Inspection on 11/05/07 for The Garden House

This inspection was carried out on 11th May 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Garden House 17/02/10

The Garden House 21/12/09

The Garden House 02/06/09

The Garden House 14/06/06

The Garden House 27/02/06

The Garden House 09/11/05

The Garden House 20/10/04

The Garden House 08/06/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

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

CARE HOMES FOR OLDER PEOPLE The Garden House 24 Humberston Avenue Cleethorpes North East Lincs DN36 4SP Lead Inspector Ms Matun Wawryk Key Unannounced Inspection 11th May 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Garden House DS0000038376.V339647.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. The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Garden House Address 24 Humberston Avenue Cleethorpes North East Lincs DN36 4SP 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) 01472 813256 01472 812337 worcestergarden@aol.com Worcester Garden (No 2) Ltd Miss Maria Elizabeth Austwick Care Home 44 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (44), of places Physical disability (10) The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th June 2006 Brief Description of the Service: The Garden House is a 44-bedded care home set in an exclusive area of Humberston, near the towns of Grimsby and Cleethorpes. The main house is in the style of an old manor house and retains many of its original features. The previous owner added a sympathetically designed extension in the grounds. There is ample car parking space and a well-designed and colourful garden. The home provides care for those with problems of old age and will take permanent, respite and emergency admissions. Some rooms have en-suite facilities, but there is ample bathroom and toilet facilities positioned around the home. There are several sitting rooms and a large dining room. All areas, including the gardens are accessible for wheelchair users. The owner of the home and the company secretary make frequent visits to the home. Staff working in the home are encouraged and supported to share ideas with the sister home in the Bristol area of the country. The home does not offer nursing care. Service users’ health needs are met with the assistance of other health care professionals for example general practitioners and district nurses. Information about the home and its services can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home. A copy of the latest inspection report for the home is on display in the main entrance hall of the home. Information given by the manager at the visit on the 11 May 2007 indicates the home charges as from 1st June 2007 between £360.50 and £385 per week. The home charges third party top-up fees. The amount payable is dependent upon the level of the fee paid by the responsible local authority (where applicable) and/or whether the resident occupies a shared, single or ensuite bedroom. In addition to this residents are expected to pay for hairdressing, private chiropody treatment, toiletries and newspapers/magazines. More up to date information on fees and charges can be obtained from the manager of the home. The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 5 The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This is the homes first key inspection of 2007/08. The inspection visit took place over 1 day in May 2007, Mrs Matun Wawryk carried out the visit. Prior to visiting the home the inspector sent out survey questionnaires to twenty residents, twenty staff, ten relatives and four professional staff to try and establish whether the residents’ needs were being met. Sixteen residents, six relatives and eleven staff questionnaires were retuned at the time this report was written. Some of the comments received by these people have been included in the report. During the visit the inspector spoke to nine residents, four relatives, the manager, a senior care worker, a care worker, the housekeeper and the activity coordinator to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. The inspector also looked around the home and looked at lots of records, for example; resident care plans and risk assessments, daily records, supervision schedules, menus, and other records relating to the running of the home. Information received by the Commission over the last few months was also considered in forming a judgement about the overall standards of care within the home. What the service does well: There was a very relaxed and homely atmosphere in the home, residents were observed to be very settled and comfortable in their surroundings. All of the residents who returned a questionnaire and those spoken to said they were satisfied with the overall care provided by the home. Residents and staff spoken to commented on the approachability of the manager. All those spoken to said the manager was friendly and efficient. Residents commented that they were offered a good choice of meals and that they enjoyed the quality of food. Specific wishes were catered for and residents said they had plenty to eat and drink throughout the day. Residents said that their family and friends were made to feel welcome by staff when visiting the home and that they can visit when they please. The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 7 Residents said they had good access to professional medical support when needed. Residents also said that they were able to access external services such as chiropodist and opticians as needed. The standards of care support were good; comments received from relatives included “Staff attitude is excellent- nothing is too much trouble and they are always up to date with what is happening with each resident” and “Management and staff really do appear to have the resident’s best interests in the forefront of everything they do”. What has improved since the last