Care Home: Georgian House Nursing Home

What the care home does well The home has maintained a qualified and experienced staff group; this has benefited people by providing continuity of care. On observation people appeared well cared for and comfortable in their environment. They reported being happy with the standard of care provided at the home, as did the relative spoken with.There are good management systems in place for complaints/concerns and health and safety. The home offers good staff training in working safely and professionally in a care setting. A thorough review has taken place for quality assurance; this is contained in the Annual Quality Assurance Assessment provided to the Commission for Social Care Inspection. This identifies how the home is meeting the standards required, and plans for future improvements. The home was found to be clean, hygienic and well maintained throughout. The environment was safe, calm and homely. What has improved since the last inspection? CARE HOMES FOR OLDER PEOPLE Georgian House Nursing Home 20 Lyncroft Gardens Ealing London W13 9PU Lead Inspector Susan Woolnough-Singh Key Unannounced Inspection 4th September 2008 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 Georgian House Nursing Home DS0000010947.V372082.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. Georgian House Nursing Home DS0000010947.V372082.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Georgian House Nursing Home Address 20 Lyncroft Gardens Ealing London W13 9PU 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) 020 8567 6232 020 8567 1955 andrea.gh@btinternet.com Mr and Mrs Hopley Mrs Margaret Hopley Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26), Physical disability over 65 years of age of places (26) Georgian House Nursing Home DS0000010947.V372082.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP 2. Physical disability, over 65 years of age - Code PD(E) The maximum number of service users who can be accommodated is: 26 7th September 2006 Date of last inspection Brief Description of the Service: Georgian House Nursing home is registered with the CSCI as a care home with nursing for 26 older people, four of whom may receive palliative care. The building comprises two semi-detached houses combined into one detached property, with parking at the front and a large landscaped garden and patio to the rear. There are fourteen single and six double bedrooms. Communal facilities include a large lounge and a separate dining room. The property is on a quiet residential street, not very far from central Ealing. The weekly fee’s range for £600 - £850. Georgian House Nursing Home DS0000010947.V372082.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 three star. This means that people who use this service experience excellent quality outcomes. This unannounced inspection was carried out on the 4th and 5th September 2008; the field visit took approximately eight hours. We met with the daughter in law of the Registered Proprietor and Manager who will be apply to the Commission for Social Care Inspection for registration as the Manager of the home in due course. All of the Key National Minimum Standards for Older People were assessed during this Inspection. The Inspector met and spoke privately with four people who use the service, including one relative who spoke on behalf of a resident. We looked at care files of the four people spoken with to examine care plans and health records. We looked at the recruitment and training records of two members of staff. A tour of the building took place and we looked at records relating to health and safety. Two lunchtime meals were sampled. At the last unannounced Key inspection on 7th September 2006 three requirements were made. Action had been taken to address the shortfalls identified. An Annual Service Review took place on 6th February 2008. This is a paper review of the service carried out by the Commission for Social Care Inspection. Comments cards/surveys were sent out to people who use the service for the purpose of this review. We did not ascertain the views of people in this manner for this key unannounced inspection. What the service does well: The home has maintained a qualified and experienced staff group; this has benefited people by providing continuity of care. On observation people appeared well cared for and comfortable in their environment. They reported being happy with the standard of care provided at the home, as did the relative spoken with. Georgian House Nursing Home DS0000010947.V372082.R01.S.doc Version 5.2 Page 6 There are good management systems in place for complaints/concerns and health and safety. The home offers good staff training in working safely and professionally in a care setting. A thorough review has taken place for quality assurance; this is contained in the Annual Quality Assurance Assessment provided to the Commission for Social Care Inspection. This identifies how the home is meeting the standards required, and plans for future improvements. The home was found to be clean, hygienic and well maintained throughout. The environment was safe, calm and homely. 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. Georgian House Nursing Home DS0000010947.V372082.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 Georgian House Nursing Home DS0000010947.V372082.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 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People move into Georgian House once their care needs have been assessed. The Manager of the home ensures that all the required paperwork is in place for each new person. EVIDENCE: At the time of the inspection twenty-five people were living at the home. The Annual Quality Assurance Assessment states prospective residents have their care needs assessed either in their own home or whilst in hospital. We looked at the care records of three people who live at Georgian House. Pre –admission assessments had been completed for prospective residents. A preadmission checklist has been developed. This ensures that all of the necessary Georgian House Nursing Home DS0000010947.V372082.R01.S.doc Version 5.2 Page 9 paperwork has been completed and an inventory of the person’s possessions has been made. The home does not cater for people who require intermediate care. Georgian House Nursing Home DS0000010947.V372082.