Inspection on 08/04/08 for Granville House

This inspection was carried out on 8th April 2008.

CSCI found this care home to be providing an Adequate service.

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 16/04/07

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Granville House Granville House 4 Moultrie Road Rugby Warwickshire CV21 3BD Lead Inspector Deborah Shelton Key Unannounced Inspection 8th April 2008 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.V362939.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.V362939.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.V362939.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. 16th April 2007 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. Granville House DS0000060619.V362939.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by us is upon outcomes for people who live in the home and obtaining their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The following information in this report is the findings of an unannounced inspection visit that took place on Tuesday 8 April 2008. Seventeen people were living at Granville House at the time of the visit. Three residents were ‘case tracked’, this involves finding out about their experience of living in the care home by meeting with them, or observing them, talking to them and their families (where possible). Looking at their care files and the environment in which they live. Staff training records are reviewed to ensure training is provided to meet resident’s needs. Documentation regarding staffing, health and safety, medication and complaints are also reviewed. During the inspection the manager was on duty along with three care assistants, the owners of the Home were also in attendance. The inspection process consisted of a review of policies and procedures, discussions with the manager, staff and residents. Other records examined during this inspection included, care, staff recruitment, training, staff duty rotas, health and safety and medication records. Notification of incidents received by us from the Home and any other information received were also examined. The inspector was introduced to a majority of the people that live at Granville House and conversations were held with eight people. Further information to identify the outcomes for residents’ was also gained through observation of residents and staff. The inspector wishes to thank the manager and staff for the hospitality on the day of inspection. Granville House DS0000060619.V362939.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Although improvements were noted in care planning and the new documentation in place, further work is required to ensure that all of the care needs of residents are identified and recorded. Risk assessments are undertaken however there was no care plan in place where a high risk was identified. This is required to guide staff of the action to take to reduce the risk. Granville House DS0000060619.V362939.R01.S.doc Version 5.2 Page 7 Weight records were not up to date and not all clearly demonstrate that weight is being sufficiently monitored. Activities are now provided on a more regular basis but there is no evidence that these activities are suited to the wants of residents and are provided on a daily basis. Moving and handling techniques witnessed were poor and put both the residents and staff at risk of injury. Some improvements are required to infection control practices to reduce the risk of cross infection. This includes a hand wash sink in the laundry, sluice cycle on the washing machine and keeping the sluice room door locked at all times when it is not in use. An up to date criminal records bureau check must be available for all staff. This should be provided by Granville House and not the person’s previous place of employment. There was no appropriate documentary evidence to demonstrate that staff have received training recently. Induction is not completed in line with skills for care requirements. Staff should receive appropriate induction and ongoing mandatory training to ensure that they have the necessary skills to meet the needs of those under their care. The systems in place to ensure that the quality of the service provided meets the needs and expectations of those people who live at Granville House are limited. Audits of working practices do not take place. There is no system in place to find out if people are satisfied with the care provided and life in general at Granville House. Finding out resident’s individual wants and needs and trying to provide a service that meets these will improve the life of the people that live at the Home. Some of the documentary evidence to demonstrate that electrical and gas systems are safe was not available. The Landlord’s Gas Safety Certificate was not available and work is still to be undertaken on issues identified during the five-year electrical wiring test. Up to date safety certificates must be available to demonstrate that health and safety requirements are met and the Home is safe. 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.V362939.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.V362939.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): 2 and 3 Quality in this outcome area is good. People who are considering moving into the home benefit from having their care needs assessed. This ensures that the Home can meet the individual’s identified needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents were chosen at random to “case track” during this inspection. This involves looking at their care files and associated documentation, all aspects of the service they receive and the accommodation in which they live. Contracts of residency were available in all files seen. An issue was identified at the last inspection, as the contract does not specifically mention items that must be paid for over and above the fees. The contract has not been amended and still states “the provider will provide services which have not been specifically listed but which can reasonably be expected to be provided within the contract”. Residents are therefore not fully informed of what Granville House DS0000060619.V362939.R01.S.doc Version 5.2 Page 10 services they can expect for their fees and what they must