Inspection on 03/05/06 for The Gloucester

This inspection was carried out on 3rd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 Gloucester 24/07/07

The Gloucester 12/10/06

The Gloucester 24/05/05

The Gloucester 15/02/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Gloucester 83 Gloucester Road North Filton South Glos BS34 7PT Lead Inspector Odette Coveney Key Unannounced Inspection 3rd May 2006 09:30 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 Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 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 Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Gloucester Address 83 Gloucester Road North Filton South Glos BS34 7PT 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) 0117 9699626 Alutarius Ltd Mr Neil Andrew Plummer Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd November 2005 Brief Description of the Service: The Gloucester is registered with the CSCI to provide care and accommodation for up to 13 older people. In October 2004 there was a change of service provider. The home is now operated by Alutarius Limited and managed by Mr Neil Plummer. The property is situated on the A38 Gloucester Road approximately 4 miles North of the centre of Bristol. The home is on major bus routes and the M32 and M4 are easily accessible from the home. Local amenities are within walking distance of the home. Accommodation is provided on three floors. There is a passenger lift. There are nine single and two double bedrooms. The home has two lounges, a dining room and a kitchen on the ground floor. There are bathroom and toilet facilities on each floor. There is level access to a patio area to the rear of the premises and steps to a small garden area. There is access to the garden from the side of the property. The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that was conducted in order to look at the requirements and recommendations made at the last announced inspection that took place on 2nd November 2005 and also to monitor the care and services provided to those who live at the home. During this inspection time was spent examining care documentation, staff employment and training records, an examination of health and safety documentation, a tour of the home and also discussion with residents, the registered manager and staff employed at the home. Further discussion took place with the registered manager in respect of the Commission’s commitment to improving service’s through its ‘inspecting for better lives’ programme and talked about how this would inform the inspection process and also the risk assessment completed by the commission about the service. The inspector found that of twenty one requirements made at the last inspection nine have been met, there were seven outstanding requirements in respect of the inspection that had been undertaken in May 2005. An evaluation of the requirements made at the last inspection found that two had been met. The home has been requested to forward further information to the inspector in respect of two of the requirements in order that these can be fully evaluated. Confirmation of staff first aid training has been received by the Commission following the inspection and confirms that this requirement had been met. Both of the recommendations made at the previous inspection have been met. At this inspection a further 12 requirements and three recommendations were made. There were a number of standards that were not reviewed at this inspection such as the admission process, medication and quality assurance these will be reviewed at the next inspection. Throughout the inspection process the registered manager, assistant manager and staff spoken with were informative and engaging and participated fully with the inspection. Resident’s spoken with spoke favourably of the care and attention they receive from the staff at the home. The inspector had the opportunity to speak with two relatives and received comment cards from three relatives and three health professionals and these have been incorporated into the body of the report. What the service does well: Good standards of care remain at the home, with many favourable comments received from residents and relatives about the care staff at the home in respect of their caring manner and approach. Those residents spoken with during the inspection said they were happy and enjoyed life at the home. The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 6 The house is located within close proximity to local services and provides a homely environment for those who live there. What has improved since the last inspection? What they could do better: In order to ensure that residents can be assured that their needs will be met and that clear guidance is provided to staff it is required that all care plans must accurately reflect resident’s personal, healthcare and social needs and how they are to be met, these must be reviewed and any changes must be clearly recorded. Staff supervision provides a formal process in which staff’s personal development needs and the care needs of residents can be discussed to ensure continuity of care and effective communication. Record keeping in this area must be improved. Residents are issued with contracts, which clearly outline the services to be offered, and the charges for these. The resident, or their representative, and someone from the home should sign them and copies of these must be available for inspection. Residents must be offered a suitable alternative to meals and improvement in this area must be made, this has been outstanding since May 2005 and comments made by both residents and relatives prior to and during the inspection demonstrated dissatisfaction in this area. Residents would be assured that staff had been appointed following robust recruitment and selection if the home ensured that criminal record bureau checks were