Inspection on 12/09/05 for Grafton Lodge

This inspection was carried out on 12th September 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 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

Grafton Lodge 06/03/07

Grafton Lodge 16/01/06

Grafton Lodge 18/02/05

Grafton Lodge 11/10/04

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

CARE HOMES FOR OLDER PEOPLE Grafton Lodge 40 Goddington Road Strood Rochester ME2 3DE Lead Inspector Sue McGrath Announced 12 September 2005 9.30am 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 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. Grafton Lodge H56-H06 S28885 Grafton Lodge V239384 120905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Grafton Lodge Address 40 Goddington Road Strood Rochester Kent ME2 3DE 01474 833531 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Lee James Boyson Miss Anne Carmel Perkins Care Home 20 Category(ies) of OP Old Age - 20 registration, with number of places Grafton Lodge H56-H06 S28885 Grafton Lodge V239384 120905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18 February 2005 Brief Description of the Service: Grafton Lodge is a large house, which accommodates twenty older people. The home has a shaft lift to the first floor, plus stair lifts to the first and second floors. There are steps to the front entrance, but wheelchair access is possible via the driveway to the rear. The home has a large garden, which includes sitting areas. It is located on a hill close to the town centre with access to local amenities and public transport. Grafton Lodge H56-H06 S28885 Grafton Lodge V239384 120905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection which took place on 12th September 2005.The focus of the inspection was on reviewing progress towards meeting requirements of the last inspection and talking to Residents and staff on duty to monitor ongoing health, safety and wellbeing of the Residents. Records were viewed including care plans and some policies and procedures. Staff files were also viewed as well as staff training and support. Time was spent talking to Residents and all of their rooms were viewed. A tour of the building was also undertaken and several improved areas were noted. What the service does well: What has improved since the last inspection? The home’s kitchen has been refurbished and only has one or two minor finishing touched needed to be completed. The home was cleaner on this visit, but concerns still remain over the number of domestic hours being provided. The majority of the radiators are now covered and the manager stated that the downstairs bathroom was to be refurbished soon. The fire escapes were free from the debris noted at the last inspection and access to them was now clear. Some of the bedroom furniture had been replaced and some bedrooms had been decorated, as had the lounge and hallway. Grafton Lodge H56-H06 S28885 Grafton Lodge V239384 120905 Stage 4.doc Version 1.40 Page 6 The home now has a basic maintenance programme in place, as recommended in the last report. The owners had clearly responded well to the requirements and recommendations made in the last report. 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. Grafton Lodge H56-H06 S28885 Grafton Lodge V239384 120905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Grafton Lodge H56-H06 S28885 Grafton Lodge V239384 120905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3,4,5,6 Residents benefit from a comprehensive assessment of their needs prior to moving into the home to ensure their assessed needs can be met. Residents and families benefit from the opportunity to visit the home prior to admission to assess the quality, facilities and suitability of the service. EVIDENCE: The Statement of Purpose and the Residents’ Guide were in the process of being updated to ensure there were fully in line with the requirements and reflected any recent changes. Discussion took place around what was to be included in these documents. These documents will be assessed in full at the next inspection. The home does have contracts for all residents and advice was given regarding the Office of Fair Trading recommendations. Not all of the contracts were signed and again advice was given regarding spaces for resident or their representative to sign and date these documents. All of the residents undergo comprehensive assessments of needs prior to admission to ensure assessed needs can be met. Care Managers assessments were also obtained, if appropriate, prior to admission. The manager visits the Grafton Lodge H56-H06 S28885 Grafton Lodge V239384 120905 Stage 4.doc Version 1.40 Page 9 prospective resident in either their home or current address to obtain this information. The care plan is generated from information gained at these meetings. Emergency admissions were avoided where possible. The needs of the majority of the residents were met with advice being sought from various professionals such as Falls Co-ordinators, Kent Association for the Blind and District Nurses and the Diabetic Nurse. One residents with a visual impairment had access to Talking