Random inspection report
Care homes for older people
Name: Address: The Garden House 24 Humberston Avenue Cleethorpes North East Lincs DN36 4SP two star good service 02/06/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Rob Padwick Date: 2 1 1 2 2 0 0 9 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): Name of registered manager (if applicable) Worcester Garden (No 2) Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 44 Number of places (if applicable): Under 65 Over 65 20 44 0 dementia old age, not falling within any other category physical disability Conditions of registration: Date of last inspection Brief description of the care home 0 0 10 0 2 0 6 2 0 0 9 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. Care Homes for Older People Page 2 of 13 Brief description of the care home 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 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. Details of current fees payable are available from the home. Care Homes for Older People Page 3 of 13 What we found:
Information about the service is available to help those thinking about using it to make a decision about the home. Case files belonging to people using the service contained evidence that their needs are generally assessed before they move into the home or at the time of their admission, with details obtained from their funding authority or an assessment carried out by staff in the service. This is to ensure the home will be able to meet their needs appropriately. Whilst the last time we visited service people living in the home and their relatives told us they were satisfied with the standards of care and considered staff listened to them and treated them with dignity and respect, we made a requirement that care plans are further developed to ensure staff have up to date information about the support people need. Although there was evidence of work carried out to implement this requirement with details about the type of support needed from staff, some of these details were being inconsistently implemented and there was evidence of significant gaps in daily recordings and care plans and key worker entries not updated as needed. An unexplained injury had occurred to someone living in the home, however from inspection of the care records we were unable to determine how this had occurred. Whilst case files contained a range of assessments concerning the management of known risks to people living in the home there was evidence these had not been reviewed for over two months which placed people at potential risk of harm. Although policies and procedures are in place to ensure staff know how to give medication safely, we previously made a requirement to ensure accurate records about these are properly maintained. Only senior staff trained in this element of practice are responsible for this aspect of the home; however a check of the records for these indicated this aspect of the service continues to need further improvement and that practices concerning this aspect of the home poses a potential risk to the safety of people using the service. Staff entries had been recorded in the medication records against someone who was no longer living in the home and we were unable to tell if an individual had received their medication earlier that day. When the above omission became clear we asked for clarification about what steps the manager was going to take regarding this. Whilst pharmaceutical guidance concerning the potential consequences of this was sought by a senior manager for the service, we had to prompt them to contact the prescribing doctor to check if this error would pose any possible risks to the individual concerned and for them to make a further safeguarding alert about this to the Local Authority. People living in the home told us staff generally listened to them and confirmed they could make choices about their lives and ensure they experience a lifestyle that met their wishes and needs. People told us their friends and families are able to visit and are welcomed into the home and a number were observed to be visiting at the time of our visit. A part time activity co-ordinator is employed by the service and people living in the home told us they had recently been out on a Christmas meal and that parties were held to celebrate special events. Someone living in the home was celebrating a birthday on the day of our visit and we saw evidence of a cake and other food items prepared as part of this. On the day of our visit the activity organiser was covering for staff shortages as a result of an outbreak of sickness in the home, however we were told she would resume her normal duties once this was over. We observed people choosing to sit together in the communal areas of the home, with others spending time in their own rooms. However following the introduction of isolation measures to reduce the risk of an outbreak of infection currently in the home, one person
Care Homes for Older People Page 4 of 13 told us they felt very lonely and indicated they wished they could be with others although they confirmed they had visited a relative who was living elsewhere in the home. People using the service confirmed the standard of food continues to be good and that they can enjoy their meals in the company of others or in the privacy of their own rooms. Owing to staff shortages at the time of our visit, a member of domestic staff was temporarily assisting with the provision of meals; however we observed these to be of a healthy, home cooked nature which were well presented. Specialist diets continue to be provided and we saw evidence of assessments about these to ensure the nutritional needs of people using the service can be met. When we last visited the service people living in the home and their relatives told us they were happy with the service they received. We were satisfied that arrangements to ensure their concerns were being taken seriously and they were being protected from possible harm. Since then a compliments slip has been developed to enable the home to gain further feedback from about the home and the service it provides. Since we visited the home in June 2009, we received some concerns about staff shortages and staffing arrangements, which we passed to the provider to investigate. The provider told us he was addressing these issues and would write to us when these were resolved. Whilst a complaints policy was in place to ensure the concerns of people living in the home are taken seriously, a minor amendment was needed to this to ensure it includes details about how to contact the Care Quality Commission. Similarly, whilst the complaints book contained details of two complaints received by the service in July 09, we were unable to find records of actions to follow these up and others that relatives told us they had approached the provider about. A letter of complaint dated December 09 was pinned to the office notice board, however no details of this had been entered into the homes complaints log. A requirement is made about this to ensure an auditable record of concerns raised is appropriately maintained to enable people living using the service and their relatives to be assured these will be addressed and taken seriously. Although training has previously been provided to ensure staff know how to safeguard people living in the home from possible harm and policies and procedures are in place concerning the protection of vulnerable adults, there was some evidence further development on this area of practice was needed to ensure appropriate action is taken when needed. A senior manager had contacted us following discovery of an unexplained injury to someone using the service which we advised must be referred to the Local Authority as a safeguarding concern, however we were subsequently told they had not been able to action this properly. The home was comfortable, clean and tidy and there was evidence it was being generally well maintained. The provider told us some progress had been made to implement recommendations made the last time we visited with further improvements to upgrade a number of bedrooms and a lock was now fitted to the laundry door to prevent unauthorized access. We received some anonymous concerns about inadequate heating in the home, however despite adverse weather conditions and snow showers prior to our visit the temperature in the home was generally satisfactory. People using the service told us the conservatory lounge had been placed out of use over the previous weekend due to it being too cold to use and it is recommended the temperature is regularly monitored to ensure appropriate action is taken to promote and protect their health and welfare. There was evidence that servicing of equipment was generally being carried out appropriately, however we were again unable to find records for weekly checks of the fire systems to make sure they are maintained in full working order and the five year electrical renewal certificate for the building had been allowed to expire 2 months previously. There had been a recent outbreak of sickness in the home and whilst CQC had not been
