Care Home: Gifford House Care Home

What the care home does well The Gifford House staff recruitment process is thorough; this means that people living there are protected by the safe recruitment of professional and friendly staff. Relatives told us they were generally happy with the service and care provided, they particularly expressed they could approach the manager at any time with any concerns they may have and be confident they would be dealt with appropriately. The staff team demonstrated good knowledge of how each person preferred to be cared for and supported. Residents told us they enjoyed the food at Gifford House and it was clear that peoples` choices were catered for. Residents said: "It`s a very nice home" and "We`re well fed and watered!" and "The staff are lovely and they all know our names". Visitors told us: "Very happy with the care my relative receives thank you!" and "we have no issues with the care at the home, 10 out of 10!" and "Can`t fault the place, thanks to their hard work our relative has really picked up since they have been living here" and "Staff never seem to stop working". Peoples` personal monies maintained by the management for safe keeping are safely stored and well documented. What has improved since the last inspection? People living at Gifford House can be confident that the medication storage and administration are organised and safe. Care planning and risk assessments have had considerable development by the management team involving an external consultant. The outcome for the people living at the home has improved in this area. The management team has undergone some change and is now settling down with good effect. What the care home could do better: The staff team at the home would promote peoples` dignity better by not using institutional terminology such as referring to people needing assistance to eat as `feeders` and those people able to mobilise independently as `walkers`. Peoples` social history and interests they enjoyed prior to moving into the home were documented however this information needs to form the basis of peoples` activity plans. This is so that people can be stimulated and fulfilled. There was some redecoration of communal areas underway at the time of this visit. Discussion took place with the registered provider about creating a more enabling environment for those people living with dementia or with visual impairments.Consideration needs to be given to the management of odour on one unit at the home and keeping the lounge furniture free from staining. Staff generally worked 12 hour shifts with some people working 5 of these long days in a row. This needs to be reviewed as it means that staff may not always be fit to care for residents, especially on the dementia units, when working these long shifts. Key inspection report Care homes for older people Name: Address: Gifford House Care Home London Road Bowers Gifford Basildon Essex SS13 2DT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Greaves     Date: 1 4 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Gifford House Care Home London Road Bowers Gifford Basildon Essex SS13 2DT 01268554330 01268498070 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): AMS Care Limited Name of registered manager (if applicable) Alan James Young Type of registration: Number of places registered: care home 61 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Number of places not to exceed 61 in total. One named person known to the Commission, aged under 65 years. Date of last inspection Brief description of the care home Gifford House Care Home is a purpose-built, elegant two-storey building situated in a rural location but within easy access of Saddlers Farm roundabout, and all major local routes including the M25, A127 and A13. Parking is available on site. There is a large enclosed garden area, which is accessible and includes seating a patio area as well as walks. The home provides care with nursing and accommodation for up to 61 older people, Care Homes for Older People Page 4 of 34 1 0 Over 65 39 61 Brief description of the care home including up to 39 people who have dementia. All bedrooms are single and ensuite and sited on both floors. There are also a number of lounges and lounge/ dining rooms, a smoking room and a quiet room/visitors room, as well as several areas around the home where additional seating is available. A passenger lift provides access to all levels within the home. The home has six assisted bathrooms and three shower rooms, and well equipped laundry and kitchen facilities. The homes weekly fees currently range from £555 to £740. Additional charges to residents are for hairdressing and chiropody. There are no charges to residents for staff escorts to hospital appointments etc. Residents make individual arrangements with the local newsagent in relation to newspapers and magazines, provide their own personal toiletries and would also pay the going rate for taxis to appointments. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: A tour of the premises was undertaken, care records, staff records, medication records and other documents were assessed. Time was spent talking to, observing and interacting with people living at the home, visitors and staff. Prior to the site visit the manager had completed and sent us the homes Annual Quality Assurance Assessment (AQAA). This is a self assessment document required by law and tells us how the service feels they are meeting the needs of the people living at the home and how they can evidence this. Views expressed by visitors to the home during the site visit have been incorporated into this report. Care Homes for Older People Page 6 of 34 Feedback on findings was provided to the manager throughout the day and the opportunity for discussion and clarification was given during a summary at the conclusion of the visit. We would like to thank the residents, the manager, the registered provider, the staff team and visitors for the help and co-operation throughout this inspection process. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The staff team at the home would promote peoples dignity better by not using institutional terminology such as referring to people needing assistance to eat as feeders and those people able to mobilise independently as walkers. Peoples social history and interests they enjoyed prior to moving into the home were documented however this information needs to form the basis of peoples activity plans. This is so that people can be stimulated and fulfilled. There was some redecoration of communal areas underway at the time of this visit. Discussion took place with the registered provider about creating a more enabling environment for those people living with dementia or with visual impairments. Care Homes for Older People Page 8 of 34 Consideration needs to be given to the management of odour on one unit at the home and keeping the lounge furniture free from staining. Staff generally worked 12 hour shifts with some people working 5 of these long days in a row. This needs to be reviewed as it means that staff may not always be fit to care for residents, especially on the dementia units, when working these long shifts. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use this service are provided with information they need to help them choose if this service will meet their needs. Evidence: Copies of the Statement of Purpose and Service Users Guide were provided at the inspection. These contained detailed information about the services provided at the home, the facilities available and also included the complaints procedure. As part of the inspection process the records and care pathways of five people living in the home were tracked to ascertain how well the home is meeting their individual needs. Four records contained pre-admission assessments detailing the residents care needs. One person had been admitted from a geographical location some considerable distance from the home. In this instance the records stated that the resident had been admitted on the basis of information provided from the family and a full assessment of needs provided by the persons social worker. The records stated that an assessment Care Homes for Older People Page 11 of 34 Evidence: of the persons needs would be undertaken 24 hours following admission and this would be reviewed within seven days from admission. This indicated that the home aimed to ensure that the residents needs could be met before confirming arrangements. The records also contained a letter to the relatives confirming these arrangements, the room to be occupied and the cost of fees. Assessments we looked at were comprehensive and included all areas of need, for example, personal care, physical well being, diet and weight, communication ability, sight and hearing, skin integrity, foot care, mobility and dexterity, continence, medication usage, mental state and cognition etc. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive health and personal care, based on their individual needs, and can be reasonably assured that at the time of their death and dying they will be supported by a staff team who have the skills to ensure their comfort and dignity. Evidence: We looked, in detail, at care plans for one person living on the Radcliffe Unit, two people on Betts Unit and one person on Lynford Unit. All files viewed contained very detailed care plans that provided good instruction to staff on meeting the residents needs. For example, one care plan advised staff in meeting the needs of a resident with a hearing impairment to talk to X in X room where there are less distractions and noise and speak clearly, face to face with an elevated tone but not to shout. Repeat questions again and acknowledge that x understands, what has been said. Evidence of the residents or representatives agreement was seen in each of the care plans viewed. Nutritional risk assessments were undertaken on admission and reviewed with weight monitoring also regularly undertaken (weekly, monthly) as indicated by need with supplements provided for those at risk (confirmed from Care Homes for Older People Page 13 of 34 Evidence: observation and the records viewed). Risk assessments were seen for risks associated with manual handling, use of bed rails, tissue viability and nutritional risk. All had been regularly reviewed ensuring that residents changing needs were assessed and that staff had information to be able to meet them. It was positive to see that residents pain was assessed and action taken to ensure they had medication to provide relief. Daily records provided good detail of how the resident spent their day and recorded any changes in their condition or mood and the action that had been taken as a result. Residents comments seen in the records made on review of care were positive, for example well done and thank you. Residents access to healthcare services was discussed with the manager and registered nurses and confirmed from the records viewed. Residents were all registered with a local GP who visited the home on request. One residents care records viewed confirmed they had received visits from their GP, Parkinsons Nurse, Macmillan Nurse, physiotherapist (4 visits over a two month period), optician and chiropodist. A resident spoken with confirmed they had received visits from a dentist and attended outpatient appointments with staff accompanying them. The home had policies and procedures for managing end of life care. The records confirmed that the home was supported by the Primary Care Trust (PCT) End of Life Care Facilitator who provided training for nurses and care staff in meeting palliative