Inspection on 24/07/08 for South Garth

This inspection was carried out on 24th July 2008.

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

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

Other inspections for this house

South Garth 25/07/07

South Garth 16/08/06

South Garth 07/11/05

South Garth 03/05/05

South Garth 14/01/05

South Garth 11/08/04

South Garth 03/03/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 27/11/2008.

CARE HOMES FOR OLDER PEOPLE South Garth 1 Elwyn Road Exmouth Devon EX8 2EL Lead Inspector Rachel Doyle Unannounced Inspection 24th July 2008 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 South Garth DS0000022033.V365965.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. South Garth DS0000022033.V365965.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service South Garth Address 1 Elwyn Road Exmouth Devon EX8 2EL 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) 01395 265422 01395 227474 Mrs Christa Elizabeth Greaves Woodland Health Care Limited Vacant Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25), Physical disability over 65 years of age of places (25) South Garth DS0000022033.V365965.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25/07/07 Brief Description of the Service: South Garth provides personal care for up to 25 older people who may also have physical disabilities. The property is a detached converted house with a modern extension in a suburb of Exmouth. Accommodation is arranged over two floors and there is a passenger lift to the upper floor. There are two lounge areas plus a large conservatory that is used as a dining room. There is a small car parking area, but in practice people tend to park on the road. There are pleasant level gardens that are sunny and sheltered. The most recent inspection report is available upon request and a copy is also in the information pack, which is in the hallway of the home for anyone to read. Fees are currently £314-£410 weekly. Services not included in this fee are hairdressing, chiropody, papers and magazines, incontinence pads and transport to hospital. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk . South Garth DS0000022033.V365965.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection took place over 16 hours over two days towards the end of July 2008 and the beginning of August 2008. Two inspectors conducted the inspection on the second day. During the inspection 3 people were case tracked. This involves looking at peoples’ individual plans of care, and speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. As part of the inspection process CSCI likes to ask as many people as possible for their opinion on how the home is run. We sent questionnaires out to a sample of people living at the home and staff. At the time of writing the report, responses had been received from 10 people living at the home and 8 staff. The responses from people living at the Home were generally positive with noone making any handwritten comments. During the inspection 8 people living at the home were spoken with individually and 5 in a group setting, as well as observing staff and people living at the home throughout the day. We also spoke with 3 staff and the Deputy Manager. A full tour of the building was made and a sample of records was looked at, including medications, care plans, the fire log book and staff files. What the service does well: Southgarth provides individuals with a clean, comfortable and homely place to live where they are cared for by a friendly staff team. The staff and management at the Home are hard-working and committed. They are keen to ensure the wellbeing and comfort of people living at the home and were observed treating them with great respect and kindness. There was obvious warmth and affection between all those living and working at the home. People living there were generally happy but most people would like staff to be able to spend more time with them rather than ‘rush about’. There is a good admission process, which enables staff to be certain that they can meet peoples’ needs before they are admitted to the Home. Meals are well presented and provide variety for individuals with an alternative if they do not like what is on the menu. South Garth DS0000022033.V365965.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There were some areas in the Home which posed a high risk to people living there such as a faulty call bell system, dangerous window, hot water and two bathrooms that were not fit for purpose. Immediate requirements were issued during the inspection. A response has been received from the Provider and the areas relating to Health and Safety are being addressed promptly. It is noted that some of these issues have been a problem for some time and that they have been identified as needing attention by the Provider. The Provider commented that the bathrooms had been ear-marked for refurbishment and that an uncovered radiator in a bathroom had been fitted many years ago, however they still pose a risk to people at the Home and needed to be dealt with as soon as possible. The Providers must ensure that the home is run in the best interests of the individuals living there. This includes ensuring that they are offered choices in areas of their daily lives and that they are provided with opportunities for meaningful social interaction and trips and time outside and/or away from the Home as appropriate. Staffing levels should ensure that staff are able to fulfil the above as well as their basic care needs and that numbers account for management duties. People living there were generally happy but most people would like staff to be able to spend more time with them rather than ‘rush about’. This appears to be a temporary issue. Care plans must be developed and shared with staff and people living at the Home to ensure that people have their needs met consistently and fully and that any identified risks are minimised. Medication is generally well managed but small improvements should be made to ensure consistency and staff welfare. South Garth DS0000022033.V365965.