Inspection on 09/05/05 for Graham House

This inspection was carried out on 9th May 2005.

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

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

Other inspections for this house

Graham House 16/06/06

Graham House 15/11/05

Graham House 17/08/04

Graham House 19/05/04

Graham House 03/02/04

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

CARE HOMES FOR OLDER PEOPLE Graham House 12 Graham Road Mitcham Surrey CR4 2HA Lead Inspector Jean Stuart Unannounced 9 May 2005 11.15 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Graham House G54-G04 S27242 Graham House V226318 090505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Graham House Address 12 Graham Road Mitcham Surrey CR4 2HA 020 8646 0606 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Rudolph Edgar Lewis and Mrs Ena Etheldina Lewis Mrs Ena Etheldina Lewis Care home only (PC) 3 Category(ies) of Old age, not falling within any other category registration, with number (OP) of places Mental Disorder, excluding learning disability or dementia - over 65 years of age (MD(E)) Graham House G54-G04 S27242 Graham House V226318 090505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18.8.04 Brief Description of the Service: Graham house is a registered care home for up to three elderly people with 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 G54-G04 S27242 Graham House V226318 090505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One regulation inspector carried out this unannounced inspection on 9 May 05 . At the time of the inspection two residents were living at the home. At the previous inspection six requirements were made. With one exception these are being worked on or are achieved. The one exception is the monthly monitoring of care plans. A monthly review must be completed to ensure information about residents reflect current need.. What the service does well: What has improved since the last inspection? What they could do better: Every effort must be made to ensure that care plans reflect current needs. Policies and procedures in two areas must be available in the home, these will ensure staff are aware of their working environment. Recruitment and medication policies are required. Staff must receive accredited training on the Graham House G54-G04 S27242 Graham House V226318 090505 Stage 4.doc Version 1.30 Page 6 administration and handling of medication. Formal one to one supervision must be given, to develop care practices. 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 G54-G04 S27242 Graham House V226318 090505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Graham House G54-G04 S27242 Graham House V226318 090505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6. The Local Authority initially assesses the needs of a resident, the provider also carries out an assessment of need when the resident moves into the home ensuring that their needs can be met. EVIDENCE: Before moving into the home, an assessment of the needs of each person is carried out by the placing Local Authority. This enables the provider to judge if the establishment needs can meet the resident’s. A copy of the Local Authority assessment of need is sent to the home, and provides staff with information to set up an initial individualised plan for new residents. The home does not offer intermediate care, feeling that this would be too disruptive for the other residents. Graham House G54-G04 S27242 Graham House V226318 090505 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11. Care planning documentation in place for individual residents requires further review and development to ensure that there is a complete and current record of residents needs. EVIDENCE: Care plans were available for the two residents in the home. A monthly review is not being completed for the total care plan, but the manager is commenting on selected sections of the plan. To ensure that some areas of need are not overlooked the total care plan must be reviewed every month. One resident requested bread at meal times. The manager stated that he enjoys bread with most meals. To ensure that this knowledge is available to all staff, this must be recorded on the care plan. The risk assessments require further reviews. For one individual the care plan states that the use of the stick should be encouraged. When walking from the bedroom to the table for lunch, it was noted that a stick was not used. The degree of risk presented by their preference not to use the stick and how this is to be managed must be documented on a risk assessment. A resident with poor mobility was accommmpanied to the toilet by the manager. This was not detailed on the care plan, nor the reason given as to why it was necessary to Graham House G54-G04 S27242 Graham House V226318 090505 Stage 4.doc Version 1.30 Page 10 accompany the individual. If the resident is at risk this must be documented on the risk assessment and a statement made as to how the home is to reduce the risk. A part of one risk assessment was that a resident on moving into the home presented in the past suicidal tendencies. The homes record does not demonstrate how the individual’s behaviour supports this statement. The reason for this statement must be explored and the