CARE HOME ADULTS 18-65
Graceland Care Home 113A Parchmore Road Thornton Heath Croydon Surrey CR7 8LZ Lead Inspector
Mohammad Peerbux Unannounced Inspection 5th October 2005 11:00 Graceland Care Home DS0000025785.V255994.R01.S.doc Version 5.0 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 Graceland Care Home DS0000025785.V255994.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 Adults 18-65. 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. Graceland Care Home DS0000025785.V255994.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Graceland Care Home Address 113A Parchmore Road Thornton Heath Croydon Surrey CR7 8LZ 020 8771 5691 020 8768 1445 charlesbasoah@hotmail.com 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) Graceland Care Home Limited Mrs Grace Basoah Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Graceland Care Home DS0000025785.V255994.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th May 2005 Brief Description of the Service: Graceland is registered as a care home to provide a service for up to two young adults between the ages of 18 to 65 years, under the category of learning disabilities. There are two Registered Providers, one of whom manages the home on a day-to-day basis. The home is positioned on a main road in Thornton Heath, with the town centre and local transport links within easy reach. Due to the good location, service users benefit from being able to access a variety of community resources. The home comprises of a lounge/ dining area, small kitchen, two large bedrooms, one smaller bedroom, upstairs bathroom/ toilet and ground floor toilet/ shower room, with laundry facilities outside. Entry to the premises is via the rear of the building as the proprietors’ business office is at the front. There is no garden but a good- sized paved yard for service users to utilize in the summer months. Graceland Care Home DS0000025785.V255994.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes second inspection for the year 2005/06. It was an unannounced inspection and took place over two hours. Some times were spent looking at the policies and procedures, talking to the manager, staff and registered provider. A tour of the building was also carried out. Requirements and recommendations from the previous inspection were also discussed with the registered manager. Overall the inspection confirmed that the home provides a good level of care for the service users who live there. What the service does well: What has improved since the last inspection?
The home has recently reviewed its Statement of Purpose and Service Users’ Guide. Records indicate that staff training has been ongoing, with the manager continuing to seek out training sessions relevant to the needs of the current service user group. Graceland Care Home DS0000025785.V255994.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. Graceland Care Home DS0000025785.V255994.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Graceland Care Home DS0000025785.V255994.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 The Statement of Purpose, and Service User Guides’ provide prospective service users with details of the services the home offers. This enable them to make an informed decision about admission to the home .All prospective service users have their needs assessed prior to admission to ensure that the home and staff are aware of their assessed needs. EVIDENCE: The home has a comprehensive Statement of Purpose, and Service User Guide. Both are extremely well presented and cover all the information required by the Care Homes Regulations (2001), including the aims and objectives of the home and the facilities and services provided. They have been amended as previously required. Service users are only admitted to the home after a full assessment of their needs has been carried out by the home and the Placing Authority for individuals referred through Care Management, involving the prospective service user/recognised representative. However it was noted that the home still has to develop its own care plans. Graceland Care Home DS0000025785.V255994.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9 Service users’ personal, physical and emotional health needs are not being reviewed on a regular basis as no in house care plans are in place and therefore their quality of life experienced is not being maximised. EVIDENCE: The home has care plans that have been compiled by the care manager. However it was noted that the home still has to develop its own care plans. The registered manager must ensure that all service users have a care plan in place that sets out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the service user are met. Risk assessments for service users were examined. Potential risks are identified covering all aspects of their daily living both inside and outside the home. However the risk assessments must be updated for the service users so that staff are kept up to date to what actions need to be taken to minimize identified risks and hazards. Graceland Care Home DS0000025785.V255994.R01.S.doc Version 5.0 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,14 and 16 Service users are adequately supported to participate in the local community, with the aim of maximum integration. The daily routines and house rules promote service users’ rights, and ensure equality and that all rights are enjoyed by service users. EVIDENCE: The service users assist with weekly shopping, menu planning, and household chores. Both service users have a high degree of independence. It was clear that staff at Graceland support service users to continue their education or training, and / or take part in valued and fulfilling activities. One of the service users attends South Norwood and is learning French and sign language. The other service user has a voluntary job. The service users are clearly all able to express their social / leisure needs and interests. Staff support service users in pursuing these activities if and when necessary / requested. Service users take part in a range of local leisure activities.
