Care Home: Garland House

What the care home does well Residents continue to be very happy at Garland House and feel glad and lucky to live there. The residents speak very highly of the staff and feel well cared for. Residents said they feel listened to and that within reason changes are made to suit them and if they ask for something every effort is made to provide it. The home benefits from the sound, proactive and capable leadership from the manager, which results in an open and positive atmosphere for residents and staff. Residents benefit from a thorough admission process, which not only ensures their needs can be met but makes the transition of moving into a care home as pleasant as possible. Residents said that any comments or suggestion they make about the home are acted upon. Residents benefit from the good quality of the food, which includes plenty of fresh fruit and vegetables, regular menu changes and good choice. The physical environment is pleasant, light, airy, and decorated to a good standard. The home enjoys good relationships with the local GP, and other health care professionals and with relatives and advocates of the residents What has improved since the last inspection? The service users guide has been updated and this along with the brochure is given to every prospective resident, helping them make an informed choice to move into the home. The home now has a comprehensive and clear medication policy. The changes made to the 1st floor bathroom enable residents to access the toilet when the bathroom is in use. All the residents are enjoying the newly refurbished bathrooms. The home has produced a newsletter with a diary of events for residents, relatives and staff. The staff have produced a comprehensive infection control policy, which covers how staff are to manage the lack of sluicing facility on the washing machines, this better protects residents from potential infection control hazards. Staff have received the training updates, which were due, and additional training is planned in a variety of subjects, ensuring residents are cared for by staff that have the skills and knowledge to care for them. What the care home could do better: The new care-planning format does not provide enough detail of how the residents` needs are to be met. The new risk assessments do not contain a detailed, clear falls risk assessment. Work should continue to cover the radiators to ensure residents` safety. CARE HOMES FOR OLDER PEOPLE Garland House 2 Garlinge Road Southborough Tunbridge Wells Kent TN4 0NR Lead Inspector Justine Williams Key Unannounced Inspection 24th October 2007 10:00 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 Garland House DS0000068655.V352154.R01.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. Garland House DS0000068655.V352154.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Garland House Address 2 Garlinge Road Southborough Tunbridge Wells Kent TN4 0NR 01892 532707 F/P 01892 532707 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) Davis Care Limited Mrs Tracey Ann Allcorn Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Garland House DS0000068655.V352154.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st February 2007 Brief Description of the Service: Garland House is registered to provide personal care and accommodation for 20 older people. The home is owned by Davis Care, and is currently the only care home owned by the company. The responsible individual, who is also the owner of the home, visits frequently. Garland House is located in a residential area of Southborough, close to a variety of local shops and public transport. The main town of Tunbridge Wells is approximately 4 miles away and offers the usual town amenities. The home was first registered on 16th February 1984. It consists of an attractive property and gardens with car parking facilities to the side of the building. Accommodation is over three floors, with access to all floors by a shaft lift. Disabled access is to the rear of the building. Garland House has nineteen single rooms, four of which have en-suite facilities. There are telephone points and staff call points in every bedroom. The home is run by the registered manager and deputy manager, in the manager’s absence. The home employs care staff working a roster, which gives 24-hour cover. The home also employs other staff for catering and domestic duties. The current fees are £350.00 to £450.00 per week; this information was given to the inspector at the time of the inspection. Garland House DS0000068655.V352154.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was carried out on 24th October 2007 between 10.00 am and 1.00 pm by regulatory inspector Justine Williams. During that time residents, staff and the manager agreed to speak with the inspector both in public and privately. This report contains assessments made from observations, conversations and records, case tracking and a tour of the premises. Feedback was given during and at the end of the inspection. As part of the inspection process surveys were sent to service users, GP’s, health care professionals, care managers and relatives of residents. Some specific comments made included: “I think garland House is excellent in every way, the staff are caring and there is always a lovely atmosphere” “The staff treat the residents with respect. The home is immaculate, the food is good” “My relative is now very frail, but has had the most wonderful care at Garland House” What the service