This inspection was carried out on 7th March 2006.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.
CARE HOMES FOR OLDER PEOPLE
Ghyll Grove Residential and Nursing Home Ghyllgrove Basildon Essex SS14 2LA Lead Inspector
Unannounced Inspection 07:00 7 & 8 March 2006
th th 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 Ghyll Grove Residential and Nursing Home DS0000015535.V260232.R01.S.doc Version 5.0 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. Ghyll Grove Residential and Nursing Home DS0000015535.V260232.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Ghyll Grove Residential and Nursing Home Address Ghyllgrove Basildon Essex SS14 2LA 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) 01268 273173 01268 288289 BUPA Care Homes Limited Mrs Christine Ann Walton Care Home 150 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (150), of places Terminally ill (4) Ghyll Grove Residential and Nursing Home DS0000015535.V260232.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. Nursing and Personal Care to be provided for up to a maximum of one hundred and fifty (150) Older People. Nursing and Personal Care to be provided for up to a maximum of four (4) people who have a diagnosed Terminal Illness. Nursing and Personal Care to be provided for up to a maximum of thirty (30) Older People who have a diagnosis of Dementia and who require nursing care Accommodation and Personal Care to be provided for up to a maximum of thirty (30) Older People who do not require nursing care and have a diagnosis of Dementia. Nursing Care for people who have a diagnosis of Dementia to be provided on Kennett House only. Accommodation and Personal Care for people who do not require nursing care and who have a diagnosis of Dementia to be provided on Thames House only. 8th June 2005 5. 6. Date of last inspection Brief Description of the Service: Roding House is one of the five houses which make up BUPA Ghyllgrove. Roding House provides nursing care and accommodation for up to thirty people who have a variety of nursing needs. Nursing and care staff with appropriate skills and knowledge were employed at the home to meet the needs the people who live there. The house provides each resident with their own bedroom and access to clean and well maintained communal areas including a combined lounge and dining area and garden space.Ghyllgrove is situated in a residential area of Basildon close to the town centre, local shops and amenities and bus and train links to Southend and London. Ghyll Grove Residential and Nursing Home DS0000015535.V260232.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection carried out on 7th & 8th March 2006 between the hours of 07.00 and 17.00. Carolyn Delaney, Lead Inspector for the home, carried out the inspection. Records including care plans and assessments in respect of residents’ needs and risks to health, safety and welfare were examined. Five residents were spoken with to obtain their views as to how the home is managed and the care provided. The relatives of seven residents at the home were contacted by post so as to offer them the opportunity to make comments about the services provided by the home. Five relatives responded and a summary of the comments made has been included in the report. Five members of staff were spoken with during the course of this inspection so as to determine their awareness of the needs and wishes of the people living at the home and the homes policies and procedures. Key standards as identified in the intended outcomes sections of this report are inspected at least once every twelve months. Where key standards have not been inspected on this occasion they will have been inspected at the previous inspection. Reports in respect of previous inspections may be accessed via the Commissions website www.csci.org.uk What the service does well:
Roding House provides a purpose built clean and comfortable environment for people who need nursing care. The environment is well maintained, clean and bright. The majority of the residents who were spoken with during the course of the two inspections said that they were happy with the care provided by the home. Four of the five relatives who responded to the survey questionnaire indicated that they were satisfied overall with the care provided by the home. Wherever
Ghyll Grove Residential and Nursing Home DS0000015535.V260232.R01.S.doc Version 5.0 Page 6 it is possible residents and / or their relatives are consulted about the care and treatment to be provided and their agreement sought. BUPA Ghyllgrove provides a detailed and comprehensive training package for all staff so as to ensure that they can best meet the needs of the people who live there. What has improved since the last inspection? What they could do better:
Particular attention should be given when developing care plans for all residents so as to include information as to how a person’s pain is to be managed effectively. Where people spend prolonged periods being cared for in bed it should be clearly recorded the reason for this and any possible complications and how these are to be managed. The advice of suitably trained persons such as physiotherapists should be sought as and when it is required.
