Care Home: Garrett House Residential Home

What the care home does well Garrett House offers a comfortable and attractive environment with spacious rooms and very good décor. The communal rooms are well furnished and give a choice of seating areas so people may choose to sit alone or with others. Residents can receive visitors privately in their own rooms or in one of the home’s communal rooms. The grounds are extensive and have a variety of areas of interest including stocked ponds, a waterfall and statue lined walks. The residents told us they are provided with good information about the home before they move in. They also told us that the level of care the home provides is good, and that this met their particular care needs. All residents said the meals were very good, and there was evidence of a wholesome and varied diet.Garrett House Residential HomeDS0000024394.V377688.R01.S.docVersion 5.2Residents at the home are able to choose a lifestyle that suits them. This included undertaking activities like reading, a walk in the garden, games or simple exercises. Peoples’ complaints would be treated seriously. There are sufficient staff to meet the residents care needs, and staff are appropriately recruited, trained and supervised, to ensure they can meet the needs of the people living at the home. Residents described the home as ‘friendly atmosphere, helpful staff’. ‘The staff are kind and considerate’. ‘The carers have patience and a sense of humour’. A visiting professional told us: ‘Every effort is made to ensure the well-being of the clients is met’. What has improved since the last inspection? The procedure for the administration of medicines has been changed to eliminate the practice of secondary dispensing. This change will prevent errors and ensure the safe delivery of medicines to the residents. The security of the medicines trolley has been tightened up to ensure the safety of residents. Red alert tabards have been introduced to identify when carers are administering medication. These warn staff and others not to interrupt them to prevent errors being made. Care plans now provide good details of residents’ needs and how staff should support them. They are regularly reviewed as are risk assessments such as moving and handling, and nutrition. Staff recruitment records are complete and staff training and supervision have been improved. Together these protect residents from abuse and ensure they are cared for by well-trained and monitored carers. Several environmental improvements have been made, as part of an on-going programme of repairs and refurbishments. What the care home could do better: The AQAA identifies areas that the management intend to work on to improve their service. These include replacing the hot water and main heating system, increasing the variety of entertainment and activities offered to residents, strengthening the understanding of staff about the safeguarding of vulnerable people, and continuing the programme of redecoration and refurbishment. No requirements or recommendations have been made as a result of this inspection. The management have shown that they are pro-active inGarrett House Residential HomeDS0000024394.V377688.R01.S.doc Version 5.2 maintaining and improving the quality of life for their residents. They continue to let the Commission know about things that have happened since our last key inspection and they have shown that they have managed issues well. Key inspection report CARE HOMES FOR OLDER PEOPLE Garrett House Residential Home 43 Park Road Aldeburgh Suffolk IP15 5EN Lead Inspector John Goodship Key Unannounced Inspection 9th September 2009 09:00 DS0000024394.V377688.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.2 Page 2 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 Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Garrett House Residential Home Address 43 Park Road Aldeburgh Suffolk IP15 5EN 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) 01728 453249 01728 454094 garretthouse@btinternet.com Mrs W Stedman Mr B Stedman Mrs W Stedman Care Home 45 Category(ies) of Dementia (6), Old age, not falling within any registration, with number other category (39) of places Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th August 2008 Brief Description of the Service: Garrett House is a large Georgian house, which has been registered with the current providers since 1982. The home is located on a private road within a residential setting in the costal town of Aldeburgh. It is situated in grounds of approximately four acres of landscaped gardens, which incorporate a croquet lawn, tropical themed courtyard, a summerhouse and a fenced pond. The house has views to the river Alde. There is a parking area and the garden has a number of decorative marble statues in place. The main house and extension offer accommodation on two floors. There is a passenger lift serving both sides of the home. Most of the bedrooms are single, seventeen of which provide very spacious accommodation, with two larger bedrooms available should couples wish to share. Within these numbers the home offers four suites incorporating adjoining rooms and exceeding the standards for accommodation. All the bedrooms in the extension have en suite facilities, as do all except one in the main house. The fees for the home range between £352.00 and £700.00 and may vary depending on the accommodation occupied or the level of support required. Fees do not include the cost of private telephone lines, newspapers, toiletries, hairdressing and chiropody. Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. We visited Garrett House for a key unannounced inspection. The visit lasted seven hours. We focussed on the outcomes for the residents, and also checked that the home had taken action on the requirements made at the previous inspection in 2008. The Deputy Manager was present all day and assisted us to meet residents and staff and to access the records we requested to see. We talked in depth to two residents, and chatted to several more in the course of the visit. We also interviewed two members of staff. We toured the home, and examined care plans, staff records, maintenance and safety records. Prior to our visit, we sent out survey forms to a sample of residents, staff, and visiting health professionals. We received back eight forms from residents, five from staff and one from an NHS professional. The manager was also required to complete an AQAA (Annual Quality Assurance Assessment) which gives them the opportunity to describe how the home has improved over the past year, and what plans there are for further improvements. Information from all these sources has been used in the preparation of this report. What the service does well: Garrett House offers a comfortable and attractive environment with spacious rooms and very good décor. The communal rooms are well furnished and give a choice of seating areas so people may choose to sit alone or with others. Residents can receive visitors privately in their own rooms or in one of the home’s communal rooms. The grounds are extensive and have a variety of areas of interest including stocked ponds, a waterfall and statue lined walks. The residents told us they are provided with good information about the home before they move in. They also told us that the level of care the home provides is good, and that this met their particular care needs. All residents said the meals were very good, and there was evidence of a wholesome and varied diet. Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.2 Page 6 Residents at the home are able to choose a lifestyle that suits them. This included undertaking activities like reading, a walk in the garden, games or simple exercises. Peoples’ complaints would be treated seriously. There are sufficient staff to meet the residents care needs, and staff are appropriately recruited, trained and supervised, to ensure they can meet the needs of the people living at the home. Residents described the home as ‘friendly atmosphere, helpful staff’. ‘The staff are kind and considerate’. ‘The carers have patience and a sense of humour’. A visiting professional told us: ‘Every effort is made to ensure the well-being of the clients is met’. What has improved since the last inspection? What they could do better: The AQAA identifies areas that the management intend to work on to improve their service. These include replacing the hot water and main heating system, increasing the variety of entertainment and activities offered to residents, strengthening the understanding of staff about the safeguarding of vulnerable people, and continuing the programme of redecoration and refurbishment. No requirements or recommendations have been made as a result of this inspection. The management have shown that they are pro-active in Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.2 Page 7 maintaining and improving the quality of life for their residents. They continue to let the Commission know about things that have happened since our last key inspection and they have shown that they have managed issues well. 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. Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.3 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 Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5. People using the service experience good quality outcomes in this area. Prospective residents can be assured that they will receive good information about the service, and have their needs assessed prior to entering the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We saw a copy of the home’s statement of purpose. This contained detailed information about the services offered by the home and about the qualifications of the staff. It also included a Price Tariff which set out clearly what fees were charged for different levels of accommodation. Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.3 Page 10 The AQAA told us that prospective residents were encouraged to ‘try us before committing to us’. This could be through a trial period, respite stay or a holiday. The AQAA told us that there had been nine short-term residents over the previous twelve months. All eight residents who replied to our survey told us that they had received enough information about the home before moving in. We looked at the admission documentation for four residents. Each included a pre-admission assessment. The assessment information was in booklet format which helped to keep all the information together. The assessment information included sections around the person’s past medical history, any current medicines, any disabilities, areas of personal care needed, mobility issues including any falls, and any nutritional problems. It was designed to encourage residents and their families to fill in some of the information, for example on a resident’s social background, which included their place of birth, their previous occupations and work locations, their hobbies and interests, and their family history. This gave staff a more holistic picture of that person’s life background. The home does not provide an intermediate care service. The following is a selection of feedback received from residents and relatives about the care provided by the home: ‘Friendly atmosphere and helpful staff’. ‘Carers have patience and a sense of humour’. ‘Provides a happy, non-institutional environment’. A visiting health practitioner said: ‘The service is a well-run friendly one where to my knowledge and experience every effort is made to ensure the well-being of the clients is met’. Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. People using the service experience good quality outcomes in this area. Residents can expect to have their health needs identified, met and reviewed regularly. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We examined four individual care plans covering residents who had a wide range of care needs, and who had lived at the home for varying lengths of time, from three months to eleven years. Each individual care plan checked had a health profile for the resident which looked at oral hygiene, hearing, sight, foot care and weight on admission. A Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.3 Page 12 section was provided for information about the resident’s medical history. Care was linked to fourteen areas of Activities of Daily Living and included sections on orientation, personal hygiene, continence, mobility, eating and drinking, likes and dislikes, communication, spiritual needs and night needs. For a recent admission of a person with dementia, we noted that the care plan had been signed by a relative. There was a record of the dates when this had then been reviewed with the family. The AQAA told us that care plans were regularly reviewed residents, or with the family if the resident agrees. A specified member of staff was responsible for flagging up when each review was due to ensure that reviews took place. All the staff who replied to our survey said that they were given up-to-date information about the needs of residents. Staff told us that this was through shift handovers and the daily diary as well as the care plans. Admission assessments included areas of care where staff needed to provide particular support, such as mobility, nutrition and medication. The plans we saw showed that staff were able to know clearly what support they should provide, and these assessments were regularly updated. One person had been self-medicating until recently when they had agreed that staff should administer their medication. Their file contained the risk assessment for selfmedication, and their consent for the change. No residents were completely self-medicating, only for PRN (as required) medication. We saw that moving and handling assessments had been regularly reviewed. Nutrition assessments were completed where a resident showed weight loss. All residents were weighed regularly. We saw the record for one resident who had been weighed fortnightly due to the concern over their weight loss. A nutritional assessment had been made, asking staff to encourage the person to have ‘high calorie choices’ in their diet. Their weight had now stabilised and their mobility improved so that they were able to walk around the garden on their own. Previous inspections had noted the involvement of the hospital falls prevention team to suggest strategies of care and the use of appropriate equipment where the risk of falls for a resident had been assessed as high. Other records checked showed evidence of good pressure area care, crossinfection control and care of a dying resident. We observed the care of a very poorly resident. The record listed all visits by NHS professionals, the frequency of turning them, food and fluid charts. The home had used the support of Macmillan nurses and the Hospice at Home service to ensure the best palliative and terminal care of residents. Feedback from eight residents said they ‘always or usually’ received the ‘care and support’ they needed, or ‘medical support’ required. The lunchtime medication round was observed and the medication administration records (MAR) sheets were seen and checked. The deputy assistant manager administering the medication was careful to ensure that Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.3 Page 13 each person took their medication before returning to the trolley and signing the MAR sheet. No signature gaps were noted on the MAR sheets. Records also included ‘refusal codes’ being used to identify when a resident refused any medicines. While the manager went to the table where the resident was sitting, another carer stood by the medicine trolley for security. This arrangement had been put into practice following a recommendation from the previous inspection. The two carers wore red tabards with the words ‘Do not disturb’ on them, to ensure that they were not interrupted thus preventing errors. The AQAA told us that the size of the drug trolley had been increased to ensure that the cassette boxes could be stored securely. We saw records showing that all care staff received refresher training in the administration of medication annually. The manager told us that the medication procedure had been changed to eliminate secondary dispensing. This was confirmed by staff. This had been a requirement at the previous inspection to ensure that residents received the medication prescribed for them. Staff were observed to be hardworking throughout the inspection, and were polite and caring towards the residents. Residents’ dignity was maintained during care sessions. We noted how a carer approached and spoke to a resident who was in bed unable to communicate to explain what they were doing and to reassure them. A resident who was in their room told us that all the staff were helpful. One of them was ‘always in a hurry’. The resident used the call bell at night sometimes and said that staff always came quickly. They also told us that staff were ‘meticulous in writing up notes’. Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.3 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. People using the service experience excellent quality outcomes in this area. Residents can expect to be offered a choice of lifestyle opportunities suited to their preferences. They can expect to be offered appetising and well-balanced diets. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The AQAA told us that ‘We provide a wide range of activities on the premises, based on the preferences of our residents. We promote constant contact with family and friends and our residents are welcome to have guests for lunch or supper.’ Further, ‘We have internet facilities including online shopping and email. We invite residents to parties for musical nights and karaoke. We Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.3 Page 15 celebrate St Patrick’s Day, St George’s day, American Independence day (for people with links to USA), Halloween and Christmas’. The deputy manager told us that the computer was being repaired. There was one resident who used it to buy goods. Nearly all residents had phones in their room. The activities records showed that events programmed included films, a theatre company visit, Communion, books on wheels, and exercise classes. Some residents had attended the Aldeburgh Carnival in August. Feedback from several residents confirmed that there were a variety of leisure opportunities they could attend at the home. These included singing groups 2-3 times a year, exercise groups, crosswords, games, and daily newspapers. Five residents told us in the survey that there were always or usually activities arranged by the home that they could take part in if they wished. Two residents said that there should be more organised activities and outings. There were regular films in one of the lounges equipped as a cinema, a church service each month, and a weekly visit from the local vicar (who arrived during our visit). The AQAA told us that the home had broadened its pool of visiting entertainers to provide a more diverse programme for residents. Staff said that when the weather is fine, residents could access the garden, and one resident told us they enjoyed walking in the garden. We saw them doing so during our visit. During the inspection, a carer was seen providing nail care for several residents. During the day we saw a number of families and friends visiting their relatives, and some told us they were able to visit the home whenever they wanted. The visitors were made to feel welcome by the staff, and they could visit with their relatives in one of the lounges or the privacy of their relative’s room. We were able to speak to a visitor who said they were there visiting a relative and were very happy with the standard of care. One resident told us they ‘preferred their own company’, so chose to stay in their own room. They valued the freedom to decide where to spend their time. ‘We can stay in our rooms, sit in the lounge or go out provided they are told.’ They said they could get up in the morning when they wanted, and could take meals in their room. Some of the residents had their own private telephones to keep in touch with their family and friends. One resident regularly went out to lunch. Two other residents were going out to lunch on the day of our visit. A selection of menus was seen and was included in the introductory brochure. This showed us that there was a wide choice of main dishes for each meal for example, toad in the hole, or sea bass, roast supreme of chicken or pan fried salmon, garlic and rosemary roasted leg of lamb, or pan fried cod, pan fried escallop of turkey or lemon crusted rainbow trout, or braised steak and kidney pie or sautéed fillet of sea bass. Lunch on the day of inspection was very well presented, looked and smelt appetising, and residents told us that the meals were very good. Feedback from residents’ surveys when asked ‘do you like the meals at the home’, six out of eight said ‘always or usually’, one said ‘sometimes’ and one did not answer that question. Three residents said that Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.3 Page 16 the organisation of the lunchtime could be improved to ensure the vegetables arrived promptly with the main course. ‘The service is very slow’. We observed the lunch but could not fault the way it was served. Each table was served with its main course and vegetables at the same time. There were sufficient staff on duty to ensure this happened. There were three staff serving twenty-eight residents. All tables were served within a reasonable period of time. Breakfasts were served in residents’ rooms, morning coffee and tea was served as well as afternoon tea and homemade cakes. Supper on the day of our visit could be chosen from broth, chicken salad, and quiche. The AQAA told us that following informal meetings and chats with residents, the home had been asked for more simple fare on occasions. New dishes such as bangers and mash had therefore been added to the menu range. Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. People using the service experience good quality outcomes in this area. Residents can expect to have their concerns taken seriously and be protected from abuse. