Inspection on 06/03/07 for Grafton Lodge

This inspection was carried out on 6th March 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

Grafton Lodge 16/01/06

Grafton Lodge 12/09/05

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 Kent ME2 3DE Lead Inspector Sue McGrath Key Unannounced Inspection 6th March 2007 09:00 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 Grafton Lodge DS0000028885.V331014.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. Grafton Lodge DS0000028885.V331014.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grafton Lodge Address 40 Goddington Road Strood Rochester Kent ME2 3DE 01634 722621 01634 722621 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) Mrs Lavinia Mary Boyson Mr Lee James Boyson, Mrs Lesley Ann Boyson, Mrs Sharon Rosemarie Boyson, Mrs Jo Ann Weston, Mr Rickie Michael Boyson Miss Anne Carmel Perkins Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Grafton Lodge DS0000028885.V331014.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th January 2006 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 of Strood, with access to local amenities and public transport. Fees are from £330 - £340 per week. Grafton Lodge DS0000028885.V331014.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection that took place on 6th March 2007 and was conducted by Sue McGrath, Regulation Inspector for the Commission for Social Care Inspection. The key inspections for care home services are part of the new methodology for The Commission For Social Care Inspection, whereby the home provides information through a questionnaire process and further feedback is gained through surveys sent to service users and relatives and information provided from professionals associated with the home, wherever possible. The actual date of the site visit is unannounced. At the site visit, service users and staff were spoken to, records were viewed and a tour of the environment was undertaken. Some judgements have been made through observation only. Overall this was a positive inspection with generally good outcomes for service users. What the service does well: The home offers a warm and homely environment in which to live. Residents spoken to were complimentary on the care offered and all spoke highly of the staff. Residents benefited from having pleasant rooms, which they were encouraged to personalise. Some of the rooms do not provide the required amount of space. Visitors to the home also spoke highly of the care offered and of being made very welcomed at all times. Residents stated that the food was good and that they enjoyed the home cooking. Health needs were well met and residents benefit from having full support from other health professionals. Staff were well trained with 39 having completed NVQ level 2 or above in Care. Grafton Lodge DS0000028885.V331014.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 Grafton Lodge DS0000028885.V331014.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Grafton Lodge DS0000028885.V331014.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grafton Lodge DS0000028885.V331014.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with the information they need to make an informed choice about where to live prior to admission however, this information must be kept current. Residents move into the home knowing their assessed needs can be met. They are aware of their rights and responsibilities. EVIDENCE: The home’s statement of purpose and service user guides were viewed and both need updating. The statement of purpose contains incorrect information regarding staff structures and needs to be revised. The service user guide also needs to be revised to include the details highlighted in the guidance on the Grafton Lodge DS0000028885.V331014.R01.S.doc Version 5.2 Page 10 CSCI website regarding fees and any extra payments. These guidelines are relatively new and the documents will be revisited at the next inspection. Each resident is provided with a written contract/statement of terms and conditions with the home, which is signed either by the resident, or their representative. Evidence is available that confirms detailed assessments are completed prior to any resident moving into the home. The manager confirmed that prospective residents and their families are invited to visit the home prior to admission and if they wish to remain in the home a four-week settling in period is offered. This time could be extended if necessary. Intermediate care is not offered and the home is not registered for dementia care. Grafton Lodge DS0000028885.V331014.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Whilst residents benefited from detailed care plans some areas of the plans need to improve. The health needs of individuals were well met and residents benefited from good multidisciplinary working. Residents are protected by the home’s policies for dealing with medicines though some areas of practice need to improve. EVIDENCE: Some elements in some of the care plans needs addressing especially on the admission and social history section. It could not be evidenced that care plans were agreed and signed by the resident of their representative (7.6) and no nutritional assessments (8.9) could be found. However good evidence was seen that all of the residents benefit from having their health needs well met. Grafton Lodge DS0000028885.V331014.R01.S.doc Version 5.2 Page 12 This was discussed with the manager who agreed the required changes would be made as soon as possible. Records indicate that District Nurse, G.P, and Chiropody visits and outcomes are recorded. Dental and optical appointments can be arranged as required. Comments given by the Community Staff Nurse confirm the manager and staff are very aware of health care needs and work closely with the D.N.team. In her opinion ‘the care service appears to provide a safe and comfortable environment for all individuals and are quick to respond to any changing needs.’ Care plans are regularly reviewed. The administration of medication was assessed and some errors were found. The home must improve its record keeping and also ensure staff who administer medication are fully trained and competent. Two requirements have been made. It was advised that a Pharmacy visit would be arranged. Again the manager agreed with the issues found and stated she would deal with the problem areas immediately. Many of the residents were spoken with and all confirmed that staff treated them very well and they felt respected and safe at all times. Discussion with some of the staff also confirms they have a good understanding of privacy and dignity. A quiet room is available for residents to use that has a telephone for private use. Grafton Lodge DS0000028885.V331014.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 home still does not have a designated activities co-ordinator and staff continue to try to fit some activities in with their normal care work. One of the owners does come to the home for 5-6 hours per week for activities, but these sessions are not well recorded. The home has lost the use of its minibus, which was used for some outings and the owners state they are looking for alternative means of transport. It remains a recommendation 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 Grafton Lodge DS0000028885.V331014.R01.S.doc Version 5.2 Page 14 basis. The home would benefit greatly with designated staff time being allowed for activities. The manager did explain that she had advertised for activity staff but had difficulty finding the right person. It was again suggested that extra care hours be offered with special responsibilities for activities. Several of the residents said they enjoyed most of the activities but used to really enjoy going out for trips. Families confirm they can visit whenever they wish and are always made very welcomed in the home. Residents can see their visitors in either the lounge, quiet room or their own bedrooms. Some of the bedrooms viewed were well personalised and very homely. During the inspection staff were seen offering choices about food and drinks and confirmed residents always choose their own clothing every day. All of the residents spoken with said the food was very good and if the main meal of the day was something they did not like they could have an alternative. Staff appeared very knowledgeable about resident’s likes and dislikes. The kitchen was clean and tidy and had all the relevant paperwork completed. Grafton Lodge DS0000028885.V331014.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by a robust complaints system and residents and relatives feel their views are listened to and acted upon. The home’s Adult Protection Policy and procedures protect residents from abuse. Residents’ legal rights are protected EVIDENCE: The home has a written complaints procedure in place that staff are aware of. The home had no recorded complaints. The home has 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. Grafton Lodge DS0000028885.V331014.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,23,24,25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a clean, safe and well-maintained environment. They had safe access to comfortable indoor communal areas although the rear garden is in need of attention before the summer. Whilst residents’ rooms are homely and comfortable not all benefit from living in rooms that meet the requirements for space. EVIDENCE: The environmental requirements made at the last inspection have been complied with. The owners have started work on redecorating the bedrooms and many now benefit from redecoration, new furniture and curtains. Some areas of the hall Grafton Lodge DS0000028885.V331014.R01.S.doc Version 5.2 Page 17 and stair carpets have been replaced. There are plans in place to redecorate the lounge and to purchase new carpets and curtains. The hallway is also to be painted. New chairs have been purchased for the lounge and dining room. As required from the last inspection a small wash basin has been fitted in the toilet. Several new pictures are hanging on the walls. The front garden has been replanted and now looks more cared for. The rear garden was discussed as several residents said they like sitting out there in the summer. The pond has been filled but the work is not yet complete. The owners are hoping to have a water feature fitted there before the summer. The guard fence around the pond area needs attention before the summer. Five of the rooms are shared and some are below the required size but residents all seem happy with their rooms. Some of the rooms are unable to contain all of the furniture required by regulation due to their size, but again the residents are happy with this arrangement. The owners have taken some old photographs of a resident in his youth when he was a boxer and had them enlarged and framed. Also a programme of one of his forthcoming fights has been framed and hung on his bedroom wall. The resident is very pleased with this and so are his family. This was a very personal touch and much appreciated. Although the call system is very old it is still operational however the owners are seeking quotes to replace it. The home is very homely and comfortable with several period features. On the day of the inspection it was clean and fresh. The issue of a sluice was again discussed (26.6). It was recommended in the last report that one should be fitted. This was confirmed by a visit from the Infection Control Nurse. Although it is recognised this work has been discussed and quotes applied for, the work now needs to be completed. A requirement will be made Grafton Lodge DS0000028885.V331014.