Inspection on 14/06/06 for The Garden House

This inspection was carried out on 14th June 2006.

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

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

Other inspections for this house

The Garden House 17/02/10

The Garden House 21/12/09

The Garden House 02/06/09

The Garden House 11/05/07

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 Unannounced Inspection 14th June 2006 09:00 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 The Garden House DS0000038376.V300610.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.V300610.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 Worcester Garden (No 2) Ltd Position Vacant Care Home 44 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (44), of places Physical disability (10) The Garden House DS0000038376.V300610.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th February 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 13th June 2006 indicates the home charges a fee of £327.50 per week. The home also 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. The Garden House DS0000038376.V300610.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced key inspection and took place over 2 days in June 2006. The inspector issued 40 resident questionnaires out of which 17 were returned, 25 staff questionnaires of which 14 were returned, 15 relative surveys were posted out of which 12 were returned. Surveys questionnaires were also sent to 4 care managers and 4 GP practitioners. During the visit the inspector spoke to nine residents, the manager, a deputy manager, three care workers, and three relatives to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. Following visits to the home a family member of one resident contacted the inspector by telephone. The inspector looked around the home and looked at lots of records, including residents care plans, staff training records 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. The site visit was carried out by Mrs M Wawryk, Regulation Inspector, the visits lasted eleven and a half hours. What the service does well: The home was clean and tidy and provides satisfactory facilities; most areas of the home were decorated and maintained to a good standard. Residents commented that they are 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 and that they can visit when they please. All the relatives and friends who returned a questionnaire and those who spoke to the inspector at the visit confirmed staff welcomed them into the home at any time. Residents said they had good access to professional medical support when needed. Residents also said that they were able to access external services The Garden House DS0000038376.V300610.R01.S.doc Version 5.2 Page 6 such as chiropodist, dentists and opticians as needed. Three general practitioners returned a questionnaire. All indicated that they were satisfied with the overall care provided to residents. What has improved since the last inspection? What they could do better: All the residents had a care plan setting out how staff should support the resident, but the practice of involving residents in the development and review of their plan was variable. The plan in some cases included only basic information and in some cases information documented in plans did not reflect the care being provided. This was important because all staff needed to know what care is needed so they could support people fully. Information gathered from discussions with staff, survey questionnaires and examination of the staffing rotas and pre-inspection questionnaire indicates that staffing numbers needs to be looked at to ensure staff numbers are matched to the needs of residents, to ensure there are enough staff on duty at peak activity times. Most residents praised the care staff, their skills and attitudes, however staff do not get regular formal supervision sessions, therefore the manager cannot demonstrate how she is assessing/ monitoring their continued ability. This requirement has been outstanding since the introduction of the National Minimum Standards and efforts must be made to prioritise the full implementation of a formal programme. The Garden House DS0000038376.V300610.R01.S.doc Version 5.2 Page 7 The manager had not sat down with each member of staff to check what training they had done and to decide what training they needed. This is needed to ensure the homes training plans meet the training needs of staff. Thereby ensuring staff are able to meet the changing needs of residents. The manager reported that she spends time talking to residents and resident meeting were held. However the manager had not yet fully implemented a formal programme of audits and surveys. This means the home does not have a structured and formal way of asking residents, their relatives, staff and relevant others about their views on the care that is provided and how the home is run. The manager now needs to consider how she is going to develop the home and how she is going to ensure residents and other people are able to contribute to the running of the home. This requirement has been outstanding since the introduction of the National Minimum Standards and efforts must be made to prioritise the full implementation of a formal programme. 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 Garden House DS0000038376.V300610.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 The Garden House DS0000038376.V300610.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both before and during the visit to this home. 