Inspection on 16/07/05 for Granby Place

This inspection was carried out on 16th 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 Place 15/01/09

Granby Place 17/01/08

Granby Place 24/07/07

Granby Place 20/07/06

Granby Place 08/11/05

Granby Place 08/11/04

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

CARE HOME ADULTS 18-65 Granby Place 1-3 High Street Northfleet Gravesend Kent DA11 9EY Lead Inspector Eamonn Kelly Announced 16 July 2005 11:00am 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 Place H56-H06 S59719 Granby Place V229875 160705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Granby Place Address 1-3 High Street Northfleet Gravesend Kent DA11 9EY 01474 326233 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) DGSM Limited Mrs Rae Sayers Care Home 10 Category(ies) of Learning Disability (10) registration, with number of places Granby Place H56-H06 S59719 Granby Place V229875 160705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Two of the 10 services users also have mental health difficulities . Ages will be from 45 years of age and above. Date of last inspection 08 November 2004 Brief Description of the Service: The home provides accommodation and residential care for up to 10 people with learning disabilities. There is a condition of registration relating to the category of service users at the home and the ages of service users. Each service user has a single bedroom, one of which is on the ground floor (to facilitate a service user with more pronounced mobility problems). Twenty four hour supervision is provided (with one support worker on sleep-in duty at night). The premises are close to local facilities and to public transport. There is a carpark and garden at the rear. Granby Place H56-H06 S59719 Granby Place V229875 160705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection consisted of meeting with service users (most of whom were at the home on a Saturday) and members of staff. Use was made of a preinspection questionnaire. There was a very limited response to the Commission’s “comment” card survey (ie. quality assurance questionnaires intended for service users, relatives/friends, social and healthcare staff). An inspection of the premises was made. Some of the home’s records were checked. A brief summary of the requirements and recommendations to be contained in the inspection report was given to the registered manager at the end of the inspection visit. What the service does well: What has improved since the last inspection? What they could do better: The written pre-admission information should be improved. The personal contract for new service users should be reviewed and improved. The Granby Place H56-H06 S59719 Granby Place V229875 160705 Stage 4.doc Version 1.30 Page 6 furnishing in bedrooms should fully reflect the needs of service users. The complaints procedure should be reviewed and updated. The assessment process for staff undertaking NVQ 2/3 in Care qualifications must be improved. Additional staff training is necessary. The staff supervision process should be improved to ensure that all relevant issues are identified and addressed. 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 Place H56-H06 S59719 Granby Place V229875 160705 Stage 4.doc Version 1.30 Page 7 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 Place H56-H06 S59719 Granby Place V229875 160705 Stage 4.doc Version 1.30 Page 8 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) 1 & 5. Prospective service users and their supporters do not receive the levels of assistance that is required at admission stage from current pre-admission documents. The longer-term aspirations of service users are not served well by current procedures. EVIDENCE: The pre-admission information available for prospective service users and their supporters was assessed in some detail. It was agreed with the registered manager that the current documents, whilst containing some useful information, does not comprise full and unequivocal information about the home’s services and facilities. The manager undertook to produce material that would be appropriately informative and accurate. The manager also undertook to review the current personal contract and to have a revised contract available for any new service users. The shortfalls in the current personal contract for service users were discussed in some detail with the manager and ideas were exchanged to enable the new document to comply more fully with the requirements of national minimum standards. During the case tracking exercise (ie. assessment of the care needs of some service users), it was agreed by the manager that the home needed to carry out more work to ensure that the personal aspirations of all service users are being met in all cases. This is likely, it was agreed, to require significant Granby Place H56-H06 S59719 Granby Place V229875 160705 Stage 4.doc Version 1.30 Page 9 further insights by members of staff into working with people with mental health difficulties. Granby Place H56-H06 S59719 Granby Place V229875 160705 Stage 4.doc Version 1.30 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) x These Standards were not assessed on this occasion. EVIDENCE: Granby Place H56-H06 S59719 Granby Place V229875 160705 Stage 4.doc Version 1.30 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) 11 & 13 Service users are enabled to be part of the local community. However, additional work is needed to enable all service users to have appropriate and sufficient opportunities for personal development. EVIDENCE: Service users are helped to remain part of