Inspection on 25/10/05 for Grace Manor Care Centre

This inspection was carried out on 25th October 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Grace Manor Care Centre 03/04/07

Grace Manor Care Centre 23/10/06

Grace Manor Care Centre 06/12/04

Grace Manor Care Centre 14/06/04

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

CARE HOMES FOR OLDER PEOPLE Grace Manor Nursing Home 348 Grange Road Gillingham Kent ME7 2UD Lead Inspector Sue McGrath Announced Inspection 25th October 2005 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 Manor Nursing Home DS0000026175.V260636.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. Grace Manor Nursing Home DS0000026175.V260636.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Grace Manor Nursing Home Address 348 Grange Road Gillingham Kent ME7 2UD 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) 01634 570230 01634 580469 Grace Manor Care Limited Moira Edmondson Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60), Terminally ill (4) of places Grace Manor Nursing Home DS0000026175.V260636.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. To admit a resident aged 63. Date of last inspection 16th May 2005 Brief Description of the Service: Grace Manor is a Nursing Home for Older People. The home caters for 60 people with various nursing needs. The main part of the home was an old Manor House and the décor etc. is in keeping with the period of the home. The new addition affords service users en-suite rooms and there is plenty of day space to choose from. There is a courtyard garden at the centre of the home, which is a suntrap in the summer, which service users enjoy and benefit from. The home itself is set in generally well-maintained grounds and overlooks the river Medway. The nearest town is Gillingham, which has a main line railway station and high street stores. Grace Manor Nursing Home DS0000026175.V260636.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection under the terms of the Care Standards Act 2000 and was carried out by two inspectors who were in the home from 10.00 to 15.30 on the 25th October 2005. During the inspection the Manager was in attendance. Documentation and records were read, including care plans. A tour of the premises was undertaken and a considerable amount of time was spent talking with residents and some staff. What the service does well: What has improved since the last inspection? More nursing staff have been employed since the last inspection and rotas have been adjusted to provide better staff cover. These figures will need to be maintained at all times. The general atmosphere within the home and staff morale appeared to have improved since the last inspection. The administration of medication has also improved with only one minor error highlighted. Care plans have also improved but care must be taken to ensure that daily logs are kept detailed and consistent. Grace Manor Nursing Home DS0000026175.V260636.R01.S.doc Version 5.0 Page 6 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. Grace Manor Nursing Home DS0000026175.V260636.R01.S.doc Version 5.0 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 Manor Nursing Home DS0000026175.V260636.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 and 6 Residents and their families have access to the required information for them to make an informed decision about moving into the home. Prospective residents have the benefit of a trial period within the home in order for them to assess its suitability. EVIDENCE: The home has its statement of purpose and service users guide together in one format. It is clear and concise with all relevant information included and is accessible to all residents by being stored in communal areas and in a format, which is user friendly. Residents are provided with a statement of terms and conditions when moving into the home. Evidence was seen of the homes contracts, which were very detailed and signed by the resident or their representative. The homes manager stated the policy of the home was to offer where possible a trial period to all residents. This however is harder in a nursing home when most of the residents are coming to the home from hospital, however most residents had a family representative assess the home on their behalf. All the residents spoken to felt that family or care managers had been thorough when looking for a home for them. Grace Manor Nursing Home DS0000026175.V260636.R01.S.doc Version 5.0 Page 9 The home does not offer intermediate care. Grace Manor Nursing Home DS0000026175.V260636.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 and 11 Residents benefit from a high standard of care planning and are treated with respect and dignity. Residents’ health needs are well met. All residents would benefit from being consulted regarding their wishes concerning terminal care and arrangements after death. EVIDENCE: Three residents’ plans of care were looked at all of these were detailed records that contained good personal and health care recording. The care plans had all been reviewed monthly and rewritten six monthly if significant changes. The plans of care were excellent, detailed and well written, promoting the independence of the service users. The care plans were completed and reviewed in consultation with the residents; signatures of residents on all consent forms confirmed this. In all the files sampled the inspector saw risk assessments, which included moving and handling, and areas of risk to the residents as well as the staff these where very detailed and ensured protection for everyone. Grace Manor Nursing Home DS0000026175.V260636.R01.S.doc Version 5.0 Page 11 The inspector was particularly impressed with the management of a resident who is declining treatment. The home is ensuring her rights are promoted and her dignity and independence are maintained. The home is also working well in a multi-agency way to ensure every thing possible is put in place for this resident to be as pain free as possible. The manager is putting in place a system to monitor all care plans after the