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home had a complaints procedure that was available to the residents with the statement of purpose, or in the home’s brochure, ‘A guide to making a complaint’. The home had a four-step complaint process, which included talking with a staff member about the problem or making a formal complaint. The complaints log was seen and showed that the home has not had a recent complaint. The AQAA told us that ‘we have received no formal complaints in the last twelve months and our residents’ questionnaires show an overall high level of satisfaction with the home’. Four residents in the survey were aware of how to complain, and that they ‘always or usually’ knew who to speak to, if they were not happy. Three residents said they did not know how to make a Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.3 Page 18 formal complaint although these all said there was someone they could speak to informally if they were not happy. The home showed us their safeguarding policy, which contained information on protection of vulnerable adults policy (POVA) that covered the key areas for recognising abuse and the different types of abuse. The home had informed the Commission earlier in the year that it had referred one of the residents to the Safeguarding team, as they were concerned about their welfare and financial circumstances. Matters were resolved after a police and social service investigation, which showed that the home had properly safeguarded the resident. The manager told us that social services were considering whether this person lacked the capacity to make decisions about their affairs and whether an independent mental capacity assessor should be appointed. The senior management team had attended training around the Mental Capacity Act, and the Deprivation of Liberty Safegurads. Staff records checked included criminal record bureau (CRB) and protection of vulnerable adult (POVA First) checks and reference checking to ensure that staff were suitably checked and cleared to work with vulnerable adults. Discussion with the management and staff records checked confirmed that adult safeguarding training was provided for staff, either directly in the home or through the NVQ course. Thirteen of seventeen staff members had achieved their NVQ level 2, which does cover safeguarding training. This would ensure that these staff members would know what to do in the event of any allegations of abuse being made. The staff we spoke to confirmed that they had received training in this area. Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,25,26. People using the service experience excellent quality outcomes in this area. Residents can expect to live in a comfortable, hygienic and well-maintained home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Garrett House is a large Georgian house, set in around four acres of wellmaintained landscaped gardens, which incorporate a croquet lawn, tropical themed courtyard, a summerhouse and a fenced pond. The house has views Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.3 Page 20 to the river Alde. There is a parking area and the garden has a number of decorative marble statues in place. The main house and extension offer accommodation on two floors. There is a passenger lift serving both sides of the home. Most of the bedrooms are single, seventeen of which provide very spacious accommodation, with two larger bedrooms available should couples wish to share. Within these numbers the home offers four suites incorporating adjoining rooms and exceeding the national minimum standards for accommodation. All the bedrooms in the extension have en suite facilities, as do all except one in the main house. We noted that the internal décor was of good quality with soft furnishings and furniture in keeping with the style of the home. The rooms were spacious and the views from the windows were attractive. On the day of inspection the home was clean and well maintained, with no unpleasant odours detected. Two residents had told us in their surveys that their rooms could be cleaned better, although the other six said the home was always clean and tidy. The rooms we saw were clean and odour free. The AQAA told us that housekeeping staff duty times had been increased to maintain the home’s standards. There were large attractive informal seating areas evident throughout the home with small tables and fresh flowers and plants displayed. During a tour of the home a number of individual rooms were checked and some residents told us they had brought some of their own personal items of furniture and belongings. The hallways, corridors and the communal rooms were all clean and tidy. Anti-bacterial hand gel dispensers were sited throughout the home as a back-up to hand washing for the staff. Liquid soap and paper hand towels were noted at various places throughout the home for staff use. On the week of our visit, the engineers were on site replacing one of the three boilers, for greater energy efficiency and lower maintenance. This was part of a programme to replace all the heating and hot water plant. The AQAA told us that five rooms had been redecorated and three had been recarpeted. One of the lounges was due to be recarpeted. Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. People using the service experience good quality outcomes in this area. Residents can expect to be supported by adequate numbers of correctly recruited and very well-trained staff. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The duty rotas were checked and these showed that there was a senior carer on duty at all times. They were supported during the day by two or three junior staff and at night by one carer. In addition there was a chef daily between 8.00 and 16.00, a domestic morning and afternoon, an administrator and a maintenance person. A further member of staff was rostered during the evening to help with supper delivery and assist with evening baths. The management team was supernumerary but readily available at all times. The home employed seventeen care staff. Thirteen staff held a National Vocational Qualification (NVQ) at level 2 or above with two working towards Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.3 Page 22 the qualification, so around 75 of staff had achieved this award. Three senior staff members were starting their