Inspection on 17/10/07 for Gracelands

This inspection was carried out on 17th October 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 25/08/09

Gracelands 27/05/09

Gracelands 30/04/07

Gracelands 16/11/06

Gracelands 21/02/06

Gracelands 16/08/05

Gracelands 07/02/05

Gracelands 20/08/04

Gracelands 25/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Gracelands Ellesmere Road Whittington Oswestry Shropshire SY11 4DJ Lead Inspector Sue Woods Unannounced Inspection 17th October 2007 09:40 Gracelands DS0000038691.V347765.R01.S.doc Version 5.2 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 DS0000038691.V347765.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 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. Gracelands DS0000038691.V347765.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gracelands Address Ellesmere Road Whittington Oswestry Shropshire SY11 4DJ 01691 652153 01691 652153 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) www.loppingtonhouse.co.ukE mail office@loppingtonhouse.co.uk Loppington House Limited Miss Julie Palin Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Gracelands DS0000038691.V347765.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th April 2007 Brief Description of the Service: Gracelands is registered with the Commission of Social Care Inspection (CSCI) to provide accommodation and care for seven people with a learning disability. The home is situated in the village of Whittington in North Shropshire. Loppington House Ltd owns the home and the Registered Provider is its Director, Mr Paul Harris. The Registered Manager for Gracelands is Ms Julie Palin. Accommodation is spacious and all bedrooms are single. Consultation with people who live at the home takes the form of regular meetings, discussions and involvement in the development of care plans. Advocacy services are promoted and family members are also consulted in how they feel the home is run. The Weekly fees charged ranges from £887.92 - £971.08 Gracelands DS0000038691.V347765.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection of Gracelands was unannounced and took place on 17th October 2007. The inspection lasted four hours and reviewed all 22 key standards. Information to produce this report was gathered from the findings on the day and also by review of information received by CSCI prior to the inspection date. A quality rating based on each outcome area for service users has been identified. These ratings are described as excellent/good/adequate or poor based on findings of the inspection activity. As part of the fieldwork activity the inspector met with everyone who lives at the home and staff who were on duty at the time of the inspection. The inspector also spent time with the registered manager of Gracelands and looked at care files and other records that are referred to within this report. Time was also spent reviewing the home’s improvement plan. What the service does well: People living at Gracelands are supported by a motivated and enthusiastic, staff team who enjoy their work and receive good support and training opportunities. Staff find training ‘helpful and interesting’. Prior to moving to the home people are supported by a detailed assessment and introductory process that has led to someone moving to Gracelands who shares similar likes and hobbies as people already living there. Care plans are well written and contain detailed information as to how people would like their care and support needs to be met. The organisation has developed an Equality and Diversity policy that is being introduced to Gracelands alongside staff training and a social event to promote the message behind it. Gracelands DS0000038691.V347765.R01.S.doc Version 5.2 Page 6 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. Gracelands DS0000038691.V347765.R01.S.doc Version 5.2 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 Gracelands DS0000038691.V347765.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Gracelands has an effective admissions procedure that ensures that the needs of people moving into the home are properly assessed and that compatibility with people already living at the home can be considered. EVIDENCE: Since the time of the last inspection one person has moved from Gracelands and a new person has moved in. The inspector reviewed his file and although there was no recent health or social care assessment available for review there was evidence that the home has completed its own assessment of the person’s needs. This assessment was carried out by the manager of the home and the staff at the person’s previous home (which is part of the same organisation). The manager reported that people living at Gracelands knew the person well before his admission and he had spent time socially and also part of the formal introductory process at Gracelands. It is recommended that some formal agreement for the move is sought from the person’s funding authority to support verbal communication prior to the move. Gracelands DS0000038691.V347765.R01.S.doc Version 5.2 Page 9 It was positive to note that the family of the new admission had played an active part in his move. Gracelands DS0000038691.V347765.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 6,7 and 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Care-planning systems are in place to provide staff with the information they need to effectively meet the support needs of people who live at the home. People are supported with decision-making processes and enabled to take responsible risks. EVIDENCE: As part of the inspection the inspector reviewed two care files. Both were found to contain information in relation to how the person’s care and support needs should be met. Likes and dislikes were seen recorded, as were specialist communication methods. Staff felt that the care plans were very useful in identifying care needs. One man’s plan contained an assessment from the speech and language team and a behavioural support assessment. Gracelands DS0000038691.V347765.R01.S.doc Version 5.2 Page 11 Staff have received training in effective communication using signs, pictures and symbols and this has been particularly useful when supporting the latest person to move in to the home. Staff who haven’t received the training are receiving guidance from the manger and deputy manager until the training is arranged. All plans seen had been recently reviewed and an effective key worker system is in place. Advocacy support is used effectively. Decision-making is supported using pictures, signs and objects. For example, one man chooses his favourite meal by using a cookery book. People living at Gracelands help with cooking and cleaning tasks. Risk assessments were seen on files reviewed and they had recently been rewritten. The format was very user friendly and clearly identified action plans to eliminate or reduce risks. Again staff felt these were useful documents. Gracelands DS0000038691.V347765.