staff have completed their reviews. The home operates a key worker system where residents have an identified staff member. The staff have now started to recording enough detail in the daily Nursing notes, however it was also noted that when events and care delivery occurs after the morning shift has gone off duty there is not a detailed and comprehensive record being kept. The home promotes and maintains residents health through supporting and facilitating medical appointments as required. The home is well able to manage residents with pressure areas with treatment and also support from the tissue viability nurse and the homes own link nurse. The home has good links with other professionals e.g. dietician O.T, Physio and the home can offer a choice of G.Ps from the many surgeries situated locally. The home photocopies and keeps on file all drug information relating to that client. The home has started its winter vaccination program. The staff on duty were observed indirectly throughout the inspection, they were seen to interact in a positive and respectful manner with residents. Residents gave positive feedback during the inspection about the approach of the staff team, comments included “so kind and caring” and “they are very helpful”. In the residents shared rooms it was noted that privacy curtains were in place that ensured privacy and dignity for the occupier. Medication administration was observed during the inspection and the correct procedure was observed. One concern was that one medication that should have been administered before food was actually given during or just after food. This needs to be addressed urgently. Mar sheets were seen and were correctly filled out and no gaps were seen. An audit showed that current medication, apart from the one medication highlighted above, was being administered in accordance with the guidelines from the Royal Pharmaceutical Society of Great Britain. . All residents need to be consulted regarding their wishes concerning terminal care and arrangements after death and added to their care plans. Grace Manor Nursing Home DS0000026175.V260636.R01.S.doc Version 5.0 Page 12 Grace Manor Nursing Home DS0000026175.V260636.R01.S.doc Version 5.0 Page 13 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): 12,13,14,and 15 EVIDENCE: The home had two activity co-ordinators who between them worked 6 days a week. The home offered a full programme of activities every afternoon except Sundays. This included on a weekly basis bingo, Music and Movement and a library service. Different entertainers visited the home and church services were held monthly. Evidence was seen of daily log of activities with nearly all clients being seen daily, for a one to one chat or a hand massage if not able/wanting to partake of the afternoon activity. A number of residents spoken to in the home who commented on the food, said how good it was and that they welcomed the daily choices offered. Evidence was seen of the four-week rota and of stocked larders and fresh food orders. Residents were observed during meal- time and choice and variety were offered. The residents also commented on the home and how it encouraged them to maximise their independence and freedom of choice. They were offered choices and were not told what to do and most felt valued by the staff. The staff team had a good understanding of the support needs of the residents. Grace Manor Nursing Home DS0000026175.V260636.R01.S.doc Version 5.0 Page 14 This is evident from the positive relationships, which had been formed between staff and residents. Comments from the last report regarding the fairly rigid routines have now been dealt with and these routines are now far more flexible and resident led. Visitors were made welcome at any time and a private visitors room was made available with refreshments as required. This was evidenced during the inspection and on speaking to relatives. They stated, “They were free to visit when ever they wished and were very happy with the home”. Grace Manor Nursing Home DS0000026175.V260636.R01.S.doc Version 5.0 Page 15 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): 16,17 and 18 The home has a robust complaints system and service users and relatives feel their views are listened to and acted upon. The home has robust adult protection policies and procedures to ensure that residents are protected from abuse. EVIDENCE: The home has a written complaints procedure, which was seen with the Service User Guide. A copy of which was also on display in the foyer. Visitors spoken too were aware of the procedure although had not needed to use it. They had found that the manager had always acted on any minor issue before they needed to make a full complaint. The home had thirteen complaints in the last year, eight of which were substantiated, with suitable action taken and five had been partially substantiated again with appropriate action taken. The manager confirmed that she would be very proactive in protecting residents from abuse and would apply to POVA if the action warranted the referral. Staff spoken to could demonstrate an understanding of the Adult Abuse policy and of the effects of such abuse. The home would arrange for any resident to vote in any local or general election if required. Grace Manor Nursing Home DS0000026175.V260636.R01.S.doc Version 5.0 Page 16 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): 19 - 26 Residents benefit from living in a home, which is generally well maintained and is suitable for it’s stated purpose. EVIDENCE: All of these standards were assessed at the last inspection as met and no changes were evident. The above judgement remains the same. Grace Manor Nursing Home DS0000026175.V260636.R01.S.doc Version 5.0 Page 17 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, 28, 29 and 30 The residents benefit from being cared for by staff who have a good understanding of their needs. Residents are protected by the homes robust recruitment procedures. Residents would benefit if more staff had completed NVQ 2 or above. EVIDENCE: Extra Nursing staff and some care