Inspection on 14/11/08 for The Georgiana

This inspection was carried out on 14th November 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Georgiana 14/01/08

The Georgiana 20/09/07

The Georgiana 08/11/06

The Georgiana 12/01/06

The Georgiana 02/06/05

The Georgiana 04/03/05

The Georgiana 01/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Georgiana 10 Compton Avenue Luton LU4 9AZ     The quality rating for this care home is:   two star good 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: Sally Snelson     Date: 1 4 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. the things that people have said are important to them: They reflect 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 Older People 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 Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 Older People Page 3 of 26 Information about the care home Name of care home: Address: The Georgiana 10 Compton Avenue Luton LU4 9AZ 01582570650 Telephone number: Fax number: Email address: Provider web address: Noemailyet.3/7/2007 Name of registered provider(s): Name of registered manager (if applicable) Mrs Mary Ainsbury Type of registration: Number of places registered: Heritage Care Homes Ltd care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The Georgiana is 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 was purpose built to meet the environmental standards detailed by the National Minimum Standards 2001 for the care of forty-four frail older people. The proprietor is Heritage Care Homes Ltd that also operated two other care homes in the vicinity. The accommodation is distributed over three floors that are accessed via staircases and a shaft lift. The upper floor is 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 and their families 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 Care Homes for Older People Page 4 of 26 Over 65 12 44 0 0 Brief description of the care home with call bells and had en suite toilet and washbasin facilities. The building has been decorated and furnished to a high standard and provided an attractive and comfortable environment. The fee is in the range of 450 pounds to 475 pounds. Care Homes for Older People Page 5 of 26 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out in accordance with the Commission for Social Care Inspection’s (CSCI) policy and methodologies, which requires review of the key standards for the provision of a care home for older people that takes account of residents’ views and information received about the service since the last inspection. Information from the home, through written evidence in the form of an Annual Quality Assurance Assessment (AQAA) (this was requested earlier in the year) has also been used to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit. Sally Snelson undertook this inspection of The Georgiana. It was a key inspection, was unannounced, and took place from 08.05am on 14th November 2008. Care Homes for Older People Page 6 of 26 Mary Ainsbury, the manager, was present for the whole inspection. Feedback was given throughout the inspection, and at the end. During the inspection the care of three people who use the service (residents) was case tracked in detail. This involved reading their records and comparing what was documented to what was provided. In addition to sampling files, people who lived at the home, visitors, and staff were spoken to, and their opinions sought. Any comments received from staff or residents about their views of the home, plus all the information gathered on the day was used to form a judgement about the service. Prior to the inspection a random selection of residents had been asked to complete and return quality questionnaires. These were also used to inform our judgement of the service. What the care home does well: What has improved since the last inspection? What they could do better: 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 Older People Page 8 of 26 Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. The manager was aware of the need to ensure that prospective residents were thoroughly assessed prior to admission. This ensured that the home, and the staff team, could meet the physical and social needs of a person. Evidence: There was a Statement of Purpose in place for this home which was displayed in the entrance hall. This document was held electronically and reviewed at regular intervals. Each of the residents had been given a Service Users Guide which was described to them as a quick reference guide to the home. Both of the documents were up-to-date and included the required information, including details and minutes of relative meetings and quality surveys. All of the resident had contracts that included information about the services to be provided and the fees. The contracts had been signed by the resident, or a person on Care Homes for Older People Page 11 of 26 Evidence: their behalf, and the manager. The person using the service was given a copy and a copy remained in the home. In the files we looked at there was a clear trial from the initial enquiry to admission that provided the evidence that the manager had assessed any prospective residents prior to offering them a place at the home. The home did not offer intermediate care. Care Homes for Older People Page 12 of 26 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. The current care documentation ensured that staff had clear instructions as to how care needs were to be met. This meant that people using the service received the correct care. Evidence: The home continued to use a commercially produced needs assessment and care plan book to record the details of a persons care needs. The manager and the staff reported that this book was suitable for the task, and they felt it guided them