CARE HOMES FOR OLDER PEOPLE
Grantley Court Nursing Home 22 York Road Sutton Cheam Surrey SM2 6HH Lead Inspector
Alison Ford Unannounced Inspection 1st November 2005 16.45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Grantley Court Nursing Home DS0000044083.V258138.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Grantley Court Nursing Home DS0000044083.V258138.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Grantley Court Nursing Home Address 22 York Road Sutton Cheam Surrey SM2 6HH 020 8661 0273 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) Mr Soondressen Cooppen Mr Rajoo Govinden Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (0) Grantley Court Nursing Home DS0000044083.V258138.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th July 2005 Brief Description of the Service: Grantley Court is a home registered to provide nursing care, for up to thirty adults over the age of sixty-five, with dementia or other mental health disorders.The Registered Provider , Mr Coopen, who also owns three other homes in the area bought the home in July 2003. The home is a large detached house situated in a quiet area in Cheam, well served by public transport links and there is off street parking to the rear of the proerty. Accomodation is provided in twelve single and nine double bedrooms all of which have been fitted with washbasins, some have en-suite facilities.There is a large open plan lounge and separate dining room, and a small smoking area has been provided for residents use.There are sufficient numbers of toilet facilities conveniently located throughout the home and kitchen and laundry facilities are clean and well equipped.There is a pleasant back garden which includes flower beds, fruit trees and a patio area which is well maintained and enjoyed by residents in the summer months. Grantley Court Nursing Home DS0000044083.V258138.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two and a half hours, commencing at 16:45 in the afternoon. A partial tour of the premises was undertaken, a sample of care plans, accident records and medication systems were seen. Ten residents, two staff members and a relative, who was visiting, were spoken to. An acting manager is still in post and has not yet applied to The Commission for registration and she was in the home at the time of this visit. What the service does well: What has improved since the last inspection?
Since the last inspection, staffing levels have been raised in the home and there are now two trained nurses on duty until six-o-clock in the evening every weekday. This allows greater supervision of care staff and more time to be spent with residents. This move was prompted by previous complaints about the service and none have been received since that time either by the home or The Commission. Previous concerns about resident’s safety in the event of a fire, raised at the last inspection, have now all been dealt with. Grantley Court Nursing Home DS0000044083.V258138.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Grantley Court Nursing Home DS0000044083.V258138.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grantley Court Nursing Home DS0000044083.V258138.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 A comprehensive pre-admission assessment and a care manager’s review ensure that the facilities within the home are suitable for prospective residents and that the home can meet their assessed healthcare needs. This home does not offer intermediate care. EVIDENCE: A sample of three care plans, of residents who had been admitted since the last inspection, was assessed. In all cases a comprehensive pre-admission assessment, to ensure suitability of the placement, had been undertaken and a care managers review was present. All aspects of the resident’s personal, social and healthcare needs had been considered and these then formed the basis for subsequent care planning. There was evidence of regular review of all of the relevant problems to ensure that all assessed healthcare needs continue to be met. Grantley Court Nursing Home DS0000044083.V258138.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 An individual care plan, generated from the initial assessment process and according to assessed healthcare needs, is drawn up for each resident to ensure that appropriate care and interventions are given. Medication procedures are in place to ensure the safety of residents although they now require updating in line with current guidance. Residents can be confident that they will be treated in a way, which maintains their respect and dignity. EVIDENCE: The three care plans that were assessed accurately reflected the resident’s current health and personal care needs and individualised risk assessments were in place in respect of the prevention of falls and pressure sores. Visits from other members of the multidisciplinary healthcare team were recorded. A key worker system is in place and records indicate that they had reviewed care plans on a regular basis. Pressure relieving aids, hoists and other items of equipment were seen in use around the home and the homes GP visits on a weekly basis. Grantley Court Nursing Home DS0000044083.V258138.R01.S.doc Version 5.0 Page 10 The accident book was viewed, no resident had required admission to hospital, all incidents had been relatively minor, and only one resident has a pressure sore, which he had been admitted from hospital with. It was recommended that some method of monitoring the healing process of pressure sores should be introduced either by wound measurement or photographic evidence. Trained nurses administer all medication in the home and records and storage were maintained appropriately. Recent changes to legislation require homes to change the way in which unwanted medication is disposed of and the home must now introduce this. Grantley Court Nursing Home DS0000044083.V258138.