in place for all staff before they commenced employment and if The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 7 staff records were in place and the organisation made these available for inspection. All care staff are offered NVQ training and are registered to undertake this qualification when they commence employment. However, those living at the home would be assured that staff have received sufficient, appropriate training if there were a training programme/audit in place and if the manger ensured that the homes induction was recorded and demonstrated that this matches the National ‘Skills for Care’ Standards, this is to ensure that residents benefit from good, safe working practices. A recommendation to improve induction for staff has been in place since May 2005 with no evidence of improvement. The home would be a safer place for residents if there were effective management of health and safety. Fire prevention and safety must be improved in order to ensure that all aspects of the residents safety, and to avoid potential risks the home must build on their existing fire risk assessment in order to cover all aspects of fire safety within the home, to record what the home’s procedure is at night and how individuals with special needs would be supported in the event of a fire occurring. Staff must receive sufficient fire instruction and residents would be better assured that staff have received fire instruction if staff names were individually recorded on fire training records. There are staff at the home that have completed manual handling training. However, the safety of both residents and staff would be improved if manual handling risk assessments were completed for all residents and if current risk profiles in place were improved to include the date and recorded who had completed the assessment. Those living and working at the home would be assured that the organisation are committed to providing a well maintained, hygienic and safe environment if the following requirements were met: If radiator covers are fitted to ensure residents personal safety, it is noted that these have to be hand built, however the requirement remains. If the identified toilet frame seat be repaired or replaced, locks must be fitted on toilet doors to ensure individuals privacy, if the identified vanity unit was repaired and cleaned and the source of odour in this area was eliminated and also if hot water pipes in bathroom area were covered. Resident’s valuables and money would be safer if all residents were provided with a lockable facility to enable residents to keep valuables safe if they wish and also if records of monies held on resident’s behalf for safekeeping were accurate, it is further recommended that receipts are kept of monies spent. The home has been requested to forward a copy of the bath hoist maintence service report to demonstrate the safety of this equipment use. The wishes and choices in the event of end of life for residents would be adhered to and respected if these were recorded on individual’s records. The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 8 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 Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 9 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 Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 10 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): 2. Quality in this outcome area is poor, residents are not aware of the contractual arrangements of their placements and do not have written terms and conditions of their placement outlining individuals rights and responsibilities. EVIDENCE: The home is registered to accommodate thirteen older people, there were ten residents accommodated at the home at the time of the inspection. The home’s statement of purpose and service user’s guide, admissions processes and assessment of individual’s needs were not viewed at this inspection and therefore will be reviewed at the next inspection. A requirement was made at the inspection undertaken in May 2005 that contracts between the home and the resident must be discussed and agreed with each resident and/or their representative and signed by all parties. This has not been done. The inspector spoke with two residents who were unaware of this documents existence. Two relatives were also spoken with, neither of them were aware that contracts should be in place and the home had not made them fully aware of the terms and conditions of the placement. Mr The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 11 Plummer said that the organisation were in the processes of issuing contracts and that these would be in place within the next two months, the date given for compliance by the Commission is July 4th following this date further checks will be undertaken by the inspector to ensure that these contracts are in place and that they contain the required information in order that all are fully aware of their rights and the terms and conditions of the placement. Following a meeting with the registered provider on 28th June it has been agreed that confirmation of issue of terms and conditions, to those concerned in the form of a letter will be accepted alongside a blank copy of the document in order that verification of its contents may be undertaken. The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 12 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, 8, 11 Quality in this outcome area is poor, although residents are able to access healthcare services. Care plans continue to require further development and do not fully reflect the current and changing needs of residents with little evidence to show that these are reviewed. Additional information is needed in order to ensure that resident’s wishes are known and respected at the end of their life. EVIDENCE: The care documentation for four residents were reviewed at this inspection, from the