Inspection on 08/11/06 for The Georgiana

This inspection was carried out on 8th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Georgiana 14/11/08

The Georgiana 14/01/08

The Georgiana 20/09/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Georgiana 10 Compton Avenue Luton LU4 9AZ Lead Inspector Mr Pursotamraj Hirekar Unannounced Inspection 8th November 2006 01:50 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.V318235.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. The Georgiana DS0000044852.V318235.R01.S.doc Version 5.2 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 Mrs Mary Ainsbury Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places The Georgiana DS0000044852.V318235.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th January 2006 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 forty-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 fee was in the range of £420/- to £450/. The Georgiana DS0000044852.V318235.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of the unannounced key inspection carried out by pursotamraj hirekar on 08/11/06 over 4 hours. The manager had coordinated the entire inspection. The methodology of the inspection included study of relevant care documents, pre-inspection questionnaires, and discussion with the manager, staffs and service users’. Partial tour of the home was undertaken; observations were made of staffs and service users’ interaction. 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 summary of this inspection report can be made available in other formats on request. The Georgiana DS0000044852.V318235.R01.S.doc Version 5.2 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.V318235.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had ensured a detailed need assessment prior to the admissions of potential service users’. EVIDENCE: The home had a clear system, procedure and a pre-admission needs assessments tool that was used before the service users’ were admitted to the home. On this inspection 3 new service users’ admitted were case tracked. Service user – 1 admitted on 11/09/06, Service user –2 admitted on 25/09/06 and service user – 3 admitted on 17/07/06 needs assessment records were seen and found appropriate. However, 1 service user’s care plan preparation was in progress. The Georgiana DS0000044852.V318235.R01.S.doc Version 5.2 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. 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. The home had carried out detailed need assessments and developed individual care plans. The care plans implementation were regularly reviewed. EVIDENCE: The details of the service users’ case tracked on this inspection are follows. Service user – 1 admitted on 11/09/06 needs assessment was done but the care plan preparation was in progress. Service user –2 admitted on 25/09/06 needs assessments were carried out and care plan was prepared on 03/10/06. Service user – 3 admitted on 17/07/06, the care plan preparation process had taken into account the mental health assessed needs by the social services on 14/07/06. The home had undertaken the monthly care plan review on the 18/09/06 and 19/10/06. Service user – 4 The monthly care plan review was carried out by the home on 13/06/06, 16/07/06, 15/08/06, 18/09/06 and 19/10/06, had no impact on the risk assessment scores and recorded that there was no need to update the care plan. Service user –5 monthly care plan The Georgiana DS0000044852.V318235.R01.S.doc Version 5.2 Page 9 reviews were undertaken on 30/06/06, 22/7/06, 31/08/06 and 27/09/06, the 6 monthly detailed review was scheduled to take place on the 13/11/06 at 2.30pm.Service user – 6 monthly care plan reviews were carried out on 18/6/6, 27/7/6, 18/8/6, 18/9/6 and on 19/10/06 and signed by the key worker, manager and the service user’s representatives. The medication review was carried out on the 6/7/6 and on 2/11/6. Service user-7 monthly care plan review was undertaken on the 20/09/06 and 28/10/06. The 6 monthly care plan review was carried out on the 02/08/06 that was more detailed as compared with the monthly care plan review. The home had coordinated the medication reviews’ of 6-service users’ and 3 service users’ medication review is scheduled to complete before 21/11/06. The Georgiana DS0000044852.V318235.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home must engage all the service users’ were appropriate in suitable activities and consult service users’ for their choice of the food. EVIDENCE: The home had various activities that would engage the service users in the recreational activities, which included yoga exercises to music, gift party, birthday parties and outings. The home had a weekly food menu system for breakfast, lunch and supper. The details of the responses received from the service users’ through the questionnaire sent in by the commission are; service user - 1 have asked for more activities. Service user –2 said ‘not many activities at present, compared to a while ago, life quite boring – days seem endless’. When asked do you like the meals at the home – the reply was ‘now being offered a wide range - Pasta found meat and 2 vegetables are repetitive would like a wider range of options (Toad in the hole!)’