Care Home: Gough House

What the care home does well Gough House continues to provide a homely, caring and supportive environment. Staff are dedicated to meeting the needs of people living in the home in a personal, Person Centred way. The opinions of people in the home are valued, encouraging independence and taking into account the need to respect dignity and privacy. Comments received about Gough House were very positive. Comments on the surveys were, `I am very happy living here the staff are very helpful,` `Generally it is a very caring home the staff are good and the food is good,` and `care staff are very skilled and experienced in looking after people living there so it creates an ethos of care for residents and warm welcome for visitors.`One resident spoken to said they felt `very well cared for and involved in the day to day running of the home.` Relatives indicated that they were very happy with the care provided. One commented that `The care given to residents is excellent and staff are very approachable all needs are met.` What has improved since the last inspection? Since the last inspection the new manager has taken up post and changes have been evident in the home. Staff are now dedicated care staff rather than domestic staff with some caring responsibilities. Residents spoken to said that the care they received from individual staff was very good. Issues raised at the last inspection have been met. All wardrobes are now secured to the walls to prevent accidents, paper towels and soap dispensers are provided in the communal toilets and staff are commencing regular supervision. Since the last inspection person centred care planning has been introduced and developed to meet the assessed needs of people living in the home. This shows an understanding of the right people have to continue to take control over their lives when they move into a care home setting. What the care home could do better: No requirements were made following this inspection. It is recommended that the manager commence the registration process with the Commission for Social Care Inspection. CARE HOMES FOR OLDER PEOPLE Gough House 13 Ellenborough Park North Weston Super Mare North Somerset BS23 1XH Lead Inspector Juanita Glass Key Unannounced Inspection 10:30 7 and 19th February 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Gough House DS0000008042.V358452.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Gough House DS0000008042.V358452.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gough House Address 13 Ellenborough Park North Weston Super Mare North Somerset BS23 1XH 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) 01934 622019 01934 419244 general-manager@abbeycarehomes.org.uk WSM Free Church Housing Association Vacant Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Gough House DS0000008042.V358452.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 16 persons aged 65 years and over requiring personal care only 10th February 2003 Date of last inspection Brief Description of the Service: Gough House provides personal care for up to 16 older people. The Registered Provider is Weston-super-Mare Free Church Housing Association. The General Manager is Mrs Pauline Harvey. The house is a distinctive building situated within easy walking distance of town centre, local parks and the sea front. There is a large lounge, with a baby grand piano, and a well-stocked library area. This room is used for daily prayers and a weekly church service. Although optional, the majority of service users choose to attend these services. A pleasant and homely dining room leads from the lounge. The large garden to the front of the property is mainly laid to lawn, with attractive planted borders. Ample seating is provided. There is private parking to the rear of the home. Private accommodation is provided in fourteen single and one double room. Eleven of these rooms have en-suite facilities. Although a chair lift is provided on the main staircases, there are several areas of the home, which would not be accessible to service users with impaired mobility. This is reflected in the statement of purpose and the service users guide. The current fee levels are between £356 and £378 per week. Gough House DS0000008042.V358452.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 service is 2 stars. This means the people who use the service experience good quality outcomes. This inspection took place over two days and a total of nine hours were spent in the home. To gather enough evidence to support our judgments for this inspection, we the commission asked the service provider to complete an Annual Quality Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people living in the home. It also gives us some numerical information about the service, and how they intend to maintain or improve outcomes for people using their service. We also looked at surveys returned to us by people living in the home and people with an interest such as relatives, social workers and GPs. We received 12 surveys, 5 from people living in the home, 4 from relatives, 2 from staff and 1 from a health care professional. Once we had received this information we carried out a visit to the home and spoke to people living there, staff and relatives. Whilst in the home we also looked at documents maintained for the day-to-day running of the service. These included care plans, staff recruitment, training and supervision. Also records relevant to the administration of medication, service records and health and safety. What the service does well: Gough House continues to provide a homely, caring and supportive environment. Staff are dedicated to meeting the needs of people living in the home in a personal, Person Centred way. The opinions of people in the home are valued, encouraging independence and taking into account the need to respect dignity and privacy. Comments received about Gough House were very positive. Comments on the surveys were, ‘I am very happy living here the staff are very helpful,’ ‘Generally it is a very caring home the staff are good and the food is good,’ and ‘care staff are very skilled and experienced in looking after people living there so it creates an ethos of care for residents and warm welcome for visitors.’ Gough House DS0000008042.V358452.R01.S.doc Version 5.2 Page 6 One resident spoken to said they felt ‘very well cared for and involved in the day to day running of the home.’ Relatives indicated that they were very happy with the care provided. One commented that ‘The care given to residents is excellent and staff are very approachable all needs are met.’ What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Gough House DS0000008042.V358452.R01.S.doc Version 5.2 Page 7 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 Gough House DS0000008042.V358452.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5. 