Inspection on 16/04/07 for Granville House

This inspection was carried out on 16th April 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 but made no statutory requirements on the home.

Other inspections for this house

Granville House 08/04/08

Granville House 26/06/06

Granville House 31/10/05

Granville House 16/05/05

Granville House 05/10/04

Granville House 05/05/04

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

CARE HOMES FOR OLDER PEOPLE Granville House Granville House 4 Moultrie Road Rugby Warwickshire CV21 3BD Lead Inspector Deborah Shelton Unannounced Inspection 16th April 2007 09:45 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 Granville House DS0000060619.V335188.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 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. Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Granville House Address Granville House 4 Moultrie Road Rugby Warwickshire CV21 3BD 01788 568873 01788 550574 trustedcareltd@aol.com 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) Trusted Care Ltd Miss Rita Maija Plume Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registration is for 17 places in the category of old age, not falling within any other category. 26th June 2006 Date of last inspection Brief Description of the Service: Granville House provides personal care for 17 older people aged 65 years and over. It does not provide any specialist services or nursing care. The providers are hands on in the running of the home. Granville House is a converted domestic dwelling, extended to the rear. It is situated approx 1/2 a mile from the town centre of Rugby. The home is sited on the corner of Moultrie and Elsee Road opposite Lawrence Sheriff School. Shops, buses and main town are within a short walk of the home. Accommodation is over two floors. There are 13 single rooms and 2 shared. No en-suite rooms are available. A passenger lift enables access to both floors and is large enough to take a wheelchair. The gardens to the front and rear of the house are well tended. A large conservatory is available to the rear of the building. The current weekly charge for accommodation, board and personal care is £385. Additional charges are made for private chiropody, hairdressing, personal items, toiletries and newspapers/magazines. This information was provided by the manager on 16 April 2007. Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The following are the findings of an unannounced inspection visit that took place between the hours of 09:45am and 7:45pm on Monday 16 April 2007. The Home owner and his wife were on duty along with the manager and two care assistants. Seventeen people were living at Granville House. One resident was ‘case tracked’, this involves finding out about the individual’s experience of living in the care home by meeting with them, talking to them and their families (where possible) about their experiences, looking at their care files, looking at their environment, discussions with staff on duty and reviewing staff training records to ensure training is provided to meet resident’s needs. Documentation regarding staffing, health and safety, medication and complaints was also reviewed. The inspector was introduced to a majority of the people that live at Granville House and conversations were held with six people. No visitors were spoken to during the inspection. The inspection process enabled the inspector to see residents in their usual surroundings and see the interaction between staff and residents. Our comment cards were sent out to residents and relatives. Four responses were received from relatives and one from a resident. Their comments are included in the main body of this report. The inspector wishes to thank the management and staff for the hospitality on the day of inspection. What the service does well: The atmosphere at Granville House is relaxed and friendly and residents appeared to be at ease in their surroundings. The manager has an in-depth knowledge of those under her care and was seen to have a good relationship with residents and their relatives. Granville House is reasonably well maintained and fixtures and fittings are in a good state of repair. The Home was clean and hygienic on the day of inspection. The manager dedicates a lot of time talking to residents and makes herself available to both residents and relatives if they wish to chat to her. Residents confirmed that if they had any worries or issues they would speak to the manager and felt sure that she would sort any problems out for them. Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 6 Staff were seen to treat residents with respect and dignity and residents spoken to confirmed that staff are caring and kind. What has improved since the last inspection? What they could do better: The owner and manager have worked hard to address or partially address a number of issues identified during the last key and random inspection visits. The Home owner has ideas for action to enable other outstanding issues to be addressed but further work is needed. Although the manager has worked hard to introduce new standardised care plan documentation for one resident, further work must be undertaken to ensure that all resident’s care plans are up to date and contain sufficient detail to enable staff to meet care needs. Evidence must be made available that the gas boiler is safe. There is no landlord’s gas safety certificate and no documentary evidence to demonstrate that the boiler has been serviced within the last twelve months. Moving and handling training has been booked, however staff have not undertaken any moving and handling training within the last twelve months Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 7 and staff were seen moving a resident inappropriately on the day of inspection. This unsafe practice puts the resident and staff at risk of injury. 