Inspection on 15/11/07 for The Gardens Nursing Home

This inspection was carried out on 15th November 2007.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Gardens Nursing Home 27/11/08

The Gardens Nursing Home 20/11/06

The Gardens Nursing Home 23/01/06

The Gardens Nursing Home 16/09/05

The Gardens Nursing Home 07/01/05

The Gardens Nursing Home 20/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOME ADULTS 18-65 The Gardens Nursing Home High Wych Road Sawbridgeworth Hertfordshire CM21 0HH Lead Inspector Claire Farrier Unannounced Inspection 15 &19 November 2007 11:30 th th The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 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 Gardens Nursing Home DS0000019570.V358766.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 Adults 18-65. 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 Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gardens Nursing Home Address High Wych Road Sawbridgeworth Hertfordshire CM21 0HH 01279 600201 01279 721297 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) Ramsay Health Care Investments UK Ltd Janet Helen Usedon Care Home 54 Category(ies) of Old age, not falling within any other category registration, with number (2), Physical disability (54), Physical disability of places over 65 years of age (54), Terminally ill (54), Terminally ill over 65 years of age (54) The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th November 2006 Brief Description of the Service: The Gardens is a care home with nursing, providing accommodation and care for 54 adults with a neurological disorders and physical disabilities as a result of acquired brain injuries. It is owned by Capio Healthcare UK, which is a private company. The home was opened in January 1992 and consists of a two-storey purpose built building. It is situated in a complex of Capio services that includes a private hospital, The Rivers, and another home, The Jacob Centre. The home is located in a rural setting on the outskirts of Sawbridgeworth, not far from the outskirts of Harlow. There is a shop for the residents of The Gardens and The Jacob Centre, situated in The Jacob Centre, and a pub that also serves food across the road from the Capio complex. Other community amenities, including shops, banks, cafes and leisure facilities, can only be accessed by use of the homes transport. All the bedrooms are single with en-suite facilities. There is a passenger lift. The home has a patio garden accessed from the ground floor dining room. The home is fully accessible for the residents. The Statement of Purpose and Service Users Guide provide information about the home for referring professionals and prospective clients. The current range of charges was not available on this occasion. The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We spent one day at The Gardens, and the people who live there and work there did not know that we were coming. The focus of the inspection was to assess all the key standards. Some additional standards were also assessed. We talked to as many of the people who live in the home as we were able to. We also talked to some of the staff. When we were in the home we looked at the records and care plans, and we made a tour of the premises. We made a second visit to the home a few days later so that we could talk to the manager about what we had seen during the inspection. The manager sent some information (the Annual Quality Assurance Assessment, or AQAA) about the home to CSCI, and her assessment of what the service does in each area. Evidence from the AQAA has been included in this report. Following this inspection Ramsey Healthcare has taken over The Gardens. At the time of the inspection Capio Healthcare was still the proprietor. What the service does well: The AQAA stated, “Through care standards and the inspection process, CSCI has supported our development as a service and the model and culture we believe in. Based on research and stakeholder feedback we are providing a unique and much needed service. The uniqueness relates to the client group we support within the service model we provide and the outcomes we achieve. Important aspects include the extent of skills and expertise we have within the service, the can do and never say never culture of the service and our drive to continually develop and improve (the service, the residents, the staff, etc). “We regulalry receive positive feedback from residents, relatives, staff, funders and a wide range of external professionals. The feedback relates to the outcomes we achieve (which frequently exceed all expectations), the cost effectiveness of the service (relative to alternatives which either cost considerably more and/or are unable to achieve the same outcomes), the culture and conduct of the service (e.g. homely, friendly, caring, supportive, professional, capable, empowering, holistic). An example of this is a relative of a newly admitted resident raised concerns about an NHS hospital where his wife was treated and the difference in her and the way she has been treated since she came to The Gardens. He felt that we offer much better value for money than the NHS where hands on care was concerned.” The home provides a good quality of personal care and health care. There is good relationship between the staff and the people who live in the home. The staff are aware of each person’s individual needs and preferences, and they support them to make appropriate choices and decisions about their lives in The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 