Inspection on 09/11/05 for The Garden House

This inspection was carried out on 9th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 17/02/10

The Garden House 21/12/09

The Garden House 02/06/09

The Garden House 11/05/07

The Garden House 14/06/06

The Garden House 27/02/06

The Garden House 20/10/04

The Garden House 08/06/04

Similar services:

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Snydale Care Home

Hawkhills

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Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

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

CARE HOMES FOR OLDER PEOPLE The Garden House 24 Humberston Avenue Cleethorpes North East Lincs DN36 4SP Lead Inspector Ms Matun Wawryk Unannounced Inspection 9th November 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 DS0000038376.V260732.R01.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 DS0000038376.V260732.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Garden House Address 24 Humberston Avenue Cleethorpes North East Lincs DN36 4SP 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) 01472 813256 Worcester Garden (No 2) Ltd Tina Goodwin Care Home 44 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (44), of places Physical disability (10) The Garden House DS0000038376.V260732.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th October 2004 Brief Description of the Service: The Garden House is a 44-bedded care home set in an exclusive area of Humberston, near the towns of Grimsby and Cleethorpes. The main house is in the style of an old manor house and retains many of its original features. The previous owner added a sympathetically designed extension in the grounds. There is ample car parking space and a well-designed and colourful garden. The home provides care for those with problems of old age and will take permanent, respite and emergency admissions. Some rooms have en-suite facilities, but there is ample bathroom and toilet facilities positioned around the home. There are several sitting rooms and a large dining room. All areas, including the gardens are accessible for wheelchair users. The owner of the home and the company secretary make frequent visits to the home. Staff working in the home are encouraged and supported to share ideas with the sister home in the Bristol area of the country. The management team have put together an extensive training programme for staff, using in house expertise, visiting trainers and outside courses. The home does not offer nursing care. Service users health needs are met with the assistance of other health care professionals for example general practitioners and district nurses. The Garden House DS0000038376.V260732.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place on the 9th November 2005. The Inspector spoke to the manager and three care workers who were on duty at the time of the inspection. Throughout the day the Inspector spoke individually to six people who lived in home. In addition the inspector also looked at a range of paperwork in relation to staff recruitment, induction, supervision and training, the staff rota, a sample of care plans and activity records. The Inspector completed a partial tour of the building. What the service does well: What has improved since the last inspection? The Garden House DS0000038376.V260732.R01.S.doc Version 5.0 Page 6 The manager had tried to make sure some of the things that needed to be done since the last inspection had been carried out. The manager had improved arrangements for recording income and expenditure for the service users amenity fund. Amenity fund money is used to pay for outings, meals out etc. Changes introduced by the manager now means the home maintains proper records. The manager had looked at the homes polices and procedures for the running of the home to ensure these meet legal requirements. The manager had completed a management-training course to enable her to further develop her management skills and knowledge. This was needed to meet legal requirements. What they could do better: All service users must have their needs properly assessed prior to admission to the home. Assessment reports must be updated if the service user’s needs change. This is needed to ensure the home is able to provide the necessary care and support. All service users must have a care programme and these must be kept up to date. This is needed to ensure staff know how to support service users from the date of admission and to ensure staff are able to provide the service user with the right care. Proper checks must be carried out on staff before they start work to ensure the protection of service users. Staff must be provided with more regular supervision to ensure staff are provided with guidance and information and to ensure staff are supported properly. Please contact the provider for advice of actions taken in response to this The Garden House DS0000038376.V260732.R01.S.doc Version 5.0 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Garden House DS0000038376.V260732.R01.S.doc Version 5.0 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 DS0000038376.V260732.