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. Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 8 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 Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The Home’s contract does not fully inform residents of the terms and conditions of occupancy and what they can expect for their fee. The preadmission process does not fully protect residents and they are at risk of not having all needs met if documented pre-admission assessment information is not fully completed. Important aspects of care such as personal safety and risk and carer and family involvement are not covered in the process. EVIDENCE: A requirement was made at a previous inspection requesting that an up to date Service User’s Guide must be supplied to each person that lives at Granville House. Letters were available in care files, signed by the resident or their relative confirming that they had received this document. This requirement has now been met. The Service User’s Guide was not reviewed on this occasion. Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 10 A very basic contract of residency is available for all that live at Granville House. This contract states what the resident is entitled to i.e. a single room, use of communal facilities, laundry, care and support as set out in the care plan. A further statement records that “the provider will provide services which have not been specifically listed but which can reasonably be expected to be provided within the contract”. Details recorded in national minimum standard 2 are not contained within this contract, for example the period of notice, fees payable or additional services to be paid for over and above those included in the fees. Residents are therefore not fully informed about the services, fees or terms and conditions of occupancy in this contract. The pre-admission documentation of the most recently admitted resident was reviewed. Standardised documentation is used to obtain information, this enables the manager to decide whether the prospective resident’s care and social needs can be met at the Home. Documentation seen consisted of a tick list regarding various health care needs, i.e. mental health, vision, hearing, oral health and details of the number of staff that would be required to assist the resident with personal care. Where a health care need was identified i.e. confusion, no further information was recorded to guide staff regarding how to meet this need or things that trigger the problem. Some parts of the form had not been completed. The manager stated that if they are left blank they are not applicable to that resident. This should be recorded on the form as evidence that each issue has been reviewed. Information regarding lifestyle needs was not fully completed. The document was not signed by the person completing the information. Some important information such as details regarding personal safety and risk and carer and family involvement may be missed and therefore not included in the Home’s initial plan of care upon admission to the Home. The manager confirmed that the pre-admission process has not changed. The manager visits potential residents and conducts the assessment. Information is then transferred into an initial care plan, which is fully completed within the first week of admission. Four relatives responded to our questionnaire sent out before the inspection. Two of the relatives responded that they always get enough information about the care home to help make decisions whilst another two responded that they usually get the information. A relative responded to a separate questionnaire and stated that enough information was given before admission to Granville House. Providing sufficient information and conducting detailed pre-admission assessments enables the potential resident to decide whether they would like to live at the Home and whether the Home would be able to meet their individual needs. Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Not all care plans contain sufficient up to date information to enable staff to be able to care for those that live at Granville House. However, residents have good access to a wide range of health professionals which results in their healthcare needs being met. Systems and practices regarding storage and administration of medicine have improved. Further work is to be undertaken regarding the policies and procedures for dealing with medicines to protect residents from risk of harm. Residents are treated with respect and their rights to privacy and dignity are maintained. EVIDENCE: Requirements have been made at previous inspections regarding the lack of information held in care plans. The manager has started to address this issue Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 12 by developing new standardised documentation. This has been trialled for one resident. The manager confirmed that all other care plans will be updated, however currently the old system of care planning is in use. It was identified at the last inspection that the information recorded in these care files was not sufficient to enable staff to provide care for residents. The manager assured the inspector that all remaining care plans would be updated within three months of this inspection. New documentation has space for signatures by the resident or advocate and the manager. These are to be dated and signed as part of the regular review process. This is considered to be good practice. Details regarding religion, contact details for external professionals such as GP, social worker, continence advisor etc are recorded. A new life story/interests record is completed which gives staff information about past life, hobbies and interests, likes and dislikes. Standardised documentation is used for the care needs assessment and action plan and a broad range of areas will be reviewed for each resident. The