Inspection on 07/04/08 for Guysfield Residential Home

This inspection was carried out on 7th April 2008.

CSCI 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 06/04/09

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Guysfield Residential Home Willian Road Willian Letchworth Hertfordshire SG6 2AB Lead Inspector Yoke-Lan Jackson Unannounced Inspection 7th April 2008 11:00 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.V362031.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.V362031.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@caringhomes.org Guysfield House Ltd Mrs Stephenie Mary Cole Care Home 51 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (51) of places Guysfield Residential Home DS0000019399.V362031.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th April 2007 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 village amenities and about two miles from Letchworth town centre. The accommodation comprises forty-eight 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. 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 £407.89 to £690 per week. Information about the 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. Guysfield Residential Home DS0000019399.V362031.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use the service experience adequate quality outcomes. The unannounced inspection was carried out on 07/04/08. The registered manager was present. The home has 47 residents. The inspection included a tour of the premises. Time was spent observing how the staff interacted with the residents. Staff and residents were interviewed and documents were examined. Survey questionnaires were sent to residents and their relatives and their response and other information received by us were reviewed. The Annual Quality Assurance Assessment (AQAA) forms were not sent in time for this inspection. We will re-issue the AQAA for the next key inspection. What the service does well: What has improved since the last inspection? The home manager was successful in her application for registration with us (The Commission for Social Care Inspection) in August 2007. All Statutory Requirements and Recommendations have been met, as have those from the Hertfordshire Fire and Rescue Service. Since the last inspection, the home has experienced a high turnover of staff. Guysfield Residential Home DS0000019399.V362031.R01.S.doc Version 5.2 Page 6 What they could do better: 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.V362031.R01.S.doc Version 5.2 Page 7 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.V362031.R01.S.doc Version 5.2 Page 8 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): Standard 3. Standard 6 is not applicable. Quality in this outcome area is good. This judgement has been made using available 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 home will only admit a prospective client if the pre-admission assessment concluded that all their care needs can be met. The care plans examined included the pre-admission assessment documents for each resident. Guysfield Residential Home DS0000019399.V362031.R01.S.doc Version 5.2 Page 9 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): Standards 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available 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 are identified in care plans so that staff can identify the needs to be met. People are protected by the home’s medication policy and procedures. EVIDENCE: All the residents appeared comfortable and well cared for. The members of staff were observed to be caring and readily available to assist the residents. The revised care plans are person-centred, informative and they are kept up to date. All aspects of the health, personal and social care needs of each resident were clearly documented. Risk assessments were undertaken where appropriate. Residents have access to their own doctor and to specialist medical, nursing and other therapeutic services when required. Guysfield Residential Home DS0000019399.V362031.R01.S.doc Version 5.2 Page 10 On the day of the inspection, a family doctor visited one of the residents who said their arm was quite sore following treatment in hospital for a fracture. A district nurse visited another resident who had pressure sores and confirmed that the pressure area was completely healed. The manager said that no one else in the home has developed pressure sores and that the number of fall incidents has decreased. The management has complied with the statutory requirements and recommendations made during a pharmacy inspection arranged by the Commission at the last key inspection. The team manager confirmed that there have been no medication errors since the last inspection. A trained member of staff administers medication. All controlled drugs are stored in a controlled drug cupboard in a storage room. Proper records are 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 charts examined were correctly filled in. Guysfield Residential Home DS0000019399.V362031.R01.S.doc Version 5.2 Page 11 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): Standards 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that their choice and preferences will be respected; people will be encouraged to engage in communal activities and to maintain contact with their family and friends. A healthy diet is promoted to meet people’s individual needs and preferences. EVIDENCE: On the day of the site visit, the majority of the residents, some with dementia, were in the conservatory. They seemed happy and content. Some had visitors with them who told us that visitors are welcome at any reasonable time and may be entertained in any of the communal areas or in residents’ bedrooms, according to individual preference. The activity co-ordinator was busy preparing for the afternoon activity. The residents had just participated in the morning session of music and exercise. The activity programme was on display on the notice board. There is an activity record for each resident. Current activities include bingo, puzzles, films, nail care, hairdressing, old time music hall, piano/organ recitals, visits to the library and local walks. There is a regular communion service for those who wish to take part. Guysfield Residential Home DS0000019399.V362031.R01.S.doc Version 5.2 Page 12 The majority of the residents have their lunch in the main dining room. The dishes are appetising and there is a choice of hot dishes and salad. Residents seem to enjoy their meals and the general comments have been positive. Guysfield Residential Home DS0000019399.V362031.R01.S.doc Version 5.2 Page 13 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): Standards 16, 17 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that their legal rights will be protected and that they will be listened to, but any complaint made may not be dealt with promptly and effectively by the provider. EVIDENCE: Since the last inspection, the home has received a written complaint dated 17/07/2007. The complainant contacted us to express their concerns that they have not received a response to the complaint that the provider’s regional manager was investigating. The relative was assured that their complaint would be responded to within a maximum of 28 days in accordance with the Complaints’ Policy and Procedures. We received