Care Home: Gernon Manor

What the care home does well Gernon Manor provides a comfortable, homely, and relaxed environment for residents. People living at the home and their advocates made some positive comments about the home and staff; `the staff are kind`, `the staff do their best for us`, `as you walk into the home it has a nice open friendly atmosphere`, `excellent food`, `the home is well maintained`. Care planning documentation is well organised and up to date. Communal areas of the home are comfortable and provide a range of areas for people to use. The home was well maintained and clean throughout. Staff spoken to were enthusiastic about the quality of training offered, but concerned about the impact of staffing difficulties on their ability to provide a high quality of care at all times. There is a robust system for recruiting and training new staff and appropriate checks are carried out. There is a formal corporate complaints procedure and a clear safeguarding adults procedure and most staff have received appropriate training. What has improved since the last inspection? The home have worked hard to improve the physical environment for the safety and comfort of people living at the home. Work has been done on the roof and skylights. New furniture has been purchased and bedrooms and communal areas been decorated. Some wardrobes have been updated and are now more convenient to use. Some toilet seats have been raised. Care planning documentation has been updated and now includes a range of risk assessments and `last wishes` plans. There are signatures on personal service plans indicating that care plans have been discussed with people living at the home. Levels of dependency of people living at the home are now being formally monitored. What the care home could do better: The home have been experiencing continuing staffing and recruitment difficulties. This has had an impact on the provision of people` care and on the availability of activities and one to one time. The number of catering and domestic hours provided is currently less that identified in the home`s Statement of Purpose. This impacts on care staff responsibilities, and care hours provided are also less that identified in the Statement of Purpose. A great deal of management time is spent ensuring the staff rota is covered. Because of these problems the home does not have full occupancy. Staffing levels need to improve to both ensure that people currently living in the home and those wishing to move to the home receive a high standard of care. Respite staff need to be recruited to ensure there is coverage for when staff go on holiday or are sick. Systems for communicating with people living at the home need to improve. Residents meetings have not taken place for some time. There has been a substantial delay in `feeding back` the results of the quality assurance surveys which has still not happened on a formal basis.People`s lives would be enhanced by a consistent programme of activities that are carried out regularly, and by staff being able to spend some one to one time with people living at the home. People`s comfort and convenience would be enhanced by the programme of refurbishing wardrobes and raising of toilet seats being completed. CARE HOMES FOR OLDER PEOPLE Gernon Manor Dagnall Gardens Haddon Road Bakewell Derbyshrie DE45 1EN Lead Inspector Denise Bate Unannounced Inspection 28th April 2008 09:15 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 Gernon Manor DS0000035737.V363404.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. Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gernon Manor Address Dagnall Gardens Haddon Road Bakewell Derbyshrie DE45 1EN 01629 778411 01629 778419 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) www.derbyshire.gov.uk Derbyshire County Council June Richardson Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th July 2007 Brief Description of the Service: Gernon Manor was built in 1980 and is a care home with 33 places, registered to accommodate older people. This Derbyshire County Council home provides permanent care, short-term care and day care. It is situated close to the centre of Bakewell and accommodation is provided on one level with 33 single occupancy bedrooms. All bedrooms are equipped with washbasin, built in wardrobe, TV point and a link to the call system. There are several lounge and dining areas. The home is set around a pleasant enclosed garden area, which is easily accessible. Services include personal laundry, meals, and personal care designed to meet individual needs. A range of leisure and social events are organised. Fees are £392.18 per week for permanent residents, but a range of prices for short term care residents. Additional charges, e.g. hairdressing, chiropody, are clearly identified in the home’s Statement of Purpose and Service User Guide. Copies of inspection reports are available in the foyer. Gernon Manor DS0000035737.V363404.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 the service is two star. This means the people who use this service experience good quality outcomes. The inspection was unannounced and took place over seven hours. During the inspection eight people living at the home, one visitor and two staff members were spoken with. Prior to the inspection we looked at previous inspection reports and a self assessment questionnaire (AQAA) completed by the manager of the home. Pre inspection questionnaires had been completed by people who live at the home, their relatives and staff. Information provided by the questionnaires has been included in this inspection report. The manager and a deputy manager were present during the inspection and provided assistance and information. A telephone call was made to the home after the inspection to clarify various issues and obtain further information. A number of records were examined, including care planning documentation, minutes of staff meetings, minutes of residents meetings, regulation 26 visit records, medication records, staff records and action plans. Three residents were case tracked. Case tracking involves identifying people who currently stay at the home and tracking the experience of the care and support they have received. The inspector also checked that information provided by the manager matched individual experiences of the people living at the home by talking with them and observing the care received. A tour of part of the building took place. Derbyshire County Council has a quality assurance system and annual surveys of people living at the home and their relatives are carried out each year. A copy of the findings were given to us and are referred to in this report. ‘Your Views’ is dated March 2008, although we were told the surveys were actually undertaken in September 2007. What the service does well: Gernon Manor provides a comfortable, homely, and relaxed environment for residents. People living at the home and their advocates made some positive comments about the home and staff; ‘the staff are kind’, ‘the staff do their best for us’, ‘as you walk into the home it has a nice open friendly atmosphere’, ‘excellent food’, ‘the home is well maintained’. Care planning documentation is well organised and up to date. Communal areas of the home are comfortable and provide a range of areas for people to use. The home was well maintained and clean throughout. Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 Page 6 Staff spoken to were enthusiastic about the quality of training offered, but concerned about the impact of staffing difficulties on their ability to provide a high quality of care at all times. There is a robust system for recruiting and training new staff and appropriate checks are carried out. There is a formal corporate complaints procedure and a clear safeguarding adults procedure and most staff have received appropriate training. What has improved since the last inspection? What they could do better: The home have been experiencing continuing staffing and recruitment difficulties. This has had an impact on the provision of people’ care and on the availability of activities and one to one time. The number of catering and domestic hours provided is currently less that identified in the home’s Statement of Purpose. This impacts on care staff responsibilities, and care hours provided are also less that identified in the Statement of Purpose. A great deal of management time is spent ensuring the staff rota is covered. Because of these problems the home does not have full occupancy. Staffing levels need to improve to both ensure that people currently living in the home and those wishing to move to the home receive a high standard of care. Respite staff need to be recruited to ensure there is coverage for when staff go on holiday or are sick. Systems for communicating with people living at the home need to improve. Residents meetings have not taken place for some time. There has been a substantial delay in ‘feeding back’ the results of the quality assurance surveys which has still not happened on a formal basis. Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 Page 7 People’s lives would be enhanced by a consistent programme of activities that are carried out regularly, and by staff being able to spend some one to one time with people living at the home. People’s comfort and convenience would be enhanced by the programme of refurbishing wardrobes and raising of toilet seats being completed. 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. Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is generally available to ensure people can make an informed choice about where they live, but more information about fees levels is needed to comply with current guidance. EVIDENCE: The AQAA states that everyone receives an in depth assessment by a care manager, including all areas of a person’s care, religious, and cultural needs, social interest, etc. If someone is unable to visit the service, families are invited to view the home and talk to staff. The visit identifies if the home can meet the person’s needs and a decision is made following discussion with the management and care staff. We found that there were copies of assessments Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 Page 10 on the care planning documentation of people case tracked and this included a report of pre admission visits. The AQAA states that people can take away copies of the service users guide and reference guide to read and the manager said that copies are also available in each lounge. We found that the service user guide/statement of purpose gives information about extras that have to be paid for, but does not include information about current fee levels or explain the process of financial assessment which is done on an individual basis by care managers. Our pre inspection surveys found that some people were not sure whether they had a contract. This may be because financial arrangements are not dealt with by staff at the home but by individual care managers and the Central Assessments Team. We did not find copies of peoples contracts on their care planning documentation but there were copies of letters relating to current financial assessment on people’s files. Everyone felt they had enough information before coming to the home. However, information collected by the home’s own quality assurance found that over 20 of users rates as only fair or poor the following; alternatives offered, help to decide and information provided. Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are completed in detail and are individualised to demonstrate that people’s health, personal and social care needs are planned for. The current staffing difficulties mean occasionally people have to wait to receive the care they need. EVIDENCE: The AQAA states that everyone has personal service plans which reflect their preferred way of care. Key workers have a responsibility for promoting residents rights and choices, ensuring their clothes are kept clean, their daily aids are available such as zimmer frames, hearing aids, etc are in working order. The key worker also supports people to maintain regular contact with their families. Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 Page 12 We case tracked three people living at the home. Their care planning documentation was well arranged and up to date with regular reviews. Personal service plans were completed in sufficient detail to provide staff with accurate information about how people should be cared for. Information included social interests and health details. People had signed their personal service plans indicating that their care plans had been discussed with them. Risk assessments were up to date. Logs were kept so that day to day events were recorded. Key workers had filled in monthly summary reports, and bi monthly contact with family reports. Last wishes plans were seen. The AQAA states that people are well supported by the Mental Health Team and the CPN (Community Psychiatric Nurse) gives advice on age related mental problems, e.g. depression, dementia. People are also referred to other health professionals as appropriate, e.g. Dales Assessment and Rehabilitation Team (DART). A doctor and district nurse were visiting on the day of inspection. The surveys and people spoken to indicated that people get see health professionals when needed. Our staff survey indicated that information was usually passed on from one staff shift to those coming on duty. Staff were observed treating people with dignity and respect as they assisted people with the tasks of day to day living. The relationships between staff and people living at the home were observed to be friendly and helpful. Eight people living at the home and one relative were spoken with. People said individual staff ‘are marvellous’, very helpful’ and ‘do the best they can’ with the staffing. One person said they sometimes have to wait for attention. Staff indicate they are concerned that sometimes they are very busy and this may impact on their ability to give people the care they need in a timely manner, e.g. giving people choice around bath times, one to one time. The home is coping with staffing difficulties by not running the home to full occupancy i.e. on the day of inspection the home had 24 people registered as living there and the home are registered to take up to 33 people. The manager said they are generally managing to meet the needs of people currently living at the home with the current staffing levels. The manager is monitoring peoples’ dependency levels and documentation was seen to confirm this. On the day of inspection some people were in hospital. There are a couple of people who have been identified as needing a different type of care and they will be having assessments while they are in hospital. The AQAA states that the home has robust procedures in relation to medication. We saw records for people case tracked and medication was administered and stored in a satisfactory manner. The controlled drug book was looked at and one person’s medication checked and found to be satisfactory. Information related to medication was on people’s care planning documentation. There was information about medication and their side effects Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 Page 13 and copies of recent guidance available. The manager said all senior staff had received medication training. Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not consistently provide suitable activities and people do not therefore consistently benefit from living in a stimulating environment. The quality of catering is good which contributes to a pleasant atmosphere and the overall levels of satisfaction for people. EVIDENCE: At the last inspection the provision of social activities and daily life was judged to be adequate. At that time it was a major concern identified by the home’s internal quality assurance system as needing improvement. The AQAA states they have improved activities by introducing a range of entertainers into the home which include pianist, performing arts, old fashioned sing along, and memory box. They say they have commenced chair based exercise. A member of staff has been training in activities under the life long training program run by First Taste. We found that some improvements did occur but this was not Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 Page 15 maintained because of the staffing problems referred to elsewhere in this report. People said they didn’t do a lot and that staff often didn’t have time to talk. People said they had enjoyed outings that took place last year and they were looking forward to being able to go out again when the weather improved. Staff say activities have sometimes not been taking place recently because of staff vacancies and sickness. The AQAA states that they encourage people to take an active part in the home relating to decisions that affect them. We found that in there was a delay in reporting the results of the internal quality assurance surveys and there had been no residents meeting since before Christmas. Family and friends can visit any time and several people said they had had visitors recently and they had been made welcome. The sun lounge can be used by people when they have visitors. Community links are encouraged. The quality of the food was praised by everyone spoken to; ‘the food is very good’, ‘I enjoy my food’. There is a varied menu and special diets are catered for. Meals are well presented and the dining areas are pleasant and comfortable. The manager hopes to replace dining chairs in due course to make these easier for people to use. Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. Clear and accessible complaints and safeguarding adults procedures are in place to ensure people can be confident that any serious issues raised would be acted on effectively and promptly. EVIDENCE: The AQAA states that the home uses the complaints procedure which sets out guidance and set timescales to achieve when dealing with a complaint. They say that usually at the end of a person’s review they discuss the complaints procedure informing people and their families on how they can make a complaint if the need occurs. They also have ‘How to make a complaint’ booklets available in the foyer. Two complaints had been dealt with in line with these procedures, one of which had been made to CSCI. People spoken to said they had ‘no complaints’ but would talk to the manager or a member of staff if they were not happy; ‘I would soon shout’. A relative said that if there were any problems these would be raised with managers. Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 Page 17 However, elsewhere in this report there are comments about the poor feed back of quality assurance information and lack of people’s involvement in residents meetings. While there are aspects of the care provided that people may not happy about, e.g. the standard and consistency of activities, people do not see that as an issue serious enough to ‘complain about’. People also made it very clear that they knew staff were doing their best under difficult circumstances. The AQAA states that adult protection issues are acted on and investigated. Some staff have received training in safeguarding adults since the last inspection, and this topic is covered in initial training for new staff. Response to our staff surveys indicates that staff are aware of safeguarding adults issues, understood their responsibilities, and would take appropriate action if a safeguarding issue arose. Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 Page 18 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, 24, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides people with an attractive and homely place to live. EVIDENCE: The AQAA states that they have a business plan which identified areas for development and improvement over the next 5 years. We found that since the last inspection improvements have been carried out. This has included maintenance work on the flat roof, decoration and new furnishings for the lounge and bedrooms, (people are involved with the choice of the decoration), improving ventilation on the corridors, a number of toilets have been replaced, Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 Page 19 and some wardrobes have been refurbished (they are now easier for people to use and look fresh and attractive). The AQAA states that they assess people for equipment to enable them to maintain their independence and ensure a safe environment. We found that people used a range of mobility aids, including lifts for the bath. One bathroom would benefit from refurbishment which would make it pleasanter for people to use and this is included in the 5 year plan. Fire and COSSH risk assessments have been updated. The AQAA states that they plan to involve landscape gardeners to tidy the garden area, train staff in infection control, replace all wardrobe doors in peoples’ bedrooms and replace the old sluice fitting in both sluice rooms. All areas of the home seen were clean, fresh and attractive. Surveys indicated that people were very satisfied with the environment and the standards of cleanliness. There was one comment about the height of the toilets seats needing to be raised. Some toilet seats have been raised and others will be replaced in due course. Some care staff are having to take more responsibility for ensuring the home is kept clean and tidy because there are vacancies for domestic hours. Care staff are responsible for people’s personal laundry. On the day of inspection everyone was appropriately dressed and their clothing was clean and fresh. People said they liked the environment and liked their bedrooms; ‘my bedroom is very comfortable’, ‘I like my new wardrobe’. People can usually bring personal possessions into the home, and bedrooms seen had been personalised. One person said that they were disappointed not to be able to bring in some of their furniture. This was because of fire safety standards, which are explained in the service user guide. Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. A trained and competent workforce are in place which usually meet the dependency needs of people currently accommodated within the home. EVIDENCE: At the last inspection this standard was judged adequate. There were specific staffing problems with long and short term sickness and with recruitment of staff. The manager said they are still having difficulties recruiting staff for care, domestic and catering jobs in spite of being proactive about recruitment. Staff sickness is an intermittent problem but is having an impact on rotas at the moment. There are insufficient relief staff to cover at short notice. Current staff do their best to cover the shortfall; ‘We encourage staff to be more flexible with their shifts, so we can meet the needs of the service’. Managers spend a great deal of time ‘juggling’ staff rotas try to ensure sufficient staff are on duty. This means they have less time for other management responsibilities. Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 Page 21 Some members of staff have left in the last year so although there have been new recruits it has not eased the overall situation. The manager has come up with various suggestions, including a guaranteed minimum number of relief hours. The manager said that private agencies were approached to provide staff, but that they were unable to because they did not have staff in the area. The home may plan a ‘job fair’ to try and encourage local people to apply for posts. The manager says she is managing the situation by reducing occupancy, i.e. there were 24 residents instead of 33. However, some of the staff vacancies are in catering and domestic staff. These functions are not necessarily reduced by the reduction in occupancy and there is a knock on effect on care staff who have to ensure that catering and domestic standards are kept up. The difficulties are affecting staff morale and this was clearly reflected in the response to our surveys from people living at the home, their advocates, and staff. People spoken to said the staff were good and that individuals treated them with dignity and respect, but there were not enough staff on duty and they didn’t have time to talk. The surveys of people living in the home indicated that people felt they usually got the support they needed but also included the following comments; ‘staffing problems usually determine whether I get the support I need’, ‘sometimes there are staff shortages resulting in staff not being available for such help as taking people to the toilet’. One relative was spoken with. They commented ‘my relative is happy here and the service is good but staff should have more one to one time with residents’. Two members of staff spoken with were competent and enthusiastic, but felt that more staff were needed for them to provide continuous high standards of care. At present more work needs to be done to encourage team work and ensure that staff get day to day support. There is a key worker system and regular written reports were seen on peoples’ care planning documentation. However, people spoken with said they did not get much one to one time with their key worker. Staffing hours were discussed in detail with the manager. The home is providing significantly fewer hours than detailed in the statement of purpose. The manager is monitoring staff hours against occupancy, and also monitors people’s dependency levels. At present there are only two members of staff on some shifts which means that if they are helping someone who needs two staff to transfer safely, there is only the manager on duty to deal with the needs of the other 23 people. The outcomes of the situation is that some people are not getting bathed at the time they would prefer, activities are not provided on a consistent basis, Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 Page 22 some mandatory training may be at risk if staff cannot be released to go on training courses, and staff morale suffers. Some information was provided on