Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Galtres Care Home LLP Ox Carr Lane, Strensall, York, YO32 5TD Tel: 01904491300 Date of Inspection: 08 January 2014 Date of Publication: January 2014 We inspected the following standards as part of a routine inspection. This is what we found: Consent to care and treatment Care and welfare of people who use services Meeting nutritional needs Staffing Complaints Inspection Report Galtres Care Home LLP January 2014 www.cqc.org.uk 1
Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activity Mr & Mrs J Conroy Mrs. Jennifer Marshall Galtres Care Home provides personal care and accommodation for up to 20 older people who may also have dementia care needs. Written information about Galtres Care Home and how it operates, can be obtained by contacting the home directly. Care home service without nursing Accommodation for persons who require nursing or personal care Inspection Report Galtres Care Home LLP January 2014 www.cqc.org.uk 2
Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 5 Our judgements for each standard inspected: Consent to care and treatment 6 Care and welfare of people who use services 7 Meeting nutritional needs 9 Staffing 11 Complaints 13 About CQC Inspections 14 How we define our judgements 15 Glossary of terms we use in this report 17 Contact us 19 Inspection Report Galtres Care Home LLP January 2014 www.cqc.org.uk 3
Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 8 January 2014, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members, talked with staff and reviewed information given to us by the provider. What people told us and what we found During this visit we spoke to five people who live at the home, four relatives and six staff. People told us that they felt involved in day to day decisions about their care. Where appropriate arrangements were in place to assess capacity and ensure that decisions were made in people's best interests. People said they were well cared for, with comments including "They are good staff, they'll listen to you, help you", "It seems to be well run and organised" and "Welcoming, pleasant and understanding and humane. It is a very caring place." Arrangements were in place to assess and plan people's care needs, although the provider should note that some risk assessments had not been updated recently. A choice of regular meals, snacks and drinks was provided, with arrangements in place to provide for any specialist dietary needs. People told us that the food was good, with comments including "Terrific", "Very good" and "Oh the food is brilliant, I can't praise highly enough." Our observations showed that people's needs were met by a suitable number of staff. People we spoke to felt that staff were available when needed, with comments including "The staff are just lovely" and "There is always someone around." However, some staff felt that increasing staffing levels would help them provide a better service. People felt able to ask questions or raise concerns and felt that they were listened to. We found that comments or complaints had been responded to appropriately. You can see our judgements on the front page of this report. Inspection Report Galtres Care Home LLP January 2014 www.cqc.org.uk 4
More information about the provider Please see our website www.cqc.org.uk for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Galtres Care Home LLP January 2014 www.cqc.org.uk 5
Our judgements for each standard inspected Consent to care and treatment Before people are given any examination, care, treatment or support, they should be asked if they agree to it Our judgement The provider was meeting this standard. Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. Reasons for our judgement People who used the service and their relatives told us that they felt they were involved in day to day decisions about their care. People confirmed that they had been involved in assessments, reviews and that relatives were kept informed and involved appropriately. The manager had completed training in the Mental Capacity Act and Deprivation of Liberty Safeguards at Level 4. They were able to explain how the Mental Capacity Act was relevant to their work and how consent and capacity were considered during people's assessments and care planning. Training records also showed that staff had covered the Mental Capacity Act and Deprivation of Liberty Safeguards during their induction and ongoing training. Copies of the Mental Capacity Act Code of Practice were available in the office and staff room, so that staff had access to practice guidance when needed. This helped to ensure that staff understood their responsibilities and people's legal rights were protected. The care records we looked at showed that people had been involved in assessments and reviews of their care needs. This included people signing their care records where they were able. The care records we looked at included Mental Capacity Assessments, which had been completed if there were any issues around capacity and decision making. The service had also obtained information about any Power of Attorneys that had been appointed to help make decisions on people's behalf, including the type of Power of Attorney that was in place. Arrangements had recently been made to review all advanced decisions relating to resuscitation with the local doctor to ensure that they were appropriate and up to date. This helped to ensure that people or their legal representatives were involved in decision making and that people's legal rights were protected. The manager confirmed that there had been no recent Deprivation of Liberty Safeguards applications or authorisations required at the service. However, they had made an application in the past and understood the process if necessary in the future. Inspection Report Galtres Care Home LLP January 2014 www.cqc.org.uk 6
Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Reasons for our judgement People who lived at the home and their relatives spoke highly of the care that was being provided. People who lived at the home told us that they were happy and well cared for. Their comments included "We are a happy bundle here", "They are good staff, they'll listen to you, help you" and "It seems to be well run and organised." Visitors also told us that their relatives were well looked after, that people were clean and nicely dressed when they visited, that staff always treated people kindly and that staff would try to find ways to work around any difficulties caused by the person's dementia. For example, trying again later or trying different ways of doing things if someone was resistive to care. Comments made by relatives included "Welcoming, pleasant and understanding and humane. It is a very caring place", "They are very gentle with them (the people living at the home) and constantly talking to them" and "This home is lovely, everyone is chatting, it's a homely atmosphere." During our visit we spent time observing the care and support provided. We saw that staff treated people kindly and demonstrated an understanding of dementia care. For example, interacting positively and patiently with people, providing appropriate encouragement and explaining what was happening. Throughout our visit there was a happy and pleasant atmosphere, with people appearing comfortable and relaxed in their surroundings. People looked clean and well cared for and we saw staff supporting people with their care needs appropriately throughout the day. We looked at four people's care records during our visit. The home uses the 'Standex' care recording system, which is a hand written system for assessing, planning and reviewing people's care needs. It includes a formal system of assessments, care plans, reviews, risk assessments and care records which are completed by staff. We found that people's care needs were being assessed and planned, with information being available about the care and support people needed. When we checked to see if people were receiving the care their records said they needed, we found that they were. For example, we saw that one person received visits from the district nurse, had a pressure relieving mattress and received regular positional changes because of risks to their skin integrity. However, the provider should note that a number of risk assessments in the records we looked at had been regularly reviewed in the past, but had not been reviewed and updated Inspection Report Galtres Care Home LLP January 2014 www.cqc.org.uk 7
for considerable periods of time. It is important that risk assessments are kept up to date so that any changes to people's care needs are identified and acted upon promptly. As part of this review we contacted a local health professional who works with people who live at the home. They told us that they generally found that people were well cared for and that staff genuinely seemed to care for the people living there. In their experience staff had treated people well and they had not seen any examples of poor care or manual handling practice. However, the provider should note that the health professional did feel that staff would benefit from some education around the early signs of pressure damage, to ensure that preventative actions were put in place as soon as possible. The out of date risk assessments we found in some people's records included waterlow assessments. If used correctly the waterlow risk assessment helps staff identify people who are at risk of pressure damage and enables early preventative actions to be taken. The staff we spoke with knew the people they were looking after well. They were able to tell us about people's needs and how these were met by the service. For example, how they made sure people received regular baths and were supported to use the toilet. They were also able to tell us how they responded when people were resistant to staff assistance and how they tried different ways of working to ensure that people's needs were still met. Inspection Report Galtres Care Home LLP January 2014 www.cqc.org.uk 8
Meeting nutritional needs Food and drink should meet people's individual dietary needs Our judgement The provider was meeting this standard. People were protected from the risks of inadequate nutrition and dehydration. Reasons for our judgement People told us that they enjoyed the food and had plenty to eat and drink. Comments made by people who lived at Galtres included "Terrific", "Very good" and "I don't have any complaints about it (the food)." Relatives were also complimentary about the food provided at the service and told us how they could eat with their relative or assist their relative with meals if they wanted to. Comments made by relatives included "Oh the food is brilliant, I can't praise highly enough" and "The food is good, it's homemade." Some relatives told us about the extra effort staff had made in order provide things that might tempt their relative to eat and drink. For example, making tasty soup and providing ice cream. We observed the lunch and tea time meals and the snacks and drinks served during our visit. We also sampled some of the food that was served for the lunch time meal. The food was appetising and tasty and we saw how staff offered people choice in a meaningful and individual way. For example, asking some people what they wanted and showing others the different options available. A variety of drinks were served at lunch time, with some people having juice, while others enjoyed a glass of wine or beer. During the morning and afternoon we saw that people were provided with drinks and snacks. Staff assisted people in a pleasant way and encouraged people to eat and drink appropriately. We looked at four people's care records. These records showed that people's nutritional needs were recorded in their care plan and that weight was being monitored monthly. Generally people were maintaining weight and where concerns had been identified the records showed that appropriate professionals, such as the doctor or speech and language team (SALT), had been involved. The manager told us that some people were unwell and had their fluid and food intake monitored. We looked at some of these records and saw that they were being completed regularly, so that staff could monitor what the person had eaten and drank each day. However, the provider should note that staff were not currently using the nutritional screening tool (Malnutrition Universal Screening Tool) that was available in people's care records. This tool provides a more sophisticated way of monitoring the risks to people's nutritional wellbeing than monitoring weight alone and can help to ensure that people's nutritional needs are identified and met. The cook told us that they were able to order food fresh from local suppliers and did not have restrictive budget constraints. They told us that their focus was providing "good home cooked food" and explained how they catered for people's special needs. For Inspection Report Galtres Care Home LLP January 2014 www.cqc.org.uk 9