Books. As stated in previous reports some of the residents are awaiting assessments for their mental health and this remains on going. The home is not registered for residents with dementia. All residents benefited from being admitted on a trail basis to ensure that the home was suitable for their needs. This period was normally four weeks, but could be extended if required. Families were fully included in this decisionmaking process and reviews were held with care management if required. The home does not provide intermediate care. Grafton Lodge H56-H06 S28885 Grafton Lodge V239384 120905 Stage 4.doc Version 1.40 Page 10 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 standard(s) 7,8,9,10,11 Residents benefit from having clear and in-depth care plans that identify their individual needs and give clear guidance to staff. Residents can be confident that their care plans are regularly updated to ensure changes are recorded and acted upon. Residents can be confident that their health needs are met and that they have full access to all professional health care services as required. Residents are protected by the home’s policies and procedures for dealing with medicines and also benefit from having the issue of illness and ageing dealt with sensitively. EVIDENCE: Several care plans were sampled and were found to contain details on action to take to ensure that all aspects of health and personal care would be met. It was noted that these documents were reviewed monthly and any changes were recorded. It is recommended that residents be involved with the drawing Grafton Lodge H56-H06 S28885 Grafton Lodge V239384 120905 Stage 4.doc Version 1.40 Page 11 up and review of care plans where possible. The care plans were informative and well presented. Care plans were also seen for nighttimes. Evidence seen in the care plans confirmed residents health care needs were met and that all were registered with a local G.P. and had full access to specialist medical, nursing, dental, pharmaceutical, chiropody and community health services according to need. Discussion with the Manager confirmed that skin integrity was clearly important and risk assessments were seen. No residents in the home had any pressure areas. It is recommended that nutritional screening be undertaken on admission and subsequently on a periodic basis to ensure a balanced diet is maintained. The administration of medication was assessed and only a few minor areas did not meet the guidelines from the Royal Pharmaceutical Society of Great Britain. These minor discrepancies were around the storage, ordering and recording of controlled drugs. This was discussed with the manager who confirmed she would complete the changes as soon as possible. The home is to be congratulated on having the majority of staff having completed an accredited medication administration course. Discussion with many of the residents confirmed that they were all very happy with the level of care provided and all stated that staff looked after them very well. Comments like ‘I am very happy living here’ and ‘we are all good pals’ and ‘staff look after me very well and I like living here’ were made by some of the residents. One visiting family member also stated that she was extremely happy with the level of care her mother had received since moving to Grafton Lodge. On the day of the inspection all of the residents looked clean and tidy and happy. The home had a policy on palliative care and on the death of a resident. These had been written sensitively and reflected the practise of the home. The manager stated that it would be their intention to keep a resident who was terminally ill for as long as was medically possible and that residents would be able to spend their final days in their own rooms, surrounded by their personal belongings, unless there were strong medical reasons to prevent this. The home is not registered to offer nursing care. Grafton Lodge H56-H06 S28885 Grafton Lodge V239384 120905 Stage 4.doc Version 1.40 Page 12 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 standard(s) 12,13,14,15 Resident’s social and recreational interest and needs are not well provided for as only limited activities are offered. Residents are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. The residents benefit from the appetising meals and balanced diet offered by the home and those service users requiring specialist diets are well catered for. EVIDENCE: The issue of activities was discussed with the Manager, as it was evident that the programme of activities listed in the hall were not actually taking place. The home did not have a designated activities co-ordinator and staff tried to fit some activities in with their normal care work. Limited activities were taking place and some residents went on days out. It is recommended that a more structured approach to activities be taken, with the residents being involved with deciding what activities be made available and how often. Activities should be recorded to evidence that they do actually take placed on a regular basis. The home would benefit greatly with designated