NVQ 4 in Health and Social Care. All five staff who returned our surveys said that they were updated with training which was ‘relevant to their role’. The staff training records showed that staff had attended courses within the last year about dementia awareness and Parkinson’s disease, moving and handling, first aid, infection control, fire safety, medication administration, and the Mental Capacity Act. The deputy assistant manager who administered the lunchtime medicines confirmed that they had received training in medication administration. We checked three staff recruitment records which showed that the home had undertaken Criminal Records Bureau (CRB) and protection of vulnerable adult (POVA First) checks, and 2 reference checks for each employee. Records also contained a photograph of the person, and an application form including a previous work history. All new staff followed an induction programme that covered personnel, staffing and human resource issues as well as training relevant to the job they were to perform. These areas include the ageing process, fire awareness, health and safety, communication, infection control, moving and handling, food hygiene and control of substances hazardous to health (COSHH) regulations. Staff surveys confirmed that induction training covered everything they needed to know to do their job, and that training undertaken was ‘relevant to their role’. Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38. People using the service experience good quality outcomes in this area. They can expect that the home will be effectively and efficiently run in their best interests. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Mr. and Mrs. Stedman have owned Garrett House for ‘over twenty-six years’ according to their brochure. Mrs. Stedman is the registered manager. The Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.3 Page 24 deputy manager and the property and services manager are family members. All the management team have relevant professional qualifications. Residents and staff spoken with said the management team were approachable. ‘The manager is interested in the staff and residents. She listens if we have a problem.’ There are two assistant deputy managers who have a specialist area of responsibility, one for continence promotion, the other for medication. The deputy manager had completed the NVQ 4 Registered Manager Award during the year and two other senior staff members had completed NVQ Level 3 in management. The registered manager lived on the premises and provided round the clock supervision, especially at evenings and weekends. The deputy manager and property services manager lived close by. This ensured staff always had immediate access to a senior member of the management team. The home had a quality assurance process in place and surveys had been given to residents and relatives during the summer. All the replies expressed satisfaction with the home and their care. Some asked for ‘more entertainment’. Room maintenance surveys were also conducted to identify where improvement action needed to be taken. There were maintenance slips placed in each room for residents and staff to use if anything needed attention. The AQAA provided by the home said, ‘We maintain records with regards to residents personal monies held. We have an efficient administrator and bookkeeper’. The home had a system for managing residents’ personal monies and records and receipts were maintained. We confirmed the process with the administrator. The home maintained maintenance and service records, and the fire records were checked. The home had undertaken a fire risk assessment in accordance with the local fire service requirements. Fire training was provided for new staff members. The AQAA showed that the home continued to maintain equipment including hoists, fire detection equipment, call bells, the heating system, soiled waste and gas appliances. The home confirmed they have a written assessment around the control of substances hazardous to health. The home had been inspected by an environmental health officer and a health and safety officer from the local authority in July. The home was given the highest rating for safety risk, health risk and confidence in management. The AQAA confirmed that the home has a range of policies and procedures for staff, which includes health and safety, and financial procedures, which are regularly reviewed. Staff records show that they have received health and safety training including moving and handling, fire procedures, infection control and food hygiene training. This was confirmed by feedback received from staff. The tour of the premises showed that the building was very well maintained. The home maintained fire check records and undertook checks of hot water temperature checks to ensure that these remained safe for the residents. Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.3 Page 25 Feedback from staff surveys said that they were ‘regularly’ supported by their manager who would meet with them to discuss how they were working. Staff told us that they received regular supervision sessions and annual appraisals. Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.3 Page 26 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 3 X X 3 3 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 3 3 X 3 3 3 3 Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.3 Page 27 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. Refer to Standard Good Practice Recommendations Garrett House Residential Home DS0000024394.V377688.R01.S.doc Version 5.3 Page 28 Care Quality Commission East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. 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