Graceland Care Home DS0000025785.V255994.R01.S.doc Version 5.0 Page 11 The daily routines at Graceland clearly promote opportunities for service users to maintain, or further develop their personal skills in areas such as money / household management and personal relationships. Activities such as cooking, cleaning and self-care are a normal part of the daily life for service users in this home. Graceland Care Home DS0000025785.V255994.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and21 Overall the arrangements for health care needs of the service users is good and they receive personal support in the way they prefer. This ensures that the service users’ physical and emotional health is well maintained and therefore the quality of life experienced is also maximised. EVIDENCE: The findings indicated that service users are able to exercise some level of independence in their personal care needs with appropriate support from staff where needed. The overall impression indicated a good culture of semiindependent living, where service users have reasonable control over their lives and support from staff where needed. It was previously required that the manager must consult both service users and/or their respective families about their last wishes and this must recorded in their personal files. The manager stated this has been done. Graceland Care Home DS0000025785.V255994.R01.S.doc Version 5.0 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Standard 22 and 23 were previously met and there has been no change; they were not assessed at this inspection. Graceland Care Home DS0000025785.V255994.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 25 The home is generally hygienic and clean, homely and comfortable; this environment therefore facilitates the service users’ health and emotional wellbeing. Fire safety inspection still needs to be carried out to ensure the safety of service users in compliance with fire regulations. EVIDENCE: The home is a normal family home; it meets the needs of the service user. The home is clean, well presented and furnished. To ensure that the premises comply with the requirements of the local fire brigade (LFEPA), the Registered Provider was required to arrange for a safety inspection to be carried out by the fire service with a report made available to inspection. The manager stated that she has written to the local fire brigade (LFEPA) and still waiting for a response from them. Therefore this requirement will be repeated. The inspection findings indicated the home provides adequate living and bedroom spaces for each service user. One of the bedrooms was checked. It was decorated to a good standard. The room contained a variety of personal furniture and fittings that reflected the individual’s personality. Graceland Care Home DS0000025785.V255994.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 and 36 Recruitment policies have not been consistently followed resulting in service users receiving care from staff members who have not been properly vetted. This potentially leaves people who use the service at risk. No progress has been made with regards to the frequency of staff supervision. This might have an impact on the quality of care being provided. EVIDENCE: Staff records were examined and were seen to contain references, criminal record checks, original application forms and copies of identification. However it was noted that none of the staff have evidence on files to indicate that they are physically and mentally fit for the purposes of the work that they perform at the home. The manager must ensure that staff files must contain all relevant documentations as per schedule 2 of the revised Care Homes Regulations 2001. It was previously required that the Registered Provider must ensure that all care staff have regular, recorded supervision. No supervision records were available at the times of inspection therefore this requirement will be repeated. Graceland Care Home DS0000025785.V255994.R01.S.doc Version 5.0 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 42 and 43 The home is generally managed well however the health, safety and welfare of service users and staff are not being promoted/protected and this potentially places them at risk. EVIDENCE: The home has a satisfaction questionnaire for service users and their relatives to gain feedback on the services being provided. The manager explained that an annual quality development plan still needs to be developed for the home and this requirement therefore still stands. It was previously required that the home must ensure that environmental risk assessments are completed for all safe working practices as listed in standards 42.2 and 42.3. This still has to be completed and therefore the requirement will be repeated. Graceland Care Home DS0000025785.V255994.R01.S.doc Version 5.0 Page 17 During the inspection it was noted that the hot water temperature in the washbasin of the bathroom and the washbasin in one of the service users’ bedroom were above the recommended level of 43 degrees. An immediate requirement was issued to address this issue. The registered manager must ensure that the hot water temperature is always within the recommended level. This issue was addressed on the following day of the inspection. No business and financial plan was available at the time of inspection. The Registered Provider must ensure that a business plan, demonstrating that the home is financially viable for the purpose of achieving the aims and objectives set out in the Statement of Purpose, is supplied to the Commission for Social Care Inspection. Graceland Care Home DS0000025785.V255994.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 2 X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 X X X X X LIFESTYLES Standard No Score 11 3 12 X 13 X 14 3 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X X X 2 X 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Graceland Care Home Score 3 X X 3 Standard No 37 38 39 40 41 42 43 Score X X 2 X X 2 2 DS0000025785.V255994.R01.S.doc Version 5.0 Page 19 YES Are there any outstanding requirements from the last inspection? 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 YA6 Regulation 15(2) Requirement The registered manager must ensure that all service users have a care plan in place that sets out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the service user are met. Timescale for action 15/12/05 2 YA9 15(2) The risk assessments of service 15/12/05 users must be updated so that staff are kept up to date to what actions need to be taken to minimize identified risks and hazards. To ensure that the premises comply with the requirements of the local fire brigade (LFEPA), the Registered Provider must arrange for a safety inspection to be carried out with a report made available to inspection.Previous timescale of 31/07/05 not met. The manager must ensure that staff files must contain all relevant documentations as per schedule 2 of the revised Care
DS0000025785.V255994.R01.S.doc 3 YA24 23(4) 15/12/05 4 YA34 19 15/12/05 Graceland Care Home Version 5.0 Page 20 Homes Regulations 2001. 5 YA36 17(2) 18(2) The Registered Provider must ensure that all care staff have regular, recorded supervision. (Timescale of 19/05/05 not met) 21(2) The home must produce a 24(1)(a)(b) written record of an annual quality development plan.(Timescale of 31/07/05 not met) 13(4)15(1) The home must ensure that Sch.3,3q environmental risk assessments are completed for all safe working practices as listed in standards 42.2 and 42.3. (Timescale of 31/07/05 not met) 13(4) The registered manager must ensure that the hot water temperature is always within the recommended level. This was addressed on the 6th of October 2005. 25(2)(a)(c) 15/12/05 6 YA39 15/12/05 7 YA42 15/12/05 8 YA42 07/10/05 9 YA43 The Registered Provider must 15/12/05 ensure that a business plan, demonstrating that the home is financially viable for the purpose of achieving the aims and objectives set out in the Statement of Purpose, is supplied to the Commission for Social Care 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 Graceland Care Home DS0000025785.V255994.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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