Care Home: Garden House

What the care home does well The needs and wishes of each person living at Garden House have been properly assessed before they moved into the Home. This meant that staff knew about the needs of each person and what care and support they required. Good plans of care and risk assessments are completed for people. This meant staff had the information they needed to support each person. Peoples` health care needs are met by good care practice and effective joint working with health professionals. People are encouraged and supported to make decisions about their daily lives and preferences so that they retain their independence and individuality. People living at Garden House are encouraged and supported to maintain contact with their friends and family. The relationships between staff and people living at the home were good and personal support was provided in such a way as to promote and protect privacy and dignity. Complaints procedures are clear and people living in the home are made aware of them. Staffing levels are adequate and appropriate training is provided to ensure that staff have the skills and knowledge to provide high quality care. Good systems are in place for auditing the quality of the service. What has improved since the last inspection? There is a programme of building work and refurbishment in place to provide a more spacious environment for the people living there. The new care plans have almost all been introduced and staff are working towards completing these. These will provide good information about peoples` needs for staff. The garden near the front door has been tidied and is very attractive. Menus have been revised and provide a choice at mealtimes. What the care home could do better: The refurbishment of the building is started and the completion of this work will provide residents with good en-suite rooms and larger and more spacious public areas of the home. The odours identified in two bedrooms should be eliminated. The sealant on the floor of the shower room should be replaced to prevent further growth of mould. CARE HOMES FOR OLDER PEOPLE Garden House 174 Main Street Spittal Berwick Upon Tweed Northumberland TD15 1RD Lead Inspector Anne Urwin Brown Key Unannounced Inspection 11th September 2008 09:00 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 Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Garden House Address 174 Main Street Spittal Berwick Upon Tweed Northumberland TD15 1RD 01289 330942 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) Wellburn Care Homes Limited Manager post vacant Care Home 24 Category(ies) of Dementia (24), Old age, not falling within any registration, with number other category (24) of places Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE, maximum number of places: 24 Old age, not falling within any other category - Code OP, maximum number of places: 24 The maximum number of service users who can be accommodated is: 24 This is the first inspection of this service. 2. Date of last inspection Brief Description of the Service: Garden House is situated on the main street in Spittal near Berwick upon Tweed. Bus and train links are available in Berwick, with local buses running past the home. This service has recently changed hands and is now owned by Wellburn Care Homes Ltd. Garden House has been adapted and extended to provide accommodation for up to twenty-four elderly people. There is a garden to the front of the house and a patio area outside the dining room at the back of the building. Accommodation is provided on two floors and there are sixteen single and four double bedrooms. A shaft lift is fitted. The Statement of Purpose and Service User Guide are available at the home and provide good information about the service offered. Fees range from £409.40 to £414.71 per week. Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of this service is 2 star. This means that people using this service experience good quality outcomes. How the inspection was carried out Before the visit: We looked at: • Information we have received since the home was registered. • How the service has dealt with any complaints & concerns. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on 11th September 2008. During the visit we: • • • • • • Talked with people who use the service, relatives, staff, the manager & visitors. Looked at information about the people who use the service & how well their needs are met, Looked at other records which must be kept, Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, Looked around the building/parts of the building to make sure it was clean, safe & comfortable, Checked what improvements had been made since the home changed hands. We told the manager/provider what we found. What the service does well: The needs and wishes of each person living at Garden House have been properly assessed before they moved into the Home. This meant that staff knew about the needs of each person and what care and support they required. Good plans of care and risk assessments are completed for people. This meant staff had the information they needed to support each person. Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 6 Peoples’ health care needs are met by good care practice and effective joint working with health professionals. People are encouraged and supported to make decisions about their daily lives and preferences so that they retain their independence and individuality. People living at Garden House are encouraged and supported to maintain contact with their friends and family. The relationships between staff and people living at the home were good and personal support was provided in such a way as to promote and protect privacy and dignity. Complaints procedures are clear and people living in the home are made aware of them. Staffing levels are adequate and appropriate training is provided to ensure that staff have the skills and knowledge to provide high quality care. Good systems are in place for auditing the quality of the service. What has improved since the last inspection? What they could do better: The refurbishment of the building is started and the completion of this work will provide residents with good en-suite rooms and larger and more spacious public areas of the home. The odours identified in two bedrooms should be eliminated. The sealant on the floor of the shower room should be replaced to prevent further growth of mould. Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 8 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 Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good information is available to help people make choices about coming to live at Garden House. Comprehensive assessments are carried out before and after admission to ensure that peoples’ needs can be planned and properly met. EVIDENCE: Information is available about the service provided at Garden House. Work has started to make some minor changes to reflect the change of ownership and these are ongoing as there is building work going on to provide more extensive facilities that will also need to be included. One relative said that he had received enough information about the service before his wife was admitted. He said that staff had been very helpful and reassuring. People are Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 10 encouraged to visit the home and this results in them having good information on which to base their decision to move into the home. Wellburn Care Homes Ltd have issued new contracts to everyone living in the home and some have been returned. Each person has a pre-admission assessment completed so that staff can be sure that they can meet their needs. Records show that this information is used to inform the care planning process. Staff said that they usually have enough information about peoples’ needs when they come to live at Garden House. The company are changing the care planning and assessment documentation, but they are continuing to use some of the old paperwork in the interim period. This allows the staff to maintain the records effectively and gives continuity to people living in the home. Care management assessments are also available. Intermediate care is not provided at Garden House. Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is good recording of peoples’ health and personal care that ensures that staff have up to date information about individual needs and how these are met. EVIDENCE: A new care planning system is being introduced following the change of ownership. Staff are working on completing the new format for each person. Each resident has an individual plan of care, which is based on the admission assessment and is then added to during the placement. The care plans show that peoples’ needs are regularly assessed. Plans are agreed with residents or relatives where appropriate, up to date and are regularly reviewed. Comprehensive risk assessments are in place for specific interventions, and these are updated when necessary. Each person has regular reviews and they are involved in this process together with relatives/representatives if Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 12 appropriate. Staff are well informed about individual needs and demonstrated this during the inspection. Peoples’ health care needs and any specific treatments are clearly recorded. All contact with the doctor, district nurse and other health care professionals is recorded appropriately. Records showed that the home seeks expert advice from external professionals if necessary. Aids and other equipment are in place for those who need it. People living in the home said that the staff are aware of their health needs. They said they get support to attend appointments. Two people said they were satisfied that they can access the health services that they need. The systems for managing medicines in the home are in line with safe working practice guidelines. The records relating to the administration of medicines are in good order and staff are clear about the procedures. Monthly audits of medicines are carried out. A new monitored dosage system has been introduced. Staff training in handling medicines has been provided so that they understand their responsibilities. Risk assessments are in place for people wanting to manage their own medicines and lockable storage is provided. Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Routines around daily living are flexible and provide people with good opportunities to engage in meaningful actives and control over their lives. This enables them to make choices affecting their daily life and maintain preferred life choices. EVIDENCE: People living at Garden House said that they are able to make choices about their daily routines, like when they get up, go to bed and what they do with their time. Individual routines are identified within most care plans. There is a programme of activities. An activity co-ordinator is employed who arranges the programme of activities and outings. In addition there are opportunities for people to have aromatherapy, massage, exercise class and manicures. Records show what peoples’ interests are and how they like to spend their time. People are encouraged to make choices about where and how they spend their time. There are videos, music tapes, newspapers and books available. Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 14 People living in the home said that they have regular visitors and this was evident from the Visitors Book and from seeing visitors coming in during the inspection. Information about arrangements for visiting is provided for people before they move in. One relative said that staff are welcoming and they enjoy visiting the home as there is a relaxed atmosphere. This person also said “Staff are very friendly and helpful.” People are encouraged to continue to manage their finances for as long as they are able and this was evident from care plans. Staff encourage people to bring in furniture, ornaments and pictures from their previous homes. Rooms are personalised and reflect peoples’ interests and taste. People are able to follow their own religion and local ministers visit the home regularly. The menus have been reviewed since the service changed hands. Menus show that a varied diet is provided that offers choice at each mealtime and fresh foods are used in preference to frozen or tinned. Peoples’ likes and dislikes are recorded and the staff ask for comments about the food. The food was well presented and cooked at the mealtime during the inspection. Staff have completed Food Hygiene training. Records show that there are regular cleaning routines and temperature checks of food and fridges. Half of the dining room was blocked off as work is going on to create a new sitting/dining area. Staff are managing this well so that people are not inconvenienced. Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A satisfactory complaints procedure is in place to ensure that complaints are dealt with effectively and to the satisfaction of the complainant. Good arrangements for protecting people using the service are in place. EVIDENCE: The complaints procedure provides clear information about how to make a complaint. Three people said that they felt able to talk to staff if they had any concerns. Staff are aware of the new complaints procedure. Two complaints have been made since the last inspection and records of these showed that a comprehensive investigation had been carried out and a satisfactory outcome achieved. All staff have completed safeguarding training. No referrals have been made since the last inspection. Staff are aware of the procedures to be followed in the event of an allegation being made. Procedures are in place for dealing with allegations. Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The building is safe, clean and well maintained. Refurbishment and new building works are going on to create a more comfortable environment that provides more space and better facilities for people living at Garden House. EVIDENCE: Since the change of ownership work has started on a refurbishment and building programme that will provide more public space and en-suite bedrooms in all but four rooms. This work has been carefully planned to create the least disruption possible for people living in the home. At present part of the dining room has been blocked off as it is being extended to form a large sitting/dining area. Once this work is completed the new extension will be built. Residents Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 17 said that they have not found the work disruptive to their daily routines, although there is some noise created by the workmen. People have access to specialist equipment and aids that are necessary to help them live as independently as possible. There is a shaft lift fitted at Garden House that provides good access to the first floor. The garden is accessible at the front of the house and work has been undertaken to improve this area and a patio area is planned at the rear. Parking is available at the front of the building. Storage space is limited throughout the home and the deputy manager said that this can be a problem. The deputy manager said that the handyman is good at carrying out repairs promptly. Maintenance checks are carried out regularly and records were in good order. One person said “I like my room, but I am looking forward to having my own toilet when the new rooms are finished. I have brought things from my home that make it like my own.” There is an assisted bath on the ground floor and another bathroom where work is planned. There is mould growing in the sealant on the floor of the shower room on the first floor. The deputy manager said that upgrading of toilets and bathrooms is planned as part of the refurbishment. Bedrooms are mostly well decorated and maintained. There was an odour in two bedrooms and this was highlighted during the inspection. People are encouraged to bring items from their previous home. The laundry is very cramped and the only ventilation is through vents in the external door. The boilers are in the laundry and the room is hot for staff working there and space is very limited. Staff have had infection control training. Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient experienced and trained staff are available to meet the needs of the people living in the home. People are protected by the home’s robust recruitment procedures. EVIDENCE: The service has appropriate numbers of staff at all times to support the needs of the people living at Garden House. There is a settled staff team who work well together and support each other. Staff members’ roles and responsibilities are clearly defined and understood and appropriate job descriptions support this. People who use this service and their relatives spoke highly of the staff and one relative said “…everyone is really friendly and helpful and I come in every day to visit my wife who is very well looked after.” Staff training is targeted and prioritised to allow staff to undertake training beyond basic requirements. A level of 44 of trained staff has been achieved. Staff said that they get enough training opportunities. Records show that mandatory training is provided as appropriate. Induction training is provided for all new staff and staff said that new staff are well supported to ensure that Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 19 they are competent to meet residents’ needs. Equality and diversity issues are covered within training so that staff practice is improved. Staff records are completed in line with the company policies and procedures, including two references and a completed application form. The requirement to have a CRB and POVA check in place is applied to all of the staff in the home. Equality and diversity policies are reflected in recruitment and employment procedures. Records show that all checks are carried out and recorded to ensure that staff appointments are only made after the management has satisfied itself that applicants have the appropriate qualities to fully meet the needs of people living at Garden House. Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good management systems in place to make sure that the home is managed effectively taking into account the needs and wishes of the residents. EVIDENCE: The manager is experienced in the care of older people and has the Registered Manager’s award. She has made an application for registration as manager and is about to have a fit person interview. She undertakes regular training to keep up to date. Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 21 There are good systems for auditing of the quality of the service provided. These audits together with regular resident meetings provide evidence of a quality assurance system that is customer focussed. One relative said that he felt able to approach the manager or any of the staff about his wife’s care. Formal supervision for care staff is up to date and staff said that they are well supported by the manager and deputy manager. All staff spoken to said that they had been well supported during the change of ownership of the home and had been kept informed by the new owners of any changes proposed. Practice and performance are discussed at supervision and training needs are identified from this. Regular staff meetings are held and staff said they are encouraged to contribute. There are effective systems in place for safeguarding and managing money held on behalf of people living in the home including clear records. People using the service or their relatives have access to the records whenever they wish. Records show that training in health and safety matters is provided and individual training records reflect this. Staff said that they receive this training. Health and Safety checks are regularly undertaken and records were available to show good standards are maintained. Policies, procedures and risk assessments for safe working practices are in place to promote and protect residents and staff. Staff said that appropriate induction training is provided for new staff and records are in place to confirm this. Full details of accidents are kept and evidence was available to show these are monitored for trends. Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 22 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 OP1 OP21 OP26 Good Practice Recommendations The Statement of Purpose and Service User guide should be updated to reflect the change of ownership and alterations to the building. The sealant on the floor of the shower room on the first floor needs replaced. The odour identified in two bedrooms needs to be eliminated. Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Garden House DS0000071690.V371671.R02.S.doc Version 5.2 Page 25 - 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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