Care Home: Garden House

What the care home does well People are supported to lead the life they want to and participate in a variety of activities both in the home and in the local community. People tell us the food is very good and they enjoy it. Staff are supported and encouraged to participate in training. People who use the service tell us that staff are very kind and caring. What has improved since the last inspection? At the end of the key inspection in October 2008, there were two requirements and three recommendations. Written care plans have been improved and contain more information on how peoples needs will be met. These plans are reviewed. We are sent information by the home on any incidents or accidents that happen and what the service has done to deal with it. Improvements have been made to handwritten changes in the mediation records. There is a system in place to audit accidents and incidents. What the care home could do better: At the end of this key inspection there are five requirements and five recommendations. The statement of purpose has to be an accurate refection of the facilities and service so that people are fully informed before they make a decision to move in. It is important for the safety of people using the service that current good infection control practice is followed in the home. The well being and safety of people using the service must be protected by a robust and clearly followed recruitment practice. To ensure that people living in the home are protected fire checks must be completed and recorded when they occur. Equipment being used in the home must be serviced properly to ensure the safety of the people using the equipment. Pre admission assessments need to contain more information to demonstrate that the home has the skills needed to meet individual needs. To ensure that people`s needs are fully met, understood and their dignity maintained, staff should be supported with further training. The nutritional needs of vulnerable people using the service should be clearly recorded. The safeguarding policy needs to be updated to ensure that everyone understands the process consistently. All maintenance in the home should be clearly recorded with timescales. Key inspection report Care homes for older people Name: Address: Garden House Priestlands Sherborne Dorset DT9 4HN     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Tracey Cockburn     Date: 2 7 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Garden House Priestlands Sherborne Dorset DT9 4HN 01935813188 NOFAX Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Garden House Rest Home Limited care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Garden House is a residential home registered to accommodate 15 older persons. It is situated in a quiet residential area of Sherborne and within walking distance of the town centre. Mr Calder purchased the home in 1992 and continues to take an active role in the management of the home. He lives in private accommodation within the grounds of Garden House. In August 2005 a new registration certificate was issued to reflect the fact that the home is under the ownership of Garden House Ltd (the change to a limited company occurred in 1999). Mr Calder is the responsible individual and Mrs Houghton is the registered manager. The care home is established in the main house and an extension to the property named Trudys Cottage and is set in landscaped grounds. The front garden is set to lawns and herbaceous borders with mature trees and shrubs and a parking area for visitors convenience. A series of steps lead to the front entrance and a large sliding glass door/window at the front of the house allows access to a raised patio area with garden furniture. The back garden has mature fruit trees, lawns and seasonal flower borders. Once inside the home there is level access to Care Homes for Older People Page 4 of 27 Over 65 15 0 2 1 1 0 2 0 0 8 Brief description of the care home residents rooms and communal facilities. The accommodation is furnished and decorated to a high standard. Laundering of clothing and household linen is carried out at the home and arrangements are made for chiropodists, opticians and other health and social care professionals to visit individual residents. On 10 October 2007 the Commission received an undated letter from the registered manager stating that fees range from #350 to #559 per week depending on different factors. Information regarding the subjects Value for Money and Fair Terms in Contracts can be obtained from the web link: www.oft.gov.uk Care Homes for Older People Page 5 of 27 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: zero star poor 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: This inspection was carried out by two inspectors throughout the report the term we is used to show that the report is the view of the Care Quality Commission. We visited the service unannounced on the first day, we then returned on a second day to complete the visit. We sent surveys to the home and nine were returned by staff who work in the home, eleven were returned by people who live in the home and one was returned by a professional who visits the home. We looked at information the home sent to us such as the annual quality assurance assessment, this informed aspects of the service we wished to look at. We also looked at the last key inspection report. We spoke to people living in the home as well as staff and the manager, we also spoke briefly with the registered provider. We looked at a variety of care records. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: At the end of this key inspection there are five requirements and five recommendations. The statement of purpose has to be an accurate refection of the facilities and service so that people are fully informed before they make a decision to move in. It is important for the safety of people using the service that current good infection control practice is followed in the home. The well being and safety of people using the service must be protected by a robust and clearly followed recruitment practice. To ensure that people living in the home are protected fire checks must be completed and recorded when they occur. Equipment being used in the home must be serviced properly to ensure the safety of the people using the equipment. Pre admission assessments need to contain more information to demonstrate that the home has the skills needed to meet individual needs. To ensure that peoples needs are fully met, understood and their dignity maintained, staff should be supported with further training. The nutritional needs of vulnerable people using the service should be clearly recorded. The safeguarding policy needs to be updated to ensure that everyone understands the Care Homes for Older People Page 7 of 27 process consistently. All maintenance in the home should be clearly recorded with timescales. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering using the service do not have enough information on whether the service will fully meet their needs. More information is needed in pre admission assessments to ensure that an individuals needs can be fully met before they move in. Evidence: The manager told us that the colour brochure is given to all prospective residents and she said that this clearly shows that the annexe, known as Trudys, is a completely separate building. It also does not say that the only access to it is across the car park. We were concerned that the only access to the main home is up a flight of shallow steps, the manager told us that this has been fully assessed by a qualified occupational therapist. The brochure states that the home is registered under Section 1 of the Registered Homes Act 1984. Care Homes for Older People Page 10 of 27 Evidence: Pre admission assessments are completed before someone moves into the home however in the two files we looked at this information is often only one word answers.Under the heading hearing it said good under heading speech it said clear under heading bowels it said no problems. Under heading dressing ability said needs checking but usually fine We found that there was little information in these assessments. Only one part of the registration certificate is displayed. We explained that it was an offence not to display both parts of the certificate. Care Homes for Older People Page 11 of 27 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. Improvements to care planning means there is clear information about how people need and prefer to be supported which gives staff accurate information on the needs of individuals living in the home. Evidence: We found that the manager has worked hard since the last key inspection improving the care plans and the information within them. We looked at one care plan which demonstrated that the home know the person well and had provided good written information on the way the person needed to be supported to have their daily needs met. We found that in some of the plans we looked at further work was needed to involved the person in the development of the care plan and to be clear about their health needs. For example one person care plan stated they were diabetic, but it did not provide further information on whether this was diet or medication controlled. We found that staff clearly know which it is. We also found that there are no nutritional risk assessments in place for those people who require support in this area, although people are weighed regularly and there are no problems it was unclear what action they would take as recording of meals and what people eat is limited. We looked at Care Homes for Older People Page 12 of 27 Evidence: medication and storage and generally found the practice to be good. We were also concerned about some entries in the daily records which showed that sometimes people were not always supported in the way they needed. One person had their clothes removed by night staff as they kept getting up and getting dressed in the middle of the night. This practice was not respectful of the individuals dignity and highlighted that staff may not have an understanding of this persons need and mental health. One person who uses the service wrote: I am lucky to live here The annual quality assurance assessment says that the care people receive is reviewed every four to six weeks, with their consent and help change their care plan to suit them Care Homes for Older People Page 13 of 27 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. People are able to participate in activities which interest them. People are offered a varied diet. Evidence: One person who uses the service told us in a survey form that: main meals are excellent A member of staff wrote in a survey form that; Garden House offers a very good range of meals and organises plenty of trips for all residents to take part in. All said food was good and whilst no actual choice of meal is available they all can and do request alternatives if they dont like the meal that is being prepared. Those with special diets, e.g. diabetics are not given puddings etc which may not be appropriate for them. We found that food records were very weak with very few notes of the different meals eaten by residents. The annual quality assurance assessment says: we encourage all residents to enjoy life and go out and about if they can, also we have lots of things in house. The AQAA also says that we have an entertainment book which details all who and what participate in They also tell us that when asked what they could do better: nothing we ask them Care Homes for Older People Page 14 of 27 Evidence: (all residents and staff) we have an entertainment co-ordinator and have input from residents, friends and families An environmental health officer has visited the service and is happy with the preparation of food and how it is transported across to Trudys. Care Homes for Older People Page 15 of 27 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. People know who to speak to if they are unhappy, however some inaccurate information could be misleading to people. Evidence: The annual quality assurance assessment tells us: we have full complaints and abuse procedures we have not had one complaint for years and years as we have a very open approach and any resident can and does ask anything Under the heading what could we do better it says nothing keep an open house We looked at compliments people write about the service and note there were no complaints, when we spoke to people they told us who they would talk to if they were worried or unhappy. Staff have completed safeguarding training. Care Homes for Older People Page 16 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an ongoing plan of improvement to the decor and rooms of the home. Evidence: The annual quality assurance assessment tells us they have done the following in the past year: new carpet in one room, new hand towel holders, new television in residents lounge, new bath hoist, new boiler in the annexe, new kitchen doors and 2 new windows. The home is warm and comfortable, the home is of an unusual layout although all the rooms in the main building are on one level except one room which has a number of steps leading down to it, there is a chair hoist in place in this room. The annexe known as Trudys is not linked to the main house. People have comfortable rooms which are personalised. There are six shallow steps which lead to the front door of the home, there is a small ramp at the front door. The manager told us that an occupational therapist had visited in the past and told them the shallow steps were OK. We are concerned that some frailer people who use the service might find the steps difficult, it means the home is not entirely accessible. Care Homes for Older People Page 17 of 27 Evidence: We found there had been a water leak in on of