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Inspection on 12/01/06 for The Georgiana

Also see our care home review for The Georgiana for more information

This inspection was carried out on 12th January 2006.

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.

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 home was clean, tidy and the service users live in a hygienic environment. The service users have expressed their satisfaction with the services and particularly the staff behaviour towards them as always caring. The partners, family members and service users representatives were happy with the care arrangements the home had made for the service users.

What has improved since the last inspection?

The home had new manager. The current manager had taken proactive steps to develop and introduce new tools for needs assessment, care planning and staff confidence-building measures.

What the care home could do better:

The service users need assessment, care plan and care plan review documents needed regular and timely update. Staff recruitment practices should be more robust and needed strict adherence. Quality assurance audit tool should be updated and implemented in letter and spirit.

CARE HOMES FOR OLDER PEOPLE The Georgiana 10 Compton Avenue Luton LU4 9AZ Lead Inspector Mr Pursotamraj Hirekar Unannounced Inspection 12th January 2006 1:20 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 The Georgiana DS0000044852.V272251.R01.S.doc Version 5.0 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. The Georgiana DS0000044852.V272251.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Georgiana Address 10 Compton Avenue Luton LU4 9AZ 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) 01582 570650 thegeorgina@btconnect.com Heritage Care Homes Ltd Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places The Georgiana DS0000044852.V272251.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd June 2005 Brief Description of the Service: The Georgiana was located in a residential suburb of Luton within walking distance of a train station. The amenities of the town were a short car journey away. The home had been purpose built almost three years previously to meet the environmental standards detailed by the National Minimum Standards 2001 for the care of fourty-four frail older people. The proprietor was Heritage Care Homes Ltd that also operated two other care homes in the vicinity. Mrs Ainsbury had been the manager and had recently submitted her application to be registered as the manager at the home to the CSCI. The accommodation was distributed over three floors that were accessed via staircases and a shaft lift. The upper floor was used for administrative purposes, food storage and preparation. The building had been designed to provide four distinct living areas. Each had a lounge/diner and convenient access to toilet and bathing facilities. Small kitchenette facilities for the use of service users were located on the ground and first floor. The home had a hairdressing room that could also be used for chiropody treatment. All of the bedrooms, which were for single occupation, were fitted with call bells and had ensuite toilet and washbasin facilities. The building has been decorated and furnished to a high standard and provided an attractive and comfortable environment. The Georgiana DS0000044852.V272251.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of the unannounced inspection carried out at 1.20pm on 12.01.06 over 4 ½ hours by PursotamRaj Hirekar. The inspection methodology included a review of service users care documents, conversation with service users, partners, relatives and representatives of service users, staff, manager and owner. A partial tour of the building was also carried out. What the service does well: 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 Georgiana DS0000044852.V272251.R01.S.doc Version 5.0 Page 6 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 The Georgiana DS0000044852.V272251.R01.S.doc Version 5.0 Page 7 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 the following standard(s): 3 and 4 Service users pre-admission assessments were not comprehensive to assure that their needs will be met by the home. EVIDENCE: Service users were admitted to the home from two streams: referred by social services and private. Service users pre admission assessment of need had not detailed personal preferences in relation to social or recreational pursuits, cultural or religious needs. The current manager had planned to develop a new tool for pre-admission assessments that would cover areas including personal choices and preferences of service users. This new tool will be used for all the new admissions and for the existing service users the information gaps will be duly recorded. The pre-admission need assessment records will be updated and will be operationalised for all the service users by 1st April 2006 using the new tool, the manager committed. The Georgiana DS0000044852.V272251.R01.S.doc Version 5.0 Page 8 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 the following standard(s): 7, 9, 10 The need assessment, risk assessment and care planning tools were not wide ranging and as such there was a risk that some aspects of care needs would be overlooked. EVIDENCE: The current care plans of service users do not have comprehensive information about the service users personal; social care needs and health care needs. The current manager had taken notice and had initiated a new process of preparing care plans using a new tool that is comprehensive covering areas such as personal profile, social and leisure, physical health and mental health assessment including periodic reviews. As on the day of inspection 3 service users care plans have been written and signed only by the manager. All the new and old service users care plans would be developed using the new care plan tool by 1st of April 2006, the manager committed. Risk assessment identified that service users were not competent to administer their own medication. The staff members of the home-administered medication to all the service users needed medication. The Georgiana DS0000044852.V272251.R01.S.doc Version 5.0 Page 9 The service users and their representatives were happy with the services the home was providing and have said that the staff treated service users with dignity and respect. The Georgiana DS0000044852.V272251.R01.S.doc Version 5.0 Page 10 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 the following standard(s): 12, 13, 14 and 15 The home had made appropriate arrangements to meet the daily life and social activities of the service users EVIDENCE: The home had made arrangements for daily activities and holiday plans that stimulate and engage service users during their free time. Service users have expressed their happiness and enjoyed Christmas lunch and party. Service users spoken to maintain contact with their family members and representatives as they wish and were happy with arrangements made by the home. Service users were encouraged by the staff to exercise choice and control over their lives. However, it is not evident from the current care plans. The manager had said that the new care plan tool would fill this information gap and ensure that the service users choices and control over their lives were systematically recorded. All the service users were consulted before preparation of meals about their choice of meal and served accordingly. The current manager planned to undertake nutritional assessment of all the service users and record all The Georgiana DS0000044852.V272251.R01.S.doc Version 5.0 Page 11 individual service users diet needs and commence implementation before 1st of April 2006. The Georgiana DS0000044852.V272251.