Care Home: Gorseway Lodge Nursing & Residential Care Home

What the care home does well Gorseway Lodge provides a clean pleasant environment for the people who live in the home and the house is surrounded by well maintained landscaped grounds that the service users can wander about freely. The home employs a complement of staff, some of whom have been at the home for some years and this affords continuity of care. Staff surveys told us that, `I have worked at the home for 16 years and there have been big changes over the years but we look after the needs of the elderly very well`. `I have the experience and the knowledge but not always the support`. `The home is kept clean and the service users have entertainment`. `The standard of care we deliver is very good`. `The diet is good and the general hygiene and well being of the resident is good`. `The home takes care of the needs of the residents to the fullest of the staff`s ability and provides them with a very homely atmosphere in which to live`. Service users surveys say, `The home gives excellent care`. `Good food`. `Overall the home is very good and the staff are caring and helpful`. `The staff are very attentive`. The home provides a varied activities programme that is planned on a monthly basis and a copy of which is given to all service users to consider. The chef provides a varied and nutritious menu which demonstrates a choice of menu at every meal time. Service users told us the food is `excellent`. What has improved since the last inspection? The manager has gained her registered manager`s award and now has a deputy manager in post, who she considers has supported her and the staff a great deal and allows her to undertake more of her managerial role. The manager now holds regular meetings with the residents at which time any issues or suggestions are heard and discussed. A training plan from Guiness Care and Support is now is place for all staff. An appraisal and supervision programme has been arranged for all staff. New carpets have been put down in the lounge areas and new furniture purchased for the dining room. The kitchen. laundry area and reception has been redecorated. There is now an annual development plan for the home that has identified what is achievable for the home in the next year. A new system has been introduced for the management of medication and the local pharmacist supplies medication in the blister packs. What the care home could do better: Care plans should be more person centered and have evidence that the service userhas been involved with the planned care, if they are able to be. There should be an indicator or written description of how effective the planned care has been. Recruitment practices must be made more robust. The manager is responsible and must ensure that staff do not commence employment until she is satisfied that all the appropriate checks, CRB, POVA and references have been received before the job start date is agreed. It is recommended that service users` past social histories and recreational preferences be recorded as part of the assessment to enable their recreational activities in the home to be planned around these areas of interest and which may stimulate memory especially in those with a dementia illness. Evidence must be recorded that either cosent or discussion has taken place with the service user or their representative with regards to the use of bedrials. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Gorseway Lodge Nursing & Residential Care Home 354 Seafront Hayling Island Hampshire PO11 0BA     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: Janette Everitt     Date: 1 9 0 5 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 38 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Gorseway Lodge Nursing & Residential Care Home 354 Seafront Hayling Island Hampshire PO11 0BA 02392466411 01252612539 jmcdonald@gorseway.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) : Gorseway Care Limited care home 60 Number of places (if applicable): Under 65 Over 65 60 0 old age, not falling within any other category physical disability Additional conditions: 0 60 The maximum number of service users to be accommodated is 60. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Physical disability (PD). Date of last inspection Brief description of the care home Gorseway Lodge is a purpose built care home for service users in need of nursing care. The home has 4 NHS GP beds that are used for a maximum of 2 weeks. There is a strict criterion for referrals for the use of these beds to ensure that they are within the conditions of registration of the Home. Gorseway Lodge is situated in the Gorseway complex, which is adjacent to Hayling Island beach and local amenities. The meals for the companys other home, Gorseway House, are prepared and cooked at Gorseway Lodge. The laundry facilities provide for both Homes. The home has been extended to accommodate a total of 60 service users and provides en-suite facilities in all rooms. Care Homes for Older People Page 4 of 38 Brief description of the care home Fees are between £600 -£640 residential care only £700-£850 nursing care £650-£700 respite care Care Homes for Older People Page 5 of 38 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: This report details the evaluation of the quality of the service provided at Gorseway Lodge and takes into account the accumulated evidence of the activity at the home since the last inspection, which took place in June 2007. For the purpose of this report the commission will be referred to throughout at we. The site visit inspection to Gorseway Lodge, which was unannounced, took place over a one-day period on the 19th May 2009 and was attended by one inspector who was assisted throughout the visit by the registered manager Mrs. McDonald. An Annual Quality Assurance (AQAA) had been completed by the home following the last inspection visit and information from this and the last inspection report was also used to inform this report. Care Homes for Older People Page 6 of 38 Evidence for this report was obtained from reading and inspecting records, touring the home and from observing the interaction between staff and users of the service. During