. Rooms not always dusted, and would love the opportunity of going to a day centre once a week. Service user-3 said that ‘ beginning to look scruffy the paint work, carpets could be replaced – look as though they The Georgiana DS0000044852.V318235.R01.S.doc Version 5.2 Page 11 need a good clean, bathrooms (ensuite) need redecoration, air freshener plugin would be nice especially to help mask unpleasant odours. Service user-4 said in response to the survey that ‘food is really good and soft to eat as my denture were lost here in the home’. There were recommendations also saying that the home must also devote there energies on the personal hygiene of the service users’ as one of the family member said ‘my father does not always smell too fresh’. The Georgiana DS0000044852.V318235.R01.S.doc Version 5.2 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. 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. The home’s complaints policy and procedure that ensured the service users’ were protected from abuse. EVIDENCE: The home had complaints policy and procedure that ensured the service users’ were protected from abuse and neglect. There was a complaint from a service user about quality of care provided by the home, which was written to the provider by the social worker, Luton social services. The manager had responded to the Luton social services and ensured not to have such incidents at the home and had also said that she would discuss with the provider about staffing levels at the home so that the service users’ needs were not neglected. The daughter of this service user was spoken on this inspection, the daughter said ‘things have settled down now, if I bring anything to their attention they will do’. The Georgiana DS0000044852.V318235.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home need to record water temperature seperatly for all the water points. The home must always ensure to keep the premises neat and tidy. The home must complete all the outstanding requirements from the previous inspection reports. EVIDENCE: The hot water temperature checks were carried out by the home on the 12/08/06, 15/09/06 and 02/11/06 of bath, hand basin and sink. However, there was no clarity from the records maintained about the frequency of checks. Considering the size of the home with 44 beds the home must record checks of each point separately. The manager confirmed that the lift of the home was broken and could not be repaired for 4 weeks for want of some spare parts to fix the lift; the home do not have stair lift, during which time the service users’ could not access the lift and their mobility was restricted. The Georgiana DS0000044852.V318235.R01.S.doc Version 5.2 Page 14 In response to the pre-inspection questionnaire one service user said that the home ‘ beginning to look scruffy the paint work, carpets could be replaced – look as though they need a good clean, bathrooms (ensuite) need redecoration, air freshener plug-in would be nice especially to help mask unpleasant odours. On this inspection a tour of the premises was undertaken, facilitated by the person responsible for repair and maintenance of the home. In response to the requirement made in the previous inspection report, it was found that only 2 toilets had been repaired. This was discussed in great length with the manager, who had put up an argument saying that the report of Clare Hammond dated June 2005 had mentioned as recommendations not as requirements. However, the Letter from the manager received by the commission in the form of a fax on the 24/05/06 which said ‘Building risk assessment carried out by Clare Hammond in June 2005, still to action the recommendations as set out in the report. Suggessted to complete over the next two months’. In the random inspection report of 26/07/06 under environment outcome group said - A requirement was made in the previous inspection report that the home must action all recommendations of the building risk assessment before 30/07/06. None of the recommendations were actioned as on 26/07/06 and the manager suggested for a time extension until end of September 2006 to complete. However, a requirement was made with another extension of time 31/10/06. The home must action all the building risk assessments recommendations to ensure safety and comfortable stay of all the service users’. (Previous time scales 30/07/06). The manager had sent in a letter dated 13/11/06 saying that ‘ I confirm that all toilet hand rails where the walls are able to take them will be completed by the end of December 2006, and where it is not possible to fit these a free standing raised toilet seat with hand rails will also be in situ by the end of December 2006’. The Georgiana DS0000044852.V318235.R01.S.doc Version 5.2 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 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 adequate. This judgement has been made using available evidence including a visit to this service. The home had a good skill mix of staffs and work as a team. However, the home must have adequate staffs’ to ensure all the assessed needs of all the service users’ were met on all the shifts. EVIDENCE: Only 2 service users’ have responded the staffing section of the pre inspection questionnaire, when asked whether you receive the care and support you need in our survey. Service user - 1 said ‘usually if a member of staff is available’. When asked are the staff available when you need them – the response was ‘when we are not short of staff there is no problem’. Service user –2 said that ‘most of the staffs’ are very helpful and caring. The managing staff at the home are excellent’. The home had a good recruitment policy and procedures. Since the previous inspection the home had appointed new staffs’, on this inspection 5 new staffs records were seen. The home had ensured that all statutory checks were completed before appointing any new staff person. The manager had also