Inspection on 19/12/08 for Grapecroft Care Home Ltd

This inspection was carried out on 19th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Grapecroft Care Home Ltd 21/05/09

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Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Grapecroft Care Home Ltd 82-84 Calcutta Road Tilbury Essex RM18 7QJ     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Diane Roberts     Date: 2 2 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Grapecroft Care Home Ltd 82-84 Calcutta Road Tilbury Essex RM18 7QJ 01375852020 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Festival Care Homes Ltd Name of registered manager (if applicable) Phidelima Ajao Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence past or present drug dependence dementia learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 62 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE Mental Disorder, excluding learning disability or dementia - Code MD Learning Disability - Code LD Physical Disability - Code PD Past or present drug dependence Code D Past or present alcohol dependence - Code A Old age, not falling within any Care Homes for Older People Page 4 of 30 care home 62 Over 65 0 0 0 0 0 62 0 62 62 62 62 62 0 62 other category - Code OP Date of last inspection Brief description of the care home Grapecroft is a new, purpose built home set over three floors. At the current time some parts of the home are not operational due to the number of residents admitted, for example, Rosecroft the mental health rehabilitation unit for adults. All bedrooms are ensuite and there are communal lounges, a dining room and kitchen on each floor. The home has some secure gardens to the rear of the property and car parking space available. The home is located in central Tilbury, close to the local shops, bus route and train station. A statement of purpose and service user guide is available and the current fees for the home range from £407.26 to £595.77 per week, depending on need. Additional costs are charged for newspapers and hairdressing etc. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home over two days and met with the manager on both days. During our time at the home we talked with four residents, five members of staff and two relatives. We sampled and reviewed records that related to, for example, care provision, medication administration, staff recruitment and training, activities, meals, complaints and the building itself. In addition to this the manager completed a comprehensive self assessment prior to the inspection, called an Annual Quality Assurance Assessment (AQAA). This tells us how the manager thinks the home is running and what they do well and what they could do better. This assessment is referred to throughout the report. Prior to the inspection, we sent feedback surveys to the home for residents and staff to complete to give us their views, but we had a limited response. Care Homes for Older People Page 6 of 30 Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that they would be properly assessed prior to admission and have sufficient information on which to base any decisions. Evidence: The manager has a statement of purpose and service users guide in place. These were seen to be available in reception and the service users guide was seen around the home. Residents spoken to said that I have seen the guide and I still have it and Yes, I have a copy of the guide. Consideration should be given to reviewing the format of the guide in relation to the needs of the resident group, i.e font size, layout and the use of a more pictorial format to help people with dementia. The manager, in her AQAA said that we provide a comprehensive package of information to all prospective residents. At the current time the manager undertakes all the pre-admission assessments and Care Homes for Older People Page 10 of 30 Evidence: has assessment forms and a pre-admission draft care plan to complete. These were reviewed and seen to be fully completed and a basic draft care plan outlying key issues written, giving an initial picture of the persons needs. The assessment and the draft care plan need to be more person centered, showing preferences, choice etc. and an agreement needs to be in place for staff as to how long the draft care plan is utilised before a full care plan must be in place. Where appropriate, assessments were backed up with information from the referring authority but key information from this had not always been transferred into the draft care plan and/or subsequent care plans. Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents cannot be assured that their care needs would be appropriately met in all areas. Evidence: The manager of the home has a care planning/care management system in place. This includes a physical and social assessment, care plans and risk assessments. Three care plasn were fully reviewed along wioth additonal care plans for cross referencing. The team at the home do need to improve the care planning recording in order to ensure that staff are adequately guided by the care plans and that residents care needs are appropriately managed and evaluated. Residents with complex care needs only had basic care plans in place and many of their needs were not identified and/or had a management plan in place. For example, mental health needs, dietary needs, behavior management/support and the management of acute health needs such as urinary tract infections. Discussion with permanent staff also evidenced that they did not know the residents very well as they Care Homes for Older People Page 12 of 30 Evidence: were not aware of valuable information obtained at the time of assessment or subsequently in the home. Most of the care plans in place were seen to be up to date but on review of the evaluation/reviews, the plans should have be altered in line with these, to reflect changes recorded at this time. Some plans did not reflect the residents current needs especially if they had experienced a recent change in condition. The quality of the care plans was variable. Some contained sufficient detail to