Inspection on 24/05/04 for The Garden House

Care Home For Older PeopleThe Garden HouseCote Lane Westbury on Trym Bristol BS9 3UNAnnounced Inspection24th May 2004 Commission for Social Care InspectionLaunched in April 2004, the Commission for Social Care Inspection (CSCI) is the single inspectorate for social care in England. The Commission combines the work formerly done by the Social Services Inspectorate (SSI), the SSI/Audit Commission Joint Review Team and the National Care Standards Commission. The role of CSCI is to: · Promote improvement in social care · Inspect all social care - for adults and children - in the public, private and voluntary sectors · Publish annual reports to Parliament on the performance of social care and on the state of the social care market · Inspect and assess `Value for Money of council social services · Hold performance statistics on social care · Publish the `star ratings for council social services · Register and inspect services against national standards · Host the Childrens Rights Director role.Inspection Methods & FindingsSECTION B of this report summarises key findings and evidence from this inspection. The following 4-point scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The 4-point scale ranges from: 4 - Standard Exceeded (Commendable) 3 - Standard Met (No Shortfalls) 2 - Standard Almost Met (Minor Shortfalls) 1 - Standard Not Met (Major Shortfalls) O or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable. ESTABLISHMENT INFORMATION Name of establishment The Garden House Address Cote Lane, Westbury on Trym, Bristol, BS9 3UN Email address info@stmonicatrust.com Name of registered provider(s)/company (if applicable) St. Monica Trust Name of registered manager (if applicable) Mrs Donna McDermott Type of registration Care Home No. of places registered (if applicable) 50 Tel No: 0117 9494000 Fax No:Category(ies) of registration, with (number of places) Old age, not falling within any other category (50) Registration number D050000823 Date first registered 30th June 2003 Was the home registered under the Registered Homes Act 1984? Do additional conditions of registration apply ? Date of last inspectionDate of latest registration certificate 8th July 2003 NO YES 9/10/03 If Yes refer to Part CThe Garden HousePage 1 Date of inspection visit Time of inspection visit Name of inspector Name of inspector Name of inspector 1 2 324th May 2004 09:30 am Karen WalkerID Code087036Name of inspector 4 Name of specialist (e.g. Interpreter/Signer) (if applicable) Name of establishment representative at the time of inspectionThe Garden HousePage 2 CONTENTSIntroduction to Report and Inspection Inspection Visits Brief Description of the Services Provided Part A: Summary of Inspection Findings Inspectors Summary Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Methods & Findings National Minimum Standards For Older People: Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management & Administration Part C: Part D: D.1. D.2. D.3. Compliance with Conditions (if applicable) Providers Response Providers Comments Action Plan Providers AgreementThe Garden HousePage 3 INTRODUCTION TO REPORT AND INSPECTION Every establishment that falls within the jurisdiction of the Commission for Social Care Inspection (CSCI), is subject to inspection, to establish if the establishment is meeting the National Minimum Standards relevant to that setting and the requirements of the Care Standards Act 2000. This document summarises the inspection findings of the CSCI in respect of The Garden House. The inspection findings relate to the National Minimum Standards (NMS) for Care Homes for Older People published by the Secretary of State under the Care Standards Act 2000. The Regulations applicable to the inspected service are secondary legislation, with which a service provider must comply. Service providers are expected to comply fully with the National Minimum Standards. The National Minimum Standards will form the basis for judgements by the CSCI regarding registration, the imposition and variation of registration conditions and any enforcement action. The report follows the format of the NMS and the numbering shown in the report corresponds to that of the Standards. The report will show the following: · Inspection methods used · Key findings and evidence · Overall ratings in relation to the standards · Compliance with the Regulations · Required actions on the part of the provider · Recommended good practice · Summary of the findings · Providers response This report is a public document. INSPECTION VISITS Inspections are undertaken in line with the agreed regulatory framework with additional visits as required. This is in accordance with the provisions of the Care Standards Act 2000. The report is based on the findings of the specified inspection dates.The Garden HousePage 4 BRIEF DESCRIPTION OF THE SERVICES PROVIDED. The Garden House is situated on a 23-acre site of well-established gardens and parkland on the edge of Durdham Downs in Bristol. The home opened in July 2003 and provides Residential care with nursing to residents over the age of 65 years. The conditions of registration ensure the registered manager is registered on parts 1 or 12 of the Nursing and Midwifery Council (N&MC). The home is purpose built with all rooms having en-suite facilities and telephone connection points. The home lends itself to residents who use a wheelchair. There are specially designed hoist facilities available in all the bedrooms. A high percentage of the care assistants hold a National Vocational Qualification level 2 or above in care and also show a commitment to attending additional training.The Garden HousePage 5 PART A SUMMARY OF INSPECTION FINDINGSINSPECTORS SUMMARY (This is an overview of the inspectors findings, which includes good practice, quality issues, areas to be addressed or developed and any other concerns.) Brief Introduction The Garden House was subject to a three-day inspection in October 2003 and all of the standards were assessed. A number of requirements and recommendations were made all of which have been met. Therefore this inspection was carried out in one day and not all of the standards were assessed. Any standards not assessed will remain a focus of the next inspection. The inspector gained resident and relative feedback on service provision through questionnaires. Some residents were spoken with on the day of the inspection. Most of the feedback received was positive although there was one complaint officially made to the Commission for Social Care Inspection. As the complaint was received after the inspection date and is not a Protection of Vulnerable Adults issue it has been passed back to the manager for investigation. The manager will investigate accordingly and feedback to the Commission within a set timescale. Choice of Home (Standards 1-6) 5 of 5 standards assessed were met. One is not applicable. Changes have been made to the statement of purpose and service user guide and both are included in the welcome pack offered to prospective residents. Residents have written letters of thanks for the welcome packs and find them both informative and accessible. The inspector witnessed a conversation between a resident and the manager regarding the admission procedure. The enquiry was treated sensitively and informatively. The deputy manager was able to demonstrate through care planning and records that the home has the capacity to meet the assessed needs of the current resident group. The inspector examined two care folders and it was clear that specialised services and support are sought where necessary. One resident who moved into the home on the 3/03/04 had been assessed by the physiotherapist regarding her mobility needs by the 8/03/04.Health and Personal Care (Standards 7-11) 5of 5standards assessed were met. The home has implemented new care planning documentation for assessing, planning and evaluating care. The manager said that The Garden House want to work towards a social model of care. The system used at the moment replaces the Standex system, although not seen, the inspector was told this currently overlaps in some cases. The care plans seen by the inspector meet relevant clinical guidelines, a resident with diabetes has regular recorded blood monitoring and the relevant advice and guidance has been sought from the general practitioner and the diabetic specialist nurse at Southmead The Garden House Page 6 hospital. The care plans seen were reviewed on a regular basis and were updated to reflect the changing needs of residents. The inspector discussed the