information seen and discussion with the registered manager it was evident that there had been little improvement in this area. Information seen recorded varied in both detail and guidance for staff with also significant differences in the quality of person centred information being recorded. A requirement was made at the last inspection that all care plans must accurately reflect resident’s personal, healthcare and social needs and how they were to be met in the way that the residents prefer, the timescale given for action to be taken was June 1st 2006. Although no work has commenced Mr Plummer showed the inspector a new proposed format for resident’s care plans. These were seen to contain relevant information and covered areas of The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 13 physical health, mobility and risk assessments. Each plan will be tailored to reflect the individual wishes and needs of the individual. It was clear that the proposed care plans had been formulated with a medical model of disability rather than a social model and discussion took place that there may be some areas of the proposed care plan that may not be relevant. Care Plans reviewed did not show that they had been reviewed or updated, it is essential that these documents are maintained in order that they can reflect the views and choices of residents and record individual’s current and changing needs with information as to how these will be met. At this inspection it was found that the records have been moved into the office and were held in locked cabinets, however there was no door to this office and consideration should be given to fitting one in order to ensure full security. Two of the residents spoke with the inspector at some length about how staff support them with aspects of their personal care; they both said that staff were sensitive to their feelings due to the nature of the support being given, they said that doors are always knocked for privacy and that they are treated in a respectful way. However it was brought to the attention of the registered manager that upon arrival to the home one resident was being shaved at a dining table and that residents shavers are held communally and is not in line with good practice, also a toilet door on the ground floor had no lock (see standard 21). Systems of medication administration and recording and storage were not reviewed at this inspection and therefore will be fully reviewed at the next inspection. It was noted at a previous inspection that a risk profile for one resident indicated that when the person refused their medication it was concealed in their breakfast cereal and that this practice must cease. Discussion with both the registered manager and assistant manger confirmed that this practice is not in place at the home. Although there are no records in place to confirm that staff members had received training on the administration and control of medicines three staff members spoken with confirmed that they are currently working through a distance learning pack which covers administration, recording, medication refusals and errors and that at the end of completing each module they undertake an assessment that is verified externally from the home. The assistant manager confirmed that the pharmacist who dispenses medication to the home provides a flexible service and discussions have taken place that they would also be providing additional training to staff at the home in respect of the monitored dosage system in place. This will be reviewed at the next inspection. There was evidence in place to show that residents are supported with their primary healthcare needs, at the time of the inspection a visiting healthcare professional said that ‘staff are helpful and support the residents well’. A The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 14 comment card from a general practitioner who supports residents at the home said ‘usually no concerns and seems a happy environment’. Upon examination of care records it was clear that the home has sought the views of some residents as to their wishes in the event of their death, however not all of the residents had their views recorded, it was recommended that the home seeks to rectify this. The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 15 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): 13, 14, 15 Quality in this outcome area is adequate although residents are able to maintain contact with family and friends and can make choices about aspects, which affect their life. Improvements are required in the choice and quality of meals as dissatisfaction was expressed by both residents and their relatives. EVIDENCE: Residents told the inspector about their preferred routines at the home and said that they are able to choose when to get up and when to retire. Two residents said that the home had changed for the better since the new providers had taken over although they were unspecific as to the reasons why. The visitor’s book showed that there are a number of visitors to the home and those spoken with said they are always made welcome by staff at the home. And also said they are able to visit their relative at any time and spend time with them in the privacy of their room. At the previous inspection it was recommended that further staff are trained to drive a suitable vehicle, the assistant manager said that since the last inspection one staff member had undertaken training and is able to drive to take residents for outings. The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 16 An activity log is maintained at the home this records that bingo, skittles, arm chair aerobics and visits to the local shops take place, residents said they enjoyed playing cards and enjoying the garden during the warmer weather. Resident’s rooms contained many of their personal possessions such as small items of furniture, ornaments, pictures