Inspection on 06/10/05 for The Garden House

This inspection was carried out on 6th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 06/02/07

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 Sam Fox Unannounced Inspection 6th October 2005 09:30 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.V255867.R02.S.doc Version 5.0 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.V255867.R02.S.doc Version 5.0 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.V255867.R02.S.doc Version 5.0 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. 9th May 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. As such, there is a registered nurse on duty throughout any 24-hour period. In order to qualify for residence, individuals need to be baptised into the Church of England or one of the Protestant faiths. The home is situated on a 23-acre site of well established parkland on the edge of Durdham Downs in Bristol. Bedrooms are located on the first floor and are separated into two distinct areas, the Cedars and the Oaks. The premises was purpose built two years ago and thus is 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, computer room and hydrotherapy pool. The Garden House DS0000046263.V255867.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the home’s second unannounced inspection this year – the purpose of which was to check on progress made relating to previous requirements and recommendations and to examine key records. These included medication, training profiles and care plans. Another major focus was to speak with staff to find out about their experiences of working within the home. Nine members of staff were interviewed and some residents were consulted with. Their views will be included in the body of this report. Not all standards were assessed on this occasion and this report should be read in conjunction with other reports so that a fuller picture of the home can be gained. What the service does well: What has improved since the last inspection? The medication system has been reviewed and improved – it is therefore safer and the risk of errors has been reduced. The Garden House DS0000046263.V255867.R02.S.doc Version 5.0 Page 6 The home have begun to change the way in which they write care plans. Once complete, this should mean that the system is easier to follow and includes all the information needed to provide a consistent and personalised service. The home continues to maintain good standards throughout many areas of practice. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Garden House DS0000046263.V255867.R02.S.doc Version 5.0 Page 7 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.V255867.R02.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 There is sufficient information for residents to make an informed choice about moving to the home. They can be confident that staff will have the resources and skills to meet with their assessed need. EVIDENCE: The Garden House has a completed Statement of Purpose, which includes the home’s admissions procedure, complaints policy and the ethos of the home. This meets with the requirements of the legislation. There is also a service user guide which is written in a more user-friendly format and includes the facilities and services available. Residents are also given a “welcome pack” when they move in which includes further information that may be of use to them. The Garden House DS0000046263.V255867.R02.S.doc Version 5.0 Page 9 Three residents spoken with confirmed that they were given the above information and these were seen in the bedrooms at the time of the visit. They said that they felt they had enough information to make an informed choice about moving there. The admissions procedure states that qualified members of the staff team will carry out an initial assessment. If a resident is funded by social services they also receive an initial care plan. One senior member of staff explained how this process worked and said that the home tries to consult with families and health care professionals to get a complete picture of individual needs. The home has introduced a new care plan format which includes a proforma for carrying out the initial assessment – this will be looked at in more detail during the next inspection. The Garden House DS0000046263.V255867.R02.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9,10,11 Staff are sensitive to individual needs and residents can expect to be treated with respect. There are improved systems in place for the administration of medication which makes it safer. EVIDENCE: The home have recently developed a new care plan format and at the time of this visit staff were in the middle of transferring and reviewing all the information they had for each resident. They anticipated that this would take them a number of months. This is a positive development and should improve the standard and detail of care plans. Those that already exist do contain areas of need and how staff can support individuals to lead more fulfilled lifestyles. Each resident is allocated a co-keyworker who are named nursing care assistants who take more responsibility for ensuring they have what they need. Two staff spoken with about this displayed a good understanding of their roles and responsibilities in this respect. The Garden House DS0000046263.V255867.R02.S.doc Version 5.0 Page 11 The new care plans will be a focus of the next visit. Members of staff spoke respectfully about residents needs and referred to them in the term of address that they preferred. Residents continue to speak warmly of the staff team and highly of the service that they provide. When questioned they said that they felt they were treated with respect. A number of residents have their own telephone lines and were observed receiving and opening their own mail. The emergency call bell system has