medication system with the deputy manager Shirley Wyse. It was noted at the last inspection that side 1 and 2 of the Garden House both received the services of two different pharmacies. The Deputy manager now confirms that medication is supplied by one source. This is good practice and ensures continuity. All records pertaining to medication were well kept and in order. Standard 11 scored 4 due to the commitment of the staff team. Residents wishes are well recorded from the choice of funeral service to the making of wills; family members have also recorded their wishes and choices.Daily life and Social Activities (Standards 12-15) 2 of 2 standards assessed were met. 2 were not assessed. Two standards were exceeded. Residents confirmed that regular meetings take place in which they can make suggestions for activities to be bought into the home. The inspector saw that the computer suite had changed rooms on request of residents who found the original room too small and dark. The notice boards around the home advertised various activities both within the home and in the local community. The manager told the inspector that various guest speakers and performers were invited to entertain by the residents committee. It was evident that the manager and her team conduct the home so as to maximise residents capacity to exercise personal autonomy and choice. The care planning system has changed and is much improved. The inspector was told that care plans are now kept in the individual residents room. Relatives found this beneficial as they could easily keep in touch with the care received by their relatives. Complaints and Protection (Standards 16 ­18) 2of 2 standards assessed were met. One not assessed. The inspector received a complaint about service provision, which included making complaints to the management team that were not investigated or acted upon. As the inspector did not receive this complaint prior to inspection the decision has been made to pass it on to the manager Donna McDermott for full investigation. Until the CSCI receive the findings of the investigation it would not be appropriate to give this standard a score. The inspector saw that since November 2003 the manager and her team have received sixteen compliments. These range from thanks to the team for the `care of a dying relative to `congratulations on the excellent care provided received from a physiotherapist. The inspector gave the manager some updated information regarding the Protection of Vulnerable Adults (POVA) list due to be put in place by the Department of Health. The manager was already aware of the list and had a copy of the consultation document. All staff are made aware of the POVA policy and a booklet in bullet form is given to all staff members. There is an updated `whistle blowing policy in place that staff also have access to. The inspector saw that social services had carried out six placement reviews throughout February and march 04 and had commented the `high level of compliance with regards POVA issues.The Garden HousePage 7 Environment (Standards 19-26) 6 of 6 standards assessed were exceeded and one was met. The Garden House provides a range of large attractive communal rooms, which is accessible to all residents. The communal space available includes: Rooms in which religious activities can take place A large dining area with additional seating and a bar facility More than adequate outdoor space Large lounge Reading room Library Large reception area with seating Computer room All furnishings, fixtures and fittings are domestic in character and of a high quality. All rooms are smoke free and residents confirmed they are made aware of the `no smoking policy prior to entering the home. The home provides private accommodation to all residents that are well furnished and equipped to assure comfort and privacy, and meets the assessed needs of residents. Rooms are well decorated, clean and comfortable. Some residents have their own personal furniture in place and all have their own ornaments, clocks and personal pictures. Residents have their own letterboxes and telephones and are able to lock their rooms if they chose. The bathrooms have lockable cabinets where residents can store medication if they chose to self-medicate. There is also a separate lockable facility available. The home provides private accommodation to all residents that are well furnished and equipped to assure comfort and privacy, and meets the assessed needs of residents. Rooms are well decorated, clean and comfortable. Some residents have their own personal furniture in place and all have their own ornaments, clocks and personal pictures. Residents have their own letterboxes and telephones and are able to lock their rooms if they chose. The bathrooms have lockable cabinets where residents can store medication if they chose to self-medicate. There is also a separate lockable facility available.Staffing (Standards 27-30) 4 of 4 standards assessed were met. There is much improvement with the recruitment of new staff and the manager confirmed there were only 1.5 Carer vacancies. There are no qualified nurse vacancies. Rotas confirmed there has been no outside bank or agency staff used in the last month. Personal development profiles are now in place that are accessible to all shift leaders and are linked to supervision and training needs. New staff members are linked to a mentor who supports them with the completion of their The Garden House Page 8 personal portfolio and standards, which link to TOPPS and the national vocational qualification. Staff members are expected to attend training sessions within their first month of employment that include, POVA, Understanding the needs of older people, loss and bereavement and death and dying. Staff will also attend training sessions relevant to the specific needs of residents.Management and Administration (Standards 31-38) 6 of 8 standards assessed were met. one was not met and one not assessed. It was evident to the inspector that areas of health and safety are paramount to the organisation. The manager is open to any advice from the appropriate professionals that will help improve standards.The Garden HousePage 9 Requirements from last Inspection visit fully actioned? If No please list belowYESSTATUTORY REQUIREMENTS Identified below are areas not addressed from the last inspection report which indicate a non-compliance with the Care Standards Act 2000 and accompanying Regulations. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard Required actions Timescale for actionAction is being taken by the Commission for Social Care Inspection to ensure compliance in regard to the above requirements. RECOMMENDATIONS Identified below are recommendations from the last inspection that have not been implemented No. Refer to Good Practice Recommendations StandardCONDITIONS OF REGISTRATION THAT APPLY (OTHER THAN NUMBERS AND CATEGORY OF SERVICE USERS).Met (Yes / No)The Garden HousePage 10 STATUTORY REQUIREMENTS IDENTIFIED DURING THE INSPECTION Action Plan: The Registered Person is requested to provide the Commission with an Action Plan, which indicates how requirements are to be addressed with the time scale within which such actions will be taken. This action plan will be made available on request to the Area Office.STATUTORY REQUIREMENTS Identified below are areas addressed in the main body of the report, which indicate noncompliance with the Care Standards Act 2000, and accompanying Regulations 2001 and the National Minimum Standards. The Registered Provider(s) is/are required to comply within the given time scales. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard * Requirement Timescale for action 1 Schedule 3 3(i) YA4 17(1)(a) Schedule 4 (14) OP38 17(3)(a)(b) Details of any communication needs of the residents and methods of communication must be kept. All information relating to fire equipment checks, training and drills to be recorded, easily accessible and centralised. 