CARE HOMES FOR OLDER PEOPLE
The Garth Care Home The Square Kington Herefordshire HR5 3BA Lead Inspector
Sandra Bromige Unannounced Inspection 9 August 2005 10:20 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Garth Care Home E52 - E02 S27690 The Garth Care Home V241106 090805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Garth Care Home Address The Square Kington Herefordshire HR5 3BA 01544 230502 01544 230903 garthcare@hotmail.com Mr A J & Mrs P J Prior Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs P J Prior Care Home 32 32 32 Category(ies) of Physical disability over 65 years registration, with number Old age of places The Garth Care Home E52 - E02 S27690 The Garth Care Home V241106 090805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: No conditions of registration Date of last inspection 12 January 2005 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. The Garth Care Home E52 - E02 S27690 The Garth Care Home V241106 090805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6.75 hours. The Inspector looked around some parts of the building and a number of records were inspected. Comment cards were sent to the Home prior to the inspection to be distributed to residents and relatives. The Home had recently distributed their own comment cards to relatives and residents as part of their quality service review, so these have been shared with the Commission and the outcomes from the Home’s written consultation format has been used to inform this inspection. The owners, residents, visitors and staff were also spoken to during the inspection. The Commission has received one complaint since the last inspection regarding aspects of care. This was referred to the owner for investigation. Parts of the complaint were upheld and action has been taken by the Home to rectify the shortfalls highlighted through the complaint. The Home continues to send in written reports to the Commission of any significant events that take place in the Home. What the service does well:
The Garth is situated in the centre of the small market town of Kington with shops and amenities accessible to the residents. The Home and gardens are very well maintained. Relatives and visitors report that staff are “very pleasant and cheerful”, “are always patient and kind, and always make time to listen to any concerns we may have” and “have a dedicated team of people”. Residents are assessed before being admitted to ensure that the Home are able to meet their care needs. The care planning system in use is satisfactory providing information so that the staff know what to do for each resident. The systems for the administration of medicines are satisfactory. Personal support is offered in such a way as to promote and protect resident’s dignity, choice and independence. A comment from a relative supports this by saying “I like the way staff let residents have a choice to go to day rooms or stop in their own rooms”. Residents are clean, well dressed, their hair is done nicely, glasses clean and fingernails are clean and well looked after. Links with the community are good and support and enrich resident’s social opportunities. The Home has a satisfactory complaints system with some evidence that residents and relatives feel that their views are listened to or acted upon. The Home is clean and there are no bad smells.
The Garth Care Home E52 - E02 S27690 The Garth Care Home V241106 090805 Stage 4.doc Version 1.40 Page 6 Sufficient staff are employed to provide nursing and personal care for residents, for the provision of meals, to keep the Home clean, tidy and the residents clothes nicely laundered. What has improved since the last inspection? 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 Garth Care Home E52 - E02 S27690 The Garth Care Home V241106 090805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Garth Care Home E52 - E02 S27690 The Garth Care Home V241106 090805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Assessments are carried out by the Home prior to residents moving into the service to ensure that their care needs can be met. EVIDENCE: Individual records are kept for each resident and inspection of these records showed that assessments had been carried out by the Home prior to admission of the resident. The formats of the assessments are very comprehensive, although one assessment seen had not been fully completed. The Garth Care Home E52 - E02 S27690 The Garth Care Home V241106 090805 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 The quality of the information in the individual care plans vary, and is not providing a consistent care planning system to adequately provide staff with the information to ensure the health care needs of residents are identified and met. These shortfalls have a potential to place residents at risk. The systems for the administration of medication are satisfactory to ensure resident’s medication needs are met. Personal support is offered in such a way as to promote and protect resident’s dignity and independence. EVIDENCE: Individual plans of care are available which cover the health, personal and social care needs of the residents. Some records were very detailed and up to date providing good information about the care needs of the individual residents. Two records inspected were less detailed and had not been reviewed each month. Areas of healthcare needs not included in the care plan included continence assessments, night care needs, activity plan, and any evidence of the review of the residents diabetes following a change of dose of insulin. The Home obtains the residents and or their representatives agreement to the care plan. The Garth Care Home E52 - E02 S27690 The Garth Care Home V241106 090805 Stage 4.doc Version 1.40 Page 10 Medication administration records show that records are kept of medication received and administered by the Home as prescribed by the General Practitioner. The Medication Administration Records are handwritten, and there was no evidence that a second trained nurse is checking the records for any transcription errors. The allergy box was not routinely being completed. Residents seen and spoken to were clean, tidy and well dressed. Resident’s privacy and dignity is respected by staff when assisting residents to wash, dress and use the toilet. The Garth Care Home E52 - E02 S27690 The Garth Care Home V241106 090805 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 13 Progress has been made towards identifying and providing social activities that are stimulating and interesting for the residents living in the Home. Links with the community are good and support and enrich residents social opportunities. EVIDENCE: