This is the latest available inspection report for this service, carried out on 24th February 2009.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Not yet rated. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.
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.
Inspecting for better lives Random inspection report
Care homes for older people
Name: Address: Grimsargh House Residential Home Preston Road Grimsargh Preston Lancashire PR2 5JE new service which has yet to be given a quality rating The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Pauline Caulfield Date: 2 4 0 2 2 0 0 9 Information about the care home
Name of care home: Address: Grimsargh House Residential Home Preston Road Grimsargh Preston Lancashire PR2 5JE 01772651031 01772653994 info@grimsarghhouse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Stanner Manufacturing Limited care home 28 Number of places (if applicable): Under 65 Over 65 28 old age, not falling within any other category Conditions of registration: 0 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 The maximum number of Service Users who can be accommodated is: 28 Date of last inspection Brief description of the care home Grimsargh House is situated within extensive grounds in the village of Grimsargh. The home is registered for 28 service users and provides personal care to older people both male and female. The home is not purpose built and has three floors accessible by a lift. There is ample communal space with two conservatories as well as a large dining room and lounge. The service provided is intended for service users who are fairly dependent but do not require nursing care. The fees for the home range from 346 Care Homes for Older People
Page 2 of 13 2 0 1 1 2 0 0 8 Brief description of the care home pounds to 390 pounds per week with additional costs for hairdressing toiletries and magazines. Care Homes for Older People Page 3 of 13 What we found:
The reason for this inspection was to check that the excellent 3 star rating given at the last key inspection is still valid and that nothing has changed. We looked at all the key standards. The findings of the random inspection suggest that there may be a change to the current excellent 3 star rating at the home. In light of this we will review our current inspection schedule and undertake a key inspection. Assessment, care planning and record keeping and recruitment and selection are the main areas of concern and need attention to ensure the safety of and appropriate care of residents. We will review our plans for Grimsargh house and may bring forward the key inspection to ensure that improvements have been made. We looked at the admission process for two residents. One resident had an assessment completed by the home in place before admission. This helped staff to be aware of the residents specific care needs and how to meet these. The other resident did not have a care assessment in place completed by either social services or by the home, even though the inspection was several weeks after the resident was admitted. There was very limited information available on this resident with some admission information such as religion and marital state missing. The assessment and other admission details are very important in order to provide appropriate and effective care to residents. We case tracked two residents. There were care records in place for one resident. There was a detailed assessment and risk assessments in place. These were reviewed every month. However the care plan in place from these was very limited. Records did not show how a resident needed support or how staff would do this. There was very limited information about this residents agitation in the daily diary - simply that the resident had been agitated. There was a behaviour diary where staff were supposed to record any issues/incidents. This was more detailed but was not always used. Sometimes incidents of agitation/aggression were recorded in the behaviour diary, sometimes in the daily report and sometimes not at all. Staff must record all incidents in detail explaining exactly what behaviour is occurring rather than stating agitated or aggressive in order to provide accurate information. The manager also needs to provide a strategy for managing the agitation/aggression detailing the form this agitation/aggression takes, how to manage it and ways of reducing it effectively. The other resident did not have a care plan or any other information except individual diary reports and an assessment which had been written two days before the inspection (several weeks after admission) . No care plan or risk assessments had been compiled from the assessment. A blank care plan was waiting to be completed but the manager said that the home had never completed care plans until 2 or 3 months after admission when they knew people better. She also said that short stay residents did not have care plans. We explained the need to commence care plans immediately on admission for permanent, and short stay residents, using information from the assessment and adding more information day by day as staff gained more knowledge about residents.All residents must have a care plan, risk assessments and other relevant documents in place. There were some detailed entries relating to the residents care in her individual diary notes. This has given staff some information on the resident. Staff were reasonably aware of the care needs of this resident but detailed information must be recorded from admission to get a full picture of each Care Homes for Older People Page 4 of 13 resident and so all people involved in a residents care have up to date written information. One resident was eating poorly on admission and was given a food supplement that the home had available. If there are concerns about a residents nutritional intake, the GP and if appropriate a dietician should be consulted, if appropriate the resident will be prescribed supplements. The home should not be giving supplements without a GPs involvement. The manager said that recently a resident wanted to go for a walk, staff felt that she was unsafe as she was unsteady so asked her to wait and went with her as soon as they had time. They felt that she should not go out unaccompanied. We advised the manager to carry out a risk assessment to see whether this was the case and to discuss this with her. Where a residents rights may be restricted, staff must look at the residents ability to make a decision about this and follow a best interests pathway if the