make additional payments for. The care files of two residents recently admitted to the Home were reviewed to evidence the admission process at Granville House. The manager confirmed that it is usual practice for her to undertake pre-admission assessments. Once a placement has been offered residents stay for a four-week trial period before agreeing to a permanent placement. This trial period ensures that the resident is happy in the Home and the Home are able to meet their needs. Potential residents and their relatives are encouraged to visit Granville House and have a look around before agreeing to move in. They are able to have a copy of the Service User’s Guide when they agree to a placement. In both files seen the pre-admission documentation had not been signed by the person making the record. The manager confirmed that she completed these assessments. Care plans provided by Warwickshire Social Services record the past medical history for these people. In one file viewed the care plans developed by the Home did not record any specific details of a previous medical history (depressive illness). The manager confirmed that the person had not shown any signs of this since admission to the Home. However, this person is taking regular medication for depression. Without written information staff may not be aware of the symptoms and the action to take should the person become depressed. Standardised pre-admission documentation covered aspects of health, welfare and daily living. Some of the information on documentation was left blank, for instance, medical history and details of medication. Details of the number of staff required to provide assistance, were recorded, however in one file, the level and type of assistance was not completed in detail on each occasion, i.e. washing, needs all help, encourage … to help. This does not record preferences or exact needs and therefore individual needs may not be met. Likes, dislikes, and personal preferences regarding times for getting up in the morning and going to bed are recorded. Including these preferences should improve the daily life of those at Granville House. Residents spoken to were happy that their care needs are being met. Granville House DS0000060619.V362939.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. Care plans have not been developed for every area of need, this may result in care not being given and reducing the quality of the person’s life. Medication is managed in a safe way protecting residents from harm. Residents are treated with respect but screening is needed in one bedroom to ensure that all people’s rights to privacy and dignity are maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Those people living at Granville House looked well cared for and were clean, their hair had been combed and nails were trimmed and clean. They were well presented and wore clothes that were suited to the time of year. The care files of three people identified for case tracking were reviewed. Risk assessments regarding tissue viability, falls, nutrition, moving and handling were in place. Information in these risk assessments was not up to date and all required reviewing. One risk assessment had not been reviewed Granville House DS0000060619.V362939.R01.S.doc Version 5.2 Page 12 since June 2007, another since November 2007. It was seen that in two cases the risk assessment did not described accurately what the person was able to do and where they needed assistance. For example a moving and handling and a mobility risk assessment had not been dated or signed by the person recording the information. The mobility risk assessment was not fully completed and the number of staff required to assist with a task was not recorded. Another risk assessment recorded that the person is able to walk inside and out. However during a conversation with the resident it was noted that they are now mainly confined to bed. The general risk assessment was not dated or signed and stated that one carer is to walk with the resident. This information is out of date and does not provide clear guidance for staff. One fall risk assessment seen states that the resident is at risk of falling, the care plan states that there is a history of falls and no other information is recorded. Once a risk has been identified a plan of care should be put in place, which should detail the action that staff are to take to reduce this risk. The care plans in place had not been dated to show when they were implemented. It is therefore difficult to see how long these care plans have been in place, and whether the information is up to date. The manager said that all care plans were transferred on to new documentation between April and September 2007. The date of last review was 15 February 2008 in one file seen. Care plans should be reviewed on a monthly basis or more often if required. This is particularly important for more dependent residents whose needs may change regularly. This ensures that staff are working towards meeting the current care needs. Care plans had been signed by either the resident or a member of their family to demonstrate that they have been involved in the care planning process and agreed to the care prescribed. Some of the care plans were comprehensive whilst others did not contain sufficient information to guide staff regarding the care needs of individuals. In two of the files seen social services care plans identified issues i.e. mental health or memory problems and one stated that the resident is to be supervised when walking due to a risk of falling and is to be encouraged to eat. The Home have not developed detailed care plans regarding these issues and there were no weight records for the resident who is to be encouraged to eat. Care plans must be in place for all areas of need, particularly if this is recorded as one of the reasons for admission. Care needs may be missed if care plans are not in place. In one file weight records show a 1kg weight loss between 8 Feb and 24 March. No other weight was recorded since that date. The manager said that this is because the person is no longer able to weight bare and therefore Granville House DS0000060619.V362939.R01.S.doc Version 5.2 Page 13 cannot use stand on scales. Other methods to monitor weight should be used as