Inspection on 03/03/09 for Grace House

This inspection was carried out on 3rd March 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Grace House 08/03/07

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Grace House 71 Lodge Hill Road Farnham Surrey GU10 3RB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mary Williamson     Date: 0 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Grace House 71 Lodge Hill Road Farnham Surrey GU10 3RB 01252726406 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): grace_lane@btconnect.com Mrs Tracey O`Shea,Mrs Allison Day Name of registered manager (if applicable) Mrs Tracey O`Shea Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 16. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Grace House is registered with the Commission for Social Care Inspection, henceforth referred to as the CSCI, to provide accommodation and care to sixteen service users in the category of older people. The home is located in a residential area and close to public amenities and other Care Homes for Older People Page 4 of 26 care home 16 Over 65 0 16 16 0 Brief description of the care home community facilities. Accommodation is provided on two floors accessed by stairs or stair lift and comprises of an office, lounge, dining area, kitchen, bathrooms, toilets, laundry and fourteen single bedrooms some with en-suite facilities. The home has a garden which is secure and accessible and private parking is available. The range of fees charged by the home is £400to £660 per week and the registered manager is Mrs. Tracey O?Shea. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this home is two star. This means that people using this service experience GOOD quality outcomes. This was the first site visit of a key inspection and was unannounced. The inspection was carried out by Mary Williamson Regulation Inspector. Both providers were present for at various times during the inspection. A tour of the premises was undertaken and records relating to the care of the residnets and the managment of the home were examined. These included care plans, medication records, menus, activity programmes, staff employment and trainingri files and health and safety arrangements. Care Homes for Older People Page 6 of 26 It was possible to meet and talk with most of the residents, who were able to express their views and experiences about living at Grace House. Staff on duty spoke about working in the home and the training they receive. The providers completed an AQAA (Annual Quality Assurance Assessment) that provided us with the information required and has been used as part of this ispection process. The CSCI would like to thank the residnets and staff team for their help and hospitality during this inspection. What the care home does well: What has improved since the last inspection? The providers continue to make significant improvements to the home. More bedrooms have been refurbished, and the lounge has been redecorated and new ceiling and wall lighting fitted. A new floor has been laid in the kitchen. A full upgrade of the fire alarm system has taken place including new fire doors with magnetic releases. The home has introduced external entertainers including a visiting farm, and music for health. Care Homes for Older People Page 8 of 26 There is a team of stable bank staff now in place and the use of agency staff has been discontinued. Following a requirement made at the last inspection care plans are now reviewed monthly to reflect residents changing needs. Staff employment files now include photographs for identification purposes. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have access to sufficient information about the home prior to making a decision about living there. Arrangements for pre assessing needs are good ensuring that specific needs can be met by the home. All residents have a copy of the terms and conditions of the home. Evidence: The home has a statement of purpose and residents guide in place. This provides prospective residents and their relatives with sufficient information about the home to enable them to make a choice about living there. All prospective residents have a full needs assessment undertaken prior to being admitted to the home. This is undertaken by the registered manager and provides the specific information required to ensure that the home can meet the assessed needs of individuals. Four needs assessments were seen and these are detailed and informative. Care Homes for Older People Page 11 of 26 Evidence: Trail visits can be arranged as and when appropriate. Contracts of occupancy are in place and a selection of these were sampled. The contracts outline the type of accommocation available, the care provided, the amount of fees charged and the method and frequency of payment. The home does not provide intermediate care. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health and personal needs are identified in individual well maintained care plans. Arrangements in place for meeting residents health care need are good. The medication policy in place protects residents living in the home. Privacy and dignity of residnets are promoted ensuring residents are treated with dignity and respect. Evidence: Individual care plans are in place. These are written with input from the resident, information gathered from the pre admission needs assessment, care manager reports and additional information from the multidisciplinary team. The care plans sampled were informative and updated daily. Monthly reviews of care plans take place or when needs change. Risk assessments are also included in the care plans for nutritional screenig, manual handling and the prevention of falls, tissue viability, and the prevention of pressure sores. Care Homes for Older People Page 13 of 26 Evidence: All residents are registered with a local GP who attends the home regularly. Arrangements are also in place for dental treatment, chiropody care, eye care and hearing tests. Residnets spoken to were satisfied with their health care arrangements and stated that they could see their GP when necessary. The home also has good support from the district nursing team. There is a medication administration policy in place and all staff undertake medication awareness and safety training prior to undertaking medication administration. This training can be accessed by Boots or Opus. Medi forms are used for the monitoring and recording of medication. Audit trails of medication entering and leaving the home are maintained. The home has appropriate facilities in place for the storage and safekeeping of medication. Privacy and dignity are observed. Residents can have visitors in the privacy of their own bedrooms. Staff address residents in a polite and respectful manner. Keys can be provided for bedroom doors on request. Personal care is undertaken in privacy of residents own rooms. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activity programme in place is good and meets the recreational needs of the residents. Spiritual and diverse needs are observrd and promoted. The systems for autonomy and choice are good enabling residents to exercise choice and control over their lives. The standard of catering is excellent and offers residents a wholesome, and varied diet. Evidence: The home has an activity programme in place that reflects individual needs and choice. Activities mainly take place in the afternoons and are facilitated by the staff. An example of these include quiz, bingo, card games, board games, art and craft, sing alongs, or music and movement. A film afternoon was organised during the inspection. Garden activities are organised weather permitting and special events and birthdays are celebrated. Family contact is maintained and relatives and visitors are welcome in the home at any reasonable time. Relatives are encouraged to contribute to the care planning process and to attend care reviews. They are also encouraged to participate in home events Care Homes for Older People Page 15 of 26 Evidence: and functions. Spiritual needs are supported and a monthly church service is organised in the home. Visits from various clergy are also arranged on request. The home provides for the diverse needs of residents. Residents are given the opportunity to to make choice regarding all aspects of their daily lives. The can choose when they get up and go to bed, when they wish to bath or shower, what clothing they wear, how they wish to spend their day, what activities if any they wish to take part in. They can choose to spend time alone or in the company of others, and choose to take meals in the dining room or in their bedroom. Menus are planned by the cook with input from the residents, and manager. Everyone is offered a choice of food for all three main meals. A cooked breakfast is available daily if required, two main alternatives are offered for lunch and at least three options are available for supper. Drinks and snacks are served throughout the day, and homemade cakes are available with afternoon tea. The cook has a good understanding of the nutritional needs of older people and holds a certificate in food hygiene. She operates a daily cleaning schedule of the kitchen and maintaines all the required records for food safety. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure and safeguarding procedures in place protect the residents living in Grace House. Evidence: The home has a complaints procedure in place. This forms part of the residents information guide and a copy ot this is also displayed in the home. Staff spoken to were aware of this document and residents felt that any issues or concerns are managed before they ge to the formal complaints process. Records confirmed that there have been no complaints about the home since the last inspection. The home also receives many thank you cards and letters. There is a safeguarding procedure in place and staff confirmed that they receive training in this procedure, and would know what to do if they felt abuse was taking place. The home also has a copy of Surreys Multi Agencies policies and procedures on Safeguarding Vulnerable Adults in place. The senior staff have attended external local authority training in these procedures and have cascaded this to the staff team. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is suitable for its stated purpose. The residents live in a comfortable, homely and well maintained environment, which meets their individual and collective needs . The standard of cleanliness is good and procedures are in place minimise the spresd of infection. Evidence: A tour of the premises was undertaken and residents and staff spoken to regarding the facilities available. The home is comfortable, homely and decorated to a good standard. The providers have an ongoing programme of refurbishment and several areas of the home have been redecorated since the last inspection. New furniture, central lighting and wall lights have been provided in the lounge making this a comfortable and relaxing area to sit in. The dining room is spacious and residents were observed having lunch in comfortable and unhurried surroundings. Bedrooms are single occupancy some with en-suite facilities. Residents can bring items of furniture and personal possessions with them on admission to help personalise their rooms and make it feel homely. Several residnets stated that they were satisfied with the facilities provided and were very comfortable. Care Homes for Older People Page 18 of 26 Evidence: Toilets and bathrooms have been adapted to meet the mobility needs of the residents. There is a stair lift to access the first floor and ramp access to the garden. The standard of cleanliness is good, however two rooms presented mal odour, which had been identified by the management and plans are in place to replace the carpets causing this problem. The laundry is small and well equipped. Staff undertake the laundry duties and the night staff undertake the ironing. There is an infection control policy in place and all staff undertake training in this policy. Disposable aprons and gloves are provided, and staff were observed to wash their hands frequently. Arrangements are in place for the collection of clinical waste. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements are sufficient ensuring that residents needs are being met. Staff training and development is ongoing providing a competent staff team to care for the residents living in the home. The recruitment and vetting of staff is good promoting the welfare and safety of the residnets. Evidence: The staff duty rota was seen and the staffing levels discussed with the provoders. Two care staff are allocated on duty throughout the day and one carer at night. The home also employs a cook, a housekeeper and a maintenance man. Both the housekeeper and maintenance man live in providing twenty four hour on call support if required. Residents spoken to stated that the standard of care was excellent and that they were well cared for. Some staff stated that there are times when the home is busy another staff member would be welcome. Staff training is ongoing and evidence of this was seen in individual files. All staff undertake induction over a two day period overseen by the registered manager. Mandatory training is in place and includes fire safety, manual handling, food hygiene, health and safety, and medication safety awarenessn. NVQ records evidenced that five staff have achieved NVQ level 2, and that two staff are undertaking NVQ level 3. Staff Care Homes for Older People Page 20 of 26 Evidence: also confirmed that formal supervision is in place. There is a recruitment procedure in place. Three staff employment files were seen. These included written application forms, two wreitten references, an employment history and a CRB (Criminal Records Bureau) disclosure. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for the day to day management of the home are good ensuring that the home is well managed. The systems in place for monitoring quality assurance is good ensuring that the home is managed in the best interests of the residents. Policies and procedures relating to residents finance are good and safeguard their interests. The health, safety and welfare of the residents and the staff are promoted and protected. Evidence: The home is well managed by the registered manager who is a qualified nurse and also one of the providers. She has several years experience in the provision of care for older people and strong leadership skills. She is supported on a daily basis by the second provider who has a sound knowledge of administration and home management. Between them they operate on open and inclusive style of management and make themselves available to see residents and relatives as much as possible. Care Homes for Older People Page 22 of 26 Evidence: Residents spoken to stated that the home was well run and I can always talk to the manager. Systems are in place to manage quality assurance. Quesrionnaires are distributed to residents, relatives, and other stakeholders and their feedback is analysed and acted upon. This is discussed at staff meetings, and residents meetings. Care plans are reviewed monthly, and audits of medication are also undertaken monthly. Health and safety audits are undertaken and maintence checks weekly. The health, safety and welfare of the residents and the staff are observed and promoted. All staff are familar with the health and safety policy in place and undertake training in this policy during their induction period. Risk assessmnets are in place for all identified risks and to promote safe working practice. The inspector observed that COSHH (Control of Substances Hazardous to Health) procedures are adhered to. Fire safety is observed and there is a contract in place for the maintenance of fire fighting equipment. All staff have regular training in fire safety awareness. The AQAA indicated thet all the required safety certificates are in place and renewed as required. The inspector noted the home kept records of all accidents and incidents and these are reported accordingly. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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!