Inspection on 18/04/07 for Grafton Manor Head Injury & Rehabilitation Unit

This inspection was carried out on 18th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 Manor Head Injury &... 23/12/08

Grafton Manor Head Injury &... 01/12/05

Grafton Manor Head Injury &... 13/07/05

Grafton Manor Head Injury &... 22/11/04

Grafton Manor Head Injury &... 29/04/04

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

CARE HOME ADULTS 18-65 Grafton Manor Head Injury & Rehabilitation Unit Grafton Regis Manor Nursing Home Bozenham Mill Lane Grafton Regis Towcester Northants NN12 7SS Lead Inspector Irene Miller Unannounced Inspection 18th April 2007 12:50 Grafton Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.R01.S.doc Version 5.2 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 Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.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 Adults 18-65. 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 Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grafton Manor Head Injury & Rehabilitation Unit Address 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) Grafton Regis Manor Nursing Home Bozenham Mill Lane Grafton Regis Towcester Northants NN12 7SS 01908 543131 01908 542644 mamos@partnershipsincare.co.uk www.partnershipsincare.co.uk Partnerships In Care Limited Mrs Moira Amos Care Home 26 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (26) of places Grafton Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No one falling within the category MD may be admitted into the home where there are 26 service users of this category already accommodated within the home. That one bedroom within the chantry measures 10 square meters with additional en suite as agreed in variation application number V000020532 1st December 2005 2. Date of last inspection 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 accommodation comprises of 13 single rooms in the main manor house with a further 6 bedrooms in the Chantry along with a cottage, bed-sit and flat offering a choice of accommodation to suit individual needs. There is a range of communal areas within the different units and residents are able to enjoy the garden areas. Weekly fees range from £3,231 for rehabilitation and £2,396 per week for long term care. Grafton Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is based upon outcomes for service users and their views of the service provided. This inspection was a ‘Key Inspection’ that focused on the key standards under the National Minimum Standards and the Care Standards Act 2000 and the Care Homes Regulations 2001, for homes providing care for younger adults aged between (18 – 65). The primary method of inspection used was ‘case tracking’ which involved, reviewing the health, social, emotional and physical needs of three residents living at the home and tracking the care and support that they receive. The residents care plans were looked at (a care plan sets out how the home aims to meet the, personal, health, social and emotional needs of the resident), and discussion took place with and staff and general care practices were observed. Some of the residents were unable to comment on their care, however a period of observation and discussion took place with residents were possible to establish if they were satisfied living at the home. The homes policies, procedures and records in relation to staffing recruitment and training, concerns and complaints, medication management, and general maintenance and upkeep of the home were viewed. The inspector spent approximately two hours planning the areas to focus on at this inspection, based upon information gained from reviewing the homes previous inspection reports and other information relating to the home. The registered manager Moira Amos was available at the home on the day of inspection and the inspection took place over a period of approximately six hours. What the service does well: Grafton Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.R01.S.doc Version 5.2 Page 6 The physical and mental healthcare needs of residents are met through having a team approach, which ensures that resident’s rights are promoted and protected There are good risk management systems in place, which are reviewed regularly. The staff recruitment practice is robust which ensures that residents are protected and that staff employed to work at the home have the necessary skills to care for the residents needs. The management of the home is open and transparent; the views of the residents and their representatives underpin the service that is provided. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Grafton Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Grafton Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 Quality in this outcome area is good. Prospective residents and their representatives can be assured that admission will only take place once it has been established that the home can fully meet their assessed needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The three care plans viewed had comprehensive assessments in place that had involved other healthcare professionals, the level of information ensured that all staff were aware of the support the residents needed to achieve their individual goals. Where possible the home seeks to gain information about the resident’s lifestyle prior to and following their brain injury. Grafton Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7 & 9 Quality in this outcome area good. Residents are encouraged and supported to take risks to promote their independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The risk assessments viewed identified what control measures were in place to allow residents to take risks and have a good level of independence in line with their level of understanding and capabilities, the assessments were regularly reviewed by the healthcare team and updated as