Care Home: Galsworthy House Nursing Home

What the care home does well Feedback from people who live there included `on the whole it`s very good`, `the staff are marvellous`, `the surroundings are nice`, `I`m well looked after` and `I`m very pleased - it`s the easiness of it`. Visitors commented `I have nothing but praise for the staff` and `everybody is very kind`. We saw the that the home serves the majority of people very well. Individual health outcomes are good and medication is managed well for people. The environment is very comfortable and maintained to a high standard. What has improved since the last inspection? Better assessments are completed about people before admission and these capture good information about the individual. Care planning has improved and more detail is now being recorded about how to support each person in the way they wish. The activities programme has continued to develop and an additional dedicated staff member employed. What the care home could do better: The home needs to develop the service for people who have dementia or who have limited communication. More time should be spent with individuals and focus put on quality of life through engagement and occupation. Additional resources may be needed to improve outcomes in this area. Mealtimes could be made better for some people living at the home. Ways of working such as protected mealtimes should be tried. Care plans could be made even more detailed and person centred. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Galsworthy House Nursing Home 177 Kingston Hill Kingston Surrey KT2 7LX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jon Fry     Date: 1 9 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Galsworthy House Nursing Home 177 Kingston Hill Kingston Surrey KT2 7LX 02085472640 02085473175 carolew@slnh.co.uk www.slnh.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: South London Nursing Homes Ltd care home 72 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 72 The registered person may provide the following category of service only: Care home with nursing (CRH - 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 - Code OP Dementia - Code DE Physical disability Code PD Date of last inspection Brief description of the care home Galsworthy House provides nursing care for up to 72 older people. It also provides care to older people who may have a terminal illness, dementia and / or a physical Care Homes for Older People Page 4 of 24 Over 65 0 72 0 72 0 72 Brief description of the care home disability. The home is situated in a pleasant residential area of Kingston. Accommodation is provided over three floors in a listed building that has been thoughtfully extended. The majority of rooms are single and some have the attraction of overlooking Richmond Park. The home has two lifts. Care Homes for Older People Page 5 of 24 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: One inspector spent nine hours in the home over two separate visits. We spoke to ten people who live at the home, two visitors, the registered manager and seven members of staff. We looked at three care plans and other documents such as training and recruitment records. Care Homes for Older People Page 6 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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 7 of 24 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 8 of 24 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. Good information is available to people about the home. Assessments are completed to make sure that the service can meet the needs of individuals. Evidence: My doctor found it, I was put here, ive no idea but its alright and my relative found it were comments from people about how they came to live at Galsworthy House. Two visitors we spoke said that they had been able to visit the home and ask questions about the services provided in order to help them make a choice for their relative. A written guide is available about the home and we saw that this had last been updated in July 2009. This document is available in large print and we recommend that other formats be developed to make the information accessible to as many people as possible. Care Homes for Older People Page 9 of 24 Evidence: The guide aims to provide answers to the questions most frequently asked by people coming to live at Galsworthy House and also contains details of how to make a comment, complaint or suggestion. The assessment process has been improved since we last visited and more person centred information is now captured. This includes a social assessment and a life history that both capture some important information about the individual, their past and how they like to lead their life now. The challenge for the service is how to meaningfully include this information within each persons care plan. We saw that the care planning within the service, although improved, tends to still be too clinical and task focused. Care Homes for Older People Page 10 of 24 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. Care plans contain some good information but could be made much more individualised and person centred. Medication is managed well. Evidence: Feedback from individuals about the care they receive included they look after me well, they do very well, they look after us awfully well and nice. We looked at the care plans for three people. These have improved and contain some good information about individual support needs but could still be made more individual. The staff should look to replace generic statements such as ensure they are offered a wash daily or requires some assistance when washing with more specific information. They should describe when, where, who and exactly how this support is to be provided with the individual preferences of this person reflected. Statements about ensuring dignity and privacy at all times may not need to be repeated in each care plan as this practice should be standard across the service. Care plans could also be written in the first person and other formats tried - what