Inspection on 21/05/09 for Grapecroft Care Home Ltd

This inspection was carried out on 21st May 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Grapecroft Care Home Ltd 19/12/08

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Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

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:   one star adequate 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 1 0 5 2 0 0 9 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.cqc.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): Type of registration: Number of places registered: Festival Care Homes Ltd care home 62 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 Care Homes for Older People Page 4 of 30 Over 65 0 0 0 0 0 62 0 62 62 62 62 62 0 62 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 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. 2 2 1 2 2 0 0 8 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: one star adequate 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: Two regulation inspectors visited the home and spent a full day there and met with the manager. During our time at the home we talked with three residents, five members of staff and one relative. On the day of our inspection many of the residents and some relatives were enjoying a day out from the home. 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. We received a good response from residents and Care Homes for Older People Page 6 of 30 relatives and two from staff. We have referred to these throughout the report. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.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: In the foyer of the home the last inspection report, the service users guide and general information about the home and moving into a care home are available. Residents and relatives who commented all said that they had received sufficient information about the home prior to making a decision. The service users guide is available in large print but still needs work to make it more suitable, especially for those residents with dementia who may benefit from a more pictorial guide. The manager in her AQAA said that we provide a package of comprehensive information to all prospective residents. The manager undertakes any pre-admission assessments for prospective new residents to the home. Two completed assessments were reviewed and were found to Care Homes for Older People Page 10 of 30 Evidence: have been completed fully, giving the team at the home a draft care plan to follow, if required. The deprivation of peoples liberties had also been considered. The assessments are sufficiently detailed to enable a decision to be made on the suitability of the home for the resident and information from the assessment had been transfered into the substantive care plan. The assessments now contain some person centered information, giving staff a picture of the individual as well as an outline of their physical needs. The manager in her AQAA says that a thorough needs assessment is carried out by suitably qualified and experienced staff. 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 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 their care needs would be generally met by the team in this home and therefore outcomes would be positive. Evidence: The manager has a care planning system in place. Three care plans were reviewed along with further care plans to cross check evidence. The care plans were seen to have improved significantly since the last inspection along with the care delivery, which with a more stable staff team, is more individual and consistent. Residents who commented said that they received the care that they needed and that the staff listened and acted upon what they said. They also said that the staff were very attentive, very helpful, I am very happy in the home, the staff are polite and helpful, and they answered the buzzer quickly. There was evidence to show that either residents or relatives had been actively involved in the care planning process, either signing the assessment or the care plans themselves. It was positive to hear that two residents in the home were in the process of being supported to move back out into the community. Care Homes for Older People Page 12 of 30 Evidence: Assessments and care plans that were in place were seen to be generally detailed and outlined the residents needs and subsequent management well. The care plans were up to date and had been altered, where required, at the time of review. Records titled individual preferences and choice have now been completed, which give more person centered information on the individual and these contained some key information. However these were often tucked behind other records and need to be linked to or actually recorded on the care plan so they are not lost and are therefore used by staff. Overall the care plans are more person centered, containing personal preferences and the recognition of residents rights, but work needs to continue to develop this further. For example, residents strengths, the retention of skills and promoting self worth should be contained in the care plan wherever possible. Care plans were seen to promote independence and staff recognition of residents rights. However, staff were observed to interact with some residents inappropriately, for example, instead of talking to a residents and assessing whether they would need assistance in toileting, staff were observed to go up to a resident and check them by touching with no warning at all. This staff approach needs addressing to ensure residents dignity is respected. Both residents and relatives also commented about reduced mobility in the home with wheelchairs being used instead of walking being encouraged and deterioration in mobility since the physiotherapist had stopped attending. Staff need to be aware of this and promote residents independence and self worth through improving their mobility as far as possible. Staff spoken to knew the residents quite well and could discuss both their physical and social needs. They knew the family histories of the residents and their social histories as well. The manager in her AQAA said that we will continue to regularly appraise care plans and identify where improvements can be made to increase the focus on person centred care and ensure that our residents are invloved at the centre of the process. A range of risk assessments were seen to be in place for