resident may not be able to make an informed decision about a particular issue. Residents have access to appropriate health services. There are visits when needed to and from the GP and District Nurses and records are kept of these. Records showed involvement of the chiropodist, opticians and GPs. One of the residents case tracked had been involved in an accident/incident where another resident had injured her. The home had not informed anyone of this incident. A report showed a similar incident where the case tracked resident had hit another resident. It was not clear if injuries were sustained. Reports on residents do not seem to be always described accurately so it is not always clear how serious the injury is. Where a resident is injured by another the home should inform social services of the incident and of the actions the home has taken to reduce the risk of further injury so that residents are kept safe. Case tracked residents had not had any accident relating to falls. Other people had occasionally fallen in the home. The manager audited falls to see if any lessons could be learnt or accidents reduced if accidents/falls occurred. Staff are familiar with residents needs and residents are satisfied with the care and support they receive. We observed care at the home sitting in the lounge before and during lunch, where we could observe the dining room and when walking around the building. Staff were kind and helpful with residents. Staff were knocking on doors before entering and were respectful and pleasant with residents. Staff interaction was good with a lot of non verbal communication, touching gently, smiling and eye contact from staff. Residents were moved carefully and where possible supported to walk slowly and carefully rather than simply putting the resident into a wheelchair for speed. Residents spoken to were complimentary about staff support and attitudes, said staff were kind and willing to help and that they were happy in the home. Satisfactory and careful moving and handling were occurring the home. One resident who often had a short stay at the home was very complimentary about staff and said he enjoyed coming to Grimsargh house. A relative said how good the home was, she added I can relax knowing that he is safe and well cared for. Another resident said,I am very settled and happy here. I like my room and the staff are nice. Care Homes for Older People
Page 5 of 13 Most medication administration was satisfactory with clear entering of medication and disposal of medication, appropriate signing in most cases and storage of medication. However one residents care records showed that on several occasions she spat out her medication but on all but one of these occasions it was signed as administered. The manager said that this may be because it was partially spat out and then taken, if this is so it is not good practice. Records need to be clear and accurate. At the pharmacy inspection in November 2008 one of the recommendations was for when required medication to have additional guidance to help make sure the medication is used appropriately. This guidance has not yet been included and should be. Residents said there were some activities offered including bingo, jigsaws and exercises but they would like more indoor activities including board games. There are some trips out offered but these are more popular in the warmer weather. Routines in the home are quite flexible and residents spoken to said that they can choose when they get up and go to bed and whether they want to join in activities. One resident said, It suits me here. Another resident added, We are very comfortable. The lunchtime meal was observed. This looked hot and was well presented. Special diets are provided as needed. The menu was seen which showed a varied diet was offered. A resident said, The food is lovely and I like it here. another resident added, The food is very nice, always good. Relatives said they are always made welcome in the home and staff encourage people to visit. All current residents are White English or Irish and are nominally Christian or have no religious persuasion. Residents who want to can see the ministers of their choice. Residents spoken to said they knew who to complain to if they had any concerns. There have been no complaints to the home since the last inspection but some concerns were made anonymously about care of residents to social services. The manager said that these were checked by a representative from social services but the representative was satisfied that staff were providing appropriate care. Residents spoken to said they were happy and that staff listen to them. They added that they could talk to staff if they were not happy about something. Some staff have received safeguarding adults training and have an understanding of the action to be taken if they are alerted to a safeguarding issue. Other newer staff still need to have this training. We toured the home and found the environment comfortable, homely, clean and tidy. Residents said the home was comfortable and homely. The home was clean and fresh smelling. Aids and adaptations are in place to help residents get about more easily and to be as safe and as independent as they can be. A lot of the staff have worked in the home for several years and there is only a small staff turnover. Having a stable staff team ensures that staff are familiar with residents and their care needs and residents know the people caring for them. Staff rotas showed sufficient staff on duty doing the inspection. Residents spoken to felt that Care Homes for Older People