through the process and ensured that they did not omit any areas of care by using it . All of the people using the service had one of these books, and we noted that they were kept up-to-date and it was apparent how decisions had been made. In addition to care needs the book included information about a persons social interests, physical health,and mental health, it also directed the staff to the necessary risk assessments and how to deal with areas of concern. The books also included signed consents for areas such as, the administration of medication, bed rails, and end of life care. There was evidence that some of the people using the service had been consulted about their Care Homes for Older People Page 13 of 26 Evidence: plans and they or a family had signed to agree the plan. The care plans had been reviewed monthly and were updated as needs changed. Each care plan had any associated risk assessments and guides. Staff worked closely with the community nurses who visited to undertake dressings and support the home with end of life care. The community nurses offered advice and could on occasions be a source of training. A diabetic liaison nurse had provided some training to the staff team and as a result the staff had identified the need for emergency diabetic resources within the home. Throughout the inspection we witnessed people being moved correctly and the use of moving and handling equipment, such as slide sheets and hoists. We checked the Medication Administration Record (MAR) sheets for the three residents we case tracked, plus four more. Medications were appropriately stored in a locked trolley that was secured to the wall. We did remind staff that they need to be vigilant and close the trolley when leaving it in order to administer medication to a person who was sitting away from the trolley. Monthly medication deliveries had been appropriately signed into the home. However there were some instances where medication remaining from the previous month, had not been carried forward. Reconciliation was not possible for these as it was not clear if the old stock had been returned or carried forward. On the whole charts had been accurately completed with signatures and omission codes where appropriate. The back of the MAR sheet had also been completed when an omission code had been used. Controlled drugs (CD’s) were stored appropriately and all administrations had been recorded accurately with two signatures in the CD register. Throughout the inspection we saw resident’s being treated with respect and dignity and offered choices at all times. All of the residents appeared clean and well dressed, for example the females were wearing tights or stockings, and the men belts on their trousers. Some residents had written advanced directives about their end of life wishes, and these had been correctly signed by those providing care and those close to them. Care Homes for Older People Page 14 of 26 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. 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. The service enabled people to participate in some meaningful activities in order to provide stimulation. Meals were well planned, well presented and nutritious. Evidence: A member of staff had recently taken on the role of activity co-ordinator and had worked with the people using the service to establish an activity plan that suited them. The proposed activities were on display for the month, but they could be flexible. Individual diaries were available in residents room for staff to record any activity a resident had participated in, and how they had reacted to this. This had been initiated as a result of some relatives being unsure how their loved ones spent their time during the day. Residents told us about a recent firework evening, to which they were able to invite friends and families to enjoy a firework display, hot dogs and soup. In addition to group activities staff provided some one to one time with people and there was a rolling programme for different residents to be taken out each week to a place of their choice. The manager was aware of the need to try and stimulate those residents who did not enjoy group activities, and encouraged staff to spend time talking to those who preferred to remain in their own bedrooms during the day. Relatives and friends were welcomed into the home as were visiting church groups, entertainers and choirs. Care Homes for Older People Page 15 of 26 Evidence: Throughout the home were displayed arts, crafts and photographs done by, or taken of, the people living at the home. We did note that mealtimes were a social occasion and people were encouraged to remain in the dining room talking with each other and/or staff. The inspection spanned breakfast and lunchtime. Breakfast was taken as those using the service were ready to eat. At lunchtime the meal was served from 12:30, but those needing support had there meal as staff became available. On the day of the inspection lunch was a choice of fried fish, poached yellow fish, or chicken burger in gravy with chips or mashed potatoes and peas, followed by sponge pudding and custard. The dining room looked nice with flowers on each table. The kitchen had been awarded the top mark of five stars by the local environmental health department. Care Homes for Older People Page 16 of 26 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. A robust complaints procedure, and staff awareness of safeguarding ensured people were kept safe at all times. Evidence: The homes’ complaints policy was displayed in the reception area and was easily accessible to residents and visitors to the home. It confirmed the expected timescales for responses, and advised people of the process if they were dissatisfied with the outcome. Since the last inspection there had been one complaint and a number of complements made to or about the home. All staff had undertaken safeguarding training and the staff spoken to appeared to know how, and when, to make safeguarding referrals. The manager worked closely with the Local Authority safeguarding team and made appropriate referrals. Recruitment processes ensured that staff employed were ‘fit’ to work with vulnerable adults. Care Homes for Older People Page 17 of 26 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, 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. 