the visit we spoke to a number of residents both in their bedrooms and in the communal areas, and also spoke to members of staff on duty at the time. In order to prepare for the visit, surveys were sent to the people living in the home, staff and other professionals involved with the home. Sixteen (16) service users, twelve (12) staff and one visiting professionals surveys were returned and most comments were positive about the care, staff and environment. The general issues raised in the surveys are discussed in the main body of the report. There was positive feedback from the visiting health professional. The home is registered to provide support for 60 residents and at the time of the inspection there were 42 people in residence. What the care home does well: What has improved since the last inspection? What they could do better: Care plans should be more person centered and have evidence that the service user Care Homes for Older People Page 8 of 38 has been involved with the planned care, if they are able to be. There should be an indicator or written description of how effective the planned care has been. Recruitment practices must be made more robust. The manager is responsible and must ensure that staff do not commence employment until she is satisfied that all the appropriate checks, CRB, POVA and references have been received before the job start date is agreed. It is recommended that service users past social histories and recreational preferences be recorded as part of the assessment to enable their recreational activities in the home to be planned around these areas of interest and which may stimulate memory especially in those with a dementia illness. Evidence must be recorded that either cosent or discussion has taken place with the service user or their representative with regards to the use of bedrials. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 38 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Records show that pre-admission assessments are carried out to ensure that the home can meet individual needs and potential service users are encouraged to visit the home prior to moving in. Evidence: The AQAA states that prospective service users are invited to visit Gorseways Lodge and have a trial stay before any decision is made about their admission. Trained personnel visit the person to undertake a full assessment to ensure the home can meet their needs. All service users are given a contract and statement of terms and conditions for the home on their admission. A sample of four service users pre-admission assessments was viewed by us. These evidenced that the assessment covered all aspects of their physical, emotional, mental Care Homes for Older People Page 11 of 38 Evidence: and spiritual needs, although the assessments did not contain a great deal of detail in each section the assessing person had completed a detailed analysis of the persons needs on a separate record. The manager told us that she, her deputy or senior registered nurse will undertake the assessments in a persons home or, more often than not, in the clinical area. If the assessment is done in a hospital, further information is gathered from records and an information sheet accompanies the person when they are transfered to the home. Information is also gathered from care managers, if they are involved in the admission. The assessment and information gathered allows the assessing person an overview of the potential service users care needs. There is sufficient information available for service users to make an informed choice about whether they would like to live in the home. Service users receive a welcome pack on their admission and this includes all the information about the home and includes the complaints procedure. The service user surveys and comments received from residents about their admission to the home would indicate that for many of them the arrangements for their residency had been undertaken by close family and in general they were very satisfied with their placement. The surveys also indicated that the service users considered they had received sufficient information about the home prior to their moving in. Surveys also told us that for some residents they had lived in the flats on site before they decided to move to the residential home. At the time of this visit there was a prospective service user looking around the home. The manager said that some people come in for a period of respite care with a view to taking up permanent residence. A service users spoken to told us that she had moved from another area and left it to her son to find a suitable home. She said the senior nurse had visited her in her home and she had given her all the information about Gorseways, and she in turn had asked lots of questions about the home. She had now lived at the home for four years and was very happy there. The home has one allocated GP bed that is left available for people who may need an emergency respite care stay, or a period of assessment with a view to remaining in the home on a permanent basis. The home does provide care for those who need a period of care and support before going home following hospitalisation and if necessary therapist visit the home to aid rehabiliation but this is funded by the person privately. Care Homes for Older People Page 12 of 38 Care Homes for Older People Page 13 of 38 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. The home ensure that the health and care needs of the residents are met in a way that respects their privacy and dignity. However the care planning system is not person centred and there are short falls in recording risk assessments and evaluating care. Evidence: The AQAA tell us that each service user has an individual care plan documenting their personal needs for activities of their daily living and these are updated and evaluated regularly. The AQAA also tells us that the home is reviewing the care planning system with a view to adopting another more person centered system. A sample of five service users care plans was viewed by us. The care planning system being used currently is not person centered. Risk assessments are undertaken but not consistently for all