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. South Garth DS0000022033.V365965.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 South Garth DS0000022033.V365965.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good systems are in place to ensure prospective residents’ needs are fully assessed, promoting the success of any admission to the home, although one issue needs clarifying. The home does not provide intermediate care. EVIDENCE: We looked at the procedures followed by the home from the time they received an enquiry from someone who was thinking about moving in to the point when the person had moved in and decided to stay permanently. We found that the home has a simple ‘pre-admission’ assessment form that directs the person who is completing the assessment to gather some essential information and to find out a little bit about how much help the person wants. We ‘case tracked’ one person who moved into the home earlier this year and heard how they had visited the home before agreeing to move in. We found South Garth DS0000022033.V365965.R01.S.doc Version 5.2 Page 10 the home had gathered a range of information about the person to help the home decide if they could meet the person’s needs. This was good. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to improve pre-admission gathering and involve other workers in the assessment process and develop other formats for those who are partially sighted or with hearing problems. South Garth DS0000022033.V365965.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are adequate systems in place for informing staff about peoples’ care needs, although lack of detail in some care plans may lead to inconsistencies in care and a risk that some people may not receive all the care they need. Regular reassessment and multidisciplinary working ensures that people living at the Home receive good health care. Management of medication is adequate, but one aspect must be addressed to avoid risk to staff welfare. There is generally good respect for peoples’ privacy, with promotion of their dignity and rights. EVIDENCE: We looked in detail at the care given to three people who live in the home. We looked at their care plan files to find out it the staff have been given South Garth DS0000022033.V365965.R01.S.doc Version 5.2 Page 12 sufficient information about how each person wants to be assisted. We talked to these three people to find out if the care plans were correct, and if they were satisfied with the help they receive. The care plans have been drawn up using a ‘tick box’ style form. These forms cover a wide area of needs and are helpful in guiding the person drawing up the care plan on the questions they must ask and the areas they must consider. There is a space on each form to show when the plans have been reviewed and we could see that this had been carried out regularly. However, there is very little space for the staff to write any additional information. The plans did not provide detailed instructions where the care needs were complex. We talked to some of the staff to find out how the care plans are used. We found that forms used in the care plans are helpful checklists for senior staff when reviewing overall care needs, but the forms are not generally used by care staff on a day–to-day basis as they do not give a clear explanation of exactly how each individual wants to be assisted. We found that staff who have worked at the home for some time had a good understanding of the needs of each person and they do not look at the care plans regularly, although they use the care plan files to complete daily care notes. We heard that there are usually good handovers at each change of shift, and staff are told verbally about any change of care needs. However, there have been a number of staff changes recently (see Staffing section). The home will be using agency staff in the coming weeks to cover shifts and it will be very important that new or agency staff can turn to the care plan files to find out exactly how each person wants to be helped. We found that the current care plan format does not give sufficient detail about some aspects of care, for example, how to reassure someone who may suffer from anxiety; specific information about individual skin care needs; or how to care for a person who may have a condition that could be infectious. New or inexperienced staff will rely on experienced staff giving them verbal instructions in these areas. We talked to the Deputy Manager about how the care plans can be improved to make them a working tool that care staff follow on a daily basis and find useful. During our visit she talked to the staff team about how they can all work together to make sure the care plans contain sufficient information that ensures they are all working in a consistent manner. The care plan files contained risk assessment forms on continence, falls, hot water, manual handling, nutrition, and pressure. Some of these forms included a section on outcomes, and where these had been completed they gave brief but clear guidance to staff on how they can help to minimise any risks identified. In other cases there was no outcome, (for