Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 17/01/06 for Brendoncare Ronald Gibson House

Also see our care home review for Brendoncare Ronald Gibson House for more information

This inspection was carried out on 17th January 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides clean and comfortable accommodation to residents. Feedback from residents and their visitors regarding the care provided was generally very positive. Comments included "the care is very good", "the staff are very kind and caring", "my mother is doing great here" and "I like it here". Care staff were seen to attend to residents in a considerate and caring manner during this inspection visit. The home has its own therapies team who provide an impressive range of activities both in and out of the home.

What has improved since the last inspection?

The needs of residents are assessed before moving into the home. Care plans for residents are being reviewed and updated. This process was still ongoing at the time of inspection. Records to document the food and fluid intake of individual residents were seen to be well maintained.

What the care home could do better:

There are opportunities to further improve the quality of care provided to residents. The report highlights areas such as developing person centred care and looking at how care plans could better reflect the individual resident. The majority of residents have very high care needs and it is important that the organisation reviews the numbers of staff on duty to make sure that all individual needs can be properly addressed. This will allow care staff additional time with residents other than when providing direct physical care.

CARE HOMES FOR OLDER PEOPLE Ronald Gibson House 236 Burntwood Lane Tooting London SW17 0AN Lead Inspector Jon Fry Unannounced Inspection 17th January 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ronald Gibson House DS0000019116.V279401.R01.S.doc Version 5.1 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. Ronald Gibson House DS0000019116.V279401.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ronald Gibson House Address 236 Burntwood Lane Tooting London SW17 0AN 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) 020 8877 9998 020 8877 3860 ronaldgibson@brendancare.org.uk www.brendoncare.org.uk The Brendoncare Foundation Heather Butler - Gallie Care Home 56 Category(ies) of Dementia (4), Dementia - over 65 years of age registration, with number (16), Old age, not falling within any other of places category (56) Ronald Gibson House DS0000019116.V279401.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Management of the home There will be a total of 56 management hours per week available within the Home. The Manager of the Home will remain supernumerary and work full-time. The balance of the 56 hours will be provided by designated staff. Care Staff and Dementia Unit Care staff must be provided in sufficient numbers, and with the necessary qualifications and experience, to meet the assessed needs and dependency levels of all low, medium, high, and continuing care band service users accommodated in the Home at any one time. As a minimum care staff shall be provided as follows: 8am to 2pm : 2 Registered Nurses 8 Care Assistants 2pm to 8pm : 2 Registered Nurses 7 Care Assistants 8pm to 8am : 2 Registered Nurses 3 Care Assistants The specified registered nurse numbers are additional to the supernumerary management hours set out above. The low, medium and high bands refer to assessments for Registered Nursing Care Contributions (RNCCs). The continuing care band applies to service users whose needs are predominantly for health care, and who are therefore wholly funded by the NHS Ancillary staff for all units There will be adequate and sufficient staff and/ or contract arrangements in place at all times to ensure a good quality catering, domestic, cleaning, laundry, maintenance, and administrative service for all users. Respite Care Respire Care agreed for one specified female service user who is under 55 years of age. 19th April 2005 2. 3. 4. Date of last inspection Brief Description of the Service: Ronald Gibson House provides nursing care and accommodation for 56 residents, 20 of whom may have dementia. The service is organised on two floors with one unit providing dementia care being located on the ground floor. The home is operated by the Brendoncare Foundation and is situated near Springfield Hospital in Tooting. Ronald Gibson House DS0000019116.V279401.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by a regulation inspector on the 17 and 18 January 2006. The inspection took place over nine hours. The inspector spoke with five residents, four visitors, the manager and five members of staff. A number of records were examined, as well as a tour of the communal areas of the home. What the service does well: What has improved since the last inspection? What they could do better: There are opportunities to further improve the quality of care provided to residents. The report highlights areas such as developing person centred care and looking at how care plans could better reflect the individual resident. The majority of residents have very high care needs and it is important that the organisation reviews the numbers of staff on duty to make sure that all individual needs can be properly addressed. This will allow care staff additional time with residents other than when providing direct physical care. Ronald Gibson House DS0000019116.V279401.R01.S.doc Version 5.1 Page 6 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. Ronald Gibson House DS0000019116.V279401.R01.S.doc Version 5.1 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 Ronald Gibson House DS0000019116.V279401.