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 Information provided to prospective service users and their carers is detailed thereby enabling them to make informed decisions about whether the home can meet their needs. Service users must have their needs assessed prior to admission to the home. This is needed to ensure the home is able to provide the necessary care and support. EVIDENCE: The home had a statement of purpose and service user guide. Both these documents include all information set out in National Minimum Standard 1, Regulation 5 and Schedule 1 of the Care Homes Care Regulations. The inspector saw evidence that the guide was routinely issued to new service users and/or their carers. The Garden House DS0000038376.V260732.R01.S.doc Version 5.0 Page 10 The inspector examined the care records for two recently admitted service users, one of whom had recently died. There was no evidence to show a needs assessment had been completed for one of the service users, the needs assessment for the other service user was very brief and had not been updated following admission to reflect all identified needs. In the absence of a local authority needs assessment the registered person must ensure needs assessment are completed, where necessary assessments reports must be updated to reflect changes in the service users circumstances and needs. Without this there is no assurance that the home is able to provide necessary care and support. From records seen there was no evidence to indicate the manager formally wrote to potential service users following the assessment stating that the home was able to meet their needs. This must now happen. This is needed to meet legal requirements. The inspector checked the care records for one service users who was self funding. There was no evidence that a contact/ statement of terms and conditions had been issued to the service user. The manager was spoken to about this matter. It was agreed the manager would confirm to the Commission whether a contact had been issued. Confirmation had not been received at the time of issue of the draft report. The registered person must ensure contacts are provided to all self-funding service users. This is needed to ensure service users and their carers are fully aware of contractual obligations and expectations of care to be provided. The Garden House DS0000038376.V260732.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 10 Care plans did not consistently include all the information staff need to meet the service users assessed needs. The absence of important information potentially puts service users at risk and means their care and health needs may not be met. Personal support is offered in such a way as to promote and protect the service users right to privacy and dignity EVIDENCE: The Inspector examined four care plans and the quality and quantity of information varied. One care plan was comprehensive with all areas of assessed needs covered. The care plan for another service user had not been updated to reflect the service user was now bed ridden and had been for some months. Two recently admitted service users; one of who has since died did not have a care plan. Records indicated one of the service users had pressure areas to his heels and buttocks and was receiving regular district nursing support. A water Low assessment had not been completed and there was no care plan for skin integrity. This is unacceptable, as staff need to know how to support service users from the date of admission. Care plans must be updated The Garden House DS0000038376.V260732.R01.S.doc Version 5.0 Page 12 to reflect changes in circumstances and needs. This is needed to ensure staff are provided with sufficient information to deliver all the care that’s needed. The home had a range of risk assessment in place and there was evidence these were subject to regular review. The Garden House DS0000038376.V260732.R01.S.doc Version 5.0 Page 13 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 & 15 Service users are encouraged and supported to maintain family links and friendships. The meals in the home are good offering choice and variety. EVIDENCE: Staff reported that service users visitors are made welcome at any reasonable time. Visitors are required to sign in and out when entering and leaving the home for health and safety reasons. The home does not provide a separate visitors room. However the home provides a variety of communal space, which visitors can use in addition service users entertain visitors in their own rooms. Key workers helped service users to maintain family contacts by sending cards at significant occasions such as birthdays and Christmas where this was needed. This means service users are enabled and supported to maintain family contacts. This was confirmed in discussions with service users. The home provides service users with three meals a day and a light supper. Staff advised the inspector that hot drinks are available at set times and or on request. This was confirmed in discussions with service users. All of the service users spoken to said the meals were good and that choice of meals was provided. The Garden House DS0000038376.V260732.R01.S.doc Version 5.0 Page 14 The Garden House DS0000038376.V260732.R01.S.doc Version 5.0 Page 15 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 The home had a satisfactory complaints procedure. Service users, their relatives and staff can be assured their complaints will be listened to and acted upon. EVIDENCE: The complaints procedure is clearly set out in the service user guide and timescales for resolution and contact details are provided. Feedback from discussions with service users and staff evidenced they would feel confident in making a complaint if this was necessary. This means complainants can be assured their complaints and concerns will be listened too and acted upon. The Garden House DS0000038376.V260732.R01.S.doc Version 5.0 Page 16 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, 