Inspection on 03/10/08 for Gresham Lodge

This is the latest available inspection report for this service, carried out on 3rd October 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

Gresham Lodge 23/01/07

Gresham Lodge 02/03/06

Gresham Lodge 17/11/05

Gresham Lodge 03/03/05

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

CARE HOMES FOR OLDER PEOPLE Gresham Lodge Gresham Lodge 255 Ashby Road Scunthorpe North Lincs DN16 2AB Lead Inspector Jane Lyons Key Unannounced Inspection 3rd October 2008 08:30 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 Gresham Lodge DS0000061798.V373509.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. Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gresham Lodge Address Gresham Lodge 255 Ashby Road Scunthorpe North Lincs DN16 2AB 01724 846504 01724 846504 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) Mr Sukhuinder Marjara Miss Suzanne Treece Care Home 21 Category(ies) of Dementia (21), Old age, not falling within any registration, with number other category (21) of places Gresham Lodge DS0000061798.V373509.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 category: Old age, not falling within any other category, Code OP Dementia , Code DE The maximum number of service users who can be accommodated is: 21 2. Date of last inspection Brief Description of the Service: Gresham Lodge is a well established home situated in a pleasant central location of Scunthorpe, it has access to local amenities and public transport. The home is registered to provide care for up to twenty-one residents with problems associated with old age. The home consists of two storeys accessed by stairs and a stair lift. There are thirteen single and four double rooms; none of these are en-suite. Communal areas are provided for residents to spend time in with others, and these include a conservatory and open plan sitting and dining areas. The home has pleasant rear gardens with ample parking to the front of the property. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home. A copy of the latest inspection report for the home is on display in the reception area of Gresham Lodge. The home charges a weekly fee of £347.86 per week. There are additional charges for hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these can be found in the Service User Guide. Gresham Lodge DS0000061798.V373509.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 star. This means the people who use this service experience good quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This inspection included an unannounced site visit carried out by Mrs Jane Lyons on the 3rd October 2008. During the visit we spoke with some of the people who live at the home, a number of relatives, care staff, the cook, a visiting district nurse, the deputy manager, the manager and the registered provider. We looked round the home to see if it was kept clean and tidy. Some of the records kept in the home were checked. This was to see how the people who live in the home were being cared for, that staff were safe to work in the home and that they had been trained to their job safely. We also checked records to make sure that the home and the things used in it were safe and were checked regularly. The manager at the home also completed an annual quality assurance assessment that was requested by CSCI (Commission for Social Care Inspection), which includes information about people who live at the home, the staff that work there, the service provided, complaints and any incidents or accidents that have occurred. Prior to this visit, surveys were sent out to obtain the views of people who live at the home and staff who work there. Three surveys were returned from people who live at the home and four from the staff; the feedback was positive. Comments from surveys have been included in the main body of this report. We would like to take this opportunity to thank everyone who participated in the inspection process. Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? There has been positive action on the requirements listed within the last inspection report. All the requirements and most of the recommendations had been acted upon and resolved. People’s care plans have been improved upon. They are much more “person centred” and contain more information about their wishes and interests so that staff are clearer about what care is needed, and how it should be provided. This also helps the people using the service to have choice in how they are cared for and helps them stay as independent as possible. Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 7 People who are working in the home have been attending more training around safe working practices which better protects their health and safety and that of the people living in the home. The manager of the home has made sure she receives sufficient information and references about new staff before they start work, to protect the people living in the home from harm. Aspects about the management of the home have improved to make sure staff are happier in their work place, feel more valued and supported. This has made sure the working atmosphere is more positive and staff have stayed working at the home which provides more continuity of care for people. New key code locks have been fitted to all external doors in the home which has improved the security of the home. Medication administration records have been completed properly, which better protects people. Other improvements to the facilities in the home have taken place such as the provision of a call bell in the conservatory, lockable facilities have been provided to all people’s private accommodation and the number of toilet facilities for people has increased which improves the overall quality of the environment. The garden areas have been made more secure which will provide a safer environment for people. People have accessed more activities and trips out which enables them to pursue their interests and have access to the local community. Many people commented about the variety of activities that are arranged although one person commented that they would appreciate more trips out to the local public house which they very much enjoyed. What they could do better: They must provide hand-washing facilities in the staff toilet area to protect people from infection control risks. They should consider moving the staff toilet facilities to a more appropriate area where the staff’s privacy is fully protected. They should refurbish and redecorate the bathrooms in the home. They should provide appropriate flooring in the ground floor bathroom to ensure that areas around the toilet facility can be kept clean and hygienic. Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 8 They should ensure the manager has more responsibility for completing the dependency statistics in line with the Residential Staffing Forum and these records should be held in the home to support the staffing levels in place. 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. Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 9 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 Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 10 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): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Proper pre-admission procedures are in place and followed so that people who are thinking about moving into the home can feel confident that their needs will be met. Gresham Lodge does not provide intermediate care. EVIDENCE: The manager explained that people wanting to move into the home or people close to them, are given the opportunity to visit the home and are given full, clear, accurate and up to date information about the home. If they decide to move into the home, the manager added that people are given information about their rights and responsibilities in an easy to understand contract or statement of terms and conditions between them and the care home that Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 11 includes how much they will pay and what the home provides for the money. People living at the home and some visitors confirmed this. There was evidence in three peoples’ care records to confirm that their needs were properly and thoroughly assessed prior to being offered a place at the home. Comments about the format of the assessment record are covered in the next section of the report. The manager explained that admissions to the home only take place if the service is confident staff have the skills and ability to meet the assessed needs of the prospective new person. One staff member said that people looking at moving into Gresham Lodge would be given the opportunity to spend time in the home, prior to them moving in. The manager confirmed this. Since the last inspection visit the home has varied their registration to accommodate persons with needs associated with dementia. The manager confirmed that this means the home can still accommodate individuals whose needs have changed since their admission to the home and that they now take new individuals with mild to moderate needs associated with dementia. The majority of care staff have received training in dementia, surveys received from some of the staff indicated that they felt they still needed further training in this area especially around the management of more challenging behaviours; discussions with the manager confirmed that she had also identified this training need and was currently sourcing some more in depth courses staff could access. People who completed our surveys confirmed that they received enough information about the home before they moved in, one person told us that they had chosen the home following recommendations from friends, they knew some people who lived there and enjoyed being with them. A relative spoken to said that they had chosen the home as it was small and has a very homely atmosphere, their loved one has some sensory problems and has managed to settle in very well, the position of the home also suits them well as they are able to visit regularly and take their relative out to local places that they know. A visiting district nursing sister spoken to confirmed that the manager always carries out re- assessment visits for people who have been admitted to hospital to ensure that the home can continue to meet the individuals needs, which is very good practice. People are able to make a choice of staff gender when deciding whom they would like to deliver their care, as the home currently employs one male care assistant. People confirmed that they are consulted about this and felt comfortable with the arrangements in place. The home does not provide intermediate care. Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 12 Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health, personal and social care needs are well met by staff at the home, and each person has a very detailed plan of care that the person, or someone close to them, has been involved in making. Medication systems are well managed. EVIDENCE: Three people’s care plans were looked at in order to obtain a picture of what their needs are and how staff support them. The care plans provide a good level of detail and enable staff to deliver the right level of care to each person. Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 14 The care plans include details about peoples’ preferred routines and how they like to spend their time. They were also found to contain clear information about individuals’ wishes, choices and decisions in relation to their healthcare needs. Information within people’s files show what they can and cannot do, how the staff should support people and what to do if problems arise. Many of the assessments are recorded on different formats, the most recent one used covers all aspects of needs the person may have but is limiting as to how much personalised information can be written, therefore many of the plans themselves often contain more specific individualised detail than the assessment record. Advice was given to the manager to look at the format of the assessment documentation to make sure a format is provided which will allow all individualised information about a persons needs to be documented in full. Relatives are asked to help complete the life history section of the care plan and this information is beneficial in terms of getting an insight into the kind of hobbies, leisure past times and significant events that make up this person’s life. Having this information helps staff to see the person as an individual in their own right and to engage people in things they are interested in such as a past hobby or a particular talking point. The care plans are regularly reviewed to keep the information up to date; relatives and people who use the service are involved in the monthly evaluations. People did say that staff sit down and talk to them about their care. The daily records were up to date, they contained a lot of information about how people’s physical needs are met and also staff had recorded how people spend their time and things they have enjoyed. Annual reviews take place to discuss people’s care with their family and others who are involved in their care. Information about people’s wishes prior to and following their death is included in the care plan where people have chosen to discuss this aspect of their care. Risk assessments are carried out to identify any risks to the individual. Where a risk has been identified, a care plan is produced to minimise the risk. Nutritional screening records were seen, and the manager said that this is undertaken on admission and subsequently on a periodic basis. The records confirmed this. A record is maintained of people’s weight gain or loss, with evidence in the records of referral when necessary to the community support team. Manual handling plans used to identify the support people require with their mobility describe in detail the assistance required so staff are clear about what is expected from them. Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 15 Risk assessments to support pressure damage are currently carried out by the district nursing team, the home should make sure that assessments to support these areas of care are also held in the home’s care plan documentation. Care plans show that people’s health is monitored and people have access to health care facilities and any relevant specialists that are necessary, the staff support people in attending appointments. Healthcare information is recorded in the care plans about why people are attending appointments and outcomes from these. The records are well maintained, this helps in making sure that everyone is aware of the person’s health needs and how these are to be met. Those people spoken with during this visit said that the home always arranges the doctor when needed and relatives spoken to said that all the staff are good at letting them know if there have been any changes. The home has an arrangement with the local Primary Care Trust whereby a District Nursing Sister is allocated to the service to work with them and case manage people’s health care needs. We spoke to the District Nurse during the visit who was very complimentary about the standards of care at the home, she said that the staff communicated with the team well and made sure that any changes in people’s care was put in place. The team are looking to work with the staff to extend their roles in carrying out simple dressing techniques to improve the continuity of care. People looked clean, well dressed and had received a good level of personal care. Comments received in surveys and during the visit from people and their relatives show that they are very satisfied with the care and support offered by the staff. Comments included: “The staff do a really good job, they know us all really well and how we like things done.” People said that they receive support in a way that respects their privacy and dignity and this could be observed during the visit. Observation of the service showed there is good interaction between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives. A key worker system is in place to enable people to receive one to one support; checks on the records kept to support this time spent with people showed them to be detailed, up to date and well maintained. A sample of three people’s medication was checked during the visit. This showed there to be good systems in place for the recording, storing, administration and disposal of medications. The medication record sheets were neat, tidy and easy to follow. Controlled drugs are stored and administered properly. The manager explained that regular management audits now take place to monitor the medication. These records were seen and were found to be in good order, showing good levels of compliance. The staff training records show that staff at the home have completed appropriate training in medication. Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 16 Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each person is treated as an individual, they are part of their local community, and they are supported to follow personal interests and activities. Meals served at the home are of a good quality and offer choice to ensure people receive a balanced diet. EVIDENCE: Activities are organised in-house and there is opportunity for people to enjoy trips out in the local community. The activity programme has been changed following information received in questionnaires completed by people who live at the home. As a result the home has employed a new activity co-ordinator, who provides support with activities three days a week. She has worked very closely with people to find out what they enjoy doing and what their interests are. It is clear from discussions with the staff member, people who use the service and their relatives that many improvements have been made to the Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 18 activity programme in the home. Bingo is still a very popular pastime and regular games are arranged with prizes for the winners; other activities such as sing a longs, videos, crafts and baking are enjoyed. People have shared access to the home’s minibus and enjoy regular trips out; recently people have enjoyed visiting one of the group’s homes for meals and games of whist. Some people enjoy trips out to the local pubs although one person spoken to said that he would like to go to the pub more often. The home is participating in an “Olympics” event, which has been arranged by the local council and involves a number of other homes in the area; three individuals at the home have agreed to participate in games held at a local community centre. The local paper had visited the home the previous day to take photographs and interview the people involved. The activity organiser described the one- to -one support she provides for the people who are very dependent and are cared for in bed; she described how individuals like to listen to her reading, enjoy manicures and also enjoy the time she spends with them talking about their families and their lives. Discussions with people living at the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family or staff would take them into the community. People can see family and friends whenever they want. Relatives said they are always made to feel welcome when visiting the home, which was observed during the visit. Comments received during the visit show a high level of satisfaction, these included “The home is welcoming and all the staff are friendly” and “ I visit at different times, the home is always clean and tidy and staff always have time for a chat and to offer me a drink”. Staff