6 the home. Almost everyone who we spoke to said that they are happy in their home. What has improved since the last inspection? What they could do better: Many of the residents could be, and should be, capable of setting and monitoring their own goals for what they want to achieve. However only one of the care plans that we saw has been written in a person centred way, that shows how each person has been involved in making decisions and planning their own care. In the others there is no obvious indication of the involvement of the residents in writing and monitoring their own care plans. Some care plans were not fully completed, so that they provide clear information for staff on each person’s current needs. In one care plan a risk assessment stated that Capio staff are not willing to accept responsibility for any possible injuries. This disclaimer is totally inadequate as a risk assessment and plan for managing the person’s care safely. There is no risk assessment for reducing the risk to people in the home from the hot surfaces of the hot food trolleys. Some of the staff are not fully aware of the home’s procedures for storage of cleaning chemicals. Medication is not recorded in a way that makes it possible for an accurate audit tot be carried out, and the storage and stock control of medication on the first floor is very disorganised. As a result, there is a risk that people may not receive the medication that is prescribed for them. The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 7 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 Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has sufficient information on residents’ needs and access to appropriate services to enable their needs to be met. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) stated, “We undertake thorough, holistic pre-placement assessments by gathering written information from all parties involved, visiting the prospective resident and assessing them in person. These assessments are undertaken by experienced qualified practitioners - nurses, physiotherapists and our consultant in Neuro Rehab. They are designed to provide information on which to judge the suitability of the placement (e.g. ability to meet the persons needs, fit with other residents, etc) and to ensure teams are able to prepare appropriately for admission. Steps are taken to ensure that the necessary equipment is in place including specialist and individual equipment.” We looked at the assessments of five people who have moved into the home since the last inspection. Each person had a comprehensive assessment from the home or hospital from which they moved to The Gardens. The Gardens’ own assessment is a basic checklist of each person’s needs, with some additional details. But together with the other service’s assessment, these The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 10 provide sufficient information to show that the home can provide appropriate services to meet each person’s needs. Care plans are written from the information in the assessments, and the assessments and care plans provide appropriate information so that the staff can meet each person’s needs. The assessments include risk assessments for moving and handling, the risk of falls and pressure area care. Other assessments are also carried out when appropriate, for example for special seating and for the use of restraint in the form of wheelchair straps. The residents who we spoke to feel well cared for and have confidence in the ability of the staff to understand and meet their needs. Capio has introduced a new web site address that takes you directly to Neuro Services. On the website they have added some 360 degree photographs of the centre to help those who are unable to visit to get a clearer idea of what it is like. Many of the people living in the home have varied and complex needs, including a group of people with learning difficulties. These are young people who had previously been based in a residential school and now require continued health support in adulthood. The learning disability is secondary to their long term neurological conditions. Both the nursing and the care staff have access to a good training programme that includes training on specific conditions, including an understanding of neurology, epilepsy and learning disability, and specialised techniques including tracheotomy care and PEG tube feeding. Most of the residents who were spoken to feel well cared for and have confidence in the ability of the staff to understand and meet their needs. The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who live in the home said that they feel involved in decision making in the home. However there is little indication that most people are involved in writing and reviewing their care plans, in line with the principles of person centred planning (PCP). EVIDENCE: The Annual Quality Assurance Assessment (AQAA) stated, “We actively support individuality and the freedom to be who you are and achieve whatever you want/can.” “All residents have an individual holistic care plan based on an assessment of needs, risks, preferences and aspirations. Residents and relatives are involved in the process of planning and reviewing the care plan and care programme and provided with copies/access where wanted/appropriate. In addition, we hold regular multidisciplinary reviews and regular case reviews (involving the resident, relatives and internal and external professional involved).” The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 12 We looked in