Please wait

Inspection on 24/11/09 for Ghyll Grove Residential and Nursing Home

Also see our care home review for Ghyll Grove Residential and Nursing Home for more information

This is the latest available inspection report for this service, carried out on 24th November 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Ghyll Grove provides people wishing to use their services with good information; the Statement of Purpose and Service User Guide describes the service well. The home has a good assessment process and people receive a thorough assessment of their needs before they move into the home. The homes care planning process is good; each person has a care plan that is developed from the initial pre-admission assessment and it is kept under review at frequent intervals. The home has employed staff specifically to arrange activities for the people living in Ghyll Grove and people said that they were happy with these. Ghyll Grove provides people with good healthcare; the records showed that people received the help and support that they required when they required it. People are encouraged and supported to complain if they wish to do so and the home has a good complaints system. Ghyll Grove employs staff to carry out minor maintenance tasks and any repairs are carried out promptly. The buildings and grounds are well maintained and Ghyll Grove has a clean and hygienic homely atmosphere. The home has a very experienced management team; the manager is a registered nurse with many years experience and she provides staff with clear leadership and direction. The staff at Ghyll Grove are well trained, well supervised and competent.

What has improved since the last inspection?

Both the medication records and the storage of of medication has improved since the last inspection. There has been many improvements to the home including new extensions to three of the houses and new carpet, new flooring and new furniture has been purchased. A number of both large and small flat screen televisions have been bought in the past year and people said that these were much easier for them to watch. The recruitment process is now more robust and the home ensures that a check on any gaps in a prospective employee`s employment history is carried out. Staff now have supervision at least six times each year. Fire drills are now carried out regularly to ensure that staff and the people living in the home are aware of the procedure should there be a fire.

What the care home could do better:

Each of the houses should make sure that people have access to their emergency call bells at all times to enable them to call for assistance if they need it. If there are people that are not able to use their emergency call bell, this should be clearly recorded in their care plan, which should provide details of what other measures are in place to address the issue. All of the home`s care plans must be reviewed at regular intervals and any changes must be recorded to ensure that all staff knows about them. The memory boxes should be filled to help people with dementia to recall their past as these will only be beneficial to people if the boxes contain some memorable personal items. To ensure that the people have their say on how each house is run the home should make sure that all of the houses hold regular meetings to gather people`s views. Ghyll Grove had several different copies of it`s complaints procedure around the home and each of these were slightly different. All copies of the complaints procedure must clearly show the contact details and the role of the Care Quality Commission. The maintenance store was left unlocked, the door was wide open and it was unattended by staff for a long period of time. As the store contained electrical power tools and other dangerous items it must be kept shut and locked when not in use to avoid the risk of potential accidents to people.

Key inspection report Care homes for older people Name: Address: Ghyll Grove Residential and Nursing Home Ghyllgrove Basildon Essex SS14 2LA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Pauline Marshall     Date: 2 4 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Ghyll Grove Residential and Nursing Home Ghyllgrove Basildon Essex SS14 2LA 01268273173 01268288289 weltona@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Ltd care home 169 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) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service: Care Home with Nursing - Code N To service users of the following gender: Both Whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 169 Date of last inspection Brief description of the care home Ghyllgrove provides accommodation and nursing care for up to a maximum of one hundred and sixty nine people who have a variety of nursing and care needs including people who have dementia. Accommodation is provided in five purpose built single storey houses each with a small garden/ patio area, which residents can access. All residents are accommodated in single bedrooms. The home is situated close to Basildon town centre in a mainly residential area. Care Homes for Older People Page 4 of 31 Over 65 0 169 169 0 Brief description of the care home The manager provides people interested in living at Ghyll Grove with a copy of the homes Statement of Purpose and Service user Guide that supplies them with up to date information on the home. Fees range from £453.11 to £750.00 per week and there are additional charges for hairdressing, chiropody and newspapers. Care Homes for Older People Page 5 of 31 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 was an unannounced key inspection that lasted for eight hours and forty five minutes and was