Inspection on 29/08/06 for Brendoncare Ronald Gibson House

This inspection was carried out on 29th August 2006.

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.

Other inspections for this house

Brendoncare Ronald Gibson House 19/06/08

Brendoncare Ronald Gibson House 24/05/07

Brendoncare Ronald Gibson House 17/01/06

Brendoncare Ronald Gibson House 19/04/05

Brendoncare Ronald Gibson House 23/11/04

Brendoncare Ronald Gibson House 15/06/04

Similar services:

Ashlong House

Norbury Crescent (30)

Henry Nihill House

Birchwood

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

The Infirmary

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Ronald Gibson House 236 Burntwood Lane Tooting London SW17 0AN Lead Inspector Janet Pitt Unannounced Inspection 29th August 2006 10:00 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 Ronald Gibson House DS0000019116.V309826.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. Ronald Gibson House DS0000019116.V309826.R01.S.doc Version 5.2 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 Care Home 56 Category(ies) of Dementia (4), Dementia - over 65 years of age registration, with number (16), Learning disability (2), Old age, not falling of places within any other category (56) Ronald Gibson House DS0000019116.V309826.R01.S.doc Version 5.2 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. One male service user aged 48-55 requiring general nursing care 0ne Service user aged 53-65, with Dementia, can be accommodated within the home Two Service users aged 53-65, with Learning disabilities, can be accommodated within the home 2. 3. 4. 5. 6. 7. Ronald Gibson House DS0000019116.V309826.R01.S.doc Version 5.2 Page 5 Date of last inspection 17th January 2006 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. There is sufficient parking on site for visitors and the home has access to local bus routes. The range of fees at the time of inspection range from £752.50-£845.00 per week, depending on care needs. Ronald Gibson House DS0000019116.V309826.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook this unannounced inspection. A total of two site visits were made which lasted a total of eight hours. Records relating to staffing and resident care were examined. Surveys were sent to fifteen service users and five care professionals. Response was poor and insufficient information was available to be used in this report. Discussion with staff, residents, visitors and the manager also took place. An inspecting pharmacist examined the medications and his findings are detailed in this report, but are subject to different timescales, which have been reflected in the requirements section of this report. A tour of the premises was undertaken. What the service does well: What has improved since the last inspection? What they could do better: Staff at the home must make sure that care is resident focused and there is clear evidence that residents or their representatives have been involved in the process. Assessments of residents must involve the resident or their representative, to make sure that all needs are identified. Care must be taken to make sure that care plans detail resident preferences and daily records must detail that this care has been carried out. Residents’ privacy and dignity must be promoted and protected at all times. Staff must make sure that residents are able to have choice in their daily life and are able to maintain significant relationships. An immediate requirement was made regarding availability of fluids. This was actioned by the home and a drinks dispenser has been ordered for the Ronald Gibson House DS0000019116.V309826.R01.S.doc Version 5.2 Page 7 lounges. In the meantime, staff have been instructed to make sure that fluids are readily available. Improvement is needed in making sure that mealtimes are a pleasant and sociable experience. Residents must be enabled to maintain independent living skills and have a choice in what they drink. Alternative menus should be available for persons with dementia, to enable them to eat independently, such as ‘finger foods’. Staff should check with residents that the food choice is to their liking before serving a meal. Staff need to make sure that they interact positively with residents and involve themselves in one to one activities. Significant requirements were made in relation to medication handling within the home. Information regarding this can be found in the Health and Personal Care section. 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.V309826.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ronald Gibson House DS0000019116.V309826.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. The admission of new residents is process driven and not particularly personalised. Residents must be involved in the process and all needs identified. EVIDENCE: Residents are assessed prior to and on admission. Residents need to be involved in the process, to make sure that their needs are identified. New documentation was in the process of being introduced, but the home must make sure that this is used as an opportunity to update and reassess residents, rather than transferring information. One resident had not been involved in the assessment process, although they had been fully involved in their care whilst in hospital. The evidence indicated that there had a been a reliance on information from other health professionals collated prior to admission, and this information had not been verified with the resident. Ronald Gibson House DS0000019116.V309826.R01.S.doc Version 5.2 Page 10 Residents must be confident that assessments will identify their care needs and detail appropriate information to make sure they are met. Specific assessments for care needs, such as continence, did not detail frequencies, e.g. ‘requires regular toileting’, but there was no indication of timings. Manual handling assessment did not specify the type of hoist to be used. Assessments of residents were not always available in files or had not been completed fully. Ronald Gibson House DS0000019116.V309826.