the bathrooms which meant it could not be used we were told that the owner would be repairing and upgrading the bathroom. We were told by the manager that all the hoists in the home were serviced by the owner, we were concerned that there is no evidence of the services having taken place. Care Homes for Older People Page 18 of 27 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment processes are not robust enough to ensure that the people who use the service are protected. Evidence: One person who visits the home in a professional capacity told us in a survey form that: staff respond to service users with patience and understanding and give them time. One person who uses the service told us that: staff are thoughtful and kind Another person wrote: the owner and the staff look after us extremely well A member of staff wrote in a survey form that: Garden House is very homely and friendly and residents are very well cared for Another member of staff wrote: I love working at Garden House, I think the home is a nice place to work The annual quality assurance assessment tells us that: there are eleven staff in total, six have NVQ level 3 and 3 have NVQ at level 2 and two staff are working toward level 2 The AQAA also tells us that they are planning on all staff having level 3 NVQ. Care Homes for Older People Page 19 of 27 Evidence: We looked at several recruitment records for staff and found that there was not enough information available, we found that one person had a testimonial instead of a written references which is not good practice, although the testimonial was addressed to the manager. In one persons file there was no photograph, no evidence of identity, no health declaration, no criminal records bureau disclosure or POVA 1st check. We looked at information on a volunteer working in the home and could only find evidence of a criminal records bureau check being undertaken there was no other information. We found information on one member of staff who left in 2004 and returned in 2008 but no recruitment procedures were followed. The manager has since supplied us with a copy of the Criminal Records Bureau dislcosure which was returned before they started work in the home. We were told that there is dementia awareness training planned in the new year, the manager also told us that nurses come in to give talks to staff about specialist areas of care. Care Homes for Older People Page 20 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management of the home has to be more robust to ensure that people who use the service are protected. Evidence: The annual quality assurance assessment tells us that: they have a happy well staffed and run home, we do not use any agency staff. The manager also says: have a good working relationships with all staff and a caring one with residents The AQAA also tells us that they believe they need to improve the following: care plans, accident forms and MAR charts the manager also acknowledges that they need to: improve on paperwork by giving more time to it We were concerned that the manager has recruited people to work in the home without following correct procedures ( see standard 29 staffing). the manager has Care Homes for Older People Page 21 of 27 Evidence: since supplied us with information not available at the inspection which clarifies and fills some of the gaps we found. The manager has been in post a number of years and has a very hands on approach to care. On both days we visited the manager was cooking the mid day meal. The annual quality assurance assessment did not contain much detail about the service. Fire records - those required to be done by a contractor were all up to date, those done in house were out of date. The person responsible for completing these health and safety checks visited on first day of our inspection and wrote up all weekly checks including those which were out of date and not signed. Care Homes for Older People Page 22 of 27 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 23 of 27 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 1 1 4 The registered provider shall 29/01/2010 compile in relation to the care home a written statement as to the facilities and services which are to be provided by the registered person for services users. It is important that the statement of purpose is clear about how people are supported in the annexe and how accessible the home is to frail people. 2 26 16 The registered person shall having regard to the size of the care home and the number and needs of the service users make suitable arrangements for maintaining satisfactory standards of hygiene in the care home. It is important that current good practice is followed in relation taking soiled 29/01/2010 Care Homes for Older People Page 24 of 27 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 laundry through a food preparation area. 3 29 19 The registered provider shall 29/01/2010 not employ a person to work at the care home unless the person is fit to work at the care home subject to paragraph (6) he has obtained in respect of that person the information and documents specified in paragraphs 1 to 7 of Schedule 2. Proper recruitment procedures must be followed to ensure that vulnerable people who use the service are protected. 4 38 23 The registered person must 29/01/2010 ensure that equipment provided at the care home is maintained and in good working order. It is important for the safety of people living in the home that equipment they use such as bath hoists are serviced by someone qualified to do so. 5 38 23 The registered person must make adequate arrangements for reviewing fire precautions and testing fire equipment at suitable intervals. 29/01/2010 Care Homes for Older People Page 25 of 27 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 To ensure that people are protected fire equipment must be tested at the appropriate intervals not just when someone remembers they should. 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 3 The registered manager should provide more written information in the pre admission assessment in order to clearly evidence that peoples needs can be met by the home. The registered manager should ensure that staff receive training in how to support people with mental health needs in order to ensure their dignity is maintained at all times. The registered manager should ensure that peoples nutrition needs are clearly recorded. The registered manager should ensure that the safeguarding policy accurately reflects the action which needs to be taken if an allegation of abuse is made. This will ensure that continuity for staff who have completed the training. The registered provider should ensure that a routine maintenance and renewal of the fabric and decoration of the premises is produced and implemented with records kept. 2 10 3 4 15 18 5 19 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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