CARE HOMES FOR OLDER PEOPLE
Grantley Court Nursing Home 22 York Road Sutton Cheam, Surrey SM2 6HH Lead Inspector
Alison Ford Unannounced 18 July 2005 16.30pm
th 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 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 G53-G53 s44083 GrantleyCourtUI v211397 180705 stage0.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Grantley Court Nursing Home Address 22 York Road, Sutton, Cheam, Surrey, SM2 6HH 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) 020 8661 0273 Mr Soondressen Cooppen Mr Rajoo Govinden Care home 30 Category(ies) of DE(E) Dementia - over 65 (30) registration, with number of places MD(E) Mental Disorder - over 65 Grantley Court Nursing Home G53-G53 s44083 GrantleyCourtUI v211397 180705 stage0.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22nd November 2004 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 throughot 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 G53-G53 s44083 GrantleyCourtUI v211397 180705 stage0.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over three hours commencing at 16.30 in the afternoon. A partial tour of the premises was undertaken, a sample of care plans, accident records and medication systems were seen. Eight residents three staff members and two relatives, who were visiting, were spoken to. Since the last inspection two anonymous complaints had been received about the service: the majority of the issues that were raised were not upheld, however there are still ongoing discussions taking place concerning staffing levels within the home and the ratios of trained staff required. Since the last inspection the Registered Manager has resigned and an acting manager is in post. She was not in the home at the time of this visit, having worked earlier in the day. The nurse in charge of the shift is to be commended on her ability to cope with the inspection; however, on this occasion certificates of worthiness of equipment and evidence of procedures designed to safeguard resident’s welfare could not be viewed. What the service does well: What has improved since the last inspection?
Previous visits had revealed that residents were being put into their nightclothes during the middle of the afternoon, a practice that was felt to be undignified for them. This appears now to have ceased: after supper, staff sat and spoke to them or played a ball game with them and were not beginning to
Grantley Court Nursing Home G53-G53 s44083 GrantleyCourtUI v211397 180705 stage0.doc Version 1.40 Page 6 help them to change their clothes until around 18.45. There was an overall perception that communication between residents and staff was, on this occasion, greatly improved, the atmosphere was calm and unhurried. There had also been some concerns, raised at previous inspections, about the variety of food served at suppertime. During this visit, the evening meal was served and residents enjoyed a hot snack and portions were ample. 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 G53-G53 s44083 GrantleyCourtUI v211397 180705 stage0.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Grantley Court Nursing Home G53-G53 s44083 GrantleyCourtUI v211397 180705 stage0.doc Version 1.40 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 standard(s) 1,3 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 however they are not always given the information that they require in order for them or their relatives to make an informed choice about the placement. This home does not offer intermediate care. EVIDENCE: A sample of four care plans was assessed, one of which was of a resident who had been admitted recently. 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 needs could continue to be met. Previous inspections had revealed that a well-presented service user guide had been produced outlining all of the information required by prospective service
Grantley Court Nursing Home G53-G53 s44083 GrantleyCourtUI v211397 180705 stage0.doc Version 1.40 Page 9 users. At this visit it was apparent that this is not always used. Two relatives were spoken to; one had not received any pre-admission information and neither had been made aware of the homes complaints procedure. Grantley Court Nursing Home G53-G53 s44083 GrantleyCourtUI v211397 180705 stage0.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8.9.10 An individual care plan, generated from the initial assessment process and according to his or her assessed healthcare needs is drawn up for each resident to ensure that appropriate care and interventions are given. Appropriate medication procedures are in place to ensure the safety of residents and they are confident that staff will respect their privacy and dignity. EVIDENCE: The 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. 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. Grantley Court Nursing Home G53-G53 s44083 GrantleyCourtUI v211397 180705 stage0.doc Version 1.40 Page 11 The evening drug round was observed and procedures, drug storage and records all appeared in good order. Trained nurses administer all medication in the home, there are specimens of their signatures at the front of the records and the residents have their photograph on their medication profiles. Staff were seen treating the residents very kindly and sensitively and the residents, who were able to communicate, and the relatives that were spoken to agreed how caring they all were. Grantley Court Nursing Home G53-G53 s44083 GrantleyCourtUI v211397 180705 stage0.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13,14,15 Visitors are always welcomed into the home so that residents can maintain contact with their families and friends and a varied menu ensures that they receive an appealing and balanced diet. EVIDENCE: The visitors that were there on the evening of the inspection, confirmed that they were always made to feel welcome whenever they came into the home. They are able to sit in the communal areas, with residents, or in private as they wish. There had been previous concerns, within the home, that staff were getting residents up very early in the morning and putting their nightclothes on in the middle of the afternoon even though that may not have been their choice . There was no evidence of this at this visit. The evening meal was observed and this was a hot supper dish, drinks were offered, those who required assistance, to eat received it in a dignified manner and others, who wished to, sat in the dining room. One resident chose to have his meal a little later as he had been busy in the garden, and this request was accommodated without any problem. The meal that was served matched the published menu. There had previously been concerns about the choice of supper dishes served; this appears now to have been resolved.