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. Each resident has a care plan, but the practice of involving residents in the development and review of the plan is variable. Care given is not consistently documented and does not fully detail care given. Residents are able to take care of their own medication and the home has access to a pharmacist for advice. Errors in administration, poor record keeping, inadequate storage and lack of certain procedures could put the health and welfare of residents at risk EVIDENCE: Residents care plans did not lead from the assessments. It was difficult to find relevant information. One resident had a complicated wound, but there was insufficient evidence to demonstrate how it was being managed. Preferences for baths or showers were detailed, but not always carried out. The resident who had a complicated wound had not had a shower or bath since they had been admitted and only one hair wash was documented. The dressing change record indicated the frequency had been changed, due to the resident requiring outpatient treatment in hospital three times a week. There was no clear rationale for this, as the care for this particular resident was Ronald Gibson House DS0000019116.V309826.R01.S.doc Version 5.2 Page 12 planned around staff rather than the resident. For example the dressing frequency had been reduced, as staff perceived that the dressing had to be done in the mornings, no account was taken of the fact that the home provides twenty-four hour care, and the resident had previously been able to have regular baths whilst in hospital. One entry in the daily records stated ‘daily dressings would be difficult considering [the resident’s] outpatient programme. The home must not admit residents that they are unable to provide continuous care for. Care plans on this resident included statement such as: Provide [the resident] with requirements for oral hygiene and assist as necessary.’ with no indication of what was required and how to assist. And ‘[the resident] is able to choose outfit for the day allow him to.’ This does not indicate personal preference. The resident had not been involved in the care planning process, even though they were aware of their condition and had been fully involved whilst in hospital. Dietary needs were not consistently recorded and nutritional risk assessments were incomplete, this could put residents at risk, particularly if they have a know dietary requirement e.g. low sodium. The change to new documentation has not been handled in an efficient way. Instead of a small number being updated at a time, all care plans were being subject to review. Staff must make sure that changes are implemented in a planned way, to make sure that all relevant information is recorded. Daily records did not consistently detail what care had been given, entries such as: ‘Pressure areas treated’, ‘refused all medications’ and ‘out to the dining room for lunch’ are some examples of the staffs attitude toward the residents. One resident who had been recently admitted did not have any care plans, risk assessments or nutritional information. The resident had needed an X-ray on their arm in July 2006, but there was no evidence of any result being obtained. Residents’ wishes for end of life care had not been consistently documented. The privacy and dignity of residents is not always promoted and protected by staff. One resident was being called ‘mummy’, but there was no indication in the care plan that this was at their request. Another resident was distressed at lunchtime, as they had a ‘bib’ on and wanted to take it off. The carer did not deal with the situation effectively. The resident was lashing out at the staff member, but no attempt was made to find out what was wrong and the carer continued trying to get the resident to eat. An inspector intervened and spoke with the carer. This member of staff said that the ‘bib’ was being used to protect the resident’s clothing, but it was noted that the resident’s top had a stain on it. Use of ‘bibs’ do not enhance the resident’s dignity, there must be a Ronald Gibson House DS0000019116.V309826.R01.S.doc Version 5.2 Page 13 choice of napkins available. There was no alternative available for the resident to eat, such as ‘finger foods’ which would have enable the resident to retain independent living skills. The inspecting pharmacist visited the home to examined medications within the home, below is his report. Requirements were made which will be followed up in a separate visit by the inspecting pharmacist and reflected in the next inspection report. The requirements with timescales have been included in the relevant section of this report. A sample of current records relating to receipt, storage, administration and disposal of current medication and the storage facilities were examined on two floors. Three staff member were interviewed. A sample of the current medication in stock was compared to the current records and counted and compared to the amount that should be in stock. Residents are encouraged to take control of their own medication following an assessment. The home has a contract with the supplying pharmacist for advice. Most medication is supplied in a monitored dosage container where all the medication for a particular time of day is placed in the same section. In one instance the details on the back of the container did not agree with the contents. In another instance the details on the container were not sufficient to be able to identify individual medications. It is important that staff are able to identify individual medications for when medication is not to be given for a reason or the resident does not want their medication. One resident had not been given their medication for six days as it had been out of stock. The home had requested the medication in sufficient time. The medication was in stock on the day of the visit. No local procedure was available describing ordering and supply of medication arrangements. One resident was recorded