recently been updated. During this visit it was observed that two call bells had been pressed and not attended to for approximately five minutes. This was during a busy time in the morning and it was noted that this was the exception rather than the rule. No residents commented or complained that they felt they were kept waiting too long. The manager, however, did undertake to monitor response times. Each resident has a Waterlow risk assessment which identifies if they are at risk of developing pressure sores. The home has a number of specialist mattresses and beds – the former were being serviced at the time of the visit. At the last inspection one resident had a pressure sore. The manager said that this has since healed and that no one has any pressure sores. This is a positive development. The home operates a monitored dosage system for the administration of medication that is supplied at regular intervals by the local pharmacist. There were a number of errors noted during the last inspection. These have been rectified and standards for this have greatly improved. All records seen were found to meet with requirements of the legislation. The medication fridge was locked and the home have begun to develop individual medication profiles as part of the new care planning system. The Garden House have recently developed end of life plans which detail residents wishes in the event of their death. These also state in what circumstances they would want to go to hospital. This is good practice. In addition to the above the home is working with St Peters Hospice on a project which explores issues around death and dying. The Garden House DS0000046263.V255867.R02.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Residents can expect to be supported to lead active and interesting lifestyles of their choice. They receive a wholesome and balanced diet. EVIDENCE: The routines of daily living continue to be flexible within the home, residents can get up and go to bed when they like, have their meals in their bedrooms and go out when they wish. This was confirmed through discussion and observation at the time of this visit. There did not appear to be any unnecessary rules. A number of residents attend daily Anglican services and there is a chapel on site. It was apparent that these opportunities to follow their faith is an important part of a number of residents lives and that they value it. The Garden House continues to organise planned programmes of entertainment. There is a computer room with access to the Internet and a number of residents had been booked in to take courses about this. There are also pottery classes and a library. In addition to this the home is planning a trip to London. Residents have regular meetings and it was apparent that they are consulted with and influence the social activities plan through this. The Garden House DS0000046263.V255867.R02.S.doc Version 5.0 Page 13 Visitors are able to visit the home at any time and this was confirmed through discussion and observation. During this inspection one relative had travelled a long way and she joined her mother for lunch (it was also a celebration of her birthday). She said she was always made to feel welcome and pleased with the standards of care at the home. The manager explained that they do not handle finances and that residents either organise this themselves, use family representatives or have solicitors. This was confirmed at the last inspection through discussion with a number of residents. Residents also confirmed they could bring their own furniture with them and this makes their room more homely. Opportunity was taken to join residents with their lunchtime meal. There were three courses and a choice of main meal. Residents are asked to fill out a menu sheet which includes them choosing what vegetables they want. The meal was tasty and appetising. It was served in an unhurried manner. Some residents require assistance with eating and this was achieved in a sensitive and dignified manner. There were plenty of staff available to provide assistance. Opportunity was taken to talk with a catering assistant. He displayed a good knowledge of residents’ food preferences. He also confirmed he had basic food hygiene training. The Garden House DS0000046263.V255867.R02.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Residents can be confident that their concerns will be listened to and acted upon. 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 includes in the service user guide and displayed on the home’s notice board. Residents spoke of regular meetings they attend and it was clear that these gives them a real opportunity to comment upon and influence the running of the home. All those residents consulted with spoke openly about the service they received and did not appear to be afraid to speak their minds. Some had concerns but felt confident that these would be dealt with if they bought it to the attention of the manager. There continues be an open atmosphere. The Garden House DS0000046263.V255867.R02.