Inspection on 17/01/08 for Garfield Grange

This inspection was carried out on 17th January 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Garfield Grange 27/01/09

Garfield Grange 12/07/06

Garfield Grange 05/01/06

Garfield Grange 27/01/05

Garfield Grange 14/07/04

Garfield Grange 10/02/04

Garfield Grange 20/11/03

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Garfield Grange Lelley Road Preston Hull East Yorkshire HU12 8TX Lead Inspector Christina Bettison Key Unannounced Inspection 17th January 2008 09:30 Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 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 Garfield Grange DS0000019672.V357612.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 Adults 18-65. 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. Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Garfield Grange Address Lelley Road Preston Hull East Yorkshire HU12 8TX 01482 896230 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) londonroad@tiscali.co.uk Milbury Care Services Ltd Mrs Diane Baxter Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th July 2006 Brief Description of the Service: Garfield Grange is situated on the outskirts of the small village of Preston some 6 miles from the city of Hull. There is no public transport service to or from the premises. The site offers two facilities, a large detached two-storey house and a smaller bungalow to the rear. Garfield Grange gives respite care to a maximum of twelve guests at any one time. The large detached house provides eight single bedrooms and the bungalow a further four. There are sufficient communal areas, toilets and bathrooms in each location. Specialist lifting, moving and safety equipment is provided as necessary. Garfield Grange offers short term accommodation for adults with a learning disability and associated health and behavioural problems including some challenging behaviour. The staff provide personal care, help, advice and guidance with daily living skills and activities, a catering service, a laundry service and domestic and cleaning services. Activities are offered both on and off site. Garfield Grange DS0000019672.V357612.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 1 star. This means that the people who use this service experience adequate quality outcomes. The site visit took place over 1 day in January 2008. Surveys were posted out prior to inspection; two were returned from relatives and two returned from people who stay in the home. The home has been closed for 6 months of the year due to flooding and the focus has been on the refurbishment of the building and replacement of furnishings. The Registered manager was not at the home on the day of the visit, however the acting senior support worker and one staff member who was on duty on the day of the visit were spoken to and one guest was seen. The interactions between staff and the guest staying in the home was observed to find out how the home was run and if the people who stayed there were satisfied with the care and facilities provided. The inspector looked around the home and looked at records. Information received by us over the last twelve months was considered in forming a judgement as part of the inspection process. Prior to the visit the inspector referred to notifications sent to the Commission for Social Care Inspection, the event history for the home over the past year and the completed Annual Quality Assurance Assessment all of which forms part of this inspection. The site visit was led by Regulation Inspector Mrs. T. Bettison, the visit lasted 5 hours. What the service does well: The people that stay in the home and their relatives are provided with information that is easy to read so that they know what to expect from the home. Relatives told us;“I have never had any concerns about my sons care while he has stayed at Garfield Grange” Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 6 “I find everything satisfactory” People who might like to stay at the home are able to visit and stay overnight to help them to decide if the home will be able to meet their needs or not. All of the people that stay there have a basic plan of care that help staff to know what their needs are and meet them. People that stay in the home are treated as individuals and opportunities for activities and outings are provided. Although the home is isolated, people were helped to make use of community facilities and amenities through regular outings in the minibus. A balanced and generally nutritious diet is provided. Specialist crockery and cutlery was available. All of the people have a single room, providing them with a private area to their liking where they can spend private time or receive visitors. Relatives are made to feel welcome in the home. The people who stay in the home and their relatives concerns are listened to and staff make sure they take action to sort problems out quickly. The staff are very committed and caring and treat people with respect and dignity. The person who was at the home was spoken to and said that staff members were “great”. There are enough staff in the home so that the staff can meet the needs of the people that stay there and carry out all of their duties safely. A good recruitment policy is in place. The home is safe, comfortable and homely and meets peoples individual needs and the kitchen is kept clean and people are helped to eat a healthy diet but also some foods that they like. What has improved since the last inspection? The home has been closed for 6 months of the year due to flooding and the focus has been on the refurbishment of the building and replacement of furnishings. The management team and staff are keen to develop the care plans for people based on the new corporate format however this has only just started due to the closure of the home. Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 7 What they could do better: 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. Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 People who use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Information detailing peoples assessed needs was not available in the home which means that staff are not aware of all of peoples needs and previous histories, this does not help the staff to meet peoples needs and keep them safe from harm. EVIDENCE: The home has a statement of purpose and service users guide, and people who might want to stay in the home and their representatives are provided with information about the home. There was evidence that people had the opportunity to visit the home and had overnight stays prior to admission, to test out the home. Three care files were examined as part of this site visit, there was some very basic information on file about peoples needs but no copies of community care assessments or evidence that the home had completed their own detailed assessment. Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 10 For one person who was on an extended stay, this information was not available and we were informed that the registered manager knew all about them and their history but the staff team didn’t. This mans that the staff team will not be aware of all their needs and therefore will be unable to meet them and keep people safe from harm. Without adequate assessment information it will be difficult to develop detailed plans of care. Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s basic needs are generally met however the lack of assessment, poor quality of the care plans and risk assessment has the potential to place people at risk and mean that all of their assessed needs may not be met. EVIDENCE: All of the people that stay at Garfield Grange have a care file, the inspector is aware that Milbury/Voyage are in the process of introducing new care planning paperwork and the management team and staff are keen to develop the care plans for people based on the new corporate format however this has only just started at Garfield Grange due to the re opening of the home following refurbishment after the flooding. Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 12 Although relatives and carers take full responsibility for meeting peoples needs when they are at home, whilst people are receiving respite care at Garfield Grange the home and staff are responsible for meeting all needs. Three care files were examined as part of the inspection process; care files were untidy and disorganised. The lack of assessment information hindered the development of detailed plans as staff were not aware of all of the peoples assessed needs. A section entitled “Things You Need To Know About Me” showed the persons likes, dislikes, preferences and choices in a number of activities of daily living, however this did not detail all care needs. Local authority care plans were in place however some of these related to previous placements and not Garfield grange. The home had developed care plans however they were generic with some minimal amendments in an attempt to individualise them. Plans were very basic and ill thought out, for example in one care file the person had a plan for teeth care and teeth brushing, however this person did not have any teeth. The first care file examined was for a person who was on an extended stay: there was no local authority assessment and the home had not completed their own detailed assessment of this persons needs. The local authority care plan detailed some of their needs as having allergies and asthma, some mental health needs and the potential for verbal and physical aggression. However the homes own care plan was generic and did not cover any of these needs. There were no health needs identified and no records of how these will be met and no outcomes recorded. There were a range of risk assessments provided however these were of poor quality and given the persons potential for physical and verbal aggression this was not covered in a risk assessment or behaviour management plan. There was no review on file for this person. Risk assessments had been completed for a range of issues that pose a risk including moving and assisting, fire, and epilepsy however these were of poor quality. In addition to this some people have bed side rails fitted however satisfactory risk assessments had not been completed for this. In another care file examined it did not include a local authority assessment, however there was a LA care plan that detailed someone with behaviour that can be difficult to manage, a skin condition and needing a soft diet. Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 13 Once again the homes care plan was generic and none of the above needs had been covered. The behaviour management plan for this person was dated 2005 and had not been amended or updated since then. There was a person centred review on this file dated June 2006 but none since. In the third care file examined again there was no assessment information and the homes own care plan was generic. This person has epilepsy, can lash out and take items belonging to others, has no road safety awareness, a lot of personal care needs and needs all food cutting up. None of these areas were covered in the care plan and there was no epilepsy management plan in place. Daily records indicated that there had been two occasions of this person having a fall once from bed and once from the chair in the dining room. Risk assessments were in place