CARE HOMES FOR OLDER PEOPLE
Granby Care Home 50 Selborne Street Liverpool Merseyside L8 1YQ Lead Inspector
Mrs Lynne Lynch Unannounced Inspection 24th February 2006 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 Granby Care Home DS0000032775.V283154.R01.S.doc Version 5.1 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.V283154.R01.S.doc Version 5.1 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.V283154.R01.S.doc Version 5.1 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. 18th November 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 safety 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.V283154.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on February 24th 2005 over nine and half hours. At the time of the inspection there were 26 residents living at the home. The inspector spoke with five service users, four staff, the Deputy manager and the registered manager of the home. A staff member asked many of the Chinese speaking residents on the blue unit if they wished to speak to the inspector with her acting as translator, however all the residents asked declined. The staff member advised that she felt that this was a cultural issue and that the Chinese people in the home did not like to pass comment and were very tolerant and accepting by nature. Documentation in respect of resident’s Care Planning and associated risk assessments were viewed. Staff files were inspected and some of the written policies were viewed. Records relating to menus and activities in the home were also seen and observation of residents and staff interaction was observed throughout the day. Key standards not assessed at this inspection will have been addressed at the previous inspection on the 18th November 2005. What the service does well: What has improved since the last inspection? Granby Care Home DS0000032775.V283154.R01.S.doc Version 5.1 Page 6 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. Some of the staff team have completed training on the protection of vulnerable adults. Formal supervisions have been planned for the forthcoming year these should be monitored. 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
Granby Care Home DS0000032775.V283154.R01.S.doc Version 5.1 Page 7 contacting your local CSCI office. Granby Care Home DS0000032775.V283154.R01.S.doc Version 5.1 Page 8 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.V283154.R01.S.doc Version 5.1 Page 9 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): None of the above standards were inspected at this visit. EVIDENCE: Granby Care Home DS0000032775.V283154.R01.S.doc Version 5.1 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 and 10 Care plans evidenced should be further expanded and developed to ensure that they provide a full and accurate account of current strengths, needs and requirements. Individual risk assessments should be in place for all residents. The health care needs of residents are well met with evidence of good multi disciplinary working taking place on a regular basis. EVIDENCE: All residents at the home have an individual plan of care based on current assessed strengths and needs that is developed from the initial assessment process. However on a number of care plans evidenced, there was insufficient guidance for staff for example one residents care plan stated that he required walking exercise with no indication of the level of support required or distance he was able to cover stated even though he had poor mobility. Individual risk assessments were not available for all residents even though a statement of risk had been made. Some manual handling risk assessments were old and require reviewing. The outcome of the risk assessment must then be incorporated in the individual care plan and reviewed on a regular basis. The Deputy manager advised that they were awaiting new risk assessment documentation from the City Councils Health and Safety Department. All Care Plans were not signed by the service user or their representative; this should
Granby Care Home DS0000032775.V283154.R01.S.doc Version 5.1 Page 11 be done wherever possible as acknowledgement of their understanding and acceptance of the content. In instances where a service user cannot sign their care plan or do not wish to become involved in the process, this should be recorded. It was evidenced through discussion; observation and documentation that Residents health needs are fully met. The home maintains a good relationship with health and social care professionals in order to maintain health and social well being. One Residents health had clearly deteriorated due to her reluctance to eat and drink there was good evidence on her file of encouragement being given by staff and liaison with her GP. A referral to a consultant had been made for a further assessment. The home had obtained food supplement drinks, and requested a nursing bed and other specialist equipment to meet this ladies health needs in particular pressure area care. Good records of fluid intake and pressure relief had been maintained. Staff confirmed that they were aware of the importance for privacy and dignity via training received. One service user spoken to said, “staff show me respect here, they are nice to me, they treat me very well. The inspector observed a service user receiving his medication via his PEG (percutaneous endoscopic gastrostomy) and this was seen to be done in the privacy of his own room. Following the previous inspection were concerns regarding medication procedures were noted the Commission For Social Care pharmacist inspector was requested to visit the home to assess the medication standard. As is normal practice following a pharmacist inspection, a separate letter in respect of the findings has been provided to the responsible person and home’s manager. Granby Care Home DS0000032775.V283154.R01.S.doc Version 5.1 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): 12, 13, 14 and 15 Activities within the home need to be planned and reflective of resident are interests. Residents are encouraged to maintain contact with family and friends and links with the community are promoted. The home provides healthy meals, which meet cultural and dietary needs, however the storage of cooked meals should be monitored. EVIDENCE: During the course of the inspection it was observed that the routines of daily living and activities remain flexible to meet individually assessed needs. Residents are enabled as far as possible to exercise choice in all aspects of their daily life. Social relationships are encouraged either through family/friends visiting or social stimulation from the wider community. It was evidenced that the individual residents interests are recorded on the care plan. There is no programme of activities for the home and these are left to be organised on an ‘ad hoc’ basis. There was evidence of planned activities occurring around special dates such as Christmas and cultural events such as the Chinese New Year, however there were no future events planned for the forthcoming year. Staff at the home have a good awareness of important religious and cultural dates, which are relevant to the many residents from ethnic communities. The manager advised that two of the Chinese residents
