Inspection on 24/08/09 for Gregory House II Care Home

This is the latest available inspection report for this service, carried out on 24th August 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gregory House II Care Home 04/10/06

Gregory House II Care Home 07/02/06

Gregory House II Care Home 15/03/05

Gregory House II Care Home 19/10/04

Gregory House II Care Home 20/10/03

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Gregory House II Care Home 391/393 Mansfield Road Carrington Nottingham NG5 2DG     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: Mary OLoughlin     Date: 2 4 0 8 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 Adults (18-65 years) Page 2 of 29 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 Adults (18-65 years) 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 Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Gregory House II Care Home 391/393 Mansfield Road Carrington Nottingham NG5 2DG 01159692320 01159245232 gregoryhouse2@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Pam McKale care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Gregory House II was originally a pair of semi - detached houses that have been converted into a care home to accommodate 12 people with mental health needs. It is located on a main road in the Carrington area of Nottingham, offering easy access to routes, shops a post office and local facilities and amenities. The house has a frontage laid to tarmac for car parking and there is a small, enclosed rear garden. Accommodation is provided on 3 floors and the premises are unsuitable for anyone with significant mobility problems as the home does not have a passenger lift. The manager said that the fees for the service range from £336.43 - £560.91 per week depending on dependency needs. There are additional charges for hairdressing and chiropody. Further information about the home is available in the statement of purpose and service user guide. The manager welcomes any telephone or email enquiries and a Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 12 Brief description of the care home copy of the latest inspection report is available in the office. Care Homes for Adults (18-65 years) Page 5 of 29 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star which means that people who use this service receive good outcomes. This was a key inspection which included 6 hours planning and a visit to the home over 5 hours. Prior to the visit we looked at all the information we have received about the home. We looked at the last Annual Quality Assurance document ( AQAA) the manager had sent to us, any notifications we had received and complaints or safeguarding alerts we had been informed of. We received 5 responses from residents to our Have Your Say surveys and 2 responses from staff at the home. Care Homes for Adults (18-65 years) Page 6 of 29 The registered manager was available throughout our inspection and we spoke to the 2 staff on duty. Our main method of inspection was to case track 3 residents which means we looked at their records, spoke with them and looked at the facilities and services available to support them. All 3 residents were under the care of the community mental health team and we contacted the allocated Community Psychiatric Nurses to obtain their views about the care delivery. We looked at the management of health and safety and spoke with the Nottinghamshire Fire Officers about their recent inspection of the home. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: 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 Care Homes for Adults (18-65 years) Page 8 of 29 order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 can expect to have a proper assessment of their needs before admission to the home to make sure that the staff are able to plan and support each individual in accordance with their needs and wishes. Evidence: We looked at what arrangements were in place when people are being admitted to the home. The records of a recently admitted person showed that the manager liaised with the community mental health services and obtained their care programme assessment information about the needs of the person before he completed an assessment to determine whether the home was able to meet the persons needs. The records we saw show that residents are fully involved and contribute to decisions about the care they receive. 5 residents responded to our surveys and all said they were provided with information to help them decide if the home was right for them and were able to make their own decision about coming to stay. Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: The NHS community mental health staff told us that the staff in the home work hard to provide support in a way that preserves and values the unique identity of each person. Residents we spoke with said they were happy with the home and received the care that they expected. Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Residents at the home have an individual care plan developed with their agreement which sets out a care programme respecting their right to make decisions about their lives and take responsible risks. Evidence: A residents meeting was taking place during this inspection and we saw how people were able to contribute their views on how the home was being managed and make suggestions for improvements. We case tracked 3 people living at the home and found that each person was achieving an individually appropriate lifestyle determined by regular assessments and care planning. Where risks were evident the staff had ensured that they put in pace safeguards to allow residents to take responsible risks and make informed decisions about their lives. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: We spoke to 3 residents who told us they knew about and had agreed to their care plans, they said that they were supported by the staff to achieve their goals. When we spoke to community mental health nurses who visited residents regularly in the home we were told that they felt people were being properly cared for and that staff worked hard and worked closely with them to develop programmes of care that gave people with very complex needs opportunities to improve their lives giving them greater freedom within the community. The manager told us that some residents are taken to the homes of care staff to spend time with them but this had not been recorded or risk assessed within the care plan of those people to ensure that they were properly protected and that health and social care specialists were in agreement with this. New laws about how people make decisions is mentioned in some care plans but not all, we suggested that the manager include information in each plan about peoples capacity to make decisions so that their rights are fully protected. The manager agreed to do this. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. Residents are supported to achieve their goals, follow their interests and be integrated into community life. Evidence: The home has previously been assessed at the last inspection as meeting these standards and we found that the manager has continued to develop opportunities for residents to take part in fulfilling activities. We heard during the resident meeting that people were invited to provide choices of venues for day trips out to make sure each individual had an opportunity to participate in something they wanted to. When we spoke to those residents we case tracked they told us that they enjoyed having visitors, were able to go out with their family and regularly visited local shops Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: and facilities without any restrictions being placed on them. They said they chose how they wanted to live their lives, got up when they wanted to and were able to lock their own bedroom door. Residents said they did not have a key to the main front door but they did not mind having to ring the door bell to gain entry. The manager has recently re- assessed the opportunity for people to have their own front door key but finds that keys are lost so frequently this presents a security risk. We saw within the care plans how staff had assessed any risks to residents who wanted to go out alone, this enabled them to take responsible risks as part of their daily lives. Community mental health professionals told us that one resident had now secured a day centre place to provide more opportunities for social skills development. The manager told us that another resident was about to commence college after he had chosen a subject he was keen to develop. Residents told us that staff supported them to attend local churches, however the care plans did lack information on each persons religious needs. Residents told us they thought the meals provided were excellent, they said they had opportunities to help prepare meals if they wished but staff always supported them. 5 residents responded to our surveys, 4 people told us they always make decisions about what they did each day and 1 person said they usually did. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Residents have effective health and personal care support based on their needs and wishes but medicine storage is not compliant with safe custody laws. Evidence: The 3 people that we case tracked were each receiving the regular support of a community psychiatric nurse. We contacted the nurse as part of our inspection process and she told us that the home staff worked closely with her and demonstrated that they could manage residents needs well. We saw that those residents requiring aids and equipment were supplied these to improve their independence. We spoke to the residents that we case tracked and they told us that they were able to see a doctor if they needed to and that staff always asked how they were. One person told us that the staff were lovely, very helpful and treated her well. During our inspection a visiting optician was testing peoples vision in private. The care plans showed that staff monitor peoples oral health regularly and wherever Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: possible access community health care in accordance with their wishes. The 2 staff responding to our surveys told us they had enough knowledge about health care and medication to undertake their role safely. We looked at how medicines were stored and found that the storage of controlled medicines was not compliant with safe custody laws, however none were in use at this time. The staff tell us they are trained to administer medicines safely and we saw that they had appropriate policies to work to. A medicine error that occurred over the last year was appropriately dealt with to ensure safeguards were put in place to reduce any risk of further error. Each person taking medicines had a record sheet that was fully completed, gave clear instructions on prescriptions and showed that medicines were being administered as prescribed. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The procedures and culture of the home ensures that people are safe and supported to share any concerns in relation to their protection and safety. Evidence: We saw within the minutes of a recent residents meeting how staff had taken time to explain what people could do if they had concerns or complaints. Each person has access to a concerns form that they can keep in their room and use if they feel they need to. All 5 residents that responded to our surveys told us they know what to do if they have concerns and that staff always listen to them and act on what they say. The residents we case tracked told us they felt safe at the home. The staff told us they have received training in how to protect people from abuse and respond to any suspicion of abuse. The commission has received 1 complaint during the last year which was investigated through the safeguarding of adults procedures by the mental health team. The manager said the investigation did not uphold the concerns expressed. The manager has previously held complaints within individual files which is not Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: suitable as these are then archived and not available for audit or inspection purposes. He told us that he is in the process of preparing a separate file for any future complaints or safeguarding alerts to ensure that they are accessible. Care Homes for Adults (18-65 years) Page 20 of 29 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortable and safely maintained. Evidence: We found that improvements have taken place to the