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. The home was clean, tidy, and well decorated and provided the people using the service with a homely place in which to live. Evidence: For operational purposes the home was divided into ground floor and first floor areas, accessed by stairs or a lift. Residents used the communal areas in which their bedrooms were situated, but were free to access any of the home or garden Individual rooms had been decorated and furnished to meet with personal tastes. Photographs and ornaments on display in some of the rooms clearly reflected the family and personal history of the residents. The home had a variety of assisted bathing facilities and all bedrooms had en-suite toilets and wash hand basins. One resident told us he would decide when he wanted bathing and if he wanted a shower or a bath. It was noted that when curtains were opened (because there were no net curtains) visitors arriving at the home via the car park, could see into some of the bedrooms on the ground floor. Care Homes for Older People Page 18 of 26 Care Homes for Older People Page 19 of 26 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. 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. A variety of training was offered to all of the staff to ensure that collectively, they had the skills and experience, to meet the needs of the people living at the home. Recruitment procedures were fully adhered to so that residents were protected. Evidence: There were eight staff on duty at the start of the inspection and this did not include the manager, the cleaners, the kitchen staff or the handyman. The manager believed that the staff compliment was sufficient to meet the assessed needs of the people using the service, but she was aware that some staff were planning to leave the area to look for alternative employment as they found the cost of living in Luton to be high. The manager had advertised for additional staff in preparation for this time. According to the AQAA at the time of the inspection all staff had NVQ level 2 or above or were working towards it. Staff continued to undertake a variety of different training and the manager had produced a matrix of what training staff had undertaken and what they needed to do or refresh. However the manager had recently sourced and external training company Care Homes for Older People Page 20 of 26 Evidence: who were keeping this information electronically and advising her when staff training was due. We examined the personal files of three members of staff. All contained fully completed application forms, appropriate references, induction checklists and training records and certificates. Criminal Record Bureau (CRB) checks had been carried out on all staff, and home office paperwork was present where required. Care Homes for Older People Page 21 of 26 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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. The manager is committed to the home and is continually making improvements. She supports the staff team to realise their full potential. Evidence: Throughout the inspection we witnessed the manager speaking and interacting appropriately with staff, residents, visitors and health professionals. The manager believed in leading by experience and would work ‘hands on’ shifts at times. She would also regularly make herself available to the night staff. Last year the manager had sent out annual quality assurance questionnaires to residents and their families and to other stakeholders such as the GP. She had drawn a conclusion of the responses and had written a report and acted on the received information. The process had just been started for this year. The home held small amounts of petty cash on behalf of some of the residents we Care Homes for Older People Page 22 of 26 Evidence: sampled three of these and noted that receipts were correctly kept and the money held reconciled to that on the balance sheet. Receipts were mainly for hairdressing, chiropody or toiletries. All staff were now being supervised regularly and the supervision was not task led but gave the staff the opportunity to discuss work practises and plans with the manager. We looked at health and safety documentation, including the fire log and maintenance book. There was evidence to indicate that fire call points and the emergency lighting were being tested on a regular basis, and that fire drills were carried out periodically. Maintenance issues and redecorations were being addressed in a timely fashion. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 24 of 26 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 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 1 2 9 24 Care should be taken that the medication trolley is not left open and unattended at any time. Staff should give consideration to protecting a persons privacy by providing a net curtain in ground floor bedrooms or ensuring the curtains are closed at times. Care Homes for Older People Page 25 of 26 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 © (2008) 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. Care Homes for Older People Page 26 of 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. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!