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Inspection on 19/04/05 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 19th April 2005.

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

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

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 continues to maintain a pleasant environment for residents and works with the CSCI towards meeting the Standards. The staffing levels are sufficient to meet care needs of residents and care is taken to ensure continuity of staff. The home offers a variety of activities which residents are able to choose whether they wish to participate in.

What has improved since the last inspection?

The home has dealt with the issue of death and dying with residents sensitively and has recorded their wishes. Residents are protected through the improvements have been made on the recruitment and selection of staff and the ensurance that all necessary checks have been carried out prior to the new employee commencing.

What the care home could do better:

Assessments of residents and care plans require significant improvement to ensure that residents` needs of identified and met. Reviews and evaluations should be undertaken regularly to evidence changes in condition of residents. The majority of the home is well run and provides a safe environment for residents. However, on one unit there was evidence that residents were not respected and their dignity maintained at all times. Care had not been taken to ensure that food was appropriately stored and handled, to prevent contamination. Residents were denied an unhurried meal if they needed assistance to eat and drink. Staff were not checking that residents nutritional intake was adequate to reduce the risk of weight loss.

CARE HOMES FOR OLDER PEOPLE Ronald Gibson Home 236 Burntwood Lane Tooting London SW17 0AN Lead Inspector Janet Pitt Unannounced 19 April 2005 10:00 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. Ronald Gibson Home Version 1.10 Page 3 SERVICE INFORMATION Name of service Ronald Gibson House Address 236 Burntwood Lane, Tooting, London SW17 0AN 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) 020 8877 9998 020 8877 3860 The Brendoncare Foundation Heather Butler-Gallie Care Home with Nursing (N) 56 Category(ies) of Old age, not falling within any other category registration, with number (OP) of places Dementia , over 65 years of age (DE(E)) Dementia (DE) Ronald Gibson Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1 Management of the home 2 Care staff and dementia unit 3 Ancillary staff for all units 4 Respite care Date of last inspection 23rd Novemebr 2004 Brief Description of the Service: Ronald Gibson House is situated near Springfield Hospital in Tooting. The home is within ten minutes walking distance of the main Trinity Road and is on local bus routes. The home offers accomodation and nursing care for up to fifty-six residents in single rooms, with ensuite faciltiies. The home has a designated unit for persons with dementia. Accomodation is over two floors and each floor has communal areas. The main dining area is situated near the kitchen. The home has garden areas for residents and there is a programme of activities and outings for residents to participate in if they choose. Ronald Gibson Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out unannounced by one inspector. The inspection commenced at 10:00hrs and concluded at 15:30hrs. The inspection involved examining care documentation, training records and a tour of the premises. During the course of the inspection there was discussion with the manager and four members of staff. The inspector spoke briefly with two residents. What the service does well: What has improved since the last inspection? What they could do better: Assessments of residents and care plans require significant improvement to ensure that residents’ needs of identified and met. Reviews and evaluations should be undertaken regularly to evidence changes in condition of residents. The majority of the home is well run and provides a safe environment for residents. However, on one unit there was evidence that residents were not respected and their dignity maintained at all times. Care had not been taken to ensure that food was appropriately stored and handled, to prevent contamination. Residents were denied an unhurried meal if they needed assistance to eat and drink. Staff were not checking that residents nutritional intake was adequate to reduce the risk of weight loss. Ronald Gibson Home Version 1.10 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ronald Gibson Home Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Ronald Gibson Home Version 1.10 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 standard(s) 3 Inconsistent completion of the homes assessment of residents could place residents at risk of not having care needs identified. EVIDENCE: Seven residents files were examined, selected at random from each unit. The structure of the files detailed a combined assessment and long term care plan being developed on admission. Four of the residents’ files did not have an assessment of the care needs, which means that the residents are at risk of care needs not being identified. One residents file lacked admission details, therefore information relating to next of kin, medical history and social history were not available to staff. Staff were requested to find the information, but it was not available on the day of inspection. The two assessments, which were available for inspection, contained information of bed times and getting up times, dietary likes and dislikes and an assessment of care needs. The admission details also contained information on next of kin, social contacts and previous occupation. This indicated that staff are able to collate relevant information on residents to identify care needs. Ronald Gibson Home Version 1.10 Page 9 One assessment had not been signed by the member of staff completing the document and did not evidence involvement by the service user or their representative. Ronald Gibson Home Version 1.10 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 standard(s) 7,8,9,10 and 11 Inconsistent review and evaluation of residents care plans does not adequately provide staff with the information they need to satisfactorily meet residents’ needs. Improvements have been made in recording residents’ wishes and ensuring access to health professionals. EVIDENCE: Seven residents care plans were inspected. Assessments of residents care needs in relation to pressure area care, manual handling and body weights were undertaken on admission, providing a baseline assessment on which the care plan could be formulated. However, Waterlow pressure risk assessments and manual handling assessments were not consistently reviewed and evaluated monthly, which could place residents at risk. Residents have a separate file detailing their medical details and visits by other health professionals. This information was able to be cross-referenced between the two sets of files, which evidenced that specific health needs of residents were being addressed. On six of the residents care documentation the residents wishes for death and dying had been recorded, the manager explained that the wishes of the other resident were not recorded, as the family did not wish to discuss it, at this time. Ronald Gibson Home Version 1.10 Page 11 Daily records did not adequately detail the care given and contained vague statements such as: ‘total care rendered’ and ‘diet taken fairly well’ The manager stated that the medicine policy is currently being updated as required at the previous inspection. Ronald Gibson Home Version 1.10 