a good day looks like for the person and what works and what doesnt with the individual. Care Homes for Older People Page 11 of 24 Evidence: We saw that medication is managed well by the service. The people who live there are supported to take their medication as prescribed and full records are kept of this administration. The records we looked at showed that individual health needs are met well. Good records are kept of health appointments and the people we spoke to said they were able to see their GP as required. Assessments are completed by staff around important areas such as nutrition, pressure areas and manual handling. Care Homes for Older People Page 12 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers a good programme of activities and this should be extended further with more activities for people who have dementia. Mealtimes could be improved for some people living there. Evidence: The home has a strong activities programme that has improved since our last inspection visit in August 2007. An additional part time staff member has been provided to support the activities co-ordinator in this important provision. The programme includes one outing a month as well as regular Religious services and visits from entertainers. The individual records we looked at showed that people are taking part in activities such as word games, poems circles, bridge, exercise and dance. Outings have been made to places such as the tennis at Wimbledon, Ascot, opera at Hampton Court and the transport museum in central London. We recommend that the home continues to develop the activities programme and, in particular, think about how it can better serve people with dementia. It may be necessary to increase the hours for activities further to reach people individually or Care Homes for Older People Page 13 of 24 Evidence: make more time for care staff to spend quality time with individuals. During our first day at the home, we observed people queuing in the ground floor corridor to see the hairdresser. This is not good practice and the system needs to be reviewed as soon as possible. Comments about the food provided included very interesting, very good, its good and very nice. Individuals told us that they were given a choice and we saw staff providing alternatives for people if they were not keen on the menu choices. two people said it was sometimes hard to make a choice in advance when the menu only indicated soup of the day or dessert of the day. We observed the mealtime on the top floor during our inspection and saw some very good practice from staff when individually supporting people. Two staff members were very person centred in their practice and took their time helping the person, explaining all the time what they were doing. We think there is room for improvement particularly in the co-ordination of this mealtime and trying to make it a more relaxed pleasant occasion. The focus is sometimes too clinical and this detracts from the social side of the mealtime. The television needs to be turned off during mealtimes. The mealtime in the main dining room was observed to be positive for the people using this facility. Menus were displayed and it was an unhurried relaxed occasion. We acknowledge the difficulties experienced by staff on the upper floors in particular with dining space and the amount of support required by individuals during each mealtime. The home could look at introducing protected mealtimes and engage other staff (domestic / clerical) in helping out on each floor. Other tasks such as giving out medication or answering phones could be done at other times. We do recommend that the home look at introducing menus that are produced in large print or have pictures. Care Homes for Older People Page 14 of 24 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. Concerns and complaints are listened to and acted upon. People living at the home are protected from abuse through staff training and recruitment practices. Evidence: People who live at the home told us I would speak to one of the sisters, no complaints, I would speak to my relative privately and I feel able to air my views if necessary. One individual said that they did not know how to make a complaint. One visitor we spoke to said that they felt able to speak to the staff if they had any concerns. We saw that good records are kept of any concerns or complaints. These detailed the responses given and how long the home took to respond. As stated previously, the guide about the home has details of how to make a comment, complaint or suggestion. We recommend that this procedure is made available in other formats and could include pictures of key people in the process. Staff receive mandatory training around safeguarding adults. There are procedures for individuals to follow in the event of any allegations being made. Care Homes for Older People Page 15 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Galsworthy House provides high quality clean and comfortable accommodation for the people who live there. Evidence: The home provides high quality comfortable accommodation for the people who live there. We saw that the home is well maintained with re-decoration of bedrooms and communal areas going on at the time of our visit. New wet rooms have been created on each floor to enable choice for individuals. The people we spoke to were happy with their rooms and these were seen to be personalised with individual furniture and pictures. We have recommended that the home looks at extending the dining room. This could help to improve the mealtime experience for the people living there. Additional items should also be provided in the top floor lounge to help staff positively interact with people. This could include sensory items, books, puzzles, crafts, hats, glasses, dolls and games. Two people who live there spoke very positively about the laundry service in operation at the home with one person commenting its all beautifully done. Care Homes for Older People Page 16 of 24 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. The people who