unexplained weight loss or gain could be the result of an underlying health problem. Another resident’s weight was recorded in September 2007 and March 2008 and not in between. There was no weight recorded on a nutritional risk assessment. People should be weighed on a regular basis, particularly if they are at a high risk of nutritional intake problems and therefore weight loss or gain which could affect the person’s health. Two of the files contained detailed life histories. This is useful for staff to be able to talk about the individual’s past or to arrange suitable activities relevant to individual needs. Detailed records are kept of visits made by external professionals such as GP, Optician, Chiropodist, Dentist and District Nurse. Copies of optical prescriptions were on file for review. These demonstrate that residents are being reviewed by an optician as needed. Daily entries are recorded on standardised documentation, which is broken down into details of care plan needs. The care given is not written down on separate paperwork, instead staff use a tick box system to show what care has been given such as bathing/strip wash. Records were confusing. Other information describing the person’s day was not recorded. This lack of information may result in the staff missing changes in health and behaviour of the resident. The manager agreed to change this method of completing daily entries. The manager has worked extremely hard to transfer all information from the old style of care planning onto the new documentation. Care plans now contain more detail to guide staff than the previous systems in use. Care needs identified must have a plan of care devised to enable staff to meet these needs. If a risk assessment identifies that the resident is at a high risk a plan of care should be devised so that staff can take action to reduce the identified risk. Residents spoken to confirmed that their health care needs are met. One resident commented that “they call the Dr or paramedics if you need them, you get your tablets on time every day”. Another resident said “I missed my tablets yesterday as the chemist didn’t deliver them but they are here today which is good”. The medication records for the three residents being case tracked were reviewed. Medication administration records were audited against the amounts of medications available. Each record correctly detailed the number of tablets available. At the beginning of each medication cycle, new medication received is checked against the original prescription and the medication administration record. Granville House DS0000060619.V362939.R01.S.doc Version 5.2 Page 14 This reduces the risk of residents being given the wrong medication by the pharmacy. Medication was stored in a secure manner. There is no medication fridge, the food fridge in the kitchen is used but any medications requiring refrigeration are stored in a plastic container, which is clearly labelled to identify its contents. A dedicated medication fridge should be available to ensure the safe storage of medication A signature list is available which records the signatures of all staff responsible for administering medication. This is good practice and provides an audit trail when needing to identify who has administered medication. The manager and four care staff have enrolled on the distance-learning, safe handling of medication course. All staff that administer medication should undertake training and be checked to ensure that they are competent. A monthly audit of stock is undertaken and records are available. The manager and staff have worked hard to improve medication systems and practices in place, which makes these systems safer for residents. Residents confirmed that they get their medicines on time every day. All staff treated residents with respect and dignity during the inspection. Residents were dressed appropriately for the time of year and their hair was nicely brushed. Ladies were wearing make up as they wished. Staff knocked on resident’s bedroom doors and all personal care was undertaken in private. However, the privacy and dignity of two residents sharing a room was not being maintained. Screening is not available in the room to maintain privacy whilst getting dressed or using the commode. Granville House DS0000060619.V362939.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 good. Activities take place providing stimulation and social interaction, which enhances the quality of life of residents. Visitors are made welcome and their needs considered. Residents have choices and control over their daily lives. Residents benefit from the nutritious and varied meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is no activity programme in place currently. The manager said that staff go into the lounge to ask what residents would like to do, activities are therefore provided at the choice of residents. Certain activities such as dominoes, library books, hand and nail care, jigsaws, skittles are undertaken on a regular basis. A social activities record is kept which details when activities have taken place for each individual resident. The records for one of the people being case tracked showed that the resident has joined in an activity every two or three days between 6 February 2008 – 2 March 2008. Activities such as reading a book, chatting, colouring, dominoes and had nails done were all recorded. The records for the other residents being case tracked show that one resident Granville House DS0000060619.V362939.R01.S.doc Version 5.2 Page 16 joins in activities every three to four days and the other resident on a less frequent basis. Another record reviewed showed that the resident joined in an activity on 26 January 2008 “walk outside” and then no activities were recorded until 28 March 08 “made labels for dinner table”. This does not demonstrate that sufficient activities are provided on a regular basis. A member of staff was playing dominoes in the lounge with three ladies. All appeared to be enjoying the experience. Those residents spoken to about activities said that: “they do activities in the Home but we are not interested” “we play dominoes but I am not an expert” “we play dominoes in the day, they do lots of things to pass an hour away” “I like dominoes, we play