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 in so far as staff ensure new residents are made to feel welcome. However a review of the homes registration category must be undertaken to ensure admissions to the home meet legal requirements. EVIDENCE: A statement of purpose and residents guide was available and a copy of the most recent inspection report was on display in the main entrance of the home. Five resident files were case tracked; pre-admission assessments were evidenced and those residents who were able to express an opinion confirmed that they were either assessed in their own homes or in hospital. The Garden House DS0000038376.V300610.R01.S.doc Version 5.2 Page 10 Pre admission assessments for two residents were found to be very brief and records did not accurately reflect all the residents need for example, psychological health. The inspector advises that a review of the documentation is carried out. This was needed to ensure better recording of residents needs to aid effective decision-making concerning the homes capacity to meet the needs of prospective residents. A number of residents confirmed that they had taken the opportunity to visit the home prior to admission although most said that their families or friends had visited the home to assess its suitability, which had been a satisfactory arrangement. One resident wrote in her survey questionnaire ‘my daughter went to see several homes and The Garden House was best by far’ The home is registered to provide places for ten residents with dementia. In discussion with the inspector three residents commented that they felt some residents were wrongly placed; they said that they were unable to hold conversations with some residents and that they were troubled by the behaviours of one or two residents. Information provided in the pre inspection questionnaire identified there were significantly more that ten residents with dementia living in the home. This matter was discussed with the owner of the home at the previous inspection and the owner was advised to carryout a review, and following that review to submit an application to the Commission to vary the homes registration category where required. This must now happen. This is needed to ensure the homes registration category accurately reflects the needs of residents and to meet legal requirements. The registered person must not admit any residents who do not meet the homes registration status, unless the Commission has granted a variation. The manager said that all residents had received a statement of terms and Conditions and the inspector saw signed copies of documents for some residents. Eleven of the residents who returned a questionnaire confirmed a contract had been issued. Five residents stated they had not been issued with a contract. The inspector advises that a check is made to ensure contacts have been issued to all residents and/or their representatives. Contracts and/or statements of conditions must be issued to those who do not have one. This is needed to ensure residents have access to information on what they can expect to receive for the fee being paid and any terms and conditions of occupancy. There was evidence to demonstrate that care staff were accessing a range of service specific training which will help ensure that they have the skills to enable them to deliver up to date care methods and have a better understanding of the varied conditions common to older people. However records indicated that the provision of induction training for new staff must The Garden House DS0000038376.V300610.R01.S.doc Version 5.2 Page 11 improve. This is needed to ensure staff are able to carry out care tasks in a competent way There was a mixture of experienced and inexperienced staff at the home. Discussion with six residents indicated that they are very satisfied with the care at the home and said the staff were caring and attentive to their needs. One resident told the inspector some staff could be abrupt. This matter was referred back to the manager for her to address. Fifteen residents who returned a questionnaire indicated that they were very or usually satisfied with the care and support provided by staff, comments included ‘I receive the best care anybody could wish for at the Garden House’; another resident wrote ‘ the standard of care is excellent’. One resident wrote ‘lack of attention in respect of personal care and attention’ another wrote ‘staff not always helpful and caring, occasionally abrupt’ Fourteen of the relatives who returned a questionnaire indicated they were satisfied with the overall care provided, one relative commented that they were dissatisfied with the overall care provided and two relatives stated they were mostly satisfied with the overall care provided. From discussions with residents, some relatives and feedback obtained from survey questionnaires it was evident whilst there is general satisfaction with services provided by the home, there are areas, which require further development and improvement. The manager must develop and implement in practice a quality assurance programme within the home. Whereby the manager can demonstrate how she is assessing/ monitoring care practices and management systems to ensure effective service delivery arrangements. Please refer to comments detailed on page of this report. The home does not provide intermediate care therefore NMS 6 is not applicable. The Garden House DS0000038376.V300610.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both before and during the visit to the home Residents’ health and personal care needs are generally met, however the quality of the ongoing maintenance and up dating of care plans is inconsistent. Medication practice concerning the recording of administration of medication must improve by ensuring staff follow agreed procedures. EVIDENCE: Case tracking took place for five residents. The methodology used was a physical examination of care plans, written surveys to service users, relatives and health care professionals, discussions with residents, their relatives and direct observation on the day. The Garden House DS0000038376.V300610.R01.S.doc Version 5.2 Page 13 Examination of records identified that some care plans lacked detailed guidance for staff on care delivery arrangements and some care plans had not been updated to reflect changes in the residents needs. For example: The home had a range of risk assessment tools for example, manual handling, Water Low and nutritional screening. Generally these were well maintained although again some deficiencies were noted. For example, the Water-Low