care needs. Assessments included instruction for arrangements after death and were signed by the resident or their representative, showing that they had been consulted and were in agreement. The medication systems were discussed with the registered nurse from Betts Unit. Medication was provided from Boots pharmacy in monitored dosage systems and in individual containers and was administered by the registered nurse in charge of each unit. Each nurse had responsibility for the ordering, administration and disposal of medicines for their designated unit. The nurse in charge of Betts Unit confirmed that they had undertaken in-house training and distance learning programme of medicines administration training in the previous year, also confirmed from the records. The home had a medication policy and procedures for staff guidance which included protocols for PRN (as required) medication. A list of staff signatures and initials was maintained to enable appropriate follow up in the event of an adverse incident. Medication was stored on each unit of the home. The medication for Betts Unit was inspected. Appropriate procedures were in place for the receipt and disposal of medication that were seen to be well adhered to. Medication was stored in a locked clinical room in a locked trolley that was secured to the wall and in locked cupboards and a controlled drugs cupboard. A drug refrigerator was also available for medicines Care Homes for Older People Page 14 of 34 Evidence: requiring cold storage. An air controlled unit was fitted to the room to stabilise the temperature. Room temperatures were monitored and recorded to ensure medicines were stored within safe recommended levels (maximum 25 degrees centigrade). Refrigerator temperatures were also monitored and recorded and were noted to remain within safe limits. The medication storage and medicines administration records for four residents were examined. All medication sampled was available as prescribed and records were recorded accurately and in full. There was a cupboard for Controlled Drugs (CD) Storage that met requirements and a CD register that was recorded accurately and in full with entries of the name and address made on receipt of CD drugs and on discharge/disposal as the regulations require. PRN creams were observed in individual residents bathrooms. These were labelled with the name of the resident and instruction for their application/administration were recorded in their care plan.The nurse undertook regular audits of medicines (confirmed from the records) to ensure procedures were adhered to and people received their medication as prescribed. During our initial tour of the home with the manager we saw there were net pants that are used to keep incontinence pads in place. These were not named to show they belonged to an individual. Discussion was held with the providers and the manager around this practice. No parties were certain if there was a communal stock of these items and undertook to look into this matter. Upstairs on Lynford unit we noted that some peoples personal care records had been left unattended on the nurses station. This meant that anyone could access these records thus undermining peoples dignity and privacy. This was the only example of this witnessed during the visit and we concluded that the nurse had been called away in an emergency and this was not common practice. During the tour of the building we heard some members of the staff team refer to people who needed support to eat their meals as feeders and people not able to mobilise themselves as the walkers. This practice does not serve to promote peoples dignity and self worth. We spoke with a healthcare professional involved with the service subsequent to the visit. They had positive things to say about the care and support people living at Gifford House received including: They seem very capable, They seem to have settled the families very well, it is a stressful time when people move from hospital to a nursing home for end of life care, they have done a great job re-assuring relatives, I have given advice, they have rolled it out, gone with it and are using the tools effectively, They have been pro-active and open to advice, they are forward thinking Care Homes for Older People Page 15 of 34 Evidence: and the home has a nice aura about it and The carers are always very welcoming, Im very impressed with the home. We spoke with some of the people living at the home, they told us: they look after us well and a resident who had decided to stay in their room for lunch confirmed that it was their choice to eat in their room and said they had their personal care needs attended to daily. This comprised a full wash as they preferred. There was a flow of visitors at the home during this visit. Comments received included: Very happy with the care my relative receives thank you!, we have no issues with the care at the home, 10 out of 10!, Cant fault the place, thanks to their hard work our relative has really picked up since they have been living here and Very happy with the care. There is good communication and good continuity of staff. I trust (staff members name). They always let me know if there is anything untoward. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality of life experienced by people using this service could be further promoted through staff training in delivering person centered activities, which will ensure their day is meaningful and their well being is enhanced. Evidence: The home employed one full time activities co-ordinator 5 days per week 10am to 4pm and one part time person for the same hours 3 days per week. The manager reported there was a vacancy for another full time person. On our tour of the home we saw one activities co-ordinator make and distribute the morning tea and coffee on Radcliffe unit. We asked if this was their normal role. The manager told us that this particular unit did not participate well with activities so taking a cup of tea to a person and having individual one to one chat and interaction with people was one way to engage them during activities of daily living. Whilst spending some time talking with staff on Radcliffe unit we observed an activity co-ordinator batting a balloon back and forth to residents. They appeared totally disinterested and as though they were hitting the balloon back to avoid it hitting their faces. Care Homes for Older People Page 17 of 34 Evidence: We were provided with a copy of the activity planner for June. This showed that people were offered stimulation such as Movement to Music, Ball games, Magnetic darts, Balloon Volley Ball, Sing a long, Jig saw puzzles, Pets as therapy visits, Church group, Hoopla and games such as Play Your Cards Right and Millionaire Quiz. The group activities looked to be well provided for, there needs to be some more focus on peoples individual interests they had before entering the home and support them to continue with these where practical. We spoke with residents from each unit about social stimulation. Some said they enjoyed the group activities however there were as many that told us they had never been one for doing things like that that would benefit from a more individualised provision. When we looked at care plans we noted that peoples interests prior to entering the home had been recorded as part of the pre admission assessment process. It was disappointing to note that these identified interests did not drive peoples individual activity plans. For example, one persons care plan showed they were interested in gardening. There was no social care plan developed to encourage or support this person to be involved in the garden at the home, to identify certain TV programs that may interest them or maybe to secure certain magazines that could engage them. The homes manager and the provider told us that the social activity care plans were an area under current review. The home had the facility for showing television programs on a large projector screen, they had done this with success for Englands first match in the Football World Cup. Some people we spoke with during the day said they would enjoy seeing other events in this manner, events such as Chelsea Flower Show, the Trouping of the Colour and the Edinburgh Tattoo were mentioned as examples. There was a folder of photographs in the quiet lounge at the home. These showed residents engaged in various activities such as making Easter Bonnets, playing a keyboard and sitting in the garden of the home chatting. A resident who had decided to stay in their room for lunch confirmed that it was their choice to eat in their room. They told us there was a full choice of food offered and said I am having an omelette today. We visited the kitchen and spoke with the chef. They told us they were very happy with the quality and quantity of food supplies and with the autonomy they had to run the kitchen. They told us the equipment was of good quality, one cooker was out of Care Homes for Older People Page 18 of 34 Evidence: action at this time however action had been taken and repair was waiting on a part, there was another cooker in the kitchen and the faulty one was not having a negative impact for the residents. 2 chefs were employed to work at the home, one working 3 days and one working 4 days. We were provided with copies of the six week rolling menu in place at the home. The Chef reported, and the provider confirmed, that all the menus were resident led. The menu showed that residents had the option of a cooked breakfast daily, there were 3 choices for lunch every day, supper comprised of options of homemade soups, sandwiches, Jacket potatoes with various choices of fillings, beans/spaghetti, cheese etc also these options on toast. Menu choices were taken the day previously by care staff. We discussed the possibility of providing choice to people at the point of dishing the food up as people may not remember what they had chosen the previous day and may feel differently when it came to the meal time. There was a new 6 week menu in place at this time, the chef and management agreed that once the residents and kitchen were familiar with the menus and the take up rates for choices then they could consider offering choices at the table. Fresh provisions were sourced daily to meet the menu requirements so there needed to be this settling in period to make this feasible. There was a snack menu available from 9am to 5 pm daily including a range of hot and cold foods so that people could have food outside of the prescribed meal times if they wished. The chef told us this option was not taken up often. People were offered ice creams during the afternoons, selection of biscuits provided with morning coffee and afternoon tea. There was fresh fruit available on the individual units. The chef baked fresh cakes daily. Leftover cakes and sandwiches from the tea service were available for people if they felt hungry during the night, we also noted there was bread, butter and marmalade available in the unit kitchens should people fancy toast or bread and butter outside of mealtimes. There were picture cue cards available in the individual units kitchens to enable staff to communicate choices to those residents with limited cognitive abilities. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have access to a robust and effective complaints procedure. Evidence: The policies and procedures for dealing with complaints, whistle blowing and safeguarding the people living in the home were available at the home, in the Statement of Purpose and the Resident and Family handbook. People using the service and staff confirmed they were aware of the complaints procedures and were clear they would talk to the manager if they had any concerns and were confident that their concerns would be dealt with. Records showed that issues raised verbally had been recorded appropriately in the complaints records, this showed us that peoples concerns were taken seriously and acted upon. We saw many letters and cards complimenting the management and staff for the love and kindness afforded to people living at Gifford House. The managers training matrix indicated that the 7 full time qualified staff employed to work at the home had received refresher update in Adult Safeguarding procedures and 6 of the 8 qualified staff that worked on the homes staff bank had received refresher training in this area. The training records showed that 32 of the 35 care staff employed to work at the home had attended Adult Safeguarding refresher training. 11 Care Homes for Older People Page 20 of 34 Evidence: of the 16 ancillary staff employed to work at the home had attended safeguarding training. This included catering staff, maintenance, domestic and laundry staff. Staff files seen confirmed all staff were subject to Criminal Records Bureau (CRB) prior to commencing employment. Staff spoken with were clear about their role and their duty of care to raise any concerns they may have about other members of staff conduct and in reporting of incidents of poor practice and suspected situations of abuse. At the time of this visit there were three safeguarding investigations ongoing by the Local Authority safeguarding team. One alert had been raised by the homes management, one by a social worker and one longstanding alert had been made directly to social services by a relative. The manager reported that one of these investigations had been concluded however there had been no confirmation of this received from the Local Authority Safeguarding Team at this time. In one case an external advocate was involved. The recently appointed manager demonstrated good awareness of what issues would necessitate a safeguarding alert and a commitment to work closely with the safeguarding team. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Gifford House continues to provide people who live there with a safe, well maintained and homely environment. Evidence: We took a physical tour of the building accompanied by the homes manager. The home had stairs and a passenger lift to enable access throughout the premises. There were grab rails in corridors and aids in bathrooms and toilets to meet the mobility needs of residents. Call systems were provided throughout communal and individual rooms to enable residents and staff to call for assistance and records confirmed these were well maintained. A range of specialist pressure relief equipment was available to meet the needs of individual residents. A full range of slings for hoists to be used for individual residents with mobility needs were also available. Records viewed showed that all hoists in the home were serviced 4 times per year, twice by the maintenance company and twice by the homes insurers. One ground floor wing was dedicated to such things as the laundry, kitchen, staff training room, staff changing facilities and staff rest room. We saw storage rooms on each unit for wheelchairs, slings and equipment for pressure area care, incontinence aids etc. Each unit had its own lounge and this included a kitchenette area for staff to make Care Homes for Older People Page 22 of 34 Evidence: drinks for the residents, as and when required and for visitors to be able to make drinks also. There was a pleasant quiet room off the main reception area, the manager told us residents often used this to entertain visitors. We saw information about the home available here including the complaints policy and procedure and the results of a recent quality assessment survey. There was a designated room for those residents who wished to smoke. We saw that peoples bedrooms were personalised to varying degrees with pictures, photos, plants and items of furniture. The dining rooms were large, bright and airy with ample space to accommodate people using wheelchairs, walking frames and aids. We saw that bathrooms had privacy screens around the inside of the door entrance so that staff could enter and leave bathrooms whilst still maintaining the dignity of the people using the facility. The environment overall was clean and bright. The people living on the Dementia units would benefit from some consideration being given to the decor to further enable their orientation around the unit and their independence. There was re-decoration work on going at the home at this time and some discussion took place with the provider about how different colours and tones of paint could be used to make handrails stand out more and to make toilet door ways easier to identify. Discussion also took place about providing items such as hat stands for example, with hats and scarves etc. for people to touch, feel and wear. The home was clean and with the exception of one area in Radcliffe Unit, there were with no malodorous smells evident. It was clear from discussions with the manager and staff that they were having difficulty in meeting the continence needs of one resident in that unit and despite carpets being regularly cleaned, the smell remained. It was therefore evident that carpets needed to be cleaned more frequently or replaced. Several chairs in the same unit were observed to be stained where residents rested their heads. The manager agreed to ensure these were more regularly cleaned. Systems were in place to ensure staff had personal protective clothing (liquid soap and paper towels) for use when providing personal care in residents en-suites and bathrooms and in other key areas, for example the laundry room and sluice room. Alginate bags were also observed to be in use for staff