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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Records seen indicate that people have their daily health and personnel care needs met; people spoken with confirmed this, as did relatives spoken with. There are policies and procedures in place for the safe administration of medication. The new system and packaging for the administration of medication is an improvement, and will reduce the risk of potential errors. EVIDENCE: A care plan is provided for each person who lives at Georgian House. This is drawn up from the assessment of need. Georgian House Nursing Home DS0000010947.V372082.R01.S.doc Version 5.2 Page 11 We looked the care plan for three people and also spoke with them during the course of the inspection. The care plan covers social and health care needs including information on people’s likes and dislikes. The care plan contains health assessments for skin care (tissue viability for pressure areas) moving and transferring and nutritional screening. A Mental Capacity Assessment Review had been carried out. For one person, additional information and confirmation was available on the care plan and assessment, as this person had made a choice not to take advice in relation to one aspect of health care. The care plan and risk assessment viewed had been reviewed recently. People are able to remain registered with their own General Practitioner if this is agreed. We looked at the system for the administration of medication. A new system has been introduced for the provision of medicines in the home. Medicines are now dispensed from blister packs at the allotted time of day. There are still some separate prescriptions in liquid and ointment form, we saw that these were dated on opening. One person was on medication classed as a controlled drug, there was reference and guidance with regard to this on the care plan. The new medication administration records were viewed; these had only recently been started due to the new system. Refused medication is dealt with appropriately and stored in a separate container. The Registered Nurse on Duty is responsible for the administration of medication. We spoke with people who use the service and a relative who felt confident in the care provided, one person was able confirm that he/she receives personal care from two set carers of a preferred gender. Georgian House Nursing Home DS0000010947.V372082.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are satisfied with the care offered in the home and spoke in a positive manner about the staff. The care provided is suited to individual needs. Activities are arranged, people have a choice whether or not to participate. EVIDENCE: We met with four people who use the service, for one a relative spoke on their behalf. People confirmed that activities are available if they wish to attend, two people spoken with said that they had their own preferences in this regard. People said that they had their health care needs catered for; one person said that the nurses attended to her and another that chiropody and optical services were available. The relative spoken with said that the chiropodist visits every three months and he/she was pleased with the service offered by the General Practitioner. People commented that staff catered for their needs Georgian House Nursing Home DS0000010947.V372082.R01.S.doc Version 5.2 Page 13 in a way, which suited them. One person sad that the staff are good and work very hard; the relative spoken with was positive about the standard of care offered and considered staff to be friendly and caring. Two people were able to comment on the quality of the meals in the home one said that the cook had been on holiday and there had not been a choice but cooked breakfasts had been introduced. One person noted that there had been an improvement in the food and his/her views are sought on this matter. People are encouraged to make decisions about their daily routines. Choices are made in selecting a meal, activity preferences, and personal care routines. One the second day of the inspection we met briefly with the exercise activity leaders who visit the home weekly to offer gentle exercise to aid and encourage mobility. A varied menu is available and people are able to select from this. Meals are served in a separate dining room some people prefer to eat in their bedroom. We sampled the main meal at lunchtime on both days of the inspection; we judged the food to be tasty and freshly cooked. The meals served were home cooked and served with a variety of vegetables. Georgian House Nursing Home DS0000010947.V372082.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): 18 and 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Clear and informative policies and procedures are available for the protection of vulnerable adults and complaints. Complaints are addressed in a satisfactory manner. There are policies and procedures and staff training in place to protect the welfare of people who use the service. EVIDENCE: The Complaint Procedure and Safeguarding Adults Policy/Procedure is displayed in a prominent position in the foyer of the home. People spoken with were asked about their knowledge of the complaints procedure. Two people spoken said they would talk with the Manager and one person said that they would approach the Nurse in Charge if they had a concern. We looked at the complaint record. One complaint had been made with regard provision. We were able to see from the record that the complaint had been addressed in a satisfactory manner and a quality monitoring audit had been put in place to review the situation periodically. Georgian House Nursing Home DS0000010947.V372082.R01.S.doc Version 5.2 Page 15 All staff are trained in the Protection of vulnerable adults. New staff receives induction training, which includes guidance on recognising and responding to signs of abuse. No referrals had been made with regard to safeguarding vulnerable adults. We received additional information on complaints and safeguarding vulnerable adults procedure after the inspection field visit. This information comprised of evidence of correspondence sent out to Social Services and the Primary Care Trust with regard to the complaints procedure; information on the prevention of abuse and guidance on restraint. Georgian House Nursing Home DS0000010947.V372082.