Ghyll Grove Residential and Nursing Home DS0000015535.V260232.R01.S.doc Version 5.0 Page 7 Nursing staff working on Roding House must ensure that all reasonable efforts are made so as to ensure the people living there receive medicines, which have been prescribed for them. Staff working on Roding House should keep records as evidence of the activities and social stimulation provided for residents at times when the activities coordinators are not on duty, such as evenings and weekends. Staff could do more to minimise the occurrence of resident’s monies going missing. 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. Ghyll Grove Residential and Nursing Home DS0000015535.V260232.R01.S.doc Version 5.0 Page 8 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 Ghyll Grove Residential and Nursing Home DS0000015535.V260232.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Nursing staff carry out a detailed assessment of each prospective residents nursing and general care needs prior to the individual being offered a place in Roding House. EVIDENCE: Pre-admission assessments for four people living in Roding House were sampled and these evidenced that a detailed assessment of specific nursing and general care needs is carried out for each individual so as to determine that staff and resources are available at the home to meet the individuals needs. The information recorded at the time of assessments being carried out had improved since the last inspection. Ghyll Grove Residential and Nursing Home DS0000015535.V260232.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Information maintained in relation to residents nursing and general care needs including information regarding actual and potential risks to residents are generally but not consistently well recorded and kept under regular review. Nursing staff working on Roding House do not consistently ensure that residents receive appropriate medication, in particular effective pain relief. EVIDENCE: Care plans in respect of the nursing and general care needs of the people living on Roding House were for the most part very detailed and kept under regular review. It was positive to note that some resident’s relatives had been involved in and agreed the planned care and for other residents their wishes and understanding in respect of planned care and treatment was recorded. Risks to the health, safety and welfare were identified and plans implemented so as to minimise the risks to the people involved. Detailed records were maintained regarding the daily care provided by staff. Ghyll Grove Residential and Nursing Home DS0000015535.V260232.R01.S.doc Version 5.0 Page 11 There was information maintained in respect of the advice and input from other healthcare professionals such as dieticians etc. However a number of residents are nursed for long periods in bed and the reasons for this and an assessment of possible risks and complications were not consistently recorded. One relative who responded to the survey questionnaire commented that the resident spend a lot of time in bed and that there had been no physiotherapy input despite requests made to staff on the unit. Ghyllgrove has detailed policies and procedures in place in respect of the safe and appropriate receipt, administration and disposal of medicines in the home. A system for checking that all medicines administered are signed for by the administering nurse had been implemented since the last inspection, however not all nursing staff were complying with this and at the time of the inspection there were numerous omissions noted in residents Medication Administration Records (MAR). One resident who was terminally ill complained that he was not receiving effective pain relief. It was disappointing to note that there was no plan in place in respect of the pain management and that Medication Administration Records (MAR) had omissions of signatures regarding the administration of analgesia. One medication had not been administered to a resident for some time and it was discovered that this was not available in the home. There was no evidence to show that staff had taken all reasonable steps so as to ensure receipt of this medication. It was positive to note that there were detailed care and management plans in place where residents required oxygen therapy. Ghyll Grove Residential and Nursing Home DS0000015535.V260232.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 People living on Roding House are consulted about how they wish to spend their leisure time and staff interact and engage with residents in a positive manner. EVIDENCE: On the second day of the inspection there were beauty treatments such as nail painting provided for female residents. During the course of the inspection it was noted that residents were encouraged and supported in making decisions about how they wanted to spend their days including what television programmes they would prefer to watch etc. A programme of activities is available and the home employs dedicated activities coordinators. The provision of activities at times when activities coordinators are not on duty such as in the evenings and at weekends was discussed and staff could do more to evidence the activities provided during these times. Standard 15 was not fully assessed on this unit at this time, however residents who were spoken with during the inspection said that they were happy with the food provided by the home. Where one resident’s relative had requested that a soft, not pureed diet be provided and this was implemented.