as not being given their medication as it was out of stock when the records and available medication indicated a supply was available. Four residents had not been administered their medication as prescribed. This could have serious effects on the health and welfare of the residents. Nine residents did not have the administration/non-administration recorded appropriately making it difficult to see if medication had been given as directed. The date of receipt and the amount of medication received are not recorded accurately and the quantity of medication carried over from one month to the next is not recorded on the administration record. This made it difficult to monitor the correct use of medication. The policies and procedures regarding the disposal of medication and oxygen use were not up to date with current legislation and practice. The temperature of the rooms where medication is stored was recorded as being above the maximum temperature for medication storage on a daily basis. Ronald Gibson House DS0000019116.V309826.R01.S.doc Version 5.2 Page 14 Two residents prescribed sedative medication when needed did not have a care plan describing how and when medication is to be given. At the time of writing this report an action plan had been received by CSCI from the home; detailing the actions they are taking with regard to medications within the home. Ronald Gibson House DS0000019116.V309826.R01.S.doc Version 5.2 Page 15 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, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. Activities provided in the home are group orientated and more effort needs to be made to provide individual stimulation. Mealtimes need improvement for them to be a sociable occasion and demonstrate resident choice. EVIDENCE: Activities within the home are generally focused on group, rather than individual sessions. There is an aroma therapist, but residents are taken to another room for treatment. There was no evidence at the time of the site visit, of the aroma therapist visiting residents in their rooms, or providing hand massages in lounges. Religious requirements can be catered for and the home has visiting ministers who conduct Christian services. (see also under Health and Personal Care). Activities observed on the site visit were listening to music and watching television. There was little or no interaction between staff and residents whilst these activities were occurring. It was not observed whether residents had a choice of music or television programme to watch. In the first floor lounge the same CD of War Songs was played continuously for two hours without being changed. One resident who was singing along to the variety of tunes, which Ronald Gibson House DS0000019116.V309826.R01.S.doc Version 5.2 Page 16 included Andy Williams, was enjoying music in the dementia unit. One member of staff proceeded to dance in front of a resident when this particular track was playing, which is inappropriate behaviour, as the residents are adult. Also, a member of staff was singing a nursery rhyme to a resident a few minutes later. Residents are able to choose from a varied menu, however improvement must be made in the serving of meals. Lunchtime was observed in the dining room and first floor lounge. The meal for lunch was displayed in a photograph in the main entrance, which allows residents to see what they will be eating. In the dining room staff were generally good at providing assistance if a resident required it. However, two residents who required assistance in the first floor lounge were being helped by one member of staff. This meant that the second resident’s food was cold by the time the staff member had time to help them. The manager said that when he was made aware of this a hot trolley had been ordered to make sure that food was hot when served. Staff were task orientated, rather than resident orientated and improvement must be made in the serving of meals to make it a sociable occasion. One resident was observed waiting until 1pm, before they were able to go to the dining room to have lunch, as there are two sittings. When the resident enquired whether they could got down earlier, they were told to wait for 1pm by a member of staff. Drinks were not readily available and there was limited evidence of choice. One inspector was offered coffee and a resident decided that they would like one too. A carer went to ask the nurse if this was possible, as they thought the resident usually had tea. An inspector intervened and insisted the resident had their coffee, and then sat down with the resident and had a chat with them. One member of staff was seen during the morning tea round standing up to assist a resident. A visitor commented that ‘staff were pulling the stops out because you’re here’ and said that tea was not usually served in the morning. It was apparent that none of the residents in the first floor lounge were offered any other beverage, apart from tea during this time. There was a box of biscuits on the trolley, but none of the residents were offered one. Residents have limited control over their lives within the home, as evidenced above. Also, one resident was a smoker and presented with challenging behaviour was refused a cigarette by a carer, as ‘it was not time.’ Examination of this resident’s care notes had entries such as ‘was very aggressive and abusive early part of the night demanding for cigarettes even {the resident} was just given one.’ The resident stated that they knew they should cut down on their smoking, but did not wish to. The manager later explained that cigarettes were limited for health reasons, but acknowledged that the resident’s wishes were paramount, as the resident was aware of the Ronald Gibson House DS0000019116.V309826.R01.S.doc Version 5.2 Page 17 consequences. Residents must be able to make informed choices and take risk if they are able. There was concern regarding a resident who wished to take their particular friend out with them. Staff said they were ‘not told we could’ allow the residents to do this. They stated that the social worker had been informed of the ‘love affair’ and the families were aware. The resident was not subject to a Court of Protection Order and therefore there were no restrictions on their movements. The manager later explained that one of the resident was prone to ‘wandering’ off and had been known to be at risk in the community. This was why the request had been refused, as there were concerns that this resident might become aggressive. However, the manager had spoken with the residents and their families about the situation and it had been agreed that a member of staff would be made available so that the couple could enjoy outings together. Staff of the home must make sure that residents are able to take appropriate risks as part of their day-to-day living. Visitors are generally made welcome in the home and are offered refreshment. One visitor was seeing their spouse and there was no evidence that they are able to see each other in private if they wished. Staff must make sure that residents are able to maintain significant relationships. Ronald Gibson House DS0000019116.V309826.R01.S.doc Version 5.2 Page 18 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to this service. The home’s complaints procedure is readily available and staff are aware of the process to be followed. Protection of Vulnerable Adults investigations are handled in an appropriate manner. EVIDENCE: Systems are in place for recording any complaints made. CSCI has not received any complaints regarding the service since the previous inspection. The complaints record indicated that actions and outcomes were present. Residents and their representatives are provided with information on how to make a complaint. There has been one protection of Vulnerable Adults investigation since the previous inspection. The home cooperated fully with the process and provided information as requested. The investigation was upheld and the home instigated an action plan for identified issues to be addressed. These included improvement in documentation, which has not been fully actioned. (see under Health and Personal Care Section.) Ronald Gibson House DS0000019116.V309826.R01.S.doc Version 5.2 Page 19 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to this service. Residents’ benefit from a clean and tidy environment. Improvement should be made in providing a homely atmosphere for residents. EVIDENCE: A tour of the premises was undertaken. Residents live in a home, which is clean and free from unpleasant odours. Where there have been issues with odour, the home have replaced carpets in rooms, with more suitable flooring, which can easily be cleaned. This has been done in agreement with the residents and their families. Residents are able to personalise their rooms and bring in small items of furniture, if they meet fire regulations. The home has a pleasant lounge on the first floor in which a large number of residents are able to sit. However, the chairs are arranged in lines and this does not encourage interaction between residents. The staff must make sure that attention is paid to promoting a homely atmosphere. Ronald Gibson House DS0000019116.V309826.R01.S.doc Version 5.2 Page 20 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, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. The service recognises the importance of training and delivers where possible, a programme that meets any statutory requirements. There are still some areas, which need attention. Staff must make sure that their work is not task orientated, but resident focused. EVIDENCE: There is an appropriate number of staff to support residents, but improvements must be made in the deployment of staff. As detailed in Daily Living and Social Activities, deployment of staff at lunchtime, had a detrimental effect on residents. Poor practice when assisting residents to move was observed. Staff did not use moving and handling aids, but physically lifted residents. This could cause considerable harm to residents, as well as staff. The home employs a physiotherapist, but they were not evidence when staff were assisting residents. Training records evidenced that moving and handling training had occurred, but this must be put into practice. Staff have received mandatory training as required, as evidenced by records. However, their knowledge of specific conditions needs to be improved. Staff must also make sure that training they receive is put into practice. Ronald Gibson House DS0000019116.V309826.R01.S.doc Version 5.2 Page 21 The manager was aware of the need for training to reflect the needs of residents. He said that the training programme is to be re-vamped and include specific training on areas such as, Huntington’s disease and Dementia, as well as mandatory training. This will mean that training will be tailored to the residents’ conditions and enable staff to have a better understanding. The manager said that some of the training would probably be experiential, where staff experience aspects of care giving, such as assistance with eating and drinking. Examination of staff recruitment records showed there is a good process in place, which protects residents. Criminal Records Bureau checks and evidence of registration with professional bodies had been done. Each of the three files examined contained the information required in the Regulations and Schedules. Ronald Gibson House DS0000019116.V309826.R01.S.doc Version 5.2 Page 22 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, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to this service. The home has a proactive manager who recognises the importance of a resident focused service. Strategies are being implemented to enable this to occur. EVIDENCE: The new manager has been in post for six months. He has identified areas in which the home needs to improve. A Registered Mental Nurse has been employed to run the dementia unit. The three team leaders are being developed to be responsible for the smooth running of the home along with the manager. One