the local community. During weekdays, service users attend Gravesend SEC (social education centre), TRACS day centre at Longfield, Perry St day centre at Gravesend and Age Concern at Gravesend. Transport facilities are provided by the day centres. Service users have the opportunity to have voluntary and paid employment. These arrangements have been in place for some years and service users have become used to them. Service users also spend time at the home in the evening, at weekends and on the days when they do not attend day centres. Some go shopping in small groups with members of staff. They also visit local venues. Granby Place H56-H06 S59719 Granby Place V229875 160705 Stage 4.doc Version 1.30 Page 12 There was some evidence during the inspection visit that the home is having difficulty in assessing the personal aspirations of some service users. This is particularly important because of the home’s registration conditions. The need to address the requirements of service users who are actually attempting to communicate their frustrations and aspirations was discussed in some depth during the inspection visit. It is likely that these attempts at communication are being interpreted by the home as signs of “challenging behaviour” and chances are being missed to enable service users to have significant, sufficient and appropriate opportunities for personal development. Granby Place H56-H06 S59719 Granby Place V229875 160705 Stage 4.doc Version 1.30 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) 21 Service users receive appropriate and commendable care when severe illnesses and age-related problems occur. EVIDENCE: The insight of members of staff into the challenges of aging faced by service users is considerable. The home has enabled a service user with developing mobility problems to remain at the home. Members of staff understand the issue of development of dementia in service users at a younger age: observations during the inspection visit demonstrated how thoughtful consideration is given towards assisting service users. Granby Place H56-H06 S59719 Granby Place V229875 160705 Stage 4.doc Version 1.30 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 Service users are not well served by the lack of clarity of the complaints leaflet displayed. Their expressed concerns are not being sufficiently addressed. EVIDENCE: The complaints procedure displayed at the home was not clearly expressed. The manager undertook to review and improve this document. There was a poor response to the Commission’s “comment” cards. These are intended to elicit the views of service users, their friends and family and social and healthcare professionals. There was some evidence that the expression of dissatisfaction by service users is regarded by the home as “challenging behaviour” and that there is no suitable resolution to this “behaviour” (ie in a review document it was stated that “the home is not set up to manage people with challenging behaviour”). Granby Place H56-H06 S59719 Granby Place V229875 160705 Stage 4.doc Version 1.30 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, 26, 30 Service users have the benefit of a comfortable home. However, some improvements to the comfort of individual bedrooms are needed to help promote service user independence. EVIDENCE: All service users have single bedrooms, 9 of which are on the first floor and are not served by a shaft or stair lift. The garden is not enclosed by a fence at the rear and directly opens on to the car park and service road. Bedrooms are reasonably well furnished. The manager undertook to carry out improvements to some bedroom facilities (eg. provision of an armchair, and completion of redecoration in a bedroom). The provision of suitable furniture would also promote service user independence. During the inspection visit, the home was clean and hygienic. Granby Place H56-H06 S59719 Granby Place V229875 160705 Stage 4.doc Version 1.30 Page 16 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) 32, 35 & 36 Service users have the benefit of support by members of staff who have a good understanding of their needs and disabilities. Nevertheless, the shortfalls in the training programme needs to be addressed to enhance the competence of staff to meet the very diverse support needs of service users. EVIDENCE: Some support workers are undertaking NVQ Level 2 & 3 in Care under the direction of a commercial training organisation. Their progress, as outlined by them during the inspection visit, is significant. Members of staff undertaking the in-house assessed NVQ scheme have made little progress: the reason was that in-house support and the required assessment was not provided over a long period and now full support has been withdrawn. A discussion took place during the inspection visit of the range of appropriate and up to date training received by members of staff. At least 2 additional members of staff should be facilitated to receive training in first aid. The manager undertook to have this training organised. In addition, the manager undertook to review the training needs of support staff to ensure that each had received the necessary mandatory training to meet the needs of service users (there were shortfalls in some areas such as moving and handling, food hygiene, medication). The manager also undertook to urgently review the need Granby Place H56-H06 S59719 Granby Place V229875 160705 Stage 4.doc Version 1.30 Page 17 to provide suitable support and training to assist support workers address the needs of service users who have mental health difficulties. The manager outlined