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, 20, 23 24,25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A well-maintained, comfortable and attractive environment is offered to people who use the service. Standards of cleanliness are high. EVIDENCE: A tour of the building took place with the Manager. We were able to see that the home is furnished and maintained to a very high standard. There is a light and spacious lounge and separate dining room. The lounge is used during the day for activities; there is a large screen television. The seating in the lounge has been rearranged since the last inspection. People who use the service requested this. Prior to this seating was positioned in clusters; seating is now in a circle around the room to enable all to see the Georgian House Nursing Home DS0000010947.V372082.R01.S.doc Version 5.2 Page 17 television. There is a large, well-maintained and accessible garden area to the rear of the home. Improvements to the home are in progress. A new laundry is being built; this will be placed in the back garden. The laundry room space will be used to install a new passenger lift. Information in the Annual Quality Assurance Assessment states that carpet, décor, beds and mobility equipment has been purchased since the last inspection. A grant was received to make these improvements. We were able to see the bedrooms of the four people we spoke with. The bedrooms were all pleasantly furnished and comfortable. Personal possessions and ornaments had been brought in; the bedrooms are personalised and homely. Some bedrooms have more light and a better view than others, this will depend on their location in the home. All of the bedrooms have a hand washbasin thirteen bedrooms have en-suite. Communal bathrooms are available on both floors. We observed the home to be kept to a high level cleanliness. The home provides infection control training for staff. Georgian House Nursing Home DS0000010947.V372082.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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An appropriate number of experienced staff is on duty to meet the needs of people who live at the home. Care Staff are offered the opportunity to undertake NVQ training in care to further their competence and understanding in this field. A range of training is available for the development of staff. Satisfactory recruitment practices are in place. EVIDENCE: Registered Nurses and care assistants form part of the staff team. In the morning two registered nurses and four care staff are on duty. During times of peak activity between 7am and 8am there are two registered nurses on duty with five carers. The afternoon evening shift consists of one registered nurse and four carers. Waking night staff consist of a registered nurse, a carer and one sleep in member of staff. The home employs sixteen full time and five part time nursing staff. Georgian House Nursing Home DS0000010947.V372082.R01.S.doc Version 5.2 Page 19 We looked at the recruitment files of two members of staff one of whom was new. We were able to see that all of the necessary recruitment documentation was in place. The documentation seen for the new member of staff included an application form, references, national insurance and identity verification and criminal records bureau check. A recruitment checklist is completed during the selection process. Both files had a record of induction training, supervision appraisal and training certificates. New staff receives an induction into the home, this is a practical induction as well as a core induction course comprising of the common induction standards. Training in working safely in is provided to staff. The two files we examined contained evidence of protection of vulnerable adults training, fire training, moving and handling, health and safety and basic first aid. Training on Dementia Care is also available for staff. Training is provided at the home by external trainers who are generally employed to train the staff team together as a group. Six staff has achieved NVQ Level 2 and seven staff are working towards NVQ Level 2. Georgian House Nursing Home DS0000010947.V372082.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Georgian House is being managed and administered competently for the benefit of people living in the home. The home is not involved in the management or administration of people’s finances. The monitoring of one to one supervision would ensure that all staff has this frequently. There are systems in place for managing and monitoring health and safety in the home to ensure the welfare of people living and working at Georgian house. Georgian House Nursing Home DS0000010947.V372082.R01.S.doc Version 5.2 Page 21 EVIDENCE: The Proprietor of Georgian House is also the Registered Manager of the home. At the time of the inspection we met with the proprietors daughter in law who hopes to take over the day-to-day management of the home once she has completed the Registered Managers Award. Quality Assurance systems are in place to ensure care is reviewed and people are consulted. Surveys had been sent out to people who live in the home, relatives and visitors. We were able to look at these and see that people had been asked for their opinion with regard to services in the home. The Annual Quality Assurance Assessment had been completed and gave precise details on how each standard is being met. The Proprietor/Manager within each section of the standards had identified future improvements. We discussed with the Manager the administration of people’s finances. Family members who have Power of Attorney carry this out usually. The home does not hold or manage money for people. Staff receive appraisal and one to one supervision. We looked at the supervision records of two members of staff; the supervision record for one was dated in December 2007. It was clarified after the inspection field visit that this member of staff had received regular supervision, and we had not viewed the up to date record on the day of the inspection. We looked at a sample of health and safety records. A fire risk assessment for the home had been completed and reviewed in July 2007. A fire training demonstration for staff had taken place on 12th February 2008. There was a record of fire drills, fire safety equipment tests and service records. The Manager on a monthly basis carries out a Health and Safety Audit/observation. Information and dates for health and safety policies and procedures and equipment and utility servicing was provided in the Annual Quality Assurance Assessment. Georgian House Nursing Home DS0000010947.V372082.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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 3 3 X X X 3 X X 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 3 x 3 Georgian House Nursing Home DS0000010947.V372082.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. 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 Georgian House Nursing Home DS0000010947.V372082.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Georgian House Nursing Home DS0000010947.V372082.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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