carried out by two inspectors. All of the key standards were inspected; we checked a random sample of policies and procedures and we examined some of the records that the home is required to keep. We looked around the buildings and we spoke to some of the people living in the home, to some of their visiting relatives, to some of the staff and to the manager and her deputy. We carried out an observation of staff working together with people living in Thames House. This observation is known as a Short Observational Framework for Inspection (SOFI) and it allowed us to gather information on how well staff worked with the people living in the home and how frequently staff interaction took place for each of the individuals that we were observing. We checked the progress of the requirements that were made at the last inspection on 5th & 6th February 2008 and all had been met. Care Homes for Older People Page 6 of 31 The manager completed her annual quality assurance assessment (AQAA) and returned it to us within the required timescale; it was detailed and informative and provided us with good information about the service. The AQAA is a self assessment document that the manager is required by law to complete; we have used the information provided in the AQAA throughout this report. We sent surveys to the manager to distribute to twenty people using the service, six health and social care professionals and twenty of the homes staff to obtain their views on the service that the home provides. The manager said that these had not been received, so we re-sent them on 25/11/09 with a return date of 9/12/09. At the time of writing this report we have received two completed surveys from staff that work at Ghyll Grove; both surveys were positive about the service. One staff member stated that the home does well in team work but could do better in delegation. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Each of the houses should make sure that people have access to their emergency call bells at all times to enable them to call for assistance if they need it. If there are people that are not able to use their emergency call bell, this should be clearly recorded in their care plan, which should provide details of what other measures are in place to address the issue. All of the homes care plans must be reviewed at regular intervals and any changes must be recorded to ensure that all staff knows about them. The memory boxes should be filled to help people with dementia to recall their past as these will only be beneficial to people if the boxes contain some memorable personal items. To ensure that the people have their say on how each house is run the home should make sure that all of Care Homes for Older People Page 8 of 31 the houses hold regular meetings to gather peoples views. Ghyll Grove had several different copies of its complaints procedure around the home and each of these were slightly different. All copies of the complaints procedure must clearly show the contact details and the role of the Care Quality Commission. The maintenance store was left unlocked, the door was wide open and it was unattended by staff for a long period of time. As the store contained electrical power tools and other dangerous items it must be kept shut and locked when not in use to avoid the risk of potential accidents to people. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 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. People know that their needs can be met within the home. Evidence: The manger said that she last reviewed the homes Statement of Purpose and Service User Guide in June 2009. We looked at the Statement of Purpose and it provided good information about the service; it showed that people are given the opportunity to visit before they move in to the home and that they are encouraged to involve their family and friends in the admission process; people spoken with and surveyed confirmed this. The homes Statement of Purpose contained some incorrect information about the role of the Commission in their complaints procedure. The manager said in her AQAA we use the QUEST individual assessment and care planning system. There were copies of pre-admission assessments in the seven care files that we looked at and these had been carried out by senior staff, were very comprehensive and covered all areas of need such as lifestyle, maintaining a safe Care Homes for Older People Page 11 of 31 Evidence: environment, personal care and sleeping. The assessments viewed were generally undertaken a few days prior to admission and a further assessment is carried out upon admission with a re-assessment after the first six months of service. One of the care files examined showed that the assessment had been carried out on the day of the admission. The assessment documentation showed that other agencies such as social services had been involved in the assessment process. People spoken with confirmed that they were fully assessed usually before they moved into Ghyll Grove. Ghyll Grove Residential and Nursing Home does not provide intermediate care. Care Homes for Older People Page 12 of 31 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. People receive personal care in a way that suits them and their healthcare needs will be fully met. Evidence: Staff spoken with, and observations of their practice showed that they had a good understanding of individual residents needs and abilities. We sampled care plans in each of the five houses. We looked at a number of care files to see how well care is planned for and arranged. We wanted to see if people have a say in their care, how the home ensures that staff are made aware of peoples needs, and how they are