Care Home: Gold Hill Residential Home

What the care home does well The management of the medication is good and ensures that the people living there receive their medicines as required and staff assess and assist individuals to take their medications as prescribed by their doctors. The relationship between the staff, people who live there and their relatives is good and enables smooth communication. There are a variety of activities which each person can participate in and be part of the community which has improved. The acting manager has shown their commitment to valuing activities by employing two dedicated activity coordinators. This is important within Gold Hill due to some people living there who have varying levels of dementia. The food provided is of good quality with vegetables and fruit promoted and offered. Also each person has the option to choose what he or she wants to eat. The meal times are social events and staff are sensitive and caring when assisting people with their diets. All the staff communicate well and have a good understanding of the needs of each person living at this home. People living at this home now feel safe and that staff practices value them as human beings. The acting manager has an open door policy and staff, together with people who live at the home, told us that the acting manager is approachable and always willing to listen. What has improved since the last inspection? The management team have worked hard to satisfy the requirements made at the last inspection and are working to achieve good outcomes for people who live at this home. Improvements to the care planning and reviews are progressing so that people using the service receive a personalised but consistent level of support. This is going to be ‘helped along’ by the introduction of key workers. We were told that all risk assessments have been updated and the assessments we sampled showed this is the case so that individuals changing needs can be documented for staff to follow as guidance, keeping people safe. On the days we visited we did not observe any infection control practices that would place people living in this home at risk and the environmental health officer has visited. They have awarded the home four stars which demonstrates that overall very good hygiene practices are maintained by staff. Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 What the care home could do better: The acting manager must pursue their registration to manage the service, so people can feel confident of some stability and consistency in all areas of practice in the home to progress outcomes that are good for people who live at Gold Hill. Although we acknowledge some improvements have been made within the home there remains outstanding work which has been this way for some time. Redecoration of inside and outside the home, such as exterior painting, in people’s rooms, old decoration and furniture which gives the impression of a home that is not well maintained and comfortable for people who live there. This could also become unsafe and impact upon individuals sense of well being. The AQAA told us that the manager intends to improve the home in the following ways over the next 12 months: • • • • • To continue with refurbishment of the home. All service users will be offered choices in their daily living to enhance their quality of life. The continuation of training staff in NFCE, NVQ courses that will provide enhanced skills for the benefit of the service users. To continue to listen to all those who use the service and act upon suggestions and advice given. The AQAA states “Although the home has moved forward, we are fully aware there is a long way to go, the morale of staff must be kept up for them to achieve their full potential. Therefore the home must continue to work with the authorities and look at ways of improvement in the service we provide”. The acting home manager is applying to be the registered manager for the home, this will create stability for the staff and service users alike.• Key inspection report CARE HOMES FOR OLDER PEOPLE Gold Hill Residential Home 5 Avenue Road Malvern Worcestershire WR14 3AL Lead Inspector Sally Seel Key Unannounced Inspection 30th July 2009 08:30 DS0000018654.V377186.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gold Hill Residential Home Address 5 Avenue Road Malvern Worcestershire WR14 3AL 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) 01684 574000 Minster Care Homes Limited Manager post vacant Care Home 40 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (40), of places Physical disability over 65 years of age (40) Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: care home only - code PC; to service users of the following gender: either; whose primary care needs on admission to the home within the following categories: physical disability over the age of 65code PD(E) 40; old age, not falling within any other category - code OP 40; Dementia over the age of 65 - Code DE(E) 20. The maximum number of service users who can be accommodated is 40. 27th February 2009 2. Date of last inspection Brief Description of the Service: Gold Hill is a large building occupying a corner position within close proximity to the centre of Malvern, which has all of the amenities usually associated with a small town. The home is registered to provide personal care for a maximum of 40 older people. The people using the service are accommodated in 24 single bedrooms and 8 double bedrooms on four levels i.e. lower ground, ground, first and second floor. Sixteen of the single bedrooms and 7 of the double bedrooms have an en suite facility. Several of the bedrooms enjoy attractive views of the Malvern Hills and the surrounding area. The home has a small, two-person passenger lift. Communal areas consist of two lounges on the ground floor and a dining room on the lower ground floor. The dining room has an adjoining conservatory that is used as a designated smoking area. There are car-parking facilities at the front of the premises. The train station is about a 10 minute walk from the home. A copy of the Service Users’ Guide was available in the entrance area of the home. This document stated that ‘the fees currently fall within the range of £353.00 and £430.00 per week per person. Fees will be agreed prior to admission, depending on facilities offered and following a care needs assessment’. For up to date information the reader may wish to contact the provider directly. Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this care home is 2 Star, which means that the outcomes for people using this service are good. This was an unannounced key inspection that took place over two visits; the first visit took place on the 30th July 2009 from 08:30 until 17:30. The second visit on the 31st July 2009 took place from 08:30 until 16:35. The purpose of this inspection is to look at all areas of the service to ensure that the outcome for people living there is good, safe and appropriate. This inspection also enables us to ensure that the service runs according to legislation and regulations. During these visits we case tracked three people, this involves reading their records, discussing their care with staff, visiting each person and discussing their experiences where possible. We also looked at policies and procedures related to safeguarding, concerns and complaints and medication. New policies and procedures were also examined. Discussion with the acting manager and deputy manager took place on both days as well as discussion with other care staff. Where appropriate information from these discussions have been referred to. Also any comments that the management team have received from people who live in the home, at resident meetings and through questionnaires completed by family members are also documented in this report. During the process of the inspection we viewed a variety of areas of the home including the kitchen, laundry and the communal and some private rooms of the people who live there. The management team have worked hard with staff in the home to make improvements to the delivery of care and to ensure that the outcomes for the people living there are good and safe. We would like to take this opportunity to thank people who live at this home, staff and the management team for assisting us in our inspection and making us feel welcomed on the days we visited. Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 6 What the service does well: The management of the medication is good and ensures that the people living there receive their medicines as required and staff assess and assist individuals to take their medications as prescribed by their doctors. The relationship between the staff, people who live there and their relatives is good and enables smooth communication. There are a variety of activities which each person can participate in and be part of the community which has improved. The acting manager has shown their commitment to valuing activities by employing two dedicated activity coordinators. This is important within Gold Hill due to some people living there who have varying levels of dementia. The food provided is of good quality with vegetables and fruit promoted and offered. Also each person has the option to choose what he or she wants to eat. The meal times are social events and staff are sensitive and caring when assisting people with their diets. All the staff communicate well and have a good understanding of the needs of each person living at this home. People living at this home now feel safe and that staff practices value them as human beings. The acting manager has an open door policy and staff, together with people who live at the home, told us that the acting manager is approachable and always willing to listen. What has improved since the last inspection? The management team have worked hard to satisfy the requirements made at the last inspection and are working to achieve good outcomes for people who live at this home. Improvements to the care planning and reviews are progressing so that people using the service receive a personalised but consistent level of support. This is going to be ‘helped along’ by the introduction of key workers. We were told that all risk assessments have been updated and the assessments we sampled showed this is the case so that individuals changing needs can be documented for staff to follow as guidance, keeping people safe. On the days we visited we did not observe any infection control practices that would place people living in this home at risk and the environmental health officer has visited. They have awarded the home four stars which demonstrates that overall very good hygiene practices are maintained by staff. Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 7 What they could do better: The acting manager must pursue their registration to manage the service, so people can feel confident of some stability and consistency in all areas of practice in the home to progress outcomes that are good for people who live at Gold Hill. Although we acknowledge some improvements have been made within the home there remains outstanding work which has been this way for some time. Redecoration of inside and outside the home, such as exterior painting, in people’s rooms, old decoration and furniture which gives the impression of a home that is not well maintained and comfortable for people who live there. This could also become unsafe and impact upon individuals sense of well being. The AQAA told us that the manager intends to improve the home in the following ways over the next 12 months: • • • • • To continue with refurbishment of the home. All service users will be offered choices in their daily living to enhance their quality of life. The continuation of training staff in NFCE, NVQ courses that will provide enhanced skills for the benefit of the service users. To continue to listen to all those who use the service and act upon suggestions and advice given. The AQAA states “Although the home has moved forward, we are fully aware there is a long way to go, the morale of staff must be kept up for them to achieve their full potential. Therefore the home must continue to work with the authorities and look at ways of improvement in the service we provide”. The acting home manager is applying to be the registered manager for the home, this will create stability for the staff and service users alike. • 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. Gold Hill Residential Home DS0000018654.V377186.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 Gold Hill Residential Home DS0000018654.V377186.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 5. People using the service experience good quality outcomes in this area. Information about the home has been reviewed which gives people good details about the facilities and services so that they can decide whether the home is the right place for them. Individual’s needs are assessed prior to people moving into the home so that reassurance can be given that these are able to be met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: On entering Gold Hill there is a table by the main entrance door where we found the statement of purpose and service user guide. This shows that the acting manager understands the importance of having sufficient information when choosing a care home and that it is readily available for people to pick up and read. The statement of purpose and service user guide have a date of Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 10 September 2008 on the front covers to show the reader when the contents were last updated and to enable the acting manager to keep the contents under review. The information developed is clear and easy to follow to help prospective individuals choose a home that will meet their needs and preferences. The information contained in the home’s statement of purpose sets out the home’s aims and objectives, philosophy of care, accommodation, services and facilities which include activities and meals that are offered. Also importantly people who may be considering living at this home are provided with the current fees charged so that they are able to see the financial costs of choosing to live at Gold Hill. The statement of purpose is supported by a service user guide that details the accommodation and services provided the qualifications and experience of the registered provider, acting manager and staff. There is also some information about the number of places provided at the home together with any special needs or interests that can be met whilst living at the home. A copy of the complaints procedure and some sections of the latest inspection report can also be found in the guide. It is noted in the service user guide that people are able to ask a senior member of staff if they would like assistance in understanding the contents within. However, the statement of purpose and service user guide can be further improved by making them available in large print, pictorial or audio visual formats as some people living in the home would not be able to read its contents in its present format. This will also make certain that people who may be considering living at this home have accessible information they are able to gain an understanding of what the home is able to offer to them. Some consideration should be made to having all of the latest inspection report within the service user guide so that its contents meet all of the National Minimum Standard 1.2. The acting manager may also want to consider placing the views of people who already live in the home in the service user guide which can also assist individuals in gaining an insight into what it would be like to live at Gold Hill. Prospective individuals are given a copy of the service user guide, and we were told people living at the home also have a copy in their rooms so that they are able to refer to it as they wish. The certificate of registration and public liability insurance certificates are on display. The certificate of registration was old and did not give correct information about the manager as it had the previous registered manager’s name noted on it. A new certificate with updated details will be issued as the manager is completing her registration with the Care Quality Commission, (CQC). In the meantime we will issue a new registration certificate with up to date information on it so that it can be displayed within the home. On the preadmission assessment paperwork there are tick boxes that ask whether people have been offered trial visits and given the information guides. Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 11 Trial visits are offered to prospective individuals to allow them to see what the home has to offer them and to make sure their needs can be met. The statement of purpose states, ‘Service users interested in accommodation at Gold Hill are encouraged to visit the home and sample the atmosphere and level of service. This gives the service user time to get to know the staff, adjust to new people and surroundings and sample the food before committing themselves to a longer stay’. Full needs assessments are carried out during the visit involving the individual and their family. We were assured that people do not come to live at the home until their needs are fully assessed and the acting manager has the knowledge that staff will be able to meet the person’s individual needs. We found this to be the case as one preadmission assessment that we looked at was completed on the same day as the person moved into the home due to a crisis situation in their lives. The assessment took into account the individual’s diagnosis and reason for coming to live at the home. We sampled the preadmission assessments and care plans of two other people who live at Gold Hill. We found they held sufficient details to give staff a good insight into how they would provide assistance and support to meet each persons care and health needs. For example, each person’s mobility, personal care, mental health and cognitive reasoning, skin integrity, continence, and sight, hearing and communication, oral health and foot care, weight, diet and food preferences within their daily lives are detailed. This ensures staff are then provided with plans to assist and support people in remaining well cared for, healthy and safe when people come to live at the home. It also makes certain staff have the knowledge and skills to meet each persons needs which is acknowledged by the acting manager in their AQAA, ‘We provide friendly dedicated staff that are trained to meet the needs of our clients are all actively training to improve their skills in care’. Staff training records confirmed that 22 staff have completed induction training in skills for care and 12 staff have an NVQ Level 2 in health and social care which shows staff commitment in having the knowledge and skills to meet the needs of people who live at Gold Hill. We discussed with the acting manager an assessment that has just been completed. This is very comprehensive and gives a good picture of the individual and their specific needs. At the time of our visit the acting manager and deputy manager were having detailed conversations about this persons care and health needs as they were moving into the home the following week. This shows that significant preparation is made prior to people moving into the home so that their needs can be met by staff from day one of moving in. Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11. People using the service experience good quality outcomes in this area. Care plans to illustrate meeting peoples personal and health care needs have now been reviewed, to make sure that people’s needs are met and risks are fully assessed to keep people safe. Health and medication practices are robust to ensure that people get all the support they need to stay healthy and well. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People living at the home receive individualised personal and healthcare support based on their specific needs as discussed during the preadmission assessment. Personal care and health needs are identified by a thorough assessment, involving the individual and their families. For example, one assessment objectives said, ‘X requires assistance with all her personal care needs by one member of staff, she will need encouragement to keep her Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 13 independence where possible, and her dignity must remain intact at all times. At present she is bathed once a week at home’. Each persons needs including personal hygiene, specialist health, nursing and dietary requirements are identified and clearly recorded in care plans. This is an individualised plan about what each person is able to do for themselves and what assistance they need from staff so that their needs can be met. Staff said: “The care plans are very detailed and give us a good picture of the service user and their needs”. We found this to be the case when we sampled the care plans of three people who live in the home. The care plans were in formats that were easy to follow with some good detailed, informative guidance for staff to enable them to meet the needs of the individual person. For example, in one care plan it confirms, ‘X prefers to wash and dry herself’, in another, ‘One carer to help wash/dress, staff to place water in the sink and then X will wash herself with some supervision’ and in another persons ‘prefers trousers and tops to wear and chooses these from their wardrobe’. Further improvements with assessments and care plans could be made by considering writing them in formats that people living in the home and or their representatives are able to read and understand the contents. This will ensure people are taking part in writing them whatever a person’s ability to show how person centred care is promoted. The care plans are signed by staff and dated but the place where individuals and or their representatives sign to, agree the care and support at the times stated and by whom, is left blank. Therefore for good practices purpose come consideration should be given to individuals and or their representatives’ signing the care plans. We were told that when people are assisted with their personal hygiene tasks, such as, taking a bath or shower, then it is recorded by using tick boxes. These records are not stored within individuals care records and for ease of reference it is recommended that this is considered as the daily recordings are not consistent in detailing this specific information. Also it will help the acting manager to audit the care being given to people and make certain staff are following the guidelines in the care plans. These should also inform any reviews that are completed and other professionals can see at a glance what tasks staff are assisting and supporting people with each day. Staff had good knowledge of the care routines of service users. Observations showed that staff know who needs assistance and in what areas. One service user said “staff know what help I want and they are very good with their support”. There was good support to assist service users moving around the home, and accessing the toilet areas. Service users were spoken to in a kind and consistent manner. Personal hygiene needs were attended to; service users appeared well cared for, appropriately dressed and comfortable. Some individuals described aspects of their personal care they maintained independently, they were happy with these arrangements, such as, one person prefers a shower in the evening and this is respected by staff. The arrangements for, and facilities available to people for personal care ensure Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 14 that the privacy and dignity of individuals is both protected and promoted. Staff provided a good insight into individuals’ routines demonstrating that these are known and respected. One improvement in the area of personal hygiene care to ensure peoples preferences and dignity is upheld would be to consider highlighting who the person living in the home would like to assist them with this intimate care, for example, either a female or male staff member. Following the last inspection there