Care Home: Garden Hill Care Home

What the care home does well Care plans are now detailed,person centred and up to date.This means that all staff are able to provide care and support based on individual need. The advice of all specialists is now sought and their recommendations are recorded and followed.This means residents health care has improved and is continually monitored. All medication is stored within the appropriate temperature range, and regular checks of the MARs and stock remaining help to maintain accurate records and improve stock control.Everyone now has the opportunity to take part in meaningful activities and residents are able to have choices regarding daily routines. The mealtime experience has improved and residents are able to choose from a balanced diet which includes fortified drinks and snacks. Complaints and safeguarding issues are now being managed properly. The home is a clean,comfortable,safe place to live. Current staffing levels meet the dependency levels and health care needs of the residents living in the home. Staff are now supported and directed in everyday practice which means residents receive a person centred approach to care . Regular meetings with staff,residents and relatives take place and their views are listened to and acted upon. Quality assurance and regular audits of the service take place so that the staff can continually monitor and improve the service provision. The Commission is now informed of any event that affects the health,well being and welfare of people living in the home. What the care home could do better: The previous process of recording the ordering of prescriptions and receipt of medication for individual service users should be recommenced to maintain a full medication audit trail. Locks should be fitted to all medication cupboards within the treatment rooms. Staff should always make sure they knock on residents bedroom doors and wait for permission before entering.This is so residents privacy is always respected. Staff must receive training suitable to the work they perform to meet the needs of the people living here and to ensure safe working practices. This must include (but not be limited to) training on safeguarding adults, first aid, safe moving and handling, infection control and food hygiene. Records of staff supervision meetings should be in sufficient detail to evidence a summary of the discussion held and agreed actions, including evidence of what issues have been raised, what support has been requested and offered, and what actions have been agreed. The manager should progress with her application to become registered with the Commission. Random inspection report Care homes for older people Name: Address: Garden Hill Care Home 32 St Michaels Avenue South Shields Tyne & Wear NE33 3AN zero star poor service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Irene Bowater Date: 2 8 0 4 2 0 1 0 Information about the care home Name of care home: Address: Garden Hill Care Home 32 St Michaels Avenue South Shields Tyne & Wear NE33 3AN 01914975255 01914975269 gardenhill@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: Conditions of registration: Category(ies) : Southern Cross OPCO Ltd care home 40 Number of places (if applicable): Under 65 Over 65 40 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is: 40 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 category: Old age, not falling within any other category - Code OP, maximum number of places 40 Date of last inspection Brief description of the care home Garden Hill is a large detached three storeys building in South Shields set in its own grounds. The home can provide general nursing and social care for up to forty people. The home does not provide intermediate care services. There are lounges on each floor and the main dining room is on the ground floor. Bedrooms are on each floor and all Care Homes for Older People Page 2 of 14 Brief description of the care home are en-suite. Throughout the home are specialist bathing and toilet facilities and there is easy access to the gardens and car park. The gardens are to the front and side of the property with a car park to the front. There is a lift provided which enables people to get to the different floors. An emergency call system is provided in all bedrooms. It is situated in a residential area and convenient for the town centre of South Shields. It is close to local train and bus transport. The seaside, shopping outlets, local theatres and social amenities are close by. The local shops and a post office are within easy walking distance of the care home. Fee rates vary in the home dependent upon whether you are receiving nursing or social care. Personal items such as clothing, toiletries, newspapers and outings are not included in the fee rates. Care Homes for Older People Page 3 of 14 What we found: A Key Inspection was completed on the 4 February 2010 following safeguarding issues concerning the health,safety and welfare of people using the service.As a result of that inspection many requirements and recommendations were made and it was rated as providing poor outcomes for the people using the service. We undertook this site visit to follow up requirements made at that inspection. As some of these requirements had been repeated at more than one inspection we wrote a warning letter to the company. This was to tell them that what shortfalls we had found, what action was required to put these right and that we would take enforcement action should they continue to fail to address these. We found significant progress in addressing the requirements made during the Key Inspection of the 4 February 2010. Previously made recommendations were not examined as part of this inspection. Before the visit we looked at the information we received since the last visit on the 4 February 2010. This included: How the service has dealt with complaints and concerns since the last visit. Any changed to how the home is run. The providers view of how well they care for people. The views of people who use the service,their relatives staff and other professionals. A site visit was carried out on the 28 April 2010 by three regulatory inspectors and a pharmacy inspector from the Commission. The visit started at 8:45 am and was completed at 16:00 pm. During the visit we talked to the people who use the service,staff,relatives,and the manager. We looked at information about the people who use the service and how well their needs were being met. Looked at other records which must be kept. Checked that the staff had the knowledge,skills and training to meet the needs of the people they care for. Looked around the building to make sure it was clean,safe and comfortable. We told the manager what we found. We have reviewed our practice when making requirements,to improve national consistency.Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations,but only when it is considered that people who use services are not being put at significant risk of harm. Choice of Home: The home has not had any new admissions since the last inspection therefore the admission process could not be examined. Health and Personal Care: Six care plans were examined and case tracked. This means that we spoke to individual Care Homes for Older People Page 4 of 14 residents or observed that their care matched our observations to what was written in the care plan. All case tracked care plans, did reflect the actual care needed by the residents. Care plans took account of peoples diverse and differing needs. Peoples health care needs were clearly recorded,including,assessing and regularly evaluating dependency levels,nutrition status,using the Malnutrition Universal Scoring Tool (MUST),falls risk,moving and assisting,pressure ulcer prevention and hydration. Other health professionals,such as dieticians,Speech and Language Therapists(SALT), respiratory nurses,psychiatrists,physiotherapists,and GPs,contributed to the planning of care. These contributions were clearly recorded. Care plans were clearly written and had recently been evaluated. The care staff spoken to were able to identify those residents who required help to eat and drink,including those who needed to have their fluid balance recorded. The records for these residents showed that they were receiving enough fluid on a daily basis. Their care plans also confirmed that their nutritional assessments were up to date and they had received specialist advice regarding food and fluid. Where residents required thickened fluids or specialist drinking cups this was recorded. Records showed that resident weights are monitored regularly. The weights are recorded on individual care plans,the care plans examined showed that all of the residents had maintained or gained weight in the last three months. Residents told us that they received enough to eat and drink. They also said that staff were attentive to their needs,they had regular showers or baths,and clean clothes. Some visitors in the home on the day of the inspection confirmed that this was correct. All of the residents spoken to had clean nails and hair and looked well cared for. One resident chose to stay in bed for most of the day. This was recorded in his care plan along with advice from health professionals to help staff cope with some of his challenging behaviour. This residents care plan showed that staff planned for his increased risk of pressure damage and complications of bed rest. The home was equipped with suitable medical equipment for both emergency and routine use. The nurse was aware of the constraints for using some of this equipment and had access to guidance logs if needed. The nurses had not yet received training in the use of emergency suction equipment.The manager confirmed that this was being arranged.There were sufficient profiling beds,moving and handling equipment and pressure relieving mattresses. We looked at the current and previous Medication Administration Records(MARs)and counted a sample of medicines.There were no gaps in the administration records,and no discrepancies between the quantities of medication supplied,the number of doses recorded on the MARs and the quantities of medication remaining. Together this indicates that people living in the home can expect to receive their prescribed medication correctly. Further improvement could be made to ensure that daily medication counts,introduced to improve stock control,are fully completed for all medication,particularly on the nursing unit. Hand written entries on MARs were clear,and accurate although occasionally had not Care Homes for Older People Page 5 of 14 been checked by a second carer,which helps to make sure that all entries are complete and accurate. Any medication carried over from the previous month is recorded and this helps maintain a complete record of medication in the home and assists in stock control. Photographs of all service users were located in the MAR file to help in identification prior to medication administration. Since the last inspection,a cooler has been installed in the treatment room on the first floor and all medication in the home is now stored within the appropriate temperature range recommended by the manufacturer. Some improvement to the security of medicines could be made by ensuring that all cupboards within the treatment room on the residential unit containing medication are fitted with locks. In addition,we found the door to the treatment room on the nursing unit and the medicines fridge inside,unlocked. The current controlled drugs cupboard,which does not meet safe custody regulations,has not yet been replaced. The manager informed us that a replacement controlled drug cupboard had been delivered but was too small,and a replacement was expected shortly. Daily Life and Social Activities: Since the last visit to the home a range of activities have been introduced for the residents. The library is open all of the time and there is a poetry and reading club once a week.A 10 week gentle exercise class has been introduced and the residents now have their own support group which meets on a weekly basis.Residents also benefit from in house entertainment and evenings out. Social care plans are in place and show that individual resident preferences have been taken into account .For example three residents have moved to the ground floor so that they can access the gardens and cafe easily and another resident has moved to a much larger room so that her social and health care needs can be met. Residents were being