Inspection on 06/02/07 for The Garden House

This inspection was carried out on 6th February 2007.

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

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

Other inspections for this house

The Garden House 06/10/05

The Garden House 09/05/05

The Garden House 27/09/04

The Garden House 24/05/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Garden House Cote Lane Westbury on Trym Bristol BS9 3UN Lead Inspector Wendy Kirby Key Unannounced Inspection 09:30 6 & 7th February 2007 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Garden House Address Cote Lane Westbury on Trym Bristol BS9 3UN Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0117 9494000 St. Monica Trust Mrs Donna McDermott Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May accommodate people over the age of 65 years. The manager must be registered on parts 1 or 12 of the Nursing & Midwifery Council. May accommodate a named individual service user who is outside the category of registration for the home. 6th October 2005 Date of last inspection Brief Description of the Service: The Garden House is operated by St Monicas Trust, a charitable organisation, and is registered to provide personal and nursing care for up to fifty people who are over 65. The Sundials Unit is a new extension to the house and specialises in care for residents with dementia. The home is situated on a 23-acre site of well-established parkland on the edge of Durdham Downs in Bristol. The premises are purpose built and are fully accessible for people who have physical disabilities. There are numerous aids and adaptations throughout the building. Each bedroom has an ensuite facility. The communal areas are situated on the ground floor and these include a large dining area, two spacious lounges, a library and computer room, and hydrotherapy pool. The cost per week to reside at The Garden House and The Sundials ranges from £635.75 to £705.75. Fees are reviewed annually. This weekly fee does not include provision for items such as hairdressing, chiropody, dental or ophthalmic services. Prospective residents can be provided with information about the home by accessing the Service Users Guide, which will detail the services and facilities available at the home. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection conducted as part of the annual inspection process. The inspection lasted one day. The inspector sent questionnaires “Have your say” to all residents in the home prior to the inspection and twenty-nine were completed and returned. “Comment Cards” were also sent to relatives, visitors and visiting health and social care professionals, twenty-nine of these were also completed and returned. Information from these has been collated and is detailed throughout the report. The inspector spent time throughout the visit in discussions with the manager and staff; a number of records and files relating to the day-to-day running and management of the home were examined. Four residents were case tracked. Their care plans and care files were examined. The inspector had discussions with the residents and observed them going about their daily routines. The inspector toured the premises accompanied by the manager. Feedback was given on the outcome of the inspection. The inspector would like to thank the residents and staff who took part in the inspection. Their enthusiasm and support was greatly appreciated. The atmosphere in the home was warm in manner; staff were respectful, good humoured and sensitive towards the residents within a relaxed, calm environment. Staff demonstrated a very caring, committed attitude to their roles and responsibilities in ensuring they provide quality of care to the residents. What the service does well: Admission procedures are resident focussed and supportive to residents. Care plans accurately reflect the residents’ needs and how they will be met. Residents and their families are involved in this process wherever possible. Systems are in place to help ensure that there is consistency in assessing, planning, implementing and evaluating the resident’s care at the required times. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 6 Staff have a good awareness of individuals’ needs and treat the residents in a warm and respectful manner, which means that they can expect to receive care and support in a sensitive way. There are safe systems of medication. Residents benefit from a varied activities programme, which is both enjoyable, stimulating and meets individual preferences and expectations. Meals are well presented and menus verify a healthy well balanced diet for all residents who benefit from a wide variety of choice. The home is comfortable, tastefully decorated and furnished to a very high standard. It provides a safe, peaceful and well-maintained environment for the residents. The home has excellent resources and facilities including up to date aids and adaptations. This enables residents with disabilities to maximise their independence and to continue to pursue hobbies and interests that they had when they lived in their own homes. Adequate staffing levels help to ensure that resident’s needs are met. Staffing levels are increased should the dependency levels of the residents change. The recruitment procedure is robust and serves to protect vulnerable residents. The home is well organised and managed by an effective, stable management team that promotes the views and interests of the residents. The Garden House and The Sundials provide an excellent standard of care to its residents, who appear to be very happy with the service they receive and are content with their daily lives. What has improved since the last inspection? What they could do better: The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 7 All of the National Minimum Standards assessed at this inspection were met. No statutory requirements have been made as a result of this inspection. