Inspection on 16/01/07 for The Garth Care Home

This inspection was carried out on 16th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Garth Care Home 10/01/06

The Garth Care Home 09/08/05

The Garth Care Home 12/01/05

The Garth Care Home 03/09/04

The Garth Care Home 16/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Garth Care Home The The Square Kington Herefordshire HR5 3BA Lead Inspector Wendy Barrett Unannounced Inspection 16th January 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Garth Care Home The DS0000027690.V327121.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Garth Care Home The DS0000027690.V327121.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Garth Care Home The Address The Square Kington Herefordshire HR5 3BA 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) 01544 230502 01544 231638 garthcare@hotmail.com Mr Alan Joseph Prior Mrs Patricia Jane Prior Mrs Patricia Jane Prior Mr Alan Joseph Prior Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32), Physical disability over 65 years of age of places (32) Garth Care Home The DS0000027690.V327121.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: The Garth is a Georgian property situated in the centre of the small Herefordshire market town of Kington. It has been extended and is registered for 32 places, with a maximum of 22 places for service users requiring nursing care. It offers accommodation for service users of both sexes over the age of 65, who are frail or physically disabled. It is privately owned and managed by Mr Alan Prior and Mrs Patricia Prior. The Home was first registered in 1988 and consists of a two-storey building with a purpose built two-storey extension. The Home has 22 single en-suite bedrooms, two double en-suite bedrooms. There are a further two single bedrooms and two double bedrooms without an ensuite facility. There is a passenger lift in the new building and a stair lift in the original Georgian property. The gardens are well maintained and easily accessible for service users. Copies of the home’s Service User Guide are available at the home. A copy is given to enquirers and potential residents. There are also copies distributed to local hospitals and social work teams. In January 2007, the fees ranged from £385 per week to £415 per week for personal care. Nursing fees ranged from £500 per week to £525 per week. Additional charges are made for hairdressing, aromatherapy massage, toiletries and personal newspapers and magazines. Garth Care Home The DS0000027690.V327121.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on information gathered from the Commission’s service file, a pre-inspection questionnaire completed by the Provider, feedback survey forms from residents, relatives and involved care professionals, and an inspection visit to the service. What the service does well: What has improved since the last inspection? A care manager was appointed in December 2006. She has already introduced some new ideas e.g. getting more information about residents’ life experiences so that staff can understand them a little better, more checks of the residents’ accommodation to be sure they have everything they need for their everyday comfort. Garth Care Home The DS0000027690.V327121.R01.S.doc Version 5.2 Page 6 The sitting areas have been re-arranged so that there is now a suitable space for family functions and activities. An area previously used by staff has been made into an additional sitting space for residents and visitors. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Garth Care Home The DS0000027690.V327121.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Garth Care Home The DS0000027690.V327121.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information describing the service is readily available so that potential residents and their representatives can find out what they could expect from the home. Before new residents are admitted, senior staff at the home make sure they have enough information to decide if they could meet the individual’s care needs and expectations. All residents receive a contract to confirm the terms and conditions of their residence. EVIDENCE: Information literature is readily available at the home and to general enquirers and potential residents. Garth Care Home The DS0000027690.V327121.R01.S.doc Version 5.2 Page 9 When residents come into the home they are given a contract of residence that confirms the fees they will have to pay and what type of service they can expect. Examples of signed contracts were seen during the inspection visit. Before anyone is admitted to the home the senior staff gather as much information as they can about the individual’s needs and expectations. They usually do this by visiting the prospective resident in their own home or in a hospital. Sometimes reports are obtained from other care professionals e.g. community care assessment reports written by social work staff. There is already work underway to gather more information about previous lifestyle and social history. This is important so that the staff can appreciate what things are likely to be significant for the resident in addition to their physical care needs. A completed Personal Profile was seen and the care manager hoped that new residents and their relatives would help complete this record. When a new resident has been at the home for a few weeks a meeting is arranged to discuss if things are going well. An example of this type of meeting had included the Care manager, a social worker, the resident and a relative. Garth Care Home The DS0000027690.V327121.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each resident has a plan of care that informs the staff what care is needed and how that should be provided. The plans work well and residents, relatives and care professionals are satisfied with the care received. There is work being done to improve the plans in helping individual residents pursue their social interests. Medication is safely managed. It would strengthen the overall picture if staff have more specific guidance in deciding when to give medication prescribed ‘as required’. EVIDENCE: Each resident has a plan of care that is based on the findings of assessment work. When there are potential risk areas the staff use recognised assessment tools e.g. nutritional assessments, skin care assessments. The current plans Garth Care Home The DS0000027690.V327121.R01.S.doc Version 5.2 Page 11 tend to concentrate on physical needs and there needs to be more attention to other important aspects of each resident’s life. This work is already underway i.e. there is a new procedure for obtaining a life history and personal profile. Residents and relatives are consulted about decisions regarding care. The Commission’s Pharmacy Inspector visited the home in March 2006 and inspected the way that medication is managed. A sample of medication records and stock were inspected this time. They reflected a satisfactory method of handling, storing and recording, and action had been taken to comply with a requirement made by the Pharmacy Inspector. When medication is prescribed ‘as required’ it is important to be sure that there is a consistent staff approach in deciding when to administer it. There has been a previous recommendation to introduce written plans and a requirement is now made for this to be done. Garth Care Home The DS0000027690.V327121.