example, there was no information to staff on the actions they should take to reduce the risk of pressure sores in those cases where the person had been assessed as being at high risk). South Garth DS0000022033.V365965.R01.S.doc Version 5.2 Page 13 We talked to three people about the care they receive from the staff team. People told us they were generally happy with the care they receive. However, we heard that the more experienced staff had a good understanding of how each person wanted to be helped but at times new or less experienced staff struggled when faced with difficult situations. For example, staff had not been given sufficient information on how to help a person with poor mobility, and as a result the person became distressed when staff could not help them in the right way. We found that the risk assessment had not guided the staff to consider the equipment needed to help the person move safely, and the care plan did not give sufficient information about how the specific way staff should guide and assist the person when helping them to move. The care plan files contained a letter signed by the person to say if they wanted to be checked every 2 hours at night. This showed that the home had consulted with people over some aspects of their care needs. However, the people we talked to were not familiar with the care plan forms and had not been given a copy of the plans, and had not been asked to sign the care plan to agree that it was correct. One person told us that if the staff do not help them in the right way they tell the staff immediately. Another person said they would talk to an experienced or senior member of staff if the care they received was incorrect or unsatisfactory. The care plan files contained a form called ‘multi-disciplinary care notes’ in which all visits from health or social care professionals are recorded. We saw notes explaining the outcome from recent visits by General Pratitioners and District Nurses that showed that the home had requested visits/advice/treatment when needed and had recorded any instructions on changes in care to be given by the home. However, in one case the multidisciplinary notes showed a GP had visited and changed the creams used to treat a skin condition. This information had not been transferred to the appropriate section in the care plan. Accident reports have been completed for falls and these are kept in each person’s individual care plan file. The care plans, menus and medication records showed that where people have specific health problems such as diabetes the home has followed good systems to ensure the condition is controlled and checked regularly. Residents spoke positively about staff, who were described as ‘very good’, ‘cheerful’ and ‘lovely’. Discussion took place with residents about how they were supported with washing and bathing and people said they felt they were treated with respect and their dignity respected. The upstairs bathroom, however does not promote dignity and privacy because its layout does not make it easy for people to fit zimmer frames in and one person was propping South Garth DS0000022033.V365965.R01.S.doc Version 5.2 Page 14 open the door to give them more room.(see Environment). The Home have dealt with this promptly. We looked at the way the home handled the medications for the three people whose care we had ‘case tracked’. The home uses a monitored dosage system provided by a local pharmacist. We saw that the medicines received into the home had been counted in and there was a system in place to account for all medicines administered and stored in the home. Medicines are kept in a locked cabinet supplied by the pharmacy and a fridge in the office. Records completed each time medicines had been administered were completed correctly. Where treatments had been stopped or new treatments started these had been recorded clearly. Where people have been prescribed medicines to be used as and when needed these have been recorded in the medicine administration records as ‘PRN’. However, there were no instructions in the care plans to tell staff exactly when the person would need this medication, how it should be administered, and what to do if the condition does not improve. We talked to the Deputy manager about this and she agreed to ensure the care plans are updated with this information. All staff have had training in medication administration, however, see Management section. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to promote and encourage more physical activity and have better community integration and improve all paperwork and documentation through staff supervision and training. South Garth DS0000022033.V365965.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are some opportunities for fulfilment, to enrich peoples’ lives but people rarely get to go outside the Home. Good links are maintained with peoples’ families and friends helping to ensure people living at the Home benefit from supportive and interesting relationships. At present here is not consistently good promotion of peoples’ choice, offering them control in their lives possibly due to current staffing arrangements in the unforeseen circumstances of the sudden lack of a manager. The diet offered is good and nutritious, with variety that meets individuals’ preferences and is well presented. EVIDENCE: We talked to people about the activities they enjoy taking part in. We heard that recently people have enjoyed playing Bingo – people told us they found this is good fun, with small prizes provided by the home. The daily records we looked at also showed that people have enjoyed ‘sing-along’ and exercise South Garth DS0000022033.V365965.R01.S.doc Version 5.2 Page 16 sessions. During the inspection five people were joining in with a quiz with one of the staff. The Home have raised staff awareness of the need to provide opportunities for social stimulation and now have individual records for activities and there have been improvements in meeting these needs. Some records show that staff had chatted with them, showed photos and brought in their dog or baby or played Hula hoop. However, appropriate activities/stimulation are not provided on a regular basis and some people commented that time dragged with little to do, apart from thinking about their memories or snoozing. The perception of some of the residents of the entertainment offered is that there is ‘not a lot’ to do and ‘it’s boring’. Most people living at the Home had refused most of the activities, three people had refused all of them but no alternatives had been discussed or one to one time with staff offered. Staff said that no-one at the Home goes outside the Home unless with family. The Deputy did not know how to arrange outings but the Provider commented that the Home have attempted outings in the past but on the day people living at the Home had decided not to go out. This will be tried again. Staff added that about three people had used the garden this year, one person goes out every day. All but three people need assistance to access the garden due to the building layout. Staff said that they would do more if staff had time. Once a new manager is in place this should improve. Some staff have come in on their days off to go out with some people living at the Home. However, there was good interaction between everyone living and working at the home. Staff were still very concerned that they were unable to spend more time with individuals, saying that the only time they really had to talk with individuals was when they were assisting them with bathing or toileting. People living at the Home said that recently staff had become even more rushed and that they did not even have time to chat whilst helping them get up but had to rush off. (see Staffing). It is noted that due to unforeseen circumstances resulting in a change in management and the holiday time, that this should be a temporary period. The Provider commented that staff have also been spoken to about how they use their time. Individuals said that they received regular visitors and that the home always made them feel very welcome. This was seen. Staff were prompt in answering the front door and the telephone. There is a pay phone in the quiet lounge and a notice board. Peoples’ rooms evidence that they are able to bring in personal possessions when they move to the home and during conversations with people living at the Home they gave examples of making choices over their lives, which were South Garth DS0000022033.V365965.R01.S.doc Version 5.2 Page 17 confirmed by care records. For example, where they ate their meals, unless it was too hot or whether they chose to attend the activities arranged, although alternative means of meeting this need were not addressed. Staff said that recently other choices for people such as when to get up and be assisted to go to bed have been more difficult to meet due to staffing levels but again this could be due to the unforeseen circumstances. Lunch is a social time and most people like to come down to the dining room. We spent time with people taking their lunch. It was well presented with condiments, nutritious and offered a good variety of fresh produce. The kitchen was well managed. A new cook is about to start and is being trained by the existing cook. Comments by the people about the quality of the food during this inspection were positive, such as ‘excellent’ and ‘good’. One person confirmed that their specialist dietary needs were met. There are bowls of fresh fruit around the Home. Staff were very attentive to peoples’ needs during lunch. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to structure activity groups as per assessment and resource and target one to one and individual activity. South Garth DS0000022033.V365965.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a good attitude to complaints, with people living at the Home enabled to voice their views, concerns or complaints. Although there are apparently safeguarding policies and practices, these are not readily available or clearly understood by staff to fully protect people living at the Home from abuse. EVIDENCE: We talked to three people who live in the home about who they would talk to if they were unhappy about anything. They all said they felt able to speak out if there is a problem. They said they felt confident they could either speak to a member of staff, or to the Deputy manager, depending on what the problem or concern was about. All thought that the staff at the Home were lovely. There is a clear complaints policy displayed on every door and any complaints are recorded in a log book showing actions and outcomes, which is good. Although all staff have had training in the Safeguarding Vulnerable Adults they were not sure about how to report an alert or what the procedure was. The Alerters’ Guide could not be found or a clear policy on safeguarding vulnerable adults from abuse. South Garth DS0000022033.V365965.R01.S.doc Version 5.2 Page 19 The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that the home in order for the service to improve intends to access training and share information and make the No Secrets training material available. South Garth DS0000022033.V365965.