information recorded for care needs was not specific in some instances for example, foot care – feet creamed daily. This does not record the time of day that this is to be done or the foot cream that is to be used. Continence records – toilet at regular intervals. When discussing this with the manager she stated that residents are toileted approximately every two hours. This information should be recorded in the care plan. The initial care plan for this resident stated that the resident did not have a history of falls. However the medical history recorded a number of fractures as a result of falls. This has not been taken into consideration when completing the falls risk assessment or in any information regarding history of falls. The manager confirmed that the resident had not fallen whilst at the Home and this is why no information had been recorded. However, as the resident has a history of falls staff must be aware of this and risk assessment must record the potential risk and actions to be taken to reduce the risk. The fall risk assessment gives scores, which are then added to identify the severity of the potential risk. However, there are no details of how scores are allocated, what the scores mean or the action to be taken by staff once the scores have been obtained. The nutritional screening information is a weight chart with no other information recorded. This is not a nutritional screening tool and the manager must ensure that a tool is used to review nutritional risks for residents. Various changes to care plan documentation were discussed with the manager who confirmed that she will ensure that more detail is recorded to enable staff to have sufficient information to meet the care needs of residents. Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 13 Bed change, bath and bowel charts are kept in a separate file. Bowel chart records reviewed for 26 March 2007 to 1 April 2007 had not been completed for all residents. The manager reported that some residents are self caring in this respect and would tell her if there was a problem. The manager was advised to only record the names of the residents who are being monitored on the bowel chart as leaving blank spaces against some names is misleading. The chart for two residents had only been completed on one occasion, the manager stated that staff had not been completing the information sufficiently. On a separate chart for 19 – 25 March, very loose was written on one occasion against a resident’s name. There were no other entries for that week and no evidence that any action had been taken regarding the loose stools or whether this problem had rectified itself. Numerous issues have been identified during recent random inspections of Granville House. Our specialist Pharmaceutical Inspector has visited the Home twice in March and left immediate requirements for action. During the second inspection by the Pharmaceutical inspector all apart from four issues identified at the previous inspection had been addressed. The monitored dosage system of medication administration has been introduced recently. A new medication trolley and controlled medication cupboard and record book have been purchased. These were outstanding requirements from the last inspection in March that have now been addressed. New protocols have been developed for “when required” medication as requested at the last inspection. The manager had implemented these for a majority of residents and confirmed that all would be in place shortly. Staff training regarding safe handling of medication was discussed. It was noted that all staff have completed the “Care of Medicines Certificate” foundation module but only one member of staff has completed the accredited “Safe Handling of Medications” course. The manager confirmed that other staff will undertake this training. The medication administration record for the one resident being case tracked was reviewed and found to be correct and up to date. The Home owner confirmed that they are still in the process of amending the medication administration procedures for the Home to ensure that they reflect current best practice in line with the Royal Pharmaceutical Society of Great Britain professional guidelines for the safe handling of medicines. Staff were seen to treat residents with respect and dignity throughout the inspection visit. Comments received from relatives on the Commission for Social Care Inspection feedback cards were positive. One relative reported “They meet my father’s welfare needs and treat him with respect at all times”. Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 14 Staff were seen to knock on bedroom doors before entering and called residents by their preferred name. There was no screening in one shared bedroom. Previously portable screens had been used in this room. The Home owner said that new fixed curtain type screening is going to be fitted which will give a more homely feel. However, until this screening is fitted the portable screen must be put in place, particularly to maintain the privacy of both residents in this room whilst using the commode. Residents were dressed appropriately for the time of year and were well groomed. Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The current arrangement for activities and entertainment are improving, however there is no activity plan and activities currently provided do not provide adequate recreation or motivation for some residents. The service ensures that visitors are made welcome and the residents’ benefit from visits from family and friends. Residents were happy that they still had some control over their lives and the choices that they make which improves their sense of wellbeing. Meals are well presented, wholesome and provide residents with a nutritious and balanced diet. EVIDENCE: The tasks that staff must undertake on each shift has been divided by the manager into units of time, for example dedicated activity time is allocated to Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 16 one member of staff in the morning, other time is allocated to laundry and kitchen or care duties. During the morning of the inspection some residents were sitting in the lounge playing skittles with a member of staff, some residents were colouring and some were enjoying watching the activity. Residents are free to sit in the main lounge, smaller lounge or conservatory. One resident was seen knitting and listening to the radio in the conservatory area. The Home owner confirmed that they have recently purchased various games and activities for residents to enjoy. However currently there is no activity programme in place that has been discussed and agreed with residents. New care file documentation contains a sheet for recording activities undertaken. One resident spoken to said that he enjoyed playing dominoes but would like more than one person to play the game with. A member of staff said that a resident had taught her how to play dominoes and she was trying to encourage other residents to join in their games. Only one resident responded to our feedback card. This resident said that there are never any activities arranged by the Home that he/she can take part in. Another resident spoken to on the day of inspection said that she has a visitor from a local church each week which she really enjoys. Comments were made by residents regarding activities as follows: “there is something to do. I like to watch TV and there is nothing else that I like to do. We go outside in the nice weather” “I like to watch TV and there is not a lot else that I like but they have started to do things which is OK” “staff don’t really have the time to stand and chat to you, they would if they could but they are too busy” “I could play cards or dominoes, I don’t mind but it’s not what I would do normally. I want to chat to someone who understands me. All I want to do is have a laugh and some fun”. Residents confirmed that they are able to see visitors whenever they want to. They are able to meet them in the communal areas such as lounge or conservatory or in their room. Three relatives confirmed on our feedback cards that Granville House always helps their friend/relative to keep in touch with them. Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 17 The inspector did not speak to any visitors on the day of inspection but observed one person visiting a relative. The visitor was made welcome by staff and had a good relationship with the Home manager. Discussions were held with residents, staff and management regarding independence and choice. Care plan documentation was also reviewed to evidence whether information has been sought from residents regarding individual choices regarding daily living, i.e. times for getting up, going to bed, preferences regarding bath or shower, likes and dislikes. This information was recorded in the new care plan documentation reviewed. Comments received from residents when discussing independence and choice are detailed below: “you have to go to bed when you are told really but it is near enough when I want to go to bed” “you have a choice of meal, if they bring you the meal and you don’t like it they make you something else”. “I have been given a menu covering the meals for three weeks, I look at it and if I don’t like something I say and they give me something different” The manager has recently started talking to residents on an individual basis and noting their comments regarding activities, meals and general aspects of daily living. The information is recorded and then signed by the resident. The manager stated that group resident’s meetings have been trialled previously with little interest from residents. She feels this is an alternative method of gaining resident’s views. Discussions were held with residents regarding the quality and quantity of meals served. Residents commented that there was always plenty to eat and that the quality of meals had improved recently. Other comments received from residents on the day of inspection are detailed below: “The food is OK, there is too much of it, you don’t get a choice but you always get what you want” “The food is OK” “The food has improved but there needs to be more variety” Likes and dislikes regarding food is recorded in care plans. Menus seen demonstrated that residents are receiving nutritious meals. Residents have not been involved in menu planning but this will be discussed individually with residents in the future. A copy of the menu was on display in the Home and Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 18 was seen in resident’s bedrooms. The kitchen area was clean and hygienic. Residents received a regular supply of drinks throughout the inspection. Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Complaints are handled objectively and service users are confident that their concerns will be listened to and acted upon. Systems are in place to protect residents from the risk of abuse, increasing their feeling of safety and their quality of life in the home. EVIDENCE: Three anonymous complaints have been received by us since the last key inspection in June 2006. These concerns were investigated during a series of random inspections carried out in February and March 2007. Issues identified during these inspections relating to concerns raised have been addressed by the owner and manager. No complaints have been received by the Home. Both the owner and manager report an excellent relationship with residents, staff and visitors to the Home and feel that they are open to discussion at all times which results in no complaints being received. Residents spoken to during the inspection said: “If I had any problems or concerns I am sure someone would sort it out for me” “everyone communicates really well with each other” Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 20 All four relatives who responded to our feedback cards reported that they “know how to make a complaint about the care provided”. One relative commented, “They are always telling us to say if there is anything we are not satisfied with to say so, we feel very at ease with the Home”. There have been no allegations of abuse at this Home. Staff now have the relevant recruitment checks including criminal records bureau checks before employment. This was an issue identified at previous inspections of the Home that is now addressed. Staff training regarding protection of vulnerable adults has been arranged for May 2007. The owner confirmed that all staff must attend this training. Residents commented that all of the staff are friendly and kind. Staff were seen to be attentive to resident’s needs. The manager was aware of the changes needed to the adult protection and whistle blowing procedure but confirmed that other issues of higher priority have been addressed initially. Work will commence on these policies shortly. The manager was made aware that this issue will remain outstanding until works have been completed. Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The standard of the environment within this Home is generally well maintained providing an attractive, hygienic and homely place to live therefore improving the quality of life for residents. EVIDENCE: A brief tour of the premises was undertaken. Communal areas such as lounges and conservatory were clean, hygienic and had a homely feel. Residents appeared to be at ease in their surroundings, particularly those in the small lounge and conservatory. A handyman was on the premises during the inspection completing gardening and routine maintenance. The gardens were well cared for and planted with an array of colourful plants and flowers. Residents commented that they liked to sit out in the garden in the warmer weather. One resident said that she enjoyed looking at the birds in the garden from the conservatory when it was not warm enough to go out. Magazines Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 22 and board games were available in the lounges/conservatory and residents were enjoying listening to the radio or watching the television. Furnishings were in a good state of repair and clean. Bedrooms viewed had been personalised with pictures and ornaments. There was an unpleasant odour in one bedroom, which the manager stated that they had tried hard to remove and were considering other options. Other bedrooms seen were clean and hygienic. The shower room was seen, this was also clean. Residents are able to choose whether they wish to have a bath or shower. The owner is developing a cupboard in bathrooms for the storage of continence aids therefore maintaining the privacy and dignity of residents when using the bathroom. The owner has also purchased new COSHH items which will be stored appropriately and gave assurances that this will be completed within the next two weeks. There is no risk of burns or scalds to residents from hot water outlets or hot surfaces. Radiator covers are on all radiators and thermostatic mixing valves have been fitted to hot water outlets. The manager monitors the temperature of hot water on a monthly basis. Care staff were seen wearing disposable gloves and aprons appropriately throughout the inspection. The owner is nearing completion regarding the fitting of a sluice sink. Currently commodes are cleaned by care staff. The bed change chart recorded that nine residents have had their bed sheets changed once per week, some are changed more often and there were no records for one resident. When completing the tour of the premises a dirty mattress protector had been put back on the bed of one resident. The manager removed this and confirmed that a clean replacement would be put on before the resident went to bed. Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The number of care staff with a National Vocational Qualification (NVQ) level 2 will help to ensure that the skill mix of staff on duty will support meeting the needs of residents. The employment of staff is carried out in accordance with the homes’ policies and procedures ensuring that residents are supported and protected Improvements are needed to the amount of induction and ongoing mandatory training undertaken. Although systems have now been devised they have not been implemented. Lack of ongoing training might reduce the care staffs’ competence. EVIDENCE: A copy of the most recent duty rota was taken for review. Staff work shifts between the hours of 8am – 2pm, 2pm – 6pm, 6pm – 10pm and 10pm – 8am. At recent random inspections of the Home issues were identified regarding sleep over staff which were not sufficiently trained or checked to be able to provide the service, therefore putting resident’s at risk. The Home owner stated, and duty rotas confirmed that four days per week he undertakes night duty with another care assistant and on the other three nights he does night duty with his wife. One waking and one sleeping member of staff are on duty Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 24 at this Home at night. The Home owner gave assurances that only those staff who are criminal records bureau checked and who have received appropriate training will provide sleep over cover in future. Duty rotas show that the number of staff on duty during the morning 8am – 2pm varies between three and five staff. Three staff are on duty between 2pm – 6pm, including the manager Monday to Friday. Only two staff are on duty between 2pm – 6pm on Saturday and Sunday. Two staff are on duty between the hours of 6pm – 10pm on a daily basis. The owner’s wife is on duty every day between the hours of 10am – 2pm cooking the main lunchtime meal and a cleaner is employed Monday to Friday. During the weekends care staff would be responsible for cleaning