Inspection on 13/08/07 for Gracelands

This inspection was carried out on 13th August 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

Gracelands 02/08/06

Gracelands 13/12/05

Gracelands 10/08/05

Gracelands 21/02/05

Gracelands 07/10/04

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

CARE HOMES FOR OLDER PEOPLE Gracelands 42-48 Richmond Avenue Bognor Regis West Sussex PO21 2YE Lead Inspector Mrs D Peel Unannounced Inspection 10:15 13 August 2007 th 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 Gracelands DS0000059816.V342855.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. Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gracelands Address 42-48 Richmond Avenue Bognor Regis West Sussex PO21 2YE 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) 01243 867707 01243 868331 Macleod Pinsent Care Limited Margaret Anne Kerbey Care Home 31 Category(ies) of Dementia - over 65 years of age (31), Old age, registration, with number not falling within any other category (15) of places Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 31 service users in the category Dementia Elderly DE(E)of whom one named person may be in the category mental Disorder (MD) excluding learning or dementia There are currently up to 15 male and / or female service users in the category of old age, not falling within any other category. No further service users in this category may be admitted. Only persons over 65 years can be admitted. Total number of service users accommodated may not exceed 31. 2. 3. 4. Date of last inspection 2nd August 2006 Brief Description of the Service: Gracelands is a care home registered to provide care and accommodation to thirty-one service users over the age of sixty-five with dementia (DE(E)). The property is situated in Bognor Regis within close proximity of local shops and the seafront. Accommodation is provided on two floors, which are accessible by passenger lift, and consists of twenty-five single rooms and three double rooms. Communal space consists of four lounge areas and a dining room on the ground floor and a garden to the rear of the property. Macleod Pinsent Care Limited privately owns Gracelands. Mr Russell Pinsent is the Responsible Individual on behalf of the organisation. The Registered Manager responsible for the day-to-day running of the home is Mrs. Margaret Anne Kerbey. The current fees being charged by the home are from £400 to £600 per week. Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Mrs Diane Peel carried out this unannounced visit to Gracelands on the 13th August 2007. During this visit the intended outcomes for 32 standards were assessed; these included the key standards for care homes providing a service to older people. Prior to the visit to the home the inspector reviewed, previous inspection reports, information gathered about the home since it was last visited in August 2006 and seven Have Your Say surveys returned to CSCI by relatives of people living at the home and two surveys returned by health and social care professionals who visit the home. The Annual Quality Assurance Assessment (AQAA) was returned to The Commission for Social Care Inspection (CSCI) prior to this visit to the home and this was used to address areas of improvement and further improvements with the manager. On the day of the visit there were twenty-two people living at the home and during the course of the visit the inspector met all residents and spoke with those who were able to converse with the inspector in either in the privacy of their bedrooms or in the lounge and dining room. A case tracking exercise for four people living at the home was undertaken to look at how the assessed needs of this group of residents with diverse needs were being met. Staff were spoken with during the visit and observed during their interaction with people living at the home. What the service does well: A relative said in their Have Your Say surveys, which they returned to CSCI “ Gracelands always makes you feel important in your relatives life even though they sometimes have difficulty remembering who you are.” Another relative said, “ I am always made welcome and my mother, I am sure could not receive better care anywhere.” Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 Page 6 From observing staff and people living at the home the inspector was able to conclude that staff encourage people to retain their individuality, they were kind and encouraging in their approach and take time to explain what they are doing and the reasons why. The new version of care plans is comprehensive and has clear goals and expected outcomes for people living at the home. How the outcomes are to be achieved by staff are “user friendly.” What has improved since the last inspection? What they could do better: The environment should continue to be improved following the homes ongoing programme of refurbishment and renewal. The manager must make sure that all the potential risks to people living at the home have been addressed. Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 Page 7 It was discussed that the menus might be developed to include photographs of choice of food to encourage people who have some problems expressing verbally to make a choice. 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. Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 Page 8 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 Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5,6 People who use the service experience good outcomes in this area. People, who come to live at the home and their families, have information available to make an informed choice about where they want to live and people’s needs are assessed before they move to the home, so that they know that the home can meet those needs. EVIDENCE: Gracelands has a statement of purpose, service user guide and a brochure, which it gives to people who are considering moving into the home. There are opportunities for people to visit the home but for some people moving into the home it is their relatives who have visited on their behalf. The home has a three month trial period in which people can decide if the home meets their needs and it also gives the manager and staff a chance to Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 Page 10 ensure that they can address the assessed needs of individuals and deliver a care package which both people living at the home and their representatives expect. The care records of four people were looked at during this visit, which included the records of the person who had most recently moved into the home. Each set of records included a needs assessment and for those people being funded by a local authority there was a care management needs statement. For one person who records were viewed it was observed that they had stayed at Gracelands for periods of respite care before moving into the home permanently. The manager explained the process of assessment and stated that she always carries out her own assessment even if a local authority is placing the person. The specialist needs of people living at the home were observed to be identified in the care plans viewed at the visit to the home which included, mental health needs, dietary needs and social and religious preferences. Staff training records show that collectively have the skills and experience to deliver a service to people who have dementia and cognitive impairments. Intermediate care is not offered at Gracelands Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People who use the service experience good outcomes in this area. The revised care planning systems are regularly updated and they give clear information to assist with all aspects of health, personal and social care needs so that the changing needs of people living at the home can be monitored. EVIDENCE: The care plans of four people living at Gracelands were viewed during this visit as part of an exercise in tracking the care provided for people living at the home. The manager is currently converting the care records and care plans into a new system and so examples of both the old version and new version were observed. Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 Page 12 The revised version had clear evidence that families are involved in the plan of care and included a life history, and a plan of care which identified needs, the expected outcomes and the action to be taken by staff. Each care plan observed had been reviewed monthly and there were daily monitoring records in place to show that staff monitor the well being of people living at the home. Visits by health care professionals are recorded and nutritional assessments are being completed in the revised care plan format. Monthly weights are being recorded. A Doctor returning a survey to CSCI reported that that they were satisfied with the overall care provided to people living at the home. All seven relatives reported in surveys returned to CSCI that the home always meets the needs of their relative living at the home. Individual risk assessment were observed to be in place and the tracking of falls recorded in daily records to the accident reporting records showed that staff were actively recording accidents to people living at the home. The manager then has a system for auditing accidents to identify types of injuries and how they were sustained and what could be done to avoid further incidents. Medication was observed to be kept in a locked metal cabinet secured to the wall. Arrangements are in place for supply and disposal of medication with a local pharmacist who also provides advice and training. Medication administration records were sampled and those viewed were in good order with assigned codes being used when medication had not been taken. Some staff have completed medication handling training through a distance learning course and the manager confirmed it is hoped that the majority of care staff will complete the accredited course. Locks were observed to be provided on the doors to resident’s rooms and staff were observed to knock on peoples doors before entering. In communal areas of the home staff were observed to treat people as individuals and give people the time and support which they needed. A Doctor returning a survey to CSCI reported that he was able to see his patients in private at the home and that when they give advise it is incorporated into the care plan. Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People who use the service experience good outcomes in this area. People living at the home are encouraged to maintain contact with their family and friends so that they can satisfy their social and emotional needs and the social activity programme is flexible to cater for individual residents abilities and to offer variation to daily living. EVIDENCE: The social history of people living at the home is now being incorporated into the new version of care plans and this was observed to be in place for two out of the four care plans viewed during the visit. Throughout the visit people were observed to be able to exercise choices about what they wanted to do and where they wanted to be. Information about forthcoming visiting entertainment was observed to be on display on a notice board in the hallway. Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 Page 14 Whilst observing people in the lounge during the morning a resident was observed to collect paper napkins from the store and begin to fold them for use at mealtime. This person said that they liked to do this because “it helped out and they felt useful.” After lunch an outside therapist visited and carried out an exercise session with people who wanted to take part. It was encouraging to observe the enthusiasm displayed by both people living at the home and the staff taking part. Another activity recently introduced is indoor gardening and the manager has confirmed in the AQAA returned to CSCI that in response to the internal quality audits more board games and activities are to be introduced. The visitor’s book was observed to be present in the entrance hall and it showed regular visitors to the home. From comments made in Have Your Say surveys returned to CSCI relatives felt that the home encourages people living at the home to keep in touch with their friends and relatives. Relatives made comments such as “ the communication is good”, “it is a friendly atmosphere to residents and their relatives” and “ I am always made welcome when I visit.” The inspector joined residents for the main meal of the day in the dining room. The menu on the tables showed that liver and bacon casserole was the main option but there was others things to choose from such as omelette, quiche or vegetable grills. The liver and bacon was served with a selection of vegetables. The desert was chocolate pudding and custard or an alternative of fruit, yogurt or ice cream. Drinks were observed to be served throughout the day and the mid afternoon drink was served with cakes and pieces of fresh fruit for people to choose from. One person spoken with in the privacy of their room said that they generally liked the food. They went to the dining room for lunch but chose to have supper in their room. When asked when they would normally choose from the menu for lunch they said “at the table”. Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People who use the service experience good outcomes in this area. The complaints procedure enables those using the service to have the confidence that any complaints will be taken seriously and responded to. Arrangements are in place to protect people using the service from being place of harm or abuse. EVIDENCE: Gracelands has a complaints procedure, which is displayed in the entrance to the home. Complaints records were observed to include an anonymous complaint, which was received by CSCI. The manager had been asked to investigate the complaints through the homes own complaints procedure and the outcomes of the complaint had been provided to CSCI within the agreed timescales. Four complaints had been received by the home in the last twelve months of which all had been responded to within twenty-eight days. Five out seven relatives returning surveys to CSCI reported that they knew how to make a complaint about the service the other two said that they couldn’t remember, however when asked “has the care service responded appropriately if you or the person using the service has raised concerns about Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 Page 16 their care?” all seven either responded “always” or commented that they had never had to raise any concerns. Staff training records showed that all staff are provided with basic information about safeguarding adults during their induction and the further training is provided when a course is available. In the interim period the home has a video training learning set for staff to undertake. No safeguarding adults issues have come to the attention of CSCI and the manager confirmed that the home has not referred any safeguarding adults matters in the last twelve months. Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 People who use the service experience adequate outcomes in this area. Ongoing redecoration and refurbishment is improving the environment so that people have a more comfortable and homely environment to live in. EVIDENCE: Improvements continue to be made to the environment at the home. Hallways have been redecorated, as have bathrooms and several bedrooms as they become vacant. The communal areas at Gracelands feel homely and spacious and people have lots of choice about where they want to be. After risk assessments a number of stair gates have been installed to lessen the probability of falls by people who have been identified as at risk from Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 Page 18 attempting to go upstairs on their own. It was observed during the visit that more mobile people used the stairs and were able to negotiate the gates. People have been encouraged to make their bedrooms their own by displaying objects, which they recognise in their rooms. The manager commented that as rooms become vacant they are being redecorated and it was observed that some vacant rooms which had been redecorated had new carpets in place. The home had recently had new windows to the front of the property. Four windows sampled at random were found to open to an unsafe width and no working restrictors were in place. This matter was brought to the attention of the manager and the maintenance person who revisited the rooms with the inspector. Immediate action was then taken to audit all the windows and put window restrictors in place were people are at risk from falling out. The manager has agreed to confirm with CSCI when this work has been completed. The parts needed to restrain the openings had been purchased before the inspector left the property. Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 Page 19 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 People who use the service experience good outcomes in this area. People living at Gracelands are protected by the recruitment procedures and staff receive appropriate training and supervision so that they can meet the needs of people living at the home. EVIDENCE: At the time of the visit there were twenty-two people living at the home being supported by five care assistants. In addition there were catering staff and housekeeping staff and in the afternoon there are four care assistants until the night staff come on duty. Information provided in the AQAA reports that fifty three percent of care staff have an NVQ and a further ten percent are near to completion of their NVQ. The records of three staff were observed during this visit to the home, which included the most recently employed person. They were observed to include evidence of Criminal Record Bureau (CRB) and Protection of Adults (POVA) checks. A job application was on file, two written references, photograph, proof of the person’s identity and completed equal opportunity monitoring forms and health declaration forms. Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 Page 20 Induction, supervision and training records were in place, which evidenced a commitment to the training programme for staff. Comments made about staff in the returned Have Your Say surveys from relatives included: “ There is a very wide range of needs at Gracelands and the staff cope very well.” “The staff are very dedicated.” Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 Page 21 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): 31,33,35,36,37,38 People who use the service experience good outcomes in this area. People living at the home and their relatives can be confident that the manager wants to run the home in the best interests of the people that live there, but to achieve this must continue to improve the home and ensure that people have a home where all risks to their safety have been identified and action taken to minimise these risks. EVIDENCE: Mrs Kerbey has been is the Registered Manager at Gracelands since May 2006 She is a registered general nurse and psychiatric nurse and has many years experience of working in care homes and hospitals. Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 Page 22 There is an ongoing development plan for the home, which Mrs Kirby has been implementing since taking up her position as manager of the home. A quality assurance system is now in place, which also consults with people who use the service in a pictorial format. Monthly audits are carried out throughout the environment and ranges of other people are consulted which includes relatives and other visitors to the home. The home does look after a small amount of money for some residents. The system in use records all incoming money an outgoing spending and is electronic. The storage of people’s money was sampled at random during this visit to ensure that the system safeguards the financial interests of people living at the home. Those monies sampled were correct as stated on records on the day of the visit. Staff supervision records were available to the inspector and ways of recording supervised practice were also discussed with the manager. All records sampled at this visit were found to be informative and of a good standard. Information received prior to the visit shows that arrangements have been made to ensure equipment is serviced regularly and that since the last visit to the home a new boiler has been installed. Risk assessments are carried out but it was observed that at this visit at least four replacement windows were a potential risk to residents who could have fallen out of them. A Statutory Requirement has been made to ensure the safety of people living at the home and it was noted that action was being taken before the inspector left the property. Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 Page 23 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 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 2 3 2 3 3 3 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 2 Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 Page 24 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 OP38 Regulation 13.4(a)(c) Requirement Risk assessments must be carried out for all windows and measures taken to protect people from risk of falling out. Timescale for action 03/09/07 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 Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Gracelands DS0000059816.V342855.R01.S.doc Version 5.2 Page 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. 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