environment since we last inspected the home. The manager has repaired and painted windows, replaced carpets and furnishings and continues to upgrade the building through continuous improvement. The residents told us in our surveys and during the inspection that the home is always clean and fresh and that they take pride in what they feel is their home. Some people help with domestic tasks if they choose to. We found that the home was clean and tidy throughout. The manager tells us that staff are trained to control infection and have policies and procedures to ensure people are protected from any infection hazard. Care Homes for Adults (18-65 years) Page 21 of 29 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. There are safe and robust recruitment practices but training needs have not been assessed to link it to the specific needs of the residents at the home. Evidence: We inspected the process of recruitment and found that the manager always completes a thorough check on prospective employees before they commence work to ensure they are suitable to work with vulnerable adults. We saw the induction records of a newly appointed staff member showing that when people start work they commence on a nationally recognised induction training course which ensures they are not left in situations they cannot handle. The 2 staff we spoke with and the 2 staff responding to our surveys told us they felt they had the skills to manage the care of people at the home. The manager told us that over 50 of the staff team are trained to level 2 in National Vocational Qualifications in care which exceeds the minimum standard. The manager had not prepared a training needs assessment for the staff team to inform future planning and ensure that staff were up to date. The staff we spoke with Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: said they receive regular training to update their skills but there was no evidence that people received any training specifically in the needs of people with mental illness . The residents spoke highly of the staff and the manager and external professionals told us the staff work hard to provide residents with the care and support they need. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is safe and residents have a say in how it is run but not all records are maintained and up to date to ensure the effective and efficient running of the business. Evidence: The manager is registered with the commission and has been in post for a number of years. He has attained his National Vocational Qualification in care management and we saw evidence that he continues to update his training. He has ensured that he has received training in the recent changes in legislation regarding the Mental Capacity Act and associated safeguards and tells us he intends to train the staff team in this subject to ensure that care plans are written which reflect that peoples rights are fully protected. The community mental health team told us that the care residents receive is managed well and they have not received any complaints about the services provided by the home. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: We saw how residents are consulted regularly about the care they receive and how staff have taken time to fully explain to people what to do if they have concerns about their care. Residents have weekly meetings that give them an opportunity to comment on the services provided and to make suggestions for improvement, however the records did not give information on whether the suggestions were used to improve the service. The home has a consistent record of meeting health and safety requirements, on this occasion we looked at the management of fire detection and prevention and found it to be regularly checked with suitable assessment of fire risks in place. We spoke with the Fire service who inspected the home within the last year and they found no deficiencies in the fire systems at the home. We found that record keeping was not always up to date, in good order or available for inspection as described within the outcome groups through this report. Our last inspection required the provider of the business to complete monthly quality visits to the home, however the manager who is the son of the provider told us the provider lives abroad and is unable to do this. Gregory House has a sister home that is managed by a member of the same family and who the manager said was to commence the monthly visits to the home and prepare a report as required. Care Homes for Adults (18-65 years) Page 25 of 29 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 Adults (18-65 years) Page 26 of 29 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 9 13 You must ensure that all activities in which service users participate are free from avoidable risks and unnecessary risks to their health or safety are identified and as far as possible eliminated. To ensure that people are fully protected when attending the homes of staff. 30/09/2009 2 20 13 Controlled medicines must be appropriately stored. To ensure the health and welfare of service users. 27/11/2009 3 22 22 You must keep a summary of all complaints and safeguarding alerts which includes actions taken and outcomes. So that they are available for inspection. 27/10/2009 Care Homes for Adults (18-65 years) Page 27 of 29 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 4 35 18 You must complete a training needs assessment for the staff team. To inform future training and development linked to the needs of the people living at the home. 27/10/2009 5 41 17 You must ensure that records are kept up to date. For the protection of the residents and the effective and efficient running of the business. 27/11/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 6 7 16 39 Review each care plan as the residents condition changes. Include reference to the Mental Capacity Act within each care plan. Include within each care plan an assessment for the suitability for residents to have their own front door key. Provide feedback to residents on how their suggestions are used to improve the service following their participation at meetings and completing satisfaction surveys. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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