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff work hard to offer residents a varied lifestyle that suits them. The meals are particularly popular and they are arranged to be sure residents get a healthy diet. EVIDENCE: The home provides a variety of leisure opportunities and residents can choose if they want to join in – ‘sometimes likes to join in and says it’s her choice’. The activities included exercise sessions, entertainment, opportunities for religious worship and craft work. Trips out into the local community are also provided for those wishing to get out and about. A volunteer was playing whist with a small group of residents when the inspection visit took place. A resident with dementia related needs was amusing herself with a large puzzle. Residents and their families are encouraged to bring in photographs and some relatives had displayed these very attractively on bedroom walls. Where Garth Care Home The DS0000027690.V327121.R01.S.doc Version 5.2 Page 13 family members were shown their names had been added so that staff could help the resident enjoy the pictures. The dietary needs and preferences of each resident are carefully assessed and monitored. An assistant cook was met at the home. She demonstrated a thorough awareness of individual residents’ dietary needs. Mealtimes are flexible e.g. Lunch is served between 12.30pm and 2pm. The residents enjoy their meals – ‘if there is something I don’t enjoy there is always a choice of something different, and I enjoy it’, ‘healthy choice of menu due to being a diabetic’, ‘although I am vegetarian the home caters for me very well. I am satisfied’. Garth Care Home The DS0000027690.V327121.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives know how to raise any concerns and they are confident they will be listened to. The residents are protected through the open management approach and staff who are informed about protection issues. EVIDENCE: There haven’t been any complaints or allegations referred to the Commission during the past year. The home has recorded 6 complaints although survey forms do not indicate any complaints have been made. The recorded complaints were investigated internally and one was found to be justified. The home investigates and records all concerns raised, however small. All residents receive written guidance about the home’s complaints procedure and this is also advertised in the home. Residents knew who they could talk to if they had a concern –‘happy to discuss with Team Leader or new care manager’. The Providers have an open approach. This was illustrated in a file of information displayed in the hallway at the home for anyone to read. The file Garth Care Home The DS0000027690.V327121.R01.S.doc Version 5.2 Page 15 contained guidance to help people identify good and bad practice e.g. rights, expected staff attitudes, the various staff roles. Staff have received training in adult protection. Two individual staff training programmes listed adult protection training provided in October 2006. The overall training plan for 2007 included another similar session. All staff receive a handbook that contains copies of policies and procedures regarding adult protection and how to raise concerns about resident safety. Garth Care Home The DS0000027690.V327121.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a comfortable and clean environment. Furnishings and décor are kept up to a good standard and maintenance is regularly carried out to be sure all facilities are working properly. EVIDENCE: The Garth is in the centre of the small market town of Kington so it is very close to local shops and amenities. The accommodation is well maintained and the Provider makes sure all essential services and equipment are regularly serviced by outside contractors. Residents and visitors confirm that the home is always kept clean –‘this home is lovely and clean. Even visitors say how clean it is’. Everywhere was warm and there were no bad smells when the home was visited. Garth Care Home The DS0000027690.V327121.R01.S.doc Version 5.2 Page 17 The Provider considers how the accommodation can be altered to improve resident comfort e.g. a new sitting room space has recently been introduced and an area identified for activities and family functions. The care manager is introducing new procedures to ensure residents bedrooms are properly attended e.g. supplies of clean towels, toilet rolls, tidying wardrobes. There will also be additional checks of the premises and equipment to back up the existing checks done by the Provider. Residents’ bedrooms are homely although the safety of very frail residents and staff is protected in the way furniture is arranged. There were some very nice displays of family photos in bedrooms inspected. The names of some of the people shown in the photos were identified so that staff could help those residents who may not always remember who everyone was. Hygiene arrangements are well addressed at the home e.g. staff have a file of information to tell them how to handle potentially hazardous cleaning materials etc. The file also contained information to help domestic staff carry out their tasks in a safe way. Soaps/disinfectors and paper towels are provided around the home so that staff and visitors can wash their hands, and the minutes of a staff meeting referred to the need to make sure stocks do not run out. The main kitchen was clean and tidy when the inspection visit took place. Garth Care Home The DS0000027690.V327121.