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents needs are assessed prior to admission to determine the suitability of placement. They can be confident that staff will have the resources and skills to meet their assessed needs. EVIDENCE: The inspector looked at four residents pre-admission assessments. The manager and a registered nurse explained the process and the documentation used. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 10 The prospective resident, family and carers are involved in the pre-admission assessment and all information is used to determine the suitability of the placement. Where possible the manager also obtains comprehensive assessments and care plans from other professionals involved for example, social workers and hospital staff. The assessments were comprehensive covering activities of daily living, a full health screen and personal history background. The information gathered preadmission should provide a sound benchmark of the resident’s ability and state of health prior to admission. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Because they are consulted about their health and personal care needs residents can be sure their views and expectations will be considered. End of life plans ensure that residents last wishes will be acknowledged and respected Safe systems help to protect residents from the risk of medication errors. Residents can be confident that staff have a good awareness of their needs and that they will be treated with dignity and respect. EVIDENCE: From the pre admission assessments the staff are able to develop a set of care plans based on identified needs. During the first months trial period the residents’ plans are reviewed weekly and developed accordingly. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 12 These plans are relatively new to the home and the staff had worked extremely hard in developing them with the residents. All plans were detailed and personalised including personal preferences, likes and dislikes. All records evidenced consistency in assessing, planning and evaluating the resident’s care on a monthly basis. The home conducts regular care review meetings for each resident, which includes the involvement of family members and key worker wherever possible. This allows the opportunity to discuss and evaluate residents’ care plans and any issues or concerns they may have. All relative/visitors comment cards agreed that they were kept informed of important matters affecting their relative/friend and were consulted about their care. Four residents care files were looked at in detail, including pre-admission assessments, care plans personal history profiles and risk assessments. Random care files are audited monthly by the registered manager and by the responsible person during their monthly unannounced visits to the home (Regulation 26 visits). Whenever possible residents/relatives had signed that the care plans had been discussed and that they agreed with the information, the aims and objectives contained in them. Personal history profiles on the residents were very useful and information obtained included details of the residents’ childhood, adolescence, fondest memories, favourite colours, flowers, smells and adulthood memories. The profiles enable staff to see the resident as an individual and gives them a better understanding of that person. It also creates topics of conversation, encouraging life review and reminiscence, which will have meaning to that individual resident. Risk assessments were in place with detailed information to ensure safe procedures for example, manual handling, the correct use of bed rails and how to reduce the risk of falls. All staff were able to demonstrate good relationships with individuals and were knowledgeable about the care needs of the residents living in the home. One resident stated in their survey, “The care and support we receive here is exceptional and the staff go beyond their duty to keep us comfortable and happy”. Records of the General Practitioner visits/contact with residents and the outcomes are also available. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 13 Specialist referrals and visits from other professionals were evidenced in care files including Community Chiropodists, Opticians and Dentists. Visiting health professionals comment cards stated, “This is the most caring professional home I attend. Residents in my opinion receive excellent treatment”, “The home has helpful reception staff to assist with enquiries” and “I have been visiting the home for twenty-five years, twice a week, the staff have always been helpful with organised systems for conducting my rounds”. In general residents’ surveys stated that they always felt that they received the medical support they needed. Comments included, “My doctor is always most helpful”, “The home doctor fulfils a good role” and “ I have only lived at the home for six weeks, however staff respond to all my requests concerning personal care and administrating medications”. The home has a Physiotherapy department with a hydrotherapy pool, which is open every day and staffed with two Physiotherapists and two assistants. Residents do not pay additional charges for this service. Besides offering sessions in the hydrotherapy pool the department is active in rehabilitation and therapeutic massage. The staff work closely with the nursing staff and have been actively involved in various initiatives such as a music and movement group and the development of a risk of falls protocol. Policies and procedures for receiving, storing, administering and disposing of medications were examined and discussed with the manager and staff on the Sundials unit; all systems in place are effective and well managed. The home operates a monitored dosage system for the administration of medication, which is supplied at regular intervals by the local pharmacist. The GP’s conduct a medication review for all residents every six months. The home also keeps an accurate stock check of medicines given on an as required basis. Fridge temperatures are recorded daily. The administration charts were legible and continuity of administration was shown with a signature from the person dispensing. Staff were seen knocking on residents doors before entering confirming respect for the residents individual privacy and dignity at all times. Members of staff spoke respectfully about residents needs and referred to them in the term of address that they preferred, this information was evidenced in the residents care files. Residents continue to speak warmly of the staff team and highly of the service that they provide. All rooms have a telephone point from which residents can make and receive calls. The manager and staff make every effort to establish resident’s wishes concerning palliative care and any provision residents and their families would wish for by developing end of life care plans. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 14 The manager explained that the plans are sensitively completed with residents and their families and significant others including the Chaplain. Plans are personalised and signed by the residents and a member of staff. The information sought is well thought out and should help ensure that residents’ choices are respected. One question asks, “What would you not like to happen in the event of ill health” and comments included, “I do not want to be admitted to hospital” and “I want to be pain free”. The homes annual audit showed that residents were particularly complimentary about the staff and the quality of care, comments included, “Everybody id kind and we have fun together. The staff make me laugh and they make me feel human” and “I cannot speak too highly of most of the care staff. They all have to deal with quite unpleasant personal jobs with a very good grace”. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents benefit from a varied activities programme, which is both enjoyable, stimulating and meets individual preferences and expectations. Encouragement from staff enables residents to maintain good contact with family and friends. Residents receive a varied and wholesome diet that they are able to influence. EVIDENCE: There does not appear to be any unnecessary rules in the home and it was evident that the homes philosophy centralises on empowering residents and encourages residents to maintain independence, autonomy and choice. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 16 Residents’ daily routines are flexible within the home, residents can get up and go to bed when they like, having their meals in their bedrooms, they can go out when they wish and participate in activities they have a particular interest in. This was confirmed through documentation in residents care files and in discussion and through observation during the inspection. It was evident that residents are supported to follow their hobbies and interests either independently or with assistance on a daily basis. A programme of events is available for residents weekly. Some residents access this information from the notice boards; some request that a programme is sent to them and others will ask the staff on a daily basis so that may arrange their days accordingly. All residents on The Sundials unit have access to all the amenities and facilities detailed below and supervision/assistance is given dependent on individual needs. All the activities arranged throughout the year are too numerous to list; however following a recent survey conducted by the home the residents’ were asked to list their favourites, which included, Desert island discs, name that tune, poems, arts and crafts, croquet, quizzes, music and movement, relaxation sessions and reminiscence therapy. Outings are also arranged and enjoyed by the residents and last year included visits to Chew Valley Lake, A Mystery Tour, Longleat and Tintern Abbey. The inspector received positive comments about the activities provided where residents stated, “They seem to offer a wide range of activities and I am able to participate in as much as I want to”, “There are wonderful music concerts, plays, talks from guest speakers, handicrafts and outings” and “There is an excellent and varied programme of events, including church services”. A number of residents attend daily Anglican services and there is a beautiful chapel in the grounds. It was apparent that opportunities to follow their faith are an important part of many residents’ lives and they are well supported. If residents are feeling unwell or for some reason they are unable to attend the services the home has introduced an innovative idea whereby a television link has been developed and the residents can now watch the service live on their own televisions on a selected channel. This channel is also available on the homes televisions in the lounge areas. Various concerts, plays and musicals are also performed in the chapel and these too are broadcast live so that residents can enjoy them in the comfort of their own rooms. There is also a film channel and a movie is played consecutively over a forty-eight hour period before another film is selected. Residents can make requests for a film they would like to watch. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 17 Besides the home organising residents meetings the residents have their own group meetings. Residents have formed an environmental energy saving group whereby they oversee an extensive recycling programme within the home. All people that either live, visit or work at the home are responsible for recycling items such as paper and tin cans. The members insist that the home uses recycled paper and in the recent minutes of one meeting the inspector noted that residents had requested that staff were more vigilant in turning off lights when rooms were not in use. Residents also represent The Garden House at “The Residents Amenity Fund Group”, which also has members from other residencies within the St Monica’s. Residents take it in turns to be part of this group and are elected through a formal process. The group relies on donations and fund raising events and ideas are put forward on how this money can be put to use effectively for the benefit of the residents. The residents have their own computer suite which is office