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Inspection on 27/11/08 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 27th November 2008.

CSCI found this care home to be providing an Adequate service.

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 1 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 Ramsay HealthCare staff recruitment process is thorough; this means that people living at The Gardens are protected by the safe recruitment of professional and friendly staff. Relatives told us they were generally happy with the service and care provided, they particularly expressed they could approach the manager at any time with any concerns they may have and be confident they would be dealt with appropriately. The staff members demonstrated good knowledge of how each person preferred to be cared for and supported. The organisation has a comprehensive staff training provision that ensures each person has the skills necessary to safely look after the people living at The Gardens.

What has improved since the last inspection?

Since the previous inspection the service has obtained the services of an external pharmacist to undertake monthly medication audits and oversee the medication ordering processes at the home. This means that people living at the home can be confident that the medication storage and administration are organised and safe. A forum has been introduced involving residents, their families, staff members and occupational therapists to redesign some of the home`s bathrooms into more user friendly wet room facilities. The manager`s AQAA tells us the service has improved menu choices for residents and how food is served. The manager has introduced a rolling programme for resident room decoration giving the person the opportunity to choose the decor. In conjunction with the Jacob Centre the service has produced a new leaflet entitled `we value your opinion` that encourages residents and relatives to tell the home about their comments, compliments and complaints. The leaflet includes clarification on the complaints procedure including verbal, written and options if the complainant remains unsatisfied.

What the care home could do better:

Peoples` care plans should be written with the individual as the central focus rather than recording the `tasks` necessary to keep them safe and healthy. Their wishes and how their personal needs are to be met should be detailed. This will mean that peoples` care would be provided in such as way that suits them as individuals and with consistency. The registered manager needs to ensure that where areas of risk are identified through the pre-admission process or through the course of daily life at the home, plans are developed to reduce the risk and documented for all staff to follow. This will help to keep people safe from harm. People living at the home should have the opportunity to participate in meaningful activity in the evenings and at weekends. This will mean people will feel morestimulated over the weekend. People living at the home and their relatives need to be able to feel confident about raising any concerns or complaints and be comfortable in the knowledge they will be acted upon. The registered manager needs to ensure that all areas of the home are clean, fresh and pleasantly decorated. This is so that people have a pleasant environment to live and work in.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Gardens Nursing Home High Wych Road Sawbridgeworth Hertfordshire CM21 0HH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Greaves     Date: 2 8 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: The Gardens Nursing Home High Wych Road Sawbridgeworth Hertfordshire CM21 0HH 01279600201 01279721297 janet.usedon@ramsayhealth.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ramsay Health Care UK Operations Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 54 Number of places (if applicable): Under 65 Over 65 2 54 54 old age, not falling within any other category physical disability terminally ill Additional conditions: Date of last inspection Brief description of the care home 0 54 54 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 Ramsay Healthcare Ltd, 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 Ramsay Neurological 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 Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home 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 Ramsay 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. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key site visit that took place over 2 days totaling 12 1/2 hours. At this visit we considered how well the home meets the needs of the people living there and how staff and management support people. A tour of the premises was undertaken, care records, staff records, medication records and other documents were assessed. Time was spent talking to, observing and interacting with people living at the home, visitors and staff. Prior to the site visit the manager had completed and sent into the Commission for Care Homes for Adults (18-65 years) Page 6 of 31 Social Care Inspection the homes Annual Quality Assurance Assessment (AQAA). This is a self assessment document required by law and tells us how the service feels they are meeting the needs of the people living at the home and how they can evidence this. Before the site visit a selection of surveys with addressed return labels had been sent to the home for distribution to residents, relatives and staff. Views expressed by visitors to the home during the site visit and in surveys responses have been incorporated into this report. Feedback on findings was provided to the manager