Inspection on 21/07/05 for Granby Lodge

This inspection was carried out on 21st July 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 Lodge 12/12/06

Granby Lodge 12/12/05

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

CARE HOME ADULTS 18-65 Granby Lodge 10 Granby Road Harrogate North Yorkshire HG1 4ST Lead Inspector David Blackburn Unannounced 21 July 2005 12:30 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Lodge J53-J04 S63528 Granby Lodge V237179 210705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Granby Lodge Address 10 Granby Road Harrogate North Yorkshire HG1 4ST 01423 882462 01423 819329 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) Granby Lodge Care Limited Mrs Linda Ann Atcheson Care home only 14 Category(ies) of LD Learning disability (14) registration, with number of places Granby Lodge J53-J04 S63528 Granby Lodge V237179 210705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Registration for 14 service users with a learning disability some of whom may be over 65 years. Date of last inspection 16/12/04 Brief Description of the Service: Granby Lodge is a semi-detached Grade 2 listed building occupying four floors including cellars. A former dwelling house converted to a care home over 20 years ago, it provides single and shared accommodation on the upper three floors for adults with learning disabilities. Communal space is provided on the ground floor. The manager and staff seek to provide a holistic service including personal care, advice and guidance on matters of daily living, meals, laundry and a domestic service. Clients are encouraged to be involved in all aspects and activities of daily living according to their individual abilities and capabilities. A variety of in-house activities are provided. Clients also attend day care placements and a number of other activities organised outside the home. A large private garden is used for outdoor activities. Clients have easy access to the towns facilities and amenities through the homes central location and use of the registered providers motor vehicles. Full use is made of the local health services including doctors and dentists. Access to more specialised health and social care services is accessed through the doctor. Granby Lodge is owned by Granby Lodge Care Limited and managed on their behalf by Mrs Linda Atcheson who is one of the two directors of the company. Granby Lodge J53-J04 S63528 Granby Lodge V237179 210705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection on which this report is based was the first to be carried out in the inspection year April 2005 to March 2006. It was undertaken over 5.5 hours including preparation time. The focus was on a number of key standards together with any subject to requirements and recommendations at the last inspection. An inspection of some parts of the premises including bedrooms was carried out. A number of policies, procedures and records were examined. Discussions were held with the two directors of the company one of whom is also the manager, two staff members and six clients. The clients were seen in the privacy of their rooms or in the communal areas. Some were unable to enter into any meaningful discussion but a number made complimentary comments and gave positive feedback on the care and services provided in the home. Five clients were on holiday. What the service does well: Good assessment procedures were available should a vacancy arise in the home. These procedures would ensure any person admitted would have their personal needs and choices fully identified, understood and met. A well-defined care planning system was in operation that was easy to follow and understand. The wealth of information on each service user clearly showed in great detail their needs and how they would be met. Clients said they were well cared for. Staff were pro-active in encouraging service users to make full use of the local community and the mini-bus and other vehicles ensured easy access to facilities and amenities. Each client was given the opportunity of a holiday at a caravan owned by the registered provider. Service users enjoyed contact with family and friends. The premises were clean, warm, and free from offensive odours. Proper attention was given to the maintenance of hygiene. The staff was seen as a stable group with good morale who had received relevant training. A good interaction was noted between clients and staff. One client said “The staff are very nice to me. I like them.” Granby Lodge J53-J04 S63528 Granby Lodge V237179 210705 Stage 4.doc Version 1.40 Page 6 The home was properly managed. Appropriate attention had been given to matters of health and safety to ensure the home was a safe place in which to live and work. What has improved since the last inspection? What they could do better: Care plan reviews should be recorded on the review sheet produced by the registered provider. Records showing any financial transactions carried out on a client’s behalf must be kept up-to-date. Medication training should be made available to all staff who administer medicines. Enquiries should be made into the possibility of producing the complaints procedure in other formats so that it could be readily understood by all clients. The views of families, visiting professionals and other stakeholders in the home should be sought on the home’s overall performance. All hot water must be regulated so that it does not pose a risk of scalding. An immediate requirement notice to this effect was issued. Granby Lodge J53-J04 S63528 Granby Lodge V237179 210705 Stage 4.doc Version 1.40 Page 7 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 Lodge J53-J04 S63528 Granby Lodge V237179 210705 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Granby Lodge J53-J04 S63528 Granby Lodge V237179 210705 Stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2. Clients were assured their needs and choices would be properly assessed and met. EVIDENCE: The file of the last client to be admitted (March 2005) was examined. This contained a full and detailed assessment and initial care plan from the sponsoring authority. This was supplemented by information from other sources involved in the care of this client including a report from a previous placement. The process of admission was well documented in the daily record that showed the events and occurrences that affected this individual. The registered provider had produced assessment and pre-admission documentation that was comprehensive in the information it sought. This documentation would be used for all clients who were to be admitted on a privately funded basis. The registered manager said the procedure would also be used where