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,26 Residents continue to benefit from a clean, accessible and well-resourced environment. EVIDENCE: All of these standards have remained the same since the last inspection. The Garden House is situated on a large estate near The Downs. The grounds are well maintained and there is a pond and accessible pathways for people who use wheelchairs. There are also raised flowerbeds. The Garden House is 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 Garden House DS0000046263.V255867.R02.S.doc Version 5.0 Page 16 The home is planning to have a major extension and residents have been consulted with about this. One resident wrote a list of issues that may wish to be considered whilst it is being built. This was passed on to the manager. Bedrooms continue to be personalised and to reflect individual tastes. All have an ensuite facility and are lockable so that residents can maintain their privacy and keep their personal possessions secure. There is a glass panel overlooking the staircase which may cause some disorientation for residents who have a visual impairment. Residents’ opinions have been sought about this during a recent meeting. No changes have arisen as a result of this. One resident pointed out that the wood stained door and frames leading on to her patio had been weathered and it is recommended that these be revarnished. The home is kept clean to a high standard and the senior housekeeper was commended for this. She was consulted with in depth and said that she enjoyed working at the home. She said that she was always given the equipment and resources to keep the home clean and confirmed she had received training about the Control Of Substances Hazardous to Health (COSHH). There were no unpleasant smells and residents continue to be satisfied with the laundry service. The Garden House DS0000046263.V255867.R02.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Staff are well trained and residents can be assured that they will have the skills and resources to meet their needs. The recruitment procedure continues to be robust which protects vulnerable residents. EVIDENCE: Staffing rotas indicated that there are eleven nursing care assistants on duty in the morning and two registered nurses. They are split between the two “wings” of the home. This reduces to four on each side in the evening. In addition to this there are numerous ancillary staff, including housekeepers, catering assistants and porters. These levels are adequate to meet the needs of those residents currently accommodated. A report was received of the training that staff have had during this year. These include a variety of subjects ranging from a Parkinson’s update to equality training and diabetes awareness. The scope of training offered to staff is impressive. All staff spoken with were pleased with the opportunities to train. Without exception all had achieved or were about to be registered to take their National Vocational Qualifications. The Trust provides good levels of support for staff in this respect. The Garden House DS0000046263.V255867.R02.S.doc Version 5.0 Page 18 A positive development since the last inspection has been the introduction of Continued Professional Development (CPD) files that included training profiles, copies of induction and certificates. These are relatively new and some contained more information than others. The manager explained that they are encouraging staff to take responsibility for their own portfolio. Opportunity was staken to view two staff personal files (one of whom was for a new member of staff) these continue to be well organised and evidence that the home has a robust recruitment procedure. They included completed application forms, references and CRB checks. In addition to the above the personnel files included probationary reports, employees handbooks and contracts. There are clearly good systems in place to inform staff of their terms and conditions. The Garden House DS0000046263.V255867.R02.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,35,38 The home is well run and residents are protected by effective health and safety policies. EVIDENCE: All staff spoke positively about the manager and said that she was approachable and supportive. It was apparent that she was held in high regard. Systems are well organised. No finances are held on behalf of residents. All fees are paid by direct debit. All staff spoken with said that they receive formal supervision at regular intervals and that they found this a useful process. Whilst minutes of meetings confirmed this some were not written to sufficient detail. This is an area for continuing development. The Garden House DS0000046263.V255867.R02.S.doc Version 5.0 Page 20 All staff spoken with confirmed that they had received their statutory training of first aid, manual handling and fire. The home has monthly health safety audit checks from which reports with action points arise. The latest one of these was seen and this is a thorough and detailed check of the entire premises. It was difficult to establish from the home’s fire log book whether tests and checks of the system were taking place at the appropriate intervals and there were some parts of the log that did not appear to be filled in correctly. Action needs to be taken to review and improve record keeping in this respect. It also appeared that there was only one weekly test of the alarms in August and that monthly checks of the emergency lighting were either not being carried out or not recorded properly. The home has a workplace fire risk assessment dated 1\10\03. This should be reviewed on an annual basis. The Garden House DS0000046263.V255867.R02.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 4 4 4 4 4 4 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x 3 x x 2 The Garden House DS0000046263.V255867.R02.S.doc Version 5.0 Page 22 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. 1 2 3 Standard OP38 OP38 OP38 Regulation 23(4) 23(4) 23(4) Requirement Timescale for action 30/10/05 Ensure that fire alarms are tested weekly and emergency lighting is tested monthly Review record keeping in relation 30/10/05 to fire tests and checks Review workplace fire risk 30/10/05 assessment RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP36 OP19 Good Practice Recommendations Improve recording of formal supervision Re varnish wooden external doors The Garden House DS0000046263.V255867.R02.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Garden House DS0000046263.V255867.R02.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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