staff had been appointed since the last inspection and this had improved the level of staffing used. The home now employs 10 RGN’s and 44 care staff. After talking to some of the staff members it was noted that they seemed committed to the residents and the home and that their morale had improved. Several residents stated that there appeared to be more staff around lately. These figures need to be maintained. Evidence seen suggested staff training was meeting the required standard and a training matrix was seen. The manager of the home had employed a member of staff solely to undertake all the homes training. Figures given by the manager regarding staff with NVQ 2 or above, confirmed that the staff ratio is only 32.0 . This needs to be improved upon and staff actively encouraged to complete their awards. The homes recruitment process was robust and thorough. The homes induction programme is very thorough and appeared to cover most the NTO workforce training targets. All staff who were awaiting CRBs had supervision from a member of staff. Grace Manor Nursing Home DS0000026175.V260636.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37 and 38 Residents benefit from having a manager who has a clear development plan and vision for the home, which she effectively communicates to the residents, staff and relatives. The residents also benefit from having a manager who is well supported by the senior staff in providing leadership throughout the home and from staff who demonstrate an awareness of their roles and responsibilities. Residents can be confident that their financial interests are safeguarded. The health, safety and welfare of residents and staff is promoted and protected by the home’s robust procedures in this area. EVIDENCE: The current manager was registered with the commission prior to her leaving for a short period, as the time period was short and her qualification still relevant, she is to be reinstated as the registered manager and will not need to Grace Manor Nursing Home DS0000026175.V260636.R01.S.doc Version 5.0 Page 19 re-apply. Since her return in January she has worked hard to improve the service and appeared to have succeeded in levelling off the recent decline. She was seen to interact very positively with the residents and visiting families. Comment cards returned from relatives indicated a high number were concerned over staffing levels and the turnover of staff. Discussion with the manager and figures given by the manager indicated that this issue appeared to have been resolved. Staffing turnover and levels will continue to be closely monitored at future inspections. The manager was currently drawing up an Annual Development Plan and had discussed a strategic plan with the owner; again this will be assessed at the next inspection. The home’s policies and procedures had been reviewed by the manager and were signed and dated by her. Insurance cover was seen to be in place. The homes financial records were viewed and found to be well maintained. The home had two safes for resident’s monies and small personal items. Records of the resident’s personal monies were viewed and again were found to be well maintained. Two accounts were checked and found to balance. The home does not deal with resident’s pensions and allowances and families are expected to deal with these. The home is advised not to let residents have an account that goes into the red and loan monies to residents. Families received copies all monies spent on each account. Staff supervision is still being developed within the home and this is being given a high priority by the manager. It is expected that records will be maintained and at the next inspection evidence will be provided that all staff are receiving regular supervision. Records seen on the day indicated that the homes records were secure, up to date and in good order. The registered manager ensures so far as is reasonably practicable the health, safety and welfare of the residents and staff by ensuring that all the regular maintenance and physical checks were being carried out on the building and its contents. Grace Manor Nursing Home DS0000026175.V260636.R01.S.doc Version 5.0 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 1 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 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 2 3 3 Grace Manor Nursing Home DS0000026175.V260636.R01.S.doc Version 5.0 Page 21 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 OP36 Regulation 18(2) Requirement Care staff receive formal supervision at least 6 times a year. Supervision covers: • All aspects of practise • Philosophy of care in the home • Career development needs Timescale for action 31/12/05 2 OP27 18(1)(a) 3 OP11 12(1)(4) 4 OP28 18(1)(a) All other staff are supervised as part of the normal management process on a continuous basis. Staffing numbers and skill mix of 31/12/05 qualified/unqualified staff are appropriate to the assessed need of the service users, the size, the layout and purpose of the home, at all times. Numbers to be maintained. Care and comfort are given to 31/12/05 service users who are dying, their death is handled with dignity and propriety, and their spiritual needs, rites and functions observed and recorded on the care plans A minimum ratio of 50 trained 31/12/05 members of care staff (NVQ Level 2 or equivalent) is DS0000026175.V260636.R01.S.doc Version 5.0 Page 22 Grace Manor Nursing Home achieved, excluding the registered manager and/or care manager, and in care homes providing nursing, excluding those members of the care staff who are registered nurses. Action plan required by 31/12/15 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 Refer to Standard OP7 Good Practice Recommendations It is recommended that daily record keeping is detailed and consistent. Grace Manor Nursing Home DS0000026175.V260636.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 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 Manor Nursing Home DS0000026175.V260636.R01.S.doc Version 5.0 Page 24 - 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!