supported with breakfast at approximately 9:00 am.The dining tables were appropriately set.Various cereals,porridge,juices,hot drinks,toast and preserves were available including a cooked breakfast. One resident said breakfast is always good and I always have a cooked breakfast and another said,I never have a cooked breakfast,I always have plenty to eat. Staff were available to support those who needed help with food and drink and the atmosphere was calm and well managed.Some residents preferred breakfast in their rooms and this option was provided. Chef was busy putting lunch choices on the menu blackboard during breakfast.Choices were roast lamb or cheese and broccoli bake with vegetables and potatoes.The dessert was rice pudding.Menus on each dining table offered other alternatives for main and dessert courses and other snacks. The lunchtime meal was observed in a small cafe area on the ground floor. Three Care Homes for Older People Page 6 of 14 residents were being helped to eat their meal by three staff. The staff sat beside the residents whilst they ate,they allowed plenty of time for residents to take their food and offered drinks regularly throughout. The mealtime seemed to be a good social occasion,staff chatted with residents rather than with each other, and the atmosphere was relaxed. Residents were given food and fluids using a variety of adapted crockery and cutlery. Some residents had thickened fluids and some were given additional nutrients in the form of milkshakes and supplements after their meal. Two residents on the first floor chose to eat in their rooms. They were served their main meal on a tray which was attractively set, they were offered a choice of drinks with and following their meal. A resident told us that he had enough food to eat, he confirmed that he has second helpings regularly. Residents and visitors confirmed that there is a choice of main meal and several lighter options if needed. It was observed throughout the day that staff did not knock on doors before entering rooms. When an inspector was talking to a family, the domestic came in the door which was open, and started to empty bins without any explanation or seeking permission. Complaints and Protection: There have been some recent incidents requiring the intervention of the safeguarding team. The details of these were recorded in a safeguarding file and all of the appropriate agencies had been involved. The manager stated that there had been no new safeguarding issues since her appointment and the records confirm this. A safeguarding adults manager from the local authority had recently carried out a monitoring visit at the home. The report of this visit confirmed that the quality of life for people living in the home has improved. Safeguarding continues to be monitored by CQC and the local authority. There have been no new complaints recorded since January 2010. The manager stated that this was because she has an open door policy and communicates with residents and relatives on a regular basis. This results in any issues being raised and dealt with at the initial stage, before they escalate into formal complaints. One relative spoken to confirmed that she had complained in the past, this has been addressed quickly and she was satisfied with the result. Environment: A walk around the home found it to be nicely furnished ,clean,warm and odour free.The coffee lounge has had a major refurbishment and is now known as Minchies of Minchellas. Service users and visitors are able to have ice cream coffees,teas and milk shakes in the ice cream parlour at any time during the day. The lounge on the second floor has been turned into a quiet relaxing area with a selection of books,magazines and DVDs. Care Homes for Older People Page 7 of 14 The downstairs lounge has been redecorated to a good standard and there are plans to redecorate corridors into themed areas such as a beach, marine park and book theme. Call bells are now accessible in all areas including bathrooms and toilets. Bathrooms were in the process of refurbishment and en-suite toilets have been repaired. The laundry was compact but clean and organised.Liquid soap and paper towels were available in all areas so that staff could wash their hands properly and reduce the risk of cross infection. Staffing: An inspector spoke to a care assistant on the middle floor. She said things have improved since the new manager came to post. She said the manager has made a lot of changes, we are happy team now. She confirmed that she had recently had training in fire procedures, moving and handling and health and safety. The nurse in charge said things are a lot better, that she has had some training to help her in her job, mostly in medication, she said I know what Im doing now and the residents are happier. The new manager has introduced various awareness weeks.Service users relatives and staff have participated in use of oxygen therapy,introduction to Parkinsons Disease,Infection Control and hand washing. Care staff have been enrolled on National Vocational Qualifications (NVQ) level 2 and five staff have been identified to enroll on NVQ level 3 in May 2010. We looked at a sample of 5 staff files. We found that one of these workers has only worked here for a short time. Therefore they have not yet benefitted from a formal supervision meeting. We saw that for the other 4 staff that all have had a formal supervision meeting with a manager this year, some up to 5 times. The record made for each supervision meeting consists of a list of bullet points for the areas discussed, rather than a more detailed account of the discussion and actions agreed. To help ensure that care staff are supervised and directed on a day to day basis, there is always a senior carer on duty to lead each shift. This requirement has been addressed, however a new recommendation has been made to improve the level of detail within the supervision records. We obtained copies of the staff rota, looked at the numbers of people receiving care here, and observed how care and support was delivered. We found that each day there is a minimum of one nurse and one senior carer on duty. There are also 5 care workers, as well as a team of domestic and catering staff. Staffing levels at night consist