6 does not apply Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People intending to live at Gough House benefit from sufficient information to make an informed choice, they are also offered the chance to visit the home before finalising the decision to move in. A full needs assessment is carried out ensuring the home can meet their assessed needs. EVIDENCE: The homes Statement of Purpose is reviewed annually and reflects the service provided by the home. A copy of the service User guide is made available in residents’ rooms. Gough House DS0000008042.V358452.R01.S.doc Version 5.2 Page 9 Four care plans were reviewed they all contained pre admission assessments which identified the specific needs of the prospective resident. The manager confirmed that they would only take a new resident when they were sure they could meet their needs. The pre admission assessment forms the basis of the full care plan, which is then agreed with the resident. People wishing to move into the home are offered the chance to visit and spend some time in the home when they can talk to staff and residents about their experiences. One resident said that they had been given plenty of information and support when they had been trying to decide which home to go to. A survey from a resident said they had spent a two-week trial period in the home before finally deciding it was the right home for them. Gough House DS0000008042.V358452.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home benefit from a person centred approach to care. They are encouraged to maintain their independence and are treated with respect and dignity. They have access to healthcare specialists and are enabled to manage their own medication when appropriate and are protected by robust medication policies and procedures which staff follow. EVIDENCE: Since the last inspection a person centred approach to care has been implemented. All the care plans seen reflected this approach with clear guidelines for staff about peoples likes and dislikes and the way in which they preferred to receive their care. Staff have written care plans that reflect the persons personal preferences and the way they wish to be cared for. Gough House DS0000008042.V358452.R01.S.doc Version 5.2 Page 11 All care plans contained appropriate risk assessments and showed signs of regular review. Care plan reviews also reflect the changes in people’s lives these are also agreed with the resident or their relative. Staff spoken to said the new person centred care plans were really good because they spent time getting to know the resident better. Residents spoken to indicated that they were aware they had written care plans. One person said they did not really care what was in their care plan but the care they received was exactly as they had requested. All the care plans reviewed showed evidence of residents being assisted to access healthcare specialists, such as the chiropodist, dentist, optician, diabetic nurse, district nurse and to attend appointments at clinics, GP surgery or the hospital. All residents spoken to said that the care they received was delivered in a caring and respectful manner. They said that staff were very good in following their care plans so their preferences were respected. Written surveys from people living in the home said, ‘I receive excellent care at all times staff are very caring and cheerful,’ ‘I am very happy here it has become my home from home.’ One relative survey stated, ‘The care given to residents is excellent and staff are very approachable all needs are met.’ The homes policies and procedures for the receipt storage and administration of medication are robust and staff receive training before they can administer medication. Some residents administer their own medication following a full risk assessment of their understanding. An audit of the administration and storage of medication showed that there were no errors. Gough House DS0000008042.V358452.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home benefit from an approach that recognises them as individuals, and routines are built around needs and preferences rather than staff convenience. A meaningful programme of activities is provided. Menus and meals are good, and alternatives and extras are readily made available. EVIDENCE: People spoken said that a varied and meaningful programme of activities is provided; this was also reflected in the daily records kept in the home. People living in the home confirmed that they could attend an activity and during the summer had been out on trips; there were photographs of a trip to Wells Cathedral, which had been well attended. They said they were looking forward to starting the summer trips again when the weather improved. Residents said that they also enjoyed the privacy of their own rooms when they could read a book or watch TV. Gough House DS0000008042.V358452.R01.S.doc Version 5.2 Page 13 One resident returned from a walk to their local church during the first day of the inspection and said they could always pop out for a walk if they wanted to. Daily prayers are held each morning these are often organised by a resident. The home also encourages residents to attend their preferred place of worship, when they wish. People also confirmed that their relatives and friends are made welcome in the home. During the inspection relatives were seen to come and go throughout the day. They commented on the friendly and welcoming approach of staff who would assist them to find the person they were visiting and make the visit a pleasant one. The main ethos in the home is that people living there are given the chance to take control of their daily routine wherever this is practicable; people are given a degree of choice in most aspects of their lives. Residents spoken to said that they could exercise choice and control over their own lives and felt that the home was run for their benefit. Staff spoken to were very conscious of enabling people living in the home to continue to make personal choices. Residents are asked on a daily basis about their meal preference. This is then conveyed to the cook. If a person does not want either choice another option can be offered. There is a good range of hot and cold options offered at each meal. The menus continue to contain a variety of well-balanced meals that reflect the preferences of the people living in the home. People spoken to and the written surveys indicated that the meals were of a good standard. Gough House DS0000008042.V358452.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home benefit from a clear complaints procedure that they can understand. The procedure is clearly displayed throughout the service and is given to other agencies involved with the home. The manager and staff have received training in safeguarding adults and how to respond in the event of an alert. EVIDENCE: The home’s complaints policy and procedure shows a clear timeline and action to be taken in event of a complaint. A copy is clearly displayed in the home and in resident’s rooms. Subsequent copies are available on request. The policy and procedure also directs the complainant to the CSCI. The manager maintains a full record of complaints. Residents spoken to said that they felt they could talk to any member of staff and the manager if they wished to raise any issue. They also benefit from a house visitor who can act as an advocate if a resident felt they could not talk to a member of staff. Gough House DS0000008042.V358452.R01.S.doc Version 5.2 Page 15 A copy of the North Somerset policy and procedure for Safeguarding Adults under No Secrets has been made available for all staff. Staff spoken to showed an awareness of the policies and procedures in place to safeguard vulnerable adults. Staff records showed that staff had received appropriate training. The home also has a very clear whistle blowing policy, which all staff spoken to were aware of. Gough House DS0000008042.V358452.