a copy of the response letter to the complainant on 05/03/2008 following repeated requests. Since the last inspection there has been a safeguarding incident but the investigation was inconclusive. The member of staff had since left the service. Training in the protection of vulnerable adults has been provided for all the staff. The members of staff interviewed were aware of their responsibilities for whistle-blowing. The home follows the joint agency Safeguarding Adults Procedure of Hertfordshire County Council Adult Care Services. Guysfield Residential Home DS0000019399.V362031.R01.S.doc Version 5.2 Page 14 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): Standards 19, 20, 22, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service have access to all communal facilities and 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. The manager confirmed that there is a rolling maintenance programme. As the bedrooms are vacated, redecoration is being carried out. Two empty bedrooms have since been redecorated. The lounge furniture is to be replaced with new modern chairs and settee by May 2008. The management hopes to reorganise the communal areas to ensure a more homely and comfortable environment. Guysfield Residential Home DS0000019399.V362031.R01.S.doc Version 5.2 Page 15 A positive result for legionella bacteria was found during the annual test for legionella bacteria in the water system in February 2007. On 26/04/2007 a joint inspection was carried out with the Health and Safety Officer from Environmental Health, Hertfordshire County Council. Since then the management has been in direct contact with Environmental Health. 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 on 31/05/07. In spite of the treatment carried out, the test for legionella bacteria in the water remained positive on 04/04/2008. The problem remains unresolved. The home continues to engage the services of a specialist firm to help resolve this problem. The workmen were on site on the day of this inspection. Further disinfection treatment to the water system was carried out. The management continues to put in place measures to minimise the risk to residents, staff and visitors. The home has complied with all the recommendations made by the Hertfordshire Fire and Rescue Service. The Fire officer made several visits since the joint inspection dated 24/04/2007. Guysfield Residential Home DS0000019399.V362031.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. People who use the service can be assured that the home’s recruitment policy and practices safeguard their welfare. However, the residents would benefit if the staffing level were increased so that the positive care provided would be consistently maintained to a high level. EVIDENCE: On the day of the inspection, there were five care workers to 47 residents. One of the care workers was a new member of staff. Two members of staff reported sick the same morning. However, the team leader and the manager were assisting until the afternoon staff arrived. All the members of staff were working very hard to ensure that the residents’ care needs were being met. The manager said that usually there are seven care workers on duty and said that agency staff will be deployed if necessary. The home suffers from a high turnover of staff and residents expressed concern about the lack of continuity of staffing. One resident felt that the members of staff (who had left) would have stayed if the pay scales were more attractive. Both the home manager and the deputy manager confirmed that some good care workers have left recently because they could get an extra pound per hour in other care homes. However, it was stated that the provider is currently reviewing the pay structure. Guysfield Residential Home DS0000019399.V362031.R01.S.doc Version 5.2 Page 17 The home has robust policy and procedures for recruitment. Proper checks are made, including Criminal Record Bureau (CRB) checks and the protection of Vulnerable Adult (POVA) checks, before new recruits commence work. The records on two new staff were examined and they were found to be satisfactory, including their CRB records. The management continue to arrange appropriate training for members of staff. All new staff have induction training and all staff are to have training on the administration of medication. Guysfield Residential Home DS0000019399.V362031.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 31, 32, 33, 35, 37and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standards of administration and management of the service continue to improve. However, there are some areas, which need addressing to ensure people are not at risk and that the home is run in the best interests of the people who use the service. EVIDENCE: As previously stated a complaint investigation carried out by the regional manager was not completed within the maximum period of 28 days, which is set by the company’s own policies and procedures. The home manager has not notified us of a number of hospital admissions, as required under The Care Homes Regulations 2001, Regulation 37. Guysfield Residential Home DS0000019399.V362031.R01.S.doc Version 5.2 Page 19 The manager said that it was due to a lack of awareness and she has remedied the situation since the error was highlighted. We need to be aware of incidents that affect the well being of the residents so that we can monitor that the appropriate action has been taken to ensure people are safe. A specialist firm is being employed to help resolve the presence of legionella bacteria in the water system. The manager said that she has informed Environmental Health, Hertfordshire County Council, who is overseeing the current situation. The management has now complied with the recommendations of Hertfordshire Fire and Rescue Service. 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. 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 and an annual report is produced. Guysfield Residential Home DS0000019399.V362031.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 2 3 X 3 X x 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 x 3 x 3 2 Guysfield Residential Home DS0000019399.V362031.R01.S.doc Version 5.2 Page 21 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 OP32 OP38 Regulation 37 Requirement To ensure we are able to effectively monitor the performance of the service and the safety of the people living there all notifiable incidents must be reported to the Commission without delay in accordance with Regulation 37, Care Home Regulations 2001. Timescale for action 07/04/08 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 OP16 OP19 OP25 Good Practice Recommendations It is recommended that the provider comply with their own Complaints’ Policy and Procedures. It is recommended that the manager continues to monitor the water system for legionella bacteria and put in place measures to prevent the risk to residents, staff and visitors. It is recommended that the manager ensures that the ratio of care workers to residents is maintained at all times to ensure peoples needs are appropriately met. DS0000019399.V362031.R01.S.doc Version 5.2 Page 22 3. OP27 Guysfield Residential Home Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact 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. 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