Care Home: Gadlas Hall Nursing And Residential Home

What the care home does well The staff are cheerful, friendly and helpful and encourage people to enjoy themselves but also try to make sure that they are safe and well looked after. The feedback from surveys conducted by the home indicates that Gadlas Hall provides a friendly and supportive home where people are respected and well looked after. What has improved since the last inspection? The service provides a more supportive environment for the care staff and have individual training plans that allow them to develop their potential as well as meet mandatory regulations. The activity programme is developing and offers a range of activities both within the home and the local community. The monitoring of the quality of the service provision is better with audits in place. What the care home could do better: Service users with dementia should be enabled to choose an option from the daily menu. Assessments both initial and ongoing need to be developed to reflect capacity, expectations and more resident involvement. Restrictions to freedom should be assessed and no resident unnecessarily deprived of their liberty. Care plan evaluations could be better recorded and involve all relevant people, including the resident and family. The contract given to people should provide information regarding placements that are funded by other parties. Records of improvements to the premises should be kept. Key inspection report Care homes for older people Name: Address: Gadlas Hall Nursing And Residential Home Gadlas Hall Gadlas Hall Nursing And Residential Home Dudleston Heath Ellesmere Shropshire SY12 9DY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Pat Scott     Date: 2 7 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Older People Page 2 of 23 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: Gadlas Hall Nursing And Residential Home Gadlas Hall Gadlas Hall Nursing And Residential Home Dudleston Heath Ellesmere Shropshire SY12 9DY 01691690281 01691690790 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Michelle Roberts care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 29 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 19 Dementia (DE) 10 Date of last inspection Brief description of the care home Gadlas Hall is owned and managed by Mrs Michelle Roberts, and is situated in the village of Dudleston Heath, just outside the town of Ellesmere, on the North Shropshire/Welsh border. The building is purpose built with spacious communal areas and wide corridors to accommodate wheelchair users, and people with mobility difficulties. There is a well maintained garden with views of the countryside. The home has parking for cars. Care Homes for Older People Page 4 of 23 10 0 Over 65 0 19 Brief description of the care home Information of the home and the provision of the service are available in the statement of purpose and service user guide. The service user guide includes information on the current level of fees for the service and range from £310.85 - £495.30 per week. Inspection reports for this service are available from the provider or can be obtained from www.cqc.org.uk. Care Homes for Older People Page 5 of 23 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: We, the commission, looked at all the information that we have received, or asked for, since the last key inspection or annual service review. This included: The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Surveys returned to us by people using the service and from other people with an interest in the service. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. Relevant information from other organisations. Care Homes for Older People Page 6 of 23 What other people have told us about the service. Some people who use this service have a form of dementia. Many are unable to make comment and so we looked at how the service seeks their views and opinions about their care. Care Homes for Older People Page 7 of 23 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 23 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 9 of 23 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. People who use this service have general information about the home in order to make an informed decision about whether the service is right for them. People have a pre-admission assessment so that their needs are identified and planned for when they move to the home. Evidence: The service has a statement of purpose which provides basic information about the home. The guide is in a standard format and the content is clear but it does not refer to the correct regulatory body as the Care Quality Commission. There is an example of a contract which does not mention any detail about funded care if the person being admitted has the placement paid for by another party. The files of four people were viewed. The manager consults the assessment information to see if the home can meet the persons needs before they make the decision to accept the application for admission and offer a placement. Evidence shows that people have a needs assessment carried out before they are admitted to Care Homes for Older People Page 10 of 23 Evidence: the home. The manager has received copies of the summary, and care plans, from those assessments carried out through care management arrangement for most of the residents. Staff training to ensure that they have the necessary skills and ability to care for residents who are admitted is improving. Care Homes for Older People Page 11 of 23 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 practice regarding the planning and delivery of care means that all residents can be sure that their health and personal care needs will be fully met to ensure their well being. The manager understands the need to comply with safe medication systems and staff practice has improved so that service users health matters are now more safely addressed. Evidence: Four care plans were examined. The practice of involving residents in the development and review of the plan is not clear. The plans include the basic information necessary to plan the individuals care. The manager stated her intention to audit care plans in the future, to assess whether the staff consistently provide an indication of care provided and progress made by individual people. There is recorded evidence of updating information and changing actions in the care plans. However, the practice of routinely writing no change in an evaluation is not enough to determine whether the planned care is meeting the needs of individuals. People have access to health care services that meet their assessed needs both within Care Homes for Older People Page 12 of 23 Evidence: the home and in the local community. People have access to dentists, opticians and other community services. Peoples health is monitored and appropriate action taken. The home seeks professional advice on health care issues, acts upon it and is able to provide the aids and equipment recommended. There is written evidence in the daily notes of health care treatment and intervention, and a record of general health care information including weight monitoring, and nutritional information. Staff were seen to be aware of the need to treat residents with respect and to consider dignity when delivering personal care. The service provides screens for privacy in shared rooms. Residents seen and spoken with all appeared well groomed with their hair, nails and clothes looking clean. This indicates that people have the support they need so ensuring they feel good about themselves. The trolley for peoples medication is locked away. At the front of each persons medication administration record (MAR) there is a photo of the person so that any unfamiliar staff would know who to give the medication to. MARs sampled had been signed when medication had been given. Receipt, and disposal are also accounted for. Medication audits have been completed by the manager and staff receive a competency review with a record kept. Controlled drugs are safely managed and a register