each resident and covered such areas as nutrition, falls, manual handling and pressure sores. These were detailed and up to date and generally gave good information on the management of any risks identified. Those residents presenting with challenging behavior had the appropriate risk assessments in place to guide staff, although more detail is needed, for example remove the stimuli that make x agitated but there is no indication as to what the stimuli is. Some were seen to be more detailed than others. In some cases there were several risk assessments covering the same issue and this could be confusing and needs review as they were all saying slightly different things. Risk assessments were generally linked to the care planning process where the management of any identified risk was given in the more detail. It was noted that in some cases resident with identified risks, for example for pressure sores, did not Care Homes for Older People Page 13 of 30 Evidence: always have a care plan in place outlining the management and/or action to be taken. This needs to be addressed as both the AQAA and records in the home show that residents have developed pressure sores or wounds whilst in the home. On discussion with the manager it may be beneficial for the records to show why the pressure sore or wound has developed in the first place as some of the recorded incidents are not true pressure sores or are the result of resident behavior. Staff spoken to in the home say that there is plenty of pressure relieving equipment about and observation would agree with this. Records show that residents are being weighed regularly and where appropriate food and fluid charts show the effort made by staff to ensure that residents nutritional intake is as good as it can be. These charts were completed consistently which gives a good overall picture of the residents intake. Staff need to be aware of making drinks available to residents outside the regular drinks round times as it was observed that no drinks were available in the lounges between these times. Where residents are refusing to be weighed, staff should record this on the chart. Records show that residents are seeing external health care professionals such as opticians and chiropodists etc. on a regular basis and are seeing their doctors in a timely manner. The medication systems in the home were reviewed and found to be managed well. Records were clear and the recording on the administration sheets matched the tablet blister packs. Staff were using the appropriate codes and there was evidence of reviews by doctors. Dates of opening were recorded on liquid medications and regular medication audits are carried out in the home to check practice. Staff were seen to have made appropriate arrangements for residents who were going out for the day to ensure that they did not miss their medication. Staff spoken to said that they try and have a person centered approach to the administration of medication to but they are very strict with items that have to be given on time, such as those for Parkinsons disease. Residents spoken to said that they had a key worker as their name was in their room, however they said that they did not know who it actually was as they had not introduced themselves. Relatives commented that key workers are often changed without notice and that they found this an issue with regard to communication and possibly confusing for residents. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents experience generally good outcomes in relation to social care and nutrition but outcomes are variable Evidence: Residents spoken to about the routines of the day said that they had choice about how they spent their time. Comments included they keep encouraging me to have a lie in but I like to get up and I can do whatever I want. Residents who commented in surveys also confirmed they had choice as to how to spend their time. Staff spoken to demonstrated a person centered approach to the care they provided and were aware of residents rights in relation to choice. Social profiles have now been completed for residents, giving staff information on residnets life and career histories, hobbies and interests. These were seen to have been completed well and are a valuable tool in developing person centered care in the home. Where possible it was good to see that relatives had been asked to provide the team with some valuable information on the residents past. A full time activities coordinator is employed at the home. The activity co-ordinator had completed reviews for each resident and these also showed input from residents and thier families and outlined social preferences. The social care plans in place still need to identfy that an Care Homes for Older People Page 15 of 30 Evidence: assessment of need has taken place to help ensure that, where appropriate, some of the social activites benefit the residents by the retention of skills and the promotion of self worth. This is especially pertinent to those residents who plan to move back to independant living. Records completed by the activities officer show that apart from external outings, which are good and well organised, residents are generally taking part in the same activities, that are not linked to their social preferences or any assessed need. Activities included chatting, gentle keep fit, home baking, television and one to one discussion. Any one to one time needs recording in more detail to evidence whether residents individual needs are being met. A weekly activities programme was seen to be displayed in the staff offices. Consideration should be given to making this more available to the residents. On a notice board in the home, planned activities are shown and include visits out and entertainers coming into the home. A BBQ with relatives is planned along with a Summer fete. Residents were going out on the day of the inspection to a local museum. We spoke the chef who was obviously very committed to providing a good service to the residents. At the time we spoke he was preparing a picnic for the residents who were going out for the day and was very conscious to provide a range of food to suit all and of temperature control for food hygiene. The chef had also considered what these residents might need for their evening meal and had changed the menu accordingly. On discussion, he was aware of residents preferences regarding food and says he knows this as he does go and talk to the residents. A