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from being cared for by staff who have a good understanding of their needs. Residents are protected by robust recruitment procedures. EVIDENCE: Rotas indicate that the home employs sufficient staff to meet the needs of the current residents and staff themselves confirm they do not feel under pressure and feel they have sufficient staff numbers. The home rarely uses agency staff but if it has to, it ensures they are competent and have the necessary CRB checks in place. The home employs eighteen care staff seven of whom have completed a National Vocational Qualification to level 2 with one of those having completed level three as well. Two staff are currently undertaking their awards and nine are planning to start this year. This means that currently the home has only 39 of its staff qualified. This figure has fallen from the last inspection due to changes in the staff group. It is recognised that when all staff complete their Grafton Lodge DS0000028885.V331014.R01.S.doc Version 5.2 Page 19 qualifications the home will more than meet the 50 of qualified staff that is required. Other mandatory training is current and staff are competent to perform the duties required of them. The home has robust recruitment procedures in place to ensure residents are protected and safe. The file of the last member of staff to join the staff of Grafton Lodge was viewed and was found to contain all of the relevant information required by regulation. Grafton Lodge DS0000028885.V331014.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 36,37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. Current arrangements were sufficient to protect the health, safety and welfare of residents and staff. EVIDENCE: Grafton Lodge DS0000028885.V331014.R01.S.doc Version 5.2 Page 21 The manager is undertaking her Registered Managers Award and hopes to finish the award with in the next three months although this was also stated in the report from January 2006. The main problem seems to be around suitable verification. The manager has completed her NVQ 4 in Management and NVQ 3 in Care. Throughout the inspection the manager was able to demonstrate she had the necessary skills to manage the home in a competent and compassionate way. Staff state they feel well supported and benefited from regular structured supervision. Residents also commented that they felt happy to discuss anything with the manager or the owners and that they are approachable and friendly. The ethos of the home is positive and supportive to residents and staff alike. The records kept in the home were accessible and also secure. Staff confirm they receive regular supervision and appraisals and records indicate regular meetings. Residents and staff meetings occur on a regular basis. Evidence was supplied by the home that confirms all the necessary health and safety checks are being carried out and that as far as possible the health, safety and welfare of residents and staff is protected. Grafton Lodge DS0000028885.V331014.R01.S.doc Version 5.2 Page 22 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 2 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 X X 2 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X x 3 3 3 Grafton Lodge DS0000028885.V331014.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Home’s Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 Requirement The home’s Statement of Purpose and Service User Guides are to be updated to reflect current practise and staffing. Accurate records must be kept of all medication that is administrated (9.4). All staff who administer medication must prove competency (9.7). The home must fit suitable sluicing facilities The home must complete its programme for effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in meeting the aims, objectives and the statement of purpose of the home. Timescale for action 23/04/07 2. 3. 4 5 OP9 OP9 OP26 OP33 13(2) 13(2) 13(3) 24(1)(a)( b)(2)(3) 23/04/07 23/04/07 31/08/07 31/08/07 Grafton Lodge DS0000028885.V331014.R01.S.doc Version 5.2 Page 24 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. Refer to Standard OP19 OP12 Good Practice Recommendations It is recommended that the garden pond is either repaired or replaced It is strongly recommended that more opportunities for stimulation through leisure and recreational activities inside and outside the home be provided and recorded. It is recommended that care plans contain more detailed social history of the resident. It is recommended that nutritional assessments are completed for each resident and are updated as required. It is recommended that residents or their representative are involved in the drawing up of care plans and agree with them It is recommended that assessment forms are fully completed prior to admission. 3. 4. 5. 6. OP7 OP7 OP7 OP7 Grafton Lodge DS0000028885.V331014.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Grafton Lodge DS0000028885.V331014.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. 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