and photographs. During the inspection staff were observed asking resident’s for their views and opinions and residents were encouraged to make choices on aspects that affect their life. A recommendation was made at the inspection that was undertaken in May 2005 that improvements must be made to the quality of cooked meals and residents must be offered choices, this standard was reviewed at a subsequent inspection as residents felt there was room for improvement, a timescale of November 2006 and a requirement in respect of this area was given to improve this. Comments from a relative prior to the inspection was that tea time meals were poor and they were concerned that their relative appeared to be losing weight, a relative spoken with at the inspection voiced concern over the ‘three water biscuits with a tiny portion of cheese and a thin sliver of cake’ given their relative. Comment cards received from relatives prior to the inspection recorded ‘by far the biggest complaint I have is the standard of food; this is badly cooked and unimaginative. Tea is almost always sandwiches’. Another relative commented that ‘residents could be given more choice with the food, particularly in respect of the sandwiches given at teatime’. Mr Plummer said that the organisation has employed a catering manager that will liaise with staff at the home in order to determine how meals can be improved ensuring consultation with residents in order that their choices can be incorporated. The home were advised to contact the community diabetic nurse and the dietician at Southmead hospital in order that the special dietary needs of residents can be met. The inspector also left an information bulletin produced by the Commission entitled ‘improving meals for older people in care homes’. The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 17 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, 18 Quality in this outcome area is good. The complaints process in the home is good and there was evidence that residents views are listened to and acted upon and that residents have confidence in the process. The risk of residents suffering from any form of abuse or neglect is appropriately minimised, however records of monies held for residents must be better maintained. EVIDENCE: Since the last inspection a protection of vulnerable adults issue was brought to the attention of the Commission by a health professional, the concerns were investigated by a care manager who visited the individual at the home and their conclusion was that there had been no intended abuse and that there was a manual handling deficit at the home, issues in respect of this were discussed with the management of the home who were able to discuss how improvements have been made at the home. Certificates seen in staff files, along with discussion with staff confirmed that most staff have now completed a half-day protection of vulnerable adults training session. Those spoken with were able to demonstrate an understanding of their responsibilities and their understanding of what constitutes abuse. A copy of the home’s complaints procedure was on prominent display. All resident’s spoken with told the inspector that if they had any cause for concern or complaint they would speak to either staff or the assistant manager for the home. All of those spoken with said they had no complaints except for meals. The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 18 No complaints have been received by either the home or the Commission for Social Care Inspection. No areas of concern were recorded on care documentation. A requirement was made at the last inspection that the CSCI must be informed of all events, which adversely affect the well being or safety of any resident, the assistant manager has contacted the Commission for Social Care Inspection to inform of incidents that have affected the wellbeing and safety of those living at the home and this requirement has been met. The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 19 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, 20, 21, 22, 23, 24, 25, 26 Quality outcomes in this area are adequate. Although there have been some improvements to the environment however further improvements are required in order to ensure that residents right to privacy is respected and to maintain a safe hygienic environment. EVIDENCE: The Gloucester is a semi detached three-story house set within a residential area of Filton. The home is located near to local amenities such as churches, shops, a library and the community centre. The home has good transport links and is located on the main bus route for the centre of Bristol and The Mall shopping centre at Cribbs Causeway. There are two spacious lounges, one to the front of the house the other overlooking the rear garden that also has an adjoining dining area. Upon arrival at the home both fire doors leading into the ground floor lounges were being wedged open, this had been noted at the inspection undertaken in May 2005 and a requirement was made that for fire safety reasons this The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 20 practice must cease. During the inspection three automatic release devises were fitted to the lounge doors and a door leading from the dining area. Residents were seen making full use of these areas and appeared to be ‘at home’ in their environment. At the inspection undertaken in May 2005 it was required that the home ensures that covers are fitted to radiators where there is a risk to residents personal safety, progress was noted at the inspection undertaken in November 2005 and at this inspection staff said that a further four covers had been fitted to radiators. At this inspection all rooms were viewed and the lounge areas and all but one of the residents bedrooms have no radiator covers on them. This requirement will remain and will be reviewed as part of