equipped with printers, a laminator and a shredder. IT training is available to all residents who book their sessions every week. At present the residents have IT access in their bedrooms, however they have proposed that The Amenity Fund Group look at upgrading the system because they feel the system is too slow. The residents are invited to the homes “Residents Liaison Meetings”, which are held every other month. A letter is sent at the beginning of each year to all residents informing them of the dates and times for each meeting that will take place throughout the year. The letter also informs the residents about any guest speakers and staff who will be attending. A head member from each staff group for example housekeeping, catering and nursing attend. The letter states that a blank agenda will be placed throughout the home one week prior to the meeting so that residents can add items they wish to discuss. Refreshments are provided and there is a loop and sound system in operation for those residents with hearing impairment. The inspector looked at minutes for the meetings held, which evidenced a very good attendance. The minutes show that the residents are very proactive throughout the meetings and have ample opportunity to voice concerns, share information and put forward ideas. Anything that requires an action is handed to the relevant head staff member and the outcomes are discussed at the next meeting. There is an extensive library, with a large selection of fiction, non-fiction books, video sets, historical books and talking books to name a few. A librarian operates the library every afternoon for residents use and they can ask for books at reception if they have missed the set opening times. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 18 The home also has a salon and the inspector spent some time talking to the staff that work there. The salon is set up and operates just like a community based salon and is open five days a week. Residents book their own appointments and enjoy the socialisation of this service and the independence it provides. Lounges in the home provide good entertainment systems, including plasma screen televisions, video and DVD players, and musical systems. There are also two pianos in the home which residents enjoy listening to. On the day of the inspection volunteers, residents and staff were setting up stalls for the regular popular “shopping day”. Residents are able to come and buy various items at very reasonable prices that would normally be available at the local high street. The additional beauty of this service is that, the event is combined with a coffee morning where residents enjoy socialising with friends and catching up on any news. The home operates an open door policy for visitors. Residents are able to see visitors in the privacy of their rooms and there are several semi-private seating areas around the home and in the gardens. All relatives/visitors comment cards agreed that they are always welcomed by the staff when visiting. The inspector spent time throughout the two-day inspection observing mealtimes. In the Garden House, the dining experience is not dissimilar to going to a restaurant, whereby residents have menus and once they have selected their choice they can have their lunch brought to them by the waitress service. Alternatively they can go up to the counter and serve themselves. The size and layout of the dining room makes it possible for all residents to enjoy the social advantages of dining together and staff also have lunch with the residents. Staff had used their expertise and knowledge of the residents, personalities, preferences and ability to eat independently, when seating them for lunch. The dining room is light, spacious and the tables were attractively laid. Staff members supported residents that required assistance with eating their meals in a respectful, sensitive manner. Staff sat at the same level as the resident and assisted them without rushing. They were also seen to be polite and helpful when serving the meals. Residents had also chosen to receive meals in their rooms and one resident stated, “Freedom of choice to take lunch in ones room is much appreciated”. The food is home cooked offering various choices of hot and cold alternatives and fresh fruit is available at times. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 19 On the second day of the inspection the inspector had lunch with the residents and staff in The Sundials unit. This again was a relaxed social occasion and interaction between staff and residents was sensitive and supportive. There was some good light conversation around the tables, which was most enjoyable. On this particular day the menu was fresh juice or home made watercress and potato soup for starters, silverside of beef with a selection of vegetables and roast potatoes, cauliflower cheese with home made fish cakes and a large salad cart menu. A selection of puddings were also available. The housekeeping staff serve all meals and one resident stated in their survey that, “All housekeeping staff are eager to please”. Due to time constraints and his busy schedules a brief conversation took place with the chef and the kitchen assistants were indirectly observed going about their daily routines. The kitchen was well organised and seemed to run efficiently and effectively whereby all staff were aware of their designated tasks, roles and responsibilities. The chef was able to demonstrate an awareness of individual requirements and needs of the residents, including special dietary requirements and personal preferences. The 4-week menu rota displayed traditional meals and menus are reviewed to reflect seasonal trends and availability of produce. Extras are ordered on request for birthdays and special occasions. Any visitors to the home are welcome to stay for lunch. The kitchen was very clean and spacious. Stores exhibited a good range of foods. Food hygiene training was up to date for staff. Documentation was provided to show the inspector that required temperature checks were being carried out on fridges and freezers and that food was also being probed after being cooked before serving. Risk assessments were in place and up to date. The chef also attends the residents meetings and suggestions/comments with regards to the menus are appreciated. Minutes from the residents meetings evidenced this. In addition to this the homes annual quality assurance covers an audit of catering facilities provided. One resident stated in their survey, “Suggestions and comments are always listened to by the chef and our comments are accepted”. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There are robust and comprehensive policies in place to ensure that complaints by residents or their families are taken seriously and acted upon. There are good arrangements in place for staff training and awareness of protection of vulnerable adults so that residents are protected from abuse. EVIDENCE: The Garden house has a formal complaints procedure and the manager maintains a log of all concerns raised and actions taken to resolve them. This information is included in the service user guide and displayed on the home’s notice board. The manager has always kept the inspector informed of any ongoing complaints and has copied the inspector into her responses to the complainant and provided evidence on how things have been resolved. It is evident that residents are encouraged to voice their concerns at all times. All residents stated in the surveys that they knew who to talk if they were not happy and how to make a complaint. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 21 Comments included, “I would be happy to speak to the sister in charge”, “I would speak to the staff who are sympathetic and helpful” and “ I don’t normally have cause to complain but I would should the need arise, there’s a complaints form available”. There are procedures as well as a range of guidance information on the topic of protection of vulnerable adults from abuse’ including the Local Authority “No Secrets” document. The staff handbook and induction training provides education on topics for whistle blowing, management of aggression and bullying. The inspector was informed that the home actively promotes staff training and education in the protection of vulnerable adults on induction and on an annual basis the staff receive an update. Staff records evidenced this. A number of staff are also undertaking the National Vocational Qualification in care award, and a component of the award addresses issues around the topic of the protection of vulnerable adults from abuse. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well-maintained and is decorated and furbished to a very high standard. It provides a safe, homely, peaceful environment for all the residents. The home is a clean, pleasant and hygienic place for residents to live. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 23 EVIDENCE: The Garden House and The Sundials Unit are situated on a large estate near The Downs. The grounds are extensive and well maintained. There is a pond, accessible pathways for people who use wheelchairs and various seating areas with plenty of sun screening. Boarders are well established with an array of shrubs and trees are found throughout the grounds allowing for plenty of wildlife for residents to observe and enjoy. Flowerbeds had been planted with an array of colours and were full of polyanthus. The Sundials have recently opened an interesting meandering garden to assist the residents with dementia, allowing residents to explore which never comes to an end as it continues around in full circle. The design is excellent and as planting becomes more established the gardens should bring much enjoyment to the residents living there. Again these gardens allow for plenty of seating areas and a barbeque area was greatly enjoyed in the finer weather. Plans are now in place to develop raised flower and vegetable beds for the residents so that they may enjoy this as an activity. During the inspection the inspector saw the installation of a water feature including a soft running water fountain, this again should provide a relaxing feature for the residents to admire and enjoy. It is evident from the homes annual audit that the residents enjoy the surroundings, residents stated, “The lawns are beautifully kept. Flowerbeds are bright and colourful, trees and shrubs are well pruned. Everything is tidy and cared for with no litter or rubbish around. A joy to walk or sit in” and “Paths are wide and easy for wheelchairs. Lovely views with plenty of seats, sunny areas and shady areas. Water features, scented plants and wonderful trees”. Both homes are purpose built and as such it is fully accessible and has a number of aids and adaptations throughout the premises to enable physically disabled residents to maximise their independence. This includes wide corridors and pathways, overhead tracking for hoists, powered light switches, specialised bathing facilities, grab rails and assisted toilet facilities. The new wing incorporating the Sundials maintains the same specification as the Garden House, however due to the specialised needs of the residents who live there additional systems have been put in place to further ensure their comfort and safety. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 24 These include, sensor pads in the mattress, which will indicate to staff when a resident has got out of bed. When this happens an overhead light comes on so that the resident can see where they are going. This in turn will alert the staff as to whether the residents has got up to go to the toilet because an en suite bathroom light switches on automatically. When the resident gets back into bed all the lights will gradually fade and the staff are alerted that the resident is safe and back in bed. This is a wonderful system to allow and encourage independence for each resident yet ensures that their safety is continually monitored and not compromised so that staff can interact and assist whenever necessary. Despite various aids and adaptations throughout both the Garden House and the Sundials unit great attention has been given to ensure that all areas are homely. Residents are supported to personalise their bedrooms with pictures and ornaments and are able to bring items of furniture should they wish. All areas of the home are tastefully decorated, clean and well maintained, pictures and planting are throughout the homes corridors and communal rooms. All bedrooms are of generous size and have en suite facilities; rooms are lockable so that residents can maintain their privacy and keep their personal possessions secure. Overall residents expressed in the homes annual audit that the most important thing they liked about their accommodation was having their own bathroom and the privacy that this enabled them. One resident stated, “I have a lovely big room with a view. It is good to have a bathroom of my own”. As stated previously lounge areas are spacious and allow for many residents to be seated together enjoying the entertainment systems on offer. Residents were making full use of all these areas and their bedrooms on the day of the inspection. All residents stated in their surveys and in discussion with the inspector that the home was always clean and smelled fresh and pleasant throughout. Comments included, “The home is inexplicably clean and staff are well trained” and “The cleaning is excellent”. The homes annual audit showed that residents were very satisfied and appreciated the housekeeping services provided, one resident stated, “My room is kept beautifully clean and sweet smelling. There is an apparent endless supply of clean towels, sheets etc. Delightful, helpful, friendly staff”. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 25 The inspector had lengthy discussions with the head of housekeeping who was able to demonstrate a sound knowledge of the policies and procedures within the home and the residents who lived there. It was evident that he was confident and knowledgeable in ensuring that he and his staff team fulfilled their roles and responsibilities to the highest standards. As the head of housekeeping he explained that he was responsible for recruitment, induction, training, and supervision. In conjunction with the manager they have excellent systems in place to ensure that things run smoothly and that all requirements are met and maintained to ensure the highest standards that are achieved. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Adequate staffing levels help to ensure that resident’s needs are met. Residents are supported and protected by the homes recruitment policy. Staff are trained and residents can be assured that they will have the skills and resources to meet their needs. EVIDENCE: The manager ensures that staffing levels are indicative of the needs and levels of care required by the residents twenty-four hours a day and confirmed that levels of staff would rise should dependency levels increase. The home also has a steadfast group of volunteers on a daily basis. In general all twenty nine residents’ surveys agreed that staff were usually available when they needed them comments included, “There are many residents in the home so I understand why sometimes the staff are not able to give me immediate attention when called”, “Staff are very cooperative and help when they can” and “The staff have nursed me back to such an improved state of health”. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 27 Some residents felt that there were shortfalls in staffing during handover periods and when staff take their lunch breaks. The manager found these comments useful and at present she and her team are reviewing daily routines to try and alleviate such problems. A robust recruitment policy and procedure is in place and the files inspected showed all the appropriate documents and checks were in evidence. CRB (in full) disclosures are being retained until the inspector has examined them. Nurse PIN’s (in full) are validated annually. On recruitment staff are given a handbook, which contains, many of the homes policies and procedures including manual handling, health and safety and first aid. There is an induction programme, which covers all mandatory training, including Fire, Manual Handling, Health and Safety and the Protection of Vulnerable Adults. The home has a mentor system where all new staff are linked with and shadow a senior staff member during each shift to enable continuity and continued training throughout the induction process. The St Monica’s Trust provides the staff at the home with a vast amount of training and development opportunities tailored to individual needs. The manager and all staff are conscientious in attending training relevant to the care needs of the residents and those relevant to the roles they perform. This year courses will include, “Understanding Parkinson’s Disease”, “Working with Loss and Bereavement”, “Dementia Awareness” and “Wound Care management”. It was encouraging to hear that housekeeping and porters also access these courses and not just the care/nursing staff. Staff confirmed in discussions that they value the training they had received and what courses are available to them. The home continues to support their staff with their NVQ training. Staff records and the homes training matrix confirmed that training was up to date and future courses had been arranged. The manager and the trained staff also target courses each year for their professional development and attend refresher courses. These include, “Using Resources Effectively”, “Supervision and Appraisals”, “Understanding legislation in relation to Staff Recruitment”, Infection Control” and “The importance of Written Communication for Nursing Staff”. The scope of training offered to staff is impressive. Relatives comment cards expressed how pleased they were with the all aspects of the home, the staff and services provided. Residents stated in their surveys, “ I am very happy here I never dreamed that it was possible to have such a full and interesting life, living in one room and more or less confined to a wheelchair” and “St Monica’s in the best home in England, I would not want to live anywhere else”. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents’ needs and best interests are central to the management approach in the home. Good accounting methods are adopted and policies and procedures are followed correctly when handling residents’ personal money so that residents can be sure their finances will be managed correctly. Staff receive appropriate, effective supervision. The health and safety of residents, staff, and visitors is protected. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 29 EVIDENCE: The inspector spent two full days in the company of the manager Mrs McDermott who consistently demonstrated effective leadership skills within her role. Her vast knowledge and enthusiasm of the Trust, the home, the residents and all staff who work at the home was second to none. One resident stated, “The homes manager is an exceptional, gifted person and we could not do better”. Through observation and discussions it was evident that she is a team invigorator, engendering a productive positive atmosphere throughout the home. From discussions with the management teams and staff the home has a stable workforce that supports a commitment to providing quality care for the benefit of the residents. The management teams encourage innovation within staff teams and ideas that are generated are respected and actioned, which demonstrates an open and inclusive atmosphere. There was a high degree of satisfaction expressed by all of the residents, relatives and visitors who stated, “The Garden House is quire astonishing, I cannot think of anyway of improving it”, “The community spirit is delightful” and “It is a very friendly, well run home”. Based on all the comments made throughout this report and through the inspectors observation it is evident that the home is run in their best interests to ensure their needs are being met. As mentioned throughout the report the home has completes an annual audit to assess the satisfaction of residents with regards to the service that the home provides by asking residents to complete surveys. The results and comments from the surveys were generally very positive. Information from the surveys is collated and documented effectively. The results have enabled the home to identify strengths and weaknesses within the service they provide and are acted upon in their development plan for the coming year. Progress of any outcomes are discussed with the residents at their meetings. The policy and procedure for holding residents personal money was examined and four individual accounts were looked at. It was evident that good accounting methods are adopted which account for all transactions documented and receipts for sundries were available to see. Residents’ accounts are audited on a weekly basis. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 30 There is an annual appraisal process, which ties in with the supervision arrangements. The management and senior staff have established a formal recorded supervision procedure for all staff. A plan is devised for discussion relating to the residents, work issues, staff issues, personal development and training. The recorded outcomes of the supervision evidenced the effectiveness of the sessions with excellent record keeping and detailed accounts. The inspector spoke with a senior staff member stated that the sessions were rewarding particularly when discussing working practice and how this can be further developed. At the previous inspection the following requirements were made, ensure that fire alarms are tested weekly and emergency lighting is tested monthly, review record keeping in relation to fire tests/checks and review the workplace fire risk assessment. These requirements have now been met. Some of the Health and Safety records in the home were examined. Documentation showed that relevant checks were maintained correctly and at the required intervals including all fire alarms and equipment and emergency lighting. The homes records showed all necessary service contracts were up to date including, gas and electrical services and the passenger lift. The fire logbook evidenced compliance to the weekly, monthly and annual checks alongside records of staff training and drills completed, records clearly identified that all members of staff have been present during fire drills as recommended by the Fire Prevention Officer. All night staff undertake this on a three-monthly basis, and day staff six-monthly. The home has a portering service and the inspector spent some time discussing their roles and responsibilities with the manager if this service. The porters are responsible for providing many services, including transport requests, reception cover at weekends, low level maintenance, setting up for concerts and conferences etc, distribution of mail and morning papers and most importantly they are responsible for ensuring residents are secure in their home and within the grounds. There are nine members in the team, who provide security to the home twenty-four hours a day, seven days a week with constant surveillance. The homes annual audit confirmed that residents felt secure with the presence of the porters and the security at night. Also mentioned was the reception desk where visitors are required to sign in and out of the building. The head porter told the inspector that he has a happy committed team and that the residents’ appreciation makes it all worthwhile. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 31 The head porter is also responsible for ensuring that his team receive appropriate training and the required mandatory training, all of the porters had training in “Dementia Awareness”, “Customer Care” and “Lone Working” last year. The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 4 4 4 4 4 4 STAFFING Standard No Score 27 3 28 3 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 3 X X 3 4 The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Garden House DS0000046263.V316005.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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