problems. An example of this was one person had been assessed as being at high risk nutritionally and the dietitian had visited and documented the care plan to manage that risk. Conversely on another service users assessment it said that Care Homes for Older People Page 14 of 38 Evidence: they were unable to move independently but there was no moving and handling risk assessment to identify the level of risk nor a care plan documented to describe how this persons moving and handling needs could be met. It was observed that in each service users en-suite bathroom there was a tick list indicating the service users for moving and handling needs but this only identified if one or two carers were needed or if a hoist was required for moving them. There was no specific person centered description of what and how that persons moving and handling needs could be met. We also identified that the initial assessment to identify needs did not document any mental, emotional or mood assessments nor care plans to manage any challenging behaviours. There was no evidence of social histories or social aims and needs being recorded. The manager said that at inimical assessment they try to document as much social history as possible but acknowledged that a more detailed information about their social history needs to be captured, taking into consideration that many of the service users have a degree of dementia and may be unable to communicate their needs. It was observed that the care plans are not evaluated to record how effective the planned care has been for the service user. The care plans were reviewed monthly and document no change every file viewed. Daily records were in place but could be improved by more detail being recorded to assist with continuity of care. In many instances phrases such as all care given or care plan followed were all that was recorded. This was discussed with the manager, who said that she would ensure that this was improved and would be communicated to the care team. Some of the care plans do describe the service users preferences of how they like to undertake their daily routines and likes and dislikes with food. The manager told us that service users may spend their time how they wish and that they have no rigid routines with regards to their daily lives. Service users spoken to told us that they can come and go as they wish with some telling us that they prefer to eat in their rooms, others saying they prefer not to join in the activities as they like their own company. There was no evidence in the care plans of service user or relative involvement with the planning of care and this was discussed with the manager as to how this could be recorded. Service users spoken to on this visit and the comments on the surveys returned to CQC told us that service users feel they receive all the support they need and say. Staff are very attentive. Excellent care. As I have deteriorated my care has increased. The staff are so good. Care Homes for Older People Page 15 of 38 Evidence: It was noted that for service users who were using bedrails when in bed, a risk assessment was recorded and signed by the nurse but there was no evidence of consent from the service user or records of any discussion with them or relatives as to the reason they were being used was in the best interests of the service users safety. The care planning system falls short of describing service users needs and how the needs are being met in a person centered way. This was discussed with the manager and she acknowledged that the system in out dated and not person centered. She and the manager from the sister home on site, are currently researching several other forms of care planning documentation, used in other homes, to enable them to gauge what is best for the Gorseways homes and will introduce this over the coming months. The AQAA says that the service users are registered with the local GP. Psychological health is monitored by the local community mental health team. Service users have access to hearing and eye tests, chiropody and other primary care professionals, as they are referred. The care plans demonstrated that a record is kept of every visiting professional and these are documented by the professional if possible and the outcome of the visit or any new treatment is recorded in these notes. We evidenced the records that had been documented by the visiting doctor, dietitian, the community mental health nurse and the speech and language therapist. A visiting GP returned a survey to CQC and this indicated that they were satisfied with the care delivered to their patients in the home and said,They are doing a good job right now and the service does well in all aspects. The AQAA states the home has recently changed their system for the management of medicating to blister packs and this is thought to be safer for service users. Medication policies and procedures have been reviewed. Medication audits are more regular and medication error form have been introduced to identify areas of ongoing improvement. The manager told us that a medication error had been reported to her that day and she was in the process of investigating this and reporting it. The error occurred whilst a nurse transcribed the wrong dose of a medication from information from the hospital onto a medication administration record (MAR) chart. She was adivced by us to write into policy that any medication being transcribed by a nurse must be checked and signed by a second member of staff as correct. This is seen as good practice. The medication system is the blister pack system and only registered nurses administer this.The trolleys and cupboards were looked in and these were clean and Care Homes for Older People Page 16 of 38 Evidence: well organised. There was no evidence of over stocking of the medication prescribed on an as needed basis (PRN). The controlled cupboard was of the type to meet the requirement of the Misuse of Drugs Act Regulations 2001 and this was evidenced to be storing controlled drugs correctly. The register was viewed and this demonstrated correct recording of the controlled medication being administered with a second staff member signing the register as evidence of this. The