detail at the care plans of six people. The information on each person’s needs is detailed and clearly written. However not all personal care needs are recorded from the resident’s perspective. Only one of the care plans that we saw have been written in a person centred way, that shows how each person has been involved in making decisions and planning their own care. In the others there is no obvious indication of the involvement of the residents in writing and monitoring their own care plans. The information on meeting the person’s needs is written from the point of view of the staff, rather than that of the person concerned. For example, “Encourage appropriate attire, encourage mouth care, ensure privacy and dignity.” Many of the residents could be, and should be, capable of setting and monitoring their own goals for what they want to achieve. For example, one person told us that they want to move from The Gardens, either to the sister home, The Jacob Centre, or to live independently in their own home. This has been discussed with the person, with the reasons why this is not possible at the moment. However there is no evidence in the care plan of this discussion, and of how the person may be able to take some responsibility for achieving their goal. One person had lived in the home for a month at the time of this inspection. The care plan was not fully completed: it made reference to some guidelines in the pre-admission assessment, but there was no information on daily life, and no input from the person of their wishes and preferences, or plans for the future. The care plan for a person who has pressure ulcers had no care plan for pressure area care, detailing the procedures to be followed. (See Personal and Healthcare Support) The care plans are reviewed regularly, with a monthly evaluation. Any changes needed are written in the evaluation, but the care plan remains unchanged. In some cases this may be confusing. Care plans should be written so that they provide clear information for staff on each person’s current needs. The AQAA stated that the home is in the process of revising the assessment and care planning guidance and documentation to incorporate further evidence based tools and also to try to streamline and simplify the paperwork. There are appropriate risk assessments that provide procedures and safeguards to enable people to take part in the choice of activities safely. Each person has assessments for moving and handling and pressure areas as appropriate. However one person has a risk assessment for the person’s relative assisting them to transfer without staff supervision. This states that Capio staff are not willing to accept responsibility for any possible injuries. This disclaimer is totally inadequate as a risk assessment and plan for managing the person’s care safely. The residents spoken to said that they are able to make decisions about their lives in the home, and the staff encourage and support them when needed. There are regular residents’ meetings, and advocacy is available in cases of individual need from an independent advocacy service, PowHer. The residents can choose whether to look after their own money or to give it to the home for The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 13 safekeeping. The administration office in The Jacob Centre manages the finances. The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Most of the people who live in the home are supported to live full and active lifestyles, but some people are not able to participate fully. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) stated, “Residents are facilitated to participate in as many activities as possible and in accordance with their individual preferences and aspirations. Examples include shopping, theatre, cinema, football matches, visiting places of interest, sailing, canal boating, carriage driving, etc - all of these activities are equally available for those who are ambulant and those who are wheelchair users. We have two adapted mini-buses and full time activity co-ordinators for both internal and external activities. Residents and relatives are able to use the sensory room, which can contribute to stimulation and/or relaxation. We have aromatherapy massage available in house and facilitate residents wishing to access external services such as acupuncture. Residents nutritional requirements are The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 15 assessed with involvement of the dietician and speech and language therapist as appropriate. There are a range of menu choices each day and individual preferences and dietary requirements are catered for. Where residents are unable to make their own menu choices, relatives are consulted/involved. Residents and relatives are asked for feedback regarding the menus on a regular basis and adjustments made as appropriate. Equally, there is a system in place for residents to express their views without being asked. “We have been able to facilitate more external activities by increasing the number of available drivers. We have improved our regular in house events to benefit both adults and children. For example, having a children’s entertainer (which the adults often enjoy just as much!) and having dressing up competitions (relative to the theme of the event) with both child and adult prizes. The impact of this has been that children see the centre as fun, not daunting. Many of our residents have young children or young grandchildren and in a number of cases, this has improved their contact with them. We have undertaken