staff time being allowed for activities. Grafton Lodge H56-H06 S28885 Grafton Lodge V239384 120905 Stage 4.doc Version 1.40 Page 13 Residents confirmed that they could have visitors whenever they wished and that there families and friends were always made very welcomed. Unfortunately no comment cards were received directly from any relatives so their comments could not be added to this report. One family member who was visiting on the day of the inspection did confirm that she could visit at any time. The majority of the residents rooms were viewed and it was evident that residents had been encouraged to bring in some personal items on admission and most of the rooms were well personalised. It was evident from discussion with service users that they were encouraged to maintain their independence and that their individual preferences with regard to bathing and times of rising and going to bed were respected. Whilst there was structure to the day and a need to have systems such as a bath rota and regular mealtimes, these were flexible enough to meet the needs of any specific requests or preferences of service users. The menus were discussed with the manager and the cook and it was confirmed that three meals a day were offered and that hot and cold drinks and snacks were available regularly. Staff asked residents on admission what they liked and disliked and menus were adjusted accordingly. However no one was aware of what was on the menu on that day, this made it difficult for the residents to decide if they wanted the main meal of the day. It will be recommended that daily menus are displayed for the residents to see and they are given a daily choice of food. The meals seen looked wholesome and nutritious and several residents made comments like ‘the food is wonderful and the food is very tasty’. Three members of staff had completed the Intermediate Food Hygiene certificate and seven had completed the basic course. Grafton Lodge H56-H06 S28885 Grafton Lodge V239384 120905 Stage 4.doc Version 1.40 Page 14 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 standard(s) 16,17,18 Residents are protected by a robust complaints system and service users and relatives feel their views are listened to and acted upon. Residents are protected from abuse by the home’s Adult Protection Policy and procedures. Residents legal rights are protected. EVIDENCE: The home had a written complaints procedure in place that both staff and the family member spoken to were aware of. The family member spoken to stated that they had not needed to use the procedure and felt confident that any issues could be resolved with the manager before they got to that level. The home had no recorded complaints. The home had adopted the Multi Agency Adult Protection Policy for Kent and Medway and staff spoken to were able to demonstrate a good awareness and understanding of the policies. The Manager confirmed that all residents were registered for postal voting should they wish to vote in any local or general election. Grafton Lodge H56-H06 S28885 Grafton Lodge V239384 120905 Stage 4.doc Version 1.40 Page 15 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 standard(s) 19,20,21.25,26 Residents benefit from living in a clean, safe, well-maintained environment and have safe access to comfortable indoor communal areas although the rear garden is in need of attention. Some Residents would benefit from having their bedroom carpets replaced. EVIDENCE: The home now has a basic programme of routine maintenance and renewal of the fabric and decoration of the premises as recommended from the last report. The kitchen units had been replaced and a new bathroom was on order. Some new bedroom furniture ad also been provided as recommended in the last report. The pond in the rear garden had fallen into disrepair and looked untidy, which was a shame as residents had enjoyed sitting around it. The Manager said the intention was to fill it in and provide a water feature in its place. It is Grafton Lodge H56-H06 S28885 Grafton Lodge V239384 120905 Stage 4.doc Version 1.40 Page 16 recommended that either this happens or the pond is restored. The rest of the garden was accessible to the residents. The bedrooms were cleaner that at the last inspection, but concerns were raised at the low number of domestic hours provided. The home is fairly large and it is recommended that more time be allowed to ensure high standards are maintained. Some of the bedrooms needed new carpets. The home had two bathrooms and one shower room. The Manager stated that the shower room was never used and discussion took place around converting this room to a sluice room. Advice is to be sought from the infection control nurse. The majority of the radiators now had guards fitted, as required from the last inspection; only one or two remained unguarded. The Manager stated that these were in the garage waiting to be fitted. One radiator guard obstructed the door opening of one room and the manager was advised to complete a risk assessment to ensure safe environment was provided. Advice was to be sought from the homes Health and