21 & 26 The home was clean and was free from mal-odours. Service users bedrooms were found to be safe, homely and furnished with their own possessions to varying degrees. EVIDENCE: The inspector carried out a partial tour of the home. A full tour of the premises will be carried out at the next inspection. The home appeared clean and tidy and had a welcoming and homely feel. The home met the requirements of the local environmental health and fire departments. There is ample car parking facilities and CCTV is not used in the home or grounds. Service user bedrooms seem were personalised according to individual preferences. All of the service users spoken to stated they were very happy with their rooms. All commented that they had everything they needed. The Garden House DS0000038376.V260732.R01.S.doc Version 5.0 Page 17 The Garden House DS0000038376.V260732.R01.S.doc Version 5.0 Page 18 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 & 29 Staffing levels are sufficient to meet the needs of service users. The arrangements for recruiting staff must improve. This is needed to ensure staff are properly vetted before they commence working in the home to ensure the protection of the service users. Without this service users are potentially placed at risk. EVIDENCE: Staff interviewed were very clear about their roles and responsibilities and understood the management and reporting structures for the home. Feedback from staff and examination of the rota indicates staffing levels are generally satisfactory. The inspector examined a sample of staff personnel records. Records showed recruitment practice was not in line with regulation 19 of the Care Homes Regulations. For example, one staff member had had her Criminal Records Bureau (CRB) check completed by a previous employer. A POVA 1st check had not been sought. A new CRB check had been sent for but had not been obtained prior to the worker commencing employment. Records for three workers showed two workers commenced working in the home prior to a POVA 1st check. CRB checks for these workers had been obtained after they commenced employment. Similarly records for one worker showed a POVA 1st check had not been carried out, a CRB check had been requested but at the time of the inspection had not received. Records for one worker showed one The Garden House DS0000038376.V260732.R01.S.doc Version 5.0 Page 19 written reference had been obtained after they commenced working in the home. This practice potentially puts service users at risk and must cease. The inspector advised the manager that CRB checks are not portable. The registered person must ensure staff do not commence working in the home unless a POVA 1st check has carried out or a satisfactory CRB check and two written references have been obtained. The Garden House DS0000038376.V260732.R01.S.doc Version 5.0 Page 20 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): 36 Staff must be provided with more regular supervision to ensure staff are provided with necessary guidance and support and to ensure proper management oversight of the home. EVIDENCE: The inspector examined a sample of staff supervision records. These indicated staff had not been provided with supervision as a minimum of six times a year. Records showed staff had had an annual appraisal. The registered person must ensure staff are provided with formal and regular supervision. This is needed to ensure staff receive necessary guidance and support and to ensure proper management oversight of the home. This remains an outstanding requirement from the last inspection and must now happen. The Garden House DS0000038376.V260732.R01.S.doc Version 5.0 Page 21 The Garden House DS0000038376.V260732.R01.S.doc Version 5.0 Page 22 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 2 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 2 X X The Garden House DS0000038376.V260732.R01.S.doc Version 5.0 Page 23 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 Standard OP36 Regulation 18 Requirement The registered person must ensure supervision programmes comply with NMS 36 and is linked to the training programme. Timescale of 28/11/03 and 20/3/05 not met The registered person must ensure all service users are provided with a contact/statement of terms and conditions The registered person must ensure a needs assessment is completed for all service users prior to admission. Assessment reports must be updated to reflect changes in circumstances and needs The registered person must write to potential service users or their representative following the assessment stating the home is able to meet their needs. The registered person must ensure all service users have a care plan. Care plans must identify all care needs. Care plans must be updated to reflect changing needs and DS0000038376.V260732.R01.S.doc Timescale for action 31/03/06 2 OP2 5 14/12/05 3 OP3 14 14/12/05 4 OP3 14(1)(d) 14/12/05 5 OP7 15 14/12/05 The Garden House Version 5.0 Page 24 6 OP29 19(1)(b) 7 OP29 19(1)(b) circumstances The registered person must ensure staff do not commence working in the home unless POVA 1st checks have been completed or a satisfactory CRB check has been obtained The registered person must ensure staff do not commence working in the home until two satisfactory references have been obtained 14/12/05 14/12/05 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 DS0000038376.V260732.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 DS0000038376.V260732.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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