helped to meet them in an individual way. We saw that care plans in place provided sufficient information for staff to enable them to offer individual support. Individual personal plans are based on the QUEST assessment that is completed prior to, on admission and then six months following admission. This identifies peoples needs and informs ongoing care planning. Personal plans were in place for all sections as identified on the QUEST assessment such as lifestyle, maintaining a safe environment, personal care and sleeping. Each of these sections containing sub-sections to ensure that peoples holistic needs are assessed and addressed. Care Homes for Older People Page 13 of 31 Evidence: On the whole care planning was satisfactory, although the quality did vary, and there were areas where improvements could be made. Although there is a section to record relatives expectations of care, there was little evidence to show that residents are pro actively involved in planning for their ongoing care, other than in perhaps supplying information about their past lifestyle, interests and family on the map of life sheet. A member of staff confirmed that they try to involve residents in the lifestyle section of the care plan and where possible seek information from relatives. The AQAA acknowledged under what we could do better that We can encourage service users and relatives to take an active part in reassessment of care needs by asking their expectation and regular input in QUEST care documentation reviews. Although care plans are reviewed on a monthly basis sometimes changes in need recorded at review were not then reflected on the care plan. For example one person had been able to mobilise intermittently and a good care plan was in place to help staff assess this and manage needs appropriately. A review indicated that they now used a hoist with two carers. This was not on the care plan and may therefore provide conflicting information for staff that could potentially put them or the resident at risk. People were offered appropriate care and support by staff, who approached residents in a calm and kind manner. There is however a need to ensure that people are able to call for assistance when they need it. In some houses people being cared for in bed did not have access to their call bells. In some cases staff said that this was because the people concerned would be unable to use them due to their level of disability. When this is the case this fact, and strategies to offset this such as regular checks should be reflected in care planning. This was not the case. Each person had a personal plan relating to medication in place but these may not always be up to date or provide staff with the information that might be useful to them. For example we saw that one person was on a medication that may cause them to bruise or bleed more than normal. The medication was not listed on the personal plan, so staff might not be aware of potential problems or appropriate actions should an injury occur. Some care plans gave a very good level of detail and provided a person centred approach that gave a feel for the person, such as X likes to have a head to toe wash every morning and two staff will need to assist X with this. X is able to choose the clothes they want to wear and so on. Other care plans were less person centred. Some care plans were very clear and easy to read, others took time to decipher. This will not assist staff who need to access and understand information quickly and easily. The management team at the home have developed an auditing system that is Care Homes for Older People Page 14 of 31 Evidence: gradually reviewing all care records. This aims to look at 10 of care plans each month. Hopefully this process will assist in achieving a good and consistent standard of care planning throughout the home. We noted that where peoples care involves an element of risk such as moving and handling, the person wandering or the use of different equipment, good risk assessment and management processes were in place. We saw that good daily records of peoples care were maintained on Daily life sheets which are completed by each shift. Records of bathing are held separately to peoples individual files. We looked at bathing records on one house and saw that some people were not having baths very often. The person in charge said that this could be for a number of reasons including residents preferences and staff availability. The manager said that they are aware of this issue, and are looking at how best to address it to ensure that people have regular opportunities for baths/showers according to their preference. Records showed that people access appropriate health care to meet their individual needs. Records of health professionals visits were maintained and showed that people have opportunities for dental, optical and foot care. We saw that when peoples needs change referrals to appropriate professionals are made. Care plans incorporate assessments for tissue viability, falls and nutritional needs to ensure that any issues are identified and managed. People have their weight monitored regularly so that any concerns will hopefully be picked up on and addressed. Where there is cause for concern, or assessments indicate a high level of risk, daily detailed records of food and fluid intake are maintained. Nutrition records are not however routinely maintained for residents where no concerns are highlighted. Staff said that if someone was not eating or if their weight dropped below a certain point they would immediately commence a full food diary. For people where no food diarys are maintained it is recorded in daily records that they ate well, or good diet taken