30/06/04230/06/04RECOMMENDATIONS Identified below are areas addressed in the main body of the report, which relate to National Minimum Standards and are seen as good practice issues which should be considered for implementation by the registered Provider(s). The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Refer to Good Practice Recommendations Standard * 1 OP7 Ensure care plans indicate `trigger factors that may influence behaviour.The Garden HousePage 11 * Note: You may refer to the relevant standard in the remainder of the report by omitting the 2-letter prefix e.g. OP10 refers to Standard 10.The Garden HousePage 12 PART BINSPECTION METHODS & FINDINGSThe following inspection methods have been used in the production of this report Direct observation Indirect observation Sampling · Pre-inspection questionnaire · Records · Care plans / Care pathways · Meals · Activities · Other (Specify) `Tracking care and support Group discussion with service users Individual discussion with service users Group discussion with staff Individual discussion with staff Discussion with management Service user survey Relatives/significant others survey/feedback Visiting professionals survey / feedback Tour of premises Formal interviews Document reading Additional inspection information: Number of service users spoken to at time of inspection Number of relatives/significant others the inspectors had contact with Number of letters received in respect of the service CRB check for the responsible individual seen CRB check for the manager seen Certificate of registration was displayed at the time of the inspection Certificate of registration accurately reflected the situation in the service at the time of inspection Total number of care staff employed (excluding managers) Total number of staff with nursing qualifications employed Date of inspection Time of inspection Duration of inspection (hrs) YES YES YES YES YES YES YES NO YES NO YES NO YES YES YES YES YES YES NO YES 3 1 X NO YES YES YES X X 24/05/04 0930 6.5The Garden HousePage 13 The following pages summarise the key findings and evidence from this inspection, together with the CSCI assessment of the extent to which the National Minimum Standards for Care homes for older people have been met. The following scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The scale ranges from: 4 - Standard Exceeded 3 - Standard Met 2 - Standard Almost Met 1 - Standard Not Met (Commendable) (No shortfalls) (Minor shortfalls) (Major shortfalls)0 or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable.The Garden HousePage 14 Choice of HomeThe intended outcomes for the following set of standards are: · · · · · · 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.Standard 1 (1.1 ­ 1.3) The registered person produces and makes available to service users an up to date statement of purpose setting out the aims, objectives, philosophy of care, services and facilities, and terms and conditions of the home; and provides a service users guide to the home for current and prospective residents. The statement of purpose clearly sets out the physical environmental standards met by a home in relation to standards 20.1, 20.4, 21.3, 21.4, 22.2, 22.5, 23.3 and 23.10: a summary of this information appears in the homes service users guide. Range of fees charged From (£) 580 To (£) 665Any charges for extrasYESIf yes, please state what the extras are: 3 Key findings/Evidence Standard met? The manager was able to show the inspector a new welcome pack devised for residents. This was individualised with the persons name and room number. The welcome pack contains both the statement of purpose and the service user guide. Residents made suggestions at their regular meetings for various information to be included in the pack. The suggestions were actioned by the management team and the inspector saw various letters of `thanks from satisfied residents. A new `whos who information sheet has been added at the request of the residents this includes the colour coding of uniforms to enable residents to distinguish between nurses and other support staff. The fees have been added and include the RNCC breakdown, methods of payment and due date and terms and conditions of occupancy.The Garden HousePage 15 Standard 2 (2.1 ­ 2.2) Each service user is provided with a statement of terms and conditions at the point of moving into the home (or contract if purchasing their care privately). 3 Key findings/Evidence Standard met? The inspector was shown two contracts that were signed by the resident. The contract includes payments, room to be occupied, obligations of both the Trust and the resident, visitors and complaints. A section of the contract makes reference to the Registered Nurse Care Contributions (RNCC) in that `the Trust will claim from the state and retain the RNCC, etc. which relate to your care and support. The inspector made further enquiries into this practice after the last inspection held in May. Concerns were then raised by residents regarding the contributions and the breakdown of the RNCC. The management team responded to the concerns and have since provided all residents with a `breakdown and a choice of payment methods.Standard 3 (3.1 ­ 3.5) New service users are admitted only on the basis of a full assessment undertaken by people trained to do so, and to which the prospective service user, his/her representatives (if any) and relevant professionals have been party. 3 Key findings/Evidence Standard met? Prospective residents are visited prior to admission and the `easy care assessment tool is completed. This gives details of abilities, which range from managing money and medicines, personal care needs, memory, support required, mental and social care needs. Both the prospective resident and the person carrying out the assessment complete this tool. A personal preferences profile is also completed which includes all aspects of the persons likes and dislikes, choices and hobbies. The records of two new service users were examined. They contained the detailed preadmission assessment, which gives a comprehensive and full picture of the person. Other documentation included the Personal Preferences Profile giving an excellent social and dietary picture. The inspector also saw letters following this assessment to confirm the visit to the home and then the date of admission. All new residents are assessed by the NHS nurses in respect of their level of funded nursing care (RNCC). The inspector saw a letter to a resident stating that this would be subject to review after 3 months. The welcome pack is given to all prospective residents and this document has been updated to include fees and breakdowns. The pack contains the service user guide and the statement of purpose. Residents are now fully aware of their care plan and the key-worker system. Residents and relatives said they found it much easier to find out about the care provided now that the care plans wee kept in the individuals own rooms.The Garden HousePage 16 Standard 4 (4.1 - 4.4) The registered person is able to demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. 3 Key findings/Evidence Standard met? Ceiling hoists are in situ which allow for easy access in individual bedrooms and then into each en-suite shower. At the previous inspection a resident told the inspector that the hoisting system had made a positive change to the way he was moved and handled. The deputy manager was able to demonstrate through care planning and records that the home has the capacity to meet the assessed needs of the current resident group. The inspector examined two care folders and it was clear that specialised services and support are sought where necessary. One resident who moved into the home on the 3/03/04 had been assessed by the physiotherapist regarding her mobility needs by the 8/03/04. A referral to the Audiologist was made on admission and the resident was duly assessed on 6/04/04. Although there were clearly hearing difficulties identified for this resident there were no details of communication needs and preferences or hearing ability. It was clear that the recording systems have improved due to a new system being introduced however this resident was admitted over two months ago and the inspector would expect this information to be made available to the staff team. The manager thought maybe the information would have been available in the old spandex system however the inspector was shown the current plans of care currently used by the staff team. Spiritual needs being met are an integral part of the daily life of the home. Residents were unanimous in their praise of the staff team.Standard 5 (5.1 ­ 5.3) The registered person ensures that prospective service users are invited to visit the home and to move in on a trial basis, before they and / or their representatives make a decision to stay; unplanned admissions are avoided where possible. 