CARE HOMES FOR OLDER PEOPLE
Grampian House Grampian Drive Peterlee Co Durham SR8 2LR Lead Inspector
Ms Kathy Bell Unannounced Inspection 15th November 2005 09:30 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 Grampian House DS0000031225.V257132.R02.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. Grampian House DS0000031225.V257132.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Grampian House Address Grampian Drive Peterlee Co Durham SR8 2LR 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) 0191 5864833 0191 5864776 Durham County Council Mrs Maria Luke Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20), Physical disability (10) of places Grampian House DS0000031225.V257132.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17th September 2004 Brief Description of the Service: Grampian House is registered to provide care (by not nursing care)for up to 20 older people. As long as the total number is not more than 20, they can also look after up to 10 people with physical disabilities. 10 beds within the home are within an intermediate care unit which provides care and treatment for people who need to improve their mobility and ability to care for themselves before they can return home, after , for example, a stay in hospital. All the bedrooms are single and are on the first floor of the building. On this floor, each of the two wings has its own lounge and dining room and small serving kitchen. On the ground floor there is a day centre, with large lounge and dining room which can be used by residents. One wing on the ground floor contains the offices used by workers such as physiotherapists , occupational therapists and care managers who provide support to the intermediate care unit and to those who receive similar services in their own homes. The home is in a housing estate near the town centre of Peterlee. The building is pleasantly decorated in a domestic style throughout and appears to be well maintained. Grampian House DS0000031225.V257132.R02.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place during one day in November 2005. The inspector, Kathy Bell, spoke to 8 residents, one relative, five staff and the manager. She looked around the building and looked at some records. The residents and the relative were very pleased with the home. They particularly praised the staff, saying they were pleasant, they have a great way of talking to people, talk to residents as adults and nothings a trouble to them. They also liked the meals provided and the choices they were offered. In the intermediate care unit, a resident described how staff had helped him improve his mobility and retain his independence as much as possible while in the home. What the service does well: What has improved since the last inspection?
All the staff who work with the intermediate care unit now have offices on the ground floor and are able to work together more easily. The manager has now achieved the recommended qualifications of NVQ 4 in care and management.
Grampian House DS0000031225.V257132.R02.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. Grampian House DS0000031225.V257132.R02.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 Grampian House DS0000031225.V257132.R02.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): 3, 6 Residents are fully assessed before they come into the home to make sure that their needs can be met. Residents in the intermediate care unit receive intensive physiotherapy etc and , whenever possible, are able to regain the abilities they need to return home. EVIDENCE: Residents records included assessments by care managers and also by occupational therapists and physiotherapists in the case of people being admitted to the intermediate care unit. Therapy support workers are employed to work on the intermediate care unit, under the direction of health professionals, to make sure that residents are helped to carry out the exercise programmes recommended for them. The intermediate care unit has a kitchen and other facilities which staff can use to assess residents abilities to manage at home. The manager reports that the unit has a good record in helping people return to their own homes.