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4. Resident’s benefit from their needs being appropriately assessed before admission. The majority of residents have high dependency needs. The quality of service to residents would be improved by an increase in staffing levels. EVIDENCE: There is an appropriate procedure to make sure that the individual needs of a resident are assessed before they move into the home. These assessments were in place for three residents whose care plans were examined. Comments from residents were generally positive regarding the care provided and included “wonderful”, “I like it here” and “the care is very good”. Four regular visitors to the home were spoken to during the inspection and feedback included “I’m very pleased with the care” and “very good overall”. The majority of residents living at the home require a very high level of support. Care staff were seen to help residents in a considerate way but were Ronald Gibson House DS0000019116.V279401.R01.S.doc Version 5.1 Page 9 clearly pressed with regard to the time available. Ronald Gibson House DS0000019116.V279401.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 and 10. Care plans are currently being updated and are subject to a monthly review process. The care plans should be developed to be more person centred and to better reflect care needs and their individual life, experiences and preferences. Satisfactory medication systems are in place for the protection of residents. EVIDENCE: Further work needs to be carried out to develop the care plans for residents. This is to make sure they cover the full social, emotional and physical needs of the individual. The current practice of having a working care plan in each resident’s room is good, however these documents must be expanded to give clear information on how individualised care will be provided. The current care plans were seen to concentrate on physical needs with more limited information about emotional and social needs. The therapies team at the home keep their own care planning information and the home should look at ways to integrate all available information to allow all staff to contribute to the social and emotional care of residents. Ronald Gibson House DS0000019116.V279401.R01.S.doc Version 5.1 Page 11 Daily records looked at did not satisfactorily detail the care given and contained statements that were too general such as “care implemented” and “personal hygiene and safety maintained”. Further discussion should take place within the staff team to make sure that staff are recording useful information. The role of the key worker at the home should also be reviewed to make sure they are contributing as much as possible to the care planning process. Medication administration records were satisfactorily maintained in one unit. The staff member in charge was able to access information about individual medications and spoke of recently contacting the GP regarding a query about medication being taken by one resident. Ronald Gibson House DS0000019116.V279401.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15. Residents have opportunities to engage in appropriate activities. There is scope to develop a more person centred care approach and allow more time for care staff to address the social and emotional needs of residents. The dietary needs of residents are well catered for. EVIDENCE: The home has its own therapies team that includes a physiotherapist, an aroma therapist, a qualified masseur and an activities co-ordinator. An impressive array of in-house activities and day trips are provided. Excursions include boat trips and days out to Windsor and the seaside. A pianist was seen entertaining residents in the first floor unit at the time of this inspection. The home also has its own Day Centre for up to 10 individuals. Comments from residents and their visitors were however mixed. These included “there could be more stimulation”, “could do a bit more with activities” and “would like to do a bit more”. One visitor said that the party held at Christmas for residents was “brilliant”. Religious services are held at the home and notices were displayed giving times for these. The manager reported that arrangements were made for each resident as required on admission. Ronald Gibson House DS0000019116.V279401.R01.S.doc Version 5.1 Page 13 The home provides a service for a large number of residents with high care needs and this does mean many residents are in their rooms for the majority of time. There are opportunities for the home to develop its practice to be more person centred and to better address social and emotional needs. Care plans need to include all the information held by the therapies team to allow all staff to contribute to the social and emotional care of residents. Care staff need to be provided with time to interact with residents other than when providing direct