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Inspection on 15/11/05 for Graham House

Also see our care home review for Graham House for more information

This inspection was carried out on 15th November 2005.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides comfortable accommodation to residents. The premises are kept to a high standard of cleanliness and the bedrooms are personalised to individual tastes. The home has a group of staff some of which have worked at the home for a long time. Staff have brought with them qualifications and experience which are relevant to the job. The manager is very committed to the care provided.

What has improved since the last inspection?

The registered person now ensures that care plans are reviewed each month, and details of the needs and wishes of residents are included in the care plan. Accredited medication training is given to staff. The home has an annual development plan. Prior to the new residents coming into the home, the bedroom was repainted, a new boiler has been fitted, grab rails have been placed by the front door, a bath aid purchased, new windows have been fitted and fire exit signs put up.

What the care home could do better:

The manager is aware that regular staff supervision must take place, a recruitment policy and procedure must be introduced, the medication policy must include the residents right to self medicate. The manager hopes that another resident will occupy the third bed.

CARE HOMES FOR OLDER PEOPLE Graham House 12 Graham Road Mitcham Surrey CR4 2HA Lead Inspector Jean Stuart Unannounced Inspection 15th November 2005 10:40 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 Graham House DS0000027242.V266251.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Graham House DS0000027242.V266251.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Graham House Address 12 Graham Road Mitcham Surrey CR4 2HA 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) 0208 646 0606 Mr Rudolph Edgar Lewis Mrs Ena Etheldina Lewis Mrs Ena Etheldina Lewis Care Home 3 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (3), Old age, of places not falling within any other category (3) Graham House DS0000027242.V266251.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9 May 05. Brief Description of the Service: Graham house is a registered care home for up to three elderly people, some of whom may have past or present mental health needs. The home is the ground floor of a semi-detached property. The home is situated within a residential area of Mitcham, with a small number of shops within a short walking distance. Parking is to the front of the home. Public transport bus services are within a short distance of the home. Three single bedrooms are available in the home. Graham House DS0000027242.V266251.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on the 15 November 05, with both providers being present. A brief tour of the premises took place and care documentation for two residents (the total number of residents) was inspected. Two residents were spoken to individually. The inspection took three hours and forty minutes. What the service does well: What has improved since the last inspection? The registered person now ensures that care plans are reviewed each month, and details of the needs and wishes of residents are included in the care plan. Accredited medication training is given to staff. The home has an annual development plan. Prior to the new residents coming into the home, the bedroom was repainted, a new boiler has been fitted, grab rails have been placed by the front door, a bath aid purchased, new windows have been fitted and fire exit signs put up. Graham House DS0000027242.V266251.R01.S.doc Version 5.0 Page 6 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. Graham House DS0000027242.V266251.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Graham House DS0000027242.V266251.R01.S.doc Version 5.0 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 the following standard(s): 1,3,4,5. Information provided in the service users guide requires updating to reflect the services provided. Residents’ benefit from having their needs appropriately assessed before admission. EVIDENCE: A resident moved into the home a week ago. The resident and the family visited the home before the resident moved in. The resident and the family were able to assess the suitability of the home. As a part of the assessment of need, the providers have ensured there are grab rails by the front door and a bathing aid. The family of the resident reported that the home is “helping” the resident to settle in. The resident stated that they are “happy” here. The needs of the resident are appropriately assessed before the resident moves into the home. Where applicable a Local Authority assessment of the resident is completed by social services and placed on file. The assessments ensure that the individual’s needs are met. Graham House DS0000027242.V266251.R01.S.doc Version 5.0 Page 9 The statement on the front of the service users guide that the home provides care for the elderly mentally infirm is not correct and must be removed Information provided in the service users guide requires updating to reflect the services provided. Graham House DS0000027242.V266251.