Safety adviser. The kitchen had recently been refurbished as recommended in the last report and only a few minor finishing touches like a few broken tiles and an edging strip on the work surface were needed to complete the job. A new cooker had also been purchased. Grafton Lodge H56-H06 S28885 Grafton Lodge V239384 120905 Stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,30 Residents benefit from being cared for by staff who have a good understanding of their needs and who receive regular supervision. EVIDENCE: From information given by the manager in the pre-inspection questionnaire and following the guidelines issued by the Department of Health, the home had sufficient staff at present for the 18 residents. However, should the home become full (20 residents) then it would be slightly understaffed and this must be taken into consideration when accepting any new residents. This new calculation has been made assuming all residents are of low risk. Fourteen of the eighteen staff had completed NVQ 2 or above. Others training this year included Manual Handling, First Aid, Food Hygiene and Safe Handling of Medication. The manager was advised to produce a training matrix to ensure that staff training can be accurately monitored and planned for. Staff spoken to on the day could demonstrate that they had the skills and competencies to care for the residents in the home. Grafton Lodge H56-H06 S28885 Grafton Lodge V239384 120905 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,36,37,38 The Residents benefit from living in a home where the manager is competent, enthusiastic and experienced with the care of older people and has a clear vision for the home. The health and safety of residents is put at risk because of the identified shortfalls in the home’s practice in this area. EVIDENCE: The manager had completed her NVQ 4 in Management and NVQ 3 in Care and was currently applying to complete her Registered Managers Award. Throughout the inspection she demonstrated the necessary skills to manage the home in a competent and compassionate way. Staff stated they felt well supported and benefited from regular structured supervision. Residents also commented that they felt happy to discuss anything with the manager and that she was approachable and friendly. The records kept in the home were accessible and also secure. Grafton Lodge H56-H06 S28885 Grafton Lodge V239384 120905 Stage 4.doc Version 1.40 Page 19 One issue of concern was the lack of any suitable lock on the door leading to the main office. It will be a requirement that a suitable lock is fitted to prevent anyone opening the door and falling down the stairs leading to the office. It must be accessible from both sides. The registered manager had completed the majority of health and safety checks on fire equipment and gas and electrical equipment, however evidence could not be found of any maintenance work being carried out on the shaft lift and bath hoists. An immediate requirement was made to ensure this work had been carried out. The accident book was inspected and no major accident had occurred. Grafton Lodge H56-H06 S28885 Grafton Lodge V239384 120905 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 x x x 3 2 STAFFING Standard No Score 27 3 28 4 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 x x x 3 3 2 Grafton Lodge H56-H06 S28885 Grafton Lodge V239384 120905 Stage 4.doc Version 1.40 Page 21 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. 1. Standard OP38 Regulation 23 Timescale for action The registered person shall To be having regard to the number and completed needs of the residents ensure by the 17th that the premises used as a the October care home meet the needs of the 2005 residents in that a lock is fitted to the door to the office. The registered manager ensures Immediate the health and safety of the residents by evidencing the shaft lift and bath hoists have been serviced and maintained. Requirement 2. OP38 23 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. 2. 3. 4. Refer to Standard OP19.3 OP38.2 OP27.7 OP12.3 Good Practice Recommendations It is recommended that the garden pond is either repaired or replaced It is recommended that advise is sought from the Fire Officer regarding the painting over of the intumescent strips around the doors it is recommended that domestic staff are employed in sufficient numbers to ensure that the home remains clean and in a hygenic state. It is recommended that more opportunities for stimulation H56-H06 S28885 Grafton Lodge V239384 120905 Stage 4.doc Version 1.40 Page 22 Grafton Lodge 5. OP15.7 through leisure and recreational activities inside and outside the home are provided. It is recommended that daily menus are displayed for the residents to see and they are given a daily choice of food. Grafton Lodge H56-H06 S28885 Grafton Lodge V239384 120905 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent. ME16 9NT 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 Grafton Lodge H56-H06 S28885 Grafton Lodge V239384 120905 Stage 4.doc Version 1.40 Page 24 - 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!