duties. Issues have been identified at previous inspections regarding inaccurate duty rotas which did not correctly record the staff on duty. However on the day of this inspection those staff recorded on the duty rota were working in the Home. The owner, manager and staff spoken to all feel that sufficient staff are on duty at all times to be able to meet the care needs of residents. During some parts of each shift the manager works as part of the staffing establishment. Ten care staff are employed at Granville House including the care manager. Four of these staff have obtained a national vocational qualification (NVQ) in care at level two and the manager has obtained this qualification at level four. One staff member is a state enrolled nurse and therefore has qualifications higher than NVQ. Undertaking training goes some way to ensure that staff employed are suitably qualified to care for elderly residents. The staff files of the three most recently employed staff were reviewed. An issue identified at a previous inspection regarding evidence that a member of staff is currently undertaking training as per the conditions that must be met to stay in the United Kingdom, detailed in a letter from the Home Office were addressed during this inspection. The manager provided up to date evidence that this staff member is still undertaking training and attached this to the Home Office documentation. Another issue identified regarding a partially completed application form has been addressed – although documentary evidence of qualifications obtained is still outstanding. New skills for care induction training has been started for all new staff. The manager discussed the process of induction and confirmed that staff will only be given three months to complete the process. Previously induction records were seen partially completed and the staff member had worked at the Home for over a year. No records were available for review, as staff have only very recently been issued with documentation. The manager was aware that this standard cannot be considered as met until the process has commenced for staff. Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 25 Mandatory training regarding moving and handling, food and hygiene, first aid, protection of vulnerable adults and infection control is booked for April and May and a majority of staff have been allocated places at some or all of these courses. The Pharmacist who provides the pharmaceutical service to the Home had provided training for some staff. Lack of mandatory training has been identified as an issue of concern at previous inspections of this Home. Two staff were seen moving a resident in an inappropriate manner during this inspection which could result in injury to the resident or the staff. The manager must ensure that all staff undertake regular moving and handling training. Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The Home has an experienced manager who has an in depth knowledge of the needs of those under her care. Systems need to be put in place to ensure that the quality of the service provided meets the needs and expectations of the Service users who live at the Home. Resident’s financial interests are safeguarded. Not all health and safety issues have been addressed to ensure that residents live in a safe environment. This could put residents at risk. EVIDENCE: Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 27 The manager has worked at Granville House for a number of years. Issues relating to the management of the Home were identified at the last random inspection of this Home. However the owner and manager have worked hard to address issues and a majority have been actioned. Quality assurance systems are in the process of being developed. The Home owner is putting together a quality assurance audit plan which will commence shortly. The Home have a book that is used to store letters of thanks and praise that are received. A satisfaction survey was sent to all relatives on the 12 February 2007 and the results are being collated. Work is still underway regarding quality assurance and this standard is still not met. The spending money records for one resident were reviewed. Records were in good order and up to date, receipts are available for any expenditure such as personal items, hairdressing etc. Log sheets are used to record any expenditure and two signatures are required for any payments in or expenditure. Supervision notes were reviewed at a recent inspection of the Home and found to be inadequate. Records were not dated or signed and there was limited information regarding the content of supervision, which was largely practice, based regarding cleaning duties, the need to put clean clothes on residents etc. The manager was made aware that supervision should also cover issues such as training needs, development and feedback from staff should be recorded. The manager has devised new forms and will implement the process shortly. This issue remains unmet until supervision systems have been fully implemented. Accident records were reviewed and were up to date, however information is not being kept in line with data protection requirements. The manager was advised to store accident records separately for each resident. An external company were completing the three monthly servicing of fire fighting equipment and systems during the inspection visit. Portable appliance test stickers were dated April 2007, the next test being due April 2008. There was no log of equipment tested and whether the item had passed or failed. The manager confirmed that this information was due to be forwarded to the Home by the company who undertook the testing. Lift servicing was booked for shortly after the inspection visit, this was due. An issue was identified at previous inspections regarding the Gas Boiler and the fact that there is no Landlord’s Gas Safety Certificate to