live at Galsworthy House are supported by a well trained staff team. There could be further improvement in practice around dementia care. Evidence: Comments from the people who live there included some carers are extremely efficient, the staff are marvellous, very nice staff and polite. Individuals felt that there were generally enough staff around to help them as required. As stated previously, we strongly recommend that more thought be given to supporting individuals who have dementia. Current staffing levels do not allow for staff to spend prolonged periods of time engaging with individuals. Our observation on the top floor showed that staff members engaged positively with people for short periods but the focus was too task orientated. Spending time with people needs to be prioritised with much more focus on wellbeing, engagement and occupation. A dementia champion within the service could also help with developing staff practice within the home. We saw that improved levels of training around dementia care are now being provided for staff and this now needs to be effectively translated into day to day practice. The staff we spoke to said they received the training they needed to do their jobs. The Care Homes for Older People Page 17 of 24 Evidence: homes training manager organises internal and external training as required and we saw that good records are kept for each member of staff. Training provided includes Safeguarding, manual handling, fire safety, infection control and customer service. Staff also have good access to NVQ training. Care Homes for Older People Page 18 of 24 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 home is well run. Health and Safety checks take place to keep people safe. Evidence: The manager has been running the service for many years and this knowledge and experience benefits the people who live there. he staff we spoke felt that that they were providing a good service and felt well supported in their individual roles. The organisation has a system for ensuring quality within the home. This includes monthly visits by a senior manager that looks at areas such as training, Health and Safety, care planning and medication. We additionally saw that a full audit had been carried out in April 2009 with a overall rating given to the service and an action put in place to address any shortfalls. One meeting has taken place for the people who use the service within the last year but the manager told us that they were planning to hold these every two months. This is strongly recommended to give people regular opportunities to voice their opinions Care Homes for Older People Page 19 of 24 Evidence: about how the service is run and suggest improvements. We have recommended that the service looks at using observational tools as part of its quality assurance procedures. Dementia Care Mapping (DCM) or similar tools could give valuable insights into the quality of life of people living at Galsworthy House. We saw that regular Health and Safety checks take place to help keep people safe. Improvements have been made to make sure that fridge temperatures are regularly monitored and that hot water temperatures are checked in baths and showers. Care Homes for Older People Page 20 of 24 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 24 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 1 2 We recommend that the guide about the service be made available in other formats such as audio tape and pictorial. Staff should look at how information gathered during the assessment process can be used in the individual care plans. This is with particular reference to social needs, likes and dislikes and life history. General statements around ensuring dignity and respect could be removed from the care plans as this should be standard practice throughout the service. A dignity champion for the home could help to reinforce good practice on a day to day basis. Care plans could be made more person centred and better reflect individual support needs. Generic statements should be replaced with more detailed information about how the individual likes to be supported. Care plans could be written in the first person and different formats tried. Each document could contain information such as what a good day looks like for the individual, what works well, what doesnt work and how to communicate effectively. Page 22 of 24 3 7 4 7 5 7 Care Homes for Older People 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 6 12 Additional staff should be provided to help with activities or care staff given more time to spend quality time with individuals. The current system for supporting people to see the hairdresser needs to be urgently reviewed. The home needs to look at extending the provision of activity, engagement and occupation for people with dementia. The mealtime on the top floor needs to better co-ordinated. Staff need to focus on making the mealtime a more pleasant social experience. The television should be turned off during the mealtime. Protected mealtimes could be introduced to improve the mealtime experience for some people. 7 8 12 12 9 15 10 11 15 16 Menus should be produced in large print and picture format. The comments, complaints and suggestions procedure could be made available in other formats and include photographs of key people in the process. The home should look at extending the dining room provision. More items and objects should be provided in the top floor lounge area. It is strongly recommended that the home look at providing additional staff in order to increase levels of engagement, occupation and wellbeing for people with dementia. A dementia champion could help to focus on good practice within the service. Regular meetings should be held for the people who live there to enable them to formally feed into the running of the service. Observational tools should be used as part of the quality assurance procedures for the home. 12 13 14 20 20 27 15 16 27 33 17 33 Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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