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 12,13,15,16 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People living at Gracelands are starting to lead full and active lives enabling them to have new experiences and develop new skills. Family links are supported and maintained and people are provided with a varied and balanced diet in accordance with their personal preferences. EVIDENCE: Since the time of the last inspection circumstances within the home have changed and this has had a positive effect on opportunities for the people living at the home. Staff and the manager all commented that people are going out more and accessing the local community on a more regular basis. Records support these statements and staff are committed to improve things further. It was positive to hear that there are plans for some people to go to college and pursue Gracelands DS0000038691.V347765.R01.S.doc Version 5.2 Page 13 daytime work opportunities within the community as opposed to within the organisation’s own services. People have applied for free bus passes and this will again increase opportunities to visit new places. In house activities have also increased and on the day of the inspection people were writing letters, singing, doing craftwork and later enjoying a game of darts in the lounge. The atmosphere during the inspection was very relaxed and friendly and positive interactions were seen between people living at the home and staff team on duty. Arrangements for meal times have not altered from the time of the last inspection when it was found that menus reflected a varied and balanced diet for people living at the home and the identified dietary needs are catered for. One woman told the inspector that she likes to go shopping. Her favourite place to visit is Telford. People have been able to have a holiday this year and everyone chose where they would like to go. Some people went with their family, staff from Gracelands supported others. Gracelands DS0000038691.V347765.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 18, 19 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The personal and health care needs of the people who live at Gracelands are well met and well documented enabling them to have a good quality of life. People are safeguarded by the home’s system for handling, storing and administering medication EVIDENCE: Care plans seen at the time of the inspection suggest that personal care is delivered in a sensitive and discreet manner taking into consideration individual needs and preferences. Support plans have improved significantly since the time of the last inspection, as have risk assessments that support personal care tasks and medical considerations. Shopping receipts demonstrate that people have recently been shopping for clothes, bedding and towels. One person was said to enjoy one member of staff in particular dressing her hair. Everyone at the time of the inspection was seen to look well groomed. Gracelands DS0000038691.V347765.R01.S.doc Version 5.2 Page 15 The home operates a key worker system and it was reported by the manager that key workers actively support people to achieve goals and objectives. Discussions with staff suggest that they are aware of individual likes and preferences and are thinking creatively as to how these can be planned and accessed. People are supported to attend health care appointments and the home has recently implemented Health Action Plans. The manager said that staff actively take an interest in the medical conditions of the people they support and have researched information that gives them a better understanding of people’s identified behaviours. Medication arrangements were reviewed and found to be satisfactory. There were no gaps in records seen and fridges containing medication were being monitored for the correct temperature. The protocol seen for the administration of medication taken as required was very detailed and is to be supported by the local GP who, the manager said, is very supportive of the home. Since the time of the last inspection behavioural guidelines have been reviewed and amended for everyone living at the home. Those seen were very clear and descriptive focussing on techniques that staff are taught and familiar with. A policy for the Management of Challenging Behaviour now supports practice within the home. Gracelands DS0000038691.V347765.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 22 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live at Gracelands are protected by an effective complaints procedure and a management team who are now confident to use safeguarding adults procedures By reviewing existing arrangements the home can ensure better protection for the people living at the home and the staff that are handling their money. EVIDENCE: Since the time of the last inspection of Gracelands there have been no complaints about the service and since one man moved out there have been no further accidents or incidents reported in relation to anyone living or working at the home. A situation managed within the safeguarding adults protocols has now been resolved satisfactorarily and although the process has been very difficult and stressful for everyone an outcome has been reached that supports the best interests of all concerned. The Policy to support the protection of vulnerable adults is in place although information is not necessarily found within it. The manager committed to review similar policies and collate information to make the process clear for future use. Gracelands DS0000038691.V347765.R01.S.doc Version 5.2 Page 17 As part of the inspection the inspector reviewed the finances of two people living at the home. Records were found to be up to date and accurate. The organisation’s policy for managing money was seen but it is strongly recommended that it is updated to reflect arrangements in place at Gracelands for the protection of the people who live there and the staff team. It was also found that bank statements are sent to the organisations main office for monitoring and audit and not to the people they belong to. The manager will follow this up and make changes to ensure that people receive information that relates to them. Receipts reflected recent activities and events that had been spoke of during the inspection. Gracelands DS0000038691.V347765.