Inspection on 08/03/07 for Grace House

This inspection was carried out on 8th March 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

Grace House 03/03/09

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

CARE HOMES FOR OLDER PEOPLE Grace House Grace House 71 Lodge Hill Road Farnham Surrey GU10 2RB Lead Inspector Deavanand Ramdas Announced Inspection 8th March 2007 10:00 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 DS0000066545.V329925.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 DS0000066545.V329925.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grace House Address Grace House 71 Lodge Hill Road Farnham Surrey GU10 2RB 01252 726 406 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) grace_lane@btconnect.com grace_lane@btconnect.comwww.gracehousefarn ham.co.uk Mrs Allison Day Mrs Tracey O`Shea Mrs Tracey O`Shea Care Home 14 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (12) of places Grace House DS0000066545.V329925.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th September 2006 Brief Description of the Service: Grace House is registered with the Commission for Social Care Inspection, henceforth referred to as the CSCI, to provide accommodation and care to fourteen service users in the category of older people. The home is located in a residential area and close to public amenities and other 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 £380- £500 per week and the registered manager is Mrs. Tracey O’Shea. Grace House DS0000066545.V329925.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the homes site visit as part of the key inspection process by the CSCI. The visit was carried out by D. Ramdas, regulation inspector and included a tour of the premises, interviews with staff and service users, and a review of documents and records. The visit commenced at 10:00hrs and finished at 14:30hrs. The inspector would like to thank the manager, staff and service users for their contribution to the inspection. What the service does well: The home has good needs assessment procedures to ensure the needs of prospective service users can be met by the home. During discussions a service users commented ‘‘I am happy here, absolutely’’. The home values equality and diversity and service users care plans reflect the unique needs of individual service users. During discussions a service user commented ‘‘staff know my routine and they respect that’’. Meals at the home are good and offer variety, choice and healthy eating options. During discussions a service user commented ‘‘lunch is very good, nice indeed, thank you’’. Activities at the home are planned and organised and reflect the choices and personal preferences of service users. During discussions a service user stated ‘‘the care provided is very good’’. The home has a motivated staff team who work hard to improve the quality of life of service users in the home. During discussions a service user stated ‘‘staff are extremely good and respectful’’ and ‘‘I have never come across anyone aggressive’’. The complaints process is good with complaint information accessible in the home. During discussions a member of staff stated ‘‘I am aware of the complaints policy’’ and a service user remarked ‘‘if you have any problems you can go to the senior person’’. The home has an experienced registered manager who provides management stability, leadership and direction to the staff team. During discussions a service user commented ‘‘the home is pleasantly managed, I have no complaints’’ and a member of staff remarked ‘‘management is fair, approachable and accessible’’. Grace House DS0000066545.V329925.R01.S.doc Version 5.2 Page 6 The home is clean, nicely presented and comfortable. During discussions a service user stated ‘‘it is a good homely place’’ and ‘‘it is a nice home to live in’’. The quality assurance procedures in the home are good with questionnaires used to obtain feedback from staff, service users and relatives. During discussions a member of staff commented ‘‘we are always looking for improvements’’ and a service user remarked ‘‘everything is absolutely super. I wouldn’t want to be anywhere else’’. 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 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Grace House DS0000066545.V329925.R01.S.doc Version 5.2 Page 7 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 DS0000066545.V329925.R01.S.doc Version 5.2 Page 8 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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for assessing needs are good ensuring the needs of prospective service users are assessed and met by the home. EVIDENCE: The manager stated prospective service users are admitted to the home on the basis of a full assessment of needs. The inspector sampled documents and noted the home had a policy on admissions, a referral form and pre-admission checklist which covered personal care, health needs and social support. The manager confirmed prospective service users have the opportunity to visit the home with input from relatives, friends and care management as appropriate to ensure service users assessed needs will be met by the home. During discussions a service user commented ‘‘I am happy here, absolutely’’. The manager indicated the home does not offer intermediate care and this standard was not assessed. Grace House DS0000066545.V329925.R01.S.doc Version 5.2 Page 9 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): 7,8,910 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for care planning need strengthening to reflect the changing needs of service users. The systems for health care are good ensuring service users have access to health care services to meet their assessed needs. Medication management is good safeguarding the welfare of service users and promoting health. The arrangements for privacy and dignity are good ensuring service users are treated with respect and their right to privacy upheld. EVIDENCE: The manager stated the home is in the process of introducing an approved care planning system. The inspector sampled care plans which covered all aspects of health, personal and social care needs with daily evaluations carried out by care staff. Grace House DS0000066545.V329925.R01.S.doc Version 5.2 Page 10 Care plans were dated and signed by service users as appropriate and included risk assessments to safeguard the welfare of service users. During discussions a service user remarked ‘‘staff know my routine and they respect that’’. Following discussions with the manager a requirement has been made for care plans to be reviewed regularly to safeguard the welfare of service users. The home has arrangements to promote service users health and a review of records confirmed service users were registered with a local GP (General Practitioner) and had access to chiropody, optical and dental services