visitor stated that the manager ‘was approachable’ and it was observed that visitors and residents are able to speak with the manager at any time when he is in the home. Ronald Gibson House DS0000019116.V309826.R01.S.doc Version 5.2 Page 23 Resident and relatives meetings have been held and their views are encouraged. Evidence from previous inspections show that residents’ personal allowances are held by Power of Attorneys, the residents relatives, the resident or the home. The home maintains records of all transactions. There were no issues relating to health and safety at the time of the two visits to the home, made as part of the inspection. At the second visit workmen cut a mains electricity cable in a nearby road. The home’s emergency generator commenced working and staff in the home were quickly informed of the situation. The manager and his staff handled the incident calmly and residents’ care was unaffected. Ronald Gibson House DS0000019116.V309826.R01.S.doc Version 5.2 Page 24 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Ronald Gibson House DS0000019116.V309826.R01.S.doc Version 5.2 Page 25 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 OP3 Regulation 14 (1) (c) Requirement The registered person must ensure that residents are involved in the assessment process. The registered person must ensure that assessments of residents are completed fully. The registered person must ensure that assessments identify all needs and include specific details. The registered person must ensure that they are able to provide care in accordance with all assessments and residents preferences. The registered person must ensure that care plans are residents focused. The registered person must ensure that the care plans lead from assessments. The registered person must ensure that residents are involved in the care planning process. The Registered Persons must continue to review the care plans for each resident to ensure that DS0000019116.V309826.R01.S.doc Timescale for action 30/11/06 2 3 OP3 OP3 12 (1) (a) 12 (1) (a) 30/11/06 30/11/06 4 OP7 14 30/11/06 5 6 7 OP7 OP7 OP7 15 (2) 15 (1) 15 (2) (c) 30/11/06 30/11/06 30/11/06 8 OP7 15 (1) & 12 (1) 30/11/06 Ronald Gibson House Version 5.2 Page 26 9 OP8 12 (2) 10 OP9 13 (2) 11 OP9 13 (2) 12 OP9 13 (2) 13 14 OP9 OP9 13 (2) 13 (2) 15 OP9 13 (2) 16 OP9 13 (2) 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. (Previous timescale of 01/04/06 not met.) The registered person must ensure that specific risk assessments are in place and completed fully. Risk assessments must evidence the resident’s right to take appropriate risk. The registered person must ensure that all medication is given as directed by the prescriber unless sufficient reason is recorded. The registered person must ensure that the administration /non-administration of medication is recorded accurately. The registered person must ensure that the receipt of all medication is recorded accurately. The registered person must ensure that sufficient stocks of medication are available. The registered person must ensure that sufficient details are available to identify individual medications in the monitored dosage system The registered person must ensure that care plans are available for all residents prescribed sedative medication used to control behaviour. The registered person must ensure that policies and DS0000019116.V309826.R01.S.doc 30/11/06 14/09/06 14/09/06 14/10/06 14/10/06 14/10/06 14/10/06 01/11/06 Page 27 Ronald Gibson House Version 5.2 17 18 OP9 OP10 13 (2) 12 (4) (a) 19 OP10 16 (2) (m) 12 (2) 20 OP11 21 OP12 16 (2) (m) 22 OP14 12 (3) 23 OP15 16 (2) (i) 24 25 OP15 OP19 16 (2) (i) 23 (2) (h) 26 OP27 12 (3) procedures are up to date with current practice. The registered person must ensure that medication is stored at the correct temperature. The registered person must ensure that the privacy and dignity of residents is protected and promoted. Residents must be addressed appropriately. There must be a choice of napkins available at mealtimes, bibs must not be used. The registered person must ensure that residents are able to maintain and develop significant relationships if they wish. The registered person must ensure that residents’ wishes with respect to end of life care and death and dying are documented and respected. The registered person must ensure that activities promote individuality and staff interact on a one-to one basis with residents. The registered person must ensure that mealtimes are a sociable, flexible occasion and resident choice is evident. The registered person must ensure that food choices are available for persons with dementia. An immediate requirement was made in respect of availability of fluids. The registered person must ensure that furniture within the home is arranged in homely way, which encourages interaction between residents. The registered person must ensure that staff are deployed in a manner, which is not task orientated. DS0000019116.V309826.R01.S.doc 01/11/06 30/11/06 30/11/06 30/11/06 30/11/06 30/11/06 30/11/06 29/08/06 30/11/06 30/11/06 Ronald Gibson House Version 5.2 Page 28 27 OP30 18 (1) (c) 28 OP30 18 (1) (c) The registered person must ensure that training given is put into practice and staff receive training on specific conditions seen within the home. The registered person must ensure that moving and handling training is put into practice at all times. 30/11/06 30/11/06 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 2 Refer to Standard OP9 OP9 Good Practice Recommendations It is recommended that the quantity of medication carried over each month be recorded on the current administration record. It is recommended that the current guidelines from the Royal Pharmaceutical Society and CSCI Professional advice documents are available in the home. Ronald Gibson House DS0000019116.V309826.R01.S.doc Version 5.2 Page 29 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.V309826.R01.S.doc Version 5.2 Page 30 - 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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