inspection? What they could do better: New residents and their relatives are provided with information about fees and charges but further improvement is need. It is important that each resident and or their representative knows what he or she is paying for and any terms of residency. The manager was advised to ensure everyone who is coming to live in the home is given a personalised statement specifically relating to the care, accommodation etc that they will receive for the fee being paid. This should be supplied, at the latest, at the point at which someone takes up residence in the home and should be updated as fees change. Full details about what information needs to be provided can be found in the revised Care Homes Regulations. The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 8 Although staff training is generally satisfactory new staff were not always getting a proper induction. Records also showed not many care workers had had much specialist training in areas appropriate to the needs of residents for example; dementia, diabetes, strokes and continence management. Action needs to be taken to address this. Failure to do this may mean staff do not have all the knowledge and skills they need to meet the needs of residents and this could impact on the care they receive. Although some staff were getting supervision from their supervisors this was not happening as often as it needs to. The registered manager and other staff must be provided with more regular, formal support to ensure they are provided with the appropriate guidance and leadership they need and to receive management feedback on their performance. The inspector would like to thank everyone who completed a questionnaire and/or took the time to talk to her during this inspection. Your comments and input have been a valuable source of information, which has helped inform this report 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. The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 9 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 The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 10 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): 1, 2 and 3 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents and their relatives were provided with sufficient information to help them decide if the home was right for them. The admission process was thorough with staff ensuring that new residents are made to feel welcome and secure. EVIDENCE: Information about the home such as the statement of purpose and service user guide were generally up to date, but further information about fees and charges needs to be included. The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 11 The admission procedure was adequate to guide staff on the actions to be taken to ensure new resident’s needs are properly assessed and planned for. Examination of records for two recent admissions to the home showed the manager had completed a needs assessment prior to the person’s admission in the absence of a professional assessment. The manger confirmed residents had been issued with a contract/statement of terms and conditions but a number examined were out of date. It is important that each resident and or their representative knows what he or she is paying for and any terms of residency. The manager was advised to ensure everyone who is coming to live in the home is given a personalised statement specifically relating to the care, accommodation etc that they will receive for the fee being paid. This should be supplied, at the latest, at the point at which someone takes up residence in the home and should be updated as fees change. Full details about what information needs to be provided can be found in the revised Care Homes Regulations. Residents and relatives spoken to during the visit told the inspector that they had chosen the home for reasons such as: the friendly atmosphere, the location and the kindness and friendliness shown by the staff. Staff in interview confirmed that they understood the admission process and were aware of the importance of ensuring new residents were made to feel welcome. One relative told the inspector that his mother had settled into the home very well, he visits the home regularly and said he always found the staff to be polite and friendly. He also said he was always kept informed of any changes to his mother health. Another relative said she planned to spend a period of respite in the home because she thought it was so good. This person also said she found the staff to be ‘very friendly and helpful’. The following comments were detailed in returned surveys. ‘I do not forewarn the home when visiting. Everything seems peaceful and everyone knows what they are doing. Good communication systems with me at least’. ‘Unit busy, but at ease. Staff turnover seems to be constant factor, I’m never sure who my mothers care attendant is, but I know to whom to go to find answers so it’s not a problem’. ‘Very good and caring. Mum has been in hospital they rang me after they rang the ambulance so very good’. The home provides care and support to people with dementia and two resident’s commented that they spent more time in their rooms place because they unable to hold conversations with some residents. Information from the Pre-Inspection Questionnaire completed in April 2007 and discussion with the staff and observation on the day indicates that all but one of the residents living in the home are white/British. The manager said staff would be able to support individuals with specific cultural or diverse needs following a needs assessment being completed. And where necessary The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 12 additional training and guidance would be provided to staff to enable them to be responsive to the resident’s needs. The home does not provide intermediate care therefore NMS 6 is not applicable. The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 