activities to promote healthy eating and balanced diets, including a promotional week recently featuring relevant activities and information. “What we could do better is to develop our knowledge of what is available for our client group in terms of education and occupation.” During our visit to the home we saw a discussion taking place on the ground floor with a number of residents and staff about arrangements for Christmas. The activities co-ordinator was not in the home at the time, and there were no other activities taking place during the day. The staff that we spoke to said that on the ground floor everyone is involved in their choice of activities, as described in the AQAA. However one said that the staff on the first floor have no time to do anything except for personal care. There is a programme of activities on the first floor, but many people do not take part in any of the arranged activities. The care plans that we saw have poor details of each person’s wishes and aspirations for education and social activities. One care plan had a plan for the activities and education that the person wished to take part in, but there was no evidence that they were happening. The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who live in the home are confident that they will receive a good quality of personal care and healthcare. Poor auditing and storage of medication means that there is a risk that people may not receive the medication that is prescribed for them. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) stated, “We provide individualised programmes of care, therapy and support based on residents’ needs, wishes, preferences and aspirations. The centre is multidisciplinary and includes qualified and experienced practitioners in nursing and care, physiotherapy, speech and language therapy, dietetics, tissue viability, psychology, activities and pharmacy technician. We also have an experienced GP who visits the service daily (usually morning and afternoon/evening), provides on call cover 24/7 and has a surgery registered at the centre specifically for our residents. We have a consultant in neuro rehab who works with us at least one day per week and is directly involved in all pre-admission assessments. The regional rehab team from Northwick Park visits monthly to provide outreach support. A specialist wheelchair seating service from Stanmore Hospital visits weekly to provide assessment, reassessments and The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 17 individualised seating systems. We have encouraged and facilitated residents and relatives to train staff e.g. in particular aspects of care and/or individual preferences. “The centre has staff with the appropriate skills, experience, knowledge and commitment to provide sensitive and effective palliative care. This includes effective pain assessment and control, attending to individual needs and wishes, supporting families through the palliative care and end of life stages. Equally, staff and other residents and relatives are offered support through this time. Training in this area is provided and support from external professionals obtained when required.” The home provides care for service users with a high level of need, including tracheotomy care and PEG feeding. There are four trained nurses on duty in the home throughout the day, and three during the night. The home has a physiotherapy gym and a team of physiotherapists. The care plans that we saw provide generally good details of each person’s needs for personal care and health care. The treatment and monitoring of pressure sores is recorded appropriately. However we asked for an example of a care plan for a person who has pressure ulcers. The care plan that we were shown had appropriate recording of the pressure area care, and progress notes and reviews record improvements. But there was no care plan for pressure area care, detailing the procedures to be followed. Most of the people we spoke to said that the staff provide good personal and nursing care, and that they are confident that they can meet their needs. One person who has a tracheotomy is not confident that the staff have the skills to meet their needs, especially in an emergency. However evidence was seen that the staff have had training in the procedures, and the nursing staff are competent to deal with emergencies. The Annual Quality Assurance Assessment (AQAA) stated that in the last twelve months, “We have improved our medication processes and practices. Most RNs have now completed a BTEC in medicine management. We have a pharmacy technician who audits all medicine supplies every 4 weeks and generates orders for repeat prescriptions to maintain appropriate supply levels. Air conditioning has been installed in the clean utility areas on both floors, to allow for medication to be stored at the recommended temperature.” However on the day of the inspection we found that medication is not recorded in a way that makes it possible for an accurate audit tot be carried out. On the first floor the medication cupboard was very disordered. There was no record of the stocks of medication that were stored for each person, and no method of ensuring that medications are used in date order. New stocks of one medication were supplied when there was no need for it. On both floors a controlled medication had not been returned to the pharmacist when it was no longer required. The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are confident that their concerns are listened to, and that they are safeguarded from the risks of abuse. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) stated, “New residents and relatives are provided with information on how to make complaints and suggestions. This information is also periodically reinforced for existing residents and relatives. Complaints and outcomes are monitored as they arise and through quarterly and annual quality processes. “The service is active in protecting residents from abuse, neglect and selfharm. This includes ensuring all appropriate pre-employment checks are complete and satisfactory. All staff receive training relative to POVA as part of their induction programme. Staff are encouraged and supported to blow the whistle if they suspect or know of any POVA concerns. Residents and relatives are provided with a leaflet giving them information about what abuse is and what they should do if they experience, suspect or observe it.” The plans for improvement are to: “Canvass views from residents, relatives and external stakeholders in terms of our performance in dealing with complaints and suggestions and improve our practice based on their views and experiences.” The residents who were spoken to during the inspection said that they are able to make any concerns known. The home has a clearly written complaints procedure. There have been two allegations of poor care since the last The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 19 inspection. These were reported and investigated appropriately, and the record shows that appropriate action was taken and the complaints were unfounded. The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable and well maintained environment for the people who live there, and the staff maintain a good standard of cleanliness and hygiene. EVIDENCE: The Gardens is a purpose built home for people with physical disabilities. It is fully accessible for the residents, and there are adequate aids and equipment for their needs, including a physiotherapy treatment room. The Annual Quality Assurance Assessment (AQAA) stated that in the last twelve months, “Several residents have decorated and extensively personalised their own rooms. A lounge area has been developed for the use of residents living on the first floor.” This refurbishment has improved the environment of the home, and the communal areas are more attractive and homely. The home appeared to be clean and well maintained, and appropriate policies and procedures are in place for the maintenance of hygiene and control of infection. The laundry is used for washing the personal clothing of the The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 21 residents of both The Gardens and The Jacob Centre, and towels and bedding are taken to The Rivers hospital. The laundry meets the standards for control of hygiene. The Annual Quality Assurance Assessment (AQAA) stated that in the last twelve months, “We have reviewed and updated some of the infection control policies and protocols in consultation with experts from within Capio UK, local external infection control specialists and our occupational health service.” The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are supported by a stable staff team who have the experience and training to understand and meet their needs. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) stated, “Generic criteria for the recruitment and selection of all staff includes the ability to demonstrate warmth, empathy and consideration; the willingness to listen and ability to communicate effectively using appropriate interpersonal skills; an appropriate balance between being person centred and task centred; a commitment to their own development and that of others; a commitment to equality and diversity. “The training programme provided is comprehensive and includes internal courses (run by internal or external experts) relative to health and safety, the client group, particular equipment/techniques used, the service values, culture and expectations; NVQ; IT; BTEC, etc. There is also a Capio UK training programme that staff can access and full or part support to attend external conferences and courses including those leading to qualifications e.g. diplomas and degrees. The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 23 “The staff team is rich in its diversity e.g. different ages, genders, races, religions, sexual orientations, abilities and beliefs. The culture within the service is to understand, respect, appreciate and benefit from this diversity. Staffing levels are carefully monitored relative to the needs of residents and adjusted as appropriate. Some residents require 1-1 care, others 1-2 or 1-3, etc. The number and skill mix on each shift is maintained in accordance with the population and needs at that time.” All the members of staff who we spoke to were enthusiastic about their work and feel well supported by their colleagues and the management. They said that the training is very good, and provides them with the specialised information and skills that they need. There has been a big increase in the number of staff taking NVQ qualifications. 