and so on. The need to perhaps ensure a better level of detail was discussed with the manager. As part of this inspection we looked at medication systems in three out of the five houses. Medication at the home is well managed and no errors in records or the system were identified. Relevant policies and procedures were readily available to staff on each house. It was however advised that, particularly for the residential units, that the Royal Pharmaceutical Guidelines relating to the management of medicines in a social care setting be made available to staff. Staff spoken with confirmed that they had completed training both through a distance learning course and also through a Bupa medication awareness course. We saw that medication is audited to ensure that correct procedures and practice are being maintained. On one unit we saw that two members of staff undertook the morning medication round. The person in charge of the unit explained that this is to ensure that people get their medicines in a timely Care Homes for Older People Page 15 of 31 Evidence: manner and at the time prescribed. This is good practice. Observations through the day showed that staff approached residents in a calm and kind manner. Doors were kept shut when personal care was being carried out. During the day people living at the home and relatives told us that they were happy with the care received at Ghyll grove Residential and Nursing Home. We spent time in, and spoke to people in each of the five houses. Residents were generally well groomed and appropriately dressed. People using the service said: I am very happy with everything, I am very satisfied with my treatment at this home. The staff are all very good, and They make sure I am comfortable and have what I need. Relatives spoken with were generally satisfied with the level of care offered. One person said the care offered to all the residents is marvelous, I have no complaints at all, another that, its not the same as having my relative at home, but they do their very best and help both of us. Our (CQCs) observations of care on the day of the site visit were positive. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well supported to live a lifestyle that meets their identified needs and preferences. Evidence: Care plans viewed and discussion with people indicated that residents have opportunities for occupation and stimulation. Peoples preferred activities are identified and records of activities undertaken maintained. One person told us that they liked the quizzes and the bingo, another that there is always something going on. The home has an activities team that provide 156 hours of activity support each week. The activity team normally work on an office hour Monday to Friday basis, but work evenings and weekends when special events or activities are arranged. The team has a central base and circulate round to each house to provide group activities and one to one engagement. The team arrange many outside people to visit the home such as Jungle Jo (with their insects,) a Pets as Therapy (PAT) dog, the mobile library and entertainers such as a harpist and gospel singers. People also have the opportunity to attend a luncheon club away from their own house. Weekly church services are held rotating round different houses to enable people to fulfill their spiritual needs. Records and documentation showed us that the activities and entertainments provided are many and varied. Care Homes for Older People Page 17 of 31 Evidence: When we visited it was a pamper day on one house, another had a sing-along another was watching an old movie. Where possible people are encouraged to attend events in other houses so that they have a change of scene. All activities equipment is stored at the teams base rather than on different houses. At weekends this area is locked so that if care staff wanted access to games or anything to engage with residents, this would not be possible. The activities team is experimenting with activities tables in the houses and weekend boxes to try to improve on this. It would be good however if each house had their own store of equipment, items to stimulate and engage and so on. This might also encourage support staff to undertake activities with residents. Routines of daily living at the home appeared to be flexible. The house where we spent the busy morning period had a relaxed feel. People had a leisurely breakfast or had breakfast in their rooms so that they were not rushed up. On other houses people followed their own routines and interests. People living at Ghyll Grove are able to welcome their visitors at any time. During the inspection people came and went and were made welcome. Each house has areas to be private when visiting if wished. Visitors told us that they could visit at any time. One person said, sometimes I am here at half past seven in the morning, sometimes in the evening. There is never any problem. Another person told us, I visit every day, I can even stay over at Christmas when transport is difficult. People utilized different areas of the houses and went where they wished during the day. A number of people due to their care and medical needs are cared for in their rooms. Others remain in their rooms through preference. Their choices and autonomy was supported by staff. We saw that people were able to bring in their own possessions in order to make their rooms homely. Televisions were available. Where peoples rooms looked out into the grounds or courtyards these areas had often been made attractive with plants and bird tables so that people had something of interest to look at. The last environmental health officers visit took place in August 2008 and the inspectors