13 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 and 10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents considered that their health and personal care needs are well met however deficiencies in the recordings of some of the residents documentation potentially places them at risk of not receiving all the care they need. The medication systems are well managed. EVIDENCE: Case tracking took place for four residents. The methodology used was a physical examination of care plans; written surveys to resident’s, health and social care professionals and direct observation on the day. The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 14 Since the last inspection new care plans had been introduced using standardised documentation. The plans examined generally contained information on all the persons health and care needs. However some of the plans had not been fully personalised to the individual resident. Examples of where this had occurred were discussed with the manger who gave an assurance that she would take steps to address this as a matter of priority. There were risk assessment tools for mobility, falls, tissue viability, bed rail provision, medication, nutrition and general issues; all high risk areas identified had been reviewed regularly and in most cases care plans were in place to support appropriate care provision. Residents spoken to confirmed that they were aware of the care programmes but had no interest in reading them; one of relatives interviewed said that they had read their mothers care plan. Not all of the residents had singed agreement to their plan and this is one area where care-planning arrangements could be improved. There was good evidence in the records that support was accessed from relevant health care professionals such as Community Psychiatric Nurses, dieticians and District nurses when necessary. Staff in interview demonstrated a good knowledge of the individual residents needs, routines and preferences for the way in which care should be delivered. Residents told the inspector during the visit and also wrote on their surveys that they were satisfied with the standards of care provided, they considered that the staff listened to them and always treated them with dignity and respect. One resident wrote in the survey “staff are very understanding and caring”. Relatives told the inspector during the visit that communication with the staff was good; they were informed of any appointments, changes in condition and when events such as falls had occurred. All surveys returned from relatives detailed that communication with the home was good. Nine residents were spoken to of these seven knew the name of their key worker and described what support they provided. The home uses a Monitored Dosage System for medication. Information provided in the pre inspection questionnaire and discussion with the manager indicates that those responsible for giving out medication have undergone medication training. The pre inspection questionnaire also identified that medication procedure are in place to support staffs practice. At the visit medication systems were examined. Storage of all medications was found to be satisfactory. External and internal medications were stored separately and stock control was effective. Transcribing records were checked and found to be generally satisfactory, although the inspector noted that not The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 15 all transcribing was being counter signed. Medication administration records were satisfactory no omissions were noted, however in some cases staff were not always recording on the medication sheet the quantities of medication received into the home. In order to ensure proper safeguards are in place a second member of staff should witness all hand written annotations on Medication Administration Record charts and must include quantities of medication. The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 16 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 and 15. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents were seen to experience a full life with opportunities to take part in varied activities. The meals in the home offer both choice and variety. EVIDENCE: Staff said the routines of the home are planned around the resident’s needs and wishes. All the residents said that they felt staff listened to them and said they were able to exercise choice in aspects of their life and daily routines. In discussion staff displayed a good knowledge of individual resident’s needs, likes/ dislikes, family support and records contained information about people’s and religious observances. The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 17 Residents confirmed that they are able to choose how to spend their day, what clothes to wear and which visitors to receive. Residents said their family and friends were made to feel very welcome when visiting the home. This was confirmed in discussion held with four relatives. Everyone spoken to said they were able to see visitors in the lounge or in their own room and there were no restrictions on visiting times The home employs a part time activity co-ordinator; this person is responsible for arranging the activity/ entertainment programme and trips out. Residents’ social and psychological needs were identified in care records, however in most cases these were very brief and further work is needed to address this matter. The activity coordinator was aware of this and advised the inspector that she was in the process of revising all the resident’s social profiles. Residents spoken to said that they enjoyed the activities; the programme included outside entertainers, trips out, games, Bingo, videos etc and an exercise class is to be reinstated. Sixteen residents returned a survey, in response to the question are you able to choose what you want to do during the