said that she was planning to have discussion with the provider, which the staffing levels needs have to be matched with the assessed needs of the service users’ and appoint additional staffs’ especially during the night shifts. The Georgiana DS0000044852.V318235.R01.S.doc Version 5.2 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 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 adequate. This judgement has been made using available evidence including a visit to this service. The home manager had ensured good service delivery to meet the assessed needs of the service users’. Which, the manager should continue to sustain and improve further. However, the non – compliance of environment requirement is a cause of concern for the service users’ safety and well being. EVIDENCE: In the random inspection of 26/7/6 it was reported that ‘A requirement was made in the previous inspection report that the home must have an effective senior staff team that has been allocated sufficient time to complete the outstanding requirements, direct and supervise the rest of the team. It was found on this inspection that every alternate month, staff supervision was The Georgiana DS0000044852.V318235.R01.S.doc Version 5.2 Page 17 carried out on a specific task / responsibility specific to individual member. The detailed bi-monthly staff supervision covering all aspects of performance, learning and development was scheduled to start in early august 2006. 21 staff appraisals were completed as of 26/07/06 and before 15/08/06, 13 staff appraisals were scheduled for completion’. 3 Kitchen staffs supervision was held on 21/10/06, 28/10/06 and on 04/11/06. The staffs’ supervision tool that used was appropriate and was signed by the supervisor and the supervisee. Care staffs supervision records that were provided on this inspection covered areas such as hygiene, toileting, mobility, observation, nutrition, general, these records appeared more as training needs assessment of the staffs as they were recorded for what the staff was capable of and what further training needed by the staff. The single page tool had in all more than 46 boxes to tick and with no space for narrative description to be written and no space for the staffs’ signature and which said completed by staff member – 1 on 11/10/06, staff member – 2 on 04/10/06, staff member –3 on 17/10/06, staff member – 4 on 07/11/06, staff member – 5 on 05/10/06, staff member – 6 on 18/10/06, staff member – 7 on 18/10/06 and staff member – 8 on 11/10/06. The home must develop a separate tool for staffs’ supervision and carry out staffs’ supervision. Rather than a tool that is used for trainings needs assessments. Probably the home may use the supervision tool used for the kitchen staff with modifications specific to care staffs. The manager had sent in the staff-training calendar taking into account the training needs of the staffs’ which were in the area of food hygiene, manual handling, infection control, first aid, POVA, fire safety, bereavement, medication and dementia. The commission received the pre-inspection questionnaire from the home, under the policy/procedure/codes of practice subject the date of last review was not recorded; the home must regularly review and update the same. The home had a variety of service users’ with multiple needs the most prominent were wheelchair users-19, incontinent of urine - 14, require dressing/undressing - 21, require help with washing/bathing - 42. in the light of the multiple needs the home must expedite the implementations of the Clare Hammond’s recommendations on the premises that meet the needs of the service users’. Including that of staffing ratio to match the assessed needs of the service users’. The manager had confirmed that the provider has not completed reg 26 reports since July’06. The Georgiana DS0000044852.V318235.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X 1 X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 1 The Georgiana DS0000044852.V318235.R01.S.doc Version 5.2 Page 19 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 OP12 Regulation 16 (m) (n) 23 (2) (d) 23 (2) (n) Requirement The home must engage all the service users’ were appropriate in suitable activities. The home must always ensure to keep the premises neat and tidy. The home must make suitable adaptations with appropriate equipment and facilities that are provided for all the service users’. Timescale for action 15/12/06 2. 3. OP19 15/12/06 30/12/06 OP19 4. OP22 23 (2)(5) The home must action all the 30/12/06 building risk assessments recommendations to ensure safety and comfortable stay of all the service users’. (Previous time scales 30/07/06 and 31/10/06). The home must have adequate staffs’ to ensure all the assessed needs of all the service users’ were met on all the shifts. The registered person must ensure that all parts of the home to which service users’ have access are free from hazards to DS0000044852.V318235.R01.S.doc 5. OP27 18 (1) (a) 15/12/06 6. OP38 13 (4) (a) 30/12/06 The Georgiana Version 5.2 Page 20 their safety. 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. Refer to Standard OP15 OP26 Good Practice Recommendations The home should consult all the service users’ individually and provide their choice of the food. The home should always keep clean, tidy and pleasant. The Georgiana DS0000044852.V318235.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 The Georgiana DS0000044852.V318235.R01.S.doc Version 5.2 Page 22 - 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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