balance in the register matched that of the number of tablets being stored. The MAR sheets were examined and evidenced that medication being administered was being signed for appropriately. The manager said that at each drug round the administering nurse will check the records for the previous drug round and if there were gaps this is recorded on a reporting sheet as a medication error and given to the manager who will address the issue with the concerned staff member. It was observed that the morning medication was being administered by the night staff early morning. This was discussed with the manager as being outdated practice and that the night staff administering the largest medication round of the day after finishing a twleve hour duty, was putting servie users at risk of medication errors. The manager told us that she is under discussion with the staff to change the time of this medication round to be given at breakfast time. A comment by a staff member said, The service could do better by giving morning medication during breakfast rather than waking residents up and giving them medication whilst they are still lying in bed before 0800. Records were seen for the medications to be disposed of, for which the home have a contract with a waste disposal company. For those service user who were unable to communicate effectively there were no records in the care plans to inform why medication, prescribed for service user on an as needed (PRN) basis was being prescribed and what assessment should be made on whether the person requires the medication, if they did not have the capacity to make the decision or communicate their need. The trained nurse was observed to be administering the medication and she was following the appropriate procedures. One service user was self-medicating one of their medications and there was evidence that this was being undertaken within a risk assessment framework and the service user had signed the risk assessment to demonstrate his understanding and agreement Care Homes for Older People Page 17 of 38 Evidence: for managing the medication. The AQAA says that service users are treated with dignity and respect by a kind and caring team and are aware of treating everyone as an individual taking into account equality and diversity. Service users have their own bathrooms, are given a choice of what clothes they would like to wear and telephone phone installed in their rooms. This was supported by observation of practices throughout the visit. The staff were seen to being courteous and respecting service users privacy. They were observed to be knocking on doors before entering, except for one nurse who, whilst we were talking to a service user in their room, just came into the room without knocking to deliver the post. This was also noted by the manager who said she would talk to the nurse about this. Privacy screens are in place in all double rooms. The manager said that she has ordered privacy curtains that hang from the ceiling and go through the entire length of the room, which will be fitted as soon as possible. Care Homes for Older People Page 18 of 38 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the social activities creates a positive, varied and interesting life for the residents, which meets their expectations for living in the home The arrangements for meals ensures that the residents have a nourishing and well balanced meals that are taken in surroundings of their choice. Service users are encouraged to maintain contact with family and friends and make choices within their own activities of daily living. Evidence: The AQAA states that the home has employed an activities organiser for both the homes on site. The home has increased the hours of work that the activities organiser undertakes. The AQAA says the home has an excellent activities programme a copy of which is delivered to every service user monthly. External activities is taking service users to places of interest. Religious leaders are welcomed and service users are taken to the local Baptist Church regularly. The activities programme was viewed and demonstrated a variety of activities for Care Homes for Older People Page 19 of 38 Evidence: residents to choose from each day. The programme is delivered to all service users each month and they choose which activities they would like to participate in. Whilst visiting a service user in her room she showed us the activities programme and said she had identified the activities and outings she wished to go on that month and that she throughly enjoys the outings. Another service user told us that she had enjoyed the exercise programme that had taken place that morning and was looking forward to going out to the garden center for a visit that afternoon. She then described her outings and activities for the previous week and appeared to have a busy social life. The activities co-ordinator was in the home and showed us the records of what activities have been undertaken and who has participated in them. She described how she talks to the service users to find out what they enjoy doing and what they would like to do as activities and plans the programme around this information. It was suggested that she try to gather a social history of the service users and their past recreational past times which could be taken into consideration when planning specific programmes for those with dementia or who are less able to communicate. This in turn might enable those service users to participate in a familiar activity that may stimulate their memories. The manager told us that if a service user chooses not to join in group activities and prefer to stay in their rooms, the co-ordinator will visit those service users on a one to one basis and do an individual activity with them. The home also has outside entertainers who visit the home to provide music and singing and another outside organisation provides craft activities monthly. The home has the availability of two buses to take residents on outings. There are trips most week and the number of people going does depend on the number of people volunteering to accompany them to support them and push wheelchairs. A comment made on a survey said there are