comments relating to the kitchen were excellent standards maintained, very good record keeping and good structural and procedural standards. People spoken with were generally positive about the food provided at Ghyll Grove. People said that they usually liked the food and were offered choice. People said, I like the food here, the food is generally very good and there is choice, I dont always like the food, but then Im finicky, and Its tasty! We looked at one weeks menu and saw that choice and variety of foods are offered. The days menu is posted in individual houses. If people do not like the main choices for the day we saw that a range of alternatives such as omelet, sandwiches or salad were available. People were also advised If you feel a little peckish, just ask the staff. Night Bites are available if Care Homes for Older People Page 18 of 31 Evidence: people are hungry at night. To try and encourage a good diet the home tries to maintain a protected mealtime regime. This means that any potential distractions such as visitors are kept to a minimum. On the day of the site visit people enjoyed a cooked breakfast, and lunch on one house consisted of soup, a main course and a pudding. As a number of people needed assistance families often visit to provide support at mealtimes. We saw that aids such as plate guards were used to assist people to eat independently. Where people needed assistance to eat we saw that staff managed this in a sensitive way. On one house we saw that a number of people ate their meals from over bed style tables. If this is necessary through residents choice staff do need to ensure that people are in the best position possible to eat. We saw one person struggling to eat as the table was a bit too high, and another person having to reach as the table was not close enough. On one house where people with dementia were accommodated we saw that it was difficult to make lunchtime a stand out part of the day through preparation, laying tables and so on. Due to peoples needs tables could not be nicely laid with condiments for individual use. We carried out a short observational framework for inspection (SOFI) on Thames House as there is a high level of dementia on this unit. The observation took place from 11.30AM until 12.45PM and it gave us the opportunity to observe staffs input and the affect this had on the people living at Ghyll Grove. We observed that when staff interacted with people, it was good and that people mainly responded well to it. One of the people we observed was asleep throughout the observation and there was no staff interaction until the lunch was served. We noticed that all of the people being observed with the exception of the person that was asleep responded well to the staff interaction. The person sleeping did not respond to the staff member that was offering her a meal. During the observation two of the people we were observing were enjoying a movie called The King and I and one of these people was chatting happily with staff members about the movie and singing alongside staff to some of the music. Another person was being encouraged by staff to join in with the group that were watching the movie and the staff member spent time explaining to the person what the movie was about; when the person declined the staff member acknowledged this and continued to interact with the person who was pursuing their own interests of reading a magazine. Care Homes for Older People Page 19 of 31 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. People will be protected from harm and abuse and their complaints will be listened to and acted upon. Evidence: The complaints procedure displayed in the home was dated October 2008. The manager said in her AQAA that the complaints policy was last reviewed in December 2006. We looked at various copies of the complaints procedure including the summary in the homes Statement of Purpose which provided some incorrect information about the role of the Commission; it stated that a summary of the Bupa complaints policy was displayed in the entrance area of each house. We found that there were different copies of the complaints procedure displayed around the home, including a large poster displayed in the reception area, which contained incorrect contact details and incorrect information about the role of the Commission. The manager said in her AQAA that the home had received eleven complaints in the past twelve months and the homes complaints records confirmed this. Each complaint was recorded in the complaints log showing a reference number, the name of the complainant, the date received and the date completed. The manager said that Bupa was in the process of devising a new complaints system where all complaints are logged on to the computer system. People spoken with said: the home isnt perfect, but if you have any concerns they do their best, I would not hesitate to complain if I felt the need to, I know who to complain to and would do so if I wanted to and, Care Homes for Older People Page 20 of 31 Evidence: Staff are very responsive if I have any concerns or comments. We looked at the homes abuse policy and procedures which were last reviewed on 31/10/08; they were very detailed and informed staff of the need to refer any suspicion of abuse to the Local Authority. Staff spoken with showed a good knowledge of safeguarding procedures and the training records showed that a majority of staff had received training in safeguarding adults including twenty nine of the homes support staff. There has been three safeguarding issues since the last inspection and they have all been dealt with appropriately by the manager. Care Homes for Older People Page 21 of 31 