Grampian House DS0000031225.V257132.R02.S.doc Version 5.0 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 the following standard(s): 7, 8, 9, 10 Staff keep up-to-date a care plan which explains the care each person needs and how they like to live. This make sure that staff are always aware of what they need to do for each person. In most ways, the home takes great care to make sure that health needs are met. This could be improved by assessing who may be at risk of developing pressure sores. Arrangements for looking after medication are generally good although extra care must be taken in recording when a GP makes temporary changes in the medication prescribed. Residents described how generally staff did treat them with respect. EVIDENCE: The care plans seen showed that staff kept them up-to-date, reviewing them monthly and when changes happened. They covered essential things such as the help people needed to get around the home and to bath. In one case, staff had not described exactly how they were going to help someone remain
Grampian House DS0000031225.V257132.R02.S.doc Version 5.0 Page 10 continent. This is important because it can also be part of the strategy for avoiding pressure sores. Residents and relatives were very pleased with the way staff looked after their health. They said that staff did notice if they were at all unwell and called the doctor out. Records showed that staff chase up the results of any diagnostic tests. Full records were kept of visits by GPs and nurses and the advice and treatment given. Although the records showed that staff had asked advice from the district nurse when they had seen pressure sores developing and the nurses had continued to treat and monitor these, there was no evidence that the home was assessing who might be at risk of pressure sores and referring them for assessment for any equipment which might reduce the risk. There is an established system for handling medications for residents and all staff who do this have received external training. Medication is stored securely. Residents who are able continue to look after their own medication. Recording was good in many ways, with planned changes shown clearly in the medication record so that staff could easily follow what they had to do. However on the day of inspection, a GP had advised staff to stop a resident s medicine, temporarily while further tests were carried out, and this had not been recorded on the record of administration where staff would be sure to see it. Grampian House DS0000031225.V257132.R02.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, 15 Residents needs for recreation are met and they are able to maintain contact with families. The meals are of good standard, with choices available and the home takes care to ensure that residents receive a satisfactory diet. EVIDENCE: The home has a day centre downstairs which residents can go to to enjoy a wider range of activities. The home can also use the day centre lounge and dining room in the evenings and weekends for any events such as entertainers or parties. In the home itself, a relative described the usual range of bingo, dominoes and craft activities taking place. Residents also have TV, videos etc and a TV is provided in each bedroom. Staff also look after individual needs one resident explained that staff bring in a steady supply of books for her. Ministers of religion visit the home for residents who wish to take part in services. A relative explained how she was free to visit at any reasonable time and relatives seemed to have good relationships with staff. Residents generally felt that the meals were very good. There is a choice of most main meals and a lighter alternative for each lunchtime. Staff record each day the food each resident has chosen. They record on this sheet whether the resident has eaten most of their meal or not. If this shows that a
Grampian House DS0000031225.V257132.R02.S.doc Version 5.0 Page 12 resident is generally eating poorly, this acts as a prompt for the home to set up an individual record of food and drinks intake for that person so they can monitor if they are eating enough. The cooks have recently completed a Focus on Food course about nutrition and methods of making everyday meals more nutritious for people who do not eat well. Following this, they plan to review the menus. Grampian House DS0000031225.V257132.R02.S.doc Version 5.0 Page 13 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): These standards were not assessed on this inspection. EVIDENCE: Grampian House DS0000031225.V257132.R02.S.doc Version 5.0 Page 14 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): 26 The home appeared to be clean, pleasant and hygienic on the day of inspection. Residents and the relative confirmed it was always kept this way. EVIDENCE: All areas of the home seen appeared clean and well maintained. Residents and a relative said that any cleaning needed was done immediately and the home was described as Nippin’ clean. There was a smell of urine in one room but the manager gave a satisfactory explanation of the steps which had been taken to deal with this. Grampian House DS0000031225.V257132.R02.S.doc Version 5.0 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 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 There are enough staff on duty during the day and night to meet the needs of current residents and they have received suitable training to carry out their work. EVIDENCE: On the day of inspection, there were six residents in the intermediate care unit and eight in the other unit ((with one more in hospital). During the daytime the rota showed and staff confirmed that there were three care staff and one supervisor on duty. In the intermediate care unit there were also therapy support workers who work under the direction of physiotherapists working between 8 a.m. and 4 p.m. There are two care staff on duty awake at night. Staff have received the training suitable for their level of responsibility. Grampian House DS0000031225.V257132.R02.S.doc Version 5.0 Page 16 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): 31 The manager is suitably experienced and qualified to carry out her duties and was aware of her responsibilities as manager. EVIDENCE: The manager has many years experience of working with older people and at least 10 years in residential care. She has achieved the recommended qualifications of NVQ 4 in care and management. The inspector formed the view that she provides clear guidance to staff on the standards she expects. Grampian House DS0000031225.V257132.R02.S.doc Version 5.0 Page 17 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 X X 3 X X 4 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X X Grampian House DS0000031225.V257132.R02.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Where the care plan says that there is a toileting programme, it must state exactly what staff are expected to do. The home must assess the risk of pressure sores for each resident and refer for specialist assessment if necessary. Changes to medication must be promptly recorded on the medication administration record. Timescale for action 30/11/05 2 OP8 13 15/12/05 3 OP9 13 30/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Grampian House DS0000031225.V257132.R02.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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