Inspection on 18/11/05 for Granby Care Home

This inspection was carried out on 18th 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 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

Granby Care Home 28/01/10

Granby Care Home 12/11/07

Granby Care Home 24/02/06

Granby Care Home 10/03/05

Granby Care Home 21/10/04

Granby Care Home 16/03/04

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

CARE HOMES FOR OLDER PEOPLE Granby Care Home 50 Selborne Street Liverpool Merseyside L8 1YQ Lead Inspector Lynne Lynch Unannounced Inspection 18th November 2005 12:00 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 Granby Care Home DS0000032775.V267096.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. Granby Care Home DS0000032775.V267096.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Granby Care Home Address 50 Selborne Street Liverpool Merseyside L8 1YQ 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) 0151 709 3988 Liverpool City Council Mrs Pauline Caddick-Bennett Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Granby Care Home DS0000032775.V267096.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The service is registered to provide care for 29 persons over the age of 65 years and for 1 named service user under the age of 65 within the overall number of 30 To allow one named male service user under the age of 65 years to live at Granby Care Home. 10th March 2005 3. Date of last inspection Brief Description of the Service: Granby Care Home is a purpose built property owned and managed by Liverpool City Council. It is situated in the Granby area of Liverpool, and is close to shops, local amenities and other facilities. Accommodation comprises of 30 bedrooms, which are divided into three selfcontained units linked by a central area called the atrium. The atrium serves many purposes and is used for social gatherings and activities, sitting, reading or meeting with family and friends. Each unit has 10 bedrooms all with en-suite facilities, shower washbasin and toilet. All bedrooms are furnished but service users can bring their own furniture, if it meets the required standard. There are two lounges in each unit for smokers and non-smokers, and a dining room with kitchenette were light refreshments can be made. The units also have a large bathroom and toilet, one of which provides assisted bathing facilities. A utility room with a washing machine and dryer is available for service users who choose to do their own laundry. The home is centrally heated throughout. The home has been designed to meet the needs of service users from all cultures and religions and a multi faith prayer room is available. All utility services are sited on the ground floor: there are offices and a staff room on the second floor, which can be accessed by a lift. The home has a bedroom for visitors who may wish to stay overnight. The home stands in its own grounds and there is a small car park to the front of the building. There are garden areas at various points around the home. Granby Care Home DS0000032775.V267096.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on November 18th 2005 over eight hours. At the time of the inspection there were 27 residents living at the home. The inspector spoke with six service users, three staff and the registered manager of the home. Documentation in respect of resident’s assessment, complaints, protection, resident’s finances and medication records were viewed. A full tour of the building was also conducted. What the service does well: What has improved since the last inspection? What they could do better: The Statement of Purpose and Service Users’ Guide for the home should be made available in the languages of the service users in the home Whist some work has been done to improve the decoration of the home this needs to be ongoing and identified areas addressed to maintain an acceptable physical standard. Granby Care Home DS0000032775.V267096.R01.S.doc Version 5.0 Page 6 The medication procedures need to be significantly improved to reduce risks to service users. The manger should ensure that all staff have completed training on the protection of vulnerable adults. Assessments should be carried out as to whether protective bumpers should be fitted where bedrails are in use. Staff interest in learning to speak languages other than English should be supported and encouraged to develop communication with the service users. Domestic staff should be employed in sufficient numbers to ensure the home is maintained in a clean and hygienic state, free from dirt and unpleasant odours. Formal supervision should be further developed and provided to staff at least six times a year. 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. Granby Care Home DS0000032775.V267096.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 Granby Care Home DS0000032775.V267096.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 and 6 The homes Statement of Purpose needs to be accessible to all potential service users. Prior to moving into the home, a full assessment takes place, which ensures that identified need can be met. EVIDENCE: The homes Statement of Purpose is still not available in languages other than English a previous requirement made in respect of this has not been met and remains. The homes manager advised that some work has been done in respect of this however due to the City Council considering revising the document and producing it in a different format this work has come to a halt awaiting the decision. Assessment records for three service users were viewed. This information provides staff with a good picture of needs, interests, abilities and support required. The home provides support for people from various cultural and religious backgrounds and anyone entering the home is advised of this to ensure a positive choice is made. Additional information from medical and Granby Care Home DS0000032775.V267096.R01.S.doc Version 5.0 Page 9 social care professionals was noted on file. There was also evidence of people being refused admission due to not meeting the criteria or being out of the homes registered category. If an emergency admission is made a member of the management team undertakes the initial assessment as soon as possible gaining as much information from social /health care professionals and family. Information from these assessments is used to create the care plan for each person. Staff confirmed that they were informed of this information and showed a good understanding of the needs of people living at the home. An individual who had been at the home for several months confirmed that she had been asked about the help she needed “ Staff (name given) asked me lots of questions, got to know me, they know what I like and don’t like”. People are not admitted to The Granby Care Home solely for intermediate care. Granby Care Home DS0000032775.V267096.