the home’s improvement plan. There are sufficient bathing and toilet facilities for residents use. It was noted at the inspection undertaken in November 2005 that the wood adjacent to the bath had chipped paint, this had been re-painted. It was also noted that a requirement was made in May 2005 that the underside of the hoist had rusted and had been repaired. It was noted that this area had been painted. The inspector has requested a copy of the service contract, due to be undertaken by an independent hoist contractor in June 2006 in order to verify the safe use of this equipment. In this same area it was found that a toilet frame seat had significant rusting. A requirement was made that this must be repaired or replaced in order to ensure residents safety and eliminate infection control. It was also found that there was no lock on the door of the ground floor toilet, it is required that a lock is fitted to ensure the privacy of residents when this area is in use. One of the bathrooms had exposed hot and cold water pipes; the manager said that a new boiler had been fitted resulting in the new pipes. These pipes were hot to touch and could be a potential burn hazard to residents therefore the home are required to cover the identified pipes and eliminate the likelihood of injury. The manager said that there are plans to refurbish one of the bathroom areas and the inspector looks forward to reviewing this at the next inspection. Lighting within the home is domestic in style. It was noted at the last inspection that the top floor of the home was poorly lit, at this inspection a bulb had blown at the top of the stairs and also in the hall of the top floor, whilst the inspector was at the home both of these bulbs were replaced. Emergency lighting is provided throughout the home, the inspector saw that this is checked on a monthly basis by staff at the home. A requirement was made at the last inspection that the stairway accessing the third floor be assessed for a handrail to ensure the safety of the residents this handrail had been fitted making this area safer. The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 21 The inspector viewed some of the resident’s private rooms, these were found to be comfortable with individual’s personal effects on display making the rooms more homely. It was also noted that there has been redecoration, new carpets and new beds in five residents rooms and the entrance hall had been repainted. None of the rooms have en suite facilities and have vanity units in place, it was noted that one of these had a rough edge and the waste pipe had been leaking, due to the odour and water residue it was evident that this had been like this for some time. The home is to ensure that the identified unit is cleaned and be repaired and the source of odour is to be eliminated. A requirement was made in May 2005 that a lockable facility must be provided in all residents’ rooms to enable the resident to keep valuables safe if so wished. The inspection undertaken in November found that this requirement had not been met and the timescale for action was November 2006. The manager said that one of the residents keeps large amounts of money in their room yet they have no facility to keep this safe, although the timescale for action has not been reached there is no evidence to demonstrate that any attempt to meet the requirement has been made, the requirement remains and will be reviewed at the next inspection. The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 22 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): 29, 30 The quality in this outcome area is poor. The relationships between staff and residents are good, and this creates a warm, supportive environment, however the home fails to protect the residents due to poor record keeping and staff recruitment and selection practices. EVIDENCE: There is a core of well-established staff with varying abilities most of which are skilled and experienced to meet the needs of the residents in the home. Resident’s spoken with said that they felt well supported and safe, that staff listened to them. Those spoken with did not raise any concerns about the staffing levels at the home. Comments from resident’s were: ‘The staff here are kind and good’ ‘staff help me and are caring’. The atmosphere at the home at the time of the inspection was calm and relaxed with residents looking clearly at ease and ‘at home’. The inspector requested the recruitment, selection and employment records for five staff members, as noted at the previous inspection there was no evidence of the full recruitment practices carried out by the home. Of the files viewed only two staff had application forms in place, only one staff member had in place a CRB check, this was of little use as it had been obtained for other purposes some time ago. The manager confirmed that there were four staff members who did not have CRB clearance in place. It is required that criminal record bureau checks must be obtained before staff commence employment at The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 23 the home in order to ensure the protection of residents. As noted at the previous inspection The Care Homes Regulations 2001 specify the records that need to be held at the care home in respect of staff, the manager confirmed that the records are kept by the registered provider, however this practice does not enable records to be inspected, a requirement was made at the inspection undertaken in May 2005 that the home must maintain staff records and make them available for inspection, as there has been no significant improvement in this area an enforcement notice has been issued to the home who must demonstrate a clear commitment to comply should this not be achieved within a timescale set by the Commission enforcement action will be undertaken. There has been a determined effort at the home to provide staff