does well: Residents continue to be very happy at Garland House and feel glad and lucky to live there. The residents speak very highly of the staff and feel well cared for. Residents said they feel listened to and that within reason changes are made to suit them and if they ask for something every effort is made to provide it. The home benefits from the sound, proactive and capable leadership from the manager, which results in an open and positive atmosphere for residents and staff. Residents benefit from a thorough admission process, which not only ensures their needs can be met but makes the transition of moving into a care home as pleasant as possible. Residents said that any comments or suggestion they make about the home are acted upon. Residents benefit from the good quality of the food, which includes plenty of fresh fruit and vegetables, regular menu changes and good choice. The physical environment is pleasant, light, airy, and decorated to a good standard. The home enjoys good relationships with the local GP, and other health care professionals and with relatives and advocates of the residents Garland House DS0000068655.V352154.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. Garland House DS0000068655.V352154.R01.S.doc Version 5.2 Page 7 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 Garland House DS0000068655.V352154.R01.S.doc Version 5.2 Page 8 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): 3,6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents benefit from thorough admission procedures and move to the home assured their needs can be met EVIDENCE: Residents who have moved in to the home recently said they found the experience of moving to the home positive. They had been offered visits to the home to see what it was like but for various reasons were unable to. Their relatives had been made very welcome on their behalf and both residents spoken with had been given the homes service user guide and brochure, which they found helpful in making the decision to move in. All residents have their needs fully assessed by the manager or deputy manager and residents felt confident the home would meet their expectations, Garland House DS0000068655.V352154.R01.S.doc Version 5.2 Page 9 though for the new residents some aspects of the home such as the friendly staff, and quality of the meals had surpassed their expectations. The assessment documentation has been made more detailed since the last inspection. Garland House does not offer intermediate care. Garland House DS0000068655.V352154.R01.S.doc Version 5.2 Page 10 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): 7,8,9,10,11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are well managed, however this is not supported fully by the recent changes in care planning documentation. Residents’ privacy and dignity is respected. Residents and their families can be assured that the home makes every effort to continue to care for dying resident if it is their wish to remain at the Garland House EVIDENCE: The home has changed the care-planning format recently and as such the newest residents do not have an adequate care plan. The new care plans fail to detail actions required by staff to meet the individual resident’s needs, and are in fact another form of assessment. However when staff were spoken with it was clear that they have a very detailed understanding of the needs of all their Garland House DS0000068655.V352154.R01.S.doc Version 5.2 Page 11 residents. The manager agreed to rewrite the care plans for the 2 residents without one, that day. Residents have signed their care plans and regular timely reviews are taking place. The risk assessment format has also been changed and now does not comprehensively include a falls risk assessment; again this alteration is for new residents only. Visits to and from healthcare professionals are recorded in the daily events and highlighted in order to make tracking the visits easier. Residents said they have regular access to their GP’s and can see their GP whenever they wish, visits for hospital appointments etc are facilitated by the home. The residents benefit from the homes close working relationships with the district nursing service, and other healthcare professionals. The district nurses assess a resident’s risk of developing pressure sores and appropriate equipment is either purchased by the home or loaned from the community central store. Continence advice is sought when needed from the relevant healthcare professionals. Whist residents are assessed on admission for risk regarding their nutritional status the home does not use a screening tool, and is looking into the various tools available at present. The manager and staff demonstrated very good awareness and knowledge about complaints and illnesses their residents have and residents said they felt well cared for. The home’s practices around storage, administration, record keeping and training in medication continue to be robust and in line with good practice. The home now has a medication policy, which reflects its own practices and includes homely remedies, although these are seldom used. Risk assessment for residents self-medicating were detailed and comprehensive. Residents said the staff are friendly and kind and “do anything for you”, staff were observed during the site visit interacting with residents in a warm and caring manner and were observed knocking on doors and waiting for permission to enter from residents. One of the residents