assessment for one resident indicated the individual was at high risk of developing pressure areas. However an individual care plan for pressure area care had not been developed, despite daily records indicating the resident had a pressure area and was receiving district-nursing support. Similarly another resident also had a high Water Low assessment but again had no supporting skin integrity/pressure area care plan. The inspector advises that for those service users at risk of developing pressure areas, individual care plans are developed. These must contain sufficient information to guide staff practice for example, they should set out in detail tasks staff are expected to carryout for that individual e.g. where ‘regular’ positional changes are advised care plans must be more specific in terms frequency, manoeuvres and monitoring arrangements etc. this is needed to ensure staff know what care should be provided. Records for one resident identified the person was now much more dependent on staff for all their care needs. The residents can plan did not reflect this. This was important because all staff needed to know when changes occurred so they could support people fully. Records and discussion with staff identified two residents had memory impairment problems. Care plans for psychological health were very brief and did not give detailed guidance for staff on how to support the residents with all their support needs or on how to manage challenging behaviours. The registered person must ensure where residents suffer from dementia care plans set out all care needs and interventions staff must follow. This is needed to ensure all the residents’ needs are clearly identified and planned for. 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 are trained nurses or 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; policies and procedures were in place, which covered all areas of management. 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 all transcribing was being counter signed. In order to ensure proper safeguards The Garden House DS0000038376.V300610.R01.S.doc Version 5.2 Page 14 are in place a second member of staff should witness all hand written annotations on Medication Administration Record charts. Medication administration records were satisfactory. However on the day of the inspection staff were observed to record administration of medication en-mass after medication had been dispensed. When questioned the worker confirmed this was routine practice. This is unsafe practice and this must now cease. The manager must ensure staff understand their role and responsibilities around medication and ensure staff follow agreed procedures. The Garden House DS0000038376.V300610.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this home. Not all the residents were seen to experience a full life with opportunities to take part in varied activities. Residents receive a healthy, varied diet according to their assessed needs and choices. EVIDENCE: Residents spoken to said daily routines in the home were flexible. Service users confirmed that they were able to choose how to spend their day, what clothes to wear and which visitors to receive and that family and friends were made to feel very welcome when visiting the home. All the residents spoken to had an awareness of their rights. There were no set times for rising or retiring. Residents stated that mealtimes were flexible. Residents’ religious needs were identified on admission in most cases. Staff reported that residents had the opportunity to access local churches or attend services held in the community. Staff reported they would support residents to access religious services where needed. Staff feedback identified that none of The Garden House DS0000038376.V300610.R01.S.doc Version 5.2 Page 16 the current residents followed any particular religious observances. This was confirmed in discussions held with three residents and one relative. Discussion with the residents indicated that they have good contact with their families and friends. Relatives who returned a questionnaire confirmed this. The relatives of two residents commented that staff always made them welcome when they visited the home and that they were offered tea or coffee Residents spoken to said they were able to see visitors in the lounge or in their own room. Again this was confirmed in discussions held with three relatives. These relatives commented that staff always made them welcome when they visited the home. There is an activity co-ordinator employed in the home that provides support within a group or one- to one basis. At the time of the inspection visit, this individual had only just taken up the post and evidence from discussions with residents and staff indicates that this individual was in the process of developing the activity programme to include a broader range of activities. Activities provided included, exercise to music, quizzes, sing-a-longs, visiting entertainers and trips out Records showed that in most cases social profiles, had been completed, however these had not been reviewed and updated to reflect changes in the needs and circumstances of residents. Records and feedback from survey questionnaires indicated that staff may need to look in more detail at peoples social stimulation needs in order to better tailor daily activities to individual wishes, needs and capabilities of some service users. Staff had not had any particular training in organising and arranging activity programmes. This would be useful in assisting staff to assess and plan activities particularly for more dependant residents including those with dementia. Feedback from the residents’ questionnaire indicated 12 residents always or usually accessed activities they could participate in. Four residents commented that this sometimes happens. One resident did not provide a response to this matter. One relative who returned questionnaire wrote more activities needed to be available for people with dementia and one resident said residents in wheelchairs needed to be taken out more. The registered