3 Key findings/Evidence Standard met? The manager informed the inspector that prospective residents have to apply to head office in the first instance and complete an application form. This is also to ensure that they meet the criteria, which is detailed in their charter. Prospective residents are invited to visit the home. If this is not possible due to illness then the family usually visit instead. It was stated that the visit is usually a short one and they are able to share a meal with current residents. The inspector heard the manager and a resident discussing the admissions process. Trial visits and stays were discussed. It was also made clear that the needs of the prospective resident would be assessed in the first instance to ensure they could be met.The Garden HousePage 17 Standard 6 (6.1 - 6.5) Where service users are admitted only for intermediate care, dedicated accommodation is provided together with specialised facilities, equipment and staff, to deliver short term intensive rehabilitation and enable service users to return home. 9 Key findings/Evidence Standard met? No intermediate or respite care is given.The Garden HousePage 18 Health and Personal CareThe intended outcomes for the following set of standards are: · · · · · The service users health, personal and social care needs are set out in an individual plan of care. Service users make decisions about their lives with assistance as needed. Service users, where appropriate, are responsible for their own medication, and are protected by the homes 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.Standard 7 (7.1 ­ 7.6) A service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. 3 Key findings/Evidence Standard met? The home has implemented new care planning documentation for assessing, planning and evaluating care. The manager said that The Garden House want to work towards a social model of care. The system used at the moment replaces the Standex system, although not seen, the inspector was told this currently overlaps in some cases. One resident has their medication crushed then put into jam to ensure that the medication is taken. There are now clear guidelines from the pharmacist and an agreement signed by the general practitioner. The inspector took the opportunity to read the daily communication report for one resident and noted entries referring to `aggression and agitation. There was no reference to this in the individuals care plan and the inspector discussed this issue with the deputy manager. The deputy manager confirmed that the `aggression was usually `only verbal and never physical which was why there was no set plan of care. Although the inspector noted a care plan for the `expression of fear and anxiety it is felt that this should be expanded upon to include how this behaviour presents itself and if known the `trigger factors should be added. The care plans seen by the inspector meet relevant clinical guidelines, a resident with diabetes has regular recorded blood monitoring and the relevant advice and guidance has been sought from the general practitioner and the diabetic specialist nurse at Southmead hospital. The care plans seen were reviewed on a regular basis and were updated to reflect the changing needs of residents. Manual handling assessments were in place for each individual. The manager explained that a score of 0 meant no risk. Where a risk was identified a risk assessment was put in place alongside details of any manual handling activities carried out, this included the number of staff needed to support the resident with each manoeuvre.The Garden HousePage 19 Standard 8 (8.1 ­ 8.13) The registered person promotes and maintains service users health and ensures access to health care services to meet assessed needs. No. of incidents where service users have been taken to Accident and Emergency during last 12 months No. of service users with pressure sores at time of inspection (from information taken from care notes) 2 23 Key findings/Evidence Standard met? Although there are two residents with recorded pressure area care one is recorded as being due to the individuals `foot movement. There has been chiropody input on a regular basis and specialist shoes are being supplied. The manager told the inspector that the second resident with recorded pressure area care is fully involved in his care. He is even more empowered now that records are kept in individuals own bedrooms. The Deputy informed the inspector that there is sufficient pressure relieving devices to meet current needs. Nutritional screening is undertaken and the inspector saw that where risks had been identified an action plan had been put in place. The inspector was told that all residents could retain their own GP if they wish. GPs visit the home upon request from the resident themselves or by the staff. There was evidence of dentist and opticians visiting residents at the home. The home has their own physiotherapy department and referrals are promptly responded to. The hydrotherapy suite has been custom built to meet the assessed needs of the residents.The Garden HousePage 20 Standard 9 (9.1 ­ 9.11) The registered person ensures that there is a policy and staff adhere to the procedures for the receipt, recording, storage, handling administration and disposal of medicines, and service users are able to take responsibility for their own medication if they wish, within a risk management framework. 3 Key findings/Evidence Standard Met? The inspector discussed the medication system with the deputy manager Shirley Wyse. It was noted at the last inspection that side 1 and 2 of the Garden House both received the services of two different pharmacies. The Deputy manager now confirms that medication is supplied by one source. This is good practice and ensures continuity. Medication was seen to be stored appropriately in the duty room and there is a separate medication cabinet available for the use of controlled drugs should they be prescribed. The inspector took the opportunity to check the balances of two controlled drugs and found them to be correct at the time of the inspection. Records pertaining to medication were up to date and in order. The inspector was told that senior care workers now support the qualified staff members in the administration of medications. This is usually at busy times and only when the staff have received the appropriate training including the completion of the medication unit in the national vocational qualification at level 3. The deputy confirmed that senior carers are also assessed by the appropriately qualified staff prior to administration; they are expected to be competent in all areas including medication uses, side effects and administration protocol. Medication that requires crushing for ease of swallowing has been assessed and agreed by the general practitioner. The pharmacist has also provided information and guidelines for this practice. The inspector saw that the pharmacist offered advice on 18/05/04.The Garden HousePage 21 Standard 10 (10.1 ­ 10.7) The arrangements for health and personal care ensure that service users privacy and dignity are respected at all times, and with particular regard to: personal care giving, including nursing, bathing, washing, using the toilet or commode, consultation with, and examination by, health and social care professionals, consultation with legal and financial advisors, maintaining social contacts with relatives and friends, entering bedrooms, toilets and bathrooms, and following death. 3 Key findings/Evidence Standard met? Whilst the inspector toured the premises staff were seen to knock on residents doors and were heard speaking to them respectfully. Residents spoken with confirmed that personal care was carried out in a dignified manner in the privacy of their own rooms. All residents have access to telephone facilities and one of the residents the inspector met at the last inspection had an answer phone. Each resident had a letterbox for the delivery of his or her personal mail. Resident feedback cards have been received in respect of this service and positive comments on service delivery were made.Standard 11 (11.1 ­ 11.12). Care and comfort are given to service users who are dying, their death is handled with dignity and propriety, and their spiritual needs, rites and functions observed. 