Inspection on 16/06/08 for Graham House

This is the latest available inspection report for this service, carried out on 16th June 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Graham House 15/11/05

Graham House 09/05/05

Graham House 17/08/04

Graham House 19/05/04

Graham House 03/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Graham House 12 Graham Road Mitcham Surrey CR4 2HA Lead Inspector Jon Fry Key Unannounced Inspection 11:45 16th & 20thJune 2008 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 Graham House DS0000027242.V365757.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. Graham House DS0000027242.V365757.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Graham House Address 12 Graham Road Mitcham Surrey CR4 2HA 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) 0208 646 0606 Mr Rudolph Edgar Lewis Mrs Ena Ethelvina Lewis Mrs Ena Ethelvina Lewis Care Home 3 Category(ies) of Dementia - over 65 years of age (3), Mental registration, with number disorder, excluding learning disability or of places dementia (3), Old age, not falling within any other category (3) Graham House DS0000027242.V365757.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following Category of Service only: Care Home Only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age not falling within any other category - Code OP Mental Disorder, excluding Learning Disability or Dementia - Code MD 2. Dementia - over 65 - Code DE(E) The maximum number of service users who can be accommodated is 3. 16th June 2006 Date of last inspection Brief Description of the Service: Graham house provides care and support for up to three older people, some of whom may have dementia or mental health needs. The home is on the ground floor of a semi-detached property and is located in a residential area of Mitcham. Public transport links and a small number of shops are within walking distance. Three single bedrooms are available, two of which have en-suite facilities. Graham House DS0000027242.V365757.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 this service experience good quality outcomes. We spent approximately four hours in the home over two separate visits. We spoke to two people who live at the home, the owners, the home’s consultant and one staff member. We looked at records and documents kept at the service including two people’s care plans. What the service does well: What has improved since the last inspection? What they could do better: We think that the service is clearly moving forward and introducing some very good practice around dementia care. Activity, engagement and purposefulness should continue to be promoted and the care plans made even more individual. Staff need to have regular recorded supervision with their line manager at least six times a year. Health and Safety issues around hot water and fridge temperatures need to be addressed to make sure that people remain safe. Graham House DS0000027242.V365757.R01.S.doc Version 5.2 Page 6 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. Graham House DS0000027242.V365757.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 Graham House DS0000027242.V365757.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 and 3. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information is available to people about the service. The home makes sure it has enough information about the individual so that their needs can be met. EVIDENCE: A brochure is available about the home that gives good information about the service and includes lots of photographs. The service now mainly focuses on providing care and support for people with dementia. An additional registration category to allow the home to admit people with dementia was approved by the CSCI in January 2008. The home uses both the social work reports and it’s own assessment processes Graham House DS0000027242.V365757.R01.S.doc Version 5.2 Page 9 to make sure that it has good information about people’s needs before they come to live there. We saw that these assessments were in place for two people whose files we looked at. A very good admission summary had been written for one person who had recently come to live there. The owners told us about the efforts they were making to find out more about this person and their life experiences. Graham House DS0000027242.V365757.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. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans contain good information to help make sure that people’s needs are met. Arrangements for the handling, storage and administration of medication are satisfactory. EVIDENCE: “It’s real nice” and “I’m quite happy” were comments from one person who lives at the home. We saw that improvements have been made to care plans and there was some good information recorded about peoples needs. Each care plan is kept under review and updated as necessary. Although the owners and staff know the people living there very well, we have recommended that the owners continue to develop the care plans to personalise them to the individual. Some information is still too general and could be made much more specific. Graham House DS0000027242.V365757.R01.S.doc Version 5.2 Page 11 A storybook has been made for one person and this includes photographs as well as some nice written reflections about the person. This is commended care plans could also be produced in this type of format and be written in the first person. The consultant employed by the home told us that they were looking at equality and diversity issues particularly around sexuality. This is to make sure that the home is well placed to care for individuals and respect their sexual orientation. We have recommended that the home look at some of the language used in care plans and daily notes. Some of this can come across as negative with words used such as ‘challenging’, ‘wandering’ and ‘suffering’. It may be worth discussing this further and looking at alternative words to use that do not label. One person who lives there told us “they drive me to the hospital for my check-ups”. We saw that people are supported with their health needs and records kept of these appointments. Satisfactory medication policies, procedures and practices are in place with items of medication appropriately stored and labelled. We have recommended that the home look at updating the administration records to make sure these clearly show the dosage instructions. It may be possible for the pharmacist to supply printed sheets or labels to the home. Graham House DS0000027242.V365757.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. People using the 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 given the opportunity to take part in activities both in and outside of the home. The menu reflects the individual foods that the people living there enjoy. EVIDENCE: We saw that the home keeps a record of activities and these include chair based exercises, manicure, reading and watching TV or videos. A rummage box has been put together for use in the lounge with lots of items to stimulate and help interaction. Both individuals go to a day centre twice weekly which reflects their cultural background and they also go out shopping regularly with staff. The owners told us that both individuals sometimes sit at the nearby bus stop with staff just watching the world going by. We discussed the possibility of extending this to include a trip on the bus during the inspection. Day trips have been made to local community events and one person goes to Church regularly with Graham House DS0000027242.V365757.R01.S.doc Version 5.2 Page 13 family members. There were some lovely pictures of one person who had been supported in attending a recent family wedding. The lounge also houses the office of the home. The owners told us that they were considering how to move the office to a different location to allow more space. This could be used for even more interactive items and rummage boxes for use by people living there. “The lady cooks – I’ve given it up” and “not bad” were the thoughts of one person about the food provided. We saw that a typed menu is in place for the home but meals are generally decided informally with the people who live there. We have recommended that the home develop a picture menu to help people make choices about what they want to eat. The use of bibs should also be discussed and alternatives such as cloth napkins considered. Graham House DS0000027242.V365757.