of one nurse, one senior carer and 2 care workers. Since we last inspected this care home, there has been only one member of staff recruited here. We looked at this persons personnel file and found evidence that an ISA (Independent Safeguarding Authority) 1st check had been received. This is a check against a list of people barred from working with vulnerable adults. We saw that a Care Homes for Older People Page 8 of 14 Criminal Records Bureau check had been applied for, and that an employment reference had been received. A second reference could not be located, but we later received confirmation that this was in place. The requirements made at a previous inspection regarding how to respond to complaints and be given training in whistle blowing procedures. And all grades of staff must complete training which links into the Local Authority Procedural Framework. This will ensure people living in the home are protected from harm. (Timescale for action 03/05/2010) The timescale for completion of this of this requirement had not yet fallen due. We have reviewed the 3 previous requirements relating to staff training and amalgamated them into one new requirement. Management and Administration: The current manager has been in post since February 2010.She is a first level nurse and had had experience working with older people.She is in the process of completing an application to become registered with the Commission. She was very aware of the many issues in the home when she took over as manager and continues to work hard to improve the service. Three staff members were spoken to and they confirmed that the manager has made a number of positive changes to the home. They told us that since the manager had been appointed the focus was on better care for the residents. Staff said they feel supported and had access to training to enable them to improve their skills and abilities. They said that the manager gave clear directives and they were aware of the standards expected of them. Regular meetings have been held for all grades of staff with minutes recorded.And a health and safety meeting was held on the 23 April 2010. Risk assessments are in place for use of oxygen and storage,slips and trips,hot water and falls. Audits of all aspects of service provision now take place including medication, accident and incident,care plans and care delivery including prevention of pressure damage. An examination of the accident book found clear recording, and accidents and incidents could be cross referenced to both care plans and Regulation 37 notifications. What the care home does well: Care plans are now detailed,person centred and up to date.This means that all staff are able to provide care and support based on individual need. The advice of all specialists is now sought and their recommendations are recorded and followed.This means residents health care has improved and is continually monitored. All medication is stored within the appropriate temperature range, and regular checks of the MARs and stock remaining help to maintain accurate records and improve stock control. Care Homes for Older People Page 9 of 14 Everyone now has the opportunity to take part in meaningful activities and residents are able to have choices regarding daily routines. The mealtime experience has improved and residents are able to choose from a balanced diet which includes fortified drinks and snacks. Complaints and safeguarding issues are now being managed properly. The home is a clean,comfortable,safe place to live. Current staffing levels meet the dependency levels and health care needs of the residents living in the home. Staff are now supported and directed in everyday practice which means residents receive a person centred approach to care . Regular meetings with staff,residents and relatives take place and their views are listened to and acted upon. Quality assurance and regular audits of the service take place so that the staff can continually monitor and improve the service provision. The Commission is now informed of any event that affects the health,well being and welfare of people living in the home. 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 2. Care Homes for Older People Page 10 of 14 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 11 of 14 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, 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 1 30 18 Staff must receive training 21/06/2010 suitable to the work they perform, the needs of the people living here and to ensure safe working practices. This must include (but not be limited to) training on safeguarding adults, first aid, safe moving and handling, infection control and food hygiene. This is to help ensure that the people living here receive the care and support they need from knowledgeable and skilled staff, who are up to date with current good practice. 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 9 All handwritten entries on MARs should be checked by a second person to confirm accuracy, signed and dated, and include the quantity of medication received. Page 12 of 14 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 Daily medication counts should be consistently recorded on all MARs Medicine fridges and cupboards within treatment rooms should be locked when not in use. A lock should be fitted to the wall medicines cupboard on the residential unit, or an alternative lockable cupboard should be used. 2 14 Staff should make sure that they always knock on residents doors and wait for an answer before entering.This follows good practice guidance and makes sure residents privacy is always respected. The manager should progress with her application to become registered with the Commission. Records of staff supervision meetings should be in sufficient detail to evidence a summary of the discussion held and agreed actions, including evidence of what issues have been raised, what support has been requested and offered, and what actions have been agreed. This is so staff are supported and directed to effectively meet service users needs and staffs performance managed. 3 4 31 36 Care Homes for Older People Page 13 of 14 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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