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): 9 There are good systems in place within the home in respect of medication however these are not always applied therefore the medication practices adopted could place residents at risk. EVIDENCE: The current medication administration records (MAR) were examined it was noted that the recording of administration was not always accurate. The use of the key coding system at the bottom of the MAR was very poor leaving the records unclear and ambiguous on several occasions, the manager is advised to develop this key code system further to ensure any non-administration is clearly explained. Handwritten records were in place for people on respite the accuracy of these records was good. Dose omissions without explanation were noted and medication had not been given from the monitored dosage system but had been signed as administered. The above errors indicate staff relying heavily on the monitored dosage system and not following the correct administration procedures namely referring to the medication administration record whilst assembling the medication and signing Granby Care Home DS0000032775.V267096.R01.S.doc Version 5.0 Page 11 the record immediately after witnessing the resident taking it. The manager is advised to take appropriate steps to ensure all staff understands their responsibilities in administering and recording medication as prescribed by the GP. The pharmaceutical fridge was temperature monitored. The recording of returns was generally accurate; there is a dedicated book where each item is documented. The signature of the pharmacist or district nurse accepting the returns was noted. The home has good storage and a register in place for controlled drugs. It was noted on viewing this registered that a controlled drug last used May 2005 was not in stock, however the register had not been signed to confirm this has been returned. The manager was advised to investigate this. Granby Care Home DS0000032775.V267096.R01.S.doc Version 5.0 Page 12 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): None of the above standards were inspected at this visit. EVIDENCE: Granby Care Home DS0000032775.V267096.R01.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): 16 and 18 Arrangements for handling complaints are in place and concerns are responded to appropriately. All staff should receive training in respect of adult protection issues to help protect service users from potential abuse. EVIDENCE: The home has a copy of the Liverpool City Council complaints procedure and a document called “Have Your Say” which gives details of who to contact and the timescale for responses. These documents were viewed in the homes reception area and were available in several languages. The people living at the home, spoken to by the inspector, all responded that they are able to voice their views and know who to speak to if they are unhappy about any aspect of their care. Since the last inspection one complaint has been received and investigated by the manager and two concerns have been raised by staff one of which has been dealt with and one, which is still under investigation. One service user said, “we get together on the unit and talk about things, there is going to be another meeting before Christmas”. Granby Care Home DS0000032775.V267096.R01.S.doc Version 5.0 Page 14 The home has an abuse policy and a whistle blowing policy, however conversation with several staff members indicated that not all staff are conversant with these documents. If an allegation of abuse were made the Liverpool inter-agency adult protection procedures would be followed. Only four staff have attended training in this area, a senior member of staff at another of the councils homes has been trained in this area to enable her to cascade this training. The manager was reminded of the importance of this training and should ensure attendance by all staff. One service user said “I feel safe and well cared for here, we couldn’t ask for anything more”. Service users and staff are informed that staff are not permitted to accept gifts or witness any legal documents. Staff need to be advised against the use of store loyalty cards when shopping with or on behalf of service users. Granby Care Home DS0000032775.V267096.R01.S.doc Version 5.0 Page 15 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): 19,20,21,22,23,24,25 and 26 Limited improvements to the décor have been made. Some areas of the home look neglected and fail to provide residents with safe and comfortable surroundings. Suitable numbers of Domestic staff are required on duty to ensure thorough cleaning on a daily basis. EVIDENCE: The Granby Care Home is suitable for its purpose and provides each service user with an en-suite bedroom, which were personalised. The home is on a single level and is appropriate for people with mobility issues or who are wheelchair bound. There was suitable specialist equipment in the home and adaptations had been made to meet needs. Each of the three living units has a separate dining area and kitchenette, which enables service users to maintain their independence making drinks a simple snack. One service user was using the laundry facilities during the inspection to do her washing. One lady said about the home “it’s very quiet here, calm like, its nice”. Since the last inspection some minor repairs and decoration have been undertaken including Granby Care Home DS0000032775.V267096.R01.S.doc Version 5.0 Page 16 a new carpet being fitted in the atrium. The inspector toured the home and observed other areas that require attention, in particular: • • • • • There was still evidence of damp in the en-suite of room 26. There is still rust developing on grab rails and shower chairs in ensuites. Room 24 en-suite door is badly damaged and requires repair or replacing. Some carpets and flooring are stained or worn and not only look unsightly but will increase the trip hazard if not replaced. Several emergency call cords in the en-suite facilities were tied up out of reach this practice needs to cease in order that the service users can call for assistance in the event of an