CARE HOME ADULTS 18-65
Grafton Manor Bozenham Mill Lane Grafton Regis Towcester NN12 7SS Lead Inspector
Moira Mosley Unannounced 13th July 2005 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Manor D.C51.C08.S12618.Grafton Manor.V238298.130705.Stage 2.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Grafton Manor Address 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) Grafton Regis Manor Nursing Home Bozenham Mill Lane Grafton Regis Towcester Northants NN12 7SS 01908 543131 01908 542644 Partnerships In Care Limited Mrs Moira Amos Care Home with Nursing 26 Category(ies) of MD Mental Disorder (26) registration, with number of places Grafton Manor D.C51.C08.S12618.Grafton Manor.V238298.130705.Stage 2.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Younger Adults up to 65 years Date of last inspection 22nd Novemeber 2005 Brief Description of the Service: Situated halfway between Northampton and Milton Keynes, Grafton Manor is a magnificent building dating back to the 15th Century. Set in 7 acres of landscaped gardens, it provides a relaxing environment for assessment and rehabilitation programmes. The accomodation comprises of 13 single rooms in the main manor house with a further 6 bedrooms in the Chantry along with a cottage, bedsit and flat offering a choice of accomodation to suit individual needs. There are a range of communal areas within the different units and residents are able to enjoy the garden areas. Grafton Manor D.C51.C08.S12618.Grafton Manor.V238298.130705.Stage 2.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a statutory unannounced inspection; 2 hours were spent gathering information and planning for the inspection and 4 hours were spent in the home. The care of two service users was reviewed to include their care plans, risk assessments, medication and other records. Due to their brain injury some of the residents were unable to comment on their care however a period of observation and discussion with four of the residents was undertaken along with discussions with four staff members to ascertain how care is provided. Questionnaires were returned to the Commission for Social Care Inspection from five of the residents and eleven relatives/visitors to the home. What the service does well:
The questionnaires completed by relatives were positive with comments including “can’t speak highly enough of the staff and facilities”, “[residents name] is well cared for, I am very pleased” and “staff are all very welcoming and kind”. The resident’s questionnaires all indicated they felt well cared for, safe, staff treat them well and their privacy is respected. Two residents said they did not like living in the home but on follow up they were unhappy at having to accept care and believed they should and were able to live at home, which unfortunately due to their injury was not possible at this time. The pre-admission process is completed to a high standard with input from all relevant professionals involved in the care along with family and resident input. Assessments include where necessary psychology, speech and language and physiotherapy etcetera to ensure they are able to meet the residents needs prior to admission. Risk assessments are fully documented and reviewed regularly with staff referring to these prior to any activities to ensure there is agreement of procedure to ensure the safety of the residents. Staff spoken to were very positive about the home and the level of support and training they receive. Grafton Manor D.C51.C08.S12618.Grafton Manor.V238298.130705.Stage 2.doc Version 1.40 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. Grafton Manor D.C51.C08.S12618.Grafton Manor.V238298.130705.Stage 2.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Grafton Manor D.C51.C08.S12618.Grafton Manor.V238298.130705.Stage 2.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 2 Residents needs are fully assessed and information provided to ensure they understand what to expect and for their needs to be met. EVIDENCE: The residents guide is a comprehensive document informing the residents about the home, its service and contains useful information including advocacy information. The residents are given this on admission and their keyworker discusses it with them, although the signatures to evidence this process were not retained by the home. The pre admission assessment process is very detailed and included information from previous placements and professionals involved in the care along with resident and their families input to ensure needs are fully assessed and the necessary skills, equipment and facilities are available prior to a new admission. Grafton Manor D.C51.C08.S12618.Grafton Manor.V238298.130705.Stage 2.doc Version 1.40 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7 and 9 Care plans and risk assessments identify service user needs and the overall care planning system provides a consistent approach. Service user rights are not being fully met due to the lack of documented evidence about restrictions made. EVIDENCE: There are care plans available for most assessed needs and written in sufficient detail to ensure staff are able to provide care in a consistent manner. The multi disciplinary team regularly reviewed care plans and amendments are brought to the whole teams attention. One resident gets frustrated about the restrictions on his smoking and although the home has a policy of no smoking during planned session times there was no evidence of this being explained and agreed with the resident. There were no individual care plans or risk assessments to identify any restrictions in place for the residents and this prevent a consistent approach by all staff. Risk assessments were cross-referenced to care plans and highlighted action to
Grafton Manor D.C51.C08.S12618.Grafton Manor.V238298.130705.Stage 2.doc Version 1.40 Page 10 be taken by staff to minimise the risks. Care staff were aware of the risk assessments and used them on a daily basis. Grafton Manor D.C51.C08.S12618.Grafton Manor.V238298.130705.Stage 2.doc Version 1.40 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 and 16 Individual programmes are in place to ensure residents receive a varied opportunity to develop skills and experience a wide range of social opportunities. EVIDENCE: The residents spoken to confirmed they have their own daily timetable and time is spent each day discussing the plans for the day ahead. An orientation session was held in the morning and residents were encouraged and supported to participate in the group discussions including current affairs in the world outside the home. Residents had been to the gym and horse riding that morning and further activities were planned for both individuals and groups. There are a range of therapists including occupational therapy and physiotherapy available for specialised rehabilitation programmes. Grafton Manor D.C51.C08.S12618.Grafton Manor.V238298.130705.Stage 2.doc Version 1.40 Page 12 The staff and residents confirmed they have access to vehicles and enjoy trips out to local amenities and facilities. Residents have access to telephones for calls to their families and regular visits are arranged where possible. One family have a monthly letter from the residents keyworker to keep them up to date as they worry about how he progresses