Inspection on 24/04/07 for Grace House

This inspection was carried out on 24th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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

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

CARE HOMES FOR OLDER PEOPLE Grace House 110 Nether Street Finchley London N12 8EU Lead Inspector Daniel Lim Key Announced Inspection 24rd April 2007 09:30 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 Grace House DS0000069354.V333329.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. Grace House DS0000069354.V333329.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grace House Address 110 Nether Street Finchley London N12 8EU 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) 020 8349 1019 020 8349 1019 Christian Care Trust - Board of Trustees Ann Veronica Gilbert Care Home 7 Category(ies) of Dementia - over 65 years of age (7), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (7) Grace House DS0000069354.V333329.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection First Inspection Brief Description of the Service: Grace House is a small care home registered in February 2007 to provide personal care for a maximum of seven older people with either dementia or mental health problems. It is run by a charity called The Christian Care Trust. The stated aim of the home is to provide high quality care in a homely and Christian environment. The home was opened following the voluntary closure of Grace House (53 Clifton Road, Finchley, London N3 2AS). All staff and one resident transferred into the new home. The home is a detached two, storey house with seven bedrooms for residents. On the ground floor is located the office, laundry, dining room, lounge and two bedrooms. On the first floor is a communal bathroom with a toilet and five bedrooms for residents. The manager’s accommodation is located on the first floor. The home has no chair lift or shaft lift. Therefore, those with mobility problems must not be accommodated on the first floor. There is a small parking area at the front of the house and a large garden at back. The gardens are attractive and accessible to service residents. There is a patio at the back of the home. The home is situated in a residential area and about half a mile from shops, restaurants, public transport and other community facilities located along Ballards Lane. There is an underground station nearby. The Trust also operates a registered domiciliary care agency from the same building. Grace House DS0000069354.V333329.R01.S.doc Version 5.2 Page 5 The fee charged by the home is £750 per week. The home manager is Mrs Ann Gilbert. The provider must make information available about the service, including inspection reports, to service users and other stakeholders. Grace House DS0000069354.V333329.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out on 24 April 2007 and took a total of six hours to complete. A second visit was made on 26 April 2006 to view documents not available on the first day. The inspector found that most of the National Minimum Standards assessed had been met or partially met and the overall quality of care provided was satisfactory. During this inspection, the inspector was accompanied by the home manager (Mrs Ann Gilbert). Two residents were interviewed. They indicated that they were satisfied with the service provided. Attempts were made to interview a further two residents. However, communication difficulties were experienced due to the mental state of these two residents and it was not possible to obtain their views regarding the service provided. Completed questionnaires were received from four relatives, one resident and a healthcare professional. The feedback received from all was positive. Statutory records including the maintenance records, accident book, fire log book and residents’ case records were examined. The premises including bedrooms, bathrooms, lounges, laundry, kitchen, garden and communal areas were inspected. These areas were clean. Three staff on duty were interviewed on a range of topics associated with their work. Staff records, including supervision records, evidence of CRB disclosures, references and training records were examined. Staff on duty were noted to be knowledgeable and respectful towards residents. What the service does well: The home was clean and furnished to a high standard. The communal rooms were spacious and newly decorated. The bedrooms appeared homely. The home had a large garden which was well maintained and attractive. Residents spoke highly of staff in the home. Staff had been carefully selected and they were noted to be responsive towards residents. Residents were satisfied with the food and care provided. Effort had been made by the home to ensure that the cultural and religious needs of residents had been responded to. Grace House DS0000069354.V333329.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? 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 Grace House DS0000069354.V333329.R01.S.doc Version 5.2 Page 8 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Grace House DS0000069354.V333329.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 Grace House DS0000069354.V333329.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): 1, 2, 3, 4, 6 The quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Arrangements were in place to ensure that prospective residents are assessed and provided the required information. However, further improvements are required in the pre-admission arrangements and statement of purpose to ensure that residents are fully informed and receive appropriate care. EVIDENCE: The two residents who were interviewed informed the inspector that they were well cared for and their care needs had been attended to. This was reiterated in completed questionnaires received from a resident, four relatives and a healthcare professional. Grace House DS0000069354.V333329.R01.S.doc Version 5.2 Page 11 Comments made by residents included, “lovely home”, “well cared for” and “well treated by staff”. Residents in the home were clean and appropriately dressed. Contracts for residents had been provided and these had been signed. A sample of three residents’ case records which was examined contained assessments. These assessments were not sufficiently comprehensive as they did not