activities available providing there are enough pushers for the outside trips to push wheelchairs. There were a number of service users going out in the afternoon on the day of this visit and they were being accompanied by staff who had volunteered to give up their own time to escort them on this outing. Surveys returned to CQC from the service users indicated that there are always activities in which they can participate if they wish. Service users spoken to told us that there are activities going on most day. Service users choices and preferences of how they like to undertake their activities of daily living are recorded in the care plan assessment. They are encouraged to bring Care Homes for Older People Page 20 of 38 Evidence: with them to the home their own personal belongings of choice to personalise their own rooms. The AQAA says the home has open visiting arrangements and provide areas for privacy. The AAA says they encourage the service users to recognise the importance of personal and social relationships. The manager told us that there are no restrictions on visiting and that friends and relatives are made welcome at any time. Service users spoken with said they have visitors quite regularly. The visitors book evidenced that there are regular visitors to the home each day. The AQAA says that the home ensures that service users receive a healthy varied diet in pleasant surroundings. The home has two dining rooms but the dining room on the ground floor is generally used by most of the service users. Some service users have chosen to stay in their rooms for meals. One resident spoken with said she used to go to the dining room but she now feels she is unable to do so as she finds it difficult eating without being messy and it embarrasses her and others, but she does not mind being in her room as she can take her time with her meals. The manager told us that service users can take their meals where they choose to do so. The dining room was observed to be pleasantly decorated and furnished and overlooked the gardens. The menus demonstrated choices of food at every mealtime and service users food dislikes and likes were documented on the assessment documents. The home provides the residents with a weekly printed menu that was varied and gives them choices as every meal time.The menu plan was viewed for the week and looked to be nutritious and catering for a variety of tastes. The chef now plans all the menus and comments made by service users at the committee meeting in relation to menus and food issues, are acted on. At one residents meeting is was reported that residents with diabetes did not consider there was enough choice in their diets. This has now been addressed and the manager has arranged training with a dietitian to give advice to the chef on alternative diets. The lunchtime meal was observed. The meals are served from a hot trolley and served out by the chef in the dining room. There was a choice of at least two main courses. One service user told us that she was looking forward to the Chinese option on the menu. Service users spoken to said they enjoyed the food one commenting it is excellent. Surveys returned to CQC indicated that the service users consider the meals to be good with comments on some saying, Good food is served. The food is excellent. Care Homes for Older People Page 21 of 38 Evidence: Drinks and snacks are available throughout the 24 hour period as the last meal of the day is served at 1700, which leaves a long gap between supper and breakfast time the next day. The chef bakes cakes most days and this is served with tea in the afternoon. The care plans evidenced nutritional risk assessments are undertaken on residents and for one resident identified as at risk, a care plan had been written to manage the risk and regular weights were being monitored. It was observed that weights were recorded regularly in the service users care plans. The manager told us that she in introducing a new nutritional assessment tool as part of the new care planning system. The kitchen was visited and was clean and well organised. Recommendations made from the Environmental Health inspection had been complied with and they had visited the home to ensure compliance. There was evidence in the training records that all kitchen staff have undertaken the relevant food handling and hygiene certificates. The manager told us that the systems and equipment in the kitchen is being audited and a report produced. Care Homes for Older People Page 22 of 38 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. Procedures are in place to ensure service users are confident their complaints will be heard and acted on. Service users are protected from abuse by the policies and procedures that are followed in the home and staff training. Evidence: The home has a complaints policy that has been reviewed and is included the Welcome Pack that all residents receive when they go to the home to live. It is also contained in the service user guide. The AQAA records that 6 complaints have been received in the past year, 2 of which had been safeguarding issues. The complaints log was viewed and was observed to be recorded in detail with outcomes from the complaints documented. The surveys returned to CQC from service users told us that people are aware of who to go to if they are not happy and they wish to complain. Comments on surveys said I would ask my daughters as they have been shown correct procedures. We have a residents committee and the home manager attends the meetings and takes our Care Homes for Older People Page 23 of 38 Evidence: complaints which she does her best to act o. We have regular meetings with the manager to discuss any problems. My daughter would take up any issues with the manager. A service users spoken to at the time of this visit told us that: I know I can go to anyone with any problems and at the residents committee meetings we can have a moan or discuss issues openly. The home has policies and procedures in place for the safeguarding of vulnerable adults. All care and anciliary staff have attended training for the protection of vulnerable adults (POVA). It was observed that the training certificates were displayed on the