the last inspection? What they could do better:
The registered Manager should ensure that the more dependent service users are proactively included in recreational activities facilitated and the name of participating residents, included in the activities record. NVQ assessment for care staff should be given a higher profile, so that the minimum ratio of 50 of the care staff members with NVQ level 2 or equivalent becomes achievable by 2005. It is essential that a disproportionate number of care staff members with limited verbal communication skills are not rostered to work on the same shift. Individual file for new members must include a recent photograph. It is also crucial that the Registered Person ensures that overseas care staff members
Guysfield Residential Home I52-I02 S19399 Guysfield v225612 190505 Stage 4.doc Version 1.30 Page 7 receive appropriate support/training, in order to develop their basic verbal communication skills. 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. Guysfield Residential Home I52-I02 S19399 Guysfield v225612 190505 Stage 4.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 Guysfield Residential Home I52-I02 S19399 Guysfield v225612 190505 Stage 4.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, 3and 5. The home’s assessment and admission process is adequately robust thus ensuring that the residents’ needs could be met on admission to the home. It is also very positive that service users and their relatives are central to the decision-making process regarding matters that affect them. EVIDENCE: The case records for eight service users were examined and these include comprehensive details of the completed pre-admission assessment undertaken by a member of the home management team. Records examined and information gained from four new service users and staff members including the Manager provides good evidence that the arrangements to enable service users and their relatives/friends the opportunity to visit and make an informed decision about the facilities offered at this establishment is satisfactory. They would spend time looking around, speaking to other service users and a meal is offered. Guysfield Residential Home I52-I02 S19399 Guysfield v225612 190505 Stage 4.doc Version 1.30 Page 10 The new resident is admitted for a trial period to enable them to decide if they want to stay and also to give the staff team the opportunity to further assess the needs of the service user. A review meeting is held at the end of the trial period involving the service user, relatives and Care Manager, and only then the placement is finalised. The trial period can be extended if more time is required to consider the placement. Staff members reported and service users confirmed that residents have visited the home where appropriate, to enable them make an informed decision. Guysfield Residential Home I52-I02 S19399 Guysfield v225612 190505 Stage 4.doc Version 1.30 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 standard(s) 7, 8 and 10. The care planning and review process is effective and service users’ participation is central to this process, which is beneficial to them. Staff members appear to offer a sensitive and individualised approach to service users identified needs and requirements. EVIDENCE: Service users’ needs and requirements, including health and personal care are being identified and addressed through a care planning process and monitored through a monthly review system. Service users and where possible relatives participate in the care planning and review process. There is some evidence to suggest that care plans are being internally reviewed, in order to reflect the changing needs and requirements of each resident. Guysfield Residential Home I52-I02 S19399 Guysfield v225612 190505 Stage 4.doc Version 1.30 Page 12 Records show that each resident is registered with a local GP of their choice who visits as and when required. There is currently a District Nurse who visits twice weekly. The outcome of the Doctor and District Nurse’s visits is well documented. Advice on nutrition can be obtained from the Nutritionist. Other professionals, service users have access to include Dentist, Optician, Audiologist, Podiatrist and Community Psychiatric Nurses as required. Information gathered from service users, staff members, care plans, District Nurse records and interview with a visiting General Practitioner indicates that the health care requirements of service users are being addressed well. A minor suggestion has been made by the visiting Doctor, which has been passed on to the Manager for consideration. Policies and procedures are in place in respect of maintaining dignity and respect for individuals. Observation of care practice and feedback from service users and a visiting Doctor suggests that residents are treated with dignity and respect. Guysfield Residential Home I52-I02 S19399 Guysfield v225612 190505 Stage 4.doc Version 1.30 Page 13 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, 13 and 15. Service users’ interests, expectations and aspirations are being sought by staff and fulfilled as appropriate. However, the level of activities for the more dependent residents should be improved, in order to provide an adequate level of stimulation for their general wellbeing. EVIDENCE: Service users who decide that Guysfield is the right home for them appear to be well informed of what they can expect, prior to their admission. Many service users reported that they are being encouraged to maintain their social, cultural, religious and recreational interests as indicated through the sample of care plans viewed. The Activities Coordinator also provided documentary evidence of a good variety of activities being facilitated on an on going basis. Records unfortunately, did not reflect the name of participants, which makes it difficult to assess if activities offered provide an adequate level of stimulation to dependent service users. Some staff including senior members interviewed reported that there is a need to ensure that dependent service users are proactively included in recreational activities offered. It is therefore recommended that dependent service users should be proactively included in recreational activities offered and the name of participating service users should be included in the activities record. Guysfield Residential Home I52-I02 S19399 