throughout the inspection and the opportunity for discussion and clarification was given. We would like to thank the residents, the manager, the staff team and visitors for the help and co-operation throughout this inspection process. The previous key inspection of this service took place on 19th November 2007. What the care home does well: What has improved since the last inspection? What they could do better: Peoples care plans should be written with the individual as the central focus rather than recording the tasks necessary to keep them safe and healthy. Their wishes and how their personal needs are to be met should be detailed. This will mean that peoples care would be provided in such as way that suits them as individuals and with consistency. The registered manager needs to ensure that where areas of risk are identified through the pre-admission process or through the course of daily life at the home, plans are developed to reduce the risk and documented for all staff to follow. This will help to keep people safe from harm. People living at the home should have the opportunity to participate in meaningful activity in the evenings and at weekends. This will mean people will feel more Care Homes for Adults (18-65 years) Page 8 of 31 stimulated over the weekend. People living at the home and their relatives need to be able to feel confident about raising any concerns or complaints and be comfortable in the knowledge they will be acted upon. The registered manager needs to ensure that all areas of the home are clean, fresh and pleasantly decorated. This is so that people have a pleasant environment to live and work in. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People moving into The Gardens can be assured their health needs would be met through a comprehensive assessment. Evidence: The service has a Statement of Purpose and Service User Guide to help people considering using the service to decide if The Gardens is the right home for them. These documents contain all the relevant information describing the skills of the staff and the facilities that The Gardens provides for people. The service has a web site that includes some 360 degree photographs of the centre to help those people that are unable to visit in person get a clearer idea of what the home is like. The service undertakes a comprehensive assessment of each persons individual health and personal care needs before offering a them place at The Gardens. This means that people can be reassured that the skills of the staff working at the home and the facilities on offer are suitable to meet their individual identified needs. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: We looked at 6 peoples pre admission assessments to confirm that sufficient information was gathered at this stage to be sure that The Gardens was the right place for individuals. Experienced qualified practitioners such as nurses, physiotherapists and a consultant in Neuro Rehab are involved in the assessments process, gathering information from all parties involved and visiting the prospective resident and assessing them in person. This process ensures that the staff team are prepared for each persons admission into the home and any specific training or equipment is provided ready to meet peoples complex needs. Staffing levels are reviewed in light of each new admission to the home and adjusted as necessary to ensure there are enough staff on duty to meet peoples needs. On each persons admission documents that we looked at there was a comprehensive medical history together with basic information about the patterns of peoples lives relating to eating, drinking and sleeping. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal choices about how they would like their care to be delivered are not always documented clearly so they cannot be sure to receive consistent care and support. Evidence: The managers AQAA told us Staff throughout the service demonstrate an excellent understanding of each individual resident - their likes, dislikes, needs, wishes, interests, skills, areas of risk etc. Currently this is not being comprehensively demonstrated in the care planning and risk documentation. We viewed six care plans from different units around the home. There was no evidence available to confirm that individuals choices were taken into account in the planning of care and if so how these choices were determined. There was no evidence of relatives being involved during the on going care planning process. Observation on this day showed us that families were at home at The Gardens and Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: were involved in their relatives lives and in caring for them. Care plans had been developed for each area of identified potential risk such as eating/drinking/ hoisting/bathing etc. However, there was no specific detail to describe how these activities of daily life were to be managed. Examples include X requires full assistance with all aspects of daily living and X requires assistance to settle at night. The Gardens has needed to rely on agency staff to cover during a period of staff shortage, these care plans did not provide enough specific detail for a person unfamiliar with individuals to deliver care and support in accordance with their needs and preferences. The managers AQAA stated In conjunction with our co-sited sister service we have been improving our care planning and risk management documentation to ensure it is based on up to date evidence and best practice, as user friendly as possible and reflects the balance of medical and social care models that is appropriate for our client group. We have introduced a new all about me booklet that provides a pen profile of the resident including their needs, choices, aspirations, background, family, hobbies, interests, skills etc. This is part of our work on maximising person centred care. The new documentation has been in progress for some considerable time and recently has been used as a pilot to ensure it is suitable for purpose. The manager reported that the new care planning documents were being phased in over a period of 3 months and that all people would have the new documents in place and working by the end of February 2009. Training has been provided for some staff to enable them to use the new documents as effective working tools, this is due to be delivered through the whole staff team. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to receive a balanced and varied diet. The weekend and evening leisure and activity provision does not meet peoples needs. Evidence: The managers AQAA told us of the improvements the service had made in relation to the activity provision at the Gardens since the previous inspection visit. We have undertaken a review of activity functions and are now working through the resulting action plan. This includes increasing activities at the weekends, increasing the focus on education and vocation for residents who are able and increasing the involvement of care staff in the provision of both structured and ad hoc activities. The Homes own resident satisfaction survey results indicated that 12 of respondents had some concerns regarding the lack of in house activities at the weekends. The Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: action plan stated that working patterns of activity staff have been adjusted to meet the identified need during weekends. However, our findings were that there was no current activity provision at weekends, the manager reported that the service was in the process of recruiting extra activity hours to cover this shortfall. The activity person currently works 6 hours daily Monday to Friday and there is another person employed to take residents out for external outings shared with Jacobs Centre. There are 52 people living at The Gardens all with extremely complex and highly individual needs. 30 hours per week of activity time is insufficient to provide the individual and personalised stimulation that people need. People responding to us via surveys told us There is enough to do in the daytime but nor evenings or weekends, There is nothing to do of an evening. Once the evening meal has been eaten we wait until it is time to go to bed. Staff expect you to go to bed early and more activities would be good. It was reported that one member of staff has taken the lead on encouraging people to use public transport. This assists in rehabilitation and means people do not have to be solely dependent on the homes two minibuses for transport. Residents told us they enjoyed the art and craft work they did at the home, on this day we saw evidence such as autumn leaf mobile decorations and home made decorations being made for the Christmas Tree. Records showed us that activities such as crosswords, 1:1, Quizzes, Art and Craft, Woodwork and exercise groups took place regularly. The activity organiser is also responsible for organising catering and staffing etc for the big events such as Christmas. Regular entertainment is brought into the home for the residents to enjoy such as musical entertainers (from rock to pop and opera to meet all preferences), a Christmas panto has been arranged, local school choir is coming in, and a Christmas party with friends and relatives invited and music from a live band. The activity co-ordinator told us about various trips that had been arranged for people living at the home depending on their abilities such as skiing, skating, firework displays, trips to see Xmas lights and the Teracotta Army. The Gardens shares a sensory room with the co-sited sister home, the Jacobs Centre. Relatives and residents told us that people living at the home are often found parked in front of the television, one person described it as mind numbing. At 4pm on the day of this visit 4 people were noted in the upstairs lounge area in front of a television. None were displaying an interest in what was being shown on the television, no staff members were anywhere in sight. One person told us They forget that inside the body there is a brain that works Notices were seen around the home informing relatives and friends about forthcoming meetings and social events. It was reported that the service had introduced a 5 minute pledge for care staff. This Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: meant that care staff were encouraged to sit and interact with people, moving away from the culture that activity input is the sole responsibility of the activity co-ordinator. It was noted that this does take place and is documented accordingly on the first floor of the home however there was no evidence or indication that this takes place on the ground floor. All main meals were prepared in the Rivers Hospital kitchens, breakfasts and snacks were prepared at the unit. The fridge had food items that had been loosely covered with cling film and had date stickers indicating the day ie Thurs or Fri but no date and the food was so loosely covered that it was not protected from cross contamination. The freezer had re-cycled ice cream tubs containing pureed vegetables. These too were loosely covered, the cling film had not sealed to the tub and ice was forming on the frozen lumps of pureed mixed vegetables. We observed a mealtime in the downstairs dining room, Residents were eating their meal with support staff alongside to deliver assistance for people when they needed it, however we saw one staff member gazing out of the window instead of paying attention to the person they were seated with. The atmosphere in the dining room was that of a cafeteria as opposed to a family dining experience. One person told us I have no complaints about the food, its lovely. The Homes own resident satisfaction survey results indicated that just 6 of residents were not totally happy with the catering provide at the home and the manager was working with these individuals to resolve any outstanding issues. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive good care and are protected by the staffs practice in relation to medication, but may not always receive the care in the way they would wish due to gaps in care planning. Evidence: The Gardens provides care for people with a high level of need including tracheotomy care and PEG feeding. There are four trained nurses on duty throughout the day and three at night. Among the facilities provided for people living at the home are a physiotherapy gym and a team of physiotherapists. The Gardens has a GP who visits the service daily, provides 24 hour on call cover and has a surgery registered at the centre specifically for the residents. There is a consultant in neuro rehab who works with the home one day per week and is directly involved in all pre-admission assessments. The managers AQAA told us that it had been identified that the service could improve methods of ensuring residents and relatives know who their allocated key workers are. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: We asked staff who was the key worker for one resident, they were unable to tell us and when they checked they found it was the person we were talking to. This told us that the key working system in place at this time was not effectively working. The previous inspection report identified that a medication audit system was necessary to ensure that discrepancies were investigated and corrected. An external pharmacist is now involved in undertaking a monthly medication audit and ordering medicines for each unit at the home. The nursing staff cross check the order and ensure that it equates to what each individual needs. The orders are then passed to the GP to produce prescriptions. When medications are delivered to the home they are checked against the audit form and the prescriptions and entered onto the Medication Administration record sheets (MARs). We looked at the MARs on the first floor of the home; there were no gaps in recording. The managers AQAA told us that the nursing staff had undertaken a series of training sessions on the management and documentation of Controlled Drugs to ensure they are up to date with best practice. Staff we spoke with confirmed they had received training in the safer administration of medications. We spoke with visiting relatives about the healthcare and support received by people living at the home, the response was mixed and varied. One person told us usually the care is very good, I have some concerns at present but am very comfortable to discuss them with the manager and The Physio and OT staff are brilliant. Relatives of people living on one unit at the home told us that communication had been a problem recently where they have raised concerns about care practice but issues remained unresolved. An example being a washbowl used for washing a residents hands and face was found balanced in the toilet bowl, despite bringing this to the staffs attention the next day it was the same. We found that concerns such as these had not been brought to the registered managers attention until this day. Another relative told us Staff do stuff for the residents because it is quicker, they do not take the time to encourage people to do things themselves with assistance where needed. Care plans did not provide detail of what assistance people needed and what encouragement was to be offered to assist people in being involved in their own personal care. For example one care plan we looked at stated Ensure Xs needs are attended properly There was nothing within the care plan to explain what needs and how they should be supported. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their relatives cannot always be confident that their complaints and concerns will be dealt with appropriately. Evidence: The managers AQAA told us that Feedback from recent resident/relative satisfaction survey showed that some people feel they do not know the procedures for making complaints. However a large percentage were happy with how their complaints were dealt with. We have introduced a new leaflet entitled we value your opinion to encourage residents and visitors to tells us their comments, complaints and compliments. With the assistance of relatives and residents we plan to assess and improve our effectiveness at all levels of the service in listening and responding to comments, concerns and complaints. Completed surveys returned to us as part of our inspection process included comments such as But what is the point in making a complaint? and Not that knowing who to speak to makes any difference. Discussions with people living at the home, visitors to the home and scrutiny of records showed us there was a discrepancy with the way complaints were perceived Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: and dealt with in different units of the home. It was identified as part of this inspection visit that one unit of the home has not been following the policies and procedures for dealing with concerns and complaints. There had been two adult safeguarding issues at the home since previous inspection visit, both had been appropriately handled in accordance with policies and procedures and had been unsubstantiated as far as the home was concerned. One safeguarding investigation was underway at the time of this visit. The registered manager had identified that maintenance crew employed to work on the Ramsay Healthcare site had not attended training in safeguarding vulnerable adults, this had now been arranged. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect in an environment that is suitable to meet their physical needs however, it may not always be clean and fresh. Evidence: The managers AQAA told us we have introduced a rolling redecoration programme for bedrooms and communal areas. We have replaced the flooring in some bedrooms and deep cleaned the flooring in others. We have installed a patio with a canopy that provides protection from the weather for those that smoke. We have installed remote control fans in peoples bedrooms, these are wall mounted so do not cause an obstruction. 50 of the beds have been replaced so now all residents have electronic profiling beds and the internal passenger lift has undergone a complete overhaul and refurbishment. A physical tour of the building showed us that some communal areas of the home were not clean and fresh, some carpets were stained and soiled. A small lounge area upstairs had an unpleasant odour with stained carpet and shabby, tired furnishings. Some communal hallways were tired and in need of redecoration. The manager reported these areas had only been redecorated one year ago however, wall protectors had not been fitted and walls had become damaged through constant wheelchair use. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: During the tour of the home we noted that several people had extensively personalised their own rooms. The residents satisfaction survey results told us that 77 respondents were very satisfied or satisfied with the environment. 19 respondents were dissatisfied with the standard of accommodation and the environment. 10 completed surveys were returned to us as part of this inspection process, 4 people said they felt the home was always clean and fresh, 4 people said they felt the home was usually clean and fresh, 1 person said sometimes and one responded never. The registered manager reported that the housekeeping hours had reduced recently however there were constant on going efforts to recruit more staff for this area. A forum group made up of residents, relatives, staff and OTs had designed wet rooms to replace some of the existing bathroom facilities. On the ground floor there was one wet room and one bathroom, upstairs there were two wet rooms and one bathroom. As a result of a previous requirement the upstairs dining room had been turned into a lounge and a dining area has been created from a large corridor space. The newly created lounge had a wall mounted plasma screen, fish tank and some comfortable sofas. In house infection control teams were responsible for implementing processes and ensuring protocols were being followed in practice around the home. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by suitably trained and safely recruited staff. Evidence: The managers AQAA told us We could ensure all staff have an annual appraisal. Although this has improved over the past 12 months further work is required. We have improved the communication of training opportunities to staff. We have provided a significant amount of training and development for staff in a wide range of areas relevant to the work that we do, this has strengthened individual, team and service level knowledge, skills and competency. As planned we have trained more NVQ assessors and are in the process of training up an internal verifier. Our practice development nurse won an award for excellence in her work with NVQ candidates. We have held regular staff forums in addition to regular team meetings and have introduced a quarterly newsletter for staff. The service operated a thorough recruitment procedure to ensure the right people are recruited to work with the people living at The Gardens. The process included taking up two satisfactory references and an enhanced Criminal Record Bureau disclosure before new people started to work at the home. Seven staff returned completed surveys to us as part of this inspection. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: The registered manager provided us with a staff training matrix identifying what training staff had attended and when. This showed us that as well as the basic core training in moving and handling, safeguarding vulnerable adults, infection control and fire awareness which the service considers as mandatory, 72 of the staff team had attended specialist training in Neuro skills. The matrix also showed us that 93 of the staff team (74 people) had completed induction training and 23 (18 people) were due to attend refresher training in the basic core elements. A member of the administration staff team is responsible for co-ordinating the training programme for both The Gardens and the co-sited sister home, The Jacobs Centre. Copies of staff rotas and discussion with staff members confirmed the staffing levels for the home. On the 1st floor unit there are 11 staff members on duty during the daytime and 8 at night for 32 residents. On the ground floor unit there are 8 staff in the daytime and 7 staff members on duty at night. There are always 2 trained nurses on each floor during daytime and 3 in the building (2 up and 1 down) at night times. The homes resident satisfaction survey indicated that overall people were happy with the staff skills and approach. People we spoke with during this inspection visit were generally please with the way