Care Homes for Older People Page 5 of 13 correctly advised of this, there was evidence that appropriate action had been taken with infection control measures in place and the Health Protection Agency informed and samples taken by the Environmental Health Department for which results were awaited at the time of our visit. Since the last time we visited the service, the previous manager had left and a new staff shift pattern introduced to ensure a greater continuity of care. We had written to the owner following anonymous concerns we received that there were insufficient numbers of staff on duty and been told by him he was actively monitoring this situation and that these were above the numbers recommended by the residential forum. On the day of our visit an out break of sickness had affected both a number residents and staff and this had resulted in replacement staff being deployed from an agency as required and a new manager had been recently appointed. From observation on the day whilst there were adequate numbers of staff available on duty and the above circumstances were exceptional, the coordinating arrangements of them could be improved as recording errors had resulted as a consequence of them not having all of the information they needed about the group of people living in the home. The last time we visited the service the recruitment, staff training and induction were judged to be satisfactory, however we had not been provided with a copy of the homes training plan as requested and a requirement is made about this. A new manager had been recently appointed and whilst this had only taken place a short time previously, we were told he was taking this role seriously and meeting with staff to provide them with guidance and leadership as was needed. The provider indicated progress to develop the service had been impeded following our last visit by difficulties associated with introduction of new staffing arrangements and that it was hoped the new manager would introduce improvements that were needed. An outbreak of sickness and diarrhoea was currently affecting both a number of staff and people living in the home and whilst the effects of these unusual circumstances had impacted on the home, there was evidence of action to manage this situation appropriately with the deployment of additional agency staff as previously noted. Whilst the current out break of the above episode of sickness and diarrhea had been reported to the Local Environmental Health Department and Health Protection Agency as required, we had not been officially advised of this or an unexplained injury to an individual living in the home. Similarly, whilst details of accidents sustained by people using the service were stored in their care records, we were unable to clearly cross reference these with details maintained in the accident book, which meant it was hard verify these. Maintenance records inspected indicated the servicing of equipment was being generally kept up to date but we were unable to find evidence of weekly checks of the fire equipment as previously required and the periodic electrical installation certificate for the home had expired two months previously. What the care home does well:
The home has a relaxed and homely atmosphere and people using the service are supported by staff who generally know them well. People living in the home are generally able to take part in a range of activities to ensure they can experience a lifestyle that meets their wishes and needs. A variety of home cooked meals are provided and friends and relatives of people living in the home are welcomed to visit to ensure they can maintain links with them. Staff are provided with a variety of training to help them to do their jobs. Care Homes for Older People Page 6 of 13 What they could do better: 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 set out on page 2. Care Homes for Older People Page 7 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 7 15 To regularly review the care 30/09/2009 plans and bring up to date as needs change. To ensure that staff have up to date information about the care people need. 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 8 of 13 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, 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 15/02/2010 plans and bring up to date as needs change. To ensure that staff have up to date information about the care people need. 2 8 13 The Registered Person must ensure assessments about the management of known risks to people living in the home are kept up to date and regularly reviewed. This is to ensure they are kept safe from potential harm. 15/01/2010 3 9 13 The Registered Person must 31/01/2010 ensure medication administered to people living in the home is given as prescribed and that arrangements are in place for the ordering, safekeeping and safe administration of medicines, with accurate and timely records for these maintained. This is to ensure the Health
Page 9 of 13 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 and welfare of people living in the home are promoted and they are protected from harm. 4 9 13 The relevant code must be recorded when a person has refused their medication. To ensure accurate records are maintained. 5 16 22 The Registered Person must 15/01/2010 ensure the complaints policy is updated with details of how to contact the Care Quality Commission. This is to ensure the concerns of people using the service can be addressed. 6 16 17 The Registered Person must 15/01/2010 ensure there is an up to date and auditable record of all concerns received by the service together with actions taken to resolve these. This is to ensure people using the service can be assured any concerns about the service will be taken seriously and that actions taken about these are transparent and clear. 7 18 13 The Registered Person must 15/02/2010 ensure all staff receive refresher safeguarding training and ensure they are able to recognise issues of potential abuse and know how to refer these
Page 10 of 13 31/01/2010 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 appropriately to the Local Authority for investigation. This is to ensure the health and welfare of people living in the is protected and they are safeguarded from potential abuse. 8 19 23 The Registered Person must ensure that an up to date periodic electrical wiring certificate for the home is obtained. This is to ensure the health, safety and welfare of people living in the home is promoted and protected. 9 19 23 The Registered Person must monitor the temperature in the home. This is to ensure appropriate action is taken to promote and protect the health and welfare of people living in the home. 10 30 18 The Registered Person must 15/02/2010 provide an up to date record of training provided to staff to the Commission. This is to ensure staff have the appropriate skills to do their jobs and ensure the health and welfare of people using the service are promoted and protected. 11 38 23 A record of weekly checks of 01/03/2010 fire systems must be kept to
Page 11 of 13 30/01/2010 29/01/2010 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 ensure fire systems are maintained in full working order. To ensure that fire systems are maintained in full working order. 12 38 37 The Registered Person must 22/01/2010 ensure significant events are reported promptly to the Commision. This is to ensure the welfare of people using the service can be protected and promoted. 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 Care Homes for Older People Page 12 of 13 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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). 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. Care Homes for Older People Page 13 of 13 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