4 Key findings/Evidence Standard met? The deputy manager said she held training sessions regarding the care of the dying with the care team. The last training session was held in April 04 and covered care of the dying, supporting families, residents and staff support. Residents wishes are well recorded from the choice of funeral service to the making of wills; family members have also recorded their wishes and choices. Relatives are supported and welcomed to stay in their relatives room for as long as they wish or are offered bed and breakfast accommodation at St Monica Court. Family members are permitted to stay for meals and drinks. There is a facility for relative to purchase a guest meal. Residents living at the Garden House have all been baptised into the Church of England, this is a requirement of admission and is made clear in the welcome pack. Many staff members attend funerals and fresh flowers are put in St Monicas chapel for the funeral service. Staff members support other residents to attend funerals if they chose. One resident told the inspector he sometimes played the organ at funerals held in the chapel but was saddened to find he was not invited to play at the last funeral held. The manager told the inspector that a tearoom is made available for families and friends to get together after the funeral.The Garden HousePage 22 Daily Life and Social ActivitiesThe intended outcomes for the following set of standards are: · · · · 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.Standard 12 (12.1 ­ 12.4) The routines of daily living and activities made available are flexible and varied to suit service users expectations, preferences and capacities. 4 Key findings/Evidence Standard met? The manager explained that a `forecast of events leaflet was published fortnightly and residents could join in with a number of activities. The inspector examined the forecast of events for 24/5/04 - 6/06/04. The following activities are provided: Falls prevention class Pottery class Tuesday shop Cocktail party Chaplains hour Calligraphy Clothes display Recall therapy Charity events Piano music Stroke association General knowledge quiz Birthday celebrations Residents confirmed that regular meetings take place in which they can make suggestions for activities to be bought into the home. The inspector saw that the computer suite had changed rooms on request of residents who found the original room too small and dark. The notice boards around the home advertised various activities both within the home and in the local community. The manager told the inspector that various guest speakers and performers were invited to entertain by the residents committee. Residents are only admitted to the Garden House if they have been baptised into the Church of England. Opportunities for prayer and religious services are excellent and the home has access to its own Chapel.The Garden HousePage 23 Standard 13 (13.1 ­ 13.6) Service users are able to have visitors at any reasonable time and links with the local community are developed and/or maintained in accordance with service users preferences. 0 Key findings/Evidence Standard met? This standard was not fully assessed however the inspector met with residents who said that visitors were always welcomed.Standard 14 (14.1 ­ 14.5) The registered person conducts the home so as to maximise service users capacity to exercise personal autonomy and choice. 4 Key findings/Evidence Standard met? It was evident that the manager and her team conduct the home so as to maximise residents capacity to exercise personal autonomy and choice. The care planning system has changed and is much improved. The inspector was told that care plans are now kept in the individual residents room. Relatives found this beneficial as they could easily keep in touch with the care received by their relatives. Residents hold various committee meetings where they can make their voice heard and raise any concerns. Resident liaison committee meetings and the Disability Focus Group meet on a regular basis. Concerns were raised about the height of the lift buttons and accessibility for wheelchair users. The inspector was pleased to note that additional buttons have been added to the lift that is now fully accessible. There is a loop system available in the downstairs communal area this has been extended to the larger lounge. Residents are able to handle their own financial affairs for as long as they are able. The inspector examined the financial systems in place for residents and this will be discussed further in standard 35.Standard 15 (15.1 ­ 15.9) The registered person ensures that service users receive a varied, appealing, wholesome and nutritious diet, which is suited to individual, assessed and recorded requirements, and that meals are taken in a congenial setting and at flexible times. 0 Key findings/Evidence Standard met? This standard was not fully assessed although the inspector joined residents in the dinning room for lunch. Lunch is served from the hatch or at the table. The inspector spoke with one resident who was delighted with the food on offer and said it was `always delicious. Residents are given a choice of foods both hot and cold.The Garden HousePage 24 Complaints and ProtectionThe intended outcomes for the following set of standards are: · · · 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.Standard 16 (16.1 ­ 16.4) The registered person ensures that there is a simple, clear and accessible complaints procedure which includes the stages and time-scales for the process, and that complaints are dealt with promptly and effectively. No. of complaints made to the home since the last inspection. No. of these complaints fully substantiated No. of these complaints partly substantiated No. of these complaints not substantiated No. of these complaints not yet resolved No. of complaints sent direct to CSCI Percentage of complaints responded to within 28 days 0 0 0 0 0 1 X 0 Key findings/Evidence Standard met? The inspector examined the complaints log and found no complaints recorded. However the inspector received a complaint about service provision, which included making complaints to the management team that were not investigated or acted upon. As the inspector did not receive this complaint prior to inspection the decision has been made to pass it on to the manager Donna McDermott for full investigation. Until the CSCI receive the findings of the investigation it would not be appropriate to give this standard a score. The inspector saw that since November 2003 the manager and her team have received sixteen compliments. These range from thanks to the team for the `care of a dying relative to `congratulations on the excellent care provided received from a physiotherapist. This standard will remain the focus of the next inspection.The Garden HousePage 25 Standard 17 (17.1 ­ 17.3) Service users have their legal rights protected, are enabled to exercise their legal rights directly and participate in the civic process if they wish. 3 Key findings/Evidence Standard met? The majority of the evidence for this standard was obtained at the last inspection where there was evidence in place to show that residents have their legal rights protected. The inspector saw the charter of Human Rights in the policies and procedures file. An advocacy service is available although relatives usually advocate on behalf of residents unable to speak up for themselves. Residents confirmed they took up the right to vote. The inspector also spoke with the person in charge of the financial department at the last inspection and was told that many of the residents look after their own finances or have a power of attorney. The manager confirmed that she rarely acts as appointee for residents. This is covered in standard 35.The Garden HousePage 26 Standard 18 (18.1 ­ 18.6) The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policies. The home has an Adult Protection procedure (including Whistle Blowing) which complies with the Public Disclosure Act 1998 and the Department of Health Guidance No Secrets No. of staff referred for inclusion on POVA lists YES X3 Key findings/Evidence Standard met? The inspector gave the manager some updated information regarding the Protection of Vulnerable Adults (POVA) list due to be put in place by the Department of Health. The manager was already aware of the list and had a copy of the consultation document. All staff are made aware of the POVA policy and a booklet in bullet form is given to all staff members. There is an updated `whistle blowing policy in place that staff also have access to. The inspector saw that social services had carried out six placement reviews throughout February and march 04 and had commented the `high level of compliance with regards POVA issues. The inspector viewed the Protection of Vulnerable Adults (POVA) procedure and found it to contain the following: Definitions of abuse Confidentiality Risk and protection Equal opportunities Privacy, dignity, independence and choice Recording Staff support Training Whistle blowing Advocacy Timescales Immediate action Strategy meetings, social services and the police The whole document is comprehensive and in context with the Bristol `No Secrets DOH guidance.The Garden HousePage 27 EnvironmentThe intended outcomes for the following set of standards are: · · · · · · · · 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.Standard 19 (19.1 ­ 19.6) The location and layout of the home is suitable for its stated purpose; it is accessible, safe and well maintained; meets service users individual and collective needs in a comfortable and homely way and has been designed with reference to relevant guidance. 