as required. The inspector noted the home had input from a district nurse and monitored service user’s weight gain and weight loss to promote health and nutrition. Further evidence confirmed the home accessed the local PCT (Primary Care Trust) for emergency healthcare. The manager stated the home had a service level agreement with a local chemist to supply medications to the home. Observations confirmed the home had adequate storage of medications and staff have accredited training in medications to safeguard the welfare of service users and promote health. The inspector noted the home kept a record of medications received by and disposed of to prevent mishandling of medications and medication record sheets were dated and signed by staff. The home had a list of staff names with specimen signatures for information and during discussions a member of staff stated ‘‘I had quite a bit of training on medications’’. The manager stated the home promoted the privacy and dignity of service users and observations confirmed the manager and staff knocked on doors before entering bedrooms and bathrooms. The inspector noted staff addressed service users by their preferred names and personal care was attended to in the privacy of service users bedrooms. During discussions a service user commented ‘‘staff are extremely good and respectful’’. Further evidence confirmed service users had good personal hygiene and were appropriately dressed to reflect their individuality and choice. Grace House DS0000066545.V329925.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for social contact and activities are good satisfying the social, recreational and religious needs of service users. Community contact is good promoting family links. The systems for autonomy and choice are good enabling service users to exercise choice and control over their lives. Meals are good and offer variety, choice and healthy eating options. EVIDENCE: The manager stated the home promoted social contact and activities and a review of records indicated the home had individual activity plans which reflected the choice and preferences of service users and based on a ‘Resident’s Profile’. The inspector noted staff have dedicated time for activities which included bingo, card games, reminiscence, reading and other relevant and appropriate activities. The home had arrangements for meeting the religious needs of service users with church volunteers and a local vicar visiting the home for religious activities. Grace House DS0000066545.V329925.R01.S.doc Version 5.2 Page 12 The home promoted community contact with service users able to receive visitors in private, if required. The inspector noted the home had open visiting times with no restrictions and information about visiting the home was included in the statement of purpose. Observations confirmed a service user leaving the home to access community facilities for his enjoyment and during discussions a service user remarked ‘‘I have visits from my family occasionally’’. The manager confirmed service users are helped to exercise choice over their lives and are able to bring personal possessions to the home for their comfort and enjoyment. The inspector noted relatives had responsibility for service users financial affairs and observations confirmed service users had personal possessions including items of furniture, television, family photographs and other personal effects. The inspector noted a service user exercised his autonomy by moving to a bedroom on the grounds of lower cost to meet his needs and supported by staff. The home had written menu plans and employed a cook to help plan and prepare meals with the involvement of service users. The inspector sampled menu plans which offered variety, choice and healthy eating options. Observations confirmed service users had a choice of curry or beef stew, dumplings, peas, carrots and boiled potatoes for lunch with sponge and custard or fresh fruits for dessert. Mealtime was relaxed and unhurried and staff supported service users appropriately using verbal prompts. During discussions a service user stated ‘‘lunch is very good, nice indeed, thank you’’. Grace House DS0000066545.V329925.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints process is good ensuring service users and their relatives feel confident that their complaints will be listened to and acted upon. The arrangements for protection are good safeguarding the welfare of service users. EVIDENCE: The home had a complaints policy with complaints information accessible in the home and in the statement of purpose. A review of records confirmed no complaints were recorded about the home. During discussions a member of staff stated ‘‘I am aware of the complaints policy’’ and a service user commented ‘‘if you have any problems you can go to the senior person’’. The home had a policy on safeguarding adults and a copy of the local authority (Surrey County Council) procedures on safeguarding adults. A review of records confirmed the providers have training in safeguarding adults with further training planned on the 05/06/2007 to safeguard the welfare of service users. The inspector noted the home had a whistle blowing policy with no safeguarding adult matters recorded about the home since the last inspection by the CSCI. During discussions a service user commented ‘‘I have never come across anyone aggressive’’ and a member of staff remarked ‘‘the care provided is very good’’. Grace House DS0000066545.V329925.R01.S.doc Version 5.2 Page 14 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): 19,24 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for the premises are good ensuring service user have a comfortable home in which to live in. The systems for hygiene are good ensuring the home is clean and hygienic for service users. EVIDENCE: The home is suitable for its stated purpose and in keeping with the local community. The inspector noted the home had a fire safety risk assessment and a visit from the local authority (Surrey County Council) environmental health department with appropriate management action taken. The home had a programme of routine maintenance and renewal with significant investment by the providers to improve facilities in the home including ordering a new stair lift, refurbishment of bathrooms and bedrooms, decoration of the hallway, new carpets and the installation of window restrictors to promote the safety of service users. Grace House DS0000066545.V329925.R01.S.doc Version 5.2 Page 15 The gardens are well maintained, private and accessible and during discussions a service user commented ‘‘it is a good homely place’’. On the day of the inspection the home was clean, nicely presented, well ventilated and free from mal odour. Observations confirmed the home had adequate laundry facilities and a service level agreement with an approved contractor for the disposal of clinical waste. Hand washing facilities were prominently sited with anti-bacterial hand wash available. The inspector noted staff practiced infection control measures by washing their hands regularly and gloves and aprons were available to prevent the spread of infection in the home and promote health. During discussions a service user commented ‘‘it is a nice home to live in’’. Grace House DS0000066545.V329925.