information from a sponsoring authority was not thought to be in enough detail and further information was required. The insistence on full details of strengths and needs of prospective clients before admission gave confidence that their needs were not only properly assessed but could also be met by staff in the home. A number of clients said they were well looked after. Granby Lodge J53-J04 S63528 Granby Lodge V237179 210705 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 7. Clients’ needs, choices and preferences were well recorded ensuring they could be properly understood and met. EVIDENCE: Each client had a well-organised case file. A number were examined. They were comprehensive in the information provided and readily showed each client’s strengths, needs and how they were to be met, preferences in the way they were to be met and choices in activities inside and outside the home. Care plans had been reviewed. Some reviews had been carried out with the sponsoring authority and review notes were available in a few instances. For those without review notes from the sponsoring authority or where reviews had been carried out by staff, notes had been made on the individual client’s daily record. It was recommended that reviews be noted on the review proforma devised by the registered provider. The registered manager handled the personal money of a number of clients. Records were maintained and were seen. A number were not up-to-date. The registered manager must ensure such records accurately reflect the present financial situation of money held for or returned to the individual client. Granby Lodge J53-J04 S63528 Granby Lodge V237179 210705 Stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15. Clients’ access to local facilities and amenities, regular contact with family and opportunities for social interaction and holidays were promoted and maintained enabling them to have a number of different life experiences. EVIDENCE: Three clients had paid employment. Nine attended day care placements including ones with an educational input such as literacy, numeracy and computer skills. A number of Certificates of Achievement were seen. Some were reluctant to attend any form of placement. One client said “I don’t want to go. I don’t like joining in.” A number of evening and weekend activities took place off-site at various locations throughout the town. Clients were able to make good use of local facilities and amenities through the home’s central location and use of motor vehicles provided by the registered provider. Some clients were able to go out unaided while others needed staff support. One client spoke of her recent enjoyable outing to Knaresborough. Others said how much they enjoyed their day care placements and the activities they did there. Granby Lodge J53-J04 S63528 Granby Lodge V237179 210705 Stage 4.doc Version 1.40 Page 12 All clients were offered a holiday at a caravan at the seaside owned by the registered provider. The majority of clients took advantage of this opportunity. All clients were said to have visitors either family members or friends. The frequency of visits often depended on the ability and location of the visitor. For those some distance from the home contact was also maintained through telephone calls and letters. The home had a cordless telephone with large keypad for clients’ use. A visiting policy was displayed in the hall. All visitors were reminded that they were entering the home of not only their relative or friend but also of a number of other people. Granby Lodge J53-J04 S63528 Granby Lodge V237179 210705 Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20. Clients’ health care was promoted and maintained through proper medication procedures. EVIDENCE: Policies and procedures on all aspects of medication had been produced and were seen. Proper arrangements had been made for the receipt, storage, administration, recording and return or disposal of medicines. A monitored dosage system was in operation. All medicines were stored in a locked cupboard. Scrutiny of the medication administration record sheets (MAR) revealed no discrepancies. The home had been subject to a visit from a Pharmacy Inspector in February 2003. A copy of the report was seen. All recommendations made were being followed. The home was visited by the local dispensing pharmacist. The one recommendation made in the last report of November 2004 had been addressed. The registered manager had undertaken external training on the safe handling of medicines. It was recommended that all staff who administer medication undertake a similar course. Granby Lodge J53-J04 S63528 Granby Lodge V237179 210705 Stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22. Clients had confidence their concerns and worries would be listened to and acted upon. EVIDENCE: A complaints policy and procedure was seen. A copy of the actual complaints procedure was displayed in the hallway. The procedure showed how to complain, to whom and gave timescales for a response. The address and telephone number of the regulatory authority were clearly shown. A residents’ meeting was held on a regular basis and the minutes were seen. These showed that a number of issues had been discussed and clients asked whether they had any worries or concerns. The minutes recorded the concerns expressed and how they had been addressed. The registered manager also felt that as many clients had regular visitors and others saw their family away from the home or had regular telephone contact if there were concerns about their care these would be raised without delay. In discussion it was agreed that the registered manager would make enquiries of a number of specialist organisations involved in the care of people with disabilities to seek advice about the production of the complaints procedure in different formats. Granby Lodge J53-J04 S63528 Granby Lodge V237179 210705 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30. Clients were provided with a homely, comfortable, safe and hygienic place in which to live. EVIDENCE: Granby Lodge is a Grade 2 large semi-detached building situated in a residential area of the town. Its’ location makes it convenient for access to local facilities and amenities and the town centre. It was originally converted to a care home over 20 years ago. It was purchased by the present registered providers in June 2003. It occupies four floors including basement. The upper floors all have bedroom accommodation with the ground floor providing the communal space. Of the 10 bedrooms, four are shared, two with en-suites and six singles, four with en-suites. Specialist baths had been provided as new equipment or to replace older normal