Granby Care Home DS0000032775.V283154.R01.S.doc Version 5.1 Page 13 had attended a special community event to celebrate the Chinese New Year. A craft tutor visits the home every Monday afternoon and this is something that residents say they enjoy. Staff will also take residents out in the local community for appointments or shopping if they so wish. The manger advised that a local day centres minibus can be used, however staffing difficulties have complicated plans for trips out. Contact with family and friends is encouraged and residents are able to have visitors at any time of their choice. Visitors are made welcome and can be entertained in the privacy of individual bedroom accommodation or in any communal area of the resident’s choice. The home maintains good contact with the local Chinese community and many people from this community visit residents in the home and are able to advocate for them at times. Individual religions and beliefs are respected and the Dean from the local church visits the home weekly to conduct a service. Wherever possible, residents are encouraged to maintain control of their own financial affairs. However in reality the majority of residents accommodated require assistance in this task that is usually provided by family or a solicitor. Details of a local advocacy service are available in the home. All residents are encouraged to bring personal possessions into the home, which was evidenced, through observation. Residents and their relatives are made aware that documentation is held in respect of themselves, and of their right to contribute to or access this documentation. Residents at The Granby are offered a varied, wholesome and nutritious diet with menus designed to incorporate the known likes and dislikes of residents accommodated. Specialist diets in respect of religious, cultural or medical need are accommodated. The home has kitchen areas on each residential unit where hot and cold drinks and snacks can be prepared throughout the day and night. Resident’s spoken with were mainly positive in their comments regarding the quality and variety of the meals served, however comments were received suggesting that the food is put in the heated trolley to early causing it to become dry and a little tough at times. A member of staff advised that one lady had a pie for tea and this was very tough to cut. There is a set four weekly menu however it was observed that a choice is always available should anyone not wish to have the set meal. Granby Care Home DS0000032775.V283154.R01.S.doc Version 5.1 Page 14 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): None of the above standards were inspected at this visit. EVIDENCE: Granby Care Home DS0000032775.V283154.R01.S.doc Version 5.1 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): None of the above standards were assessed at this inspection. EVIDENCE: Although none of the above standards were inspected, the inspector noted that some improvements had been made in respect of the issues raised in the previous report. Granby Care Home DS0000032775.V283154.R01.S.doc Version 5.1 Page 16 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, 28, 29 and 30 The City Councils policies and procedures for the recruitment of staff are robust and provide safeguards for the protection of residents, however records held in the home fail to reflect this. The home has several staff vacancies; hours worked by external domiciliary care staff should be planned and monitored to ensure consistency of care. EVIDENCE: Staffing rota’s were viewed and indicated that staff were working additional hours to supplement the rota. The rotas showed that there were generally two to three staff on each residential unit during the day with three waking staff covering the home overnight. The manager advised that the staffing during the day is considerably below the agreed levels for the home. The home currently has five care staff vacancies and two domestic staff vacancies all staff spoken to felt that they were short staffed at times. One member of staff said “we are always short staffed on this unit, sometimes there is just one staff and no cleaner, so we are expected to work on our own and clean as well”. The city council has an arrangement with the home care team where staff that haven’t worked all their hours in the community complete their shifts at The Granby. This arrangement means that staff are sometimes coming for only half an hour at a time. The manager of the home does not seem to receive prior notification of these staff members arrival and is unaware when they are coming to the home, for how long, and in what capacity. This appears to cause confusion and disruption to the home and interferes with the consistency of care. Granby Care Home DS0000032775.V283154.R01.S.doc Version 5.1 Page 17 The manager does not have supervisory responsibility for these staff and is unaware of the qualifications they hold which may pose a risk to the residents of the home. The city council has clear Recruitment and Selection procedures. Staff files for three members of staff were viewed. This standard could not be fully evidenced as not all information required in schedule 2 and 4 of the care homes regulations is held in the home. The information is held centrally at the City Councils Human Resources Department. A meeting was held with the Responsible Individual and