are processes now in place to ensure peoples care needs are reviewed on a regular basis and any changes documented on their care plans. For example, people living in the home now have key workers. These are staff members who get to know individuals on a one to one basis so that they are able to ‘pick up’ on any changes in peoples needs, likes and dislikes with a consistency of care being provided. This should help with the identification of peoples changing needs in a timely manner by staff who know them well. Also in the Assurance Quality Assessment (AQAA), it states, ‘Weekly in-house care plan review meetings for all staff has been introduced’. Also in some of the evaluation records we found individuals care needs have been reviewed by their social worker. This should make certain people are receiving some support from external professionals when considering how the care provided is meeting a person’s specific needs. Also we saw that when individuals are observed to be unwell doctors are consulted and any changes in medical care are added to peoples care plans together with being noted on the evaluation notes. There now needs to be some care taken when adding any changes to individual care plans to ensure there is a date to identify when the person’s needs changed so this can be reviewed and any treatment and or care given stopped if necessary. Included in the care records are completed forms documenting the preferred choices of the individual which are called ‘day care and night care’ plans. These inform staff of the persons likes and dislikes within their daily lives. For example, the ‘day care plan’ asks questions such as, ‘Where do you prefer to have your breakfast, i.e. in bed, up in chair or dining room’? , ‘Likes windows to be opened or closed?’ and so on. The ‘night care plans’ ask, ‘Time likes to go to bed?’ ‘What type of night clothes preferred?’ and so on. These provide another opportunity for people to lead lives that they prefer and for staff to have the knowledge to support individuals in maintaining a lifestyle they choose. Some care is needed when writing these to ensure that they are consistently signed by individuals, their representatives and staff together with the date so that they remain person centred and can be reviewed when meeting peoples changing goals. One person who lives at the home shared with us how their health had improved whilst living at Gold Hill. At one stage this person was reliant upon staff to meet their health and care needs due to their physical abilities having Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 15 declined due to their health. However, this person’s physical ability has improved and they are enjoying a more independent lifestyle now. In the AQAA it states, ‘We liaise with other healthcare professionals, to meet the needs of service users, and seek advice accordingly’. We saw examples in the care records that we examined which showed that this is the case. External professionals noted were doctors, physiotherapists and occupational therapists, opticians, chiropodists and dentists. The contact with health professionals extends to advice, information and training for staff and the people living at the home. Some staff have also received training in pandemic influenza so that people living at Gold Hill can be assured that if they get ill with this condition staff will know what to do. People with cognitive impairment are referred to specialist services to help meet their needs. Care plans demonstrated how these needs would be met. Good dementia care looks at both strengths and weaknesses. It was positive to see that the sometimes aggressive behaviour demonstrated was detailed in the care plan and staff had guidance in how to manage it and understand it from the point of view of each person’s confusion and disorientation. Staff had received training in dementia care, and this is positive. The acting manager has ensured at the time of the preadmission assessments good social and or background profiles for individuals are detailed so that staff know the values preferences, and lifestyle of the service user they are looking after, and can plan for this in a positive manner. We saw no ‘end of life’ care plans and therefore we now recommend that these are put in place so that individual’s personal care, physical and psychological needs together with following each persons spiritual pathways. This will make certain people are reassured that when the time comes their wishes and choices are put into action at this important time in their lives with respect and dignity upheld. Risk assessments are in place to make certain people gain the care and support they require in a safe manner. For example we saw risk assessments for moving and handling, a dependency assessment, falls assessment, and a detailed nutritional assessment, with a screening tool, (MUST), which monitors the weight of the person, particular diets and any special needs for nutrition. Risk assessments are comprehensive and specific to the individual person. For example in one person’s area of risks were falls and the assessment told staff, ‘Likes to hold onto carer. One carer to assist in vehicles and lift, there are three steps from own room to assist with and ensure good fitting shoes/slippers’. In another it mentioned that the person was not used to steps as they had previously lived in a home without them so staff needed to assist and be mindful of this due to the person’s confusion. We were also told that one staff member has become the homes champion for falls following a training course. As already mentioned earlier in this report following the last inspection reviews are undertaken monthly or as changes occur to ensure Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 16 people living at the home are safe, potential risks are minimised and staff have the current guidance to follow. Improvements have been made in relation to the storing and administration of medications. The medication is stored in a trolley and the key is held securely. The trolley was clean and well organised. No controlled drugs are being held, although suitable arrangements are in place if they are prescribed. Bottles and packets are being dated when opened and supplies are counted and noted when delivered. The medication is mainly supplied in a monitored dose system (MDS). Other medication is stored in the shelves of the cabinet. Medication details are in the care plans and ‘homely’ medication profiles have been agreed with the GP’s. The administration charts were clear and appropriate information was being recorded. We audited two people’s medications with the deputy manager and there were no gaps in signing for medications. This shows that all people were receiving their medications as prescribed and at the right times. There are copies medication administration policies and procedures and showed that they were aware of what they contained. Regular audits are carried out to ensure that all medication is given out correctly and signed for this ensures that any errors made can be picked up quickly and rectified. This shows the importance that the management team has placed upon the storage, records, administration and disposal of medications. Staff who administer medication have received appropriate training to do so. Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15. People using the service experience good quality outcomes in this area. All people that live in this home are now offered a varied and supportive programme of activities that meet the needs of groups of people together with social interests of individuals. This makes sure individual goals are achieved and a good quality of life is promoted for all. A wholesome and varied diet is offered and specialist diets are catered for to meet the needs of individuals. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We were informed that there have been significant improvements made to the amount and variety of activity opportunities for people who live at Gold Hill. This has been helped along by having two dedicated activity coordinators and the change in social and recreational culture within the home which has been promoted by the management team. The AQAA confirms some of the range of outings and in-house activities as, ‘swimming, Tai Chi, pub lunches, garden centre’s, coffee mornings, nail painting, bingo, drawing/painting, singing group, in-house entertainment and various selection of outside people coming Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 18 to sell their wares’. One person shared with us that a Tai Chi session is enjoyed by people living in the home, the management team and staff alike. On the days we visited we observed activities taking place, people were engaging in doing sequin picture art as a group and bingo in the afternoon. It was positive to see that the activities co-coordinator was able to ‘pick up’ on individuals feelings on the day and in doing so was able to help people overcome any feelings of low mood by promoting a sing-a-long. We also noted that people were being supported to knit, read, clothes shopping and play cards. A person who lives in the home has discovered that by supporting another person to join them in listening to classical music it has become both enjoyable and a therapeutic experience. In this home there are many people who have varying levels of dementia type illnesses and are not always able to say what is important and meaningful to them in their past and present lives. On checking the care records we found that individual life histories are completed with the help of the individual if they are able, family members and staff. This gives staff an idea of the person’s life before they came into the home, their childhood, family life, employment, hobbies and interests. This is a nice touch that values people as individuals and provides points of interest to talk about, particularly during reminiscence sessions. We were also told that the activities coordinators keep care records to show individuals dislikes and likes in connection with activities so any activities offered and planned are meaningful to each person. It is positive to note that the particular interests of each person is explored, recorded and offered to them. One person who lives at the home said they are supported to attend a bridge club once weekly which is held at a community venue in the evenings. In care records we found that individuals are supported to complete activities they enjoy and any risks attached were managed without restricting unnecessarily. For example, in one care plan it said, ‘X likes to cut up paper, staff to observe her whilst doing this activity’. Other people told us: “I quite like bingo as we have a laugh”. “I like to watch the birds”. “We go to the garden centre for lunch”. People can go out as they choose and this encourages their independence and assists them to maintain links with the community. We were told there are plans in place to visit a garden centre and have lunch and go to the Black Country Museum. We were told by some people who live in the home that there was a fete on the previous Saturday and a good amount of monies was raised. The home has an open visiting policy and this enables people to see their visitors as they choose, enhancing their quality of life. Family members and friends visit the home and people can choose to have their hair dressed as Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 19 they prefer by the visiting hairdresser. Also we were told that once a month people can take part in Holy Communion and a service if they wish to join in so that they are able to follow their religious beliefs. We observed that there were no rigid rules or routines at the home and people can choose how they want to spend their day. People can choose where they want to sit, have their meals and choose times of getting up and going to bed. We were told that there is a four weekly rotating menu and people are asked each day in the morning by a member of staff what meals they would like for the day. If people decide at any meal times that they don’t feel like the meal they have chosen then individuals can have something different if they wish. Throughout the day we saw that drinks of tea, coffee, juice and biscuits were offered. We observed breakfast being served to some people on one day and lunch. There is a choice of cooked breakfast, cereals or fruit. Some people chose to remain sitting in the dining room and were observed to be content in doing this. We were told that some people enjoy the ‘hustle and bustle’ of activity in this room. We did see staff ask people if they wanted to go to any other room in the house, some did and others wanted to remain in the dining room which was respected by staff. There is a choice of two hot meals at lunchtime and for tea there is a choice of soup and sandwiches or a hot snack. There is a menu board in the dining room so people can choose what they want. Staff were observed to assist people in a discreet manner. We were told that the manager had bought condiments and water jugs. However, we did not see any condiments on the tables and this would have been good practice so that people could choose to flavour their meals. It also makes meal times a pleasant experience for people with homely items around them for their use. This was discussed with the manager as the condiments bought should be freely available on the dining tables as there are staff who offer support at lunchtimes if people do get into difficulties with the condiments’. We saw positive practices as staff asked individuals if they would like a piece of fruit after their meals. This shows that people are being offered fruit to encourage them to meet their ‘five a day’ recommended portions to maintain nutritious and healthy diets. The kitchen staff can cater for religious and dietary needs and for preferences. Also care plans for people with diabetes were viewed and we found guidance for staff to follow, such as, ‘Diabetic, no sugar and or sweeteners. Fruit and vegetables daily’. There is information for staff to follow in relation to what could be the causes of any hypoglycaemia due to diabetes. Also triggers and awareness of treatment with a flow chart. People told us: Food is nice you get a choice”. “Food is very good. Staff told us:Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 20 “Food is good and fruit is always offered now”. “Food is tasty and residents can have choices”. Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People using the service experience good quality outcomes in this area. Some people are happy that their concerns are listened to and taken seriously. Others may need more support to ensure that any concerns they have are raised and dealt with. Residents now feel safe in their home and are generally protected from abuse, neglect and self-harm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: It is confirmed in the AQAA by the acting manager that six complaints have been received in the last twelve months. We were told by a person who lives in the home that prior to the present manager coming to work at the home people were afraid to raise any complaints with staff. The acting manager has now got an ‘open door’ policy and we were told that any complaints raised with the manager are taken seriously whatever they are and actions are taken to resolve the issues for each person. Also by the front entrance to the home it was good to find comment cards so that people can leave comments and or suggestions to improve the service offered. This shows that there is now an open ‘complaints culture’ that has been developed by the acting manager who states in their AQAA, ‘The home must learn from complaints and look at ways of improving the service to prevent further matters being raised’. Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 22 We have received some notifications of safeguarding referrals. Meetings have taken place with relevant professionals included in these, such as, social workers, police and so on. This makes certain that investigations have taken place and any actions put into practice to ensure vulnerable people who live at this home are safeguarded from harm. The training matrix informed us that staff had received training in the protection of vulnerable adults from abuse. They were also able to show their understanding of relevant issues and of the importance of reporting any incident of actual or suspected abuse. Sampling of staff records showed that appropriate checks had been carried out with the Criminal Records Bureau (CRB), to ensure that people were fit to be employed. We were told that people who live at this home now feel valued and safe which has only changed since the acting manager commenced their employment at the home. We shared this with the acting manager and deputy manager on the day we inspected as it shows that the management team has worked hard at promoting the safety of people who live at Gold Hill. Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 25, & 26. People using the service experience adequate quality outcomes in this area. Some areas of the home continue to be in need of attention, so that people can enjoy living in a house that is well maintained, comfortable and safe. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A tour of the building was completed. At the time of the last inspection, a number of issues were highlighted as needing attention. We found that the damp in the laundry has now been repainted, the flooring has been replaced in the kitchen and the broken sash window in one of the rooms has been repaired. Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 24 Some of the people’s bedrooms were seen. Though individual, with personal possessions and effects in evidence, these continue to look “tired” and in need of redecoration as was the case at our last inspection visit. We saw holes in one persons room which need filling and this was echoed by the person themselves when they were showing us their room. Some of the bedroom furniture has been in the home for a great many years and is chipped and worn, with some wardrobes having pieces of odd plain wood on the bottom where they have been repaired. All staff spoken with and the management team agree that bedroom furniture does need replacing and this has been started in one bedroom that we looked at which is vacant. It has to be acknowledged that none of the people who lived in the home complained to us about their furniture. A person who lives in the home showed us their bedroom where they have purchased some furniture themselves, such as, a settee and chairs, wardrobe and side cabinet. However, it needs to be noted that this individual is a more able person. We were told that management and staff do not always seem to actively promote people bringing their own furniture into the home when they come to live there. We did discuss this with the acting manager as something that could be encouraged when people come to live at the home. If individuals are not able to fully discuss their own furniture then this should be done with relatives and or representatives. Although, in some rooms we did see that some individuals have brought in certain pieces of furniture to make their rooms more homely and comfortable. As we mentioned earlier redecorating and purchasing new furniture in all of the bedrooms has been outstanding in earlier inspection visits. We therefore now strongly recommend that the provider continues to purchase furniture and redecorate individuals rooms as a priority to make certain people are able to live in a well maintained home which is safe and comfortable. These improvements could provide excellent opportunities for individuals to be involved in choosing colours and ornaments/decoration, making their home more personal and enhancing their sense of “belonging”. As previously stated, it should be acknowledged that the acting manager has not been in post long enough to take up all of these matters and we were told that other major necessary work has been completed in the home. We were also shown a business plan and audit of the environment that has been completed by the acting manager. It states that all redecoration and new furniture should be in place by the end of 2010. This should make certain that all areas in the home that now require attention are made a priority and improvements take place for the benefit of the people who live in this home. We will certainly look at the environment when we next inspect to see if the date in the business plan is adhered to. There are two lounges, a conservatory and dining area, in which people can socialise and relax. These were comfortably furnished but again in places some redecoration and carpets needed replacing which will ensure that the home is clean and well maintained. For example the doors in the dining room are Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 25 looking dirty with the passing traffic of people who pass through this area. However, the dining room is spacious, enabling people to access all parts without difficulty. Some of the stair carpets are old and stained which was also the case at our previous inspection visit. There is a passenger lift to access all floors which is working, which was not the case at the last inspection. There are lots of ornaments and personal touches throughout. There is ample room for indoor activities to take place. Following the last inspection it was noted that the conservatory which is placed next to the dining room is the dedicated smoking area. We observed this to be well used by individuals who chose to smoke. It did cause the dining room to smell of smoke and this was noticeable on peoples clothing who had spent some time in the dining room as the inspector did. However, we were told that none of the people who lived in the home had ever complained about this. We asked some of the people who live in the home about the smell of cigarette smoke in the dining area and they said that it did not bother them at all. Staff did make sure that there was ventilation at all times and the doors from the dining room to the conservatory remained closed. This situation needs reviewing and monitoring to make sure it does not effect people’s enjoyment when sitting in the dining room to have their meals. Therefore we recommend that it is an ongoing agenda item at resident and relative meetings. It was obvious that for some people the conservatory was a sanctuary where they could smoke and for some individuals there would be some difficult behaviours expressed if they could not access a dedicated smoking area. Outdoor space is a particularly good feature of the home for people who live there. The rear garden has been improved and very well maintained, and it is accessible for all whatever their abilities. The grounds are well kept and have lawns and borders. People who live in the home and staff spoken with said they enjoy sitting out in warmer weather. A person who lives in the home tends to flowers and another person looks out of their patio doors to watch the wildlife as they grew up on a farm. This goes some way to promoting individuals sense of well being. The external exterior of the building needs some attention in rendering and painting it as it looks tired and not cared for. This again reflects that the provider does need to progress work so the home projects an image of being well cared for and maintenance is ongoing for the people who live at Gold Hill. Assisted bathing, toilet and washing facilities are situated on each of the two floors and within easy access of the communal areas. Some of the bedrooms have en-suite facilities, which enhance the privacy of individuals. These facilities meet the needs of those people who require staff assistance. They were clean and odour free. Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 26 Aids and adaptations were seen to include raised toilets, hoists, an emergency call system and these enable staff to support people in a safe and suitable manner. The equipment seen was suited to meeting the needs of individuals. There are dedicated staff to undertake cleaning and laundry. The AQAA informs us that 31 staff have received training in infection control. We did not observe any staff practices that would indicate that people living in the home were not safeguarded from infection control practices employed. However, as mentioned earlier the dining room doors looked dirty and we communicated our views about this to the acting manager at the time of inspection. Also the environmental health officer as visited the home on the 20th March 2009 and awarded four stars which is very good in relation to the staff overall hygiene practices. Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. People using the service experience good quality outcomes in this area. Improvements have been made in the arrangements for staff supervision, training and development. This is to ensure that staff have the support, knowledge and skills they need in order to do their jobs well, for the benefit of the people in their care. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There are currently thirty-one people living at the home and the AQAA confirms that there are twenty-three care staff employed by the home. We looked at a sample of the staffing rotas. There are three day time shifts and a night shift. There are always three waking staff working at night and four staff during the day which includes senior staff. One member of staff told us that they feel the individual needs of people living in the home are met in a timely manner. Therefore in the main staff felt there were sufficient levels of staff on duty at all times. Staffing levels at the home are maintained to meet the needs of the people living at the home. The rota was seen for the month and shows that agency staff are not employed which promotes consistency of care for people living in Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 28 the home. The acting manager normally works Monday to Friday and there is always a deputy manager on duty, senior carers and carers. Robust recruitment procedures safeguard the people living at the home. We sampled the files of three members of staff and all the relevant checks had been carried out prior to the staff members starting work at the home. New staff undergo an induction programme and work with a more experienced staff member until they feel confident to work on their own. The culture and gender mix of the staff team reflected the culture and gender mix of the people living at the home so that care is provided in an understanding way. For example there are seventeen female members of staff with six male staff which is confirmed in the AQAA. From talking to staff and observing them during the day we could see that staff morale was good, and the interaction with the people living at the home was good. Comments from people living at the home included: “The staff are very friendly and welcoming and always make time to talk to us” “I like it here very much, the staff are very friendly, I am well cared for” Questionnaires completed by relatives told us:‘I feel that X is well cared for’. ‘Very friendly and caring staff. Nothing too much trouble’. ‘All staff are very caring and helpful’. ‘The regular faces of the nursing staff as relatives like to build up a relationship with regular staff they trust in and care for them’. Staff spoken to said that there was a good staff team at the home and they all worked well together to achieve the best outcomes for the people living at the home. Comments included: “It is a very busy home but we work well as a staff team”. “We have lots of training and find it very useful”. “We have regular supervisions and staff meetings, and are able to discuss any issues or problems”. The staff training and development programme at the home has now improved. The AQAA confirms that twelve members of staff have achieved their National Vocational Qualification, (NVQ), Level 2 in health and social care. This just exceeds the standard of 50 so we would encourage the progression of further staff in completing their NVQ Level 2. The training matrix also confirms that generally staff have been maintaining their mandatory training in health and safety, POVA, (Protection of vulnerable adults), COSHH (Control Of Substances Hazardous to Health), moving and handling, infection control, food hygiene, safe handling of medications, fire training and basic first. Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 29 It was good to find that some staff have received specialist training in order to meet individuals needs, such as, in bereavement care, stoma care, challenging behaviour, Mental Health Act which includes DOLS, (Deprivation of Liberty standards, this ensures that each persons rights are met), diabetes, optical awareness, palliative care, nutrition and health, falls prevention, continence, diabetes, epilepsy and challenging behaviour. This shows that the acting manager is now being proactive in providing staff with appropriate training. This goes some way to ensuring that people living at Gold Hill can feel confident that the care and support they receive is provided by a skilled and knowledgeable staff group. The acting manager confirms in their AQAA, ‘Staff have embraced all training offered to them, which has built their confidence and provided them with skills that will benefit the care they provide to the service users’. As mentioned earlier recruitment practices in the home are robust. Staff files have been audited since our last inspection visit to make sure that all appropriate background checks for staff are in place so that only people that are suitable to work with vulnerable adults are employed in the home. Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 30 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 &38. People using the service experience good quality outcomes in this area. Improvements have been made in all areas of practices within this home to ensure peoples health and safety. The management team now needs time to continue with the improvements that are outstanding together with sustaining those that have been made so that the home is run in the best interests of the people who live there. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Julie Barraclough is the acting manager of Gold Hill and has been in post since September 2008. Ms. Barraclough is not registered with CQC (Care Quality Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 31 Commission) as the manager of Gold Hill but has told us that their application is progressing through the necessary procedures that are required. It is recommended that the acting manager actively continues to pursue their application to be the registered manager of Gold Hill with CQC to show their commitment and provide some stability to people who live at the home. In their AQQA the acting manager has told us that they are currently completing their NVQ Level 4 in leadership and management and at the time of the last inspection visit the acting manager confirmed their intentions to complete it by the end of this year. This will ensure they have gained further skills and knowledge to provide effective leadership in a care home. Two experienced deputy managers assist and support the acting manager with the development of the improvements within the home. Staff feel well supported by the management team. Comments from staff included: “I enjoy working here very much, the manager is very supportive” “Things are now improving with the manager in place”. The acting manager told us that they are extremely proud of their staff. They are determined to show their commitment and dedication to improving all practice areas together with the environment to provide good outcomes for the people who live at the home. This is important as we were told that people living in this home did not feel valued as human beings by practices that were being allowed to happen prior to the acting manager commencing their role within the home. One person told us:“It is now paradise here and it is due to the manager”. We were told that regular staff meetings take place and staff are encouraged to make any additions they would like to see to the agenda. There is a well-planned staff supervision programme in