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. People live in a safe, homely, clean and comfortable environment. Evidence: Since the last inspection Ghyll Grove has built extensions to three of the five houses and this has increased the number of bedrooms in Medway House to thirty-five, in Kennett House to thirty-seven and Chelmer House to thirty-seven. The home is now registered to provide care for up to one hundred and sixty nine people. We looked around all five separate houses; Medway, Kennett, Thames, Roding and in Chelmer and we found that they were all generally well maintained. Each of the bedrooms was clean and tidy and people spoken with said that they were happy with their rooms; a number of people had their own telephones. One person who was staying at the home on a respite visit said my bed is really comfortable. Other people spoken with throughout our visit commented on how homely and comfortable their rooms were. We noticed that people on the dementia houses had memory boxes outside their rooms but most of these were empty. We asked a member of staff about this and was told that not all people have family that bother so we suggested that this would be a good thing for key workers to develop with people. We looked around the grounds of the home and they were well maintained with pleasant courtyard areas; seating is provided for people to use in the summer months; a gardener is employed and the grounds were tidy, clean, neat and Care Homes for Older People Page 22 of 31 Evidence: attractive. There was two separate sensory gardens and plenty of flowers and shrubs; people spoken with said that they enjoyed the views into the gardens. We found that on two of the houses Chelmer and Roding, hoists had been left unattended in the hallway outside of the hoist store. This is dangerous practice as people could potentially harm themselves as it restricts the space available in the hallway areas. Hoists were stored appropriately in all of the other houses. The manager said that in the past twelve months new flooring, new carpets, new curtains and new furniture and eight large flat screen televisions had been purchased for all of the communal areas and the home has also purchased nineteen smaller flat screen televisions for the rooms in the new extensions. People spoken with said that they were happy with the new televisions and one person said it is easier to see the TV now that the screen is much bigger. There is a hairdressing salon in the administration block and the hairdresser is there for four days each week. If people are unable to visit the hairdresser in the salon she will arrange to visit them in their individual house. People spoken with said it is good to have the hairdresser come to me, she did last time and it made me feel better having my hair done and I like going out to the other block to get my hair done as it feels like a bit of an outing. Each of the five houses keeps its own maintenance log where repairs such as a blocked toilet, replacing broken plug socket and fitting new batteries to a radio are recorded and when carried out by one of the homes two maintenance men the date of the repair is recorded, which showed that they had been carried out within a reasonable timescale. We noticed that the maintenance work store was left unlocked and the door wide open throughout the day of our visit; this door should be kept locked shut when unattended as it contained electrical equipment and tools that could prove a danger to people should they enter the store. The home employs one full time domestic staff on each of the five houses and the maintenance men carry out a range of additional cleaning such as removing and cleaning the lampshades, which was being done on Medway House on the day of our visit. In addition to domestic staff there are five staff employed in the laundry; they work over a twenty four hour period by way of three eight hour shifts. There is a chef and two cooks with four kitchen assistants working in the main kitchen. The training matrix showed that all staff had received training in infection control and there was no malodorous smells noticed in any of the houses and all areas were clean, hygienic and pleasant on the day of our visit. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by a competent, well-trained staff team, who are safely recruited. Evidence: Each of the five houses has its own staff duty roster and we looked at a sample of these over a six week period. The duty rosters showed that there were sufficient staff on duty in each of the five houses. In Thames House most of the care and nursing staff are rostered to work a twelve hour shift and staff spoken with confirmed that they preferred to do this. The duty roster showed that some staff worked either an early or a late shift and that staff always had at least two rest days together and when working twelve hour shifts staff often had three rest days together. People spoken with were generally very positive about the homes staff and their comments included the staff here are marvelous and they do a difficult job very well and there always seem to be plenty of staff around. There were one or two people who said some staff are better than others but others said great staff, so caring and there are plenty of staff here. We looked at seven of the homes staff files and they each included a completed application form, interview notes, two written references and satisfactory Criminal Records Bureau (CRB) checks. Where required there was evidence of the right to work for overseas staff. The manager said in her AQAA we have introduced and sustained a new three day induction programme which includes all mandatory training before Care Homes for Older