contain all items required (such as dietary preferences and an accurate mental state as stated in Standard 3). The statement of purpose was not sufficiently comprehensive as it did not include all items mentioned in Schedule 1 (such as the admission criteria and whether nursing is to be provided). The manager stated that the home does not provide intermediate care. Grace House DS0000069354.V333329.R01.S.doc Version 5.2 Page 12 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, 10. The quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The arrangements in place for ensuring that the healthcare and personal care needs of residents are attended to were only partially met. Improvements are needed in the care arrangements and care plans to ensure that residents are provided with the care they need. EVIDENCE: Residents interviewed stated that their care needs had been attended to and they had been treated with respect by staff. The sample of three case records examined were up to date and plans of care had been prepared. These were structured and neat. The care plans addressed Grace House DS0000069354.V333329.R01.S.doc Version 5.2 Page 13 the cultural and spiritual needs of residents. Arrangements had been made by the home to ensure that residents are supported in their religious observances. The care plan of a resident with nutritional problems did not have a nutritional care plan. This is required to ensure that staff and the resident are provided with appropriate guidance regarding the feeding arrangements and diet to be provided. The care plan of a resident with a high risk of developing pressure sores did not have a comprehensive pressure area care plan. This is required to ensure that staff and the resident are provided with appropriate guidance (such as having an adequate diet, ensuring that the resident does not remain in the same position for prolonged periods and checks for any early signs of soreness). These were discussed with the manager who agreed that the required plans would be prepared. Reviews had not been recorded. The manager explained that the home had recently opened and reviews were not yet due. This explanation was accepted. The medication charts were examined. These indicated that medication had been administered. The inspector however, noted that one of these charts had blank spaces and staff had not indicated if medication had been administered. This was brought to the attention of the manager. The manager reassured the inspector that this had been addressed and staff had been instructed to ensure that they must fully complete the MAR charts. Documented evidence was provided (in the form of instructions to staff) and the inspector noted that there had not been no more such deficiencies. Grace House DS0000069354.V333329.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14, 15 The quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The daily life, meal arrangements and routines of residents were on the whole, well organised. This ensured that the personal, cultural and social preferences of residents are met. Residents and their representatives expressed satisfaction in this area. EVIDENCE: The home had a varied programme of weekly social and therapeutic activities. The programme which was available for inspection included exercise sessions, religious worship sessions, special lunch sessions for residents with their friends, walks, art, massage sessions and outings. The two residents interviewed were of the opinion that the activities were appropriate. Grace House DS0000069354.V333329.R01.S.doc Version 5.2 Page 15 The bedrooms inspected had been personalised by residents with their personal items such as photos, cards, pictures and souvenirs. Residents indicated that staff were responsive towards them and their preferences and wishes had been respected. The kitchen was clean and well equipped. The menu appeared varied and balanced and reflected the ethnic composition of the residents of the home. Residents interviewed indicated that they were satisfied with the meals provided. A record of fridge and freezer temperatures had been kept. These were satisfactory. Grace House DS0000069354.V333329.R01.S.doc Version 5.2 Page 16 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, 18 The quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The arrangements for responding to complaints and for adult protection were satisfactory. This ensures that residents are well treated and protected from abuse. Residents and their representatives indicated that residents were well treated by staff. EVIDENCE: No complaints had been documented in the complaints book since the last inspection. The manager explained that none had been received. The two residents who were interviewed indicated that they had been well treated and not subject to any ill treatment. The issue of equalities and diversity was discussed with the manager and staff. Staff indicated that they had been instructed to treat all residents sensitively and with respect regardless of disability, gender, race, religion or sexual orientation. The home had an equalities and diversity policy and procedure. Grace House DS0000069354.V333329.R01.S.doc Version 5.2 Page 17 Grace House DS0000069354.V333329.R01.S.doc Version 5.2 Page 18 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, 20, 21, 22, 23, 24, 25, 26 The quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home was well equipped, clean and furnished to a high standard, therefore providing a pleasant environment to live in. Residents were pleased with their accommodation. EVIDENCE: Residents interviewed stated that they were happy with the accommodation provided. The premises were inspected and found to be clean and well furnished. Grace House DS0000069354.V333329.R01.S.doc Version 5.2 Page 19 All bedrooms have ensuite facilities. The laundry was inspected and found to be satisfactory. Safety inspections had been carried out on the portable appliances, gas installations and electrical installations. The gardens were attractive and well maintained. Grace House DS0000069354.V333329.R01.S.doc Version 5.2 Page 20 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 The quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Satisfactory arrangements were in place to ensure that staffing levels were adequate and staff were closely