Inspection on 06/04/09 for Guysfield Residential Home

This inspection was carried out on 6th April 2009.

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

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 07/04/08

Guysfield Residential Home 26/04/07

Guysfield Residential Home 13/12/06

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Guysfield Residential Home Willian Road Willian Letchworth Hertfordshire SG6 2AB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Yoke-Lan Jackson     Date: 0 6 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Guysfield Residential Home Willian Road Willian Letchworth Hertfordshire SG6 2AB 01462684441 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : guysfield@caringhomes.org Guysfield House Ltd care home 51 Number of places (if applicable): Under 65 Over 65 8 51 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 0 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 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, the 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 home charges £438 to £756 per week. Information about the home Care Homes for Older People Page 4 of 26 Brief description of the care home and the service it offers is contained in the Statement of Purpose and Service Users Guide. A copy of these and the most recent CSCI inspection report are available in the home. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced inspection was carried out on 06/04/2009. The regional manager (new) and the assistant managers were present. There are currently 42 people in residence. The inspection included a tour of the premises. Time was also spent observing how the staff interacted with the residents. Staff, residents and visitors were spoken to and key documents were examined. The inspection ended with a thorough discussion with the regional manager and the assistant managers. Information received by us included the Annual Quality and Assurance Assessment (AQAA) which providers of registered services are required to complete. The AQAA Care Homes for Older People Page 6 of 26 focuses on how the outcomes are being met for the people using the service and also provides us with statistical data. What the care home does well: What has improved since the last inspection? What they could do better: The test for legionella bacteria in the water system remains positive. The management is addressing the situation and the disinfection treatment continues. Measures are in place to ensure the safety of residents and staff. The management has assured the inspector that there will be no further admission of clients that are outside the registered category and only those clients whose care needs can be met will be admitted. Care Homes for Older People Page 8 of 26 The written care plans examined had not reflected the care provided to those with Dementia or Parkinsons Disease. Since the inspection, these care plans have been revised to ensure that all the care needs of each resident are recorded appropriately so as to provide the basis for care to be delivered. It was noted that the home continued to receive repeat prescriptions that had been cancelled some time ago. Since the inspection, the management have taken appropriate action to remedy this error by a third party following an investigation by the regional manager. The resident has not been affected by the administrative error. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective clients can be assured that a pre-admission assessment will be completed before they are admitted to ensure that the home can meet all their care needs Evidence: The pre-admission documents of three recent admissions were examined and they were found to be satisfactory. The management has assured the inspector that there will be no further admission of clients that are outside the registered category and only those clients whose care needs can be met will be admitted. In recent months a number of residents have been relocated as the home was not able to cater for their health care needs. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can expect to be treated with respect and can rest assured that their personal and healthcare needs can be met. However not all the care needs identified were reflected in their written care plans. People are protected by the homes medication policy and procedures. Evidence: Each resident has a written care plan which is drawn up with the resident and provides the basis for the care to be delivered. The home is using the redesigned format issued by the provider for all its care homes. The care planning process is person-centred. However the written care plans examined did not reflect the care provided for residents who have dementia and those with Parkinsons disease. There were specific care plans for those with diabetes. Since the inspection, the management has updated the care planning records to include specific medical conditions and the specific care that is to be provided. Appropriate risk assessment documents were seen in the care plan folder. Care Homes for Older People Page 12 of 26 Evidence: All the residents appeared comfortable and well dressed. The members of staff were observed to be caring but due to the shortage of staff on the day of the site visit, the staff had very little time to provide one-to-one interaction. Each of the residents is registered with a general practitioner of their choice and all residents have access to specialist medical, nursing and other therapeutic services when required. On the day of the inspection, several residents were observed having their eyes tested in one of the community rooms. The arranged visit by a team of opticians from a private company seemed to be a regular service and this benefited the residents, who did not have to travel for their