Guysfield v225612 190505 Stage 4.doc Version 1.30 Page 14 There is excellent evidence to demonstrate that service users maintain very good contact with family, friends, representatives and the local community. Good relationship exists between the home and the Advocacy Service, the local school and various religious groups. Visiting times are flexible and visitors are welcome at any reasonable time. Visitors could be entertained in the communal areas or service users’ own bedroom, if they so wish. Service users spoken to expressed a high degree of satisfaction in this area. The staff team including the Manager are to be commended for their hard work and consistent achievement in this area. Information is gathered as part of the admission process, in order to seek service users’ culinary likes and dislikes, which are taken into account in the preparation of menu. The menu is planned on a weekly basis. The chef Manager stated that the catering and care staff members regularly speak to each service user to seek their views about taste and preferences. Hot and cold drinks are served throughout the day and mealtimes are seen as a social occasion. Residents interviewed expressed a high level of satisfaction with respect to the catering service they receive. The chef Manager reported that the catering staff members have received their mandatory training. Guysfield Residential Home I52-I02 S19399 Guysfield v225612 190505 Stage 4.doc Version 1.30 Page 15 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 and 18. Information on how to make a complaint is available and service users felt empowered to raise any concern to staff members. Information available suggests that complaints are managed speedily and satisfactorily. The protection systems in place are adequately robust and this will ensure the safety of service users. EVIDENCE: The procedures on complaints are available and accessible to all staff members. Staff members interviewed demonstrated a good understanding of the procedures and their responsibilities towards ensuring that any complaint is dealt with quickly and satisfactorily. Service users spoken with reported that they are regularly encouraged to raise any concern or complaint they may have about the services they receive. Many service users spoken with echoed confidence, in that they would not hesitate to speak with a member of staff or the Manager, if they were dissatisfied with any aspect of the service provision. The complaints record indicates that there have been three complaints made to the home since the last inspection in October 2004. Complaints appeared to be responded to speedily and satisfactorily. The home has comprehensive procedures on the protection of vulnerable adults. The “Whistle Blowing” policy is also available to the staff team. Staff members interviewed demonstrated an understanding of the above procedures. The Manager reported, and staff members confirmed, that they have received training on the protection of vulnerable adults, a subject also covered by those members who have completed their NVQ assessment. Overall, there are good systems in operation, which should adequately protect service users.
Guysfield Residential Home I52-I02 S19399 Guysfield v225612 190505 Stage 4.doc Version 1.30 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26. This establishment continues to provide comfortable and safe living conditions to its service users. A rolling programme of upgrading has improved some parts the physical environment. The standard of house keeping was high and residents appear to appreciate and enjoy their physical environment. EVIDENCE: Health and Safety Policies and procedures are in place and records seen provide evidence that service users and staff are offered the protection of reasonable safety measures. The communal areas and bedrooms are decorated and furnished in a style to reflect the period features of the building. A further three bedrooms have been refurbished to a very good standard. Furniture and fittings are comfortable. It is evident that the home and gardens are maintained appropriately. A high standard of cleanliness was evident throughout those areas viewed. There were no mal-odours present. There are infection control policies and procedures in place, which are known to staff members. Suitable arrangements are in place for the storage and collection of domestic and
Guysfield Residential Home I52-I02 S19399 Guysfield v225612 190505 Stage 4.doc Version 1.30 Page 17 clinical waste. Risk assessment of the physical environment is carried out as appropriate. There were no health and safety hazards noted. Guysfield Residential Home I52-I02 S19399 Guysfield v225612 190505 Stage 4.doc Version 1.30 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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, 28, 29 and 30. Whilst the numbers of care staff available on both the day and night shifts are deemed adequate, there is a serious need for the overseas staff to receive training, in order to improve their verbal communication skills. Otherwise, this could affect the quality of care being offered and may possibly jeopardise the safety and welfare of service users. In addition, NVQ assessment for care staff should be given a higher profile. EVIDENCE: Information available from staff duty rotas for the period between 7.05.05 and 10.06.05 and discussion with staff members including the Manager demonstrate that the number of day and night care staff available are adequate to meet the needs of the service user group. There are sufficient ancillary members in dedicated roles for catering, laundry and housekeeping. The numbers of staff members on duty during the day of the inspection were noted to reconcile with the rotas for the day. The home has procedures for the recruitment, induction and training of staff members. The recruitment files for seven staff members who have been in post since the last inspection in October 2004 were viewed. These reflected the documents required by the Care Homes Regulations 2001 except for a current photograph not being available in most cases. A requirement has therefore been made on this matter. All staff members interviewed had had their CRB checks completed where appropriate. The Manager also seeks a police check report from the applicant’s country of origin for those new recruits coming from abroad, which is very commendable.