needs change and progress achieved in the individual goals. There were individual programmes in place for each individual resident to help them to regain some of the skills that had been impaired due to their brain injury, the information outlined the level of support required for each resident. Grafton Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.R01.S.doc Version 5.2 Page 10 Risk assessments were regularly reviewed and updated as needs change and progress achieved in the residents set goals. The risk assessments identified what control measures were in place to allow residents to take risks and have a good level of independence in line with their level of understanding and capabilities. In conversation with staff it was confirmed that they had an extensive knowledge of the needs of each resident. Grafton Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 11,12,13,14,15,16 & 17 Quality in this outcome area is good. The lifestyle experienced in the home meets the needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was detailed information on the daily routines that were based upon promoting independence and pursuing hobbies and interests. Records were available of when the residents had followed their individual programmes, which included relaxation techniques, massage and yoga. Residents were observed participating in doing a group crossword, some were watching television and others were spending time with staff. One resident had been busy making a birthday card for a relative. Grafton Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.R01.S.doc Version 5.2 Page 12 There was documentation available to support that residents were enabled to join in with peer and culturally appropriate activities and records of recent activities that residents had engaged in were visits to a garden centre, bowling, and car outings. Residents were encouraged to spend time with their families as appropriate to their individual needs and abilities. Personal celebrations were promoted, on the day of inspection one of the residents were celebrating their birthday the home had acknowledged this and had prepared a birthday cake. A garden party was planned to take place and an open invitation was on display on the notice board within the kitchen. A five-week rolling food menu was in place, and staff spoken with had a sound knowledge of the individual needs of each resident in terms of their dietary needs and the level of support required at meal times. Due to differing physical and mental health conditions, some residents required specialised diets and some required their meals to be pureed, in the main healthy eating regimes were promoted. Some residents were unable to eat solid foods and required nourishment to be provided through percutaneous endoscopic gastrostomy tubes (peg feeds). There was a high level of support available from the healthcare professionals based on site, and dietary needs were regularly reviewed. Observations of care practices during the inspection visit demonstrated that there was a strong commitment to following each resident’s individual daily routines, and in promoting skills and independence. Grafton Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19 & 20 Quality in this outcome area is good. Residents can be assured that their health and personal care needs will be fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Through observations of care practice, records available and discussion with staff it was demonstrated that the residents complex needs are met with full account of their physical and emotional capabilities, this is achieved through the teamwork and specialist support available from the healthcare professionals based on site. There was evidence of residents physical and mental health needs being regular reviewed and records were available of residents having received treatment from their general practitioner, neurophysiologist and regular health checks having being provided. Grafton Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.R01.S.doc Version 5.2 Page 14 The medication held within the home was sample checked and was well managed, however stock control could be more robust, and liquid medications would benefit from having the date of opening available to provide an audit trail (one opened liquid medication had the date of dispensing as February 2007 and was still in use). There were safe systems in place where residents may require essential medication to be given covertly. Grafton Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23 Quality in this outcome area is good. Residents and their representatives can be assured that any concerns or complaints they may have will be listened to and acted upon, and that they will be protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a complaints policy in place, since the last inspection seven complaints had been received by the home and the Commission for Social Care Inspection were satisfied that the complaints had been fully investigated by the provider following their complaints procedure. Residents have direct access to an advocate and there was evidence within the residents care records of when they had been visited by their advocate. Staff training had taken place on safeguarding adults and in discussion with staff it was confirmed that they had a sound knowledge of the importance of protecting residents from potentially abusive situations, this was also demonstrated within the residents individual risk assessments such as the support systems in place to ensure residents are safe when out in the community unsupervised. Grafton Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.R01.S.doc Version 5.2 Page 16 Grafton Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 & 30 Quality in this outcome area is good. Residents live in a home that is homely, clean, safe and comfortable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A limited tour