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,15 Residents are able to participate in activities, suited to their needs, which provide them with interest and stimulation. Varied and nutritious meals provide a balanced diet for those living in the home. EVIDENCE: An activities organiser comes into the home twice a week and carers undertake activities with residents in the afternoons. On the evening of the inspection, care staff were seen interacting well with residents and spending time with them. The evening meal was served during the inspection and residents confirmed that ” it had been nice “ and they “ enjoyed the food “in the home. The meal for one resident was being kept, as he preferred to eat later. Grantley Court Nursing Home DS0000044083.V258138.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, Residents can be confident that staff are aware of the procedures in place to ensure that they are protected from abuse. EVIDENCE: The home has an abuse policy and staff displayed an understanding of the issues and how to report any concerns. One resident had required minimal restraint to stop him falling and the care plan indicated that there had been some discussion with his family and they had been in agreement. Grantley Court Nursing Home DS0000044083.V258138.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 This home provides a clean, safe and well-maintained environment, which suits the needs of the residents. EVIDENCE: A partial tour of the premises confirmed that the home was clean and tidy and generally well maintained. Furniture and fittings are suitable for the needs of the residents and decoration is of a reasonable standard. There is a pleasant garden to the rear of the home and a smoking area has been provided. The home was extremely clean and totally free from odour at the time of the inspection. Laundry facilities are sited away from areas where food is prepared or eaten. Suitable bins are in place for clinical waste and hand washing facilities are appropriately placed. Grantley Court Nursing Home DS0000044083.V258138.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 30 There are enough staff on duty in the home, however residents cannot be confident that staff training will ensure that their needs will be met. EVIDENCE: Staffing levels have recently been reviewed and there is now an additional trained nurse on duty in the home until 6 pm on weekdays. This allows care staff to be supervised more closely and allows more time to be spent with residents. Staff files were not available for inspection and an alternative arrangement will be made to ensure that these can be seen. Although mandatory training has been undertaken by staff, given the advanced stages of dementia of the majority of the residents, all care staff must receive training in understanding the needs of those with dementia. The Registered Provider will need to submit an action plan illustrating how this will be achieved. It is recommended that staff have an individual training profile outlining training that they have received. Grantley Court Nursing Home DS0000044083.V258138.R01.S.doc Version 5.0 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35, 36,38 Residents cannot be sure that the home is run in their best interests, by a person qualified to be in charge or that staff receive adequate supervision to protect them. Evidence is not available to show that the health safety and welfare of residents and staff are protected and promoted. EVIDENCE: There is an acting manager in the home who has worked there for some time; she is studying for an NVQ level 4 qualification. The Registered Provider was previously asked to submit an application for her, or another suitable person to be registered with the Commission to manage the home. This has still not been done and now becomes a requirement. Although relatives are able to approach staff at any time there is no effective quality assurance monitoring system in place in the home and this must be implemented.
Grantley Court Nursing Home DS0000044083.V258138.R01.S.doc Version 5.0 Page 16 Residents in the home are not able to manage their own money however the home does not take responsibility for the financial affairs of any of them. Staff supervision is occurring in the home and sessions are recorded however this is not six times a year, as recommended in the minimum standards, so must be increased. Certificates of worthiness for equipment in use in the home were not available to be inspected. These will be viewed at an additional visit however, in future they must be held in the home for inspection. Grantley Court Nursing Home DS0000044083.V258138.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X 2 Grantley Court Nursing Home DS0000044083.V258138.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13(2) Requirement The Registered Provider must make new arrangements to dispose of unwanted medicines in the home in line with current legislation. The Registered Provider must submit an action plan detailing how all staff will receive ongoing training in caring for people with dementia. The Registered Provider must ensure that a suitable person is put forward for registration as the manager of the home. The Registered Provider must ensure that all care staff receive supervision at least six times a year. The Registered Provider must ensure that certificates of worthiness for all equipment and services in the home are available for inspection. Timescale for action 30/12/05 2 OP30 18(1)(c) 30/01/06 3 OP31 8(1)(a) 30/01/06 4 OP36 18(1)(c) (i) 13(4)(c) 30/01/06 5 OP38 30/12/06 Grantley Court Nursing Home DS0000044083.V258138.R01.S.doc Version 5.0 Page 19 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 Refer to Standard OP8 OP30 Good Practice Recommendations It is recommended that a method to monitor the healing process of wounds be introduced. It is recommended that training profiles should be introduced for all members’ staff. Grantley Court Nursing Home DS0000044083.V258138.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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