physical care. Two members of staff spoke of not being able to do this due to the volume of work required. Residents and their visitors generally gave positive comments on the food provided. One resident said that they “always enjoyed” the food and others said “a good standard”, “we have a choice” and “fair”. Two regular visitors to residents reported that their relatives weight had improved since being at the home. One visitor said that the menu “could be improved” but the residents preferences were respected. Three care plans seen all contained individual food preferences. Individual records of food and fluids as taken by residents are kept in each room. It is recommended that these be reviewed to make sure that information is not repeated and is easily recorded by care staff. A lunch of sausage and onion was being served on the day of inspection with grilled fish or omelette as an alternative choice. Residents in a ground floor unit were supported with eating in an appropriate and unhurried fashion. Meals in this unit are staggered because of the high numbers of residents requiring help with their meals. The plastic beakers and cutlery being used in the ground floor unit for persons with dementia were seen to need replacing in some instances. It is recommended that the home look at different ways of serving meals to benefit individuals with dementia. Ronald Gibson House DS0000019116.V279401.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. An appropriate complaints procedure is in place at the home. EVIDENCE: Systems are in place for recording any complaints made. Two complaints have been received by the CSCI since the previous inspection took place in April 2005. These issues were being looked into at the time of inspection. The homes policy and procedure on complaints provides information to residents on how they can make a complaint. A new format for documenting complaints has recently been introduced at the home. These include all actions taken and outcomes to each complaint. None of the residents spoken to had any concerns at the time of this inspection visit. Two visitors to the home said that they felt able to talk to the manager about any issues concerning resident care and were confident that these would be dealt with properly. Ronald Gibson House DS0000019116.V279401.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26. The standard of accommodation is good providing residents with a comfortable place to live. The home is kept clean and hygienic. EVIDENCE: Residents are provided with comfortable accommodation that is maintained to a good standard. No maintenance issues were seen during this inspection and all areas of the home were kept clean and tidy. The home benefits from having its own Day Centre within the building for up to ten individuals. There is also a therapies room located on the first floor. Bedrooms are personalised to individual preferences and each has en-suite facilities. One visitor reported that their relative’s room was always “kept clean”. The manager reported that problems with poor television reception to some rooms were being addressed at the time of this inspection. Ronald Gibson House DS0000019116.V279401.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 30. The organisation must carry out a review to make sure that there are enough staff on duty at all times to provide high quality person centred care to the residents accommodated. An organisational training programme is in place and care staff attend a wide range of training courses. A number of residents accommodated would benefit from staff attending further dementia training courses. EVIDENCE: Comments from residents and their visitors included “the staff are very nice”, “very kind and caring” and “brilliant”. One relative said that their relative was always “presentable” and “dressed well” by the care staff. As stated previously, the staff were seen to care for residents in a considerate and kind manner. There are opportunities for the home to develop the service but this would clearly require higher staffing levels. A Requirement has been made for the organisation to review the numbers of staff on duty to allow additional time with residents and further develop a person centred approach. Two visitors said that they thought staffing levels could be improved. One resident in their bedroom said that they sometimes “don’t see staff” for long periods. Ronald Gibson House DS0000019116.V279401.R01.S.doc Version 5.1 Page 17 The organisational training programme includes NVQ training and a wide range of courses such as food hygiene, care planning, abuse awareness and dementia. Computerised training records are kept that are well organised and kept up to date. In order to make sure staff can fully meet the needs of residents all staff working with people with dementia must be provided with appropriate training. The manager reported that this training was being planned at the time of this inspection. Eight members of care staff are studying for the NVQ Level two or three award and the manager reported that the organisation aims to have all staff qualified to Level two. A good induction pack is given to new staff members that is mapped to current national standards. It is recommended that the home start to review this document to reflect the newer ‘common induction standards’ that must be used from September 2006. Ronald Gibson House DS0000019116.V279401.