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Inspection on 20/11/06 for The Gardens Nursing Home

Also see our care home review for The Gardens Nursing Home for more information

This inspection was carried out on 20th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff continue to provide good quality personal care and nursing care, and this was confirmed by the comments of the residents and visitors who took part in the inspection. One resident said that the physical therapy is very good here. A visiting relative said that she is very happy and the staff are very caring. Very detailed assessments are completed before any resident is admitted to the home, and the assessments are reviewed as required to meet each resident`s changing 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 care plans that were seen provide good details of each persons needs for personal care and health care, and good recording was seen for the treatment and monitoring of pressure sores.

What has improved since the last inspection?

Most of the requirements made in the last inspection report have been met. The assessments carried out before a resident is admitted to the home are very detailed, and they now include information on all of each resident`s needs, including social needs and activities. Advocacy services are available for residents who need assistance with decision making. Complaints are recorded appropriately. Plans are in place for more staff to take NVQ qualifications, and for the staff who work with the group of young people with learning disabilities to take LDAF (Learning Disability Award Framework) qualifications. These improvements depend on senior staff completing NVQ assessor`s courses, and as this is not yet completed the requirement from the last inspection has been repeated. There is a regular maintenance audit in the hone to ensure that all needs for repair and refurbishment are noted and acted on. There were no issues for health and safety concerns during this inspection.

What the care home could do better:

One requirement from the last inspection report was partially met, concerning appropriate qualifications for the staff (see above). One requirement was not met, and has been repeated. It was reported that a system for auditing medication had been put in place following the last inspection. However the audit records showed that only one audit took place, in March 2006. The method used for audit provides a thorough check of all medication administered and stored in the home for each resident, and if it were used on a regular basis, the risk of medication errors would be lessened. Some poor practice was observed in the administration of medication. Several discrepancies were found in the recording and storage of medication, and the temperature of rooms used for storing medication was observed to be high. Medication not stored appropriately may loose its clinical effectiveness. The care plans provide detailed information on the residents personal and healthcare needs, and the residents spoken to say that they feel involved in decision making in the home. However there is little indication that the residents are involved in writing and reviewing their care plans, in line with the principles of person centred planning (PCP). One issue noted in the last inspection report remains. The design of the home is more suited to a clinic than a residential home. There are insufficient communal areas for the needs of the residents, and there are no facilities for the residents to prepare their own food or drinks. In order to meet the outcome of providing a homely environment, the residents should be organised into smaller groups, with specific staff and facilities for each group. Nurses from the home visit Orchard Lee, the neighbouring sheltered housing complex, every day in order to supervise the medication for the residents there. The provision of personal care to the residents of sheltered housing may require a separate registration as a domiciliary care provider. The manager must ensure that the provision of care to Orchard Lee does not detract from the care provided to the residents of The Gardens. She must also consider whether the home needs to apply for registration as a domiciliary care provider in order to provide this service.

CARE HOME ADULTS 18-65 The Gardens Nursing Home High Wych Road Sawbridgeworth Hertfordshire CM21 0HH Lead Inspector Claire Farrier Key Unannounced Inspection 20th November 2006 10:15 The Gardens Nursing Home DS0000019570.V321481.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.V321481.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.V321481.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) Capio Healthcare 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.V321481.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th August 2002 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.V321481.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two inspectors over one day and including preparation time a total of 17 hours was allocated to it. This was the first key inspection for the year, and all the key standards were inspected. The majority of time was spent talking to residents and staff, and discussions were held with the home’s manager. Some time was also spent in the office looking at records, and care plans, and the inspectors made a tour of the premises. What the service does well: What has improved since the last inspection? Most of the requirements made in the last inspection report have been met. The assessments carried out before a resident is admitted to the home are very detailed, and they now include information on all of each resident’s needs, including social needs and activities. Advocacy services are available for residents who need assistance with decision making. Complaints are recorded appropriately. Plans are in place for more staff to take NVQ qualifications, and for the staff who work with the group of young people with learning disabilities to take LDAF (Learning Disability Award Framework) qualifications. These improvements depend on senior staff completing NVQ assessor’s courses, and as this is not yet completed the requirement from the last inspection has been repeated. There is a regular maintenance audit in the hone to ensure that all needs for repair and refurbishment are noted and acted on. There were no issues for health and safety concerns during this inspection. The Gardens Nursing Home DS0000019570.V321481.R01.S.doc Version 5.2 Page 6 What they could do better: One requirement