the operation of the home’s staff supervision system. This system should have identified earlier that the in-house NVQ assessment system was not serving members of staff well and addressed the problem earlier. Nevertheless, the manager has undertaken to have members of staff affected transferred to an external scheme and to try to have their work over a long period credited. The proposed better operation of the staff supervision system is also likely to ensure that the shortfall in provision of mandatory training (identified during the inspection) is effectively addressed. Granby Place H56-H06 S59719 Granby Place V229875 160705 Stage 4.doc Version 1.30 Page 18 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 Service users benefit from a well run home. However, their interests would be promoted if the home developed procedures that enable all service users to express their concerns with confidence and to proper effect. EVIDENCE: The registered manager is currently undertaking the Registered manager’s Award. She undertook to review and improve a number of issues associated with the direct care of current and future service users as discussed during the inspection visit. The report refers earlier to the difficulty the home is experiencing in producing relevant pre-admission material for prospective service users and their supporters, to the poor use of the Commission’s quality assurance feedback system, to the difficulty in meeting the needs of service users who express concerns and are said to exhibit “challenging behaviour”, and to the need to pick up operational problems through effective use of the staff supervision system. Granby Place H56-H06 S59719 Granby Place V229875 160705 Stage 4.doc Version 1.30 Page 19 The manager is not currently submitting reports at reasonable intervals to the Commission based on review and improvement of the quality of care at the home. Nevertheless, during this inspection visit on a weekend when most service users were at home there was a positive atmosphere and service users were generally at ease. In the pre-inspection questionnaire, the registered manager made a declaration that all maintenance and associated safety certificates are in place and up-to-date. Those seen during the inspection visit were satisfactory. Granby Place H56-H06 S59719 Granby Place V229875 160705 Stage 4.doc Version 1.30 Page 20 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 2 x x x 2 Standard No 22 23 ENVIRONMENT Score 2 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x x x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x 2 x x x 3 Standard No 11 12 13 14 15 16 17 2 x 3 x x x x Standard No 31 32 33 34 35 36 Score x 3 x x 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Granby Place Score x x x 4 Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x 3 x H56-H06 S59719 Granby Place V229875 160705 Stage 4.doc Version 1.30 Page 21 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 1 Regulation 4&5 Requirement Timescale for action 30/09/05 2. 11 12 & 22 3. 22 22 4. 35 & 36 18 (2) The registered person shall produce a written guide to the care home... The current guide is acknowledged but the improvements discussed are necessary to enable prospective service users and their supporters to obtain specific and objective information about the homes services and facilities. The registered person 01/09/05 shall..enable service users to make decisions with respect to the care they are to receive and to their health and welfare. (Regulation 12.2). Service users shall have proper opportunities to learn and use life skills (eg. assertion and confidence training) including user-led training. (NMS 11) The copy of the complaints 01/09/05 procedure..shall include the name, address and telephone number of the Commission. The copy of the complaints procedure displayed should be clear and easily read by service users and visitors. The registered person shall 30/09/05 ensure that persons working in Version 1.30 Granby Place H56-H06 S59719 Granby Place V229875 160705 Stage 4.doc Page 22 5. 39 24 6. 26.1 & 26.2 16, c the care home are appropriately supervised. Whilst it is acknowledged that a supervision process is in operation, if the operation of the system had been effective the shortfall in inhouse NVQ assessment would have been recognised earlier and the training needs of staff (eg. the need for appropriately trained first aiders) is more likely to have been addressed. These operational improvements should now be implemented. The registered person shall 01/09/05 establish and maintain a system for reviewing..and improving the quality of care at the home..The registered person shall supply to the Commission a report in respect of any review conducted... It is recommended that the first of these these occasional reports from the manager should include progress on topics referred to in this report. The registered person shall 01/09/05 provide in rooms..adequate furniture... 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 5 Good Practice Recommendations It is recommended that the personal contracts for new service users are reviewed and, if necessary, updated so that the contracts reflect the reasons why the service user is receiving residential care. Granby Place H56-H06 S59719 Granby Place V229875 160705 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone, Kent ME16 9NT 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 Place H56-H06 S59719 Granby Place V229875 160705 Stage 4.doc Version 1.30 Page 24 - 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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