walls of the housekeepers work room and evidenced that all house keeping staff had attended this training. POVA training initially takes place on the induction programme and this was evidenced in the induction programme seen. POVA update training will be provided by the organisation every three years. We discussed with the manager the two safeguarding issues that have been reported in the past year. One has been resolved satisfactorily and the other is in the process of being resolved. Correct procedures have been followed and the outstanding issue is now an internal issue for the organisation to deal with through their disciplinary procedures. Staff are checked with the Criminal Records Bureau and the Protection of Vulnerable Adults register. This is not consistently received before the start date and is discussed in the staffing section of this report in more detail. Care Homes for Older People Page 24 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Gorseway Lodge provides a safe, comfortable, clean and hygienic environment for the people who live there. Evidence: The AQAA states that Gorseway Lodge provides a good standard of accommodation that is comfortable and homely for the people who live there. The building is purpose built and is over two floors with each room having en suite facilities. There are a number of double rooms, two of which are used by married couples. We toured the building and talked to service users when visiting them in their rooms. The home was observed to be very clean and comfortable and many rooms had a double aspect looking out onto the lovely surrounding landscaped grounds and large fish pond. The garden has patio areas with tables and chairs and service users told us that they enjoy sitting in the garden in the better weather and really enjoy going for walks in the garden if there is someone available to push their wheelchair. A comment on a service user survey said They need more staff to push residents about the grounds. The site employs a gardener who has worked in the gardens for many years and has Care Homes for Older People Page 25 of 38 Evidence: maintained them to a high standard. Service users spoken with as we walked around the home told us that they were very happy with their rooms and the environment, some saying they felt fortunate to be in a room with such a lovely view over the gardens. Corridors are wide and service users who are able to be independent in their wheelchairs, are able to self propel themselves to any area of the home they have access to. The two homes on site have a maintenance team on site and there is a programme for routine maintenance and repair. The manager told us that the home is in the process of being refurbished. New furniture has been purchased for some areas of the home and other furniture for bedrooms is on order. All rooms are gradually being redecorated and service users are being asked at the residents meeting, their preferred colours for their rooms and are being involved with the refurbishment. The manager showed us the refurbishment programme for the coming year that has been approved by the organisation. This demonstrated that all rooms are having new curtains and bed spreads and a quote for these was seen by us. The programme of refurbishment includes all new carpets and some new carpet has been put down in the lounge areas. Two shower or assisted bathrooms are being created to accommodate the more disabled service users who are unable to use the en suite facilities because the necessary equipment cannot be accommodated in the small area. Some of the smaller baths that were fitted in en suite bathrooms when the home was built are being replaced with walk-in showers. A comment on a survey returned to CQC said the en suite facilities are not entirely adequate and difficult to access the bath with a hoist, showers would be better. Other carpets were observed to be in acceptable condition and the home has a routine of regular carpet cleaning. The home has all adjustable beds in place and a number of profile beds. The manager told us that she is gradually replacing all of the older type hospital beds with profile beds but this will be done over time taking into account the cost of each bed. Pressure relieving equipment is in place for those who have been assessed as at risk of pressure sores and this is in the form of mattresses and cushions. The home has adequate moving and handling equipment in place and had just purchased two more hoists and Care Homes for Older People Page 26 of 38 Evidence: a weighing devise to fix to a hoist to enable staff to weigh the more disabled service users. The home employs a separate housekeeping staff group who attend the home seven days a week. The home was very clean and hygienic. House keepers spoken with said they had received health and safety training in the COSHH regulations and how to deal with toxic cleaning materials, infection control and the protection of vulnerable adult training. The home has a separate housekeeper for undertaking the laundry for Gorseway House, Gorseway Lodge and for some of the flats on site. The laundry was large and equipped with industrial type washers and dryers and was fit for purpose. All staff in the home have undertaken infection control training and this was evidenced on the training matrix.One registered nurse has been designated to be the infection control link nurse and she will link with the PCT infection control team to obtain updates on infection control and share the information with the staff. Staff were observed to wear gloves and aprons, which were observed to be readily available throughout the home. Care Homes for Older People Page 27 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers of staff on duty at any one time appear to be sufficient to meet the needs of the residents. The home provides training for staff to enable them to be competent to do their job. Recruitment practices of the organisation and home are poor and this leaves service users at risk. Evidence: Currently there are forty two people in residence. The AQAA says that staff work flexibly that allows for sufficient cover to support the delivery of care to service users. The staff rota was viewed