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for staffing are good ensuring sufficient numbers of staff to meet the assessed needs of service users. Staff training is good ensuring service users are in safe hands at all times. Recruitment and vetting practices need strengthening to safeguard the welfare of service users. Induction training is good ensuring staff are trained and competent to do their jobs. EVIDENCE: The manager stated the home had adequate staffing levels based on an approved staffing formula. The inspector noted the provider and manager were supernumerary with two carers during the day and one waking night staff. The home also employed a cook, maintenance supervisor and operated an on-call system to provide additional support, if required. The inspector sampled staff duty rosters that reflected the numbers of staff on duty and during discussions a member of staff stated ‘‘staffing levels are OK’’. Grace House DS0000066545.V329925.R01.S.doc Version 5.2 Page 17 The manager stated the home is committed to staff training and development and a review of records confirmed four care staff have NVQ – Level 1 and 2 and four care staff are enrolled on an NVQ programme which commenced on the 26/02/07. During discussions a member of remarked ‘‘I am looking forward to starting the NVQ training’’. The provider stated the home had a policy on staff recruitment and prospective employees are vetted before being employed by the home. The inspector noted the home had a policy on equal opportunities and sampled staff recruitment records which included completed application forms, written references, statement of terms and conditions, job descriptions, training records and CRB (Criminal Record Bureau) disclosure information. Following discussions with the manager a requirement has been made for staff recruitment files to include a recent photograph of the employee to safeguard the welfare of service users. The manager stated the home had training plans for mandatory training as part of the home’s induction process. The inspector sampled training plans which covered first aid, food hygiene and fire safety with training booked for the 08/05/07, 20/05/07 and 22/05/07 respectively. The manager confirmed the home is in the process of developing an induction package for staff to reflect Skills for Care common induction standards. During discussions a service user commented ‘‘staff are extremely good’’ and a member of staff remarked ‘‘the home has quite a lot of training planned’’. Grace House DS0000066545.V329925.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for the day to day management of the home are good ensuring the home is run and managed by a person fit to be in charge of the home. The systems for quality assurance are good ensuring the home is run in the best interests of service users. Policies and procedures are good and safeguard the financial interests of service users. The arrangements for health and safety are good promoting safe working practices. Grace House DS0000066545.V329925.R01.S.doc Version 5.2 Page 19 EVIDENCE: The home has a registered manager with a professional nursing qualification who provides management stability, leadership and direction to the staff team. The manager is aware of her role and responsibilities with clear lines of communication and accountability in the home. During discussions a member of staff stated ‘‘management is fair, accessible and approachable’’ and a service user commented ‘‘the home is pleasantly managed, I have no complaints’’. The home has quality assurance systems and used questionnaires to obtain feed back about the home. The inspector noted an annual survey was conducted in October 2006 to obtain feed back from staff, service users and relatives with a report available in the home for information. The home has ‘Residents Meetings’ every six months to consult service users and their relatives as a result of which improvements have been made to the activity programme and menu plans. During discussions a service user commented ‘‘everything is absolutely super, I wouldn’t want to be anywhere else’’ and a member of staff stated ‘‘we are always looking for improvements’’. The home has a policy on money and valuables and provides secure facilities for the storage of such items. The inspector noted the home kept a record of financial transactions, dated and signed by staff, with receipts to safeguard the interests of service users. The home has a policy on health and safety and as previously stated in this report training is planned for staff in the areas of food hygiene, first aid and fire safety to safeguard the welfare of service users. Observations confirmed COSHH (Control of Substances Hazardous to Health) products were appropriately stored and the kitchen appeared clean and hygienic with food safety systems in place to promote health. A review of records confirmed the home had regular fire safety checks and staff have training in fire evacuation. Further evidence indicated service inspection reports pertaining to fire equipment and gas safety were up to date and valid. The inspector noted the home kept a record of all accidents and injuries with general risk assessments to promote safe working practices. Grace House DS0000066545.V329925.R01.S.doc Version 5.2 Page 20 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 N/A 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 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Grace House DS0000066545.V329925.R01.S.doc Version 5.2 Page 21 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. 1. Standard OP7 Regulation 15(2)(b) Requirement The registered person must ensure care plans are reviewed regularly, at least monthly, to reflect the changing needs of service users. The registered person must ensure that the home has all the required information regarding persons employed including a recent photograph of the employee to safeguard the welfare of service users. Timescale for action 01/04/07 2. OP29 7,9,19 Schedule 2 01/05/07 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 DS0000066545.V329925.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection 4630 Kingsgate Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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 DS0000066545.V329925.R01.S.doc Version 5.2 Page 23 - 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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