baths. A number of bedrooms were seen. All were of good size. The actual provision of furniture and equipment in each room varied according to the wishes of the individual client, their particular needs, ability to cope within the bedroom and their agreed care regime. Each had been personalised and decorated Granby Lodge J53-J04 S63528 Granby Lodge V237179 210705 Stage 4.doc Version 1.40 Page 16 according to individual choice. Service users had brought in a number of personal items. Rooms had suitable floor coverings, bedding and curtains. All bedrooms seen had suitable door locks. Keys were said to be available to those service users who could use them. One client said she was “very happy” with her room. “My room’s nice. I have a lot of my things here.” Another said he was “very comfortable”. The home appeared to be in good structural and decorative condition internally and externally. It was furnished in a domestic style and provision was in good and serviceable condition. The premises were clean, warm, tidy and free from unpleasant odours. The laundry was located in the basement. Proper procedures were in place for the promotion and maintenance of hygiene and the elimination of cross infection. Bedding, towels, linen and personal clothing could be taken to and from the laundry without the need to cross any communal area or places where food was being prepared or eaten. Granby Lodge J53-J04 S63528 Granby Lodge V237179 210705 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 35. Clients were given consistent care through the employment of a small but well motivated and well-trained staff group. EVIDENCE: There is a small staff team of 11 carers supported by the registered manager (one of two company directors) and the second director who takes responsibility for administrative duties and transport. The rota was examined. This showed staff deployment on a variety of shifts from a minimum of two on duty to a maximum of five. Actual staff deployment depended on the time of day and the number of clients in the home. The needs of particular clients who might be in the home at certain times also dictated how the rota was managed. Weekdays through the late mornings and early afternoons saw fewer staff on duty than on weekends and evenings. Eight of the eleven care staff had achieved a National Vocational Qualification (NVQ) in care to at least level 2. This was confirmed by the two staff on duty. The staff also corroborated the registered manager’s comments about staff training. The staff on duty said they had received induction training, support for their NVQs and work in association with the Learning Disabilities Award Framework (LDAF). They had undertaken training in first aid, health and Granby Lodge J53-J04 S63528 Granby Lodge V237179 210705 Stage 4.doc Version 1.40 Page 18 safety, food hygiene and fire safety. They were to go on a moving and handling course in the near future but had already received instruction on the use of any specialist equipment in the home. Staff felt they provided good care with attention to detail. They said they worked well together and felt morale was high. Clients made complimentary remarks about staff. “They’re nice.” “I like them.” Granby Lodge J53-J04 S63528 Granby Lodge V237179 210705 Stage 4.doc Version 1.40 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39 and 42. Clients were able to live in a properly managed, safe and secure environment. EVIDENCE: The registered manager had a variety of skills, knowledge and experience together with training in areas specific to the present resident group. She was undertaking the Registered Managers (Adults) NVQ 4 award. Consideration had been given to the distribution of questionnaires to clients on seeking views on the performance of the home. This had been dismissed as it was felt many could not understand what was required. The registered manager thought the Residents’ Meeting was a good avenue to seek clients’ views. However she agreed to consider an approach to families, visiting professionals and other stakeholders to gain their comments on the overall performance of the home. Granby Lodge J53-J04 S63528 Granby Lodge V237179 210705 Stage 4.doc Version 1.40 Page 20 The registered manager and the staff were conscious of good practice in relation to health and safety maintenance. They were keen that the health, welfare and safety of service users, staff and visitors were maintained by the implementation of the correct procedures. Policies existed and were seen on general health and safety matters, COSHH (storage of hazardous substances), infection control and fire safety. A number of satisfactory safety reports and certificates were seen relating to the premises. A check on hot water temperatures recorded some outlets in excess of 48 degrees Centigrade. All hot water must be regulated to around 43 degrees Centigrade. An immediate requirement notice to this effect was issued. Granby Lodge J53-J04 S63528 Granby Lodge V237179 210705 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score 2 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 1 x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 x x Standard No 31 32 33 34 35 36 Score x x 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Granby Lodge Score x x 2 x Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x 1 x J53-J04 S63528 Granby Lodge V237179 210705 Stage 4.doc Version 1.40 Page 22 NO. 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. Standard 7 Regulation 12 & 17(2) Schedule 4.9. 13(4) Requirement The records of all financial transactions carried out on behalf of service users must be kept up-to-date. The hot water temperature to outlets accessed by service users must be regulated to around 43 degrees Centigrade. Timescale for action 15/08/05 2. 42 Immediate notice to be placed and hot water regulated by 31/07/05. 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. 2. 3. 4. Refer to Standard 6 20 22 39 Good Practice Recommendations Care plan reviews should be recorded on the review form produced by the registered provider. All staff who administer medicines should receive accredited medication training. Consideration should be given to producing the complaints procedure in different formats. The views of families, visiting professional and other stakeholders should be sought on the homes overall performance. J53-J04 S63528 Granby Lodge V237179 210705 Stage 4.doc Version 1.40 Page 23 Granby Lodge Granby Lodge J53-J04 S63528 Granby Lodge V237179 210705 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Unit 4, Triune Court Monks Cross York YO32 9GZ 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. 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