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 38. An organised and experienced management team is in place at the home There are systems in place for consultation with residents and their representatives. A system for individual staff supervision needs to be introduced to further support the delivery of quality care to residents. Health and Safety practices require improvement to fully ensure residents health and welfare. EVIDENCE: The manager is a registered nurse and has been in charge at the home since 2001. Two visitors to the home reported that they felt able to talk to the manager about any issues concerning resident care and were confident that Ronald Gibson House DS0000019116.V279401.R01.S.doc Version 5.1 Page 19 these would be dealt with properly. One member of staff said that they felt that the management team was “accessible” and another individual stated that the staff team “work very well together”. The home aims to hold a relatives meeting every three months with the last one having been held in September 2005. Issues raised were seen to have been actioned by the home. Communication booklets were being put with the care plan in each resident’s room at the time of this inspection. This is to encourage family and friends of residents to be involved with the care planning and to further enable any issues to be raised with the home. The 2006 / 2007 plan includes developing more person centred care within the service. Care staff currently have clinical supervision that helps them to develop their own practice. This provision must be reviewed to include individual one to one sessions with their line manager at least six times each year. This is to further support the delivery of quality care by the staff member to the residents. Regular checks are carried out to the building, furnishings and equipment to ensure the Health and Safety of residents and visitors to the home. The home must make sure that records are kept for monthly checks of hot water temperatures and First Aid boxes. Two instances were seen where the kitchen was left open in a ground floor unit. Staff must remember to lock this room when not in use to prevent access to scalding hot water. Ronald Gibson House DS0000019116.V279401.R01.S.doc Version 5.1 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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 2 X 2 Ronald Gibson House DS0000019116.V279401.R01.S.doc Version 5.1 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 OP7 Regulation 15 (1) 12 (1) Requirement The Registered Persons must continue to review the care plans for each resident to ensure that they fully address all aspects of health, social and personal care needs. Care plans must describe individual support needs and the specific actions required to meet these. Daily records of care must fully detail the care as given to residents. The Registered Persons must 01/03/06 ensure that suitable and sufficient crockery, cutlery and utensils are provided for use by residents and that these are kept in good condition. The Registered Persons must review the staffing levels currently provided at the home. This is to ensure that care staff are provided to work at the home in such numbers as are appropriate for the health and Ronald Gibson House DS0000019116.V279401.R01.S.doc Version 5.1 Page 22 Timescale for action 01/04/06 2. OP15 16(2)(g) 23(2)(c) 3. OP27 18 (1) (a) 01/03/06 welfare of residents. Staffing levels must be based on the dependency levels of residents. 4. OP30 18 (1) (c) The Registered Persons must ensure that all care staff are provided with dementia training. The Registered Persons must ensure that all care staff receive 1-1 supervision with their line manager at least six times annually with full records kept. The Registered Persons must ensure that: monthly checks are made of hot water temperatures at all bath and shower outlets with full records kept. monthly checks are undertaken of the contents of First Aid boxes with full records kept. access to scalding hot water by residents in kitchens is prevented where assessed as necessary. 01/07/06 5. OP36 18 (2) 01/07/06 6. OP38 13 (4) 01/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is recommended that the care plans include all available information about individual residents. Care plan documentation should be developed to be person centred and to reflect the individual as much as possible. The home should look at ways of further involving key DS0000019116.V279401.R01.S.doc Version 5.1 Page 23 2. OP7 Ronald Gibson House 3. 4. 5. OP15 OP15 OP30 workers in the care planning process. It is recommended that the records kept for individual food and fluid intake be reviewed. This is to ensure they are not repetitive and can be easily used by care staff. The home should look at ways of presenting and serving meals for residents with dementia. It is recommended that the home start to review the induction materials for care staff to reflect the new national ‘common induction standards’. Ronald Gibson House DS0000019116.V279401.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ronald Gibson House DS0000019116.V279401.R01.S.doc Version 5.1 Page 25 - 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!