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although people enjoy a spacious and homely environment not all areas are safe or fit for purpose, putting people at risk of harm. Systems are in place to promote good standards of hygiene, protecting peoples’ wellbeing in this respect. EVIDENCE: We did a tour of the Home. There is a lovely homely feel and people were able to potter about as they wished although it is not possible to access outdoors without staff help. The Home was very clean and tidy throughout and there were no offensive odours. The carpets are about to be deep cleaned. There is a maintenance person who works 16 hours a week. The gardens are beautiful with seating and flower beds although are not used by people at the Home very often. South Garth DS0000022033.V365965.R01.S.doc Version 5.2 Page 21 There is a welcoming entrance hall leading into a cosy television lounge. A quiet lounge area adjoins the large conservatory overlooking the large front lawn, which is used as a dining room. This is a lovely space but does get very hot in the summer. Sometimes people have no choice but to eat in their rooms as the temperature is excessive. It was 86 degrees in the conservatory on the day of the inspection. There were fans and some windows open. Windows open from the bottom only and staff said that sometimes people complain about the draft. One window had a sign saying ‘Do not open, Dangerous’. This was able to be easily opened and must be made safe. An immediate requirement was issued and the Provider addressed this promptly. The downstairs bathroom, although clean and tidy, is not fit for purpose as the bath water only runs tepid so staff are filling it up with boiling water from a kettle for peoples’ baths. This puts people at risk and an immediate requirement was made and addressed. The Provider confirmed that this had been identified as a problem and a plumber contacted. People living at the Home said that they would rather have a strip wash than use that bathroom. This is not acceptable. The upstairs bathroom is also not fit for purpose. There is a risk of scalding from the towel rail, which staff and people living at the Home say they use as a grab rail. Staff cover it with a towel but this still remains a risk. Zimmer frames and wheelchairs do not fit adequately into the space and staff have to climb over the toilet to help assist people. We asked the maintenance person to move a paper dispenser during the inspection as people were at risk of banging their heads using the bath hoist. People spoken to said that they would rather not use the bathroom as they were scared and didn’t have the energy for the moves. Staff confirmed this. Staff had informed the Provider who confirmed that this had been identified. An immediate requirement was issued with a timescale, which was met by the Home. Nearly all the staff survey responses mentioned the problems with bathing facilities. The Home have had some automatic fire door closers fitted to avoid people wedging open fire doors. This is good but some people are still wedging doors such as a bedroom. The occupant said that as the room got so hot they liked to have air flow. This should be risk assessed and addressed individually. Staff said that they had reported a call bell system fault, which the Provider confirmed. Staff cannot hear the call bell upstairs if they are assisting someone in their room. An immediate requirement was made to ensure peoples’ safety. It is noted that the bell has been like this for some time but it still poses a risk. Hand washing facilities are available in the laundry area. Liquid soap, gloves and paper towels were seen in peoples’ rooms to help prevent cross infection. South Garth DS0000022033.V365965.R01.S.doc Version 5.2 Page 22 The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to make maintenance improvements before issues arise, fit a new bathroom, new lounge furnishings, purchase an emergency telephone, new tables and homely touches and upgrade bedrooms. South Garth DS0000022033.V365965.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. At present staff numbers and the skill mix do not ensure that peoples’ needs can be met safely but this is due to unforeseen circumstances and should be temporary. Residents are protected by the Homes’ recruitment policies and practices. Training and support for new staff is good and helps them to provide the care people need. EVIDENCE: Unfortunately the previous manager left suddenly just before the inspection, which has obviously affected some standards. The Home employs the Deputy Manager, senior carer (although this role is unclear), nine carers (one on maternity leave), maintenance person, domestic and a cook. There are three staff in the mornings including the Deputy Manager. Staff said that they would like four in the mornings but at present they have two most of the time as the Deputy has to run in and out of the office. Staff felt that people at the Home had increasing needs. There were 20 people living at the Home at the time of the inspection, with one in hospital. Three people can access the garden independently and one person needs two staff to mobilise. South Garth DS0000022033.V365965.R01.S.doc Version 5.2 Page 24 Throughout the inspection there were many positive comments about the staff team. ‘They’re nice girls and they’re doing their best and they do it happily’, ‘they’re lovely girls’. Staff were seen to have a lovely rapport with people at the Home and there was a cheerful atmosphere. Eight people living at the Home were spoken to in depth and all were generally happy at the Home, other than sometimes bored or would like to spend more