Care Home: Glendaph Nursing Home

What the care home does well The new manager and her staff like to find out what people living in the home like to do and try to make sure that they can do it. They find out what they like to eat and try to make sure that is what they get. If a person is ill they make sure that they get the right treatment. If a person doesn`t like something they can complain to the manager and will be listened to. The staff are cheerful, friendly and helpful and encourage people to enjoy themselves but also try to make sure that they are safe and well looked after. People who use the service are very complimentary about the care experienced after a period of uncertainty without a manager in post. They find the staff helpful and friendly and they feel listened to. What has improved since the last inspection? The service has been without a manager for approximately six months but now has a new manager in post. She has identified the areas in need of improvement which we are confident she will address. What the care home could do better: The service should review the statement of purpose and service user guide so that people have up to date information about the home to take away with them or keep in their rooms. It should be in a suitable format to meet residents individual needs. The service should review the storage of equipment in resident areas. The service could make the home safer by risk assessment and providing suitable areas for storage of large items such as hoists and trolleys. There should be evidence of at least annual internal quality monitoring of the service. The manager could implement her own audit in areas such as medication and infection control taking the findings of external audits into account. This is so the service itself can ensure compliance with policies and procedures. To make sure that people who live in this home are looked after in a way that they like regular visits by the provider`s nominated person should focus on how they feel that their needs are being met. These findings should be recorded and available to those people who could use that information to improve the service. The provider could then identify shortfalls in management performance, in the conduct of the care home and the condition of the premises. It would also identify areas for improvement in line with the business plan for the service. The service needs measures in place to recognise its own weaknesses as they emerge and manage them well. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Glendaph Nursing Home North Road Kingsland Leominster Herefordshire HR6 9RZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Pat Scott     Date: 1 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Glendaph Nursing Home North Road Kingsland Leominster Herefordshire HR6 9RZ 01568708337 01568708866 glenaph@geoshine.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Geoshine Limited care home 31 Number of places (if applicable): Under 65 Over 65 31 31 31 31 31 31 dementia learning disability old age, not falling within any other category physical disability sensory impairment terminally ill Additional conditions: Date of last inspection Brief description of the care home 0 0 0 31 0 0 Glendaph Nursing Home is situated in the rural village of Kingsland (which is four miles from the town of Leominster) and is surrounded by 1.5 acres of mature gardens with car parking. It is privately owned and registered to provide nursing care for up to 31 adults. Fees are currently £583.80-£600.55 per week. Care Homes for Older People Page 4 of 25 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: We, the commission, looked at all the information that we have received, or asked for, since the last key inspection or annual service review. This included: Surveys returned to us by people using the service and from other people with an interest in the service. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. Relevant information from other organisations. Care Homes for Older People Page 5 of 25 What other people have told us about the service. What the care home does well: What has improved since the last inspection? What they could do better: 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 25 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 8 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The new manager understands the importance of having information about the service so that people can choose a home that will meet their needs and preferences. The admission process is to become more personalised so that people are given consideration to their individual needs, concerns and anxieties before moving into care. Evidence: The new manager spoke of the need to re-develop the service user guide and statement of purpose to include information to meet the national minimum standards. She aims to produce these documents in different formats to help people understand what services the home can provide. At present the format available is not a true reflection of the services and facilities provided. Discussion with the new manager established that the service maintains pre-admission and admission records. The Single Assessment paperwork is provided through the care Care Homes for Older People Page 9 of 25 Evidence: management process. The assessment information forms the care plan based on the individuals needs. The manager showed us files to evidence the above is in place but also stated that she intends to review the homes assessment document to make the process more personalised. The manager keeps copies of the assessment summary and care plans of those carried out through care management arrangements. A service user spoken with stated that he had provided information to a member of staff prior to coming to live at the home. Care Homes for Older People Page 10 of 25 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. Peoples care needs and risk assessments are set out in their individual plans of care which ensures that all care needs have been addressed and will be met. The manager understands the need to comply with safe medication systems and staff training ensures that the homes procedures are complied with and that residents health matters are safely addressed. Evidence: People have a plan of care that has been agreed with them. The manager stated that she wishes to change the format to make them easier to understand and look at all aspects of a persons life. People can talk to a qualified nurse or a care worker who will work with them on a one to one basis to support and encourage them in everyday life. Care plans viewed contain information about assessment, how they keep safe, their aims and hopes, choice in social activity as well as detailed clinical information about their health and personal care. People have the aids and equipment they need which are well maintained to support them and staff in daily living. Care Homes for Older People Page 11 of 25 Evidence: Medication is safely handled but regular management checks by the service should be implemented and recorded to monitor compliance. Staff records show that appropriate training is provided. Comments from people spoken with include: The staff are friendly and I receive good care. The care has been variable recently but I think the changes may have had this effect. They do help me as I need though. Care Homes for Older People Page 12 of 25 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. People are provided with social activity and can keep in contact with family and friends. Social, cultural and recreational activities meet peoples expectations through assessment, consultation and choice. Residents receive a healthy diet according to their assessed requirement and preference. Evidence: People are able to enjoy their preferred lifestyle with a variety of activities to choose from. The homes assessment process identifies what leisure pursuits and hobbies the person likes. Residents meetings are starting to take place which the manager stated would become a regular feature. Recent events enjoyed include: lunch clubs, ceramics workshop, nail care, aromatherapy and trips out. An enthusiastic senior care