from the last inspection report was partially met, concerning appropriate qualifications for the staff (see above). One requirement was not met, and has been repeated. It was reported that a system for auditing medication had been put in place following the last inspection. However the audit records showed that only one audit took place, in March 2006. The method used for audit provides a thorough check of all medication administered and stored in the home for each resident, and if it were used on a regular basis, the risk of medication errors would be lessened. Some poor practice was observed in the administration of medication. Several discrepancies were found in the recording and storage of medication, and the temperature of rooms used for storing medication was observed to be high. Medication not stored appropriately may loose its clinical effectiveness. The care plans provide detailed information on the residents personal and healthcare needs, and the residents spoken to say that they feel involved in decision making in the home. However there is little indication that the residents are involved in writing and reviewing their care plans, in line with the principles of person centred planning (PCP). One issue noted in the last inspection report remains. The design of the home is more suited to a clinic than a residential home. There are insufficient communal areas for the needs of the residents, and there are no facilities for the residents to prepare their own food or drinks. In order to meet the outcome of providing a homely environment, the residents should be organised into smaller groups, with specific staff and facilities for each group. Nurses from the home visit Orchard Lee, the neighbouring sheltered housing complex, every day in order to supervise the medication for the residents there. The provision of personal care to the residents of sheltered housing may require a separate registration as a domiciliary care provider. The manager must ensure that the provision of care to Orchard Lee does not detract from the care provided to the residents of The Gardens. She must also consider whether the home needs to apply for registration as a domiciliary care provider in order to provide this service. The Gardens Nursing Home DS0000019570.V321481.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.V321481.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.V321481.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. A comprehensive assessment of the needs of the residents was seen to be in place, and appropriate risk assessments are carried out to ensure that the residents live in a safe environment. The home has sufficient information on residents’ needs and access to appropriate services to enable the needs to be met. EVIDENCE: The files of six residents were inspected, and each one contained a very detailed assessment that was completed before the resident was admitted to the home. The assessments are reviewed as required to meet each resident’s changing 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 Gardens Nursing Home DS0000019570.V321481.R01.S.doc Version 5.2 Page 10 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. It was reported that the staff who work with the residents with learning disabilities will undertake LDAF (Learning Disability Awards Framework) NVQ training when there is a qualified LDAF assessor (see Staffing). 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.V321481.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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A new format has been introduced for care plans that places the residents at the centre of the care planning process. The care plans provide detailed information on the residents personal and healthcare needs, and the residents spoken to say that they feel involved in decision making in the home. However there is little indication that the residents are involved in writing and reviewing their care plans, in line with the principles of person centred planning (PCP). The Gardens Nursing Home DS0000019570.V321481.R01.S.doc Version 5.2 Page 12 EVIDENCE: Detailed case tracking was carried out through the files of six residents, which showed what care is provided for the residents and how it is recorded. A new format has been introduced that aims to get residents and their families more involved, and to record their likes and their views. The format of the care plans could provide a basis for a person centred planning (PCP) approach, which should focus on the person being totally at the centre of all planning. The information on each person’s needs is detailed and clearly written, and personal care needs are recorded from the resident’s perspective. However there is no obvious indication of the involvement of the residents in writing and monitoring their own care plans. 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 hopes to be able to leave The Gardens within the next year to live independently in their own home. The resident should be enabled to take more responsibility for how this is achieved, and the care plan should provide evidence of this. The care plans contain good details of each person’s health care needs, including appropriate risk assessments and monitoring for pressure area care and the risks of falls. 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 safekeeping. The administration office in The Jacob Centre, The Gardens’ sister home, manages the finances. The procedures were seen during an inspection of The Jacob Centre, when it was assessed that there were appropriate and secure procedures in place for managing the residents’ cash, with a comprehensive and clear system of recording. The Gardens Nursing Home DS0000019570.V321481.R01.S.doc Version 5.2 Page 13 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. There is a varied programme of activities in the home, and residents are encouraged to take part in community activities. All the residents said that they enjoy the food provided by the home. The menus offer a balanced and nutritious diet. EVIDENCE: The residents are supported in gathering relevant information regarding employment, further education, employment skills and benefit advice if required. All the residents are encouraged and supported to maintain links to the local community. Routines within the home promote service user independence. Service uses are unrestricted in movement around the home. The Gardens Nursing Home DS0000019570.V321481.R01.S.doc Version 5.2 Page 14 The provision of activities within the home