appointment. On the same day a resident was waiting for their doctor to visit them. A trained member of staff administers medication. All controlled drugs are stored in a controlled drug cupboard in a storage room with proper records kept. All other medicines are stored in drug trolleys and two of these trolleys are kept attached to the wall in the dining room. The third trolley is kept securely in another room. The Medication Administration Record (MAR) charts were examined. It was noted that one of the MAR charts had an incorrect date printed on the form by the pharmacy and the member of staff responsible for auditing had justified this error on the back of the MAR chart. Staff have been instructed to check the printed dates in future and to notify the pharmacist immediately if they are incorrect. The MAR chart for another resident indicated that two of the prescribed drugs had been discontinued by the doctor but the pharmacist had continued to deliver them and the home had continued to return them. Since the inspection, the regional manager has conducted an investigation and remedial action has been taken to resolve this administrative error by third party. The pharmacist has cancelled the items on the printed MAR chart and the management have raised the issue with the practice manager of the relevant doctors surgery. The management have confirmed that the resident had not been given the medicine since it was discontinued by the doctor and accurate information is now reflected in their MAR chart. All staff have been retrained and advised by the management to be extra vigilant in maintaining MAR charts and concerning related issues. Since the site visit, the management have also written to all seven general practitioners to review all repeat prescriptions, including those prescribed as PRN (to be given when required) medicines. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that they will be given the opportunity to make everyday choices and that their preferences and requests will be respected. They will be encouraged to maintain links with their friends and families and they will be encouraged to have a healthy diet. However, it would benefit the people who use the service further if the recreational activities and one to one interaction were delivered daily and were not dependent on staffing levels. Evidence: On the day of the site visit, the majority of the residents, including those with dementia, were in the conservatory. The residents seemed well dressed but most were just sitting around with very little stimulation or interaction due to inadequate staff number. The care workers were all busy with personal care. Some of the staff were attending a days training session in one of the communal rooms and the two activity co-ordinator were not on duty on the day. However, at around teatime the residents seemed happier and more active as their visitors arrived. As staff on the afternoon shift arrived a senior member of staff from the morning shift was observed interacting with a group of residents in a therapeutic game of ball throwing and catching. Care Homes for Older People Page 14 of 26 Evidence: The members of staff interviewed said that when the activity co-ordinators are on duty the activity programme includes bingo, puzzles, films, nail care, music, local walks and visits to the local pubs. There is a regular communion service for those who wish to take part. Lunchtime was observed to be unhurried. The majority of the residents have their meals in the dining room. They all seemed happy with the three course lunchtime menu. Members of staff were readily available to assist those residents who needed some help. The majority of residents seemed to enjoy their lunch of roast lamb, mashed potatoes and vegetables. There was a choice of an alternative dish and salad. The general comments from the residents have been positive. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that they will be listened to, and any complaints made will be handled promptly and effectively, through the homes robust Complaints Policy and Procedure Evidence: Residents meetings are held regularly and the management deal with issues raised at the meetings promptly. Residents and their relatives are aware of the homes Complaints Procedure. Members of staff have training on the protection of the vulnerable and they are aware of the Whistle-Blowing Policy. Since the last inspection, there have been a number of safeguarding meetings under the joint agency safeguarding procedures organised by Hertfordshire County Council Adult Care Services. The home had admitted a number of residents whose care needs were not met appropriately. The management had since revised some practice issues and staff have had retraining and the matters have been resolved. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that they live in a clean and comfortable environment and that they will have access to all community areas. They can be assured that safety measures are in place to minimize exposure to health hazards concerned with the presence of legionella bacteria in the water system. Evidence: On the day of the site visit, the premises appeared neat and clean. The surrounding grounds were well maintained. There is an ongoing maintenance programme for redecoration and refurbishment. Since the last inspection the dining room and some of the bedrooms have been refurbished and redecorated. As the bedrooms are vacated redecoration is being carried out. The main conservatory lounge area has been rearranged with new modern chairs and a settee to create a more homely appearance. The test for legionella bacteria in the water system has been positive since February 2007. The Health and Safety Officer from Environmental Health, Hertfordshire County Council has been involved since the discovery. Further work included fitting to each of the hot water boilers and main inlet valves a number of copper silver ionisation units to eliminate any further traces of legionella bacteria at source. This work commenced Care Homes for Older People Page 17 of 26 Evidence: on 31/05/07. In spite of the treatment carried out, the test for legionella bacteria in the water remains positive. The home continues to engage the services of a specialist firm to help resolve this problem. The management continues to put in place measures to minimise the risk to residents, staff and visitors. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that they are safeguarded by the homes recruitment policy and practices. However, they would benefit further if the staffing level were well maintained so that the positive care provided is consistently delivered to a high level. Evidence: On the day of the inspection, there were 4 care workers to 41 residents. One of the care workers was a senior care worker who had to do the medication and managed the service whilst the assistant manager was conducting the days scheduled training session to other care workers in one of the lounges. The management agreed that more staff should have been allocated in view of the planned training date. All the members of staff present on the day were working very hard to ensure that the residents personal and healthcare needs were being met. However, the activities and social stimulation were not met appropriately. The staff interviewed said that usually there are seven care workers on duty apart from the managers. The staffing level for the following day was adjusted after the inspection to ensure an adequate staffing level. The staff recruitment records were not examined on this occasion as the manager was not present but the assistant manager confirmed that the staff recruitment and Care Homes for Older People Page 19 of 26 Evidence: training records are well maintained. Staff interviewed confirmed that they have had Criminal Record Bureau (CRB) checks and the Protection of Vulnerable Adult (POVA) checks and that they only commenced working after CRB and POVA clearance. The management continue to arrange appropriate training for members of staff. All new staff have induction training and all staff have had training on the administration of medication, dementia, nutrition, infection control and other relevant topics to ensure residents care needs are being met appropriately. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that the administration and management of the service will continue to improve as the management continue to address any shortfalls in the service to ensure that people who use the service are safe and that the home is run in their best interests. Evidence: The management have recognised shortfalls in the administration and management of the service especially in the management of medication, staffing levels and written care plans. These issues are being addressed with assistance from the new regional manager, who was recently appointed to oversee this service. The registered manager had returned from long term sick leave during the week of the site visit. In her absence the home was managed by the assistant managers, one of whom was appointed as the acting manager. The regional manager gave her support on the day of the inspection as the registered manager was not on site. Care Homes for Older People Page 21 of 26 Evidence: The test for legionella bacteria in the water system has been positive since 2007. The management continue to ensure that measures are in place to minimize the risk to residents and staff. A specialist firm is being employed to help resolve the problem. The management continues to liaise with Environmental Health, Hertfordshire County Council. The home is not involved with the residents finances, but the management oversee the personal allowances for each resident and proper accounting records are kept. All servicing records are well maintained. The management has introduced a new nutritional protocol which includes food intake and fluid intake charts for those residents with poor appetite or who are feeling unwell. There is an annual quality assurance and monitoring system that includes survey questionnaires for residents, relatives, staff and others. Information received is collated and analysed. An annual audit report will then be produced. There is a monthly proprietors report in compliance with regulations. The Annual Quality Assurance Assessment (AQAA) forms issued by the Commission were received on time for this inspection and the information received were satisfactory. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 It is recommended that all written care plans are updated to include specific healthcare conditions to ensure that care staff are given accurate information in order to meet the care needs of residents. It is recommended that the management ensure that all repeat medication and PRN (when required) prescriptions are reviewed regularly by the relevant general practitioners. It is recommended that the staffing level is well maintained so that residents socail care needs of daily activities and one-to-one stimulation are being met. It is recommended that the test for legionella bacteria continues regularly until the result is negative. It is recommended that the management review the duty rota in advance to ensure the staffing level and skill mix are well maintained on training days so that residents social and recreational care needs are being met consistently. 2 9 3 12 4 5 26 27 Care Homes for Older People Page 24 of 26 6 31 It is recommended that the provider continues to support the management so as to raise the standard of service in the home. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!