current Care Staffing Guidelines as there should be sufficient staff on duty at all times to meet people’s assessed needs. Staff spoken with described training as ‘brilliant’. The AQAA states that staff now have a positive approach to training with two care staff due to complete NVQ2 in May. Two deputy managers have achieved NVQ4 in Care and cooks are due to complete their NVQ2 in cooking. There is good ‘Skills for Care’ induction training when staff commence employment. New staff receive an induction pack on the departments policies and procedures including whistle blowing and a copy of the GSCC code (General Social Care Council). They say they have an ongoing training programme and all staff receive up to date training e.g. Food Hygiene, First Aid, Safeguarding Adults. The manager has encouraged staff to take training, and the proportion or staff undertaking formal training has improved. A formal training plan will be drawn up in the near future. Sometimes staff cannot be released for training because the staff rotas need to be covered. The manager is aware of the Mental Incapacity Act and anticipates that training will be available in the near future. Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is suitably qualified and experienced and staff demonstrate an awareness of their roles and responsibilities, which contributes to peoples’ wellbeing. The system of quality assurance is not working well and does not demonstrate the home is generally run in peoples’ best interests. EVIDENCE: The manager is experienced and qualified to run the home. The AQAA was well presented and informative. It provided a clear vision of the direction in which Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 Page 24 the home should be working. They say they aim as a management team to work to improve standards in the home and create an open approach. Deputy managers are accountable for their own areas of work, e.g. hotel management, care planning, customer service, health and safety as well as the day to day running of the home. These responsibilities have recently been reviewed. They are planning to look at strategies to help the management team develop. However, we were informed that two deputy managers have recently been successful in applying for other posts and will be leaving soon. Their posts will be advertised soon. The AQAA states that they have a system in place for people, families and staff members to provide feedback on the service they provide through their quality assurance programme, and suggestion and complaints procedures. They say that, on the whole, they receive positive feedback from people and their families on the standard of care and organisation of the home. We found that although the quality assurance exercise had taken place in September 2007, no formal feedback had been prepared for people until March 2008 and has still not been made available to people living at the home. There has been no opportunity for the home to draw up an action plan. This results in people not having their views listened to and acted upon in a timely manner. Visits take place by the representative of the service provider (Regulation 26 visits). Minutes were seen. Visits take place but not always on a monthly basis. The representative sees staff and people living at the home. Staff have clearly expressed their concerns but the Regulation minutes do record what action is planned to address these issues. As at the inspection last year, some matters people raised with the inspector have not been recorded as being discussed with with the providers representative. The AQAA states they have strong financial guidelines to follow and they promote people controlling their own finances with a system to protect them if they are unable to do so. The manager says she supervises new staff for the first few months. Routine supervision may be difficult to achieve consistently because of the pressures already outlined elsewhere. However, she says staff have been having regular supervision and arrangements for group supervision may be put in place as an interim measure when deputy managers leave. Staff meetings are held and minutes were seen. The AQAA gave detailed information on health and safety and maintenance of equipment and the building. This indicated that maintenance was up to date and that staff are aware of health and safety issues. COSHH assessments and fire safety have been reviewed in the last year. Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 Page 25 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 2 X 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 1 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? yes 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 30/09/08 2. OP27 18 (1) (a) There must be sufficient staff on at all times to meet residents assessed needs. This requirement had a timescale of 30/09/07 which has not been met, although it is acknowledged that action is being taken to remedy this situation. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP27 OP7 OP12 Good Practice Recommendations More relief staff should be recruited to ensure staffing levels remain appropriate to meet people’s needs. Personal service plans should be improved further by cross referencing them with risk assessments and other detailed information. The activities, entertainment and outings programme should be developed further to meet residents needs for DS0000035737.V363404.R01.S.doc Version 5.2 Page 27 Gernon Manor 4. 5. OP22 OP24 6. 7. 8. 9. OP27 OP30 OP30 OP35 social and recreational activity. All toilet seats should be raised to a more convenient height for peoples’ comfort and safety. The planned improvements should be made to the wardrobes in all bedrooms to ensure they are easily accessible for people to encourage choice and maintaining independence. Arrangements should be made to speed up the recruitment and selection process to ensure vacancies are filled promptly. A training plan should be drawn up to identify any training requirements for current staff. Training in the Mental Incapacity Act should be arranged to that staff are aware of their responsibilities under the Act. The quality assurance system should be reviewed to ensure that suggestions are acted upon and feedback given to people in a timely manner that encourages and values their contribution. Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Gernon Manor DS0000035737.V363404.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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