protection when dealing with Care Homes for Older People Page 23 of 34 Evidence: soiled and contaminated linen. The laundry room was large with clean and dirty entrance/exits and was well equipped. There were two washing machines and two driers that were in working use. Washing machines had sluice facilities (able to wash at 65 degrees centigrade for a minimum of 10 minutes) to minimise the risk of infection. A steam iron, standard iron and ironing board and rotary iron were provided. Designated laundry assistants were employed at the home. The linen viewed was well laundered. However one relative did state that some white underwear had been returned looking grey in colour. They also confirmed that sheets were regularly changed and were always nicely ironed. Sluice rooms with a mechanical sluice were provided on each floor of the home for the safe decontamination of equipment and were well maintained. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by caring and competent staff that may not always be on duty in sufficient numbers to meet the needs of all the people living at the home. Evidence: There were fifty-two residents accommodated at Gifford House at the time of this visit. Staffing levels on the units were as follows: Betts Unit: 1 registered nurse and 4 care assistants in the morning reducing to 3 in the afternoon. Linford Unit: 1 registered nurse and 3 care assistants morning and afternoon. Radcliffe Unit: 1 registered nurse and 3 care assistants morning and afternoon. Ancillary staff comprised a minimum of 3 domestic staff 7 days per week, 2 laundry people covering 7 days per week between them and a Chef and kitchen assistant. We were provided with a copy of the last 15 days staff rota (including the day of this visit) to take away with us. Despite asking for the rotas to be signed to validate them we noted subsequent to the visit that this had not been done. The rota was delivered by one page per day showing each unit and which staff were on duty on each shift. The rotas confirmed there were generally 3 qualified staff on duty during the day and 2 at night. During this sample there was one occasion where there were just 2 qualified staff on duty during the day. Rotas showed that staff generally worked 12 hour shifts, from 8am to 8 pm. During Care Homes for Older People Page 25 of 34 Evidence: feedback to the provider and the manager at the end of the inspection we discussed a concern relating to staffing working 5 long day shifts in a row. The manager told us she felt this represented continuity of staffing and that it was the choice of staff to work long day shifts. We shared concerns that staff may not be fit to care for the residents after working 5 x 12 hour days shifts in a row. Staff told us that they had concerns relating to the reduction of staff in the afternoons and that when someone attended hospital appointments additional staff were not always provided. We shared concerns with the provider and manager about the reduced staffing level in the afternoon on Betts unit. There were 4 staff on duty for the morning shift and 3 for the afternoon shifts. The provider told us that if there was a need to increase the staffing levels this would be done and then gave an example of where this had happened to meet a particular need. The provider told us that when people needed to attend hospital appointments an extra member of staff would be allocated to provide an escort if relatives were not able to accompany the individual. We looked at staff recruitment files to assess whether the managers recruitment procedures and practice ensured that the right people were employed to look after vulnerable people. The files we looked at included all the documents necessary to confirm all the relevant checks were made before people were employed to work at the home. Files included records of supervision. The training records for the same staff were reviewed and confirmed that they had undertaken the required training in health and safety, manual handling, safeguarding, risk management and fire safety. The records viewed confirmed that training had been provided in basic food hygiene, infection control, basic first aid and drug assessment for registered nurses in the previous twelve months. We were provided with a training matrix to provide an overview of the training, updates and refresher training that took place at the home. The manager acknowledged there were some minor shortfalls in the provision of refresher updates in some areas and that these resulted from recent management structure changes within the home. The manager reported that staff training needs would continue to be identified through supervision and annual appraisals. The manager is a trainer for moving and handling and all other training modules are delivered by external facilitators. For example: A practitioner from the local GP surgery was visiting the home weekly to deliver preferred priorities of care training. Residents we spoke with praised the staff for the care and kindness they received at the home. Comments included: The staff are lovely and they all know our names. Visitors we spoke with made positive comments about the staff working at the home. Care Homes for Older People Page 26 of 34 Evidence: Comments included: Cant fault the place, thanks to their hard work our relative has really picked up since they have been living here Staff never seem to stop working. Staff we spoke with told us: Very little dementia awareness amongst the staff team, the dementia training here is sadly lacking, The staff team are pulling together and communication has improved. We discussed the dementia training provision with the management team. It was acknowledged that, whilst the staff team have received training in this area, the outcome for the residents, especially in social activities and stimulation needed to improve. The provider and manager reported awareness of this and shared plans for additional training. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is managed by a team committed to improving outcomes for the residents. Evidence: Since the previous inspection of this service there had been a change in the management structure. The newly appointed manager had not yet applied for registration with CQC however reported the intention to do so imminently once completed Criminal Record Bureau disclosures and appropriate references were received. The post of deputy manager was vacant at the time of this visit. The home employed the services of an external consultant to undertake an unannounced monitoring visit at least once annually, the results of this fed into the homes development plans and the quality assurance process. There was also an external consultancy firm that undertook a Health and Safety inspection of the home annually and provided Health and Safety training for the staff team. Care Homes for Older People Page 28 of 34 Evidence: We were provided with a summary a relatives and residents satisfaction survey for January to March 2010. This covered all areas of the service provision at Gifford House including the environment, the staff, the activities provision, the medical care, the food and the laundry. Comments included within this summary included: The whole package of welcoming, caring, cleaning, decor, staff is managed extremely well, I have recommended you on several occasions. Most carers actually care, they are a credit to you and hopefully are so appreciated by the management. It is clean and welcoming, a pleasure to speak with any of the staff. My relative seems very settled since they have been in the home, so their care must suit them. Some areas where people indicated in this survey they felt the home could provide better outcomes for people were: Could help residents mix who need social contact on their own level. Some residents on Radcliffe unit can feel isolated as most suffer advanced dementia and cannot communicate easily. Give the carers short shifts to work so they are not doing 60 hours in one stretch. We were provided with a copy of the recent registered providers report required under regulation 26, this was noted to be a robust and comprehensive report. This showed that all areas of the service were reviewed and improvements requested where identified. We were provided with copies of minutes from relatives/residents meetings and staff meetings. Residents and relatives raised some negative issues in the meeting in April 2010 such as staff being task orientated and not considering residents needs, pureed food and dirty carpets on one unit. It was also recorded that one relative stated that the care and environment etc were excellent at Gifford House and if it were not for the staff their relative would not be with us today. Staff meeting minutes of the same day showed that the management discussed the issues raised with the staff team. We looked at personal monies maintained on behalf of individuals living at the home. We found that all balances agreed with the clear records kept. All monies were kept in individual named wallets with a detailed transaction record. Monies were stored in a locked safe in the managers office. Management told us that people did not require access to their money outside of office hours however, if they did then a member of the management team would visit the home to facilitate access. The provider conducted a random audit of peoples funds on a monthly basis and undertakes a complete audit every 6 months. The staff records viewed confirmed that regular supervision was undertaken where care practices and training needs were discussed. We were informed that staff had a Care Homes for Older People Page 29 of 34 Evidence: period of handover between shifts to provide an update on residents changing needs. A residents care plan viewed also contained a record of care staff being observed when manually handling the resident. This confirmed that direct observation of staff was undertaken and ensured that handling practices were monitored to ensure they were adhered to and staff and residents were safeguarded from injury. The most recent Electrical Safety certificates, including Portable Appliance Testing (PAT)were seen and records showed that all equipment is regularly checked and serviced. The fire logbook showed that the fire alarm, emergency lighting and fire fighting equipment is regularly serviced. Evidence was available to confirm that emergency lighting and the fire alarm systems were regularly tested. Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 26 13 The malodorous smell identified on Radcliffe Unit must be removed from the home. This will ensure residents are safeguarded. 31/07/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 10 It is a recommendation of good practice that all people working at Gifford House are respectful of peoples individuality and dignity. This refers to the use of such institutional terms as feeders and walkers. It is a recommendation of good practice that the activities provision is developed around peoples individual interests and past times they enjoyed before coming to live at Gifford House. Consideration needs to be given to ensuring the Decor is enabling for people living with dementia. Systems should be in place to ensure colours do not run when laundered. Regular cleaning of furniture should be undertaken to Page 32 of 34 2 12 3 4 5 24 26 26 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations ensure stains are removed. 6 27 Staffing levels during afternoon shifts should be reviewed to ensure that the changing needs of residents are met. Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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