example, they fortified some people's food with full fat cream, milk, cheese and butter and made fresh smoothies to increase calorie and nutrient intake. They also confirmed that snacks, such as biscuits and cakes, were available in between meals and that milky drinks and supper was served in the evenings. A list of people's special dietary requirements had been made available to the kitchen staff, so that they could cater for people's individual needs. The home received a four star food hygiene rating after an environmental health inspection in August 2013. Inspection Report Galtres Care Home LLP January 2014 www.cqc.org.uk 10
Staffing There should be enough members of staff to keep people safe and meet their health and welfare needs Our judgement The provider was meeting this standard. There were enough qualified, skilled and experienced staff to meet people's needs. Reasons for our judgement People who lived at the service and their relatives spoke highly of the staff at Galtres Care Home. Comments made to us about the staff included "Extremely good", "The staff are just lovely" and "They (the staff) are so nice in here." The people we spoke with also felt that staff met people's needs and were available to help when needed. People's comments included "There is always someone (staff) you can get to" and "There is always someone around." During our visit we spent time observing the care and support provided. We saw that staff treated people well and demonstrated an understanding of dementia care. There was a good staff presence in the communal areas and we saw people being supported with their care needs throughout the day. For example, staff assisting people to go to the toilet and to eat and drink regularly, staff encouraging and helping people to do jigsaws in the afternoon, and a staff member taking someone with them to the local shop. We did not observe anything to suggest that people's care needs were not being met by the service because of inadequate staffing levels. However, the provider should note that staff told us that the service would benefit from having an extra carer on duty during the day. They felt that this was important because of the time staff now needed to spend looking after people who were nursed in bed and who needed two staff to assist them. They felt that this meant that they had less time to spend with other people and could make things seem rushed and more difficult to get everything done. When asked staff told us that they did not think that people at the home were at risk or suffering as a result of staffing levels, but felt that they would be able to provide a better service with more care staff on duty. We spoke to the manager about staffing levels at the service and the concerns raised by staff. They told us that there were usually three care staff on duty during the day, to care for the home's twenty residents. These care staff were supported by the manager and two domestic staff, who could also assist with care if necessary. Kitchen staff were provided until after lunch. A general assistant also worked between 4pm and 7 or 8 pm to provide extra assistance at tea time. At a weekend an additional member of care staff was on duty, because the manager and domestic staff were not available. At night two care staff were on duty from 8pm until 8am. The manager understood that staffing levels needed to be appropriate to the needs of the people living in the home and other factors, such as the Inspection Report Galtres Care Home LLP January 2014 www.cqc.org.uk 11
layout of the building. They demonstrated how they monitored staffing levels continuously and explained how they had recently reviewed staffing levels and made adjustments, through the employment of the tea time assistants. The manager also told us how they were in the process of creating additional apprentice positions which would benefit the home. The manager felt that staffing levels were appropriate for the current needs of the people living at the home. They assured us that staffing would be reviewed and adjusted if there was evidence that staff were struggling and people's needs were not being met. We looked at the home's rotas for the past four weeks and confirmed that the staffing levels described by the manager were usually provided. Inspection Report Galtres Care Home LLP January 2014 www.cqc.org.uk 12
Complaints People should have their complaints listened to and acted on properly Our judgement The provider was meeting this standard. There was an effective complaints system available. Comments and complaints people made were responded to appropriately. Reasons for our judgement People who used the service and their relatives told us that they found the manager and staff approachable. People said that they felt able to ask questions or raise concerns if they needed to and felt that they were listened to. Comments included "You just explain and it's implemented", "It's so easy just to go and have a five minute chat with her (the manager)" and "They do take it on board". The service had a complaints procedure, setting out how formal complaints would be responded to. This was made available to people in the service's information pack, which was given to people who used the service and their relatives. We saw a copy of this information pack during our visit. A complaints record was available and showed that no formal complaints had been made since 2010. However, the service also kept what it called 'a grumble book', which recorded minor concerns and comments and the actions taken to resolve them. When we asked the manager how they distinguished between formal complaints and 'grumbles' they told us that a grumble was something that could be resolved immediately and didn't require a more formal investigation or response. The records showed that any issues raised with the service had been taken seriously and resolved appropriately. Inspection Report Galtres Care Home LLP January 2014 www.cqc.org.uk 13
About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Galtres Care Home LLP January 2014 www.cqc.org.uk 14
How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Galtres Care Home LLP January 2014 www.cqc.org.uk 15
How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Galtres Care Home LLP January 2014 www.cqc.org.uk 16
Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Galtres Care Home LLP January 2014 www.cqc.org.uk 17
Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Galtres Care Home LLP January 2014 www.cqc.org.uk 18
Contact us Phone: 03000 616161 Email: enquiries@cqc.org.uk Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: www.cqc.org.uk Copyright Copyright (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Inspection Report Galtres Care Home LLP January 2014 www.cqc.org.uk 19