person should continue, on a regular basis, to consult service users about the programme of activities on offer in the home and consideration should be given to providing staff with training in planning and organising activities programmes. All residents spoken to said the meals were of good quality and that a choice of food was available, including fresh vegetables and fruit. The home did not have any people from black and ethnic minority groups and none of the service users selected for case tracking had any specialist dietary The Garden House DS0000038376.V300610.R01.S.doc Version 5.2 Page 17 requirements. However the manager stated they would be able to meet any specialist, religious and/or cultural dietary requirements of residents. Advocacy information was not on display in the home and it is recommended that the contact names and addresses of the local advocacy services be put into the residents’ guide. Information from the Pre-inspection Questionnaire indicates that the home does not manage the personal finances of current residents; the home did hold small amounts of monies for a limited number of residents. Residents’ finances were not checked on this occasion although the manager gave an assurance that residents could access their personal allowances when needed. The Garden House DS0000038376.V300610.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The home had a satisfactory complaints system with evidence that the majority of residents and their relatives feel that their views are listened to and acted upon. However the management of adult protection matters must be improved as certain practices show staff have failed to ensure procedures designed to ensure a proper response to any suspicion or allegation of abuse were adhered to. EVIDENCE: A complaints procedure was available. There have been no complaints made to the Commission since the last inspection. Residents spoken to said that they had no complaints about the home and felt confident to raise issues of concern if they arose. Fifteen of the residents who returned a questionnaire indicated they knew how to make a complaint, two respondents indicated they were unaware of how to make a complaint. Eight of the relatives who returned a questionnaire indicated they were aware of the home’s complaint procedure, with four respondents indicating they were unaware of the complaints process. Some of the feedback regarding complaint procedures and process may reflect a shortfall in information and understanding about the process and the manager should take steps to address this. The Garden House DS0000038376.V300610.R01.S.doc Version 5.2 Page 19 A procedure for responding to allegations of abuse was in place. Since the last inspection one adult protection referral has been reinvestigated following receipt of additional information by the local authority. The allegation was not upheld although the investigation identified that certain staff practices had failed to ensure an adequate response to the allegation and there was evidence of significant shortfalls in the recording of some information relating to the incident. The registered person must ensure all records are held within the residents care file. Where confidentiality requires information to be recorded elsewhere a record must signpost where the information can be found. Records must be clear, accurate dated and signed. Shortly before the inspection visit a further adult protection matter had been referred to the local authority. Following the inspection visit the provider notified the Commission that the local authority had concluded its investigation and was taking no further action in respect of this matter. Examination of training records identified that whilst some staff had had adult protection training, survey results from the staff questionnaires showed that individuals have different levels of understanding around the complaints procedure and their role and responsibilities regarding Protection of Vulnerable Adults (POVA) issues. The Responsible individual must ensure adult protection training is made available to the manager and all care workers who have not completed this training. This is needed to ensure staff fully understand issues concerning adult protection and to ensure they fully understand their roles and responsibilities regarding the reporting of suspicions or allegations of adult protection issues. The manager assured the inspector that she would address this matter as soon as possible. This will be followed up at future visits to the home. Examination of four staff files showed that all the staff had had their employment and background histories checked (Criminal Records Bureau). However it was noted that one staff member had commenced working in the home prior to receipt of a second reference. This practice must cease. The manager assured the inspector that from now on new staff would not start work until all checks are completed. This will be followed up at future visits to the home. The home maintained records to support equal opportunities in their recruitment practices. The Garden House DS0000038376.V300610.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 26 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this home. The design and layout of the home enables residents to live in a comfortable home and residents have access to specialist equipment they require. EVIDENCE: The home provides comfortable facilities. The home was in good decorative order and furnishings and fittings were of good quality. A tour of the home was carried out and all areas seen were clean and tidy. Residents told the inspector during the visit that the home was kept clean. Relatives who returned a questionnaire confirmed this. The Garden House DS0000038376.V300610.R01.S.doc Version 5.2 Page 21 All bedrooms examined were clean and tidy and were furnished and decorated in a homely style. The residents spoken to stated that they were happy with their rooms. 