appears to be good. Activity plans are visible and displayed within the home, and the residents are encouraged to engage in activities with peer groups and also access service and groups outside of the home. Bridge Education provides activities for the residents with learning disabilities every day. This takes place in the first floor dining room, which means that the dining room is not available for residents to use at lunchtime. (See environment) Meals are prepared in the main kitchen of the Rivers Hospital in the adjacent building and then brought over to the home in heated trolleys. There is a small kitchen within the home for the preparation of small snacks, drinks, supper and breakfast, but this is not accessible for the residents. Lunch was observed during the inspection. The meals looked appetising and all service users appeared to enjoy the food. The residents who were spoken to generally said that the choice of meals and the quality of the food is good in the home. Lunch was served first on the ground floor, and the food trolley was then taken to the first floor. This meant that on the ground floor the desserts were served up before residents had finished their main course, so that the food trolley could then be taken to the first floor. This practice detracts from an otherwise relaxed and sociable atmosphere at lunchtime, and it means that the desserts may not be hot when the residents eat them. A number of service users are fed via a PEG, which is monitored by a dietician and by regular monthly weight checks recorded on care plans. The Gardens Nursing Home DS0000019570.V321481.R01.S.doc Version 5.2 Page 15 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 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff continue to provide good quality personal care and nursing care, and many residents and visitors commented that the staff are very caring. A system for auditing medication has not been implemented as required in the last inspection report, and several discrepancies were found which could cause a risk to the safety of the residents. The Gardens Nursing Home DS0000019570.V321481.R01.S.doc Version 5.2 Page 16 EVIDENCE: The care plans that were seen provide good details of each person’s needs for personal care and health care. The home provides care for service users with a high level of need, including 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. All healthcare needs were seen to be appropriately recorded, with detailed procedures for the care required. Good recording was seen for the treatment and monitoring of pressure sores. Capio provide their own tissue viability nurse for one day a week for The Gardens and The Jacob Centre. The tissue viability nurse provides and oversees appropriate wound care, and provides guidance and training to the staff. Six members of staff attended tissue viability training in September. Most of the residents and visitors spoken to said that the staff provide good personal and nursing care, and that they are confident that they can meet their needs. The lunchtime medication round was observed on the ground floor, and the procedures for storing and recording information were checked on the ground floor and the first floor. Most medication is supplied in monitored dosage blister packs, but many tablets are provided separately, and the staff spoken to were not sure of the reason for this. The reason for using a monitored dosage system is to lessen the risk of errors in administration, and it should be used for all appropriate medications. The nurse who administered the lunchtime medication on the ground floor was observed to take a tablet from a bottle using their fingers, which is not good practice. This person also signed the MAR (medicines administration record) chart as confirmation that the medication had been administered before giving it to the residents. On the first floor the information for one medication was seen to be written by hand on the MAR chart, but the person who wrote the information had not signed to confirm its accuracy. It was not possible to check accurately whether the medications that are not in blister packs reconcile with the records, as there was no indication on the bottle or the MAR chart of the date when it was opened. One resident has a prescription for PRN (when required) diazepam. It was reported that this has never been required, but there were only three tubes of diazepam in the package that was marked to contain five. There was no record of when and why the missing tubes were administered. In both controlled drugs cupboards there were supplies of medication for residents who no longer used them, one since October 2006 and one since January 2006. It was reported that a system for auditing medication had been put in place following the last inspection. However the audit records showed that only one audit had taken place (March 2006). The method used for audit provides a thorough check of all medication administered and stored in the home for each resident. If it were used on a regular basis, the errors found on this occasion would have been discovered and rectified. The Gardens Nursing Home DS0000019570.V321481.R01.S.doc Version 5.2 Page 17 Measures must also be taken to ensure that medication is stored at the correct temperature. The temperatures recorded on the first floor were satisfactory. But on the ground floor the temperature on the day of the inspection had reached 25.5°C, it had never dropped below 25°C, and in July it was recorded as 27° to 28°C. Medication stored incorrectly may no longer be clinically effective. The Gardens Nursing Home DS0000019570.V321481.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. Residents are encouraged and enabled to make their views and concerns known. Policies and procedures are in place to ensure that service users are protected from abuse and neglect. EVIDENCE: 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. One complaint was made to the home since the last inspection, and the record shows that appropriate action was taken and the complainant was satisfied with the outcome. Capio Healthcare has appropriate policies on adult protection and whistle blowing. The staff spoken to showed good knowledge and understanding of these policies. Some of staff who were spoken to have not had training in the prevention of abuse (see Staffing). The Gardens Nursing Home DS0000019570.V321481.R01.S.doc Version 5.2 Page 19 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, 25, 26, 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Quality in this outcome area is adequate. 