Page 6 of 13 there were sufficient numbers of staff on duty to provide care when they wanted it. There are usually four care staff on duty in a morning and three care staff in an afternoon with two waking and a sleep in staff at night. Staff recruitment records were checked. The records of three members of staff were checked. The application form did not show a complete work history for any applicant checked, showing only more recent employment and either only the year of change of employment or no dates of employment changes. The reason for leaving previous jobs was not recorded either. All prospective staff should provide a complete working history from first job to present job with dates including the month and year of changes of employment to reduce the risk of employing anyone who should not work with vulnerable people. The manager should also show that she knows the reason prospective staff left any jobs working with vulnerable adults and has explored any gaps in the employment history of prospective members of staff. All staff had PoVA checks before commencing employment and CRB checks soon after. This helps to reduce the risk of unsuitable people working with vulnerable adults. Two staff files showed two written references in place but one only showed one reference. The manager said that the member of staff had two references but she could not find one of them. References must be available on inspections so it is clear that the recruitment and selection of staff is carried out safely. The relationship between the applicant and referee was not clear on some references. This information should be recorded so that the home can evaluate the usefulness of the reference. Most care staff employed have completed National Vocational Qualification (NVQ) level 2 training and some of them are starting NVQ level 3 training soon. NVQs are national awards in care that enable staff to gain up to date skills and knowledge about current care practice. Staff training records were seen. Records seen showed that there was a variety of training available to staff. Staff spoken to said they had completed food hygiene/safety in catering, COSHH training, infection control, basic first aid and health and safety. The home changed ownership in 2007. Staff said they felt the change of ownership had been positive for the home. Staff spoken to said they feel well supported by the manager who was promoted internally and was previously the deputy manager. She has been the manager of the home since August 2008 and has started the leadership and management award which is a national award which provides skills and knowledge to managers and senior staff in running a service effectively. The manager has applied to the commission to become the registered manager of the home as required by the care homes legislation. The manager advised us that she had not been involved in any of the management of the home until the previous manager left and was still familiarising herself with the paperwork. There are several areas need urgent attention and improvement, these include assessment, care planning and risk assessment and staff recruitment and selection. If this had been a key inspection these issues would have affected the rating of the home. Systems are in place for quality assurance. There are some staff meetings and residents meetings and the manager wants to make these more frequent. The owners visit the home at least monthly. they look around the home and speak to staff and residents and complete a report about the quality of the home. Care Homes for Older People Page 7 of 13 Staff training ensuring the home remains safe is in place with staff having regular fire safety and moving and handling training. The fire safety information is up to date. The fire risk assessment is in place and there are regular fire alarm and emergency light checks and health and safety checks are in place and records kept. Record keeping on care records and medication practice and record keeping need improvement. There are regular regulation 26 visits and reports are completed on these visits. What the care home does well: What they could do better:
Staff must assess residents or have information on residents about their care and support needs before admitting a resident to the home, so they can care for residents effectively Care plans, risk assessments and other relevant information must be in place otherwise information about a residents care may be missed or forgotten or may not be passed on appropriately. Staff need to involve the resident and other professionals when deciding about care issues, so that issues are discussed and decisions are clear to everyone. Medication management should be looked at so that residents are given their medication hygienically and it is correctly recorded. Prospective staff need to have a full working history so that staff are aware of their past work experience and can identify any gaps in employment. Two written references need to be in place before the person starts working at the home and available for checking at inspection. This makes it less likely that people who should not work with vulnerable residents can gain employment in the home. All staff should have training on safeguarding adults so staff know how to protect Care Homes for Older People
Page 8 of 13 residents well. 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 set out on page 2. Care Homes for Older People Page 9 of 13 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 10 of 13 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, 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 3 14 All residents must have an assessment completed before they move into the home so that staff are aware of the residents needs and know that they can meet them. 23/03/2009 2 7 15 All residents must have a 23/03/2009 care plan, risk assessments and other relevant documents completed by the home looking at all areas of care so that staff have up to date accurate written information in place so that nothing is missed or forgotten 3 14 13 If staff are looking to restrict 23/03/2009 a residents rights, a multidisciplinary meeting must be carried out looking at the residents capability to decide this issue and their best interests so that rights are not unnecessarily restricted. Care Homes for Older People Page 11 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 18 13 Appropriate agencies need to 23/03/2009 be contacted when safeguarding incidents including a resident injuring another resident occur so that the resident is kept safe. 5 29 19 Prospective staff need to 23/03/2009 have a full working history and two written references so that the manager is aware of the prospective member of staffs past work practice and experience and can identify any gaps in employment. This makes it less likely that people who should not work with vulnerable residents can gain employment in the home. 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 9 When medication is prescribed when required there should be additional guidance to help make sure the medication is used appropriately. Medication should be administered in a safe and hygienic way and recorded appropriately. All staff should receive some training on safeguarding adults so they are able to protect and support residents effectively. 2 9 3 18 Care Homes for Older People Page 12 of 13 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 13 of 13 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