4 Key findings/Evidence Standard met? The inspector saw that a covered walkway was in the process of being erected. This will allow easy access to the chapel especially in times of bad weather. The location and layout of the home is suitable for its stated purpose, it is accessible, safe and well maintained, meets residents individual and collective needs in a comfortable and homely way and has been designed with reference to relevant guidance. Some of the residents have their own well-maintained garden space. The gardens are attractive and fully accessible to all residents. There is ample seating including a large summerhouse. The inspector saw a programme of routine maintenance and renewal and the manager demonstrated that the residents wishes are taken into account. A group of residents meet regularly to discuss disability issues, which includes access and environmental adaptations.The Garden HousePage 28 Standard 20. (20.1 ­ 20.7) In all newly built homes and first time registrations the home provides sitting, recreational and dining space (referred to collectively as communal space) apart from service users private accommodation and excluding corridors and entrance hall amounting to at least 4.1 sq. metres for each service user. 4 Key findings/Evidence Standard met? The Garden House provides a range of large attractive communal rooms, which is accessible to all residents. The communal space available includes: Rooms in which religious activities can take place A large dining area with additional seating and a bar facility More than adequate outdoor space Large lounge Reading room Library Large reception area with seating Computer room All furnishings, fixtures and fittings are domestic in character and of a high quality. All rooms are smoke free and residents confirmed they are made aware of the `no smoking policy prior to entering the home. This standard has not changed since the last inspection.Standard 21 (21.1 ­ 21.8) Toilet, washing and bathing facilities are provided to meet the needs of service users. 4 Key findings/Evidence Standard met? Each bedroom has an en-suite facility comprising of a washbasin, lavatory and shower. Mobility needs are met with the aid of an overhead hoisting facility. There are ample bathrooms with assisted baths and manual handling equipment. The sluicing facilities are located away from residents private rooms and are well equipped. The inspector was pleased to note that bathrooms had been personalised to include pictures on the walls and plants. This ensures the rooms are not clinical in appearance. Continence aids were put into attractive wicker baskets and not left on show. There are an ample amount of accessible toilets for residents that are clearly marked and close to the lounge and dining areas.The Garden HousePage 29 Standard 22 (22.1 ­ 22.8) The registered person demonstrates that an assessment of the premises and facilities has been made by suitably qualified persons, including a qualified occupational therapist, with specialist knowledge of the client groups catered for, and provides evidence that the recommended disability equipment has been secured or provided and environmental adaptations made to meet the needs of service users. 4 Key findings/Evidence Standard met? The Garden House opened in June 2003 and the building takes into account residents needs with regards mobility and accessibility. Suitably qualified persons, including occupational therapists with specialist knowledge of the resident group, have made assessments of the premises and facilities. Apart from the mobile hoisting equipment and slings available there is a Guidmann overhead tracking system in place. One of the residents spoken with at the last inspection said he found this system to be the most comfortable. The system has been extended to residents bathrooms for ease of movement. There is a physiotherapy and hydrotherapy suite available with large screened changing areas. Residents have access to all parts of the home and grab rails have been provided in corridors, bathrooms and toilets. The inspector found the doorways to be of an acceptable width and most residents spoken with said they had no problems manoeuvring a wheelchair through them. One resident spoken with at the last inspection however did have a problem getting through the door of his room and suggested that the smaller fire door be left open to allow ease of access. The manager pointed out that this is a fire risk as the smaller doors are not linked to the alarm system and would not shut flush to the larger door if the alarms were sounded. The inspector again discussed this issue with the manager who said she is looking into other options for the comfort of this resident but is assured by the relevant professions (building) that the width of the doors is more than adequate. The lifts are larger than average and one resident told the inspector he could turn full circle in his wheelchair. The residents in the Disability Focus Group noted that the buttons in the lift are too high to reach from a chair. This has now been rectified. The lift is designed to meet residents sensory needs by providing spoken information i.e. doors closing. There is a loop system available in the downstairs lounge that has been extended to other areas of the home. It was evident from speaking with the manager and the residents that the manager is very approachable and wiling to make all possible changes with regards the environment for the comfort of the residents.The Garden HousePage 30 Standard 23 (23.1 ­ 23.11) The home provides accommodation for each service user which meets minimum space as prescribed Total number of single bedrooms with at least 10 sq.m usable space or additional compensatory space Pre-existing homes only (1 April 2003) - single bedrooms below 10 sq.m usable space or additional compensatory space Total number of wheelchair users accommodated for in rooms at least 12sq.m Total number of wheelchair users accommodated for in rooms at less than 12sq.m Total number of shared rooms at least 16 sq.m Total number shared rooms less than 16 sq.m Percentage of places within single rooms: 100 80 - 99 Less than 80 Total number of single bedrooms Total number of single rooms with en suite Total number of double rooms Total number of double rooms with en suite YES NO NO 50 50 0 0 50 X35 0 0 03 Key findings/Evidence Standard met? There are no shared rooms. All rooms exceed the spatial standards and are of a high quality with en-suite facilities. The manager said that due to the size of the rooms a married couple could easily share should the need arise. Room dimensions and layout options ensure that there is room on either side of the bed to enable access for cares and any equipment needed.The Garden HousePage 31 Standard 24 (24.1 ­ 24.8) The home provides private accommodation for each service user which is furnished and equipped to assure comfort and privacy, and meets the assessed needs of the service user. 4 Key findings/Evidence Standard met? This standard was fully assessed at the last inspection and an environmental tour by the inspector confirmed high standards remain. The home provides private accommodation to all residents that are well furnished and equipped to assure comfort and privacy, and meets the assessed needs of residents. Rooms are well decorated, clean and comfortable. Some residents have their own personal furniture in place and all have their own ornaments, clocks and personal pictures. Residents have their own letterboxes and telephones and are able to lock their rooms if they chose. The bathrooms have lockable cabinets where residents can store medication if they chose to self-medicate. There is also a separate lockable facility available.Standard 25 (25.1 ­ 25 8) The heating, lighting, water supply and ventilation of service users accommodation meet the relevant environmental health and safety requirements and the needs of individual service users. 