emergency. • Several ceilings are stained and damaged due to water leaking in through the roof. • Dishwasher fluids and other cleaning products found in kitchens require locking away to reduce the risk of these being ingested. • There was a strong odour in rooms 2 and 12. • Bed rails were still in place with no protective bumpers. • Room 12 had the shower chair missing and there was damage to the tiles where it had been situated Other minor issues were noted and were discussed with the manager at the time of the inspection. It was also evident that many areas of the home were not clean in particular carpets and floors had surface debris and en-suite floors were still very wet posing a hazard to service users. The home currently has insufficient domestic staff and it was evident that the sole domestic staff on duty on the day was unable to cover the workload in his allocated time. Granby Care Home DS0000032775.V267096.R01.S.doc Version 5.0 Page 17 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): None of the above standards were inspected at this visit. EVIDENCE: Granby Care Home DS0000032775.V267096.R01.S.doc Version 5.0 Page 18 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): 31,33,35 and 36 The manager is qualified, experienced and supported by the senior staff in providing clear leadership throughout the home. Evidence of formal supervision was available but not necessarily carried out on a regular basis and should be further developed to support and guide the staff group. EVIDENCE: The registered manager of the home has many years experience in the care field. Both the registered manager and her Deputy have completed their Registered manager’s awards and have previously completed their NVQ 4 in management. Another manager has also completed her NVQ 4 and is awaiting external verification. All the service users spoken to said that the management team were helpful and approachable. One service user said, “the bosses are really nice and friendly, you can talk to them.” Granby Care Home DS0000032775.V267096.R01.S.doc Version 5.0 Page 19 The service users spoken to confirmed that residents meetings are held on each individual unit to ascertain their views these are held on a monthly basis and minutes taken, interpreters are provided in these meetings wherever possible. However only two of the care staff are able to speak a language other than English. The home also has a suggestion box. The manager is considering re introducing the Friends of the Granby committee and has a mailing list in place. All service users benefits are paid direct to the City Council with the residue then being sent to the home many of the service users have amounts of money kept by the home and records of any transactions are kept with relevant receipts and securely stored, these were viewed by the inspector. Locked facilities are available in every room and service users are advised in respect of the homes insurance cover. All residents funding details are stored individually. Information in respect of power of attorney for service users is maintained. There was evidence of formal one to one staff supervision having taken place, particularly in respect of individual personal development reviews. However from observation of the manager’s records in this area, it was evident that staff do not routinely receive formal supervision on a regular basis. Through discussion with the registered manager, it is understood that staff, on occasions, do receive informal supervision on the floor but this is not necessarily recorded to identify the topics discussed. Staff spoken to confirmed that they were aware of staff supervision but had not been seen regularly one member of staff said they’d had one formal supervision within the last two years but felt well supported on a daily basis. Granby Care Home DS0000032775.V267096.R01.S.doc Version 5.0 Page 20 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 2 3 3 2 2 2 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X X Granby Care Home DS0000032775.V267096.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? No Granby Care Home DS0000032775.V267096.R01.S.doc Version 5.0 Page 22 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 OP1 Regulation 5 Requirement Timescale for action 31/03/06 2 OP9 13(2) The registered person is required to ensure that the Statement of Purpose and Service Users’ Guide to the home is made available in the languages of the service users in the home (timescale not met 30/06/05) 31/03/06 The registered manager is required to make arrangements for the recording, safe administration and disposal of medication. The following issues were identified: • The manager to develop the medication key code system further to ensure any non-administration is clearly explained. • Dose omissions without explanation were noted and medication had not been given from the monitored dosage system but had been signed as administered. A system of audit should be introduced. • Returns of medication should be monitored and recorded with a signature gained from the pharmacist 3 OP21 13 (4)(a) 4 5 OP24 OP26 23(2)(b) 23(2)(b) Granby Care Home The registered manager must 31/03/06 ensure all areas of the home are free from hazards to their safety. (Previous timescale not met 10/03/05) The registered manager must 31/03/06 address the environmental issues raised in the report DS0000032775.V267096.R01.S.doc Page 23 The registered manager is Version 5.0 31/03/06 required to ensure that all parts of the home are free from offensive odours. 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 2 3 4 5 Refer to Standard OP18 OP24 OP30 OP27 OP36 Good Practice Recommendations The manger should ensure that all staff have completed training on the protection of vulnerable adults. To assess whether protective bumpers should be fitted where bedrails are in use. Staff interest in learning to speak languages other than English should be supported and encouraged to develop communication with the homes service users. Domestic staff should be employed in sufficient numbers to ensure the home is maintained in a clean and hygienic state, free from dirt and unpleasant odours. Formal supervision should be further developed and provided to staff at least six times a year. Granby Care Home DS0000032775.V267096.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Granby Care Home DS0000032775.V267096.R01.S.doc Version 5.0 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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