Inspection on 26/09/07 for Gracelands

This inspection was carried out on 26th September 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Gracelands 23/09/08

Gracelands 09/08/06

Gracelands 30/11/05

Gracelands 06/07/05

Gracelands 09/11/04

Gracelands 30/04/04

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

CARE HOMES FOR OLDER PEOPLE Gracelands 443 Fishponds Road Fishponds Bristol BS16 3AP Lead Inspector Sandra Jones Unannounced Inspection 26th September 2007 09:30 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 DS0000026506.V351458.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 DS0000026506.V351458.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gracelands Address 443 Fishponds Road Fishponds Bristol BS16 3AP 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) 0117 9653019 Mrs Rosemarie J Hancock Mrs Rosemarie J Hancock Care Home 6 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (1), Old age, of places not falling within any other category (5) Gracelands DS0000026506.V351458.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. MD(E) for one named person. Will revert to all OP when she leaves. May accommodate up to 6 persons aged 65 years and over requiring personal care only. Date of last inspection Brief Description of the Service: Graceland’s is operated by Ms Hancock and registered as a care home for six older adults. The property is situated on the Fishponds Rd, in close proximity of shops, amenities and bus routes. It has the appearance of a domestic dwelling, which blends well with its environment. The accommodation is arranged over two floors with communal areas on the ground floor and bedrooms on both floors. The fees charged at the home is £359.00 per week. Gracelands DS0000026506.V351458.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection visit was conducted unannounced over one in September 2007 and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined, a tour of the premises was conducted and feedback sought from individuals. Prior to the visit some time was spent examining documentation accumulated since the previous inspection, including the AQAA (Annual Quality Assurance Assessment) and notified incidences in the home, (Regulation 37’s). This information was used to plan the inspection visit. The home can offer accommodation for up to six people and the four people currently living at the home were case tracked. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people using the service and other related documents. The home’s policies and procedures were also used to confirm the findings. The views of the manager, and people using the service were gathered either by face-to-face discussions or by surveys. What the service does well: The people living at the home made the following comments about the home, “ you get waited on and the food is good, you can’ t grumble”, “I was lucky to find a place like this” and “ this is the best room in the house” Individuals at the home participate in the care planning process and are able to describe the roles that staff perform to meet their changing needs. People giving feedback described their daily activities, routines and the way they are enabled to maintain their chosen lifestyle. Individuals said that the staff treat them well and that they know whom to approach with complaints. Gracelands DS0000026506.V351458.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 DS0000026506.V351458.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gracelands DS0000026506.V351458.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Individuals must be reassured that the home will have the skills and resources to meet their assessed needs. The admissions procedure must be more effective to enable individuals wishing to live at the home to make an informed choice about moving there. EVIDENCE: The home’s Statement of Purpose briefly describes the way the home will facilitate admission to the home, this includes introductory visits and trial periods. The criteria for admission must be reviewed to make clear the age range. There are two vacancies at the home and one person moved into the home since the last inspection. The case records of the most recently admitted person was examined and contained the social workers assessments from Adult Community Care and hospital. A home’s contract that lists the fees and bedroom number also held on file. The most recently admitted person said that there was a smooth transition into the home. Gracelands DS0000026506.V351458.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The care planning system in place is effective so individuals benefit from receiving an individualised and consistent service. EVIDENCE: Case records for individuals at the home contain contracts of residency, assessments of needs, care plans and reviews. The individual’s daily routine also form part of the care plan and describes morning, afternoon, evening and night routines. It states the person preferences on times to rise, retire, eating meals and routines for the day. The person physical, medical community and religious needs are also included within the care plan, with personal, emotional and social care needs. For each area of need the person’s ability to undertake the task and the assistance needed from the staff is detailed. Care plans are reviewed and during the meeting the views of the person and carers are sought. Copies of the review meeting are signed by the person and relative to show agreement with the action plans. Informal reviews are held with the person, where appropriate, their relative and service provider. Gracelands DS0000026506.V351458.R01.S.doc Version 5.2 Page 10 Individuals at the home confirmed that their needs are met at the home and named the person that provides their personal care. It was also stated that the service provider accompanies them all health care appointments. One person currently requires full support with personal care and the care plan stated the assistance needed by the staff