3 Key findings/Evidence Standard met? This standard was met at the last inspection and the inspector noted there has been no change or deterioration in standards. Therefore this standard remains as met.Standard 26 (26.1 ­ 26.9) The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation and published professional guidance. 3 Key findings/Evidence Standard met? A tour of the building confirmed to the inspector that the premises are kept clean and free from offensive odours. There are adequate systems in place to prevent the spread of infection and there are suitable policies and procedures in place. Laundry facilities are sited so that soiled articles, clothing and linen are not carried through areas where food is stored, prepared or delivered. Washing machines have the specified programming ability to meet disinfection standards. There is ample hand washing facilities prominently sited in areas where infected waste is handled. Each bedroom has a hand washbasin.The Garden HousePage 32 The Garden HousePage 33 StaffingThe intended outcomes for the following set of standards are: · · · · 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 homes recruitment policy and practices. Staff are trained and competent to do their jobs.Standard 27 (27.1 ­ 27.7) Staffing numbers and skill mix of qualified/unqualified staff are appropriate to the assessed need of the service users, the size, the layout and purpose of the home, at all times. Number of staff /hours in respect of service user needs based on guidance recommended by Department of Health. Personal Nursing Care No. service users High No. staff hours 9 X X needs allocated No. service users Medium needs No. service users Low needs No. of staff hours required (day time) No. of full time equivalent first level registered nurses No. of care staff No. of ancillary staff Key findings/Evidence 27 14 No. staff hours allocated No. staff hours allocated X X 1865.25 X X X1187.4 No. of staff hours 6 provided (day & night) 16 45 XStandard met?3The Garden HousePage 34 The number of residents determined as having high, low or medium needs have been assessed using information gained from the Registered Nursing Contribution assessments (RNCC). The number of staffing hours provided is based on the total hours provided by permanent staff members and does not take into account bank and agency usage. The Staffing hours needed calculation is based on guidance provided by the Department of Health. There is much improvement with the recruitment of new staff and the manager confirmed there were only 1.5 Carer vacancies. There are no qualified nurse vacancies. Rotas confirmed there has been no outside bank or agency staff used in the last month.Standard 28 (28.1 ­ 28.3) A minimum ratio of 50 trained members of care staff (NVQ Level 2 or equivalent) is achieved by 2005, excluding the registered manager and/or care manager, and in care homes providing nursing, excluding those members of the care staff who are registered nurses. No. care staff (excluding registered nurses) with NVQ level 2 or equivalent of care staff with NVQ level 2 31 65 3 Key findings/Evidence Standard met? All trainees are registered on a TOPSS-certified training programme. New staff members are expected to undertake a national vocational qualification and staff members who complete level 3 are usually promoted to senior carers.The Garden HousePage 35 Standard 29 (29.1 ­ 29.6) The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. 3 Key findings/Evidence Standard met? The inspector examined two staffing records and noted the following information: CRB clearance prior to employment Two or more references Work permit where necessary Copy of passport and clearance into the country as necessary Completed application form Contract of employment Job description and person specification Medical card Interview notes A picture of each employee on file Letters to confirm appointment were also present stating the 4-month probationary period. The inspector was informed that the manager checked verification of the Registered nurses qualifications. The manager confirmed that she receives a list of all PINs from the Nursing and Midwifery Council (N&MC).The Garden HousePage 36 Standard 30 (30.1 ­ 30.4) The registered person ensures that there is a staff training and development programme which meets the National Training Organisation (NTO) workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 3 Key findings/Evidence Standard met? Personal development profiles are now in place that are accessible to all shift leaders and are linked to supervision and training needs. An examination of the training records took place during the inspection and it was noted that all staff receive formal induction which includes: Corporate induction day Health and Safety training Relevant policies and procedures Instruction on use of equipment Introduction to the TOPPS study programme and TOPPS study days Training sessions relevant to residents needs At the last inspection the manager said that any new staff member would be `buddied for 5 shifts where they remain supernumerary. This was evidenced in the duty sheet and shifts for new staff members were colour coded for ease of reference. New staff members are linked to a mentor who supports them with the completion of their personal portfolio and standards, which link to TOPPS and the national vocational qualification. Staff members are expected to attend training sessions within their first month of employment that include, POVA, Understanding the needs of older people, loss and bereavement and death and dying. Staff will also attend training sessions relevant to the specific needs of residents.The Garden HousePage 37 Management and AdministrationThe intended outcomes for the following set of standards are: · · · · · · · · 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 homes record keeping policies and procedures. The health, safety and welfare of service users and staff are promoted and protected.Standard 31 (31.1 ­ 31.8) The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. 3 Key findings/Evidence Standard met? The manager is a qualified nurse and informed the inspector that she keeps abreast of service delivery standards by carrying out various care activities and joining the staff team on shift. She is then available to offer advice and support, hear residents views regarding care issues and monitor service provision. The manager further demonstrated that she continues to update her present knowledge by attending various courses relevant to the needs of the resident group. She is in receipt of many nursing subscriptions and explained that this keeps her up to date with current developments and good practice. The inspector has noted a positive change in care provision an example of one such improvent is the `open policy with regards care planning and accessibility to residents.The Garden HousePage 38 Standard 32 (32.1 ­ 32.7) The registered manager ensures that the management approach of the home creates an open, positive and inclusive atmosphere. 3 Key findings/Evidence Standard met? It was evident from the inspectors observations that the manager communicates a clear sense of direction and leadership. The aims and values of the home are clearly stated in the statement of purpose. Staff members confirmed that they were aware of the homes philosophy of care. The manager confirmed that staff have clearly defined job descriptions given to them when receiving their application packs. The inspector saw these. Staff confirmed they had job descriptions and were able to tell the inspector what they contained. Staff are made aware of the contents of the General Social Care Council (GSCC) codes of conduct. Staff members were aware of their own knowledge and skill limitations and knew when it would be appropriate to seek support from another person with more expertise. One of the residents spoken with praised the staff team and the manager for their `skills and kindness and all that they do for the residents.Standard 33 (33.1 ­ 33.10) Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in meeting the aims, objectives and the statement of purpose of the home. 3 Key findings/Evidence Standard met? The manager said resident questionnaires had been sent out to gain views on all aspects of service provision. She was pleased to note that at least two thirds had already been returned. The inspector noted that the questionnaires covered food, personal care and support, aspects of daily living, premises and management. Other comments were invited. The questionnaires will produce statistics for each area of service provision and an action plan on each will be developed. The results will be fed back to the residents via residents meetings for approval. The manager told the inspector of the plan to revisit the action plans in one year. The manager said she is committed to empowering the residents with regards choices around service delivery and hopes they will have greater input into the action plans formed. There is also an internal audit process, which will identify aspects of performance that are open to measurement and set achievable standards. This standard will be further assessed at the next inspection.The Garden HousePage 39 Standard 34 (34.1 ­ 34.5) Suitable accounting and financial procedures are adopted to demonstrate current financial viability and to ensure there is effective and efficient management of the business. 