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 residents, and the staff maintain a good standard of cleanliness and hygiene. The style, scale and facilities of the building continue to give the impression of a clinic rather than a home. There are insufficient communal areas to meet the needs of all the residents. The Gardens Nursing Home DS0000019570.V321481.R01.S.doc Version 5.2 Page 20 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 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 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. There is an on-going programme of refurbishment in the home. The heating system has been replaced, and the bathrooms are currently being refurbished. At the time of the inspection there was only one bathroom available on the first floor. One bathroom on the ground floor was used for storage, of bedding and equipment. It was reported that the residents did not use the bath. But the shower is, and a storeroom does not provide a relaxing environment in which to provide personal care. In style and scale the home continues to give the impression of a clinic rather than a home. All the bedrooms are single and have en-suite facilities, and the residents are encouraged to personalise their rooms with their own belongings. However the communal areas are not homely. On the ground floor there is one room, the conservatory, which serves as the lounge and dining room for the residents in both wings. There is an additional small lounge, and several residents were observed to use the seating area in the entrance hall for socialising. On the first floor there is one dining room, which would not be large enough for all the residents to use if they needed to. On the day of the inspection Bridge Education used this room for the learning disability group, and it was not available for anyone to use at lunchtime. It was reported that a room on the ground floor, which was previously used as a sensory room, will be made available for Bridge Education, but this is not yet in place. There is no lounge on the first floor. A wide corridor is used as a seating area. The home does not have its own kitchen, and there are no facilities for the residents to prepare their own food or drinks. There are two corridors with bedrooms on each floor, but there is no sense that these wings operate as distinct units. The staff work on the ground floor or the first floor, but they are not specific to the units. In order to meet the outcome of providing a homely environment, the residents should be organised into smaller groups, with specific staff and facilities for each group. The Gardens Nursing Home DS0000019570.V321481.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. The home is staffed with employees who are experienced and competent to care for younger adults with physical disabilities. The staff spoken to are confident of their knowledge of the needs of the residents and feel well supported in their work. Some mandatory training has not been completed by all the staff. There are plans for more staff to undertake NVQ and LDAF qualifications, but this will not be available under there are sufficient qualified assessors in the home. There is a thorough recruitment procedure in place that ensures that the staff recruited are fit to work with vulnerable people. The Gardens Nursing Home DS0000019570.V321481.R01.S.doc Version 5.2 Page 22 EVIDENCE: The staffing rotas seen showed that there are sufficient staff to meet the residents’ assessed needs. There are four trained nurses on duty in the home throughout the day, and three during the night. There are between six and thirteen care workers on each shift. All the members of staff who were spoken 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. One of the nurses mentioned that they go to Orchard Lee, the neighbouring sheltered housing complex, in order to supervise the medication for the residents there. New guidance has recently been published by CSCI on the regulation of close care developments within the grounds of an existing care home. This states, “…it is important to consider the effect of the service provided to the close care residents on the provision of care to the people within the care home. The staffing to support the close care residents should not undermine the existing obligations (under the care homes regulations) to maintain appropriate staffing levels within the care home.” The home has a comprehensive training programme that includes all mandatory health and safety training, and essential skills. Four care workers have attended training courses on working with people with learning disabilities and managing epilepsy. One of the administration staff has responsibility for co-ordinating the training for both The Jacob Centre and The Gardens, and for monitoring the training completed and when updates are due. The induction programme is currently under review to ensure that it meets the requirements set by Skills for Care. Some staff said that they have not attended training on prevention of abuse, and some housekeeping staff have not completed COSHH (Control of substances hazardous to health) training. Only four members of the care staff currently have appropriate NVQ qualifications. It was reported that there has been a difficulty in finding NVQ assessors, but four people are currently taking the assessors’ qualification. The staff who work with the residents with learning disabilities will undertake LDAF (Learning Disability Awards Framework) NVQ training when there is a qualified LDAF assessor. 