to meet the personal care needs. The manager said that one person has continence needs and aids are used to meet the need. One person is a diet controlled diabetic and one person visit the outpatients department. Documentation held within files show that individual’s health care is monitored by the staff. The medical services component of the care plan lists GP’s and other Health Care professionals involved in the care of the person. Risk assessments are in place for individuals that have mobility needs. Individuals at the home access NHS facilities and, check-ups are regularly arranged with the optician and chiropodist. A monitored dosage system is used at the home and is generally administered by the service provider and her partner. Records of administration indicate that records are signed immediately after administering medications. Information leaflets are in place for all prescribed medications. There is a record of medications no longer required at the home, which is countersigned by the pharmacist to indicate receipt for disposal. The home’s Dignity and Privacy policy states that individuals can have person items in their bedrooms and specified the rights of the person and how they promoted. Individuals giving feedback described the tasks that are undertaken, which respects their privacy and dignity. Comments from people at the home included “ I use a special bath and the door is always locked”, “I can lock my bedroom door if I want but I don’t” and “the same person bathes me and its done in private”. Gracelands DS0000026506.V351458.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good support systems in place for individuals to pursue their chosen lifestyle and to be valued members of the community. EVIDENCE: Care plans contain the individuals social care needs, which includes attending clubs, outings, and visits to the library, board games and pursuing hobbies. Daily routines also form part of the care plan and the individuals preferences and lifestyle choices are detailed. The service provider said that three people are active and will leave the home without staff support. One person visits the ARC three times per week and two people visit shops each day. The service provider further stated that three people socialise with each other and one person prefers to remain in their bedroom when they are at home. Individuals giving feedback described their daily routines and activities that they undertake. One person said, “ I get the freedom to watch the TV and to garden”, “I can watch the TV, Rosie has bought digital plasma telly for all the bedrooms” Generally individuals at the home socialise with each other watch TV together and visit shops during the day. Gracelands DS0000026506.V351458.R01.S.doc Version 5.2 Page 12 The visiting arrangements for the home are specified within the Statement of Purpose and confirm that visitors are welcome at the home. The service provider said that the individuals at the home have contact with family and friends. Individuals at the home named the relatives and friends that visit at the home and agreed that visits can take place in their bedrooms for additional privacy. Currently one relative has keys to the home and as relatives can be provided with keys to the home, risk assessments are completed. There is a Confidentiality policy, which endorses the commitment towards safe management of recorded information about the people that live at the home. It confirms their rights to access information kept about them and commits to providing, where necessary information about advocacy. The service provider said that the people at the home make their own arrangements for their finances. Daily records of food provided are maintained and specified are the beverages and meals provided at the home. It is evident from the records that a continental “style” breakfast, a cooked lunch and light tea are served at the home. Where alternatives are provided, the name of the person and the meal served are recorded. The wide range of fresh, frozen and tinned foods, reflect the menus and establish that individuals have a varied diet. Feedback from individuals about the food included the following comments “You can’t grumble about the food” and “the food is always good and there is plenty to eat.” Gracelands DS0000026506.V351458.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals can expect their concerns to be listened to and to be protected from abuse. The Abuse policy must be reviewed so that it follows “No Secrets” guidance. EVIDENCE: The Complaints procedure is appended onto the Statement of Purpose and Service User Guide. A copy of the procedure is also on display in the foyer of the property and the format is in large print to ensure that people at the home can read the procedure. There were no complaints received at the home for investigation. Individuals at the home named the person that they would approach with complaints and it was stated that members of staff will often resolve concerns before they become serious. The service provider said that the individuals at the home do not exhibit aggressive or violent behaviours. Codes of Conduct, Abuse and Whistleblowing policies set the approach for safeguarding adults from abuse. The Abuse policy must be reviewed to ensure that the actions to be taken for alleged abuse follow “No Secrets” guidance. The service provider said that there are no outstanding Safe Guarding Adults referrals. Gracelands DS0000026506.V351458.