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 24 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Gracelands provides homely, domestic style accommodation for people living there, with sufficient space to meet their needs. Routine safety checks and recent improvements have made the home a safer place for people to live. EVIDENCE: The standards within this outcome group were reviewed in detail at the time of the last inspection of the home six months ago therefore only communal areas were seen at the time of this inspection. All areas were seen to be clean and tidy and the manger reported that new sofas have been ordered for the lounge. The judgement made at the time of the last inspection is thus being carried forward. Gracelands DS0000038691.V347765.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 and 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People living at Gracelands are supported by a knowledgeable, enthusiastic and committed staff team who work hard to meet the needs of the people they support. People are protected by robust recruitment and selection procedures EVIDENCE: At the time of the inspection there were three staff on duty. Increased staffing levels are no longer required as the person requiring additional support has moved out. However the manager reported that additional staff are on duty at key times to increase opportunities for people to access leisure activities. The rota reflected staff on duty and also demonstrated that both the manager and the deputy manager now have time allocated off rota to complete administration tasks. Staff spoke of good training opportunities. One person found the training ‘helpful and interesting’’. The training plan details courses attended and supports the manager to identify where there are gaps. All staff have Gracelands DS0000038691.V347765.R01.S.doc Version 5.2 Page 20 completed the Managing Violence and Aggression training and Adult Protection training. Staff feel well supported and have regular supervision. Supervision records are kept. Staff who spoke with the inspector were very positive about their roles and all felt that ‘things are improving’ within the home offering a better quality of life for people. Staff commented on the ‘homely feel’ and an agency worker who works consistently at the home commented that the home is now ‘lighter and more relaxed’. The home currently has two staff vacancies, both are currently covered by consistent agency staff. The organisation has recently implemented an Equality and Diversity policy. Staff will be receiving training to support this and the organisation is having an ‘equality and diversity week’ to involve people who live at Gracelands. Staff meetings are scheduled to restart in October although it is acknowledged that due to issues within the home over the last twelve months these meetings have not taken place. Two staff files were seen by the inspector. Both contained all required information. Gracelands DS0000038691.V347765.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The people who live at Gracelands benefit from being supported by a committed and responsive manager enabling them to now lead a good quality of life. People’s health and safety is promoted and protected within the home. EVIDENCE: Since the time of the last inspection the manger has worked hard with the staff team to address the issues that were adversely affecting the health and wellbeing of people living at the home. She has worked with a multi agency team under adult protection processes to improve the quality of life for the people living at the home and the person whose needs could no longer be met by the home. Gracelands DS0000038691.V347765.R01.S.doc Version 5.2 Page 22 She has also instigated a review of care plans, risk assessments and other documentation that demonstrate that the home is able to meet people’s needs safely. Following the last inspection the manager produced an improvement plan and on the day of the inspection was able to demonstrate that she has met outstanding requirements made by CSCI (with only minor changes needed to the adult protection policy). At the time of the last inspection of the home health and safety checks were being carried out and since the occupancy of the home changed there have been no further accidents or incidents. Gracelands DS0000038691.V347765.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 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Gracelands DS0000038691.V347765.R01.S.doc Version 5.2 Page 24 NO 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. Standard Regulation Requirement Timescale for action 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 YA2 Good Practice Recommendations It is recommended that some formal agreement is documented to support the admission of a new person to the home. This is to demonstrate that the decision was made with full involvement of all interested agencies. It is strongly recommended that the policy in place to support staff to manage people’s money be amended to fully reflect arrangements in place at Gracelands. This is for the protection of the people who live there and the staff team. It is recommended that information required to cover all aspects of adult protection (including local multi agency procedures) be contained in one document for ease of reference. 2 YA23 3 YA23 Gracelands DS0000038691.V347765.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Shrewsbury Local Office Commission for Social Care Inspection 1st Floor, Chapter House South Abbey Lawn Abbey Foregate Shrewsbury, SY2 6DE 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 DS0000038691.V347765.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. 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!