had died the previous day at the home. The resident’s wish was to stay at the home and the manager and staff were able to facilitate this. The home worked closely with hospice staff and the GP and district nurses and were able to meet the residents needs. Staff said they received plenty of support and guidance from the manager and deputy. Garland House DS0000068655.V352154.R01.S.doc Version 5.2 Page 12 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): 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents lead a life which as closely as possible matches their preferences, beliefs and social aspirations. EVIDENCE: The home now has one member of staff running activities 2 afternoons per week, as well as other care staff running activities throughout the week. A physiotherapist runs the weekly music and movement class. In addition to the in house activities the home are regularly visited by a variety of groups including guide dogs for the blind, a reflexologist visiting monthly, entertainers, and visits from the local clergy. The home borrows a minibus from Age Concern regularly and the proprietor holds the necessary licence and insurance. Regular trips are arranged and residents are looking forward to Christmas lunch at a local restaurant. One staff member was supported by the home to train in hand massage and residents can now enjoy regular hand Garland House DS0000068655.V352154.R01.S.doc Version 5.2 Page 13 massages. Last summer residents enjoyed the sunflower competition, and several residents grew tomatoes with some success. Surveys received from relatives and residents of Garland House indicated that activities have improved a lot recently and that the variety and frequency of activities suits the residents. Residents’ relatives are made welcome at the home and are always offered a drink and sometimes stay for a meal. Residents said they felt in control of their own lives and made their own decisions. Residents spoke very highly of the quality of the meals provided at Garland House, the menus are changed seasonally and there is always a choice. Residents are offered 3 meals a day and regular snacks throughout the day. Fresh fruit is available in the lounges every day and fresh flowers are purchased regularly. Residents’ feedback about meals is sought through the residents meetings and regular surveys. Hot and cold drinks are offered at regular intervals and special diets including soft and diabetic diets are being catered for. Residents said the cook continues to bake delicious cakes and very good homemade food. Garland House DS0000068655.V352154.R01.S.doc Version 5.2 Page 14 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): 16,18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents have access to people who listen to any concerns and who will take action to ensure they are protected from abuse. EVIDENCE: The home has a clear policy for dealing with complaints and this is clearly displayed in several areas. The home has had no complaints since the last inspection, but minor issues are recorded in the comments book and the home’s actions taken to address these issues are clearly recorded. Residents said they felt listened to and that their opinion mattered to the home, they felt comfortable complaining to the manager or any staff member and were confident any issues would be dealt with. The manager signs off all complaints and comments and information from them feeds into the quality assurance system. The home has a comprehensive, and regularly updated adult protection policy, all staff receive regular training and training at induction in adult protection. Staff spoken with had a good understanding of what actions they should take and what constitutes abuse. Garland House DS0000068655.V352154.R01.S.doc Version 5.2 Page 15 Garland House DS0000068655.V352154.R01.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): 19,21,22,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have a homely, well-maintained and comfortable environment in which to live. EVIDENCE: The home is not purpose built but has been adapted to make it suitable for its use, including a shaft lift to all floors, call system and assisted bathrooms. There is a programme of routine maintenance in place to maintain the good standards of décor and furnishings at the home. The grounds were tidy and attractive, and access for residents is from the lower ground floor. The garden is to the side of the house adjoining the parking area and improvements planned for the near future are to fit a low fence between the parking and Garland House DS0000068655.V352154.R01.S.doc Version 5.2 Page 17 garden area. Improvements to the garden are also planned for spring, the manager plans to clear the large raised bed and ask residents to choose and help plant and maintain the bed. The home has recently had a fire inspection and the recommendations made have been actioned. At the last inspection residents commented that when the home’s main bathroom on the 1st floor is in use they do not have use of the toilet. These rooms have now been separated and refurbished providing a light airy clean looking bathroom with an assisted bath. The bathroom downstairs has also been refurbished and is much improved. There are some radiators outstanding to be covered or replaced with low surface temperature radiators, though the manager has risk assessed them and those outstanding are deemed low risk. The home has grab rails, and other aids and adaptations throughout the home and has sought advice from the Kent Association for the Blind and other organisations regarding special adaptations. The premises were clean and hygienic and pleasant smelling. The laundry is a good size and is located in the basement, the washing machines do not have a sluicing facility for the safe laundering of foul or infected laundry, but the manager understands that the owner will replace these in due course. The home’s new infection control policy is comprehensive and includes how the home deals with the lack of sluicing cycle for foul laundry. Garland House DS0000068655.V352154.R01.