time with staff. They all made comments saying that they wished staff had more time to spend with them especially recently as they are rushed. ‘Staff don’t stay and chat like they used to’ and ‘It’s a bit lonely here’. Staff also commented in the survey responses that although they felt that the service ‘cared well for the clients’ they needed more time to spend with them. People said that although they would like to get up earlier they did not mind if the girls were late. This does not promote choice. Staff said that everyone was usually up by 10.35 for coffee but most people preferred to be up earlier. Staff felt that they ran late all the time. With the Deputy Manager having to do management duties, the mornings are rushed with coffee time and lunchtime and staff trying to fit in a quick break. Therefore there are never any activities or time with people at the Home in the mornings. This should improve when a new manager is employed. We looked at three staff training files. There is a tick box new starter induction form, which is generally filled in during one day but this is for orientation purposes. The Deputy did not know what the induction procedure was or about Skills for Care as this had not been her role prior to the manager leaving but the Provider confirmed that there is a full induction for new starters. One staff survey response commented that the induction did not cover ‘at all’ everything they needed to know when starting the job but this could not be followed up as there was no name. The Home has the General Social Care Council Handbook and these will be given to all staff. Other mandatory training was seen to be carried out, which is good. Three staff recruitment files were looked at. These generally contained all the required information. One file was nearly complete but one reference was verbal but not followed up in writing and did not say who it was from and in what capacity. The reference said ‘would you re-engage her? answer No’. This was not followed up. Another person’s reference said ‘maybe’ under this question, with no follow up. Comments in staff files have not been investigated or taken into account when looking at staff roles/responsibilities and competencies or training, such as the senior carer role. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to review the training plan and appraisal system. South Garth DS0000022033.V365965.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is inadequate attention to Health and Safety matters in a timely manner, to protect people living at the Home and staff, putting them at risk from harm. The Provider is currently supporting the Home during a period of instablity. This is due to an unforeseen circumstance affecting management of the Home, which could have impact on people living at the Home for a temporary period. Systems and practices used by the Home protect peoples’ financial affairs. EVIDENCE: Unfortunately the Registered Manager of the Home left in June 2007 and due to personal reasons did not work any notice time. The Deputy Manager is now South Garth DS0000022033.V365965.R01.S.doc Version 5.2 Page 26 managing the Home in the absence of a manager. She has worked at the Home for 17 years, mainly as a night carer and was promoted to Deputy Manager in November 2007. Therefore she knows the people living at the Home very well. She is currently working towards her National Vocational Qualification Level 3. (This is currently on hold whilst she is Acting Manager). The Deputy Manager is extremely committed to trying to run the Home in the best interests of the people living there and the staff team but does not have the management experience, skills or support to ensure that people are safe and that their needs are consistently met long term. They were unaware of the Care Standards Act and the National Minimum Standards. The previous inspection report was displayed in the hall but has not been shared with staff. The Home have advertised for a new manager. The Deputy Manager is working over and above her contracted hours during this time and staff are working additional hours to ensure that peoples’ basic needs are met. Staff felt that they could not keep this up. At the time of the inspection senior staff were refusing to administer medication during the day so the Deputy was coming to the Home every morning to do this and the night medication sometimes. There have been incidents with other staff administering medication and problems with ordering. There has been little time to spend time with residents. Three staff have left recently and recruiting has taken up time. Some management duties have been difficult as she has not been involved in this before. Recently the Deputy was called in as staff could not assist someone living at the Home without further advice. She does not know how to access the Residents’ Fund but finances are generally well managed and peoples’ monies are not at risk. She had never done the staff duty rota before. Someone needing respite care was coming in and the Deputy was unsure how to manage this so had to quickly learn. Accident forms are being filled in correctly. Currently they admitted that this time is proving stressful, as they do not feel confident to manage the Home. Some of the Health and Safety issues were known by the Provider and included in the refurbishment plan and quotes have been sent but these needed addressing more immediately. Following immediate requirements this was done. A Manager from another Home has come to Southgarth to support the Deputy Manageron and to conduct new manager interviews with the Deputy and there have been visits