place, with monthly supervisions taking place. The supervision sessions are well documented, and cover all areas of care practice, policies, standards of care, and identify staff training and development needs. This further safeguards the people living at the home by ensuring that staff have the skills, knowledge and support they need to meet people’s needs. Resident and relative satisfaction questionnaires are sent out. We found an evaluation of questionnaires dated October 2008. The overall results show that people living at the home are satisfied with their care. Residents meetings also take place and we found that people living in the home were complaining about their laundry going missing and being found in other people’s wardrobes. On the day we visited some people also confirmed this to us. The acting manager has researched and now found some small tags that are able to be placed on individuals clothing which should ensure all laundry Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 32 will be returned to the right individuals. We were shown a photograph of these tags which were small and discreet which should resolve the complaints from some of the people who live at Gold Hill. This is another example that shows that the acting manager is determined to action and values all complaints of dissatisfaction to reach good outcomes for people at Gold Hill. There is a well-planned staff supervision programme in place, with monthly supervisions taking place. The supervision sessions are well documented, and cover all areas of care practice, policies, standards of care, and identify staff training and development needs. This further safeguards the people living at the home by ensuring that staff have the skills, knowledge and support they need to meet people’s needs. The home has a quality assurance system in place to monitor the quality of the service being provided. Unannounced visits are undertaken by a person who is nominated by the provider and these normally happen on a monthly basis. Reports document these visits and we sampled some of these. They informed us that people living in the home are spoken with and staff. Samples of care plans are checked and the environment is inspected. For example on the visit undertaken on the 16th May 2009 it told us that flooring in the kitchen had been replaced and three bedrooms had been decorated. Prior to the inspection the acting manager had completed the Annual Quality Assurance Assessment (AQAA) and this gave us details about the service provided, how it had improved and how the home wanted to improve further over the next year. The manager had a clear vision for how the home could move forward and this should ensure a proactive rather than a reactive approach. Accident records were reviewed and these were in line with the Data Protection Act. The management team informs us of accidents and injuries as required by law. Reports of accidents involving people living in the home are completed, and appropriate actions are taken following accidents to ensure good outcomes for the individual. We did not inspect any personal monies that are held for people who live at the home on this occasion. However, we were not informed about any concerns but these will be inspected when we next inspect the home. Records of servicing, tests and maintenance in respect of health and safety for utilities, appliances and equipment such as fire, emergency lighting, passenger lifts and hoists are well maintained. Water temperatures are checked so this should ensure that the potential for scalding is minimised. As mentioned throughout this report a number of improvements to the service have been made, such as, reviewing care plans, monthly audits, staff training, consistency in supervisions, staff and resident meetings. The acting manager Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 33 has empowered staff to take a pride and responsibility in their jobs, making staff aware of their roles and informing them of the role of the CQC. Also as mentioned earlier, importantly people who live in this home now feel valued as human beings and safe as prior to the acting manager coming into post we were told this was not the case. Now the acting manager needs to progress the redecoration and furniture replacement that continues to be outstanding as mentioned earlier in this report. We are confident that the acting manager will make certain that further improvements are made to ensure these are then sustained in everyday practices for the good of the people who live at Gold Hill. Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 34 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 2 X X 2 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X X X 2 Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 35 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The service should consider ways that it can make information about the service more accessible for people with different needs and impairments, so that all people interested in using the service are well informed. Consideration should be given to providing all of the latest key inspection report within the service user guide so that people are able to choose to read which section s of the report they may be interested in. Consideration should be made to care plans being signed and dated by individuals, family members and or their representatives to reflect people’s agreements with care that is going to be provided. Consideration should be given to daily documentation which shows what tasks have assisted each person with throughout the day which include any personal care tasks to make certain staff are following the guidelines in the care plans and this is also used to inform any reviews. DS0000018654.V377186.R01.S.doc Version 5.2 Page 36 2 OP1 3. OP7 4. OP7 Gold Hill Residential Home 5. OP7 6. OP10 7. OP11 8. OP14 9. OP15 10. OP24 11. OP31 12. OP31 Care should be taken to ensure that any changes and or additions to care plans in the long and or short term should be dated so that these can be clearly identified, reviewed to also show when any care provided is commenced and finished so that people can be confident that they will receive the right care, support and assistance at all times. Care should be taken to ensure that peoples wishes in respect of gender care preferences is always noted within their care records so that all intimate personal care is assisted and supported as people would choose. End of life care plans should be drawn up with the individual, family member and or representatives. This will make sure that at this important time in people’s lives they can be reassured that the care and support they receive is what they chose with their wishes respected and followed through. To consider replacing the condiments back onto the dining tables so that people are able to enjoy a pleasant experience at mealtimes with familiar homely items around them. To monitor and review the designated smoking area in the conservatory through residents and relatives meetings so that any issues can be ‘picked up’ in a timely manner. For example, ensuring that this area of the home is a standing item on the agenda which will encourage and support all people to have ‘their say’. This can then be examined at times of inspection and for auditing purposes. To continue with the redecoration of the home to include peoples rooms, furniture and carpets so that people can be reassured that they live in a well maintained home that is comfortable. The acting manager must continue to progress their application to be registered manager of the home with CQC to demonstrate their commitment to providing commitment and stability for the benefit of residents and staff. The acting manager must continue to pursue all training courses that will provide them with the knowledge and skills required to manage a care home, such as, NVQ Level 4 in leadership and management. Gold Hill Residential Home DS0000018654.V377186.R01.S.doc Version 5.2 Page 37 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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