of the building was conducted and communal areas were clean, pleasantly furnished and decorated to a good standard. The kitchen was clean and well organised, dry, frozen and perishable foods were stored appropriately and there were records available to demonstrate that food safety systems were in place. The laundry was clean and well organised and procedures were in place to reduce the risks of cross infection. Grafton Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.R01.S.doc Version 5.2 Page 18 Records of the building upkeep were available and demonstrated that fire; heating, water and gas safety checks were carried out and that there is a programme of building repairs and refurbishment in place. The organisation have recently reviewed the position of having a facilities manager based within the home, and in discussion with the registered manager it was established that the organisation plan to centralise the responsibility of property management within the homes. Grafton Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.R01.S.doc Version 5.2 Page 19 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32,34 & 35 Quality in this outcome area is excellent. Residents are protected through thorough staff undergoing thorough recruitment and selection procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels on the day of inspection were appropriate to meet the needs of the residents living at the home. Records were available to demonstrate that the staff receive all mandatory training such as health and safety, moving and handling, fire awareness, food hygiene and medication training. In addition training is provided in meeting the specific health and emotional needs of residents such as understanding brain injury, behaviour modification, epilepsy and managing challenging behaviour Staff spoken to confirmed that they had received training in the above. The recruitment files of three staff were viewed and contained all of the necessary recruitment and selection documentation. Grafton Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.R01.S.doc Version 5.2 Page 20 Clearances had been obtained from the Protection of Vulnerable Adults Register (POVA 1st), the Criminal Records Bureau (CRB) and references had been obtained prior to the members of staff taking up employment. There were interview records available that demonstrated that equal opportunities were practiced, part of the interview process involved each member of staff being given a written case scenario to read and questions relating to the scenario, the aim of the exercise was to establish that the staff had read and understood the issues surrounding the scenario, that was based upon eating and drinking guidelines. There was records available of training that had been provided and training that was planned to take place, on the day of inspection staff were receiving refresher training on health and safety, manual handling, first aid, fire awareness, infection control and the data protection act. In discussion with staff it was confirmed that they received regular supervision with their line manager. Grafton Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.R01.S.doc Version 5.2 Page 21 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,39 & 42 Quality in this outcome area is excellent. Residents live in a home that is run in their best interests and promotes their health, safety and welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has worked at the home for a number of years and has the necessary qualifications, skills and experience to ensure that the home is managed efficiently. The systems for assessing and reviewing the resident’s ongoing needs and aspirations were well managed, the care records viewed were up to date and evidenced that residents were supported through having a multi disciplinary team approach. Grafton Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.R01.S.doc Version 5.2 Page 22 The management systems were open and transparent; quality assurance systems were in place to gain the views or residents and their representatives, in addition an ethical committee meet to discuss management decisions to ensure that the resident’s rights are promoted and protected. Risk assessments were detailed and informed the staff on the control measures in place to ensure residents safety. The organisation have an appointed health and safety representative who analyse accident report on a quarterly basis and the registered manager confirmed that she is due to undertake the National Examination Board in Occupational Safety and Health (NEBOSH) health and safety course in July 2007 There is a high commitment to staff training, staff receive refresher training annually on all mandatory training such as fire, health and safety, first aid, manual handling and food hygiene. In addition there is a commitment to ensure that all staff are provided with training that is specific to the residents needs, such as understanding brain injury, and the management of challenging behaviour. Grafton Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.R01.S.doc Version 5.2 Page 23 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 4 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000012618.V335029.R01.S.doc 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 4 3 4 X 3 X X 4 X Version 5.2 Page 24 Grafton Manor Head Injury & Rehabilitation Unit 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. Standard Regulation Requirement Timescale for action 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 Grafton Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Text phone: 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 Manor Head Injury & Rehabilitation Unit DS0000012618.V335029.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. Re-publishing this information is in breach of the terms of use of that website. 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