On the day of the inspection residents were observed playing a game of whist with some regular visitors to the Home. Other residents were watching television in the lounge or their bedroom, listening to the radio, reading a book from the library or talking to relatives, visitors or staff. A list of daily activities is on display in the residential side of the Home. The manager is considering one of the current staff to take on the role of co-ordinating activities in the Home. Written feedback is now being sought from residents after any entertainment in the Home and they have also carried out an audit of the types of films enjoyed by the residents. The manager and another member of staff are planning to attend the EXTEND course to enable regular exercise programmes to be available in the Home. Social care needs are included in the care planning system. The standard of the information for the activity profiles of individual residents varies from good to poor. This needs further development in consultation with the identified residents. The Garth Care Home E52 - E02 S27690 The Garth Care Home V241106 090805 Stage 4.doc Version 1.40 Page 12 The Home is currently consulting residents, relatives and visitors to see if they would be interested in joining a relatives/friends group at the Home. The Garth Care Home E52 - E02 S27690 The Garth Care Home V241106 090805 Stage 4.doc Version 1.40 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The Home has a satisfactory complaints system with some evidence that residents and relatives feel that their views are listened to or acted upon. EVIDENCE: The Home has a complaint procedure on display in the Home. A recent audit carried out by the Home indicated that the staff at the Home listen to residents and their visitors. Feedback from staff confirmed that they were aware of the Home’s complaints procedure and would know who to go to if they had any concerns. The Home’s complaint record has two complaints recorded since the last inspection. This includes a complaint that came to the Commission, which was referred to the Home for investigation. One complaint was not upheld and a number of the parts of the complaint that came through the Commission were upheld. Action has been taken by the Home to rectify the shortfalls highlighted through this complaint. The Garth Care Home E52 - E02 S27690 The Garth Care Home V241106 090805 Stage 4.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 26 The Home is well maintained creating a clean and comfortable environment for those living there and visiting. EVIDENCE: The Home is clean and tidy and free from any bad smells. A visitor commented that the “Home is very homely and well looked after”. Policies and procedures are in place to prevent cross infection. The Garth Care Home E52 - E02 S27690 The Garth Care Home V241106 090805 Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The numbers of staff provided are sufficient to meet the needs of the residents. EVIDENCE: Staff on duty at the time of the Inspection included a registered nurse and 6 care staff. The manager who is also a registered nurse was also available providing administrative support. In addition there were two staff receiving their induction to care training. Staff rotas show that these are the normal staffing levels and in addition the Deputy Manager works three days each week. Staff spoken to on this occasion confirmed that there are sufficient staff on duty. The Garth Care Home E52 - E02 S27690 The Garth Care Home V241106 090805 Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 & 38 Progress has been made towards further development of the Home’s systems for reviewing the quality of the service provided through recent consultations, which include seeking the views of residents, relatives and visiting professionals. The Home is well managed promoting and safeguarding the health, safety and welfare of the people using, working at and visiting the service. EVIDENCE: The manager confirmed that the Home have recently sent out written correspondence to residents, relatives, visitors, General Practitioner’s, District Nurse’s and other visiting professionals to seek feedback about the quality of the service provided by the Home. A number of responses have been received to date from relatives and residents. Further work is needed by the Home to review the quality of the entirety of its service. The outcomes need to be shared through a report with the residents, visitors and the Commission. The Garth Care Home E52 - E02 S27690 The Garth Care Home V241106 090805 Stage 4.doc Version 1.40 Page 17 Information provided by the Provider show regular routine internal maintenance checks are being done and external companies are used to carry out safety checks on equipment and services in the Home. Fire system checks are recorded and staff fire training has been provided in the last 3 months. The Garth Care Home E52 - E02 S27690 The Garth Care Home V241106 090805 Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 x
COMPLAINTS AND PROTECTION x x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 2 x x x x 3 The Garth Care Home E52 - E02 S27690 The Garth Care Home V241106 090805 Stage 4.doc Version 1.40 Page 19 Yes Are there any outstanding requirements from the last inspection? 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. 2. 3. Standard 7 9 12 Regulation 15 13 16 Requirement Care plans must be reviewed each month. The allergy box must be completed on the medication administration records. The registered person must consult residents about their social interests, and make arrangements to enable them to engage in local, social and community activities. TIMESCALE PARTLY MET. The Provider must establish an action plan for the provision of 12sq m of usable floor space for wheelchair users in single rooms. BROUGHT FORWARD NOT ASSESSED. The registered person must 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 availabale for residents. Timescale for action 31/10/05 Immediate & Ongoing 31/12/05 4. 23 23 Under review by the architect. 31/01/05 5. 33 24 The Garth Care Home E52 - E02 S27690 The Garth Care Home V241106 090805 Stage 4.doc Version 1.40 Page 20 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 9 Good Practice Recommendations Handwritten medication administration records should be checked and signed by a second trained nurse for any transcription errors. The Garth Care Home E52 - E02 S27690 The Garth Care Home V241106 090805 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Hereford Area Office 178 Widemarsh Street Hereford HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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