worker is in charge of the activity programme and attempts to identify peoples preferences for leisure time i.e. one person wishes to attend an antiques fayre which the home is going to assist them to do. Residents spoken to stated they liked the food and enjoyed the ability to have a choice. Care staff were seen to be sensitive to the needs of those residents who find it difficult to eat and gave assistance with feeding at a pace that suited the resident. Care Homes for Older People Page 13 of 25 Care Homes for Older People Page 14 of 25 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. The service has a complaint procedure so that people who use the service can make complaints about the home. Training is provided so that service users are protected from abuse and have their legal rights protected. Evidence: People spoken with state that they would go to the manager or one of the staff if they had a problem. All expressed confidence that issues would be dealt with. The approach by the manager and staff have given people the confidence to air their concerns. The statement of purpose does not contain the full procedure but will be included in its review. The use of bed rails is a form of restraint and staff have involved people in the decision making process to use them. Full individual risk assessments are in place and will be renewed when the care plans are changed. Care Homes for Older People Page 15 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical appearance and storage at the home could be improved so that people live in a safer, better-maintained and comfortable environment. Evidence: The manager spoke of the changes to the environment so far achieved and of the further work she wishes to progress. The home is comfortable but lacks any programme to improve the decoration, fixtures and fittings. Upgrade tends to be when its absolutely needed rather than planned budgeted improvement e.g. some bedrooms have had new carpets but others around the home are very stained and worn. All areas seen around the home are clean and rooms personalised according to the wishes of those people occupying them. However, the manager agreed that a slight malodour was present around the ground floor lounge area. There is a lack of storage space for trolleys and hoists which are at present stored in bathrooms and corridors which could pose a hazard depending on the assessment of risk. The trolleys with incontinence pads and catheter bags on view in the corridors is also an issue re dignity, especially when visitors are present. Not all bathrooms are accessible to all people in the home because of items that staff have left in these rooms, although they do have access to a bathroom that meets their needs. The service should review storage facilities. Care Homes for Older People Page 16 of 25 Evidence: Hygiene equipment is available and staff have been trained in the use of gloves, aprons and hand washing techniques. The home has one sluicing disinfector on the first floor but a slop hopper on the ground which should be upgraded to improve health and safety for staff and residents and avoid the dangers associated with disinfecting utensils by hand. The laundry is well organised. People spoken with said the home is much cleaner with the new domestic staff. Care Homes for Older People Page 17 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are being trained and are in sufficient numbers to fill the aims of the home and meet the changing needs of residents. Evidence: Staffing rotas are in place and assistance to achieve National Vocational Qualifications (NVQ) is provided. The manager stated that the induction process provided for new starters had lapsed prior to her being appointed which has been addressed. Initial training such as infection control, manual handling, first aid and medication are provided. After induction, candidates are assessed for suitability to move onto NVQ training. Staffing in the home has improved through successful recruitment, however, one staff file lacked a second written reference before they were confirmed in post. The residents know the staff very well and observation showed that they provide a personal and professional service. Staff are seen to attend to people discreetly. Visitors are welcomed into the home. Comments from people spoken with described recent changes in the home. People feel that although the care did not deteriorate, staff morale had seemed low. They said that things had greatly improved with the new manager in place. Care Homes for Older People Page 18 of 25 Care Homes for Older People Page 19 of 25 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. The management of the home is based on openness and respect. The service is starting to have quality assurance surveys in place so that people are assured that the overall conduct of the home is taking into account their views. Peoples opinions will be more central to how the home develops and reviews its practice, and the service is developing appropriate ways of making sure they get things right. So, people have confidence in the care home because will be run and managed well. Evidence: Geoshine Ltd have a new manager in post at Glendaph. She is a qualified nurse with a range of experience and is currently studying for a management qualification. She finds out what people like by talking to them, involving them in their care and has the intention of holding regular resident meetings so that any issues can be discussed. The manager is aware of the importance of making people safe and has plans to improve Care Homes for Older People Page 20 of 25 Evidence: the assessments for use of bed rails, obtain an up to date fire risk assessment for the home, plan for staff training and review records in the home. The organisation should monitor itself through monthly visits by a nominated person. The Owner currently visits regularly but does not produce a report for the manager which would support her in the running of the service and for inspection purposes. An external audit for quality management is planned for 2009. There is a lack of internal management audit at present to ensure staff practice complies with policies and procedures, for example, in medication, infection control, care planning, health and safety. People who use the service say that they trust the staff and feel safe in the home. One stated about the management The home will be well run now the new manager is here. The manager understands where the service needs to improve to increase the quality of life for the residents and is keen to involve people in shaping the service delivery. She currently lacks a business plan or any budgetary control. The manager intends to produce an action plan which identifies her priorities for improvement over the next 12 months. Care Homes for Older People Page 21 of 25 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 22 of 25 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 33 26 (3)(4). The provider shall arrange for the conduct of the care home to be reviewed monthly and a report kept. This is so that shortfalls in service provision can be identified and acted upon. 30/04/2009 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 1 The service should review its statement of purpose and service user guide so that new people have the information they need to make an informed choice about where to live. The manager should implement regular medication audits to ensure staff comply with policy and guidance. A programme of routine maintenance and renewal of the fabric and decoration of the premises should be produced and implemented with records kept. The manager must ensure that two references are received prior to new staff being confirmed in post. There should be an annual development plan for the home, Page 23 of 25 2 3 9 19 4 5 29 33 Care Homes for Older People based on a cycle of planning, action, review, reflecting the aims and outcomes for people who use the service. 6 33 The provider should implement a process of internal audit. Care Homes for Older People Page 24 of 25 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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