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 standard(s) 12,13,14 and 15 The home is able to demonstrate choice and protection of residents’ dignity, but this needs to be evident throughout the home, to ensure that residents are treated in a respectful manner. EVIDENCE: Residents were observed to be able to get up when they wished and were not hurried by staff. Meals are served in a congenial setting and residents are able to choose what they eat. A member of staff was seen with residents assisting them to choose the next day’s meals. On one unit porridge was found on top of a microwave, ready to be re-heated, when the resident was ready for breakfast. This was discussed with a carer and the carer was made aware of the risks of harming residents by not handling food appropriately. The porridge was disposed of and instructions were given to ensure that fresh porridge was prepared, when the resident was ready for breakfast. On this same unit at lunchtime two residents were observed with the meals being left on their tables and were waiting for assistance. Staff were informed that is not acceptable to leave meals to become cold, as residents should be able to enjoy a hot meal. Assistance was provided for the two residents, but time was not taken by staff to ensure that residents had had sufficient food, thus placing them at risk of not receiving adequate nutrition. Ronald Gibson Home Version 1.10 Page 13 The inspector assisted one resident whose pudding had been left on their table out of reach. One residents was seen lying on the floor for ten minutes with food debris around them, whilst staff were aware of this, there was no urgency to protect the privacy and dignity of this service user. The meal in the main dining area and other parts of the home contrasted sharply with this particular unit, as meals were served in an unhurried manner and assistance was available when required. Residents were with visitors, reading papers and a group of residents were watching a film, one commented that they were ‘enjoying the film’. There was also displayed around the home a programme of activities which residents are able to participate in and provide a variety. Ronald Gibson Home Version 1.10 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 standard(s) 16 and 18 The home has a satisfactory complaint and a Protection of Vulnerable Adults procedure, which evidences residents concerns are heard and residents are protected from harm. EVIDENCE: The home has a detailed complaints procedure and examination of the complaint record indicated that it was followed. Three complaints have been received since the previous inspection and there were outcomes and actions present. There have been two incidents of Protection of Vulnerable Adults procedures being put into place since the previous inspection. The procedure was seen to be followed appropriately, which indicates that these issues are responded to in an appropriate manner. Ronald Gibson Home Version 1.10 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 standard(s) 19,20,21,22,23,24 and 26. The standard of the environment within this home is good providing residents with an attractive and homely place to live. However, staff must ensure that equipment is kept clean to prevent infection risks. EVIDENCE: On the day of inspection painting was being done on one of the stairways and hall, the home is continuing to ensure that the environment for residents is safe and well maintained. The home was clean and tidy on the day of inspection, providing a homely atmosphere for residents. Residents had brought in personal items for their rooms. There was adequate equipment available for residents needs, such as wheelchairs and hoists. However, food debris was observed on one wheelchair and staff must ensure that cleaning of equipment is through to prevent infection risks. Residents have ensuite facilities in their rooms comprising of a toilet and hand basin and are within easy reach of bathrooms, ensuring that personal care needs can be met. Ronald Gibson Home Version 1.10 Page 16 Ronald Gibson Home Version 1.10 Page 17 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) 27,29 and 30 The home has a satisfactory training programme and staffing levels within the home. This indicates that there are sufficient staff to meet residents needs. EVIDENCE: Since the previous inspection the home has recruited one new member of staff, this file was examined and it was noted that references had been taken and appropriate checks made, thus protecting residents. Concerns had been raised by a relative prior to the inspection on movement of staff around the units in the home. This was discussed with the manager who explained that the team leaders, trained nurses and senior carers are not moved from one unit to another and it is only two carers who are rotated to other units, leaving one carer who remains. This occurs every six months, providing continuity of care for residents and opportunities for staff to develop their skills. There have been no changes to the staffing levels since the previous inspections when it was observed that there are adequate staff to meet residents needs. The home is progressing to ensure that all care staff has a minimum of an NVQ level 2 qualification. Training files indicated that twenty-five members of care staff had NVQ level 2 or above and five were currently undertaking the award. Demonstrating the home’s commitment to ensure that staff are trained and competent. Ronald Gibson Home Version 1.10 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 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) EVIDENCE: None of these Standards were assessed, but will be during the inspection year. Ronald Gibson Home Version 1.10 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 1 15 1 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 x 2 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x x Ronald Gibson Home Version 1.10 Page 20 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. Standard 3 Regulation 14 Requirement The registered person must ensure that assessments of residents are accurate and maintained. The assessments must contain all information on the residents, inclusive of social and medical history. Assessments must evidence residents or representative involvment and be signed by the member of staff completing it. The registered person must ensure that residents care plans reflect the care needs and are routinely reviewed and evaluated monthly, with any changes noted. Daily records must detail the actual care given. (the previous timescale of 28/2/05 has been extended). The registered person must ensure that Waterlow pressure risk assessments and manual handling assessments are reviewed and evaluated monthly. The registered person must ensure that residents privacy and dignity is protected at all times. The registered person must ensure that residents receive Version 1.10 Timescale for action 30th June 2005 2. 7 15 30th June 2005 3. 8 13 (4) (c) 30th June 2005 4. 14 12 (4) (a) 30th June 2005 30th June 2005 Page 21 5. 15 16 (2) (i) Ronald Gibson Home 6. 25 13 (4) (c) adequate nutrition and are given assistance and time to eat their meals if required. The registered person must ensure that equipment used by residents is clean at all times. 30th June 2005 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 Good Practice Recommendations Ronald Gibson Home Version 1.10 Page 22 Commission for Social Care Inspection Ground Floor - CSCI 41-47 Hartfield Road Wimbledon 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 Home Version 1.10 Page 23 - 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. 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