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. The home had a range of communal space, which residents can access. Although observation indicates number of residents tended to sit in the conservatory rather than the lounges. The conservatory was noted to be very hot on the day of the inspection and the inspector advises that temperature checks are carried out on a regular basis. Where required remedial action must be taken to ensure the room is maintained at a comfortable temperature for residents. A concern about the temperature in the conservatory was also highlighted by one of the relatives the inspector spoke to. The home had a fire risk assessment, which the manager was in the process of updating and expanding. Once completed the manager gave an assurance that she would have it checked by a competent person. The Garden House DS0000038376.V300610.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality of in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this home. The deployment and number of staff available in the home requires review to ensure there are sufficient numbers of staff to meet the needs of the residents. Most staff are trained to carry out their work safely although some and improvement in the provision of training must be achieved. EVIDENCE: The home had 43 residents in residence at the time of the inspection. In discussion with the inspector most staff commented that as a result of increased dependency levels of some residents, the amount of hours set on their rota was not adequate to give quality time to the residents to enable more person centred rather than task centred care. Fourteen staff returned a questionnaire. Of these five staff reported that there was sufficient staff to meet the needs of residents. Nine staff commented that there was insufficient staff on duty to always meet the needs of residents. The Garden House DS0000038376.V300610.R01.S.doc Version 5.2 Page 23 Information on dependency levels of residents provided in the pre inspection questionnaire indicated the home had five residents with high dependency needs. This information did not match information held in the home. The homes utilises a ‘traffic light’ risk assessment tool. Residents are assessed on admission and are accorded a risk rating. A random examination of a sample of records identified seven residents had a risk category of red (high). One resident had a risk category of green (low), however information on the preinspection questionnaire indicated the resident exhibited extreme behaviour. Similarly another resident had a green risk rating, records examined indicated the resident exhibited behaviours that compromised their personal safety. This calls into question the effectiveness of the tool, particularly for those residents suffering with dementia. This matter was fully discussed with the manager who agreed with the inspector that a review of the assessment tool was needed to better reflect the needs of some residents. This must now happen. An induction-training programme was in place, however it requires review and amendment to ensure the programme meets Skills for Care specifications. The inspector examined records for induction for four staff. Induction records were only available for one worker. The registered person must ensure that new starters complete an induction, which meets required standards. This is needed to ensure staff have the necessary basic skills to care for residents properly. Information supplied in the pre inspection questionnaire identified that the home now exceeds the target of ensuring at least 50 of care staff had achieved National Vocational Qualification at level 2. The home is to be commended for this. The Garden House DS0000038376.V300610.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The manager had only been in post for five weeks, despite this the manager had made some improvements towards management of the administration systems, efforts must now be made to fully implement the staff supervision programme and formalise the quality assurance programme to demonstrate effective management of the home. EVIDENCE: The current manager had only been in post for five weeks at the time of the inspection visit. An application to register the manager with the Commission had not been received. The manager gave an assurance that an application The Garden House DS0000038376.V300610.R01.S.doc Version 5.2 Page 25 would be sent as soon as possible. This must happen to meet legal requirements. Residents, staff and relatives spoken to were complimentary about the new manager. Comments indicated that she was actively looking at ways to improve management systems and practices in the home. Further improvements need to be made to the implementation of the staff supervision programme. Records and discussion with staff indicates that supervision practice is inconsistent. The registered person must ensure staff receive as a minimum supervision every two months. This is needed to ensure staff receive necessary guidance and support from their supervisor and/or manager. From records, interviews with the manager, staff and residents it was evident that a structured quality monitoring system had not been fully introduced in the home. The registered person must ensure that a structured quality assurance programme is developed and implemented in practice. This is needed to make sure that everyone is consulted about the running of the home and to ensure continuous improvements are made. This remains an outstanding requirement from previous inspections and must now happen. The home had a range of policies and for health and safety and a current insurance certificate was on prominent display in the home. The home had current maintenance certificates for the gas, electrical system and the fire system. Certificates were in place for, the fixed bath hoist and fire fighting equipment. There was a gap in the recording of checks on the hot water, emergency lights and fire alarm however the manager gave an assurance that steps had been taken to ensure required checks were now carried out on a regular basis. Records indicated the last fire drill was carried out 17th May 2006. The inspector examined the water