Inspection on 02/06/09 for The Garden House

This inspection was carried out on 2nd June 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Garden House 17/02/10

The Garden House 21/12/09

The Garden House 11/05/07

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

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Snydale Care Home

Hawkhills

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Carentan House

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: The Garden House 24 Humberston Avenue Cleethorpes North East Lincs DN36 4SP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kate Emmerson     Date: 0 2 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: The Garden House 24 Humberston Avenue Cleethorpes North East Lincs DN36 4SP 01472813256 01472812337 worcestergarden@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Worcester Garden (No 2) Ltd care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 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. Care Homes for Older People Page 4 of 28 Over 65 20 44 0 0 0 10 Brief description of the care home At the time of the inspeciton the home were between £376 - £403 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. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection visit took place over 1 day in June 2009. Prior to visiting the home we sent out survey questionnaires to a random selection of residents and staff. Some of the comments received by these people have been included in the report. During the visit we spoke to residents, relatives, the manager, a senior care worker, two care workers 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. We also looked around the home and looked at lots of records, for example; resident care plans and risk assessments, daily records, supervision schedules, 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 judgment about the overall Care Homes for Older People Page 6 of 28 standards of care within the home. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: To ensure that staff have up to date information about the care people need they must regularly review the care plans and bring them up to date as peoples needs change. To ensure accurate medication administration records are maintained the relevant code must be recorded when a person has refused their medication. Care Homes for Older People Page 8 of 28 The temperature of the medication fridge should be consistently monitored to ensure the quality of the medication is maintained. The laundry room should have a lock provided to prevent unauthorised access and maintain a safe environment for residents. The bathroom used to store walking frames and wheelchairs should be cleared to ensure a pleasant environment for the residents. To ensure that fire systems are maintained in full working order the checks on the fire systems must be completed weekly during the handymans annual leave. The manager should bring staff supervision up to date and then continue to maintain the programme to the required number of at least six sessions per year. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of 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 were made to feel welcome and secure. Evidence: Information about the home such as the statement of purpose and service user guide were up to date, further information about fees and charges had been included since the last inspection. Examination of peoples care records showed the manager had completed a needs assessment either prior to or on admission. Assessments and care plans completed by the care management team had also been obtained. People had been provided with a contract/statement of terms and conditions which informed them about the fees to be paid. People were advised in writing where there Care Homes for Older People Page 11 of 28 Evidence: had been changes to the fees. People spoken to said that the staff were very good at helping people to settle in the home when they were first admitted. The home does not provide intermediate care. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents considered that their health and personal care needs were well met however lack of consistent evaluation of the care plans means that they were not always fully up to date. The medication systems are generally well managed. Evidence: Four care files were examined. All had care plans in place which had been developed using the information gathered at assessment. There were risk assessment tools for mobility, falls, tissue viability, bed rail provision, medication, nutrition and general issues; in most cases detailed care plans were in place to support appropriate care provision. Since the last inspection new care plans had been introduced using standardised documentation. These had not been implemented in all cases by the time of the inspection but those that had were very detailed. There was some lack of consistency in reviewing care plans and not all care plans had Care Homes for Older People Page 13 of 28 Evidence: been brought up to date as needs had changed. For example a care plan had not been developed for one person who had developed a difficulty swallowing. However staff in interview demonstrated a good knowledge of the individual residents needs, routines and preferences for the way in which care should be delivered. Not all of the residents had signed agreement to their plan. 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. 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. They said the staff are very nice and the staff are good. A visitor said I cant speak highly enough of the home. The home uses a Monitored Dosage System for medication. Information provided in the pre inspection assessment and discussion with the manager indicated that those responsible for giving out medication had undergone medication training. The pre inspection assessment also identified that medication procedures were in place to support practice. At the visit medication systems were examined. Secure storage including a fridge for medication was provided. The temperature of the fridge had not been consistently monitored and this is recommended to ensure the quality of the medication is maintained. Medication administration records were checked, in one case staff had not recorded with the relevant code when a person had refused their medication. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of 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 were enjoyed by all the residents and offered both choice and variety. Evidence: 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 residents needs and likes and dislikes. 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 a relative. The home employs a part time activity co-ordinator; this person is responsible for arranging the activity and entertainment programme and trips out. Residents social and psychological needs were identified in care records. Residents spoken to said that they enjoyed the activities; the programme included Care Homes for Older People Page 15 of 28 Evidence: outside entertainers, trips out, games and Bingo. The weeks activities progamme was displayed throughout the home. A monthly church service was also arranged. During the inspection there was a very lively atmosphere with residents being involved in a game in one communal area, a raffle in another area and a family birthday party for one of the residents being held in another communal room. There was also quiet areas for people to sit if they did not wish to join in and some people were sat in the garden. The home provided three meals a day and a light supper. A choice of food and drinks is available at meal times. Residents spoken to said they could take meals in their room if desired although most residents take their meals in the dinning room. 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 food is very good,food is good, food excellent and the food is beautiful. The meal served during the visit was 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 could be accommodated where this was needed. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A satisfactory complaints system was in place and residents and staff could be assured complaints and concerns would be listened to and acted upon. A safeguarding procedure was in place, this was now supported by a more robust staff-training programme. Evidence: The Commission has not dealt with any complaints about the home since the last inspection. The home had not received any complaints since 2007. The previous complaints had been recorded in a hard back book. The manager was advised to keep individual records to conform with data protection legislation. 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. Residents spoken to confirmed that they knew who to report concerns or complaints to but all stated they were happy with the service received. One visitor to the home said that they couldnt speak highly enough about the home. Information from the pre inspection assessment and discussion with the manager indicated the home has policies and procedures to safeguard people in their care and prevent abuse. Care Homes for Older People Page 17 of 28 Evidence: Training records identified that staff have received adult protection training since the last inspection and refresher training had been arranged. There had been one referral to the safeguarding team for investigation in April 2009 and we had not been informed of the outcome at the time of the inspection. The home had taken appropriate action to safeguard people in light of the allegation. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were provided with a warm and comfortable environment that was homely and welcoming. Evidence: The home provided and maintains comfortable and clean facilities. There was a warm and lively atmosphere in the home. All areas of the home were decorated and furbished to a good standard. A programme of refurbishment was being undertaken. Some of the bedrooms had been refurbished to a very good standard with new carpets and furniture provided. The plan was for all bedrooms to be refurbished to the same standard either as they become free or at at rate of two bedrooms per month. Generally the home was clean and tidy and with the exception of one room there were no odours. The home lacked storage space. This could be seen in that one bathroom was used to store walking frames and wheelchairs and the staff desk area was cluttered with stored items such as a television and a hoover although this was cleared later in the inspection. This detracted for the homes appearance and various options were discussed with the provider. Care Homes for Older People Page 19 of 28 Evidence: The laundry room did not have a lock provided and this is required to prevent unauthorised access and maintain a safe environment for residents. The windows in bathrooms although they had opaque glass had no blinds or curtains and this is recommended to ensure peoples privacy and dignity. The home had a range of communal space and a very well maintained garden which residents could access. Throughout the inspection the residents were seen to make good use of the facilities and various activities were taking place in different areas of the home. 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. Staff in interview confirmed a good understanding of infection control measures and confirmed adequate supplies of protective clothing. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided sufficient numbers of staff to enable residents needs to be met and recruitment practices afford sufficient protection for residents. There had been improvement in staff training. Evidence: There were thirty two residents living in the home at the time of the visit. The provider used the Residential Forum Guidance to calculate staffing hours. Based on the information set out in the pre inspection assessment the numbers of care hours provided are in line with guidance issued by the Residential Forum. In interview, staff said staffing levels were satisfactory. However in surveys three staff stated that they needed a tea time cook. The manager stated that a kitchen assistant had now been employed to cover this period. Turnover was moderate with ten staff having left the home in the last twelve months. Evidence from 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. Care Homes for Older People Page 21 of 28 Evidence: The home remained committed to providing National Vocational Qualification training for staff. The pre inspection assessment indicates 25 of the 35 care staff were trained at level 2 or above. A recruitment and selection policy and procedure is in place, which the manager follows when appointing new members of staff. Employment records for two staff appointed since the last inspection were examined. This showed that Protection of Vulnerable Adult register checks (Pova 1st) or Criminal Records Bureau check (CRB police check) were in place prior to commencing employment and they all contained the relevant documentation to comply with Schedule 2 of the Care Home Regulations. Senior staff and new staff confirmed that there was a robust induction programme. New staff were provided with an induction which meets Skills for Care Common Induction Standards specification. Staff also had some shifts supernumerary to the rota. The manager stated that there was now a training manager in place who identified the training and put together a training plan to incorporate mandatory training and updates. However the training plan was not available at the time of the inspection and the manager was requested to provide a copy to us. Safeguarding training was being undertaken on the day of the inspection. Examination of a sample of staff training records showed the majority of staff had completed fire safety, food hygiene and moving and handling. A staff member stated that the training had improved. Staff training records showed that some specialist training in areas appropriate to the needs of residents for example; dementia, and pressure area care had been provided. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A competent manager manages the home although some management processes such as quality monitoring and staff supervision need to be brought up to date following her recent absence. Evidence: The manager is a qualified nurse and has many years experience of working in care homes and has completed the registered managers award since the last inspection. The manager had just returned from nine months maternity leave. The deputy manager had been acting up in her absence. Improvements had been made to the staff supervision programme and staff stated that they had had some supervision sessions since the last inspection. The manager confirmed that this hadnt been to the required number due to her absence. The required amount of sessions is six within twelve months. Annual appraisals had been completed. Care Homes for Older People Page 23 of 28 Evidence: Information in the pre inspection assessment indicates that the majority of policies and procedures have been reviewed in the last two years. The quality assurance programme included a number of audits and and surveys of people who use the service. The manager now needs to produce an annual development plan, which identifies the areas for improvement and clearly sets out the standards to be achieved and ensure this information is made available to residents, their relatives and relevant third parties. Where people were assisted with their finances or valuables were held for safe keeping there were clear records maintained. Records showed that some people had had a negative balance for some time due to family members not providing sufficient money in a timely manner for their relative. The manager was requested to review these each of these situations and consider whether a safeguarding referral would be appropriate in respect of this issue. Information given by the manager in the pre inspection assessment indicated that there are a range of policies and procedures in place for health and safety. Safe working practices were 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. The provider information assessment 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 April 2009. The handyman was responsible for the weekly checks on the fire systems. However during the handymans annual leave these had not been conducted. This could put the home at risk in the event of a fire. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 To regularly review the care plans and bring up to date as needs change. To ensure that staff have up to date information about the care people need. 30/09/2009 2 9 13 The relevant code must be recorded when a person has refused their medication. To ensure accurate records are maintained. 01/09/2009 3 38 23 The checks on the fire systems must be completed weekly during the handymans annual leave. To ensure that fire systems are maintained in full working order. 30/09/2009 Care Homes for Older People Page 26 of 28 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 The temperature of the medication fridge should be consistently monitored to ensure the quality of the medication is maintained. The laundry room should have a lock provided to prevent unauthorised access and maintain a safe environment for residents. The windows in bathrooms should be provided with blinds or curtains to ensure peoples privacy and dignity. The bathroom used to store walking frames and wheelchairs should be cleared to ensure a pleasant environment for the residents. The manager should ensure that the quality monitoring systems are brought up to date and a report is produced and made available to people living in the home and other interested parties. The manager should bring staff supervision up to date and then continue to maintain the programme to the required number of at least six sessions per year. 2 19 3 4 20 22 5 33 6 36 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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