and demonstrated that currently there are 2 trained nurses on duty, one for each floor throughout the 24 hours period, with 9 care assistants between the two floors in the morning period and this drops to 8 for the afternoon shift. Throughout the night there are 2 trained nurses and 5 carers between the two floors. The manager and deputy manager are supernumerary to these numbers during the day. Care staff do not have to undertake any of the domestic duties as a full housekeeping staff are employed. Staff survyes made comment that at times it is not about the number of residents but about their dependancy and needs. Comments on staff surveys said some service users need more of your time and therefore we need more carers to carryout everyday Care Homes for Older People Page 28 of 38 Evidence: tasks that need to be done. Due to less bed capacity staff levels have been reduced however no consideration is given that clients are now much frailer and more dependant. Comments on surveys returned by service users were generally positive about the staff but some comments were made saying. Between 1-2 pm it is diffcult to contact staff and care is not available reason is shortage of staff. There is very often a shortage of staff. Need more staff to push service users in wheelchairs to go out and there is not enough carers. Dependency levels are recorded in the care plans once a month but not used as a guage for numbers of staff needed. The manager acknowledges that it is not always the dependency score but about the residents needs and she is looking to use a system for working out numbers of staff needed depending on the care needs of the service users. From observations of the morning, listening to response times of call bells and the general atmosphere of the home, would suggest that there were sufficient staff on duty at that time to meet the service users needs. Staff were observed to be giving time to service users and sitting with them and in one case a carer was sitting with a client, who was very anxious, giving her comfort and reassurance. The AQAA states that of the 39 carers in post 20 have achieved their National Vocational Qualification (NVQ) level 2 and above. The manager told us that the last group of carers will commence the NVQ training imminently. Care staff spoken with at the time of this visit confirmed that they are waiting to start their NVQ training and are well supported by the home to do so. Staff surveys returned to CQC indicate that the staff are receiving training that is relevant to their role and helps staff to keep up to date with new ways of working. The training matrix evidenced that staff have received mandatory training over the past year and other training associated with the needs of the clients they care for. The home has recently acquired a new management organisation called Guinness Care and Support, (GCS) although the parent company remains the same. Training is being centralised and a new training matrix produced. This is taking longer than anticipated and the home awaits a new training programme to be set up and this has resulted in the training not being consistent as the manager would have liked it. The AQAA says that it is hoped that GCS will provide corporate training on site to enable staff to attend more sessions. Care Homes for Older People Page 29 of 38 Evidence: The AQAA says the home will review the induction training and additional training sessions in order to remain in a strong position to ensure they are providing an excellent service to service users. The organisation has set up a new induction programme that is based on the skills for care induction standards, Currently there are no staff who are on this programme. The general induction to the home over three days is undertaken, at which time the new employee is familiarised with the home and clients and health and safety training takes place. They then shadow a more experienced person until they are confident in their role. Evidence of an induction programme was seen completed in one personnel file. The manager told us she has set up a supervision and appraisal programme, which has commenced with she and the deputy manager having undertaken appropriate training to appraise and supervise. She has also organised for other staff to undertake this training so that direct senior staff are appraising and supervision people they work with. There was evidence in the personnel files of one to one supervision records for some staff and training needs being discussed. However, because the programme of supervision is not fully operational, some staff do not consider they are being fully supported by the manager, the surveys returned from staff varied in their views of whether they consider they receive support from their manager and varied from saying never to sometimes. The AQAA says that all new employees are CRB and POVA checked. A sample of four of the more recent employees recruitment files was viewed by us. These evidenced that all the information stated on Schedule 2 of the Care Home Regulations had been obtained. However, when cross referencing dates of when CRB and POVA checks had been received by the organisation, two of the four files viewed evidenced that this was after their stated start date. Another recruitment file evidenced that the application form did not state referee names and addresses and when references were received it was after the person had commenced employment. Neither reference was from the previous employer. The person concerned had a long employment history of working in the care industry but neither reference was a professional reference. The poor recruitment practices were discussed with the manager who told us that all recruitment is undertaken from the human resource department of the organisation and the administrator in the home files all the records when they are returned to the home from that department. There was an assumption on the managers behalf that the information received is all correct when it is returned. It was established that it is the responsibility and Care Homes for Older People Page 30 of 38 Evidence: accountability of the registered manager to ensure that all newly recruited staff have