demonstrate that the boiler has been serviced and is considered to be in good working order and Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 28 safe. At a recent random inspection it was noted that British Gas would no longer service this boiler due to its age and commercial nature. However, during this inspection the owner confirmed that he has been in contact with a CORGI registered gas fitter who will undertake the servicing of the boiler. The owner must ensure that a Landlord’s Gas Safety Certificate is provided as soon as possible. COSHH items must be stored appropriately. The Home owner confirmed that new cleaning chemicals have been purchased and will be put in place shortly. These items were stored on the stairs between the first floor and the staff sleep over room. The owner was aware that this was inappropriate storage but stated that these items had recently been delivered and were awaiting storage for use. Two staff were seen moving and handling a resident in an inappropriate way this puts both residents and staff at risk of harm. The manager confirmed that moving and handling training is booked for April 2007. Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 29 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15(1) Requirement All people using the service must have an up to date, detailed care plan which must include details of any equipment needed to deliver their care and be signed and dated by the staff member completing the information. This will ensure that they receive person centred support that meets their needs. (outstanding since 26 June 2006) 2 OP9 13(2) Systems must be put in place to ensure that all medicines prescribed on a When required basis have supporting protocols detailing their use and outcomes are recorded to reflect on their use. This requirement is partially met. The manager has developed protocols but has yet to implement them for all residents. 3 OP9 13(2) Policies and procedures must be written to reflect current best practice in line with the Royal DS0000060619.V335188.R01.S.doc Timescale for action 08/06/07 08/06/07 22/06/07 Granville House Version 5.2 Page 31 Pharmaceutical Society of Great Britain professional guidelines for the safe handling of medicines. This requirement is partially met. 4 OP9 13(2) All staff must be trained in line with the Skills for Care Knowledge Sets including knowledge of the indications and side effects of the medicines they administer. The Home’s adult protection policy must contain sufficient information to enable staff to act appropriately should abuse be suspected. The whistle blowing policy should contain information guiding staff on the steps to take to report malpractice or concerns. (Outstanding since 31 October 05) 6 OP38 13 COSHH items such as cleaning chemicals must be securely stored when not in use. (Outstanding since 21 February 2007) 7 OP38 13(3)(4)a -c(6) 23 The gas boiler and electrical emersion heater must be safe to use and not present a risk to residents. Documentary evidence must be produced by a competent professional. 22/06/07 22/06/07 11/07/07 5 OP18 12(1) 22/06/07 Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 32 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 OP2 Good Practice Recommendations Residents should be fully informed of the services, fees and terms and conditions of occupancy within the Statements of terms and conditions or contracts of residency. These should record the rights and obligations of the service user and registered provider and who is liable if there is a breach of contract, as well as terms and conditions of occupancy. Resident’s should receive a comprehensive pre-admission assessment and information must be sought to provide evidence that the Home are able to meet the social and health care needs of the individual resident. Information regarding personal safety and risk and family and carer involvement should be included in this process. Nutritional screening should be undertaken upon admission to the Home and subsequently on a periodic basis. A record should be maintained of nutrition. Evidence should be available to demonstrate that the personal care needs of residents are being met. This includes regular bathing of residents. An activity programme must be developed following consultation with the residents about their social and leisure interests Activity programmes must be available for review and evidence must also be available to demonstrate that activities take place which are suited to the wants and needs of Service Users. Service users should be involved in the development of the Home’s menu. The unpleasant odour noted in one room should be removed so that the resident can reside in a clean, hygienic room without odour. 2 OP3 3 OP8 4 OP8 5 OP12 6 7 OP15 OP26 Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 33 8 OP30 Induction training should be completed in a timely manner. Evidence of completed induction training should be available for review. Mandatory training should be provided for all staff on a regular basis to ensure that staff have sufficient training to be able to meet the care needs of residents. The registered manager should produce an action plan from the survey results to move forward and ensure a quality service is delivered. The results of service user surveys should be shared with service user’s and relatives. Clinical and management information audits should be introduced as part of a quality system for the home. Documented, formal supervision should be implemented and carried out on a regular basis. Documentary evidence should be available to highlight topics discussed, training outcomes etc. 9 OP30 10 OP33 11 12 OP33 OP36 Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Granville House DS0000060619.V335188.R01.S.doc Version 5.2 Page 35 - 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. 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