29 of the care staff have an NVQ qualification, and 16 are working towards it. The AQAA stated, “We have 2 more NVQ assessors currently being trained. We plan to support further 2 or 3 staff to undertake the NVQ assessors award this year to help meet the demand re: carers wishing to undertake NVQ 2 and 3.” There is a thorough recruitment procedure in place, that includes taking up references and CRB (Criminal Record Bureau) disclosures in order to ensure that the staff recruited are fit to work with vulnerable people. The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and safety and confidentiality of the people who live in the home may be at risk due to poor practice in some areas of record keeping and maintaining a safe environment. EVIDENCE: The manager is a RGN (Registered General Nurse), and she has a Certificate in Management Studies, which is equivalent to NVQ level IV in management. She had several years experience in community nursing and rehabilitation before being appointed to manage The Gardens. Separate residents’ and relatives’ meetings take place, and issues raised are taken up and acted on. The Managing Director of Capio Healthcare UK carries out monthly monitoring visits as required under regulation 26, during which residents are consulted. Internal audits are carried out, for example of The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 25 maintenance, health and safety and training, and the results are given to Capio Healthcare UK and discussed in the home at the monthly senior management meetings. The Annual Quality Assurance Assessment (AQAA) stated, “We plan to review, consider, choose and work towards achieving a recognised quality award such as Investors in People or the Excellence Model. We plan to design and undertake stakeholder surveys.” The home maintains appropriate records for the health and safety of the residents and staff in the home. The AQAA stated, “Health and safety is promoted through appropriate training, monitoring, guidance, practice and maintenance. Health and safety related incidents are carefully monitored for trends and factors that suggest further action is required to prevent recurrence.” However during the inspection we noted three health and safety concerns. 1. In the utility room on the ground floor we saw a container of disinfectant detergent marked with a COSHH (Control of Substances Hazardous to Health) symbol in an unlocked cupboard. A member of staff also noticed this, and locked the cupboard immediately. A cleaning trolley was left unattended outside bedrooms while the housekeeper cleaned the rooms. The trolley contained cleaning items including toilet cleaner. Although many of the people who live in the home would find it difficult to open the toilet cleaner, these items were potentially accessible for the residents, and are therefore a health and safety hazard. 2. On the ground floor hot food trolleys are stored by the entrance to the conservatory dining room. The surface of one of the trolleys was very hot, and measured 69.3°C on the home’s thermometer. This could cause a risk of burns if anyone fell against the trolley. 3. In the ground floor kitchen we saw several containers of food in the fridge that were not labelled with the date that they were opened. The staff who were in the kitchen at the time said that they had no labels to use. Later in the day the foods were no longer in the fridge. It is likely that they were in the fridge ready to be served during the day. However if food is not dated when it is opened, there is no assurance that it is safe to serve to the people in the home. On the first floor the MAR (Medication Administration Record) charts were stored on top of the medication trolleys, in an open corridor where anyone could read them. They contain personal and confidential information about individual people, and must be stored securely. The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 X 3 X 2 2 X The Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES 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 YA6 Regulation 12(2) & (3) Timescale for action Measures must be put in place to 30/04/08 ensure that residents are enabled to provide a realistic input into their care plans, for example by setting their own targets and monitoring their own progress. Previous timescale of 20/03/07 met in part. All people who live in the home 30/04/08 must have a care plan that is up to date. This will ensure that they receive the support that meets their current needs. Appropriate and adequate risk 30/04/08 assessments must be put in place for all residents for situations in which there is any risk of harm or injury to themselves or others. The manager must make sure 30/04/08 that everyone in the home has a choice of varied and appropriate activities throughout the day. A medication audit system must 30/04/08 be put in place to ensure that discrepancies are investigated and corrected. Previous timescale of 20/01/07 met in part. DS0000019570.V358766.R01.S.doc Version 5.2 Page 28 Requirement 2. YA6 15(2) 3. YA9 13(4) 4. YA14 16(2)(n) 5. YA20 13(2) The Gardens Nursing Home 6. YA41 17(1)(b) 7. YA42 13(4) 8. 9. YA42 YA42 13(4)(a) 13(4)(c) All personal information must be stored securely in order to protect the confidentiality and privacy of the people who live in the home. A risk assessment must be implemented to ensure that there is no risk to the people in the home from the hot surfaces of the food trolleys. All substances that may be hazardous to health must be stored securely at all times. All perishable food that is stored in the home must be labelled and dated in order to ensure the safety of the people in the home. 30/04/08 30/04/08 30/04/08 30/04/08 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 Gardens Nursing Home DS0000019570.V358766.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Inspection Team Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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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