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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are cared for and supported by properly recruited and trained staff. EVIDENCE: The home employs staff in sufficient numbers to enable residents to be assisted with washing and dressing and other personal care at a time they prefer, to be able to spend time chatting with residents, and to run various activities. The rota indicates what staff are on duty and in what capacity. 4 care staff were on duty as well as the manager, cook and kitchen assistant, cleaner and maintenance person on the morning of the site visit. The home now has around 75 of staff with NVQ’s some at level 3; the home does not use any agency staff. No new staff have been recruited since the last inspection and at the last inspection the recruitment policy and practises were robust. The recruitment files for staff contained all the necessary information including 3 references, evidence of POVA and CRB checks, proof of identification etc. The manager keeps a training matrix to record training and track when training updates are due. All staff have recently received training in first aid, fire safety, protection of vulnerable adults, medication training and moving and Garland House DS0000068655.V352154.R01.S.doc Version 5.2 Page 19 handling training updates is planned for January 2008. Some staff have recently attended hearing aid maintenance training and senior staff have attended supervision and appraisal training. Garland House DS0000068655.V352154.R01.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): 31,33,35,37 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe and well-managed home. EVIDENCE: The manager has worked at the home for almost 9 years and as manager for approximately 1 year, prior to this she was in charge of the home day to day but not as registered manager. The manager has an HND in managing care and a BSc (hons) degree in health; she is also an NVQ assessor. The manager undertakes training updates to ensure her skills remain up to date. Garland House DS0000068655.V352154.R01.S.doc Version 5.2 Page 21 The manager has commenced an effective quality assurance system, which includes regular surveys to residents, relatives GP’s and other healthcare professionals, regular meetings for residents and staff, audits of documentation, many areas of which are collated to construct an informative report. The manager tracks accidents and incidents to look for patterns and acts on the results of her findings. Including collated information from surveys and meetings would inform the report further. Residents are asked to complete a survey approximately 2 weeks after they move in to the home, this survey asks the resident about their first impressions of the home and staff find this information useful in making the moving in process easier for residents. The home does not manage or look after resident’s monies and residents are encouraged to look after their financial affairs for as long as they are able. Residents are provided with lockable space so they can keep their valuables safe. The manager ensures safe working practices and environment through the home’s policies, and regular supervision, the training programme. The health and safety of residents, staff and visitors to the home is ensured through regular servicing and checks of equipment and systems. The manager is fully aware of her responsibilities to comply with relevant legislation, and carries out risk assessments for safe working regularly. Garland House DS0000068655.V352154.R01.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 X X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 3 X 3 3 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 Garland House DS0000068655.V352154.R01.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. 1 Standard OP7 Regulation 15 (1) Requirement The registered person shall after consultation with the service user or a representative of his prepare a written service users plan as to how the service users needs are to be metIn that the new care plan format must include the details of the actions to be taken by staff to meet the needs of residents. Timescale for action 10/11/07 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 Refer to Standard OP7 Good Practice Recommendations It is recommended that falls risk assessments be reviewed, and expanded upon, and that the manager look into training staff to use a nutrition risk assessment tool. As planned, radiators and pipe work should have safe surface temperatures or covers. 2 OP25 Garland House DS0000068655.V352154.R01.S.doc Version 5.2 Page 24 Garland House DS0000068655.V352154.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Garland House DS0000068655.V352154.R01.S.doc Version 5.2 Page 26 - 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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