CRB clearance, and at the least been POVA checked with two written references received, one being from the previous employer, before they commence their employment. If a POVA check has been cleared, that person may commence employment but must be supervised at all time until the CRB clearance has been received. The manager told us the organisation is in the process of re applying for CRB for all staff and will do this on a three yearly basis. Staff surveys returned indicated that the employer carried out all the relevant checks before they started working at the home. Care Homes for Older People Page 31 of 38 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 manager of the home is suitably qualified and ensures that the home is well run and that the needs of the residents are met Monitoring of practices and systems within the home safeguards the health, safety and welfare of residents, staff and visitors to the home. Evidence: The AQAA states that the manager and the newly appointed deputy manager are registered nurses with many years experience of management and caring. The AQAA says the both attend appropriate training sessions and workshops to keep their clinical and managerial skills updated. Mrs McDonald, the manager, told us that the deputy has a great deal of experience in working with the elderly in a care home and is a great asset to the home and a support to her. Care Homes for Older People Page 32 of 38 Evidence: The manager has been in post for two years and has gained the registered managers award. The manager told us that she is gradually making the necessary changes to improve the standards of care and the environment. She acknowledged that there are systems in place that need to be reviewed, for instance the care planning system, but she is working with the manager of the sister home towards this. She told us that she has made changes since her appointment and that the further necessary changes she will do gradually at a pace the staff can accept. Staff spoken to told us that Mrs. McDonald is accessible and supportive to service users, staff and relatives. The organisation Guiness Care and Support have distributed surveys to service users, relatives and staff. The outcomes have been analysed and reported on a graph format and indicate a high level of satisfaction in most areas of the service. The AQAA states that the home does listen to the needs and views of the service users and employees. The residents have a committee that meet regularly and the manager is invited to the meetings at which time they can discuss any issues and give suggestions about how to improve home life. Staff meetings are also held and minutes of this are kept. Other internal quality assurance takes place by the manager and head of housekeeping who monitors the cleanliness of the home on a daily basis. The manager has introduced a medication error reporting record that if medication has not been signed for or any other errors, a form is completed and she sees this on a daily basis and addresses any issues. All the homes policies and procedures have been reviewed. It is the policy of the home not to hold monies on behalf of service users and financial issues are dealt with by families or legal representatives. There is a locked facility in each bedroom for money and valuables. A sample of servicing certificates were viewed for equipment and systems. These were evidenced to be in order and current. The fir log was viewed and this demonstrated that all fire safety equipment and systems are checked at appropriate intervals and maintained. A fire risk assessment was in place and viewed by us. The records also evidenced that staff have fire training twice a year. Other mandatory training for health and safety, infection control and moving and handling are recorded on the staff training matrix. The organisations health and safety officer will visit the home to undertake an Care Homes for Older People Page 33 of 38 Evidence: environmental risk assessment. Care Homes for Older People Page 34 of 38 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 35 of 38 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 7 15 The registered person must 30/06/2009 ensure that risk assessments and care plans are written putting the person at the centre of the plan with evidence of their involvement. The plans must be reviewed at appropriate intervals to evaluate the effectiveness of the care plan and daily notes should be more descriptive as to how the care has been delivered. Care plans must be person centred and document service users care needs and how the service user wishes that care to be delivered. The plan must be reviewed to evaluate the effectiveness of the care delivered and to ensure that information is passed from one staff member to another to ensure continuity of care. Care Homes for Older People Page 36 of 38 2 19 19 The registered person must ensure that all appropriate pre-employment checks are received, as referred to in Schedule 2 of the Care Home Regulations, before employment commences. The employer must received the Criminal Bureau Record (CRB)check and the Protection of Vulnerable Adults (POVA) check and two written references before a person starts their employ to ensure the safety and protection of the service users 30/06/2009 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 9 It is recommended that, should there be the necessity for a registered nurse to transcribe medication onto a medication administration record (MAR) chart, a second person check the transcription and signs the MAR as evidence that this has been checked and transcribed correctly. Good practice would suggest that the manager considers changing the early morning medication round to a more appropriate hour to ensure that service users are not woken early moring to be given medication and to prevent the risk of medicaiton errors. It is recommended that the home attempts to record social histories of the service users to enable the activities to be planned around familiar and preferred recreational activities. 2 9 3 12 Care Homes for Older People Page 37 of 38 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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