Inspection on 30/11/05 for Gracelands

This inspection was carried out on 30th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Gracelands 23/09/08

Gracelands 26/09/07

Gracelands 09/08/06

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 30th November 2005 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.V263775.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Gracelands DS0000026506.V263775.R01.S.doc Version 5.0 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 NONE rosie@rosie6.wanadoo.co.uk 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.V263775.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 6 persons aged 65 years and over requiring personal care only. MD(E) for one named person. Will revert to all OP when she leaves. Date of last inspection 6th July 2005 Brief Description of the Service: Gracelands is operated by Rosie Hancock and registered as a care home to provide accommodation and personal care to six older people. Its Statement of Purpose purports that enabling residents to live independently with the care and support offered at the home as its aim. Gracelands is located on the Fishponds Road close to shops, amenities and bus routes. It a domestic dwelling converted to provide accommodation and personal care to six older people. There is level access to the front and rear of the property, with a stair lift to access the first floor. Accommodation is arranged over two floors with single occupancy bedrooms on the ground and first floor and shared space on the ground floor. Two bedrooms have en-suite facilities, with toilet and bathing facilities on each floor. Gracelands DS0000026506.V263775.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place in November 2005 with a second inspector. It is the second inspection for this year and both were conducted on an unannounced basis. Interaction between staff and residents was indirectly observed. Records, policies and procedures were examined to confirm the standards of care at the home. Three residents and one visitor agreed to give feedback on their experience of the provision of care at the home. What the service does well: 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. Gracelands DS0000026506.V263775.R01.S.doc Version 5.0 Page 6 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.V263775.R01.S.doc Version 5.0 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not examined at this inspection. EVIDENCE: Gracelands DS0000026506.V263775.R01.S.doc Version 5.0 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&9 A Person Centred approach to meeting the need must be developed to underpin key principles of rights, independence choice and inclusion. Reactive strategies must be formulated for people that may exhibit aggressive and violent behaviours. Safe systems for administration, recording and storage of medicines exist at the home. EVIDENCE: Personal information health care documentation and care plans are kept within case records. A photograph, background information and personal histories are incorporated into the personal information format. Medical profiles and other documentation evidences that residents are referred for specialist support. Care plans describe the physical, medical, community and personal needs. Emotional and social care needs are also included within the format. The assistance required by the staff to meet the individual needs is clearly described. While the care plans are specific and guide staff to meet the Gracelands DS0000026506.V263775.R01.S.doc Version 5.0 Page 9 identified action, a more person centred approach must be indicated through the care plans. Action plans must include the individual’s likes, dislikes and preferred routines. Care plans are monitored monthly by the staff and where necessary altered. Reviews take place six monthly with the resident, the staff and family participating. For residents that may become aggressive, the actions to diffuse the situation must be described. For example, moving away if the person displays violent behaviour. Reports of significant events detail outcomes of visits, daily activities and the provision of care. The records are factual and objective. Medications that staff administer are through a monitored dosage system. The records of administration indicate that staff sign the records immediately after administration. A record of medications no longer required is kept and countersigned by the pharmacist to indicate receipt of the medication for disposal. Gracelands DS0000026506.V263775.R01.S.doc Version 5.0 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 & 14 Opportunities exist for residents to make choices about leisure activities, daily routines, meals and relationships. EVIDENCE: Three residents were consulted on the standards of care at the home. Feedback on their social and leisure activities was sought. One resident participates in community-based activities while the other two residents stay at home during the day. Watching the television, reading, socialising with each other and going to the shops were the daytime activities described by two residents. Regarding organised in-house activities, the residents stated that because of their impairments they are no longer able to pursue hobbies. In terms of opportunities to exercise choice, residents reported that the food was very good and varied. It was understood that during their admission to the home, their food preferences are sought and therefore alternatives are not required. Additional comments were made about the arrangements of meals. It was felt that because breakfast in served in bedrooms, there is plenty of time in the morning for a leisurely rise, indicating that routines are based on residents needs. Gracelands DS0000026506.V263775.R01.S.doc Version 5.0 Page 11 Residents confirmed that their visitors are welcome at any time. One visitor at the home corroborated residents’ comments that visiting can take place at any time. The visitor made additional complimentary comments about the standards of care and felt the environment was more of a “family home”. Comments made by residents indicated that the staff respects their rights. Their mail is handed to them unopened; members of staff knock and wait for an invitation to enter their bedrooms and personal care in conducted in private. Gracelands DS0000026506.V263775.