day, fifteen residents said yes, one said sometimes, ‘ I don’t like to be told what to do i.e. outings told who will or not go’ Residents meetings are held and are reasonably well attended; there was evidence that areas such as meals, activities, entertainments and trips out are discussed and suggestions from residents are followed through. Two residents said the would like more trips out and three of the residents who returned a survey also said the same. The home provides three meals a day and a light supper. A choice of food is available at dinner and teatime. Three of the residents spoken to said they could take meals in their room if desired although most residents take their meals in the dinning room. With the exception of one all the residents spoken to and those who returned a survey confirmed that the home provided a good standard of meals, which the residents enjoy. Comments included ‘ the meals have got better recently’ “the food is lovely” and “I enjoy all my meals”. The meal served during the visit looked tasty and well presented. The majority of residents used the dining room and staff were observed to interact well with residents. Specialist diets were currently provided for residents with diabetic needs. The manager stated other specific dietary needs would be accommodated where this was needed. The Garden House DS0000038376.V339647.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 & 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A satisfactory complaints system was in place and residents and staff can be assured complaints and concerns will be listened to and acted upon. A safeguarding procedure was in place, this needs to be supported by a more robust staff-training programme. EVIDENCE: The Commission has not dealt with any complaints about the home since the last inspection carried out in June 2006. The manager had dealt with four complaints. There was evidence that the manager had carried out investigation of the issues raised. Three complaints were substantiated and one was partially substantiated. A complaints procedure was in place and staff spoken to said they had no complaints about the home and felt confident to raise issues of concern if they arose with the manager. The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 19 Seven of the nine residents spoken to confirmed that they knew who to report concerns or complaints to. Two residents who had memory impairment problems were unable to say who they would speak to if they had any concerns. Four visiting relatives were spoken to and all said they were aware of the complaints process. Sixteen residents returned a questionnaire all commented that there were aware of the complaints procedure. Information from the Pre-Inspection Questionnaire and discussion with the manager indicates the home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing and management of resident’s money and financial affairs. Residents spoken to said they felt ‘safe’ in the home. When asked about abuse, what it was and what they would do if they suspected or saw or suspected any abuse staff stated that they would report it to the manager or senior care worker. Training records identified that a number of staff still have not received adult protection training despite the need for this having been Identified as a requirement in previous inspection report. Since the last inspection three adult protection referrals have been made to the local authority, one matter is still being investigated. The inspector found through examination of a sample of files for new staff that recruitment practices were generally satisfactory; examination of staff files demonstrated that Protection of Vulnerable Adult register checks (Pova 1st) or Criminal Records Bureau check (CRB police check) were in place prior to new staff commencing employment. The Garden House DS0000038376.V339647.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, 22 and 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are provided with a warm and comfortable environment that is homely and welcoming EVIDENCE: The home provides and maintains comfortable and clean facilities. All areas of the home are decorated and furbished to a good standard generally although decoration and soft furnishings in some rooms is old and dated. The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 21 All areas seen were clean and tidy and with the exception of one room there were no odours. Sixteen residents returned a survey in response the to the question is the home kept clean, nine residents yes always six said usually, one person did not provide a response to this question. The home had a range of communal space, which residents can access, although observation indicates a number of residents tend to sit in the conservatory rather than the lounges. Action had been taken to carry out work identified in the June 2006 report, the manager reported that she was monitoring the temperature in the conservatory and said staff were aware of the need to draw the blinds in hot whether. The manager had also revised the homes fire risk assessment and a new boiler had been fitted to enable residents on the top floor to have access to hot water. All bedrooms examined were clean and tidy and were furnished and decorated in a homely style. Many people had furnished their bedrooms with a range of personal items, some bringing in items of furniture to reflect their own individual choice and taste. With the exception of one all the residents who were spoken to and those who returned a survey said they were happy with their rooms. One resident wrote ‘I find it absolutely wrong for some ladies to share a room, it creates a lot of trouble’ Staff in interview confirmed a good understanding of infection control measures and confirmed adequate supplies of protective clothing. Equipment provision was also discussed with the staff. Staff in interview and some of