supervised. However, this section is only partially met as further training is needed for staff. This is necessary to ensure that staff are fully trained to perform their duties. EVIDENCE: Two staff who were on duty were interviewed on a range of topics associated with their work (such as fire safety, adult protection, care of residents with diabetes and mental illness, equality & diversity, staffing arrangements, team work). They were generally knowledgeable regarding their roles and responsibilities. They stated that they had been instructed to treat all residents with respect and dignity regardless of their race, religion or sexual orientation. Residents who were interviewed indicated that staff were respectful and they had not been ill-treated. Grace House DS0000069354.V333329.R01.S.doc Version 5.2 Page 21 The duty rota was examined. This indicated that in addition to the manager, there was normally three care staff on duty during the day shift and two care staff on duty during the night. There were four residents in the home. No concerns regarding staffing levels were expressed by those interviewed. The training records examined, indicated that staff had been provided with the required training such as health & safety, mental health care, challenging behaviour, administration of medication, food hygiene and adult protection. One member of staff had not received adult protection training. Moving and handling certificates were not available for two staff although the manager stated that they had received their training. Not all care staff had received training in infection control (including MRSA infection control). Training must be provided in the areas mentioned. Recruitment records examined indicated that the required recruitment procedures (including obtaining of satisfactory CRB disclosures and references) had been followed. Supervision records examined indicated that staff had been provided with regular supervision. Grace House DS0000069354.V333329.R01.S.doc Version 5.2 Page 22 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, 33, 35, 38 The quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Arrangements were in place to ensure that the home is well managed and the welfare of residents is safeguarded. However, further improvements are needed in the area of quality assurance and to ensure that staff and residents (or their representatives) are fully consulted and informed regarding the management of the home. EVIDENCE: The registered manager had obtained her RMA and was knowledgeable regarding the needs of residents. Grace House DS0000069354.V333329.R01.S.doc Version 5.2 Page 23 The fire log book was examined. The weekly fire alarm tests had been carried out and evidence was provided. Fire drills and fire training had been documented. The home had a fire risk assessment. A current certificate of insurance was displayed. The inspector was informed by the manager that the home does not keep any money on behalf of residents. The inspector was not provided with an annual development plan or the results of any consumer survey (as mentioned in Standard 33). This is required to ensure that the home has effective quality assurance and quality monitoring systems. A requirement is made for this to be done. No minutes of formal meetings with either residents or residents’ representatives had been documented. These are needed as evidence that residents are fully consulted and informed regarding the management of the home. No minutes of formal meetings with staff had been documented. These are needed as evidence that the registered person had consulted with staff and obtained their view regarding the management of the home (as required in Regulation 21 of The Care Homes Regulations). Documented evidence of this must be available for inspection. Grace House DS0000069354.V333329.R01.S.doc Version 5.2 Page 24 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 2 3 2 3 x X HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Grace House DS0000069354.V333329.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement The registered person must update the statement of purpose to include all information required in schedule 1.(This must include the criteria for admission). The registered person must ensure that comprehensive preadmission assessments are carried out before a prospective resident is admitted into the home. This must be in accordance with Standard 3 of the National Minimum Standards for older people and address the mental, social, financial, cultural and spiritual needs of the prospective resident). 3 OP7 13(1)(b) 15(1) The registered person must provide a pressure area care plan for the resident identified to her as being at high risk of having a pressure sore. DS0000069354.V333329.R01.S.doc Timescale for action 1 OP1 4 30/06/07 2 OP3 13(1) 14(1) 15(1) 13/06/07 09/06/07 Grace House Version 5.2 Page 26 4 OP7 13(1)(b) 15(1) The registered person must provide a nutrition care plan for the resident identified to her as having nutritional problems. 09/06/07 5 OP28 18(1)(a)(c ) The registered person must provide staff with training in Adult protection Infection control (including MRSA) 01/07/07 6 OP28 18(1)(a) (c) 13/06/07 The registered person must provide CSCI with evidence that all staff had received formal training in moving & handling 08/08/07 7 OP33 24(1)(2) (3) The registered person must ensure that the home has effective quality assurance and monitoring systems. This must include a published report of the results of a recent consumer survey and an annual development plan for the home. The accompanying report and plan must be forwarded to CSCI. 8 OP33 16(2)(m) The registered person must consult with residents (or their representatives) regarding the management of the home Documented evidence of this must be available for inspection. 9 Grace House 13/07/07 16(2)(m) The registered person must DS0000069354.V333329.R01.S.doc 13/07/07 Version 5.2 Page 27 OP33 consult with staff and obtain their view regarding the management of the home Documented evidence of this must be available for inspection. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Grace House DS0000069354.V333329.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Grace House DS0000069354.V333329.R01.S.doc Version 5.2 Page 29 - 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!