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9. The home ensures that care documents are kept. Regular daily recording takes place. Risk assessments are maintained. The healthcare needs of residents are satisfactorily met. EVIDENCE: Residents needs are reflected in their care plans. The home has commenced with a new form of care planning. This is an uncomplicated method of recording. Care plans were sampled and seen to reflect the needs of residents. Good information was seen on personal and health care needs of residents in the daily record. Risk assessments have been completed. By recording information, residents wishes will not be overlooked by staff. The home follows good practice in the recording of medication. None of the current residents self administer their own medication. The possibility of selfadministration must be reflected in the medication policy and procedure. Staff, in their use of medication, promotes a positive and safe environment for all in the home. Graham House DS0000027242.V266251.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14. Residents if they wish are encouraged to maintain contact with family, friends and the local community. EVIDENCE: A resident who was out at the beginning of this inspection returned Graham House accompanied by a family member. Residents’ families are made welcome at Graham house, and tea was offered to the resident and the visitor in the lounge. Both people later retired to the bedroom, enabling the resident to talk with the visitor in private. The resident spoke of a friend who might be visiting the home, and grandchildren who helped when moving in. Maintaining the individual’s family links are important and the home will ensure that the social, cultural needs of this person are met. Graham House DS0000027242.V266251.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. A satisfactory complaints procedure is in place and is supplied to residents on admission to the home. EVIDENCE: None of the residents spoken to had any concerns at the time of the inspection visit. The home keeps a record of any complaint and actions taken. The last complaint was received in 2003. Information on what action needs to be taken, should there be an allegation or suspicion of abuse, is in place. Staff have received training in the protection of vulnerable adults. Graham House DS0000027242.V266251.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20,23,24,26. Residents’ bedrooms are well maintained and personalised to individual tastes. The premises is kept free from offensive odours. The home provides comfortable and homely accommodation to residents EVIDENCE: The communal area of the home are homely in appearance. One room serves as both the lounge and dining area, and provides a pleasant area for residents to use. In the summer there is a seating area outside in the garden. Individual bedrooms provide comfortable homely accommodation for residents. Rooms were observed to be clean and free from offensive odour. The bedrooms were personalised to resident’s own tastes. Graham House DS0000027242.V266251.R01.S.doc Version 5.0 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29. The home has sufficient staff on duty to meet the needs of the residents. A recruitment policy and procedure must be developed. EVIDENCE: At the time of the inspection the home had two residents; Both Providers were in the house with the manager named on the rota. The manager/provider was observed talking with residents, one resident was encouraged to sit in the lounge and take part in conversation. Two staff files were sampled and were found to contain adequate information. To ensure that a consistent approach to recruitment is always taken, a policy and procedure on recruitment must be developed. Staffing levels and skill mix are adequate to meet assessed and recorded needs of residents. Graham House DS0000027242.V266251.R01.S.doc Version 5.0 Page 15 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 36,37. Homes protect residents through positive use of the home’s record keeping policies and procedures. Staff must be supervised to ensure that the home operates as an effective staff team. EVIDENCE: Basic care plans are maintained, daily recording is being consistently completed, and the recruitment procedure ensure adequate staff checks are completed. Staff receive one to one supervision but a regular pattern has not been achieved. Care staff must receive formal supervision at least six times a year. The home’s practices protect the residents’ best interests, when fully utilised. The home must ensure that all policies and procedures are fully utilised. Graham House DS0000027242.V266251.R01.S.doc Version 5.0 Page 16 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 x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 x 3 x x 3 3 x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 2 2 X Graham House DS0000027242.V266251.R01.S.doc Version 5.0 Page 17 Are there any outstanding requirements from the last inspection? yes 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 1 Regulation 5(a) Requirement The Registered Person must ensure that the service user’s guide reflects the services provided. The Registered Person must ensure that self -administration is in the policy and procedure for medicines. The Registered Person must ensure that a recruitment policy and procedure is developed. (Previous time scale of 31/7/05 not met). The Regsitered Person must ensure that care staff receive formal supervision at least six times a year. (Previous time scale of 31/7/05 not fully met). The registered person must ensure that policies and procedures are used in full. Timescale for action 28/02/06 2. OP9 13(2) 31/12/05 3. OP29 19(4) 28/02/06 4. OP36 18(2) 31/01/06 5 OP38 12 28/02/06 Graham House DS0000027242.V266251.R01.S.doc Version 5.0 Page 18 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 Graham House DS0000027242.V266251.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Graham House DS0000027242.V266251.R01.S.doc Version 5.0 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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