CARE HOME ADULTS 18-65
Granvue Lincombe Drive Wellswood Torquay Devon TQ1 2HH Lead Inspector
Mark Sharman Announced Inspection 13th December 2005 11:00 Granvue DS0000018361.V256079.R01.S.doc Version 5.0 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 Granvue DS0000018361.V256079.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Granvue DS0000018361.V256079.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Granvue Address Lincombe Drive Wellswood Torquay Devon TQ1 2HH 01803 213970 01803 213970 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) Community Care Trust (South Devon) Limited Mrs Lindsay Jane Eastwood Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8) of places Granvue DS0000018361.V256079.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 8/6/05 Brief Description of the Service: Granvue is a care home offering rehabilitation for up to eight people between the ages of 18 and 65 who suffer from long-term mental health problems. It is part of a range of services provided by the Community Care Trust (South Devon) Ltd. The home is set in a quiet residential area with attractive views, about twenty minutes walk from Torquay town centre. There are a few shops and a pub in the vicinity of the home. The home has seven bedrooms (one double), a lounge (with adjacent smoking room), a dining room, and a room on the top floor which can be used for training, therapies (such as massage) and meetings. Discharge from the home is planned carefully, and follow-up support from the staff can be available on an outreach or drop-in basis. The manager and deputy manager are registered mental nurses, who supervise care planning and intervention. Granvue DS0000018361.V256079.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection and about five and a half hours were spent at the home. A pre-inspection questionnaire completed by the home’s manager was received prior to the inspection, together with other supplementary documents. One comment card completed by one of the residents (now left) was also received. Time was spent with the manager, and four residents and three of the other staff were spoken with. All of the communal parts of the home were seen. What the service does well: What has improved since the last inspection?
One requirement was made at the last inspection, namely that monthly reports on the conduct of the home should be sent to the Commission for Social Care Inspection (these had been provided but had begun to lapse). This is to ensure that there is ongoing supervision of the home by the Trust, and these reports have been resumed. Granvue DS0000018361.V256079.R01.S.doc Version 5.0 Page 6 There had been some difficulty in filling the night time rota with regular Trust staff, but two new staff have recently been appointed. This will help with the continuity of care for the residents. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Granvue DS0000018361.V256079.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Granvue DS0000018361.V256079.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2. The needs and wishes of all those admitted to the home are very carefully assessed before their admission. EVIDENCE: The files of current residents were examined. In every case the home had received a written referral from a professional in the mental health services. The manager said that she or her deputy always see a prospective new resident before admission to the home to assess the suitability of the service for him/her. In most cases people are admitted from hospital, and the manager always attends a ward round at the hospital. The new resident also visits Granvue before a decision is made about admission, which was confirmed by one of the current residents. Granvue DS0000018361.V256079.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9. Care planning is carried out thoroughly, and residents are supported to take responsible risks. EVIDENCE: Four residents’ files were examined. A care plan (Granvue Action Plan) is formulated soon after a resident’s admission to the home, centred on objectives agreed with the resident. Two keyworkers are appointed for each resident, who are responsible for implementing and updating the care plans under the supervision of the deputy manager. Risk assessments are always completed, and these were available in the individual files. Reviews are held at least six monthly, but in most cases more often than this – in one case a new action plan was written at least every three months. In this respect the Standard is exceeded. A review with one resident was held on the day of this inspection, including staff and the resident’s community psychiatric nurse. Care plans include any agreed restrictions, such as limits on a resident going out unaccompanied, and staff make judgements about responsible risk taking in conjunction with the residents. Most residents go out unescorted and return to the home when they wish, and take part in a range of activities. On the day
Granvue DS0000018361.V256079.R01.S.doc Version 5.0 Page 10 of the inspection residents went out on their own. There is a “missing persons” procedure. Granvue DS0000018361.V256079.R01.S.doc Version 5.0 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 16 and 17. The residents have opportunities to follow their particular interests and to maintain contact with the local community. They are treated respectfully, but expected to take part in the everyday running of the home. EVIDENCE: Developing social networks may well be one of the aims of a person’s care plan, and so social inclusion is important. Residents are encouraged to use public transport and normal community facilities, such as going to college or other day opportunities. One of the residents said she was going to a day centre in the afternoon to attend a women’s group, and another had played football recently at a sports centre. The home is non-institutional in appearance and fits in well with the neighbourhood. The staff were careful to respect residents’ privacy, for example not entering their bedrooms unless invited, and residents were complimentary about the attitude of the staff. The residents have unrestricted access to the home (apart from others’ bedrooms), and have a key to their own bedroom door. They choose when to get up and go to bed. They confirmed that they take a turn doing household chores, including preparing the evening meal. They were all satisfied with the food available to them. Granvue DS0000018361.V256079.