ludo, there are large print books, the only problem is that lots of the ladies are deaf and it’s difficult to communicate with them”. The Home has an open visiting policy and visitors are welcome at any time. Those who are unable to visit their loved ones on a regular basis keep in regular phone contact. Residents can use a phone if they wish to speak to anybody. The manager reports an excellent relationship with all relatives and this was observed during the inspection visit. Residents confirmed that visitors are made to feel welcome and are offered refreshments. One resident commented, “staff update the visitors with all that they need to know”. Independence is encouraged. Care plans recorded likes and dislikes and personal preferences regarding times for rising and retiring, preferred drinks and food. There is no choice recorded on the menu for the main lunchtime meal. The manager confirmed that residents are able to have an alternative if they do not like the meal on offer. Residents are told by staff what the main meal of the day is and if someone didn’t like it they could ask for something different. There is a choice of evening meal such as soup, sandwiches, tomatoes on toast, cheese on toast etc. Residents meetings are not held. The manager said that they talk to residents on a daily basis to find out if there are any problems, changes needed or particular things that the resident would like. Residents were seen being offered drinks throughout the inspection. The main lunchtime meal of cottage pie and carrots was also eaten by the Inspector. The meal was well presented and tasty. Granville House DS0000060619.V362939.R01.S.doc Version 5.2 Page 17 Residents were complimentary about meals and all said that there is plenty of food. Other comments made are as follows: “the food is ok, there is plenty of it. They tell you everyday what there is and you can say if you don’t want it and want something else”. “there is plenty of food, too much sometimes” “food is good, too much at times. You have a drink and a biscuit before bed” “food is good, there is plenty of it and it’s all nice”. Granville House DS0000060619.V362939.R01.S.doc Version 5.2 Page 18 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): 16 and 18 Quality in this outcome area is adequate. People living in the home can be confident that their concerns will be listened to and acted upon but inappropriate moving and handling techniques does not safeguard people from potential harm This judgement has been made using available evidence including a visit to this service. EVIDENCE: No complaints have been received by the Home or us since the last key inspection in April 2007. A copy of the complaint policy is on display on the wall in the manager’s office. There is a logbook to record complaints should they be received. Residents were spoken to about concerns or complaints. All said that if they had any worries or concerns they would speak to the manager. One resident said that “you can speak to the manager about anything”, another said “I would speak to the manager if I had any worries but I don’t”. Adult protection was discussed with the manager and it was noted that some staff require training in the protection of vulnerable adults. There have been no allegations of abuse at the Home since the last inspection. New policies and procedures are being developed. A computer disk has been purchased to assist with developing the policies. The adult protection policy has apparently been amended but was not on the premises at the time of the Granville House DS0000060619.V362939.R01.S.doc Version 5.2 Page 19 inspection. Therefore the adult protection policy was not seen on this occasion. During the inspection a resident was observed being moved in a wheelchair without footplates. This puts the resident at risk of injury. Two staff members were also witnessed performing an under arm lift when moving a resident from their wheelchair to the lounge chair. This was witnessed on more than one occasion. This puts both the staff and resident at risk of injury. Staff said that there is equipment for use when moving and handling residents but did not feel that there was a sufficient amount of equipment available. Records show that staff have recently undertaken moving and handling training. No handling belts were seen in use during this inspection. Granville House DS0000060619.V362939.R01.S.doc Version 5.2 Page 20 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): 19 and 26 Quality in this outcome area is adequate. The home offers the people living there comfortable surroundings, which are clean, free of offensive odour and generally safe and well maintained but with shortfalls related to infection control. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was undertaken, this included the bedrooms of those residents being case tracked, the laundry, kitchen, bathrooms and communal areas. The laundry houses one washing machine and two tumble dryers. The washing machine does not have a sluice cycle. The manager said that this is not needed currently but if an item of clothing was soiled it would be left to soak in a bucket, the contents of the bucket would then be emptied down the sluice. Putting soiled laundry in a washing machine with a sluice cycle reduces Granville House DS0000060619.V362939.R01.S.doc Version 5.2 Page 21 the amount that these items need to be handled and therefore reduces the risk of cross infection. There is no hand wash sink in the laundry. If a staff member needed to wash their hands they would need to leave the laundry re-enter the Home, walk down a corridor and use a sluice type sink housed in the boiler room. The owner was informed that this presents an infection control risk and a hand wash sink should be made available in the laundry room. A sluice sink has recently been fitted on the first floor of the Home. This door was left open and not locked. This room should be kept locked when not in use to prevent access by residents. Leaving the door open gives a risk of cross infection if a resident were to enter the room. Staff were seen wearing disposable gloves and aprons as appropriate throughout the inspection. A supply of gloves and aprons was available outside the manager’s office. Communal areas were clean and hygienic