Guysfield Residential Home I52-I02 S19399 Guysfield v225612 190505 Stage 4.doc Version 1.30 Page 19 Information available indicates that staff members have received mandatory training to assist them to do their work competently. There are only seven members of care staff who have completed their NVQ Level 2 assessment (26.3 ) to date. A minimum ratio of 50 of the care staff team should achieve NVQ level 2 or equivalent by 2005. This is an area that should be given a higher profile and therefore, a recommendation has been made. There are currently a significant number of new recruits who have joined the staff team from abroad and who speak English as a second language. Their verbal communication skills are very limited and there is evidence to indicate that this has generated some communication difficulties with service users and within the staff team – a view echoed by a significant number of staff members and all twelve residents spoken to. Most staff members and service users spoken to also felt that there is a disproportionate number of new members rostered on the same shift (5 out of 7 members on duty) on some occasion, which places both the new and experienced groups of staff under tremendous pressure. These concerns were discussed with the Regional Manager and Registered Manager and the latter said that the difficulties had arisen due to the departure of some staff members within a short period of time and the necessity to fill vacancies. Given the level of concerns expressed by staff members and service users, and supported by other evidence, a requirement and a recommendation has been made. This is an area that will be closely monitored during future inspection. Guysfield Residential Home I52-I02 S19399 Guysfield v225612 190505 Stage 4.doc Version 1.30 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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, 36 and 38. The overall management of this home remains satisfactory. The health, safety and welfare of service users, and staff are being safeguarded. Guysfield is a safe home for residents to live in – a view shared by staff members and service users interviewed. Records are maintained as required. EVIDENCE: The Manager has been a registered Manager for almost 8 years. She has the relevant management experience in nursing and residential care fields. She holds a registered nursing qualification and more recently, completed the NVQ 4 in management and Care. The lines of accountability within the home and external management remain consistently clear and well understood by staff members. The Manager is very capable of managing this establishment. Staff members interviewed confirmed that they receive one to one supervision from the Manager. She also operates an open door policy and therefore, support and informal supervision is available on an on-going basis – a view echoed by staff members spoken to.
Guysfield Residential Home I52-I02 S19399 Guysfield v225612 190505 Stage 4.doc Version 1.30 Page 21 The home has good procedures to ensure the health and safety and welfare of service users and staff. Staff members have received mandatory training as appropriate. Fire drills and weekly test of break glass points have been carried out within the required frequency and a record maintained. Staff members have received fire safety training. Hot water temperature is monitored regularly, in order to ensure a safe limit of 43 degrees Centigrade at the point of outlet. Windows have been fitted with restrictors for the safety of service users and security of the building. Portable electrical appliances are checked, tagged and a record maintained. COSSH records are held and all accidents and incidents are recorded. Guysfield Residential Home I52-I02 S19399 Guysfield v225612 190505 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 4 14 x 15 4
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x 3 x 3 Guysfield Residential Home I52-I02 S19399 Guysfield v225612 190505 Stage 4.doc Version 1.30 Page 23 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. 2. Standard OP29 OP30 Regulation 19 (1)(b) (i) 18 (c) (i) (ii) Requirement Individual file for new recruits must include a recent photograph. The Registered Person must ensure that overseas staff receive support/training as appropriate, in order to develop their verbal communication skills. Timescale for action 10.07.05 30.11.05 and ongoing 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. Refer to Standard OP12 Good Practice Recommendations Dependent service users should be proactively included in recreational activities facilitated and the name of participating service users should be included in the activities record. NVQ assessment for care staff should be given a higher profile so that a minimum ratio of 50 of the care staff team achieve NVQ level 2 or equivalent by 2005. The Registered Manager should ensure that a disproportionate number of staff with limited verbal communication skills (not more than 2) are not rostered to work on the same shift.
I52-I02 S19399 Guysfield v225612 190505 Stage 4.doc Version 1.30 Page 24 2. 3. OP28 OP30 Guysfield Residential Home Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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