from the Operations Director. Staff records showed that no other staff member is experienced to be left in charge of the Home and there has been stress within the staff team. The Deputy Manager has no allocated management office time and is included in the staff numbers ‘working on the floor’. The Provider said that this was because management provided at least 30 hours support per week with one day telephone cover. During the inspection the domestic on duty, who also does care work, had to stand in. South Garth DS0000022033.V365965.R01.S.doc Version 5.2 Page 27 This has obviously been a difficult time for the Home who have had to quickly change how it is managed whilst waiting for a new manager to be recruited. Although stressful and meaning that the staff are busier during this time it appears that the Provider has offered adequate support and that these problems are temporary. There is a formal Quality Assurance system in place, which is good. Forms should specify when carers have helped people. However, questionnaires have been collected and are able to be anonymous, which encourages true responses. These are waiting to be collated and the Deputy has been asked to send out some to Health Professionals and Relatives. This means that the home can check, maintain or improve the quality of care provided by the home. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to provide more managerial support and one to one. South Garth DS0000022033.V365965.R01.S.doc Version 5.2 Page 28 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 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 x 1 1 x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 1 South Garth DS0000022033.V365965.R01.S.doc Version 5.2 Page 29 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 OP18 Regulation 13 (6) Requirement You must make arrangements to ensure that staff know how to protect people from being harmed or suffering abuse and know where to find this information. You must ensure that the window bearing the sign ‘do not open, dangerous’ is made safe in the conservatory. This was issued as an immediate requirement during the inspection. You must ensure that the ground floor bathroom does not run with tepid water and is not topped up with boiling water from kettles. This was issued as an immediate requirement during the inspection. You must ensure that the upstairs bathroom is fit for purpose and does not put people at risk. This was issued as an immediate requirement during the previous inspection. You must ensure that the call bell system upstairs is fit for DS0000022033.V365965.R01.S.doc Timescale for action 24/11/08 2. OP19 13 (4) (a) 08/08/08 3. OP21 23 (2) (j) 15/08/08 4. OP21 23 (2) (j) 13 (4) (a) 31/08/08 5. OP22 23 (l) (n) 08/08/08 South Garth Version 5.2 Page 30 6. OP27 18 (1)(a) 7. OP31 8 (1) (a) 8. OP38 13 (4) (c) purpose and can be heard by carers when in another room. This was issued as an immediate requirement during the inspection. You must ensure that staffing levels are sufficient to meet peoples’ needs. This was issued as an immediate requirement during the inspection. You must ensure that you appoint a suitable person to manage the Home and make suitable arrangements until this time to ensure that people are safe. Fire doors must not be wedged open. This was issued as an immediate requirement during the previous inspection and has been partly addressed. 08/08/08 24/08/08 24/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations You should ensure that people (and/or their advocates where appropriate) are consulted over their care plan and the home should provide evidence to show that the person has agreed the content of the care plan. Care plans should be developed to provide clear and detailed information about all individual care needs, especially where care needs are complex. All care staff should follow the care plans on a daily basis. Care staff should be involved and consulted over the information in the care plans to ensure all staff are following the plans in a consistent manner. Care plans should give staff sufficient information about the care needs of people where risks have been identified to DS0000022033.V365965.R01.S.doc Version 5.2 Page 31 2. OP7 South Garth 3. 4. 5. OP8 OP9 OP9 6. 7. OP12 OP14 8. 9. OP19 OP31 minimize these risks(for example skin care including how to prevent the risk of pressure wounds; how to care for someone suffering from an infectious illness). You should ensure that any issues identified on care plans are followed up and actioned accordingly You should ensure that care plans must explain how and when staff should administer PRN (at any time) medicines. You should ensure that arrangements for adminstering and ordering medication are clear and that an adequate number of staff are able to perform this task to reduce strain on staff welfare. You should ensure that everyone at the Home has the opportunity to go outside and that efforts are made to offer trips outside the Home. You should ensure that people living at the home are offered as much choice as possible in all areas of their lives and that they are not restricted by staff availability. You should monitor the temperature of the conservatory and act on the findings to ensure that it is a usable space for people living at the Home. You should ensure that you appoint a suitable person to manage the Home and make suitable arrangements and review them until this time to ensure that staff are coping and able to meet peoples’ needs. South Garth DS0000022033.V365965.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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