and had a homely feel. Some residents were seated in the main lounge watching the television whilst others preferred to sit in the lounge adjoining the conservatory listening to the radio. The kitchen is in the process of being refurbished by the Home owner. A new floor has been laid, new kitchen units and worktops and a large industrial extractor hood. The owner has been working on the kitchen during the evening when it is not in use, to cause minimal disruption to the preparation of food. The kitchen was clean and hygienic. A bedroom shared by two residents was reviewed. The room was clean, décor and furniture and fittings were in good order. There was no screening to divide the room. The privacy and dignity of the residents who share this room is not being maintained, particularly whilst getting dressed or using the commode as either resident would be in full view of the other. This was identified as an issue for action at the last inspection of the Home. All bedrooms seen were clean and had been personalised with pictures and ornaments. Furniture and fixtures were in a good state of repair. The owner reported that all windows apart from one have been replaced with double glazed units, some bedrooms have been re-painted. This demonstrates that the Home owner is providing ongoing maintenance as needed. An issue identified at the last inspection related to an electric emersion heater, which the owner had repaired so that it was again operational. All electrical works should be undertaken or checked by a qualified electrician. The owner confirmed that this has been checked and is in good working order. Documentary evidence to demonstrate this was not made available. Granville House DS0000060619.V362939.R01.S.doc Version 5.2 Page 22 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): 27, 28, 29 and 30 Quality in this outcome area is adequate. There are sufficient numbers of staff on duty to meet the needs of people living in the home. Further training is needed to make sure people are cared for by competent staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the duty rota was taken for review. Currently shifts are broken down into 8am – 2pm, 3 care staff, 2pm – 6pm, 2 care staff, 6pm – 10pm, 2 care staff and 10pm – 8am, 1 waking and one sleeping staff member. Staff on duty on the day of inspection were in accordance with those recorded on the duty rota. The number of staff on duty appeared to be sufficient to be able to meet the care needs of residents. The manager and owners provide on call arrangements so that staff have access to advice and guidance twenty-four hours a day. Eight care staff are employed at Granville House, four of these staff are qualified nurses, three staff have obtained their NVQ level 2 and one staff member is currently undertaking this qualification. Three staff files were reviewed to evidence whether Granville House operate robust recruitment procedures. Each file contained two written references, dates of employment and application forms. The file for one employee Granville House DS0000060619.V362939.R01.S.doc Version 5.2 Page 23 contained a criminal records bureau (CRB) check from her previous place of employment. The owner said that he is in the process of obtaining an up to date CRB and until this is received she does not work any shifts unsupervised. The duty rota confirmed that this staff member was on duty with other staff at all times. The three files seen did not all contain evidence that training has been undertaken as certificates were not available. A price list and list of dates that the training is available was seen but this is not proof that the training actually took place. The owner said that training had been completed regarding food hygiene, moving and handling, first aid, fire and infection control. Induction and training records were reviewed. The Home undertake their own induction training, this is not in line with Skills for Care requirements. The owner confirmed that the correct induction information would be obtained ready for any new staff. Residents were complimentary about staff and commented: “they are nice, are kind and caring, knock on my door before they come in, don’t rush me. I have a bath and the staff treat me with respect”. “everyone here is lovely, I get a bit agitated sometimes but the staff sort me out. I got much more worried and stressed before I came here, now I know that there is always someone here to help me” Granville House DS0000060619.V362939.R01.S.doc Version 5.2 Page 24 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): 31, 33, 35 and 38 Quality in this outcome area is adequate. The manager is qualified to run the service but some working practices and infection control issues fails to ensure the safety of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has worked hard since the last inspection to improve management systems and practices. Work has been undertaken regarding care planning, medication and activity records. The manager said that they are in the process of reviewing all policies and procedures. The Home owners work in the Home on a daily basis and receive feedback direct from those who live at Granville House. Granville House DS0000060619.V362939.R01.S.doc Version 5.2 Page 25 There have been no changes to quality assurance systems in place since the last inspection. There are no residents meetings, the manager chats to residents on a regular basis to find out if the quality of the service provided meets their needs and expectations. A satisfaction survey was sent out in February 2007 and another survey is due to be sent out shortly. There is limited documentary evidence to demonstrate that the Home are meeting the wants and needs of the people that live at Granville House. The manager reports a close relationship with residents and their families. There is a lot of family interaction at the Home, the manager said that she always receives good feedback and has not received any complaints. A book is available which has messages of thanks/thank you cards and compliments. Apart from the medication audit there are no documented quality assurance audits, however, the owners are on the premises on a daily basis and said that they receive feedback and action any issues that require addressing. Residents