steps taken by the home to prevent self-harm must be clearly documented. The health care needs of residents are met. Good information was seen to be available on the health care needs of residents. All residents are registered with a local GP practice. A resident confirmed that they could see the GP when they wished to. Specialist mental health resources are accessed as required. The record demonstrated that arrangements are in place for a chiropodist to visit the home, and that visits are made to the dentist. The system for the administration and recording of medication is well managed, however there must be a copy of the policy and procedure available to staff. At the time of this visit none of the residents had chosen to self medicate. A medication profile listing the medication for each individual resident was in place. All staff that administer medication must be provided with accredited training on medication, this knowledge will protect residents from misuse of medicines. One resident does not wish to talk about arrangement following his death, and has no close relatives. The manager has now approached Merton Social Services Customer Liaison Manager, with resident’s knowledge is to explore the procedure to be followed when there is no family involvement. Graham House G54-G04 S27242 Graham House V226318 090505 Stage 4.doc Version 1.30 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 standard(s) 12, 14,15. Residents find that their preferred life style is accommodated within the home and they can exercise choice about how they wish to live. EVIDENCE: The care documentation shows that both residents chose not to hold social conversations. Residents were seen to spend their day as they wished. One person stayed in their room and listened to classical music, the second resident was encouraged to remain in the lounge, rather than going to the bedroom to doze throughout the day. The second resident glanced at a newspaper. The daily record demonstrates a resident goes out on short walks with staff, another person enjoys old films, and independently of each other they will both play board games with staff. When asked how they spend their day, residents could not be encouraged to talk, although one resident had an animated conversation when asked about the general election. When sitting down to lunch the residents chose not to talk with each other and offered very little in response to the manager’s conversation. One resident stated the meal was “very good”. One resident until recently attended a day centre, this has now ceased because they can no longer meet his needs. The manager’s efforts to find another day centre are documented. Graham House G54-G04 S27242 Graham House V226318 090505 Stage 4.doc Version 1.30 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 standard(s) 16,18. Residents live in an environment that through good staff practice and training, promotes the ability to complain and to be protected from abuse. EVIDENCE: The manager reported that there have been no complaints in the past year. A previous complaint has been seen on an earlier inspection, this was dealt with appropriately. Residents are protected from abuse through good staff practice and staff training. The manager reported that she has made the carers aware of the different types of abuse, and that she has been to the “no secrets” training held by the London Borough of Merton. A staff file demonstrated that a member of staff had also attended the no secrets training. A copy of the local authority procedure was seen in the home. For one resident the manager has approached Merton Local Authority Customer Liaison Officer who will be meeting with the resident to discuss who can help concerning how he wishes his assets to be managed. The resident does not have any close family to deal with such matters. Graham House G54-G04 S27242 Graham House V226318 090505 Stage 4.doc Version 1.30 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 standard(s) 19,21,23,26. Residents live in a comfortable well maintained environment, with a homely atmosphere. EVIDENCE: The lounge/ diner is small and provides adequate space for residents to eat or sit in their chair. The home does not accept people who smoke. The manager plans to improve facilities at the home by building a small extension. This will have a utility area, and a staff sleeping in area. A proposal has been placed before Merton council. The home has one bathroom. The demands on the bathroom were noted through out the visit to the home. The toilet has a raised seat. There was never a time when residents were required to wait for the bathroom. Soap and towels were available in the bathroom. A record of bath temperatures is maintained. This shows that residents take several baths in any one week. Graham House G54-G04 S27242 Graham House V226318 090505 Stage 4.doc Version 1.30 Page 14 The needs of one of the previous residents increased as they got older. An assessment of their personal need and the communal rooms was completed. The communal rooms were observed as being acceptable for the elderly people who did not have special needs. There is a good level of cleanliness through out the home. Graham House G54-G04 S27242 Graham House V226318 090505 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30. Staffing