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home benefit from a well maintained, homely environment, in a service that provides aids and equipment to meet the care needs of the residents. It is a very pleasant safe place to live with rooms that meet the national minimum standards. A high standard of cleanliness is maintained within the home. EVIDENCE: We carried out a tour of the premises. Gough House is a homely and well maintained house with views from the lounge across a local park. Residents said it was in easy walking distance of the promenade where they could benefit from a stroll in better weather. Gough House DS0000008042.V358452.R01.S.doc Version 5.2 Page 17 The home is well furnished in such a way that people living there can sit in small groups. The furnishings and lighting are domestic in style whilst providing adequate light to read by. The furniture and fittings are of good standard and communal areas are pleasantly decorated. A programme of redecoration is being followed as and when rooms become available. People spoken to said that they liked their rooms and had bought in their own furniture which made them feel more at home. People living in the home also have access to outside areas. The home shows a good standard of housekeeping and no offensive odours were apparent. The manager and staff showed a clear awareness of infection control policy and guidelines. Since the last inspection communal toilets have been equipped with paper towels. Protective clothing was being used when appropriate. The manager can obtain guidance from outside agencies if required. Gough House DS0000008042.V358452.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home benefit from sufficient numbers of staff to meet their needs on a daily basis with more staff being available at peak times of activity. The service ensures all staff receive relevant training focused on delivering improved outcomes for people within their service however this has fallen behind schedule. The service has a good recruitment procedure that clearly defines the process to be followed. EVIDENCE: Staffing rotas showed that the home is adequately staffed for the diverse needs of the people living in the home. Extra staff can be used at peak times or for activities. Staff were observed during the day. All observed interactions with service users were heard to be kind and helpful. The care staff at the home are encouraged to undertake National Vocational Qualification (NVQ) training and the home is currently working towards 50 of the care staff holding an NVQ qualification of level 2 or 3. Most staff are either attending the training or planning to start. All new staff receives Induction training following the Common Skills for Care Induction. Gough House DS0000008042.V358452.R01.S.doc Version 5.2 Page 19 The manager confirmed that training had fallen behind schedule as their training officer had left however the area manager was organising training and records showed that most mandatory training had been attended through the year. Most staff had also attended training in Safeguarding Adults, medication administration, dementia and challenging behaviour. Gough House has a good recruitment procedure that clearly defines the process to be followed. Three staff files were examined for new starters in the last twelve months, all had a CRB and relevant information on file. Gough House DS0000008042.V358452.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the required qualifications and experience to run the home and is supported in this role by the general manager for the group. They encourage an open and inclusive ethos. Staff supervision is planned and has started. Efficient systems are in place to monitor the quality of the service provided. The home works to a clear Health and Safety policy, which all staff are fully aware of. Gough House DS0000008042.V358452.R01.S.doc Version 5.2 Page 21 EVIDENCE: Mrs Beverly Young is the manager of Gough House she holds an NVQ Level 3 In Health and Social Care and is enrolled to start the Registered Managers Award. She also needs to commence the process to register with the Commission For Social Care Inspection. She has several years experience in the care sector. Her ‘open door’ policy enables staff and residents to discuss any issues with her. Residents meetings continue to be held although it is difficult to persuade them to attend monthly. They are encouraged to discuss their views on the way the home is run and the facilities provided. Minutes from the last meeting showed that residents had discussed the trips they wished to go on in the summer and a monthly church service is being arranged following a request by residents. An annual survey of residents’ views is carried out; when these are returned and collated a meeting is held to discuss any issues arising. The Annual Quality Assurance Assessment (AQAA) returned to the CSCI was clear about the homes commitment to maintaining an environment that recognises the diverse needs of the people in their care and developing a service that will meet those needs on an individual basis. The manager confirmed that the plan for staff supervision is a skill scan and competence audit, which should take place six times a year. This has started and progress in this area will be assessed at the next inspection. Due to the size of the home the manager and senior carers regularly work alongside staff and discuss issues raised at anytime. Staff stated that they felt they could talk to the manager at any time so felt well supervised. Records relating to servicing of equipment in the home were reviewed. All records were up to date and available for inspection. The implementation of health and safety within the home was satisfactory. All residents have personal risk assessments. Generic risk assessments are in place and reviewed regularly. A review of the firelog showed all tests, training and drills were being carried out to the Avon and Somerset Fire Brigade guidelines. Gough House DS0000008042.V358452.R01.S.doc Version 5.2 Page 22 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 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X 3 Gough House DS0000008042.V358452.R01.S.doc Version 5.2 Page 23 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 OP31 Good Practice Recommendations The manager needs to commence the registration process with the Commission for Social Care Inspection. Gough House DS0000008042.V358452.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Gough House DS0000008042.V358452.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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