for a range of activities that may pose a risk however significant areas of risk had not been assessed i.e. the recent falls, the use of bedside rails and choking. Once again there was no behaviour management guidelines to help staff to manage this persons difficult behaviour. All care plans, risk assessments and other guidance need to be signed and dated and reviewed and updated when needs change. None of peoples health needs had been included in the plans. Because of the nature of the service being respite, relatives and carers take full responsibility for supporting people to meet their ongoing health needs, however it is vital that the home identify, plan and meet peoples health needs whilst people are staying with them at the home. i.e. treating psoriasis, allergies and asthma and managing peoples epilepsy. However daily recordings were good, they were very informative, respectfully written and detailed action taken to meet needs, activities undertaken, food and fluid intake and there was good evidence of choice being promoted; in times of getting up and going to bed and food choices. It was evident from the daily recordings and from talking to the person in the home that activities are provided in the form of walks to the nearby garden centre, trips out in the bus, continued attendance in day services, shopping, crafts and watching TV and listening to music. Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples individual diverse needs are met whilst saying in the respite service, however better identification and planning in care files would evidence this better. EVIDENCE: A lot of the standards in this section do not apply to this service, as it is respite/short stay service only. However there was very little information in care plans as to how the home are enabling people to maintain and/or develop new skills and how their interests and/or hobbies are being supported. Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 15 However daily recordings were good, they were very informative, respectfully written and detailed action taken to meet needs, activities undertaken, food and fluid intake and there was good evidence of choice being promoted; in times of getting up and going to bed and food choices. It was evident from the daily recordings and from talking to the person in the home on the day of the visit that activities are provided in the form of walks to the nearby garden centre, trips out in the bus, continued attendance in day services, shopping, crafts and watching TV and listening to music. The diet and nutritional needs of people need to be detailed in their plan and include their likes and dislikes. The kitchen has been completely refitted following the damage from the floods. Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience adequate outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. People’s health and personal care needs are generally met however they are not being not being fully identified and planned for. These shortfalls have the potential for their needs to not be met and place people at risk of harm. EVIDENCE: None of peoples health needs had been included in the plans. Because of the nature of the service being respite, relatives and carers take full responsibility for supporting people to meet their ongoing health needs, however it is vital that the home identify, plan and meet peoples health needs whilst people are staying with them at the home. i.e. treating psoriasis, allergies and asthma and managing peoples epilepsy. A local general medical practice provides emergency cover if the persons own medical practitioner was unwilling or unable to visit. Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 17 The necessary specialist equipment to ensure people could use all the services and facilities provided by the home was in place. A medication policy and procedure was available. People bring their medication in with them when they are staying at the home. The home has a policy that all medication must be in the original bottles/packets and clearly labelled. Records of medication booked in and out is kept and medication administration records were satisfactory. We were informed that all staff had completed an external training course “The Safe Handling of Medicines” however; staff had not had their competency assessed. Where people are prescribed medication to be taken as and when required the home must have protocols in place to guide staff for the administration of all medication administered on a PRN basis, these need to be detailed and specify which medication, how much and if more can be administered when and how much and in what circumstances. Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience adequate outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. People that stay in the home and their relatives are listened to and the people are protected from harm by a caring staff team however the further development of care and health plans will evidence this better. EVIDENCE: The home has a complaints procedure and policies and procedures for safeguarding adults. Due the home being closed for a significant time there had been no complaints made to the home or the CSCI since the previous inspection. All of the staff had received training in safeguarding adults. Examination of staff files evidenced that some staff had received some training that is specific to the needs of the individuals living in the home, however this needs to improve. People staying in the home were being kept safe however the further development of care plans, risk assessments and health action plans and additional staff training will demonstrate this better. Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The home provides people with large, spacious, homely and comfortable surroundings in which to live, with all of the equipment provided to ensure people’s physical needs are met and independence is promoted and safety maintained. EVIDENCE: The home was subject to devastating flooding in June of last year and reopened in December following major refurbishment works to both properties. The home consists of two properties, Garfield Grange and Ashlyn. Garfield Grange the original building was opened over 10 years ago with Ashlyn, a later addition. The home offers accommodation for a maximum of 12 people all on respite/short term care. Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 20 The home is over a mile from the nearest village and 6 miles from the centre of Hull. There is no public transport to the properties. The premises are set in their own large secluded grounds. Access to the home is good and fixtures, fittings, fabrics and furnishings were all domestic in nature and of good quality. The home has the benefits of a maintenance person and details are kept of the necessary repairs and renewals. Specialist equipment was available as required including baths, hoists, beds and wheelchairs and a new wet room/shower had been installed in the Ashlyn bungalow. Bedrooms were all for single occupancy and contained all of the necessary items for people on a respite/short stay. Both properties were clean, tidy and odour free on the days of the site visits. Garfield Grange had a laundry area fitted with commercial machines. Suitable arrangements were in place for the laundering of linen, bedding, towels and, where necessary, personal clothing. Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are supported by sufficient numbers of staff that are caring however the provision of training not sufficient to ensure that staff are skilled and competent to meet the all of the needs of the people that stay in the home. EVIDENCE: The inspector was informed that the home has the following staff;• • • • 1 x Registered manager 3 x full time senior support workers days 70 care hours per week - support workers nights 260 care hours per week - day support workers The registered manager works supernumerary. The rota evidenced that there are usually 3 support workers allocated per day shift - am and 3 support workers per day shift - pm. There is also 1 waking night staff. Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 22 We were informed that the numbers of staff can vary depending on how many people are staying at the home. Numbers of staff are increased/decreased as required. Staff spoken to told us that the staffing was sufficient to meet the needs of the people that stay in the home. Male and female staff were employed of different ages and backgrounds. As the rota was completed only a week or two in advance, staffing levels could be adjusted according to the number of people to be admitted and their assessed needs. Bank staff were used, all employed by the Registered Provider. Senior staff said the bank staff knew the home and the people. They were confident consistency of care was maintained. Staff have the responsibility of cleaning bedrooms bathrooms and all communal areas, the preparation, cooking and serving and cleaning up after 3 meals per day, supporting people to attend appointments, activities, undertake shopping and gardening and in addition to this attend to the care needs of the people that live in the home. 4 staff files and the training records for all staff were examined in the course of the inspection. All staff had completed application forms and had contracts. However we were informed that references were kept at the company headquarters and not on staff files in the home. There was no evidence that new staff were being monitored throughout their probationary period and some staff had commenced induction but not completed it, for one staff member they had commenced in their post on October 2007 but not completed their induction, for another staff member there was no evidence of them commencing their induction even they had commenced in post in November 2007. We were informed that supervision sessions had stopped whilst staff were working at other homes during the refurbishment and this was evident from the lack of supervision records on files and there was no evidence of individual staff appraisals. Some staff were up to date with their mandatory training but not all. The inspector was informed that the Elbox electronic system had been introduced in the home and all staff will now be using this method to update some of their mandatory training and to complete NVQ. Some of the staff had received a range of training that is specific to the needs of the people who stay at the home but not all, and this included;- eating and swallowing, bowel management, autism, epilepsy and values and attitudes. The majority of staff had completed safeguarding adults training. Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 23 None of the staff had received training on how to manage difficult behaviours. A training plan was available however the home does not have 50 of staff qualified to NVQ level 2. Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience adequate outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The management and conduct of the home is adequate, the people that stay in the home are happy and their independence is promoted. Staff and managers act in the best interests of the people that stay there, however improvements are needed in the quality of care and health plans and the provision of training for staff. EVIDENCE: Garfield grange is part of Milbury/Voyage Care Services which is a national provider of care and support services for people with a learning disability. Milbury/Voyage is part of the Paragon Health Care group, which is a UK wide Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 25 organisation that specialises in providing a range of services to vulnerable people. The home has been closed for 6 months of the year due to flooding and the focus has been on the refurbishment of the building and replacement of furnishings. The home reopened in December 2007 and the manager of the home is now registered with the CSCI. The manager has her NVQ level 4 and the registered managers awards, she was not at the home on the day of the site visit. Improvements are needed in the further development of care and health plans, and the provision of training for staff. The manager had submitted an AQAA which was of an adequate standard and as part of the site visit we examined the maintenance and servicing records; • • • • • • • • • Premises electrical circuits- 20/11/07 valid for 5 years PAT tests- 27/01/07 Fire detection and fighting equipment- 20/11/07 Fire drills – undertaken monthly Fire alarm – weekly tests undertaken Hoists/baths and all specialist lifting equipment-25/11/07 Water temperatures - checked regularly Legionella – no evidence on site of checks for legionella. Fire risk assessment in place. Milbury care services have a QA system, which includes regular audits and monitoring of the service culminating in an annual service review. The area manager undertakes regulation 26 visits on a monthly basis however this has failed to be effective in highlighting the areas for improvement. None of the QA documentation was examined by the inspector during the site visit. Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 1 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 2 x 2 x x 2 x Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 YA2 Regulation 15 and 17 Requirement Timescale for action 31/03/08 2 YA6 15 and 17 3 YA7 15 and 17 4 YA9 13 and 17 The registered person must ensure that people are assessed and that all of their assessed needs and professional assessments are included in the plan of care so that all of their needs are met. The registered person must 31/03/08 ensure that care plans are developed and agreed with people and must detail the action to be taken by staff so that they can meet all of their personal, health and welfare needs. The registered person must 31/03/08 ensure that when people present behaviour that can be difficult to manage that there is an up to date behaviour management plan that instructs staff in how to manage this and keep people safe from harm The registered person must 31/03/08 ensure that there are individual risk assessments available that are maintained and reviewed so that people are protected from the risk of harm. Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 28 5 YA14 16 (2 m and n) 6 YA19 13 7 YA20 13 and 15 8 YA20 13 and 15 10 YA35 18 11 YA35 18 12 YA35 18 13 YA35 18 The Registered person must ensure that people’s interests and hobbies are identified and planned. These must be incorporated into the care plan and records maintained to evidence that this happening. The registered person must ensure that people’s health needs are met by the provision of health plans and access to health professionals to ensure their health needs continue to be met. The registered person must ensure that where medications are administered PRN that guidelines for administration are written up and followed by staff to ensure people are kept safe for harm. The registered person must ensure that staff are assessed administering medication so that they can be sure staff are competent in their role and people are kept safe from harm. The registered person must ensure that staff are provided with all training that is specific to the needs of the people staying in the home so that all of their needs can be met. The registered person must ensure that all staff receive training in how to manage difficult behaviour so that people are kept safe from harm. The registered person must ensure that staff complete their probationary interviews and a record is kept of this to ensure staff are competent in their role. The registered person must ensure that staff have an individual training profile and an annual appraisal to ensure staff DS0000019672.V357612.R01.S.doc 31/03/08 31/03/08 31/03/08 31/03/08 31/03/08 31/03/08 31/03/08 31/03/08 Garfield Grange Version 5.2 Page 29 are competent in their role.. 14 YA36 18 The registered person must 30/06/08 ensure that staff receive regular recorded supervision to ensure staff are competent in their role.. The registered person must 30/06/08 ensure that the regulation 26 visits and QA process robustly assess the quality of the service and highlights areas for improvement. The registered person must 31/03/08 ensure that the following maintenance and servicing is undertaken and records are available to evidence this;Legionella The registered person must ensure that all staff are up to date with their mandatory training to ensure staff are competent in their role.. 31/03/08 15 YA39 24 16 YA42 23 17 YA42 18 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. Refer to Standard YA32 YA32 Good Practice Recommendations The registered person should ensure at least 50 of the care staff have achieved a National Vocational Qualification in care to at least level 2. The registered person should ensure staff have the opportunity to achieve higher National Vocational Qualifications if they so wish. Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Garfield Grange DS0000019672.V357612.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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