Ghyll Grove Residential and Nursing Home DS0000015535.V260232.R01.S.doc Version 5.0 Page 13 The serving of meals was not observed on this unit during this inspection. One resident’s relative who completed the survey questionnaire commented that on a number of occasions meals were served cold and therefore not eaten by the resident in question. Ghyll Grove Residential and Nursing Home DS0000015535.V260232.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The home has a detailed policy and procedure for dealing with complaints and staff practices do not generate an undue number of complaints. More could be done so as to ensure that resident’s valuables and monies are safeguarded. EVIDENCE: The home has a detailed policy and procedure in respect of dealing with complaints. Only two of the five residents relatives who responded to the survey questionnaire said that they were aware of the homes complaints policy. Staff working on Roding House receive training and information in respect of the protection of vulnerable people. One resident’s relative spoken with during the inspection said that on a number of occasions small amounts of money had gone missing from the resident’s room. This was discussed with the head of home and the homes acting manager who undertook to address this. Ghyll Grove Residential and Nursing Home DS0000015535.V260232.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 0 These standards will be assessed at the next inspection. EVIDENCE: Ghyll Grove Residential and Nursing Home DS0000015535.V260232.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 Staff are employed in suitable numbers and with an appropriate skill mix so as to best meet the needs of the people who live at the home. EVIDENCE: The staff duty rota indicated that staff working on Roding House did not work excessive hours without appropriate off duty time. At the time of the inspection there were no adaptation nurses employed on the unit. However two of the five residents relatives who responded to the survey questionnaire commented that there were not always sufficient staff available on duty to meet the needs of the people who live there. It was positive to note that there were guidelines for rostered duties including details of details of the expectations in respect of staff conduct and practices. Two male members of staff were noted to engage in a particularly positive manner with residents on both days of the inspection. Ghyll Grove Residential and Nursing Home DS0000015535.V260232.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 & 33 There have been a number of improvements in the day-to-day management of Roding House since the last inspection, however a number of nurse related practices must be addressed so as to ensure that the specific nursing needs of the people who live on Roding House are best met. EVIDENCE: The management of Roding House has improved however there are a number of outstanding issues, which need to be addressed as identified within this report so as to improve the overall quality of life for the people who live there. Ghyll Grove Residential and Nursing Home DS0000015535.V260232.R01.S.doc Version 5.0 Page 18 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 X X X X X X X X STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X X X X X Ghyll Grove Residential and Nursing Home DS0000015535.V260232.R01.S.doc Version 5.0 Page 19 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 OP7 Regulation 15 Requirement The registered person must ensure that care plans include all relevant information including risk management where appropriate. This with particular reference to pain management and risk management where residents spend prolonged periods in bed. The registered person must ensure that all staff act in accordance with the homes policies and procedures in respect of the administration of medicines and that residents receive effective pain relief. Elements of this requirement are outstanding from the last inspection and the timescale of 30/09/05 was not met. The registered person must ensure that measures are implemented so as to safe guard residents who wish to retain control over their monies. The registered persons must implement appropriate measures
DS0000015535.V260232.R01.S.doc Timescale for action 30/05/06 2 OP9 13(2) 30/04/06 3 OP35 16(2)(i) 30/04/06 4 OP33 12 & 13 30/05/06 Ghyll Grove Residential and Nursing Home Version 5.0 Page 20 so as to ensure that Roding House is managed in a manner which safeguards the interests and welfare of the people who live there. This requirement is outstanding from the last inspection and the timescale of 30/09/05 was not met. 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 OP12 OP16 Good Practice Recommendations Staff should evidence the range of activities provided for residents at times when the activities coordinators are not on duty at the home. The provision of information to relatives in respect of the homes complaints policy and procedure should be reviewed. Ghyll Grove Residential and Nursing Home DS0000015535.V260232.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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