with training as is required in meeting the needs of older people. Staff spoken with told of their varying levels of achievement in achieving a National Vocational Qualification at level two in care practice, one staff member had finished their award and a new member of staff has recently started their award, both spoke positively about what they have learnt and how this would influence their practice. The assistant manger said that staff have undertaken first aid training, however there was no evidence to demonstrate this. A requirement was made at the last inspection that the home must ensure that that there is a fully trained person in first aid at the home at all times and ensure that evidence of staff training in first aid is held at the home and be available for inspection in line with this the home have been requested a list of those staff who have completed training in first aid with evidence that their competency has been assessed by an accredited trainer. Following the inspection copies of attendance to this training was received and this requirement had been met. Certificates seen in staff files confirmed that staff had undertaken manual handling training, protection of vulnerable adults training care practices and basic food hygiene. It was difficult to fully determine the full extent of training achieved and whether staff had received all core and role specific training, as there was no training programme in place, this was required at the inspection completed in November 2005 in order that an audit would provide an overview of the training needs of staff. Mr Plummer showed the inspector a matrix, which the organisation plans to use for this purpose, the requirement remains, and will be reviewed at the next inspection. A staff member told the inspector about their induction at the home, this consisted of working alongside other staff and learning routines. There was no evidence or records to show that this induction took place or what its contents were or the level of quality of this training, for this staff member nor any other staff member working at the home. The registered manager agreed that induction at the home was an area in need of improvement. A recommendation was made at the inspection undertaken in May 2005. Upon review at the last inspection undertaken in November 2005 a requirement was made that the manager should ensure that the home’s induction training matches National Skills for Care standards to ensure residents benefit from good safe working practices, there have been no The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 24 attempts to meet this requirement, the home have to demonstrate a commitment to improve and this will be monitored by the Commission in order that compliance will be achieved within a timescale set by the Commission. The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 25 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, 32, 35, 36, 38 The quality outcome in this area is poor with areas of health and safety including risk assessments and fire safety in the home that must be improved. Staff are well supported on a day-to-day basis to direct their work, however there are no formal recorded supervision systems in place for staff employed at the home. EVIDENCE: The Registered Manager of the home is Mr Andrew Neil Plummer who has been in the post since 2004. The manager was not present at the last inspection due to an extended period of absence from the home and it was recorded at that time that the home needs effective management in order to ensure compliance with the Care Homes Regulations 2001. At this inspection Mr Plummer told the inspector that although he is available on the telephone for advice he is currently working at the home only one day a week and at other times he is working at other homes owned by the organisation. Mr Plummer agrees that The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 26 this is not sufficient and does not meet the required expectations of a registered manager. The registered provider said that she holds Mr Plummer’s management skills with high regard. Mr Plummer said that Karen Headington the current assistant manager has been given autonomy and has been effectively managing the home. The organisation has decided that Ms Headington should take over as the registered manager. The registration process was discussed with Ms Headington and an application pack has been forwarded. All staff spoken with said that they felt well supported by the assistant manager who was approachable and listened to ideas and suggestions, however there are no formal processes in place for the supervision of staff, it is required that staff received formal, recorded supervision at regular intervals as this would ensure effective communication and continuity of care and would provide an opportunity to evaluate staff practice and development needs. A comment card received from a relative said that ‘The management are helpful and pleasant, very informative’. Prior to the inspection a copy of a regulation 26 report was received, this was the first report to ever be received and recorded a visit to the home on behalf of the registered provider, this report incorporated the views of residents, comments recorded were discussed with the individuals concerned at this inspection, both spoken with said that an issue raised had been dealt with to their satisfaction. Fire safety was discussed at the home and the fire logbook was viewed, the logbook demonstrated that the appropriate weekly and monthly checks are undertaken and that the equipment and detection systems are serviced appropriately by a contractor. Records of fire training were extremely poor with little evidence to show that staff have received sufficient fire instruction. The manager confirmed that training had been arranged for staff and was booked to take place the following week. The home