those who returned a survey said the home was generally well equipped but commented that they felt they and the residents would benefit a second ‘stand aid’, which would help then to continue to promote the residents independence and meet their moving and handling needs. This matter was discussed with the manager who gave an assurance that she would discuss the purchase of a second stand aid with the owner of the home. The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 22 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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides sufficient numbers of staff to enable residents needs to be met and recruitment practices afford sufficient protection for residents. Improvement is needed in respect of staff training. EVIDENCE: The roles and responsibilities of staff are clearly defined and in discussion with the inspector staff demonstrated understanding of the management and reporting structures for the home. There were forty-two residents living in the home at the time of the visit. The manager uses the Residential Forum Guidance to calculate staffing hours. Based on the information set out in the pre inspection questionnaire completed by the manager in April 2007, the numbers of care hours provided are in line with guidance issued by the Residential Forum. In interview, with the exception of one staff member, all staff said staffing levels were satisfactory. Eleven staff returned a survey. In response to the The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 23 question ‘are there sufficient numbers of staff on duty to enable residents needs to be met’ seven said yes, three said no and one said ‘pending sickness’ Turnover was moderate with eleven having left the home in the last twelve months. Evidence from surveys and discussions with residents during the visit confirmed that they were satisfied that the care they received met their needs and how kind and supportive the staff were. Three of the nine resident’s spoken said the staff were very busy, and they felt that they sometimes had to wait for their call bells to be answered. One resident wrote in their survey ‘‘staff are sometimes unable to attend straight away, due to other residents needs’ ‘sometimes short staffed’. Another wrote ‘Staff always make time to talk to you’. The home remains committed to providing National Vocational Qualification training for staff. The pre inspection questionnaire indicates 34 of care staff are now trained at level 2 or above; which is a positive achievement and a number of other staff had been enrolled to complete an award. A recruitment and selection policy and procedure is in place, which the manager follows when appointing new members of staff. Employment records for four staff appointed since the last inspection were examined. This showed that all workers had Protection of Vulnerable Adult register checks (Pova 1st) or Criminal Records Bureau check (CRB police check) in place prior to commencing employment and they all contained the relevant documentation to comply with Schedule 2 of the Care Home Regulations. An equal opportunities policy and procedure is in place and feedback from the manager, staff and information in personnel and training records showed the procedure is followed when employing new staff and throughout the homes working practices and staffs access to training. New staff are provided with an induction and the manager had an induction programme which meets Skills for Care Common Induction Standards specification. Examination of induction records for three staff showed this programme was not being used consistently. It is important that this now happens. This is needed to show new staff are equipped with the basic skills and knowledge to do their job properly. A training plan to incorporate mandatory training and updates was in place. Examination of a sample of staff training records showed the majority of staff had completed fire safety, food hygiene and moving and handling and further training was planned. Staff training is provided although records showed not many care workers had had much specialist training in areas appropriate to the needs of residents for The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 24 example; dementia, diabetes, strokes and continence management. Action needs to be taken to address this. Failure to do this may mean staff do not have all the knowledge and skills they need to meet the needs of residents and this could impact on the care they receive. The manager was aware of what aspects of the programme needed to be developed and reviewed. The manager stated that she hopes to accomplish this within the next twelve months. The Garden House DS0000038376.V339647.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, 32, 33, 36 and 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A competent manager manages the home and management practice is based on openness and respect. Arrangements are in place to ensure people are consulted about the running of the home although improvement is needed in respect of staff supervision arrangements. EVIDENCE: The manager is a qualified nurse and has many years experience of working in care homes and was in the process of completing the registered managers award. The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 26 Staff confirmed that moral was good and commented that there was a good team approach to the care delivery at the home. Evidence from staff interviews and staff surveys indicated that staff consider the manager and senior staff to be approachable. Staff said they take issues raised seriously and take action to resolve matters where this is needed. Staff and resident meetings were held with evidence that requests and suggestions made at these meetings were discussed and actioned where possible. Improvements have been made to the staff supervision programme with staff having accessed