guide staff whilst others did not. The care plans were also not very person centered and on the whole did not reflect residents preferences or wishes regarding their care or the way they wished to live their life. There was also evidence that care management decisions made to address care needs had not been carried out, for example, improving signage for one resident or completing a monitoring chart to assess behavior. The manager in her AQAA said that each residents has a person centered plan. The evidence would not fully concur with this statement. Staff complete daily records and these were seen to be quite informative and in some cases contained information that would be of value in the residents actual care plan. The manager in her AQAA says that care planning processes and systems are very good and comprehensive. The evidence would not concur with this statement. She goes on to say that we must not be complacent and feel that there is no room for improvement and we will continue to regularly appraise the the care plans and identify where improvement can be made to increase the focus on person centered care. Residents care plans contained a range of risk assessments, including manual handling, nutrition, pressure sores etc. Some residents did not have the risk assessments in place that were required, for example, risk of wandering from the home and challenging behavior. The risk assessments were variable in quality. Some gave good information and guidance to staff whilst others did not have any appropriate management of the risk in place. Risk assessments also needed to be linked to the care plan, where appropriate, to ensure the management of the risk is an integral part of the residents care. Some risk assessments, for residents admitted with identified risks, do need to be put in place in a timely manner. For example, one resident at a risk of falls had their risk assessment completed 8 days after admission. This resident was identified as at a high risk of falls. Residents who had manual handling risk assessments in place, were seen to be up to date One was noted to be only half completed with staff not completing the management section of the assessment. The use of fluid intake monitoring charts was reviewed and these were found to be inconsistently completed therefore limiting their value. A review of the use of these charts is needed to ensure that they are a valuable tool to aid the management of residents care. Records on fluid charts were also noted to not tie in with what staff had recorded in the daily records regarding food and fluid intake. Residents who had Care Homes for Older People Page 13 of 30 Evidence: acute needs regarding their fluid and diet intake were not being consistently monitored as some days the charts were in place and others days they were not. Nutritional risk assessments had been completed for some residents but these were not always linked appropriately to a care plan and guidance for staff gave differing instructions for the same residents, for example, how often a person needed weighing. Records showed that overall residents were generally being weighed but records showed that this was inconsistent in some cases. The manager confirmed that the nursing staff were not dealing with any wound management at the current time, but the District Nursing team were seeing residential residents. The home was seen to have a range of pressure relieving equipment, either supplied by themselves or the district nursing team. One resident had developed a pressure sore whilst in the home. It was noted that this resident did not have a care plan in place to guide staff on the specialist care management needed to prevent further deterioration or promote healing. Records showed that residents were being appropriately referred to their GP or other health care professionals but there was no evidence of chiropody and residents did comment to us that they needed this input and on observation this was the case. Residential residents were noted to be having their temperatures and blood pressures etc. taken monthly. This is not a needs or resident led approach to care management in a residential social care setting and should be reviewed. Medication administration was reviewed in the home and records were found to be in good order with clear prescriptions and good signing and use of omission codes by staff. It was noted that medication rounds were lengthy and these were often affected by the level of effective organisation on the shift. The morning medication round, which the the MAR sheet says is an 8 a.m round, the manager reports actually starts at 9 a.m. The charts should reflect the round to give and accurate picture of the medication timings. In supervision notes, staff had raised the concern that they were still undertaking the morning medication round at 11.30 a.m because of the need for them to also be undertaking personal care and giving assistance at mealtimes. Controlled medications were checked an found to be in good order with the required documentation completed. Nursing staff undertaking blood sugar monitoring should be clear as to what is required for each resident and this should be reflected in their care plan. Some records seen said that residents should be having daily blood sugar checks when on discussion with staff, that was not the case. Medication reviews were evident in residents care records. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can experience differing standards of service with regard to daily routines, meals and activities and therefore good outcomes can be limited at times. Evidence: From records and discussion with residents and staff, the routines of the day are not as residents led as they could be. Staff spoken to described a primarily task led routine although they did highlight some aspects of resident choice within the routine, for example, choosing where to eat. Records in the staff communication book were not very person centered and were prescriptive, not evidencing that residents wishes would be taken into account. Residents said sometimes you get tea early in the morning but depending on the staff on duty, sometimes you dont get it, breakfast is about 9- 9.30, its a bit late and I have to ask for a bath, I get washed when they have the time. Some residents had a good social profile in place although others had aspects of them that were basic and a lot more information could be recorded, for example, around retaining skills, promoting independence and self worth. It was not possible to speak to the Activities Officer, who works 28 hrs. per week, during the inspection, due to Care Homes for Older People Page 15 of 30 Evidence: annual leave. The residents have access to a large minibus that is shared between two homes. Eight residents had been Christmas shopping to Lakeside, there was evidence of outside entertainers coming to the home, local school choirs visiting and Christmas parties being arranged. The menu for the Christmas period was displayed in the main hallway. Activities records were reviewed and showed the activities that residents had taken part in, but contained no real assessment of individual need, although there is some information relating to this in the care plans along with social histories, but not for all residents. A social needs assessments needs to be completed and a care plan put in place for all residents, so that social care needs can be met and the input evaluated so that residents independence and self worth etc. is promoted. Records showed that residents played cards, listened to music, did exercises, cake making, bowling, taken out to local shops and markets etc. Residents spoken to about the activities programme said I dont go to the social activities, but I think they are quite good, the activities officer does not come to see me but I see him about the home and I have played basketball and skittles, there is no bingo and I would like that. Regular consultation is needed with residents to ensure peoples needs are being met in both an individual and group way. Residents completing the managers feedback from indicated that those who responded were generally satisfied with the activities programme. The manager in her AQAA said that we encourage residents to become involved with activities and to maintain or even develop new social outlets and contacts. This is an aspect that is included in every plan of care and needs assessment. Mealtimes were observed on both days of the inspection. On one day the meals were late and cold and residents were very unhappy and expressing this to care staff. Some residents were noted to sleep throughout breakfast and not eat, despite dietary intake being one of their key care needs and other residents had breakfast left in their rooms and were not given the assistance they needed. This was observed to relate to the organisation of the shift that day and the lift not working. With the lift not working the hot trolleys are unable to be used affecting the meal temperatures. It was noted that the catering staff were trying to work with the care staff to get the timing of the meals right to help with temperature control. The second day the meals service was much improved and better organised and residents were being fed appropriately and sensitively. One unit did not have tablecloths on the tables and residents on both units did not always have access to condiments. Residents who commented on the meals service said you have to ask for tea in the mornings, my breakfast was stone cold and had to be microwaved, There is enough food and the quality is OK, if it was hot, I generally have a cooked breakfast, you can choose, Tea is between 5 and 6 p.m and then you get nothing to eat until 09.30 the next morning at breakfast - if its late. We have Care Homes for Older People Page 16 of 30 Evidence: spoken to them about it and nothing has happened and the food has deteriorated a bit, smaller portions but you get choices. The managers own feedback indicates that half of the residents rate the meal service as poor or average. The manager in her AQAA said that we take a great pride in our food and catering arrangements and menus are set with the input and the suggestions of our residents. The manager also added that she has developed a simple feedback tick sheet regarding satisfaction with meals but these were not offered as evidence during the inspection. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents cannot be fully assured that their concerns would be listened to and addressed and that they would be protected by adult safeguarding arrangements in the home. Evidence: The manager has a complaints procedure in place. This can be found in the service users guide and residents spoken to said that they would raise complaints with the nurse in charge or with the manager. The complaints procedure was displayed on notice boards in the home. Staff spoken to showed an understanding of how to manage any complaints raised with them, however residents spoken to discussed additional verbal complaints that had not been addressed and this primarily related to the food and catering arrangements at the home. All complaints should be logged and appropriately addressed. The managing has a system in place for recording complaints and these records were reviewed. Complaints were seen to be dealt with appropriately and details of any investigations were evident. Complaints related to catering, laundry services and care standards. Five formal complaints had been recorded and dealt with and one was in progress regarding catering. The manager in her AQAA said that all complaints are recorded on a complaints log, including the nature of the complaint, how it was investigated and the action taken. We would concur with this, when the complaint has been recorded. Care Homes for Older People Page 18 of 30 Evidence: Policies and procedures for staff on adult safeguarding are in place, including local guidance. Staff spoken to showed a good understanding of these procedures and the reporting of incidents or concerns. Staff also confirmed their attendance at training. Staff training records showed that out of 31 staff, only 15 had attended training on this subject. This needs to be addressed to ensure residents safety as far as possible. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to live in a clean, safe and generally well maintained environment. Evidence: Grapecroft is a brand new, purpose built home, located in the centre of Tilbury, close to local amenities and transport. A partial tour of the home was undertaken, viewing the main parts of the home that are currently in use, the ground and first floor. All bedrooms are en suite and many of the residents had personalised their rooms with their own possessions etc. Each floor has a two lounges and a dining room, with a small kitchenette. The home was seen to be clean and well maintained. No odours were noted. Signage around the home, especially for residents with dementia needs to improve in order to promote independence and therefore self worth. Residents who commented said that I am happy with my room, everything is fine and my room is comfortable and I have brought some of my own things in with me. It was noted that on the day of the first day of the inspection that the lift was not working and from discussion with staff and residents, this had been an ongoing matter for some time, despite engineers coming in to attend to issues. The manager reported that they were waiting for a part which was to be installed shortly. The non -operational lift had not been reported to us under Regulation 37 of the Care Standards Act and it was clearly Care Homes for Older People Page 20 of 30 Evidence: affecting life for residents in the home, with meals being served too cold as hot trolleys could not be used and residents unable to easily come downstairs. Outside the home, the garden and front of the home require attention as weeds were growing which detracted from the original planting and affected the hard standing. Litter had also collected. This gives a poor impression of the home for residents and visitors. A maintenance man had just started working full time at the home. Records showed that hot water temperatures were being checked but due to the vacancy other internal checks of fixtures and fittings etc. in the home had not been consistently completed. The manager has an up to date fire safety risk assessment in place for the home and records showed that the systems is tested regularly and staff undertake fire drills. Staff training records showed that only 3-5 staff had completed infection control training. This needs to be addressed in order to help ensure high hygiene standards in the home. It was noted, from the rota, that on regular occasions, only one member of the domestic team was on duty from 8 a.m to 4 p.m, to cover the whole home. This needs to be reviewed to ensure that standards are maintained in the home by ensuring sufficient cover. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents cannot be assured that the staff team at the home is fully competent and would be able to meet all their needs. Evidence: The manager reports that she uses the Residential Care Homes Forum guidance for helping to decide the staffing levels needed in the home and acknowledges that there is a high dependency on the downstairs nursing floor. The staffing levels for 16 nursing residents were 1 RGN and 3 care staff, reducing to 1 RGN and 2 care staff during the later afternoon, evening and night. The manager is currently considering increasing this by one person during the day. This needs to be decided as it was noted that staff from residential/dementia unit were supporting the nursing floor leaving only 2 staff upstairs. On the residential floor, where there are also residents with dementia, there is 1 Senior and 2 Carers at all times for 12 residents, sometimes reducing to two if they are supporting the nursing floor. The manager reports that the staffing levels stay at this level during the night as well, as some residents are up during the night. At the inspection there was a high use of agency staff in the home and the experiences and comments from residents demonstrated this. They said the staff attitude is get on with it, staff shortages mean you dont always get want you want, staff go past my room all the time, but they never stop and pass the time of day, the permanent staff are friendly, if you dont ask the staff you dont get, you learn that, the staff are Care Homes for Older People Page 22 of 30 Evidence: varied, some do stop and chat but you always get a bad egg, some are a bit abrupt and rush you and I prefer the permanent staff, there is a lot of agency lately. One relative spoken to said some of the staff are good but the turnover is high and some just do not know how to deal with my relative, so they leave x alone and x needs more social stimulation but is not getting it. The manager reported that they had recruited 8 staff recently who were qualified nurses from abroad who were going to be working as care staff and undertaking their British nursing conversion course at the home. These staff were due to staff shortly and would fill all the vacancies at the home so they should not need agency staff. Unfortunately the high use of agency staff has affected standards in the home and outcomes for residents generally. On discussion the manager reports problems with recruiting permanent staff of a good quality and reiterates this in her AQAA say our aim is to recruit the best people to do the job. Staff training records show that 5 out of 13 care staff have an NVQ qualification. The manager reports that NVQ qualifications are being encouraged. Staff files were reviewed to assess whether the manager had a robust recruitment systems in place. Three files were checked and found to be in good order with all the required checks and documentation in place prior to staff commencing work. There was also evidence that staff had been issued the General Social Care Council - Code of Conduct and Skills for Care booklets and induction packs. Staff spoken to confirmed that they had been inducted into the home and had worked with other staff before starting full shifts. Agency staff profiles were checked for the staff on duty on the first day of the inspection and these were all available in the home. Records showed that staff had been attending training in the home and staff spoken to confirmed that they had attended training in adult protection, fire safety and manual handling. There are gaps in the staff training that do need to be addressed to help ensure that residents are cared for by a competent staff team. This includes, for example, manual handling - to include ancillary staff as well as care staff, health and safety, infection control and first aid. It was also noted that there is a significant shortfall in staff training for the care of people with dementia and this needs to be addressed as staff demonstrated to us that their understanding of caring for residents with this condition was limited and that they lacked the skills to deal with some residents who show challenging behavior. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is trying hard to improve standards and outcomes for residents. Evidence: The manager of the home is a qualified nurse with 13 years nursing experience and has completed the Registered Managers Award. Staff speak positively about her saying she is approachable and the manager is around for us to speak to, she makes time and is nice to talk to. Staff confirmed that the manager had held staff meetings where they felt free to discuss any matters that concerned them. From minutes the manager is also holding meetings with the heads of departments and having health and safety meetings. As part of the managers quality assurance programme, feedback is sort from residents on life in Grapecroft. The manager has recently started to send these out and some had been returned. These showed that residents were generally happy with the Care Homes for Older People Page 24 of 30 Evidence: premises, the management and administration, activities and customer care. Scores and comments were less favorable regarding the nursing and care, catering, domestic services and general section, which covered, for example the grounds of the home. The manager has also held a residents meeting for the dissemination of information regarding the home. These could be developed so that ongoing feedback is sort from residents. The manager also completes other internal audits to help maintain standards and move the home forward, that include, medication management, care planning, wounds and falls and accidents. Results of the latter are shared with the visiting GPs for review and they discuss and refer to the local falls prevention team where required. The manager holds small amounts of personal monies for residents and a two signatory system is in place and month audit checks are undertaken. No pooled bank accounts are in place. Staff supervision records were reviewed. It is clear that some staff supervision is taking place, but this is not bi- monthly as the managers procedure would require. For example, supervision had taken place in July and Nov. Supervision notes were seen to be completed well and staff had highlighted areas were they felt they needed more support or training, for example with challenging behavior, but there was not always ongoing evidence as to how this was going to be addressed. The manager acknowledges in her AQAA that staff were not achieving the recommended bi-monthly supervisions and now a matrix has been developed to help monitor this. Accident records were reviewed and found to be completed correctly,referred to in the daily notes and followed up appropriately. On touring the home, no health and safety issues were noted, including COSHH arrangements. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Residents must have care plans in place that relate to their current needs, written in a person centered way and containing sufficient detail to guide staff. So that residents receive the care that they need and want in a way that they would wish. 28/02/2009 2 8 12 Residents must have risk 28/02/2009 assessments in place appropriate to their needs, containing sufficient detail to guide staff. So that any risks to residents and staff are appropriately managed and that staff are aware. 3 12 16 Through assessing social needs of residents, person centered care plans need to be developed that outline the social needs of each resident and how those needs will be met. 14/03/2009 Care Homes for Older People Page 27 of 30 So that all residents social needs are met in both an individual and group way. 4 16 22 All complaints must be logged and dealt with in line with the managers complaint procedure. So that residents can be assured that their concerns would be addressed. 5 18 13 All staff must be trained in adult safeguarding and the appropriate reporting procedures. So that residents can be protected, as far as possible, from abuse. 6 27 18 There must be sufficient permanent staff on duty. To meet residents needs. 7 30 18 The home must have a competent and well trained staff team in place. So that the needs of the residents can be met in full in a way that they would wish. 31/03/2009 28/02/2009 14/03/2009 28/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 1 9 Review the service users guide so that the layout and font etc. is more user friendly for the residents group. The medication round needs reviewing to ensure that medications are given in a timely manner, allowing the Page 28 of 30 Care Homes for Older People appropriate times between doses. 3 4 12 15 Ensure that the routines of the day are residents led as far as possible. Ensure that following regular feedback from and consultation with residents regarding food and catering arrangements, action is taken to address concerns over mealtimes and feedback to residents. Improve signage around the home in order to promote residents independence. Staff should be encouraged and supported to undertake NVQ qualifications. The management of the home need to improve upon the staff supervision programme and ensure areas of concern are followed up. 5 6 7 19 28 36 Care Homes for Older People Page 29 of 30 Helpline: 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 We want people to be able to access this information. 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