temperatures in a sample of rooms. Water temperatures in two rooms on the top floor registered only 21 centigrade. The registered person must ensure service users on the top floor have access to hot water. The registered person must confirm to the Commission in writing of the action taken to address any identified problem. Records showed the majority of staff was up to date with mandatory training. Records indicated that some staff had not completed manual handling training and a number of staff had not been provided with an annual update. The homes employs its own manual handling trainer and at the last inspection assurances were given that further manual training would be provided as a matter of priority. This must now happen. The inspector advises that a review is completed to establish whether all staff are up to date with all mandatory training. Where gaps are identified training must be provided. The Garden House DS0000038376.V300610.R01.S.doc Version 5.2 Page 26 Accident books are filled in appropriately, and the inspector recommends that the manager completes regular audit on these to help spot any problems or recurring themes. The Garden House DS0000038376.V300610.R01.S.doc Version 5.2 Page 27 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 X 1 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 2 X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 2 X 2 The Garden House DS0000038376.V300610.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP36 Regulation 18 Requirement The registered person must ensure supervision programmes comply with NMS 36 and is linked to the training programme. Timescale of 28/11/03, 20/3/05 and 31/3/06 not met The registered person must review and amend the homes pre admission assessment form to ensure all the needs of residents are identified and recorded The registered person must not admit any residents outside of the homes registration category unless the Commission has granted a variation. The registered person must ensure staff are provided with adult protection training. Timescale of 30.4.06 not met The registered person must DS0000038376.V300610.R01.S.doc Timescale for action 31/08/06 2 OP3 14 31/08/06 3 OP3 14 07/07/06 4 OP18 18 31/07/06 5 OP36 18 31/10/06 Version 5.2 Page 29 The Garden House ensure staff are provided with an annual appraisal. Timescale of 31.5.06 not met 6 OP3 Schedule 314 The registered person must 31/07/06 undertake a review of the homes registration category and where necessary make an application to vary the registration category. Timescale of 30.4.06 not met The registered person must ensure care plans reflect all areas of identified need including social, emotional, health and psychological health needs. Timescale 30.4.06 not met The registered person must ensure staff do not commence working in the home until two satisfactory references have been obtained. Timescale of 27.2.06 not met The registered person must produce and make available a quality assurance plan for the home. A summary of which must be included in the service user guide. Timescale of 31.5.06 not met The registered person must ensure for those service users at risk of developing pressure areas, individual care plans are developed. These must contain sufficient information to guide staff practice. The registered person must ensure all new starters are provided with induction training, which meets Skills for Care specifications. The induction programme must The Garden House DS0000038376.V300610.R01.S.doc Version 5.2 Page 30 7 OP7 15 31/07/06 8 OP29 19 07/07/06 9 OP33 35 31/10/06 10 OP7 15 14/07/06 11 OP30 18 31/08/06 12 OP18 13 be reviewed and revised to reflect Skills for Care standards The registered person must 31/07/06 ensure all records are held within the residents care file. Where confidentiality requires information to be recorded elsewhere a record must signpost where the information can be found. Records must be clear, accurate dated and signed. The registered person must complete a review of staffing using a dependency-rating tool to assess whether current staffing levels meet the current needs of service users. Copy of the review should be provided to the Commission. Timescale of 30.4.06 not met The registered person must ensure staff follow agreed medication procedures. Staff must record administration of medication immediately after each residents has received it. The registered person must ensure service users on the top floor have access to hot water. The registered person must confirm to the Commission in writing of the action taken to address any identified problem. 31/08/06 13 OP27 18 14 OP9 13 07/07/06 15 OP38 13 14/07/06 16 OP38 18 17 OP29 19(1)(b) 18 OP38 13 The registered person must audit 31/07/07 staff training records to establish whether all staff have had moving and handling training. Where necessary training must be provided The registered person must 07/07/06 ensure two satisfactory references are obtained before a worker commences working in the home The registered person must 14/07/06 DS0000038376.V300610.R01.S.doc Version 5.2 Page 31 The Garden House ensure temperature of the conservatory is checked a regular basis. Where required remedial action must be taken to ensure the room is maintained at a comfortable temperature for residents. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 Refer to Standard OP9 OP3 OP12 Good Practice Recommendations A second member of staff should witness all hand written annotations on Medication Administration Record charts. The registered person should review the homes risk rating tool to ensure it reflects all needs including psychological/dementia The registered person should continue, on a regular basis, to consult service users about the programme of activities on offer in the home and consideration should be given to providing staff with training in planning and organising activities programmes. The Garden House DS0000038376.V300610.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: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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