more regular sessions however examination of a number of the records evidenced that not all the care staff and the registered manager had accessed the required amount of sessions (six) within twelve months. This remains an outstanding requirement from previous inspection and action must now be taken to address this matter. Annual appraisals for some staff and the registered manager are out of date and it is important that action is address this. It is important annual appraisals are kept up to date to ensure the homes training plans and priorities reflect the training needs of the staff team. Information in the pre inspection questionnaires indicates that the majority of policies and procedures have been reviewed in the last two years. Following the last inspection the manager has reviewed the quality assurance programme and now has a better systems in place to monitor the quality of care and services provided to residents; the manager completes a number of audits and had produced a basic report, which identifies areas needing improvement and how these improvements will be achieved. The manager now needs to produce an annual development plan, which identifies the quality areas of improvement from 2007 and clearly set out the standards to be achieved in this year and ensure this information is made available to residents, their relatives and relevant third parties. Information given by the manager in the pre inspection questionnaire indicated that there are a range of policies and procedures in place for health and safety. Safe working practices are maintained by the provision of training to staff in the form of moving and handling, basic food hygiene, basic first aid, infection control and fire safety. Detailed environmental risk assessments have been developed. The provider information questionnaire indicates current certificates were in place for the gas, portable electrical appliances and fixed electrical systems. A fire risk assessment for the home was in place. The most recent fire drill was conducted in March 2007. A recent maintenance check on the mobile hoist identified that a part needed replacing, which the manager was following up. The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 27 Bed rails were provided for resident selected for case tracking, a risk assessment had not been completed. All other residents using bedrails had completed assessments. Because of this a requirement concerning this matter was not made. The manager was advised to complete an assessment immediately, which she agreed to do. The manager was also advised to ensure risk assessments and regular checks of this equipment take place in line with guidance from the Medical Devices Agency. The Garden House DS0000038376.V339647.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 3 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 X 2 X 3 The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES 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 OP2 Regulation 5 (1) (b) Requirement Timescale for action 31/07/07 2 OP36 18 The registered person must ensure each resident be given a personalised statement specifically relating to the care, accommodation etc that they will receive for the fee being paid. This should be supplied, at the latest, at the point at which someone takes up residence in the home. It is important that this fee information is widely available at an early stage to support people to make informed choices. Further information about this can be found in the revised Care Homes Regulations The registered person must 31/07/07 ensure supervision programmes comply with NMS 36 and is linked to the training programme. Timescale of 28/11/03, 20/3/05, 31/3/06 and 31/08/06 not met 3 OP18 18 The registered person must ensure staff are provided with adult protection training. Timescale of 30.4.06 and DS0000038376.V339647.R01.S.doc 31/07/07 The Garden House Version 5.2 Page 30 31.7.06 not met 4 OP36 18 The registered person must ensure staff are provided with an annual appraisal. Timescale of 31.5.06 and 31/10/06not met The registered person must ensure all new starters are provided with induction training, which meets Skills for Care Common Induction Standards specifications. Timescale of 28.8.06 not met 30/09/07 5 OP30 18 30/06/07 6 OP33 24 (1) (a) The registered person must (b) (2) (3) produce an annual development plan, which identifies the quality areas of improvement from 2007 and clearly set out the standards to be achieved in this year and ensure this information is made available to residents, their relatives and relevant third parties. 31/08/07 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 OP30 Good Practice Recommendations The registered person should produce a written training plan that reflects the needs of older service users and those with dementia. The plan should detail, the training to be provided to staff and the dates of this training will be provided. As a minimum the training programme must include: dementia care, diabetes, continence, working with DS0000038376.V339647.R01.S.doc Version 5.2 Page 31 The Garden House people with sensory impairments/communication difficulties, strokes and nutrition. This is needed to ensure staff are aware of common diseases associated with ageing to equip them with the right skills are knowledge to support people appropriately. 4 OP9 The registered person should ensure a second member of staff should witness all hand written annotations on Medication Administration Record charts and ensure quantities of medication are recorded. The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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. Extracts may not be used or reproduced without the express permission of CSCI The Garden House DS0000038376.V339647.R01.S.doc Version 5.2 Page 33 - 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. 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