kept. Staff spoken with are alert to changes in mood, behaviour and general wellbeing. People are cared for in the least restrictive regime practicable. Full assessments of the types of restrictive practice the home operates are to be done. The service will then determine whether any practice means that people are being deprived of their liberty and take any necessary action. Care Homes for Older People Page 13 of 23 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. A range of activities within the home and community mean the people have opportunities to participate in leisure pursuits. The provision of meals, although lacking in choice, ensures service users have a wholesome meal. Evidence: The care records looked at indicate that peoples food and drink intake is monitored daily and regular meals and drinks are offered. Nutritional assessments are conducted by staff so that people at risk of malnutrition can be closely monitored and cared for. The deputy manager has recently reviewed the menus and stated that people can have an alternative to the main menu but it is not yet displayed as an option. Results of relative questionnaires showed that people are satisfied with the meal provision. Through service surveys people and their relatives can indicate their preferences for activities and comment on what is provided. Informal discussion takes place for people to decide on group events such as outings and pastimes. People were seen sitting in the two lounges or in their room watching TV, listening to music or writing. There are activities but no dedicated activity co-ordinator in charge of this at the moment. Residents look happy and relaxed. Families are at ease when they visit. Staff have a Care Homes for Older People Page 14 of 23 Evidence: good interaction with the people they look after. Care Homes for Older People Page 15 of 23 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. The service has a complaints procedure which is accessible to relatives so that people who visit the service have information of how to make complaints about the home. Adult protection training is provided for staff so that service users are protected from abuse and have their legal rights protected. Evidence: The home has a complaints policy and procedure. Residents and their families are given information in the service user guide and on the notice board. The service has not received any complaints recently. All staff working at Gadlas Hall have the relevant criminal record bureau (CRB) and protection of vulnerable adults (POVA) checks including references. One adult protection issue has been identified by the service and appropriate action taken. Staff files show that adult protection is discussed during induction and updates are provided. Good interaction is observed between staff and service users. They are relaxed in their company and showed no signs of distress. The proprietor/manager stated that no money is held for safekeeping on behalf of any people living at the home, any sundry expenses incurred are invoiced to the persons family or representative for payment. Care Homes for Older People Page 16 of 23 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. Some of the decoration and furnishings of the home have improved so that people live in a better-maintained and comfortable environment. Evidence: The owner spoke of the redecoration of parts of the home and of the further work in progress. Records of this are not kept. All areas seen around the home are clean and rooms personalised and decorated according to the wishes of those people occupying them. Responses in surveys indicate that the home is always clean. A recent infection control audit by Shropshire PCT concluded that the hygiene in the home is satisfactory. People have access to a well maintained garden and a safe courtyard area. The front door is always locked. This is seen as a restriction by the home to maintain peoples safety. Care plans seen do not yet detail staff interventions in the care of individuals to ensure that this is not a deprivation of anyones liberty, but will be done. Care Homes for Older People Page 17 of 23 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. Staff in the home are trained and are in sufficient numbers to fill the aims of the home and meet the changing needs of residents. Evidence: Staff turnover in the home is low so that continuity of care is provided. The residents know the staff very well and observation showed that they provide a personal but professional service. The staff file seen of two new recruits showed that all employment checks had been carried out prior to them starting their role. Induction processes are thorough and mandatory training updates provided. Staff also stated that other training topics have been accessed which they have enjoyed, particularly the one on dementia care. The service has qualified nursing staff and also care staff trained at national vocational qualification (NVQ) level 2. Senior staff are trained to NVQ level 3 and managers have achieved NVQ level 4 plus the registered manager award. Care Homes for Older People Page 18 of 23 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 management of the home has started to implement quality assurance systems and audits so that people are more assured that the service is closely monitoring its own practice and that the overall conduct of the home is being better managed. Evidence: The AQAA contains information that is not supported by a wide range of evidence. The AQAA lets us know about some changes they have made and where they still need to make improvements. It does not give a clear indication of how they are going to do this. The data section of the AQAA is accurately and fully completed. The management are trying to improve and develop systems that monitor practice and comply with the plans, policies and procedures of the home, for example audits for infection control, medication, quality and care plans. Records for the management of health and safety are maintained. Fire records show that tests and drills take place. It is evident that there is contact and communication between people who live in the home, the staff and relatives. Quality assurance processes are in the form of a Care Homes for Older People Page 19 of 23 Evidence: relatives survey. These are to be collated so that the management can obtain an overall picture of the views of people who are involved in the home. Results of surveys are fed back to staff during meetings. Results are not formally shared with people who use the service. Risk assessments for the management and safe working practices in the home are in place. The service does not deal with personal finances of residents. The manager is aware of the importance of making people safe and without unnecessarily restricting their freedom and will introduce the required assessments in order to do this. Care Homes for Older People Page 20 of 23 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 21 of 23 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 The example contract and information in the service user guide about fees should indicate that peoples care may be funded by a third party or authority. People should have a care plan that has been devised with their input, where able, and their family. Evaluations of care should give an indication of whether the care plan is meeting intended outcomes for people. Full assessments of the types of restrictive practice the home operates should be completed for each individual including their mental capacity. People should be offered a choice of meal from the menu, even if the staff are aware of individual likes and dislikes for food. Results of survey questionaires should be shared with people who live at and are involved with the home. 2 7 3 7 4 15 5 33 Care Homes for Older People Page 22 of 23 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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 © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 23 of 23 - 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!