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 16 and 18 The staff recruitment policy and practice is not robust enough to ensure that the service users were fully protected EVIDENCE: Staff records showed that one staff member CRB had not yet come through and 8 staff members second references were awaited. The current manager will continue to chase for CRB checks and second references, the manager committed to complete the process by end of February 2006. The home should ensure that ‘ From 26 July 2004, all care staff applying to work in care positions working with adults in CSCI regulated settings are required by law to have received a satisfactory Protection of Vulnerable Adult Check before they can take up employment’. The current manager had said that on one of her early morning surprise visit to the home found the back door of the home was not guarded. To this effect, the manager had commenced preparation of a new policy for night staff. Service users relatives and representatives spoken to have said they have no complaints and were satisfied with the complaints policy and procedures. The Georgiana DS0000044852.V272251.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 19, 22, 23, 26 The home was clean, tidy and the service users live in comfortable surroundings. EVIDENCE: Areas of the home seen during this inspection were clean, tidy and well furnished. Bedrooms seen contained many personal items of the service users to create a homely atmosphere. Weekly testing of fire alarms record showed that the weekly tests have been conducted regularly. Monthly checking of emergency lighting needed regular checking. The manager had proposed to organise a fire training and drill for the staff on the 01.02.06. One of the senior staff members had requested for a second hoist to help them carry on their work smoothly. The Georgiana DS0000044852.V272251.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The staffs have appropriate skill mix. However, the lack of team approach had some adverse impact on the quality of services. EVIDENCE: The current manager had engaged in dialogue, weekly meetings and staff appraisals to rebuild the confidence and morale of staff to work in a team approach. However, there were issues with regard to staff supervision and staff reviews. The manager and the owner had assured to address these issues on priority. The staff training needs have been assessed and a training calendar was developed to impart training to the staff. The home’s recruitment policy and practices needed to be more robust and follow strictly all the statutory pre-employment checks and references. The Georgiana DS0000044852.V272251.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, and 38 The current manager had taken pro-active initiatives to address all outstanding issues with the support of the owner and staff. However, not adhering to timescales may have adverse impact on the quality of life of the service users. EVIDENCE: There is no registered manager. The current manager is in the post for a couple of months and had made an application for registered manager with CSCI. The manager had taken proactive steps to address the outstanding issues of staff supervision, staff training, care planning tool and the quality audit tool keeping in mind the best interest of the service users. The manager enjoys the support of the owner and committed to complete all the outstanding requirements by 1st April 2006. The Georgiana DS0000044852.V272251.R01.S.doc Version 5.0 Page 16 The manager had planned to conduct risk assessment of the whole building based on the report of occupational therapist, Clare Hammond, dated 10.06.05 and develop an action plan to implement any concerns. The Georgiana DS0000044852.V272251.R01.S.doc Version 5.0 Page 17 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 X X 2 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X 2 3 X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X X X 3 The Georgiana DS0000044852.V272251.R01.S.doc Version 5.0 Page 18 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 OP7 Regulation 15(1)(2) Requirement The registered person must ensure that all care plans include the details as specified by the assessment of need. Plans must be signed as agreed by the service user or their representative (Previous timescales of 31.03.04 and 30.09.04 had not been met. The timescale from the previous report of 30.06.05 and 30.08.05 has been extended) Care plans must show how assessed needs will be met and must be updated with any significant changes of need (The previous timescale of 30.06.05 and 02.08.05 has been extended). Pre-admission assessments of need must take account of service users preferences and detail social, cultural and religious needs (Previous timescales 30.06.05 has been extended) Care plans must take account of assessments of risk, including those in relation to an DS0000044852.V272251.R01.S.doc Timescale for action 01/04/06 2. OP7 15(1)(2) 01/04/06 3. OP3 14(1)(2) 01/04/06 4. OP7 13(b)(c) 01/04/06 The Georgiana Version 5.0 Page 19 5. OP18 19(1a)(b) 6. OP27 18(1)(a) 7. OP4 14(1) (b, c, d) 8. 9. OP29 OP31 19 (4) (c) 18(1)(a) unexplained accident (Previous timescales 02.08.05 has been extended). Recruitment procedures must include an updated CRB check and two recent references (Previous timescale of 31.03.05 and 30.06.05 had not been met) The home must have an effective senior team that has been allocated sufficient time to direct and supervise the rest of the team. The home must ensure all the service users and their representatives know that the home they enter will meet their needs The home must ensure that the recruitment policy and practices protect the service users The manager must undertake training in the assessment and management of risk. 28/02/06 28/02/06 01/04/06 01/04/06 01/04/06 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. 2. 3. Refer to Standard OP36 OP22 OP38 Good Practice Recommendations The registered person should introduce a timetable to identify staff supervision schedules and implement. (Not actioned) The home should ensure that adequate equipments (hoist) are in place for smooth moving and handling of service users The registered person should maintain an audit of routine safety checks as per the managers checklist. (Not actioned) The Georgiana DS0000044852.V272251.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 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 The Georgiana DS0000044852.V272251.R01.S.doc Version 5.0 Page 21 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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