People Page 24 of 31 Evidence: any member of staff has any resident involvement. Staff spoken with confirmed this and we saw evidence in the two newest staff files which included copies of their certificates of training that showed they had completed their training prior to working in the home. The manager said in her AQAA that ninety staff had completed their Skills for Care induction (Common Induction Standards). The deputy manager showed us a completed Personal Best book which included the Common Induction Standards and the training matrix showed that twenty three staff had completed their Personal Best induction. All agency staff have to complete an induction on the first day working at Ghyll Grove and this was recorded on either an agency carer or agency nurse induction checklist. The agency checklists showed that agency staff are made aware of the homes procedures, including fire, accident and infection control. It confirmed that agency staff are aware that all hoist transfers must be carried out by two people. The manager keeps a training matrix which identifies the training needs of all of the homes staff including maintenance, catering and domestic staff. The training matrix showed that staff have had training in the past year that included Fire, COSHH (Control of Substances Hazardous to Health), manual handling, infection control, food hygiene, challenging behaviour, activity awareness, understanding dementia, medication and health and safety. The staff files contained certificates of training to confirm that this training had taken place and staff spoken with said that training was good. Care Homes for Older People Page 25 of 31 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. People live in a well run home that is run in their best interests. Evidence: The manager is a registered general nurse who has more than thirty years experience in caring for frail elderly people; she also holds the registered managers award. Since the last inspection the manager has updated her practice and received training in fire awareness, health and safety, safeguarding adults, the Mental Capacity Act and investigation training. The manager is supported by a deputy manager and between them they operate an on-call system for staff to use out of hours. The provider carries out regular monthly visits under Regulation 26 and the manager has her own auditing systems in place such as her monthly QUEST (care plan) audit, health and safety audit and complaints audit. The manager completed her annual quality assurance assessment (AQAA) in good time and it provided us with a detailed assessment of how well the home was doing and it identified areas that required improvement. Ghyll Grove carries out a SOP (surveying our people) annually and Care Homes for Older People Page 26 of 31 Evidence: people spoken with and surveyed confirmed that they had taken part in this. Only one of the five houses had held meetings for the people living in them and the manager said that this had been identified as a shortfall and that this will be addressed with the senior team. The home does not hold any cash belonging to the people living there, however, it does hold a bank account for personal allowances where small cash sums are paid in by families. The computer records showed the balance that was held in this account for each individual and there was a record of any cash withdrawn and the purpose of its withdrawal. For instance, when the hairdresser visits she provides a list of the names of people that have had their hair cut, set or permed and itemises each persons entry on the list which is kept as a record for each individuals expenditure. There were notes of meetings on all of the staff files that we looked at to show that staff have had regular supervision and staff spoken with confirmed this. We looked at a random sample of safety certificates including electrical installation, gas safety and fire detection and equipment and all were in place and up to date. Care Homes for Older People Page 27 of 31 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 28 of 31 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 1 5 The manager must make sure that the information provided in the homes Statement of Purpose is correct and up to date. To ensure that people get the correct up to date information about the service. 30/01/2010 2 16 22 The manager must make sure that the complaints procedures includes the correct contact details and the role of the Commission. To ensure that people using the service have the correct information. 30/01/2010 3 19 23 The manager must ensure 31/01/2010 that all tools and equipment are safely locked away when not in use. To ensure that people using the service do not come to harm. Care Homes for Older People Page 29 of 31 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 7 It is recommended that all people living in the home should have access to their call bells or if they are unable to use them it should be recorded in the care plan and strategies devised such as regular checks to ensure that people receive the assistance when they need it. It is recommended that any changes to an individuals care needs are recorded in the care plan as the occur to ensure that people get appropriate care to meet their changed needs. It is recommended that the memory box placed outside peoples bedrooms is used and that more signage is placed around the dementia units in order to support people with their dementia. It is recommended that each of the houses hold regular meetings for the people that live in them to ensure that they are able to participate in how the home is run. 2 7 3 19 4 33 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!