3 Key findings/Evidence Standard met? At the last inspection two inspectors met with members of the finance team to discuss and inspect the financial plan for the home. The business and financial plan for the establishment is open to examination by the Commission for Social Care Inspection and reviewed annually. There is adequate insurance cover in place and the home clearly displays their registration certificate in the entrance hall. The inspector noted at this inspection that the registration certificate accurately reflects the current resident group.Standard 35 (35.1 ­ 35.6) The registered manager ensures that service users control their own money except where they state that they do not wish to or they lack capacity and that safeguards are in place to protect the interests of the service user. Number of service users subject to Power of Attorney processes Number of service users subject to Enduring Power of Attorney processes Number of service users subject to Guardianship Orders 9 X X3 Key findings/Evidence Standard met? The personal finances for residents are kept in a safe in the managers office. Tagged pouches are used and the inspector took the opportunity to check the balances of three personal finances all were correct at the time of inspection. The inspector noted that the residents sign their own withdrawals where possible and all receipts are kept. Information regarding individual finances is shared with the next of kin or power of attorney where necessary. The manager stated that some residents prefer to use chequebooks and keep small amounts of cash on them. A record of the care homes charges to residents including any extra amounts payable on top of the fees is stated in the welcome pack containing the statement of purpose. The contracts reflect the breakdown of fees, which now include the nursing contribution components.The Garden HousePage 40 Standard 36 (36.1 ­ 36.5) The registered person ensures that the employment policies and procedures adopted by the home and its induction, training and supervision arrangements are put into practice. 0 Key findings/Evidence Standard met? This standard was not fully assessed and will remain a focus of the next inspection. This standard was met at the last inspection.Standard 37 (37.1 ­ 37.3) Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 3 Key findings/Evidence Standard met? Records required for the protection of residents were in place and regularly reviewed. The manager confirmed that relevant policies and procedures would be brought to the attention of all staff at supervision. A copy of the relevant policies and procedures were kept in both sides of the Garden House and made available to all staff at all times. Records were stored in the appropriate departments and were made available to the inspector when requested. Records seen were well maintained and up to date. The inspector regularly receives regulation 26 inspection notes and is pleased by the improvement in monitoring and recording. The regulation 26 visit for May 04 carried out by trustees was well written and sought resident and staff views. Areas covered included resident views on the standard of care, contact with staff members and their comments, the standard of the premises including residents rooms, cleanliness and hygiene. Also covered are fire safety and other health and safety issues, records kept in the home including the number of complaints received and overall conduct of the care home. Two care plans were also examined.The Garden HousePage 41 Standard 38 (38.1 ­ 38.9) The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. 2 Key findings/Evidence Standard met? The inspector saw that portable appliance testing takes place on an annual basis and tests last took place in June 2003. Whilst touring the building the inspector met with the officer responsible for the checking and maintaining of environmental aids. He confirmed that regular checks of the beds, baths, hoists, runways and slings took place. He added that the checks take place more often than is required and this is good practice. The inspector took the opportunity to examine the fire logbook. Discussions took place with the manager and nominated fire officer. It was noted that the fire book was not kept up to date with the recording of fire drills. The last recorded drill took place in August 2003 although both the manager and the fire officer stated that in fact a further two had since taken place. The fire training carried out by staff was not evident in the fire logbook although records of such training could be found in individuals supervision notes. The inspector found this confusing and a discussion took place requiring all information relating to fire equipment checks, training and drills to be recorded, easily accessible and centralised. The manager too had difficulty tracking information and will be working towards a more centralised system. The fire logbook and the frequency of training will be a focus of the next inspection. The nominated fire officer told the inspector he had contacted the Avon Fire Brigade (AFB) and provided them with a set of floor plans in the event of a fire breaking out. This is good practice. The AFB conducted a check of the building and offered advice on the `stay put policy and associated fire risk assessments. All accidents, incidents and illness or disease are fully recorded. Risk assessments are carried out to ensure safe working practices. Regulation 37 notifications are sent to the Commission appropriately and are well recorded with adequate information. Unfortunately the home has had a case of NORWALK, however this was well managed and the appropriate action taken in consultation with environmental health. The home is now clear and functioning as normal. The appropriate policies for infection control are in place. It was evident to the inspector that areas of health and safety are paramount to the organisation. The manager is open to any advice from the appropriate professionals that will help improve standards.The Garden HousePage 42 PART C(where applicable)COMPLIANCE WITH CONDITIONSCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceLead Inspector Second Inspector Locality Manager DateKaren Walker Lyn Davis 09/06/2004Signature Signature SignatureThe Garden HousePage 43 Public reports It should be noted that all CSCI inspection reports are public documents.The Garden HousePage 44 PART DD.1PROVIDERS RESPONSE TO IDENTIFIED STATUTORY REQUIREMENTSRegistered Persons comments/confirmation relating to the content and accuracy of the report for the above inspection.Comments received from the proivder were incorporated into the final report.The Garden HousePage 45 Action taken by the CSCI in response to provider comments: Amendments to the report were necessary YESComments were received from the provider Provider comments/factual amendments were incorporated into the final inspection report Provider comments are available on file at the Area Office but have not been incorporated into the final inspection report. The inspector believes the report to be factually accurateYESYESNOStatus of the Providers Action Plan at time of publication of the final inspection report: Action plan was required YESAction plan was received at the point of publicationYESAction plan covers all the statutory requirements in a timely fashion Action plan did not cover all the statutory requirements and required further discussion Provider has declined to provide an action planYESNONOOther: enter details here NOThe Garden HousePage 46 D.3PROVIDERS AGREEMENT Registered Persons statement of agreement/comments: Please complete the relevant section that applies.D.3.1 I of confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) and that I agree with the requirements made and will seek to comply with these. 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