levels are adequate to meet current needs of residents accommodated in the home. A committed staff team supports residents and staff numbers are adequate to meet the needs of residents. EVIDENCE: One member of staff is available through out the day. The home currently has two residents. There is a low turnover of staff, which provides residents with stability and consistency. The staff team have the necessary skills to meet residents’ needs. The manager is a qualified nurse and is completing the NVQ four training. A member of staff has completed NVQ level three training, another NVQ level two. Staff records show that courses have been completed in dementia, moving and handling, first aid, and food hygiene. The manager reported that staff discuss residents needs at the start and finish of each shift. Staff do not receive one to one formal supervision, this will help them to share and develop their knowledge of the services given. To developed staff skills personal development plans are now in use. A part of this is a self assessment sheet completed by the staff member. It was noted that for one staff member the manager is yet to complete the personal development sheet. Comments from residents include “staff are polite” staff offer help “as required”, “it is ok here”. Graham House G54-G04 S27242 Graham House V226318 090505 Stage 4.doc Version 1.30 Page 16 The staff files examined demonstrated that a Criminal records Bureau check for one staff member had been carried over from a previous job. To safeguard residents’ interests a new CRB must be applied for, prior to the commencement of a new job. The home does not have a recruitment and selection policy and procedure, the manager is aware that one must be developed. Graham House G54-G04 S27242 Graham House V226318 090505 Stage 4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,35,36,38. The health safety and welfare of residents are promoted and protected through policies, procedures and informal consultation with the resident group. EVIDENCE: Residents do not desire the company of others, this is reflected in the care plans. Formal resident meetings are not held. Choices in how residents spend their day are reflected in the daily report by care staff. The manager safeguards residents’ financial interests. A record of residents’ money held for safe keeping was checked and found to be accurate. The manager seeks professional help when necessary to ensure that the residents’ long term financial issues are protected. Graham House G54-G04 S27242 Graham House V226318 090505 Stage 4.doc Version 1.30 Page 18 A record is maintained of the water temperatures when residents bath. This demonstrates that the water temperatures are always to a safe level and will ensure that residents are not scalded. In the past year the home has installed a wired fire alarm system, this is checked once a fortnight. A record is maintained of fire drills and the staff who attend the drill, ensuring resident safety in the event of a fire. To develop their knowledge of the care provided to residents, staff must have one to one supervision, this provides the opportunity to talk with the manager about the services provided and to identify training needs. Graham House G54-G04 S27242 Graham House V226318 090505 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION 3 x 3 x 3 x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 3 x 3 Graham House G54-G04 S27242 Graham House V226318 090505 Stage 4.doc Version 1.30 Page 20 yes 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. 2. Standard 7 7 Regulation 15(2)(b) 15(1) Requirement The Registered Person must ensure that care plans are reviewed every month. The Registered Person must ensure that details of the needs and wishes of residents are included in the care plan. The Registered Person must ensure that all risks are documented and a statement drawn up concerning how this risk is to be managed. The Registered Person must ensure that the medication training for care staff is accedited The Registered Person must ensure that there is a policy and procedure for dealing with medicines. The Regsitered Person must ensure that care staff receive formal supervision at least six times a year The Registered Person must ensure that a new CRB is completed prior to any person starting employment. The Registered Person must ensure that a recruitment policy and procedure is developed. Timescale for action 30 June 05 30 June 05 3. 7 13(4) 30 June 05 4. 9 13(2) 31 October 05 30 June 05 5. 9 13(2) 6. 36 18(2) 31 July 05 7. 29 19 Schedule 2 19(4) 30 June 05 8. 29 31 July 05 Graham House G54-G04 S27242 Graham House V226318 090505 Stage 4.doc Version 1.30 Page 21 9. 33 24(1) The Registered Person must ensure that an annual development plan is completed. (Repeat previous timescale of 31.1.05 not met). 31 October 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 Good Practice Recommendations Graham House G54-G04 S27242 Graham House V226318 090505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 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 G54-G04 S27242 Graham House V226318 090505 Stage 4.doc Version 1.30 Page 23 - 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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