staff look after and support them. Completed surveys returned to us were mixed and included comments such as Staff should listen to what I say- need to be careful and understand my needs. certain members of staff need to be aware of hygiene Eg washing hands and Some carers are extremely good at caring, to others it seems it is just a job. Its a shame the good ones are leaving or have left. Family members we spoke with had positive comments to make about individual staff members, such as Staff member X- fantastic- if only there were more like her. We noted that staff were not wearing name badges, The registered manager reported that the current badges were not very robust and were constantly breaking and new ones were being sourced. This has been in progress since the sister home was inspected in September 2008. The registered manager reported that managers of the individual units meet with staff individually on a 1:1 basis monthly. Supervision records were not available for ground floor staff or for qualified nursing staff therefore it was not possible to confirm that people receive their care and support from appropriately supervised staff. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well managed home which is run in their best interests. Evidence: The manager is a registered nurse with a certificate in management studies. She had several years experience in community nursing and rehabilitation before being appointed as manager of The Gardens in 2004. Training records provided evidence to show that the manager undertakes the organisations basic core training refresher course (moving and handling, safeguarding vulnerable adults, infection control and fire awareness) alongside the staff team, most recently attended in May 2008. Two other training courses pertinent to her role have been attended this year. Relatives and staff had positive things to tell us about the manager. Four relatives spoken with said they were comfortable approaching the manager with any issue that concerned them and they were confident that she would listen to them and act on their concerns. Staff said they found the manager supportive and approachable. Observation over the two days of this inspection visit showed us that the manager interacted with residents, visitors and staff in a warm and professional manner. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: The registered manager told us about an exercise periodically undertaken at the service whereby the management team do different jobs for a day, for example working in the laundry or as a domestic for the day. The manager told us this provides a deeper understanding of the issues that affect other working areas of the home. The managers annual quality assurance process includes Customer Satisfaction Surveys developed and distributed by the organisation. The manager collates the responses and develops a report indicating the percentage of people who are satisfied/dissatisfied with various aspects of life/facilities/healthcare support provided for the people living at The Gardens. The management of the service demonstrates a proactive approach to improving the services and facilities the home offers for the people living there. Records were maintained to show that the safety of people living at the home and the staff working there is protected and promoted. Robust procedures were in place for fire drills with individual specific protocols in place to move each person to safety depending on their abilities. The fire authority provide the staff with training on mattress evacuation, each person attends an annual fire drill and the fire alarm is tested weekly. The previous inspection report identified a risk with the hot trolleys in the dining room. Risk assessments have been put in place and the trolleys are stored behind portable screens in the dining room when not in use. The manager told us that if the dining room is used for any activities the trolleys are moved out into a service corridor accessed by staff members only. All cleaning items were securely stored in a locked facilities, the manager had cause to remind domestic staff not to leave cleaning carts unattended in the doorways of peoples bedrooms whilst going about their duties. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 6 12(2) & (3) People must be enabled to 31/03/2009 provide a realistic input into their care plans, for example by setting their own targets and monitoring their own progress. Previous timescale of 30/04/08 met in part. 2 9 13(4) You must ensure that all 31/03/2009 risks of harm or injury to people living at the home, staff or visitors are identified and strategies are put in place to reduce or remove the identified risks. Previous timescale of 30/04/08 met in part. 3 14 16(2)(n) People living in the home 31/03/2009 must be offered a choice of varied and appropriate activities throughout the day. Previous timescale of 30/04/08 met in part. 4 42 13(4)(c) All perishable food that is 31/03/2009 stored in the home must be labelled and dated in order to ensure the safety of the people in the home. Care Homes for Adults (18-65 years) Page 28 of 31 Previous timescale of 30/04/08 met in part Care Homes for Adults (18-65 years) Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 22 22 You must ensure that people 30/03/2009 living at the home and their families and representatives are able to raise any concerns or complaints they may have and be confident they will be acted upon. This is to ensure people living at the home can be confident they are listened to and have their concerns taken seriously. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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