The Commission for Social Care Inspection following an inspection in March 2005 an agreement was reached that records regarding references and the Criminal Records Bureau (CRB) disclosure would be recorded at the home this is now a matter of urgency. There is not a current training matrix for staff at the home records showed that all mandatory training areas are covered on the City Councils intranet site. The inspector viewed the site with the manager, who explained that she has been unable to plan training for the current year, as dates for most of the training areas were not currently available. Some staff have attended Equality, Diversity and Cultural awareness training however due to the home providing care to high proportion of multi racial residents it would be advisable that more of the staff team attend these courses. Several of the residents in the home have some form of cognitive impairment, however none of the staff team have attended training in Dementia, this would be advisable. The staff team should be commended for their commitment to achieving their NVQ qualifications with all but two staff at the home now qualified at NVQ 2 or above. Several staff were spoken to during the day they felt happy with the training available, however they felt that staffing levels sometimes compromised their attendance. Residents spoken to generally felt staff were competent and supported them well. Some residents felt there wasn’t enough staff. Two members of staff spoken to felt that they didn’t always receive clear direction from senior staff and felt that when they were understaffed that senior staff should assist on the floor. The management team advised that support was given when necessary. One staff member advised that there has been a high turnover of staff in the home and this had obviously affected consistency. There is only one member of care staff who can communicate with the Chinese residents in the home; the staff team is not reflective of the cultural composition of residents. Staff feel this can sometimes cause frustration for these residents, as at times they are unable to express their daily needs, although the staff team do work hard at communicating with all the residents. Staff meeting dates were viewed on each units notice board and were planned on a monthly basis. Granby Care Home DS0000032775.V283154.R01.S.doc Version 5.1 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): 38 Staff training, policies and good practice promote the health and safety of those living and working at The Granby. Safety procedures and signage should be produced in languages relevant to the residents in the home. EVIDENCE: The pre –inspection questionnaire left at the home during the previous inspection was not returned therefore information relating to maintenance and associated records had to be viewed during the inspection. Safety certificates were all up to date. A number of records were viewed these included fire drills and equipment testing, emergency lighting and the regulation of water temperatures. Fire training is now in place with day staff attending at six monthly intervals and night staff every three months. All accidents and incidents records were maintained, the deputy manager up until her recent absence from the home had been recording and monitoring falls in the home
Granby Care Home DS0000032775.V283154.R01.S.doc Version 5.1 Page 19 and advised this would now recommence. A number of staff need to attend areas of mandatory training the manager is awaiting new training dates for these areas. Safety procedures and signage are posted throughout the home, however these are not in formats readily understood by all residents and consideration should be given to producing these in the relevant languages. Granby Care Home DS0000032775.V283154.R01.S.doc Version 5.1 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Granby Care Home DS0000032775.V283154.R01.S.doc Version 5.1 Page 21 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 OP1 Regulation 5 Requirement The registered person is required to ensure that the Statement of Purpose and residents’ Guide to the home is made available in the languages of the residents in the home (timescale not met 30/06/05) 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 nonadministration 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
DS0000032775.V283154.R01.S.doc Timescale for action 31/03/06 2. OP9 13(2) 31/03/06 Granby Care Home Version 5.1 Page 22 3. OP21 13 (4)(a) 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 provider must continue to address the environmental issues raised in the previous report The home must maintain records for employees as listed in schedule 4(6) 31/03/06 4. OP24 23(2)(b) 5. OP29 17(2) Schedule 4 30/04/06 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 OP7 Good Practice Recommendations Care plans should be signed and further developed and regularily updated to reflect current strengths and needs and formal risk assessments should be undertaken where a risk has been identified. The provision of activities should be reviewed to develop a clear plan for daily activities and ensure personal preferences and needs are met. The storage of cooked meals should be monitored to ensure they are not left in trolleys for an extended length of time to ensure food is served at its best. 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. The staff team should reflect the cultural composition of residents. Staff interest in learning to speak languages
DS0000032775.V283154.R01.S.doc Version 5.1 Page 23 2. 3. OP12 OP15 4. 5. 6. OP18 OP24 OP27 Granby Care Home 7. OP26 other than English should be supported and encouraged to develop communication with the homes residents. 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. The manager should have a planned rota of all staff working in the care home and have an awareness of their competence and abilities. Formal supervision should be further developed and provided to staff at least six times a year. Safety procedures and signage should be produced in languages, which are relevant to the residents in the home. 8. 9. 10. OP27 OP36 OP38 Granby Care Home DS0000032775.V283154.R01.S.doc Version 5.1 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
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