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 20. The home provides a supportive environment in order to develop residents’ confidence, independence and control. This includes residents managing their own medication. EVIDENCE: The registered manager and deputy manager are both nursing qualified (RMN), and support to service users is also available from community psychiatric nurses. Each service user has two designated key workers, although residents said they feel able to seek advice and support from any of the staff. Over time they are encouraged to manage their own medication, which one said he is doing now. When necessary their medication is administered by the staff, and the drugs cupboard and a sample of medication administration recording sheets was seen. Residents are encouraged to keep their medication in their own lockers (on the ground floor), which one of them confirmed. Granvue DS0000018361.V256079.R01.S.doc Version 5.0 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. There is a satisfactory complaints procedure and arrangements to prevent abuse. EVIDENCE: There is a complaints policy with clear response times which was displayed on a notice board, and a copy is given to new residents on admission. All of the residents said they were confident they would be listened to and taken seriously if they had a complaint, although none was expressed at this inspection. The manager said one complaint was passed on to the Trust’s general manager but then withdrawn by the resident concerned. There are policies on the prevention of abuse, whistleblowing, and physical intervention by staff. The home has a copy of the Alerter’s Guidance and the No Secrets video. The staff recruitment procedure is thorough (see later in this report). Granvue DS0000018361.V256079.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 and 30. There are comfortable communal areas and the home was warm, clean and hygienic. EVIDENCE: There are adequate shared areas comprising a kitchen, dining room, lounge with adjacent smoking room, bathrooms and toilets. There are also outdoor areas including a large (but steep) garden. The building is in a reasonable state of repair (a heating engineer has made a recommendation in respect of the boiler flue). It was noticed that smoke from the smoking room adjacent to the lounge does drift into the main lounge, even though there is an extractor fan in the smoking room. For the sake of non-smokers this issue should be addressed. The areas of the home which were seen were warm and reasonably clean, and residents said this is usually so. The laundry room was inspected, and there are adequate laundry facilities for this client group. Granvue DS0000018361.V256079.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 and 35. There is a very stable staff group who have received training appropriate for this client group, and staff morale is high. Recruitment practice is satisfactory. EVIDENCE: The training record for all staff was made available for this inspection, and staff who were consulted during the inspection felt that training opportunities are good (subject to the staff rota having to be manned). There is an annual training budget, and much of the training is accessed via the NHS learning and development service. The manager said that some staff are due to attend training in personality disorder, self-injury, and sexual abuse. The most recent staff member is undertaking accredited induction training. Her file was examined, and the correct recruitment practice had been followed (Criminal Records Bureau disclosure and written references). New staff are subject to a 17 weeks probationary period. Only one staff member has left in the last year or so, thus maintaining continuity of care for the residents. Granvue DS0000018361.V256079.R01.S.doc Version 5.0 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. The home is managed by a qualified and experienced manager, and there are effective quality assurance strategies in place. Arrangements in respect of health and safety are generally satisfactory. EVIDENCE: The registered manager has managed the home for several years. She is a registered general nurse and a registered mental nurse, and has a management qualification (Certificate in Management Studies). Her training record shows continuing training over the last few years. Feedback about the service is obtained from residents individually, and via their reviews and regular residents’ meetings. There are monthly staff meetings. The Trust’s general manager carries out an annual clinical audit and visits the home at least monthly (under Regulation 26). In addition the Trust’s directors visit the home twice per year. The business/development plan for 2005/2006 was available and was examined. With regard to health and safety standard training for staff includes first aid, food hygiene and moving and handling. There was evidence of professional fire training in the last year, although it is recommended that this should take
Granvue DS0000018361.V256079.R01.S.doc Version 5.0 Page 17 place for all staff every six months. The recent requirement of the Environmental Health Department (fridge temperature) has been complied with. The fire alarm system and emergency lighting system are serviced six monthly (documentation was seen). A gas engineer made some recommendations following a recent visit to the home. Granvue DS0000018361.V256079.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 4 x x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 x x 3 x Standard No 24 25 26 27 28 29 30
STAFFING Score x x x x 3 x 3 LIFESTYLES Standard No Score 11 x 12 x 13 3 14 x 15 x 16 3 17 Standard No 31 32 33 34 35 36 Score x x x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Granvue Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 x x 3 x DS0000018361.V256079.R01.S.doc Version 5.0 Page 19 No. Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA24 YA24 Regulation 16 16 Requirement The office carpet must be replaced. The matching sofa, chair and footstool in the lounge must be replaced or re-covered. Timescale for action 31/03/06 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA35 YA37 YA42 Good Practice Recommendations All staff should receive fire safety training every six months. The registered manager should have a plan to achieve the registered managers award as part of continuing professional development. The Belling cooker should be fitted with a restraining chain. Granvue DS0000018361.V256079.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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