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Residents’ views are sought and felt confident that their views would be taken seriously and acted upon. EVIDENCE: There were no complaints received by residents for investigation at the home since the last inspection. Residents reported that they had no complaints and would approach members of staff or the service provider with complaints. Their confidence with the service providers’ abilities to resolve complaints was expressed. Gracelands DS0000026506.V263775.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22 & 24 Gracelands is suited for the purpose of providing accommodation to people over 65. It has a homely atmosphere and is well maintained. Communal areas provide residents with sufficient shared space to socialise as a group. The number of toilets, washing and bathing facilities provided meet the needs of the residents. Equipment and aids are provided to assist less mobile residents with moving around the home. The premises are kept clean and free from unpleasant odours. EVIDENCE: Gracelands 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 during this inspection. Gracelands DS0000026506.V263775.R01.S.doc Version 5.0 Page 14 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 residents to eat their meals together. Within the dining room there is additional seating for five residents. There is a full bathroom on the ground floor and another full bathroom on the first floor, which is assisted, with a separate toilet adjacent to the bathroom. Currently the ratio for bathrooms is three people sharing which is above the National Minimum Standard. There is a toilet on each bedroom floor and two bedrooms are en-suite, making the ratio of two people sharing a toilet. 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. The residents currently accommodated move around the home with Zimmer frames and walking sticks. 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. One resident commented that the accommodation was the primary reason for moving to the home permanently. From observation of the premises, the property is well maintained and comfortable. The laundry is sited away from the laundry. There is a domestic washing machine and hand washing facilities. Gracelands DS0000026506.V263775.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 Application forms and references must form part of the robust recruitment process of the home, to ensure the staff are suitable to work with vulnerable adults. EVIDENCE: The standard application form requests personal information, employment and educational background. A statement regarding physical fitness is also sought through the application form. Full employment history must be required with the reasons for leaving, the names of two referees must be provided and one must be the most recent/current employer. The application form must also require the person to disclose any criminal background to establish integrity. Within the application form, the job description is included which defines the purpose and responsibilities of the role. The expectation that staff participate in training must be specified in the job descriptions. Standard request for reference formats should elicit information about the length of employment, capacity known and would re-employment be possible if requested. Additional details about the reasons for leaving their employment, any disciplinary processes and any other information that establishes their suitability to work with vulnerable adults. Gracelands DS0000026506.V263775.R01.S.doc Version 5.0 Page 16 While Codes of Conduct for the home are in place, the GSCC Code of Conduct must be provided. Employees must be provided with GSCC Code of Conduct and evidence of receipt must be kept in their personal files. New employees must be provided with the Terms and Conditions of employment at the home. Gracelands DS0000026506.V263775.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 Insurance cover and fire checks and practices indicate that residents’ safety and interests are safeguarded. EVIDENCE: Insurance certificate for employer’ liability is up to date and displayed at the home. The records that relate to fire safety policies, procedures, checks and practices were examined. It is evident from the records that checks and practices are conducted at the stipulated frequencies. Gracelands DS0000026506.V263775.R01.S.doc Version 5.0 Page 18 The Local Authority contributes towards four placements and two are selffunded. For residents placed by the Local Authority, individual schedules that denote the sources, which contribute to the fees, are in place. The arrangement for handing personal allowances to residents was discussed with the service provider. Currently residents receive direct payments for their benefits and the service provider returns their entitlement each week. A record of personal allowances handed to residents is currently maintained. It is signed by the resident to indicate receipt of their personal allowances. Gracelands DS0000026506.V263775.R01.S.doc Version 5.0 Page 19 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 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 3 3 3 3 x 3 x x STAFFING Standard No Score 27 x 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x x x 3 Gracelands DS0000026506.V263775.R01.S.doc Version 5.0 Page 20 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 2 Standard 29 7 Regulation 19(5) 13(4)(b) Timescale for action Application forms and request for 30/01/06 references must be part of the recruitment process. Reactive strategies must instruct 30/04/06 staff on the actions to be taken for residents that may become violent. Care plans must incorporate the 30/04/06 likes and dislikes and preferred routines. Requirement 3 7 12(3) 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.V263775.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Gracelands DS0000026506.V263775.R01.S.doc Version 5.0 Page 22 - 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. 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