Inspection on 24/07/07 for Granby Place

This inspection was carried out on 24th July 2007.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Granby Place 15/01/09

Granby Place 17/01/08

Granby Place 20/07/06

Granby Place 08/11/05

Granby Place 16/07/05

Granby Place 08/11/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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 Ruth Burnham Key Unannounced Inspection 24th July 2007 9:30 Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 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 Place DS0000059719.V345524.R01.S.doc Version 5.2 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 Adults 18-65. 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 Place DS0000059719.V345524.R01.S.doc Version 5.2 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 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) http/www.dgsmencap.org.uk DGSM Limited Mrs Rae Sayers Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two of the 10 service users also have mental health difficulties Ages will be from 45 years of age and above 20th July 2006 Date of last inspection Brief Description of the Service: Granby Place provides accommodation and support for up to 10 people with learning disabilities who are forty-five years of age or above. Currently there is a condition of registration for two residents who also have mental health difficulties. The home is one of four services, within the area, provided by DGSM Limited. The building is owned by a housing association. Granby Place is located in Northfleet High Street and is within easy reach of public transport and all the usual town amenities. Residents have single bedrooms which are located on the ground and first floor. There are two lounge areas, a dining room and a visitors’ room. There is a garden to the rear of the property with car parking facilities. The home employs support workers, operating a roster, which gives 24-hour cover. There is one member of staff who ‘sleeps-in’ at night with on-call cover. The home does not employ specific staff for catering or domestic duties. Current fees for the home are £621.90 per week. Full information about the fees payable and the service the home provides, including inspection reports by the CSCI, are available from the manager. Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced site visit took place on 24th July 2007 as part of the key inspection. The visit included talking with senior support workers, support workers and residents. The manager was present for the last hour of the visit. Some judgements about the quality of life within the home were taken from observation and conversations. Some records were looked at. In addition, a tour of the home and garden was undertaken. Residents were happy to talk to the inspector about their life in the home. Granby Place currently has ten residents with no vacancies. What the service does well: What has improved since the last inspection? What they could do better: Prospective residents would benefit from additional easily understood information before they decide to move in. They would benefit from the cost of their holidays being included within their contract price. Care plans and assessments should be up to date and provide clear guidance to staff on how to meet individual needs and maintain their skills and interests. The specialist needs of residents should be identified and relevant specialist services accessed to provide advice and guidance. There should be effective risk management systems in place to minimise risk of harm to residents. Residents must be protected through safe handling of medication to include accurate record keeping. There should be a specialist assessment of the premises to ensure suitability to meet the needs of older residents. People Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 Page 6 who live in the home must be protected from risk of infection through safe working practices. Staff must be trained to meet the needs of residents including those with mental health difficulties and conditions associated with old age. Staff training records should be available in the home. Induction training should meet current guidelines. Effective quality assurance systems should be in place to ensure the health and welfare of service users is promoted. 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. The summary of this inspection report can be made available in other formats on request. Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 Quality in this outcome area is adequate. People who are thinking about moving into the home have their needs assessed to ensure that the home is suitable for them. They would benefit from additional easily understood information before they decide to move in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who are thinking about moving into the home are provided with information about what life is like there in a variety of ways. They are invited to visit and spend time with other residents and staff before making any decision. Written information is available in the form of a Statement of purpose and Service User Guide. People would benefit from the availability of these documents in an easy read format. The manager said that they have been put into a pictorial format however; a copy could not be found during the site visit. A new resident who has been admitted to the home since the last inspection said that they liked living there and staff were very kind. They had been able to visit and meet people at the home a number of times before moving in permanently. Assessment records did not have enough detail about what people like to do to help staff to maintain existing skills in some areas. For example one person told the inspector they really liked making cakes, staff on duty said they did not know this. Although the manager had been aware that Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 Page 9 the resident liked to bake before they moved into the home, this information had not been passed on or recorded. This meant that the resident had not been provided with the opportunity to continue or develop this skill after moving into the home. People who move into the home can be secure about their placement. All residents are provided with a written contract. Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6 - 10 Quality in this outcome area is poor. People who live in the home are supported to make decisions. Inadequate care planning and poor risk management systems are placing people who live in the home at risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home are disadvantaged by poor care planning. Care records are stored in the staff sleep in room in a filing cabinet. These are large unwieldy lever arch folders. Staff on duty admitted that they did not use these as working documents. They explained that key workers are expected to record and maintain the care plan. Other demands on staff time leaves little opportunity for paperwork particularly when they are not used and their purpose is clearly not understood. Six individual files were examined. These were chaotic. The majority of documents were undated and unsigned. Many documents were more than 3 years out of date and in some cases 9 years. Each file had a more recent document called a service user plan. Four of the six had been reviewed in March 2007. The remaining two had not been Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 Page 11 reviewed since Jan 06 and April 06 respectively. This was of particular concern as these care plans were for two residents who are both experiencing increasing difficulties associated with old age. Staff know and recognise their needs but have no training in meeting them. People are experiencing difficulties with sight, hearing, continence and mobility. Very little reference to this had been made in care plans. Very little use has been made of external specialist services and no adaptations have been made to the environment to improve quality of life for these people. It was of particular concern that there are no waking night staff on duty in spite of the increase in falls and the aging resident group. People are being placed at risk of harm through ineffective risk management systems and failure to take appropriate action to minimise risk. Where there have been accidents these have not resulted in appropriate risk assessments. A number of risks have been identified by staff, others were identified during the site visit. It was clear throughout the visit that people who live in the home benefit from the concern and care that staff have for them. Interaction during the inspection was warm and friendly with staff promoting choice for residents and encouraging them to make decisions. There are regular residents meetings and Advocacy services are used. The confidentiality of residents is upheld. Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11 – 17 Quality in this outcome area is adequate. The majority of people who live in the home benefit from access to day services, social events and leisure activities. They would benefit from a more planned approach to in house activities in line with their wishes and preferences. They would also benefit from the cost of their holidays being included within their contract price. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home have some opportunity for social development. The majority of residents are supported to attend a variety of day and educational services. Two people are not currently attending day services and have no in house activity programme. Residents were not involved in meal preparation on the day of inspection although one did help with tea and coffee mid morning. Activities and development opportunities are not being recorded accurately within care plans. Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 Page 13 People who live in the home are treated as individuals who have different interests and aspirations. Residents are part of the local community. They enjoy participating in social events and leisure activities that personally interest them. One resident has been in paid full time employment for some years and is able to travel to and from the home independently using public transport. Another resident is currently undertaking a college course. One resident recently enjoyed a trip on a steam train. People are supported to maintain contact with their family and friends. They can visit the home at any reasonable time and can be received in private in residents’ rooms. The designated visitor’s room is currently being used as a staff sleep in room on first floor. Staff said that this was because some staff complained of being disturbed by residents at night who use the toilet directly above the ground floor staff room. Residents are supported to maintain friendships outside of the home. It was said that all residents enjoy holidays of their choice with the exception of two, one of which prefers day trips out. A recommendation was made following the last inspection that residents should have the option of a minimum seven-day annual holiday outside of the home, included within the basic contract price. Staff said the organisation does not pay for staff costs other than salaries when on holiday. Resident cover all accommodation, travel and expenses. People who live in the home enjoy privacy in their rooms and staff respect this. Residents choose what they would like to eat during residents’ meetings and a written menu is developed from this. Support workers demonstrated a good understanding of individuals’ likes and dislikes. Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18 – 21 Quality in this outcome area is poor. People who live in the home benefit from support which respects their privacy and dignity. Their health and welfare is not always promoted due to lack of understanding of specific mental health difficulties and conditions relating to old age. Failure to provide waking night staff is placing residents at serious risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home benefit from the support of a caring staff team who try hard to give the personal support residents need to maximise their independence, while respecting their dignity and privacy. People are able to exercise choice. Staff have some understanding of the preferred routines of each resident. People who live in the home are supported to access health care appointments. Some health care records are contained within care plans. However the lack of understanding or training about conditions affecting older people has meant that residents who are experiencing difficulties associated with old age are not getting the help they need. The manager had not considered referral to Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 Page 15 Occupational Therapists or specialist help re visual impairment and had not accessed relevant training for staff in the specialist needs of older people. There are no waking night staff on duty at night in spite of recent falls which have not been discovered until the following morning. There are no staff to attend to residents who have continence problems at night, daily records have entries referring to ‘sore bottoms’. Failure to provide care and supervision at night is placing residents at risk of harm. A recent serious accident occurred. A resident fell at some time during the night. He was found in the bedroom th next morning with a head injury. Staff had no idea how long he had been there. . Staff said there have been other falls with less serious consequences which they had not known about until the morning. Care plans have not been updated with this information or with risk assessments. The call bell system does not work efficiently. Call points in residents rooms are on the wall beside light switches. The manager said that she does not believe the residents would use the call bells anyway however no work has been done with residents to enable those who can to call for help if needed. Staff have not had training in the specific mental health difficulties of residents in the home. A recent report from a community nurse raises concerns about the homes ability to meet the needs of one resident who is exhibiting challenging behaviours. People who live in the home are protected through policies and procedures for the safe administration of medication. No residents currently keep their own medication. Arrangements are in place for the storage and administration of medication. Records of medication were examined and gaps were found, specifically in the use of creams. This was discussed with the manager who agreed to contact the pharmacist to seek advice about how to make the system easier for staff to maintain. The manager stated that all staff are trained and assessed as competent to administer medication and a record is kept of signatures. The home provides recent reference material and has now obtained a copy of the Royal Pharmaceutical Society Guidelines for the Administration of Medication within a Care Home. Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 – 23 Quality in this outcome area is adequate. People who live in the home are encouraged to make comment or complaint. They are disadvantaged by the failure to take positive action to address complaints. People are at risk of harm where challenging behaviours are not being managed consistently or effectively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home are encouraged to make comment or complaint. The home provides a written complaints procedure. This is also provided in a format that residents can easily understand. Recent incidents of challenging behaviour in the house have caused some fear and distress to residents. The manager supported them to make complaint to their Local Authority care managers. The homes internal complaints procedure was not used. There is no evidence of action following the complaint. The complaints log could not be located during the inspection. People who live in the home are protected from potential abuse through policies and procedures and staff training in adult protection. The manager said that all staff are checked through the Criminal Records Bureau prior to appointment. Unfortunately of the three staff files inspected only one contained confirmation of this check. Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 Page 17 It was noted at the last inspection the home has a system in place, which aims to protect the financial interests of residents and holds small amounts of cash on their behalf. This is kept securely. All money is stored individually and appropriate transaction records are maintained. The manager said that no one within the organisation was an appointee for any resident. Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 – 30 Quality in this outcome area is adequate. People who live in the home benefit from the comfortable and homely environment. Older people in the home are disadvantaged by the lack of appropriate adaptations such as a lift between floors. They are at risk of harm where bathrooms lack appropriate equipment to minimise risk of infection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home benefit from the comfortable and homely environment and the proximity of the home to local shops and amenities. Those who can negotiate the stairs without support are able to go anywhere in the house and garden. The back garden is tidy, secure and attractive. There are plans to provide a sensory garden. The security of the car park and back garden has been improved by the provision of a locked gate to the service road leading to the main road however there is no signage to direct visitors to the car park. Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 Page 19 The house is maintained and decorated by Hyde Housing Association. Since the last inspection, new carpet has been laid. Adequate recreational, dining, toilet, bathing and individual accommodation are available to residents. The home provides two lounge areas, a conservatory and a visitors’ room. There was a serious risk of infection in bathroom and toilet areas. None of these areas had soap or paper towels. Staff said there was a problem with suppliers. There was a very stained upholstered dining chair in the shower room and there were communal bathmats and rubber safety mats. All residents enjoy their own personal space in their bedrooms. All bedrooms except one are on the first floor. Residents clearly like their rooms, which are all individual and highly personalised. They are able to choose the colour schemes and how their furniture should be arranged. Chairs provided in the majority of bedrooms are not suitable for older people. They are very small, low and have no arms. One mattress needed replacing. Two first floor bedrooms had low windows opened wide onto a flat roof with an unprotected drop to ground. The manager promised to ensure that the lower half of these windows would be locked to minimise risk in future. There are few adaptations in the home to assist the older residents. One bathroom has a hoist chair for those who need assistance to get into and out of the bath. The layout of the home is causing some problems for some of the older residents in that the first floor is not served by a shaft or stair lift. Staff said that people were having difficulties with stairs. People may be at risk where the call system is ineffective. None of the radiators in the home have been covered and the manager was unsure of their guaranteed low surface temperature. Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 Page 20 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 – 36 Quality in this outcome area is adequate. People who live in the home benefit from the support of the committed, caring and stable staff team. Older people and those experiencing mental health difficulties are disadvantaged by the lack of specialist training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home benefit from the support of the committed, caring and stable staff team. Staff showed some understanding of residents’ needs and the home’s philosophy and values. Staff are committed, supportive and clearly care for the residents to the best of their ability. Induction training for staff is provided, although records seen are still very brief and are not being fully competed. The manager said that Learning Disabilities Award Framework induction and foundation training is not now being used, she was unclear what will be used in the future. Although some staff have undertaken specific training in learning disabilities, most have not. Training has not been provided in caring for older people or the specific mental health difficulties experienced by residents. Training certificates are kept in staff files. It was not possible to fully assess whether all staff had undertaken Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 Page 21 appropriate updated courses as the training matrix could not be found during the inspection. Staff training continues to need review to ensure that the needs of residents are met. All staff have either completed or are in process of completing National Vocational Qualifications. People can be confident that staff are well supervised. At the time of the site visit, the number of staff on duty met residents’ needs. There are usually two staff provided during the day with one ‘sleeping-in’ at night. Staffing hours are recorded on a roster and arrangements are in place for on-call back up. Staff are working very long shifts with sleep ins in between. Staff said that his was problem, particularly as they have disturbed nights with resident who are older getting up and down to the toilet. They said that there is very limited time to complete paperwork as well as carry out ancillary tasks and provide care. Staff support residents with cooking, cleaning and laundry tasks wherever possible. A procedure is in place to ensure that the home appoints suitable staff who can support the needs of residents. Staff files seen evidenced that pre-employment checks had been undertaken. Files did not contain evidence of a successful a criminal records bureau check, numbers were requested from central office for files checked. These could not be found. Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 Page 22 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37 – 43 Quality in this outcome area is poor. People who live in the home benefit from the open and inclusive atmosphere. Ineffective risk management systems are placing residents at risk of harm. Their interests would be better promoted by effective quality assurance systems. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home are disadvantaged by ineffective management systems that fail to identify and manage risk appropriately. The manager has completed an NVQ level 4 in care and is currently completing the Registered Manager’s Award. The manager said that she expects to achieve the qualification by September 07. The manager works with the direct care of residents in addition to ‘supernumerary’ days for management and Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 Page 23 administration. Poor outcomes as identified throughout the report may indicate insufficient time to focus on management tasks. Non Compliance with previous requirements and recommendations indicate that quality assurance systems are ineffective and the home is not always being run in the best interests of residents. There is an open and inclusive atmosphere in the home. Residents are generally comfortable chatting and spending time with staff. Residents’ meetings are held regularly. The safety of people who live in the home is promoted through a range of recorded policies and procedures that are available for staff. Since the last inspection the majority of these have been updated by the organisation. The home’s accident and incident book has been updated. Accidents and incidents are recorded within care records and daily notes, unfortunately these are not being used as part of a risk management framework. Records and certificates were seen at the last inspection which indicate that regular safety checks are carried out on equipment and installations. It was noted at the last inspection that fire drills are undertaken regularly. Two of the home’s four external doors are alarmed and locked at night. The manager assured the inspector then that there was a system in place regarding locked fire exits at night, which would not impede escape in the event of fire. The manager also assured the inspector that a previous fire exit route through a first floor resident’s room was no longer used. It was said that arrangements were agreeable to the fire authority. There were serious concerns about the safety of residents in that there is poor practice around infection control. In the process of caring for people staff have to handle soiled linen. Unsafe working practices are exposing residents to risk of infection. One example of this was where soiled bedding is being carried through the home to the laundry without being bagged. The manager said staff have had infection control training. Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 Page 24 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 Standard No Score 1 2 2 2 3 2 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 2 28 3 29 2 30 1 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 3 1 3 LIFESTYLES Standard No Score 11 3 12 2 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 3 2 x 2 3 2 3 3 1 x Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 Page 25 Yes 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 YA6 Regulation 12 & 15 Requirement The registered person shall ensure that the home promotes the health and welfare of service users and provides a written care plan as to how these needs are to be met. In that, updated care plans must be provided for each resident. All documents must be kept up to date and completed with sufficient detail. This requirement has been repeated from inspection dated 20th July 2006 and 7th November 2005. 2. YA9 13(4) The registered person shall ensure that (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; (b) any activities in which service users participate are so far as reasonably practicable free from avoidable risks; and Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 Page 26 Timescale for action 24/07/07 30/08/07 (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated, In that the home must implement an effective risk management system 3 YA3 12 (1)(a) The registered person shall 30/08/07 ensure that the home promotes the health and welfare of service users in that the registered person must be able to demonstrate the homes capacity to meet specialist needs including mental health difficulties, visual impairment, hearing impairment and conditions associated with old age. 30/08/07 The registered person shall ensure that the home promotes the health and welfare of service users in that service users should be provided with access to additional specialist support to demonstrate the homes capacity to meet specialist needs including mental health difficulties, visual impairment, hearing impairment and conditions associated with old age. The registered person shall 30/08/07 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. In that there should be no gaps in medication records. 5 YA24 23(2)(n) The registered person shall 30/08/07 having regard to the number and DS0000059719.V345524.R01.S.doc Version 5.2 Page 27 4 YA18 12(1)(a) 4. YA20 13(2) Granby Place needs of the service users ensure that suitable adaptations are made, and such support, equipment and facilities, including passenger lifts, as may be required are provided, for service users who are old, infirm or physically disabled; 6 YA30 13(3) The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. 30/08/07 7 YA35 18(1)(c)(i) The registered person shall ensure that staff working at the home receive training appropriate to the work they are to perform. In that, a review must be undertaken to ensure that appropriate training is provided to meet the needs of all residents. This requirement has been repeated from inspection dated 7th November 2005 and July 2006 24/07/07 8 YA35 17(2)(3) Sch 4 The registered person shall maintain in the care home the records specified in Schedule 4: ‘A record of all training undertaken, including induction training’ The registered person shall ensure that these records are kept up to date and are at all times available for inspection by any person authorised by the 30/08/07 Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 Page 28 Commission to enter and inspect the care home. In that, the staff training matrix was not available in the home. The registered person shall ensure that the home promotes the health and welfare of service users through effective quality assurance systems and the implementation of requirements identified within inspection reports. The registered person shall maintain in the care home the records specified in Schedule 4: ‘A record of all training undertaken, including induction training’ The registered person shall ensure that these records are kept up to date and are at all times available for inspection by any person authorised by the Commission to enter and inspect the care home. In that, the staff training matrix was not kept within the home but maintained centrally by the organisation. Staff training records must be held within the home and be available for inspection by the Commission. 11 YA42 12(1) 13(4) The registered person shall ensure that the home promotes the health and welfare of service users and ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated through the implementation of effective risk management systems and safe DS0000059719.V345524.R01.S.doc 9 YA39 12(1) 30/08/07 10 YA41 17(2)(3) Sch 4 30/08/07 30/08/07 Granby Place Version 5.2 Page 29 working practices. 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 YA1 Good Practice Recommendations It is recommended that the combined statement of purpose and service users’ guide should be available in a format that is easily understood by residents. It is strongly recommended that Pre admission assessment includes skills and interests to ensure that these are maintained following admission to the home. It is strongly recommended that all documentation should be signed and dated. It is recommended that residents have the option of a minimum seven-day annual holiday outside of the home, included within the basic contract price. In that, the organisation pays for staffing costs but not for residents. This recommendation has been repeated from inspection dated 7th November 2005 and July 2006. 5 6 7 8. YA22 YA26 YA27 YA29 The complaints log should be available in the home and any complaints should be fully investigated. Residents should be provided with suitable comfortable chairs in their bedrooms. Bath and shower rooms should be suitably equipped with shower chairs where needed. It is strongly recommended that a review should be DS0000059719.V345524.R01.S.doc Version 5.2 Page 30 2. YA2 3. 4. YA6 YA14 Granby Place 9 YA34 undertaken to ensure that adequate staff call points are easily accessible. It is strongly recommended that, with regard to staff recruitment files: The CRB number should be recorded 10 YA35 It is recommended that the home’s recorded induction training should comply with LDAF specifications. In that, the home’s induction record continues to be recorded in brief detail. This issue has been repeated from inspection dated 7th November 2005 and July 2006 11 YA37 The registered manager shall complete the RMA. Granby Place DS0000059719.V345524.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000059719.V345524.R01.S.doc Version 5.2 Page 32 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!