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. Staff files were not inspected on this occasion. The staff files of two members of staff were inspected during an inspection of The Jacob Centre, when it was assessed that they contained all the required information, including references, proof of identity and evidence of satisfactory CRB disclosures. The Gardens Nursing Home DS0000019570.V321481.R01.S.doc Version 5.2 Page 23 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 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well run by a competent manager who leads a dedicated and enthusiastic staff group. The home has policies and procedures in place to protect the health and safety of the residents and staff. Requirements were made concerning the recording of fire drills and the need for an application to vary the registration categories. The Gardens Nursing Home DS0000019570.V321481.R01.S.doc Version 5.2 Page 24 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. She was registered as manager by CSCI in April 2006. Separate residents’ and relatives’ meetings take place, and issues raised are taken up and acted on. The Acting 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 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. There is no evidence of systematic surveys of the residents in order to assess their views. One issue needs to be addressed concerning registration of the home. Nurses from the home visit Orchard Lee, the neighbouring sheltered housing complex, every day in order to supervise the medication for the residents there. The provision of personal care to the residents of sheltered housing may require a separate registration as a domiciliary care provider. New guidance has recently been published by CSCI on the regulation of close care developments within the grounds of an existing care home. This states, “The level of personal care provided to the residents in the close care accommodation will need to be examined to determine whether the care home provider also needs to register as a domiciliary care agency. Where the personal care that is provided to the close care residents is on an exceptional basis (as a result of an emergency or a short term illness) rather than routine day to day personal care, then this would not trigger domiciliary care registration.” The home maintains appropriate records for the health and safety of the residents and staff in the home, and staff follow the home’s policies and procedures. Good procedures are in place for fire drills. Regular fire drills take place, but there is no record of the names of staff who take part in each drill. The Gardens Nursing Home DS0000019570.V321481.R01.S.doc Version 5.2 Page 25 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 2 25 3 26 3 27 2 28 2 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 2 2 The Gardens Nursing Home DS0000019570.V321481.R01.S.doc Version 5.2 Page 26 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) Requirement The care plans contain clearly written information on personal and health care needs, but there is little indication of the involvement of the resident in setting up and reviewing their care plan in accordance with the principles and practice of PCP. Timescale for action 20/03/07 2. YA20 13(2) Measures must be put in place to 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. Some poor practice was 20/01/07 observed in the administration of medication. The registered person must ensure that all medication is administered and recorded in accordance with the Royal Pharmaceutical Society guidelines and the home’s policy and procedures. The Gardens Nursing Home DS0000019570.V321481.R01.S.doc Version 5.2 Page 27 3. YA20 13(2) Several discrepancies were found in recording and storage of medication. There is no system of audit in the home that would discover and rectify any errors as they occur. A medication audit system must be put in place to ensure that discrepancies are investigated and corrected. Previous timescale of 28/02/06 not met. The temperature of one of the rooms used for storing medication was observed to be high. The temperature of all rooms used to store medication must be regulated to below 25ºC. There is only one bathroom in use on the first floor. One bathroom on the first floor and one on the ground floor are used for storage. 20/01/07 4. YA20 13(2) 20/01/07 5. YA27 23(2)(j), (l) 31/03/07 6. YA28 23(2)(g), (h) Sufficient numbers of bathrooms must be available for the residents, and this number should not be less than was available at 31 March 2002. There is no lounge for the use of 31/03/07 the residents on the first floor. The dining room on the first floor is not available for meals when it used for other purposes. The communal areas on the first floor and the ground floor are not homely in appearance. Measures must be put in place to ensure that sufficient and appropriate communal facilities are provided to meet the needs of all the residents. The Gardens Nursing Home DS0000019570.V321481.R01.S.doc Version 5.2 Page 28 7. YA32 18(1)(a) & There are plans for more staff to (c)(i) undertake NVQ and LDAF qualifications, but this will not be available under there are sufficient qualified assessors in the home. 31/03/07 8. YA35 The registered person must take measures to ensure that staff working with adults with learning disabilities have accredited training; and that 50 of the care staff complete a NVQ qualification. Previous timescale of 03/04/06 met in part. 18(1)(c)(i) Some mandatory training has 31/03/07 not been completed by all the staff. This includes training in prevention of abuse and COSHH training. The registered person must ensure that all staff complete mandatory training appropriate to their roles. The names of staff taking part in fire drills must be recorded to ensure that every member of staff takes part in at least one fire drill a year. Nurses from the home visit Orchard Lee, the neighbouring sheltered housing complex, every day in order to supervise the medication for the residents there. The registered person must consider whether the home needs to apply for registration as a domiciliary care provider in order to provide this service. Provision of care to Orchard Lee must not detract from the care provided to the residents of The Gardens. 9. YA42 23(4)(e) 20/01/07 10. YA43 Section 12(1), Care Standards Act 21/01/07 The Gardens Nursing Home DS0000019570.V321481.R01.S.doc Version 5.2 Page 29 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. Refer to Standard YA17 Good Practice Recommendations At lunchtime on the ground floor the desserts were served up before residents had finished their main course, so that the food trolley could then be taken to the first floor. It is recommended that measures should be put in place to ensure that desserts can be kept warm and served to residents when they have finished their main course. In style and scale the home continues to give the impression of a clinic rather than a home. The organisation of the home should provide for groups of not more than ten residents to share a staff group and communal facilities. A method should be implemented for a regular survey of the views of the residents that informs the home’s audits and quality assurance procedures. 2. YA24 3. YA39 The Gardens Nursing Home DS0000019570.V321481.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hertfordshire Area Team 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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