is required to ensure that all staff receive sufficient fire safety instruction and it is further recommended that the record of fire drill record list the names of those who had been involved. The accident book was viewed at this inspection and incidents were found to have been well recorded with appropriate action taken in order to support individuals, due to full records not being available at the last inspection a requirement was made that the home must maintain a record of all accidents which occur at the home, this has been achieved and this requirement has been met. A record of money held for a resident for safekeeping was checked and this did not correspond with the record held at the home, no reason was given for the shortfall in the resident’s money. The home is required to ensure that records of money held for safekeeping must be better maintained. It is further The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 27 recommended that receipts be kept which correspond with resident’s record of monies spent that are held for safekeeping at the home. Although there are staff who have completed manual handling training there are no manual handling risk assessments in place, it is required that these must be developed and implemented in order that correct, safe techniques are used to move residents safely. The home has some risk profiles in place for residents, these cover individuals mobility, hygiene and medication support. These assessments must contain full information in order to direct and guide staff practice, and must also be dated and signed by the person who has completed the assessment. A requirement was made at the previous inspection that the home must demonstrate effective management of health and safety in the home, due to the requirements made in respect of fire safety, risk assessment, and environmental issues this requirement remains and will be reviewed at the next inspection. The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 28 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 1 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 X 10 X 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 1 1 2 STAFFING Standard No Score 27 X 28 X 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 3 X X 2 1 X 1 The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 29 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 5 Requirement The registered person must ensure that care/actions plans accurately reflect all residents’ personal, healthcare and social needs and how they are to be met in ways that residents prefer. (Outstanding since Nov 05) Contracts between the home and residents must be discussed and agreed with each resident and/or their representative and signed by all parties. (Outstanding since May 2005) The ground floor toilet must have a lock fitted to ensure privacy for residents when in use. The registered person is required to ensure that radiator covers are fitted to radiators where there is a risk to resident’s personal safety. Toilet frame to be repaired or replaced to ensure residents safety and eliminate the risk of infection. Vanity unit to be made safe and to be cleaned. DS0000061774.V291206.R01.S.doc Timescale for action 03/09/06 2. OP2 5 03/07/06 3. OP21 12(4) a 03/06/06 4. OP25 13(4) 03/09/06 5. OP21 23 (2) c 03/06/06 6. OP21 16(2) c 03/05/06 The Gloucester Version 5.1 Page 30 7. 8. 9. OP21 OP29 OP30 13(4) a 17(2) Schedule 4.6 18 10. OP30 18 11. OP15 16 12. OP23 16 13. 14. 15. OP18 OP36 OP38 17(1) a 21 13(4) 16. OP38 13(4) b 17. 18. 19. OP38 OP38 OP7 13(4) b 23(4) d 15 (2) b Hot water pipes in bathroom to be covered. Maintain staff records and make them available for inspection. (Outstanding since May 2005). The manager should ensure that the home’s induction-training matches National Skills for Care standards to ensure residents benefit from good safe working practices. (Outstanding since may 2005). A training programme should be developed to provide staff with training appropriate to the resident’s needs. (Outstanding since November 2005) Improvements must be made to the quality of cooked meals ensuring that residents are given choices. (Outstanding since May 2005). A lockable facility must be provided in all residents’ rooms to enable the resident to keep valuables safe if so wished. (Outstanding since May 2005) Resident’s record of monies held for safekeeping must be better maintained. Care staff must receive formal recorded supervision Demonstrate effective management of health and safety in the home. (Outstanding since November 2005). Manual handling assessments must be completed for all residents and contain full information. Resident’s risk profiles to contain full information be dated and signed. All staff must receive sufficient fire safety instruction. Care plans must be reviewed on a regular basis and changes in DS0000061774.V291206.R01.S.doc 03/05/06 03/06/06 03/06/06 03/07/06 03/07/06 03/11/06 03/06/06 03/09/06 03/07/06 03/06/06 03/06/06 03/08/06 03/07/06 The Gloucester Version 5.1 Page 31 20. 21. OP31 OP29 8 17(2) these must be recorded. It is required that a manager be appointed to fulfil the role of the registered manager. All staff must have Criminal Record Bureau checks in place before they commence employment. 03/07/06 03/05/06 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 OP38 OP11 OP18 Good Practice Recommendations Records of fire drill should contain the names of those who have attended. The home should seek the wishes of residents for the end of their life and these should be recorded. Receipts should be kept and should correspond with records of residents money held for safekeeping at the home to account for monies spent The Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Gloucester DS0000061774.V291206.R01.S.doc Version 5.1 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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