and what activities and programmes he is involved in. A new document outlining the residents’ rights has been developed to clearly outline the purpose of their care in the home and provides contact details for the commission for social care inspection and advocacy services. Observations showed staff interacting positively with residents and their rights to opening mail and other privacy issues are clearly documented. The residents spoken to said the staff were good and one resident said “its good care and the staff are great”. Grafton Manor D.C51.C08.S12618.Grafton Manor.V238298.130705.Stage 2.doc Version 1.40 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 20 Healthcare needs are generally well managed but a clear audit trail of medication entering the home is required to ensure medication is being administered as prescribed. EVIDENCE: Healthcare needs are fully assessed and documented with input evident from a range pf disciplines including GP, dentist, speech and language and psychology. Residents weights are monitored and action taken if significant weight losses or gains noted. There was one resident who had gained a lot of weight since admission and within the multi disciplinary notes there was evidence of advice taken and a plan to encourage a healthy diet with portion control, however there was no evidence of the resident being aware of this and no care plan to identify the action to be taken. There was no clear evidence of the amounts of medication entering the home however there was a clear procedure in place for the storage, administration,
Grafton Manor D.C51.C08.S12618.Grafton Manor.V238298.130705.Stage 2.doc Version 1.40 Page 14 and disposal of medication and the medication administration records were fully documented and completed appropriately. Grafton Manor D.C51.C08.S12618.Grafton Manor.V238298.130705.Stage 2.doc Version 1.40 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22. There is an effective system in place to respond appropriately to complaints made. EVIDENCE: The complaints log shows detailed investigation and an appropriate response to all complaints made. The complaints procedure is clearly documented and available in communal areas and in the residents guide and other documentation. The home logs both formal complaints and all comments and issues raised by the residents and show how they have responded. The resident spoken to felt they knew how to and who to speak to if they had any worries or concerns. Grafton Manor D.C51.C08.S12618.Grafton Manor.V238298.130705.Stage 2.doc Version 1.40 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30. The home provides a safe and comfortable environment for the service users. EVIDENCE: The home was clean and tidy and provided a range of communal space including a safe garden area for the use of the residents. The resident spoken to said they were happy with the environment of the home. The pre inspection questionnaire confirmed that the home has had recent fire and environmental health officer visits and are complying with the requirements. Staff confirmed they have access to gloves and aprons to ensure hygiene and infection control is managed safely with clear policies and procedures. Grafton Manor D.C51.C08.S12618.Grafton Manor.V238298.130705.Stage 2.doc Version 1.40 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 34 and 35. The staff team have the experience, skills and knowledge and are supported by systems to ensure they are able to meet service user needs. EVIDENCE: The staff spoken to said they felt very supported in their job and there were sufficient numbers of staff on duty to meet the residents needs. One relative commented in their questionnaire that they felt the staff were always welcoming and they were in sufficient numbers to take residents out. A new member of staff confirmed there was a detailed recruitment procedure before their appointment and this included the uptake of references and criminal records bureau clearance. The home has recently recruited further care staff to join the team and they hoped the number of agency shifts would reduce. The agency care staff spoken to and documentation submitted to the CSCI showed that they have regular agency staff and many are given the same training as regular staff in order for them to be able to participate and help the residents needs to be met. Grafton Manor D.C51.C08.S12618.Grafton Manor.V238298.130705.Stage 2.doc Version 1.40 Page 18 The training programme for the home is extensive and staff confirmed they are encouraged and supported to access a range of training to help them understand and gain the skills to meet individual needs. Grafton Manor D.C51.C08.S12618.Grafton Manor.V238298.130705.Stage 2.doc Version 1.40 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, and 42. There is an effective management system in place to give clear guidance and support to the staff team and to the service users. In addition the health and safety of the service users is maintained. EVIDENCE: The Registered Manager is an experienced Registered Nurse. She has completed a course of study equivalent to National Vocational Qualification level five, in management. The feedback from both service users and their relatives was very positive about the home and the manager. The staff and residents spoken to were clear about the manager’s role and felt able to approach the management with any concerns or queries. There are regular staff and resident meetings to ensure they are kept informed of changes and to express their views about the home.
Grafton Manor D.C51.C08.S12618.Grafton Manor.V238298.130705.Stage 2.doc Version 1.40 Page 20 There was evidence of statutory training including fire, health and safety and food hygiene. There is a trained first aider on each shift. The pre inspection questionnaire confirmed compliance with all health and safety legislation and records were available with staff aware of how to raise any issues of concern about their own or the residents’ health and safety. Grafton Manor D.C51.C08.S12618.Grafton Manor.V238298.130705.Stage 2.doc Version 1.40 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x x x Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 2 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 x Standard No 31 32 33 34 35 36 Score x x 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Grafton Manor Score x 2 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 x x x 3 x D.C51.C08.S12618.Grafton Manor.V238298.130705.Stage 2.doc Version 1.40 Page 22 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 7 Regulation 17(1)(a) schedule (3)(3)(q) 13(2) 17(1)(a) and schedule 3(3)(i) Requirement Any restrictions on residents rights must be fully documented and agreed by the resident and/or their representative. A clear audit trail for all medication in the home must be available. Timescale for action 30/08/05 2. 20 30/08/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 19 Good Practice Recommendations Care plans should be developed for all assesssed heathcare needs including weight management. Grafton Manor D.C51.C08.S12618.Grafton Manor.V238298.130705.Stage 2.doc Version 1.40 Page 23 Commission for Social Care Inspection 1st Floor, Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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