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. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a complaints procedure for people to use. The policies for Safeguarding Adults are available and give staff guidance on actions to be taken. EVIDENCE: One person said “if I was unhappy, I would tell her” indicating the staff member on duty. The home keeps a record of complaints and the actions taken to respond to issues raised. There have been no complaints since the June 2006 inspection. Information on what action needs to be taken in the event of an allegation of abuse is available. Records we saw confirmed that staff receive training in Safeguarding Adults. Graham House DS0000027242.V365757.R01.S.doc Version 5.2 Page 15 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, 21, 24 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a homely and comfortable environment. People who live there can personalise their bedrooms. EVIDENCE: We saw that people live in a clean, comfortable and homely environment. As stated previously, one room serves as the lounge and dining area as well as housing an office area. This provides a pleasant area for people to use and there is also access to a paved garden area from the lounge. Graham House DS0000027242.V365757.R01.S.doc Version 5.2 Page 16 Individual bedrooms provide comfortable homely accommodation for the people who live there. Bedrooms and the bathroom have picture signs to help individuals find their way around. All areas of were clean and free from offensive odour when we visited. Graham House DS0000027242.V365757.R01.S.doc Version 5.2 Page 17 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. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff members complete training to help them carry out their role. Staff recruitment practices help protect the people who live there. EVIDENCE: “They treat me nice” and “we laugh and joke” were comments from a person who lives there about the staff. The staff member we spoke to felt that the care was ‘excellent’ and this was mainly due to the amount of 1-1 support each person gets. We looked at the training records and saw that staff had been able to attend courses in areas such as First Aid, Safeguarding Adults and dementia care. The owners told us that they often have discussions about their practice and how to develop the service. We have recommended that these sessions could be adapted to form part of the training for staff and could be recorded in their files. The home may also be able to access funding for training through Skills for Care and could develop more specialist training for staff around dementia care. Graham House DS0000027242.V365757.R01.S.doc Version 5.2 Page 18 Staff do receive supervision but these sessions need to take place more regularly. Records need to show that full time staff receive supervision at least six times a year (pro-rata for part-time staff). We looked at the recruitment records for two members of staff and these contained all the necessary information such as Criminal Record Bureau (CRB) Checks and references. Graham House DS0000027242.V365757.R01.S.doc Version 5.2 Page 19 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, 35, 36 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the best interests of the people who live there. The service is developing a strong ethos around delivering good quality person centred dementia care. EVIDENCE: One of the owners is the registered manager for the service and is a qualified nurse with many years experience in the field. As stated previously, the owners have employed a consultant to help them run and develop the service. This person is very experienced and knowledgeable in dementia care and keeps up to date with national developments. For example, the home had Graham House DS0000027242.V365757.R01.S.doc Version 5.2 Page 20 already obtained a copy of the recent CSCI report ‘See me, not just the dementia’. The small nature of the home means that the owners and staff can spend time with individuals to informally consult with them. We saw some lovely interaction between people when we were visiting and individuals are helped to make choices in their daily life. Health and Safety is generally well managed and we saw records for gas safety, electrical and hot water checks. We found that the hot water in the bath was very hot and the owners told us that staff monitored the temperature when helping people bathe. We have made a Requirement for the home to look at this again to make sure that the people living there are not at risk. A new fridge thermometer needs to be purchased as the one in use was not of the right type. Graham House DS0000027242.V365757.R01.S.doc Version 5.2 Page 21 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 X X 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 3 X X 3 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 3 2 X 2 Graham House DS0000027242.V365757.R01.S.doc Version 5.2 Page 22 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. 1. Standard OP36 Regulation 18(2) Requirement In order to discuss and develop their practice, care staff should receive formal supervision at least six times a year with records kept (pro-rata for parttime staff). Timescale for action 30/09/08 2. OP38 13 (4) In order to ensure the health and 01/08/08 welfare of people living there, the home must fully risk assess the potential hazard to individuals from the hot water in the bath. Control measures must be identified and notified in writing to the CSCI. 3. OP38 13 (4) In order to ensure the health and 01/08/08 welfare of people living there, a new fridge thermometer must be purchased. Daily records must be kept to show that the fridge is operating between 1 and 8°C. Graham House DS0000027242.V365757.R01.S.doc Version 5.2 Page 23 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 OP7 Good Practice Recommendations The home should continue to develop the care plans to be more individualised. Each plan should be specific in saying where, when, how and who. Pictures and stories should continue to be used to celebrate the individual and direct the care to enhance the individual’s wellbeing. Language in daily notes and care plans should be looked at to make sure that it is not negative or labelling. The medication administration records (MAR sheets) should be reviewed to see if they could be updated. The pharmacist should be consulted to see if they can supply printed sheets or labels. The home should continue to look at promoting occupation, engagement and purposefulness within people’s daily lives. More items for interaction and occupation could be provided in the lounge. 5. 6. 7. OP15 OP19 OP30 The use of cloth napkins should be considered instead of bibs. Moving the office area out of the lounge to a different location should be further considered. More in-house training could be provided using the skills of people already involved with the home. Funding from Skills for Care could be obtained to fund further specialised training for staff around dementia care. 2. 3. OP7 OP9 4. OP12 Graham House DS0000027242.V365757.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Graham House DS0000027242.V365757.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. 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