Grantley Court Nursing Home G53-G53 s44083 GrantleyCourtUI v211397 180705 stage0.doc Version 1.40 Page 13 Body weights are recorded regularly and detailed records of food consumption are kept of any resident giving cause for concern. Grantley Court Nursing Home G53-G53 s44083 GrantleyCourtUI v211397 180705 stage0.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Residents and their relatives are confident that their concerns and complaints would be dealt with appropriately however a lack of information means that they are not always made aware of the procedures to be followed. EVIDENCE: The home has an appropriate complaints procedure that has been assessed at previous inspections however discussion with relatives revealed that although they considered that any concerns would be dealt with appropriately, they are not always made aware of the route to be followed. The Registered Provider must ensure that the complaints procedure is made available to residents and their relatives. Since the last inspection the Commission has received and investigated two complaints alleging poor care practices about this service. The majority of the issues were not upheld however discussions relating to trained staff ratios are still ongoing. Grantley Court Nursing Home G53-G53 s44083 GrantleyCourtUI v211397 180705 stage0.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,26 This home provides a clean and generally safe, 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. Several doors that had self-closing mechanisms were wedged open with pieces of carpet although only one of them did not work when the carpet was removed; the registered Provider must ensure that these doors are working properly at all times. Not all the bedroom doors have automatic closers and some were held open with chairs. If a resident wishes their bedroom door to be kept open, a device must be fitted to ensure that it will close automatically in the event of a fire. 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 G53-G53 s44083 GrantleyCourtUI v211397 180705 stage0.doc Version 1.40 Page 16 Grantley Court Nursing Home G53-G53 s44083 GrantleyCourtUI v211397 180705 stage0.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Staffing numbers are generally sufficient however the trained staff ratio does not always ensure that the practice of care staff is fully supervised. EVIDENCE: On the afternoon of the inspection there was one trained nurse on duty with four care staff. The off duty rotas were seen and confirmed that this was standard practice. There are ongoing discussions being held with the Registered Provider regarding the numbers of trained staff required on each shift and this will continue to be monitored. Grantley Court Nursing Home G53-G53 s44083 GrantleyCourtUI v211397 180705 stage0.doc Version 1.40 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed at this visit. EVIDENCE: Grantley Court Nursing Home G53-G53 s44083 GrantleyCourtUI v211397 180705 stage0.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 x x x x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x x x x x x x x Grantley Court Nursing Home G53-G53 s44083 GrantleyCourtUI v211397 180705 stage0.doc Version 1.40 Page 20 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 5(2) Requirement The Registered Provider must ensure that all potential residents and their reatives are given a copy of the Service User Guide. The Registered Provider must ensure that all residents and their relatves are given a copy of the homes complaints process. The Registered Provider must ensure that all automatic closing devices fitted to fire doors are working correctly at all times. The Registered Provider must ensure that automatic door closers, which operate in the event of a fire, are fitted to the bedroom doors of any resident wishing to leave their door open. Timescale for action 30/10/05 2. 16 5(2) 30/10/05 3. 19 13(4) from the day of this inspection 30/10/05 4. 19 13(4) 5. 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.
Grantley Court Nursing Home G53-G53 s44083 GrantleyCourtUI v211397 180705 stage0.doc Version 1.40 Page 21 Refer to Standard Good Practice Recommendations Grantley Court Nursing Home G53-G53 s44083 GrantleyCourtUI v211397 180705 stage0.doc Version 1.40 Page 22 Commission for Social Care Inspection Croydon, Kingston & Sutton 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
© 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 Grantley Court Nursing Home G53-G53 s44083 GrantleyCourtUI v211397 180705 stage0.doc Version 1.40 Page 23 - 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!