spoken to during this inspection spoke positively about life at Granville House. An audit of resident’s monies was undertaken. Three residents receive the services of an advocate. The spending money records of the three residents case tracked were reviewed and all were found to be in good order and up to date. A random sample of records were reviewed to evidence whether the health and safety of staff and residents is maintained. The five year electrical check was undertaken in May 2007, the owner reported that there are some works to be completed which are outstanding. The portable electrical appliance testing was last undertaken in April 2007, the owner realises that this is outstanding and gave assurances that checks will be undertaken within the next few weeks. The gas safety check was undertaken on 2 April 2008, there is no certificate as yet as the owner said that they have not paid for it. There should be an up to date Landlord’s Gas Safety Certificate on the premises to demonstrate that gas systems have been checked and are safe. A report from Warwickshire fire service dated 2 October 2007 recorded that the Home must provide frequent refresher training. The last fire training undertaken was May 2007. Emergency lighting is tested on a monthly basis, this has not been completed since February 2008 and is therefore not up to date. Ensuring emergency lighting is in good working order is important in case of fire. Fire drills were undertaken on 11 April 07, 5 September 07 and 5 March 08. An external Granville House DS0000060619.V362939.R01.S.doc Version 5.2 Page 26 professional checked fire extinguishers in February 2008 and these are not due to be checked again for six months. The fire risk assessment is yet to be completed. This was also identified as an issue for action from Warwickshire Fire Service. The Home has one hoist, which was supplied by the District Nursing Service, this is currently not in use as the manager stated that none of the residents require the use of a hoist. The manager stated that if anyone fell during the night staff would not attempt to move the person but would call the emergency services. All equipment available must be fit for use. Staff were seen moving residents in an inappropriate manner which could cause injury to the resident or to the staff. Two staff members performed an under arm lift on a resident whilst moving from wheelchair to lounge chair, another resident was moved from lounge chair to wheelchair using the same lift and was then transported in the wheelchair which did not contain any foot plates. There was no documentary evidence in the form of certificates of attendance that all staff had undertaken recent mandatory training. The owner confirmed that staff had attended the training but was unable to produce any certificates of attendance as evidence. Granville House DS0000060619.V362939.R01.S.doc Version 5.2 Page 27 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 2 8 2 9 3 10 2 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 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Granville House DS0000060619.V362939.R01.S.doc Version 5.2 Page 28 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 Care plans must be available for each of the identified needs of people living in the home and contain details of the actions required to meet each need. Care plans must be reviewed at least monthly or when there is a change in need. This is to ensure that people get the care they need. Timescale for action 15/06/08 2 OP8 12(1) Weight monitoring must be 15/06/08 undertaken on a regular basis for all residents. Alternative methods of monitoring weight loss or gain should be undertaken for those unable to use stand on scales. Systems must be in place to identify any risk to the health or well being of people living in the home and must include details of how any identified risk can be reduced. This is to make sure that risks to the health or well being of residents are identified and reduced. 15/06/08 3 OP8 12 Granville House DS0000060619.V362939.R01.S.doc Version 5.2 Page 29 4 OP18 12(1) 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) 15/06/08 5 OP29 18 Systems must be in place to 25/06/08 ensure that staff do not start working in the home until satisfactory pre employment checks, including CRB and PoVA, have been obtained. This is to ensure that people living in the home are protected from the risk of abuse. Arrangements must be made for all staff to have a current mandatory training. This is to include food hygiene, fire safety, abuse awareness, infection control and moving and handling. This is to ensure that residents and staff are protected from the risk of harm due to incorrect moving and handling techniques. The gas boiler and electrical emersion heater must be tested and any remedial work required carried out promptly to ensure the safety of those living and working in the home. (Outstanding since April 2007) 15/06/08 6 OP30 18 7 OP38 23 15/06/08 Granville House DS0000060619.V362939.R01.S.doc Version 5.2 Page 30 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. Screening should be in place in shared rooms to maintain the privacy and dignity of those that stay in that bedroom. Appropriate systems and practices should be put in place regarding the cleaning of soiled laundry. The sluice room should be kept locked shut when not in use. This is to reduce the risk of cross infection. Induction training in line with Skills for Care requirements should be completed in a timely manner. Evidence of completed induction training should be available for review. The service should be able to demonstrate the review of working practices and quality of care delivered to people living in the home. This should ensure that the home is run in the best interests of people living in the home. 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. Information recorded in care files should be dated and signed by the person making the record. 2 3 OP19 OP26 4 OP30 5 OP33 6 OP33 7 8 OP33 OP37 Granville House DS0000060619.V362939.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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.V362939.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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