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Provider works hard to make sure there are enough staff to meet the residents’ needs, and when shortfalls are identified action is promptly taken to improve the situation. New staff are carefully selected to be sure they will be suitable to work with vulnerable adults. When they start work they are given support and supervision until they settle into their new job. After this, they are offered good training opportunities to help them go about their work safely and professionally although some staff may need more frequent instruction in manual handling techniques. EVIDENCE: Duty rotas indicate a satisfactory level of staff but some residents feel there are delays in receiving attention – ‘if busy take a long time’, ‘sometimes staff can be a little slow’. Other comments were much more positive – ‘staff respond quickly’, ‘always available’. The Provider uses a recognised tool for assessing if there are enough staff to deal with nursing tasks. The minutes of the last staff meeting referred to comments about staff shortage during meal periods. The Provider had responded to this feedback by re-organising manager tasks so Garth Care Home The DS0000027690.V327121.R01.S.doc Version 5.2 Page 19 that there was more time to help the junior staff at these times of day. An annual exercise to invite staff to complete questionnaires about their work experiences contained comments about busy evening periods. In response to this, additional kitchen cover had been brought in to relieve the care staff. Although there is already good consultation with residents and staff it may be worth looking at staff availability again to see if there are any specific residents and/or situations that lead to the discrepancy in resident feedback referred to above. The number of care staff who have achieved a national vocational qualification exceeds the national target. A training officer is employed at the home and training arrangements are comprehensive and well organised. Two individual staff training records reflected good attention to health and safety training and professional practice training. However, the two records sampled at the home did suggest that the frequency of manual handling refresher training should be reviewed e.g. a care assistant last received this instruction in September 2005. A nurse last received instruction in September 2004. A recommendation is made to review whether this is regular enough for staff who have to handle residents. Two personnel files were inspected. The records confirmed a satisfactory recruitment procedure that included the necessary checks of the applicant’s suitability to work with vulnerable adults. There were also records of in-house induction and a further induction programme that meets national specifications. Garth Care Home The DS0000027690.V327121.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is managed competently so that residents benefit from a safe environment and well-trained staff. There is an open approach and everyone who has involvement with the service is encouraged to participate in decisions made to improve the residents’ quality of life. EVIDENCE: The Providers established The Garth home in 1988 and both have considerable experience and relevant qualifications in the caring profession. They have Garth Care Home The DS0000027690.V327121.R01.S.doc Version 5.2 Page 21 developed a strong management team so that all aspects of the service receive thorough attention. There is now a training officer, a personal care manager, and a catering manager. Mrs. Prior is the registered manager and leads on the nursing service. Mr. Prior takes responsibility for health and safety. The Service User Guide reflects an open management approach. It contains useful information to help members of the public understand what they could expect from the service e.g. there is a section about ‘choosing the right home for you’ and a ‘frequently asked questions’ section. The home is approved as an Assessment Centre for Btec qualification in Care, and Nursing and Midwifery Council Approved as a Provider of training for student nurses and Adaptation nurses from overseas. This status requires the service to achieve particular standards. Additionally, the managers undertake consultation exercises as part of their quality monitoring e.g. the staff had recently been invited to complete questionnaires. When the inspection visit took place the Provider was considering which formal system of quality assurance would be most suitable and had obtained written information on one system. A few residents manage their own financial affairs but most require some support. The Provider appropriately relies on relatives and other representatives to do this e.g. many residents have Power of Attorney arrangements. When small amounts of cash are held in safekeeping, records are kept of all transactions. When the inspection visit took place there were many examples of thorough attention to health and safety requirements e.g. records of bath temperature checks, guidance for staff relating to work activities and the handling of potentially hazardous materials. The Provider regularly audits the state of the premises so he can identify any shortfalls. The care manager was introducing new procedures for supporting this work e.g. checks of bedrooms to ensure supplies of clean towels, toilet rolls. Fire procedures, including evacuation arrangements for each resident, were well advertised through the home and staff were receiving instruction in new fire regulations. Garth Care Home The DS0000027690.V327121.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x x x 3 x x 3 Garth Care Home The DS0000027690.V327121.R01.S.doc Version 5.2 Page 23 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 OP9 Regulation 13(2) Requirement Timescale for action 28/02/07 2. OP33 24 Arrangements for the safe administration of medicines must include written plans describing the use for any medicine prescribed on an ‘as required’ basis. The registered person must 30/06/07 further develop a system to monitor and audit the quality of service delivered by the Home. A report of the outcome of the review must be sent to the Commission and made available for residents. (Previous timescale revised) 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 OP27 Good Practice Recommendations Further consultation with residents and staff regarding the views of some residents that there are sometimes delays DS0000027690.V327121.R01.S.doc Version 5.2 Page 24 Garth Care Home The 2. OP30 in receiving staff attention. Re-consider whether the current frequency of manual handling refresher training is adequate. Garth Care Home The DS0000027690.V327121.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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. Extracts may not be used or reproduced without the express permission of CSCI Garth Care Home The DS0000027690.V327121.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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