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is well maintained so individuals can benefit from living in a comfortable and clean environment. EVIDENCE: Graceland’s is located on the Fishponds Road close to shops, amenities and bus routes. The property is within a residential environment and maintains an appearance of a domestic dwelling. It is arranged over two floors with bedrooms on both floors and shared space on the ground floor. The premises were clean, decorated to a good standard and free from unpleasant odours. Individuals at the home said that the home is kept clean and fresh. One person explained that extensive structural work was undertaken to make their bedroom bigger and it was recently redecorated making the space the best in the house. Gracelands DS0000026506.V351458.R01.S.doc Version 5.2 Page 15 Shared facilities consist of a lounge and dining room. The lounge has seating for six residents and in the dining room there is sufficient dining space for individuals to eat their meals together. Within the dining room there is also additional seating for five residents. There is a full bathroom on the ground floor and toilet with hand washbasin. On the first floor there is a full bathroom, which is assisted, with a separate toilet adjacent to the bathroom. The individuals currently accommodated move around the home with Zimmer frames and walking sticks. There is level access and one step to enter the home. The stair lift provides access to the first floor and assists residents with moving around the home independently. Bedrooms are single and two are en-suite and contain a combination of the home’s furniture and personal belongings. As bedrooms are lockable and staff knock before entering bedroom, personal space is private. It was confirmed that keys to bedrooms and the front door are provided. From observation of the premises, the property is well maintained and comfortable. The laundry is sited away from the kitchen; it has a domestic washing machine and hand washing facilities. Gracelands DS0000026506.V351458.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Recruitment and induction must be improved to ensure the staff are skilled and qualified to meet the changing needs of the people at the home EVIDENCE: The proprietor and partner are the main carers and support workers are employed to cover days off. Application forms seek personal details, full employment history and qualifications. The names of two referees and the criminal background of the person are not currently sought through the application form. Standard request for references are use and aim to validate the reference by seeking compliment slips or the use of the office stamp. The personnel files of the staff employed at the home were examined during the site visit. Three staff were recently appointed and character references were accepted for one person and for two people references were not requested. Individuals at the home said that staff treat them well and are respectful. Gracelands DS0000026506.V351458.R01.S.doc Version 5.2 Page 17 The service provider said that new staff are shadowed and the induction in place covers familiarisation of the premises, the needs of the people at the home and fire training. There is an expectation that staff read policies and procedures of the home and sign to indicate their understanding of the policies. Two staff are also employed by the NHS Trust and training undertaken with the Trust is transferable to the home. The staff recently employed have NVQ level 2 and are nurse qualified. Gracelands DS0000026506.V351458.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals can expect to live in a safe environment. For individuals to be re-assured that standards will be the subject of ongoing monitoring, a Quality Assurance system must be further developed. EVIDENCE: The service provider is in day-to-day control of the home and acts as the main carer for the people at the home. The service provider explained that it is the aim to continue operating the care home and to maintain standard, short courses are undertaken. However, two short courses were recently cancelled. The service provider must introduce a Quality Assurance system by seeking the individuals views of the service and where appropriate their suggestions must be included into the future plans of the home. Gracelands DS0000026506.V351458.R01.S.doc Version 5.2 Page 19 Fire risk assessments were formulated and reviewed six monthly, which incorporates checks and practices of the fire system and training of staff. Service certificates and documentation of check conducted by the contractors are in place for the stair lift, portable equipment and boiler indicating that residents and staff’s safety are promoted. The Local Authority make payments on behalf of people living at the home directly into the home accounts and the service provider will then return personal allowance to two individuals. Relative make their arrangements for the payment of individuals that self fund their placements. £359.00 is the fees charged each week. While facilities for the safekeeping of cash on behalf of the people at the home exists, the individual at the home have no cash in safekeeping. Gracelands DS0000026506.V351458.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 2 x x x 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 2 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x x x 3 3 Gracelands DS0000026506.V351458.R01.S.doc Version 5.2 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 OP1 Regulation 6 Requirement The Statement of Purpose must be reviewed to detail the age range and the needs that can or cannot be met at the home. The home’s Abuse Policy must follow “No Secrets” guidance. The home’s application form must seek the names of two referees and disclosure of criminal background. The service provider must seek the references from the last or most recent employer a) New staff must complete induction programmes that follow Skills for Care. b) Training that ensures staff meet the needs of the individual must be provided. Quality Assurance system must be introduced at the home. Timescale for action 30/03/08 2. 3. OP18 OP29 13 (6) 7,9 and 19 Sch.2 7,9 and 19 Sch.2 18 (c) (i) 30/12/07 30/12/07 4. 5. OP29 OP30 30/12/07 30/06/08 6 OP33 24 30/03/08 Gracelands DS0000026506.V351458.R01.S.doc Version 5.2 Page 22 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 DS0000026506.V351458.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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