support people to attend local church services if they wish and there are visits to the home from representatives of the different churches to meet people’s spiritual needs. One individual told us that she enjoys regular communion services and also enjoys singing along to the hymns on Songs of Praise each Sunday. People said they enjoy the meals that are on offer at the home. The menus are on display in the dining room, they were seen to be varied with choices of food. The staff at the home said that the cook does cater for the varying dietary needs of the people living at the home. People confirmed this saying that the food was very nice. Feedback from relatives confirmed that they believe the food to be of a good quality. One person living at the home said, “The food is lovely, all the meals are good, we are spoilt for choice”. An observation made at breakfast and lunchtime showed that meals are presented in an attractive manner and that people living at the home were enjoying their food, and being supported appropriately. Staff were seen to interact with Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 19 people in positive ways, enjoying pleasant conversation and offering people drinks whilst talking about their day. Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. EVIDENCE: People and their representatives have been provided with a copy of the homes complaints procedure, which is also on display in the entrance hall. Surveys returned by people living at the home confirmed that each one of them knew who to speak to if they were unhappy and knew how to make a complaint. Relatives also commented that they knew how to complain, one person said that they had previously spoken to the manager about a concern and she had taken action straight away to sort things out, she would feel confident in future in discussing any issues if they arose. The records show that there is a complaints procedure that is clearly written and easy to understand. The records show that there is a full record of complaints and this includes details of the investigation and any actions taken. The policies and procedures for Safeguarding Adults were seen to be available Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 21 to people living at the home, staff and relatives. After talking with staff at the home, it was clear that they understood the procedures for safeguarding adults. The manager explained that training of staff in the area of protection is regularly arranged, this was supported by documents found within people’s individual training files. Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 22 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 and 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Gresham Lodge provides comfortable homely surroundings; although some improvements have been made to the facilities at the home in recent months much of the décor and furnishings in the bathrooms are now looking stark and clinical which impacts on the overall quality of the environment. The lack of hand wash facilities in the staff toilet area could compromise the homes management of infection control and put people at risk. EVIDENCE: People said they were comfortable at the home. The home has a variety of chairs and furniture and touches such as ornaments and pictures that give rooms a homely feel. Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 23 All areas of the home were seen to be very clean and tidy. The home smelt very clean and fresh with the exception of one bathroom, where the carpet was malodorous around the toilet facility. We observed that the sitting area, dining area and conservatory were very light, comfortable areas and well utilised during the visit. The atmosphere throughout the visit was very warm and welcoming. Since the last inspection visit a number of improvements to the environment have been made such as: a call bell facility provided in the conservatory, key pad locks fitted to all the main doors, all private accommodation has been fitted with lockable storage space and the number of toilet facilities available for people who use the service increased back up to the minimum number needed. The manager confirmed that a number of bedrooms have been redecorated and people have been consulted around their choice of décor, people spoken to confirmed this, one person said ‘I don’t like floral wallpaper or curtains and everything in my room is nice and plain, just how I like it’. The maintenance plan details that the majority of carpets in people’s private accommodation will be replaced in the next twelve months. The bathrooms in the home are now in need of complete refurbishment: the toilet in the first floor bathroom is heavily stained and the dark blue suite would benefit from upgrading. The ground floor bathrooms are quite stark and clinical, the carpet floor covering in one area is now stained and odorous. Both the bathroom areas are also used as storage areas which should be reviewed. The staff toilet facilities have been moved to an outer hall area off the ground floor corridor. The toilet facilities are now sited adjacent to a fire door, the partitioning wall does not afford complete privacy given the external door cannot be locked. The toilet area does not have any hand wash facilities provided which must be put in place to support appropriate infection control measures. The staff vending machine is also sited in this area which should be reviewed. Discussions with the provider confirmed that the plans he had submitted for major alterations to the facilities at the home had again been refused and he was currently deciding on the next course of action and had employed another consultant. The plans had included the kitchen areas, laundry areas and major upgrading of a number of existing facilities. The homes quality assessment details that the improvements to the environment hinge on the plans being approved, however given the delays more timely improvements should take place to upgrade the existing bathroom facilities and consideration given to moving the staff toilet facilities to a more appropriate area. The standard of cleaning in the kitchen areas had improved, all areas seen were clean and tidy. The kitchen units have been repaired following the last visit. Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 24 Bedrooms checked were comfortable, homely and reflected peoples personal tastes. People said their beds were comfortable and bed linen checked was clean and in a good condition. New bedspreads have been provided in all people’s rooms. The manager confirmed that four profile style beds had been provided by the community health team to support the care provision for those individuals with high dependent needs. Staff training on the use of the beds had been provided. One of the first floor bedrooms was noted to have a stone fireplace in situ, discussions were held with the manager and provider around the need to make this area safer for the person occupying the room either by the use of risk management or the provision of boarding. Discussion with the staff indicates that there is a good range of equipment to help with the moving and handling of people and to encourage their independence; this includes hoists and handrails. All the care staff have recently completed infection control training. Staff said that they had adequate supplies of protective clothing and equipment. Policies and procedures were in place to support management of infection control. The manager told us that the home is working with the local Primary Care Trust to assess the home’s current infection control management. The current lack of hand wash facilities in the staff toilet area is potentially compromising the home’s overall infection control management. The garden at the home is attractive with many mature plants and trees, it is well maintained and more secure fencing has been provided; people told us that they had a lot of pleasure from walking in the garden and sitting out when the weather is nice. Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 25 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 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have safe and appropriate support as there are enough competent staff on duty. 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. EVIDENCE: People spoke highly of the staff team and said staff always listened and acted on what they said. People wrote in their surveys that staff were “always” or “usually” available when needed. Information from the annual quality assurance assessment and staff rotas about the number of staffing hours provided, and information gathered during this visit about the dependency levels of the people living in the home, is used with the Residential Staffing Forum Guidance and shows that the home is meeting the recommended guidelines. However from observation during the day and discussions with the staff and manager it is clear the overall dependency levels in the home had increased recently, the manager said she Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 26 was reviewing the current levels on the morning shifts given one of the individual’s needs had changed and they required very close monitoring due to risk of falling. The dependency calculations should be carried out more often and the figures should be held in the home, is advised that the manager has more input into the dependency calculations to ensure they are up to date and reflect any recent admissions or changes. Staff told us that they usually had enough time to provide all the care support needed, the morning shifts were often very busy and that the manager helped out ‘on the floor’ for a few hours each morning assisting with people’s personal care. The home also employs a cook, a cleaner and maintenance man. Employment of a person to carry out laundry duties would ensure the care staff are not diverted from their care duties. There is evidence from staff surveys and discussions that staff moral has improved. Staff turnover has settled significantly from earlier in the year which has provided more consistency of care for people and supported a stronger team ethic amongst the staff. The skill mix on shifts has improved given the reduction in staff turnover. A survey returned by a member of staff said ‘We have enough people on duty to provide good standards of care but the management could consider employing more staff to cover holidays and sickness’ another member of staff wrote ‘We work well as a team, we support each other to look after people properly’. Three staff files were checked at this visit. The files contain a range of information including two references and a declaration of health and identification. The staff have undertaken a criminal record bureau check (CRB), at the enhanced level. This confirms thorough recruitment practices are in place, which is sufficient to safeguard people. The manager keeps an overview of the staff training plan, she confirmed that staff were now up to date with mandatory training. This was supported by information held within people’s individual files and confirmed by staff. The staff spoke about undertaking training such as health and safety, fire safety, moving and handling, safeguarding, and food hygiene. Feedback from people who completed our survey indicated that they believed that the staff were well trained. One staff member commented in survey that they felt they would benefit from more in depth dementia training, discussions with the manager confirmed that she had already identified this training need and was currently sourcing a course which would include some training on management of challenging behaviour. The manager explained that all new staff receive induction and mandatory training in accordance with Skills for Care, the National Training Organisation for care staff. Checks of the records confirmed this. All new staff work alongside more experienced staff as part of their induction. The manager has Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 27 undertaken ‘train the trainer’ and is able to provide training to staff in-house, she feels this is beneficial in terms of staff receiving the right level of training early on in their induction. The records show that National Vocational Qualification (NVQ) training has been arranged for care staff and that more than 50 of the staff team now hold an NVQ II care award. Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 28 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): 31,32, 33, 35, 36 and 38 People who use 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. Improvements in the management and organisation of the home ensure that the home is run in the best interests of people who use the service. In the main the homes procedures promote the health, safety and welfare of people who use the service and the staff. EVIDENCE: The manager of the home is Ms Suzy Treece and she was registered with the Commission in July 2007. She is currently working towards her Registered Manager’s Award, which she hopes to complete in November. Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 29 It is clear from this inspection visit that the manager and registered provider have worked hard to improve many of the management and administrative systems in the home with positive results in areas such as the care records, staff training, medication recording, quality assurance, supervision and recruitment. The manager is committed to ensuring that people staying in the home are consistently well cared for, safe and happy. Discussions with staff and comments received on surveys confirm that there have been improvements to the staff moral since the last inspection. One staff member said ‘ Moral has improved as the turnover of staff has settled, the management have recruited some new staff who are really good and enjoy working here.’ Issues were identified at the last inspection visit around staff not feeling valued by the management, the management acknowledged this and took steps to improve relations with the staff and support them more, staff have regular meetings, regular supervision sessions and said that working practices in the home had improved. Earlier in the year the management issued staff with surveys so they could describe how valued they felt, results of the survey indicate improvements in this area. The home holds small amounts of personal monies on behalf of people. Records are made of any incoming and outgoing monies and are signed by two members of staff. Records and receipts are kept of all transactions so that money can be easily accounted for. Records to support the management of the ‘residents fund’ are up to date and maintained. All staff said that they now receive regular supervision and regularly meet up with their manager to discuss ways of working, checks of records confirmed this. Certificates on the wall of the home and discussion with the Provider and Manager indicate that the North Lincolnshire Council has awarded the home its Gold Standard for Quality Assurance, this award was achieved in 2004 and has been reaffirmed by the council since this time. The home is also accredited with Investor in People Status, and this too has been reaffirmed. The home has a comprehensive quality assurance system. There is evidence of internal auditing of the homes environment, services and records. Regular surveys are also sent out to people who use the service, relatives and other interested parties such as health and social care professionals. Results of the audits and surveys are analysed and actioned by the management, they are also published in the home. Recent surveys identified some issues around the laundry services, which the management are currently looking into. Staff meetings are held and minutes of these meetings were seen. The responsible individual visits the home on a regular basis, a report is written following the visits. An annual development plan has been produced Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 30 which details the direction the service is going and the improvements the home is planning to make over the next twelve months. People who use the service meet with the management of the home. These quality assurance systems will help to ensure that the service is operating in the best interest of the people who live there. The home’s quality assurance assessment indicates that routine maintenance and servicing of equipment takes place. The home carries out weekly fire safety checks which are recorded and staff are involved in fire drills periodically to ensure they know what to do in the event of a fire. The fire risk assessment was updated earlier in the year, however this now needs to be reviewed to include the new security arrangements at the home. Safe working practices are maintained by risk management and the provision of training to staff in the form of moving and handling, basic food hygiene, first aid at work, infection control and fire safety. Accident records are completed and records show that all individual incidents/ accidents are followed up by the manager and audited on a monthly basis to identify any trends that may be apparent and taking the necessary action. Maintenance records were in place and support regular checks on equipment and installations. New risk assessment documentation has been put in place to support the use of bed rails in the home. As detailed in section five of this report; hand-washing facilities must be provided in the staff toilet area to ensure appropriate infection control measures are in place. People spoken to said that they felt very safe and secure at the home. Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 31 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 x X X X 2 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 2 3 3 X 3 3 X 2 Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 32 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 OP26 Regulation 16 (2) j 23 (2) j 13(4)c Requirement The registered person must ensure that hand washing facilities are provided in the staff toilet area. This will promote appropriate infection control practises and reduce the risk of infection to the people who live and work in the home. Timescale for action 15/11/08 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. 2. 3. Refer to Standard OP3 OP12 OP21 Good Practice Recommendations The assessment format should be reviewed to provide an assessment record which allows staff to record more, detailed, individualised assessment information. Increase the frequency of trips to local public houses for one individual to ensure their social needs are fully met. Upgrade the bathrooms in the home as a priority on the maintenance programme. Provide appropriate flooring in the ground floor bathroom to ensure that areas around the toilet facility can be kept clean and hygienic. DS0000061798.V373509.R01.S.doc Version 5.2 Page 33 Gresham Lodge 4. 5. 6. 7. OP27 OP27 OP31 OP38 Review the provision of a laundry worker who would have dedicated hours in that area and free care staff to focus on the delivery of care to people. Ensure that the manager is more involved in the Residential Forum Staffing calculations and that records of these are held in the home. The registered manager should achieve an NVQ 4 in management and care by December 2008. Look at ways of improving the safety of persons occupying the bedroom with the stone fireplace; ensure risk management is in place and review need for boarding up/ removal of fireplace. Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Gresham Lodge DS0000061798.V373509.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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