four week rolling menu is in place and this was seen to be appropriate for the resident group and gave choice with the main meals. The chef has prepared very good pictorial menus, which were seen in the dining room and are to be used by staff when helping the residents make choices. Special menus are provided for occasions such as St Georges Day, Easter and Mothers Day. In the dining rooms, fresh fruit was seen to be available to residents. This could be more proactively offered to those residents, by care staff, who needs mean they would not initiate this themselves. Staff need to be aware of mealtimes as some residents were seen to be eating breakfast at 10:00 a.m and then served lunch at approximately 12:30 and staff were persistant in trying to encourage residents to eat. Consideration may need to be given to the breakfast arrangements, especially on days when special outings are occuring. At lunchtime the tables were seen to be nicely laid and condiments were available and staff were helping residents make use of these and sensitively helping with feeding where required. Residents comments on the food included we seldom have to grumble about the food, its hot enough and the chef does come down and sees people but I have not Care Homes for Older People Page 16 of 30 Evidence: spoken to him. The manager in her AQAA said we take pride in our food and catering arrangements and menus are set with the input and the suggestions of our residents. 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 can be assured that their concerns would be listened to but cannot be fully assured that they would be protected from adult abuse. Evidence: There was a complaints procedure on display for people. This needs to be reviewed in order that our CQCs role in relation to complaints is clear and to let people know that they can also take their concerns to the Local Authority. On surveys people said that they knew how to make a complaint and that staff are always willing to listen. A relative spoken to on the day said that they had not has cause to raise any concerns but would feel confident to do so. The AQAA completed by the manager said that twelve complaints had been made in the previous year. When we looked at records we saw that six of these had been since the previous inspection. Complaints recorded ranged from more minor concerns about catering to concerns about care and medication. This showed us that the home treat any concerns raised seriously. Records were detailed and showed that thorough investigations had been undertaken with outcomes recorded. Records indicated that management had communicated well with complainants to advise them of actions and ensure that they were satisfied. One concern recorded in the complaints records had been a safeguarding concern. Although nothing in the records indicated that an appropriate referral had been made the manager confirmed that this had been done and named the social worker responsible for the case. At the site visit initially only an old version of the Local Care Homes for Older People Page 18 of 30 Evidence: Authority safeguarding guidelines were available to staff. A copy of the up to date guidelines was found and copies of this made to be available on the units. These will provide staff with details of the correct actions to take and contact details of local safeguarding teams. A concern raised at the previous inspection was that the manager and many staff had not received training in safeguarding. Since that time the manager has undertaken training but no further training sessions have taken place for staff. According to records 21 care and nursing staff have yet to undertake training in safeguarding vulnerable adults. The manager said that some training courses booked had been cancelled by the local authority. We saw that training sessions in safeguarding are now planned for July and August 2009. The manager also confirmed that safeguarding is covered as part of the new staff induction. When we spoke to staff they confirmed that they had not had formal safeguarding training. However they demonstrated an understanding of what safeguarding meant and understood the need to report any concerns. Grapecroft accommodates a number of residents whose behavior can challenge staff. We saw that care planning generally identified actions needed by staff to care for these people in a safe and consistent way. Some staff have undertaken a training session in dementia that had a component entitled, Dealing with Challenging Behavior. The manager said that training in managing challenging behavior is also planned. 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 live in a safe, clean and generally well maintained home that meets thier needs. Evidence: Grapecroft is a new and purpose built home. It is located in the centre of Tilbury and is close to local amenities and transport links. A partial tour of the building was undertaken. At the moment the home is only partially occupied with people living on the ground and first floors. The home provides pleasant and well furnished accommodation for people. There are two lounges a dining area and a small kitchen on each floor. Bedrooms are a good size and all en suite. We saw that people had personalised their rooms to their own taste. One hairdressers room is available for the whole home. This was situated on the third floor with other utilities such as offices kitchen and laundry area. The manager said that it is planned to change this and bring the facility into the main body of the home so that people can use and enjoy it. A small garden area can be accessed from the ground floor. On the AQAA the manager said I can confirm that our garden areas are well maintained. This was not however observed to be the case at the site visit. The garden area is not currently inviting for residents and does not provide a pleasant outlook.. The grass is poor and full of big weeds Borders are unkempt and there is no colour to brighten up the space. Poor garden maintenance had been raised as an issue on a recent quality questionnaire undertaken. It was also noted that residents do not have access to all parts of the Care Homes for Older People Page 20 of 30 Evidence: garden and the hardstanding area is small and would affect access for many residents. The manager said that there were plans to open up the rest of the garden to all of the residents. Since the previous inspection some signage has been developed to help people who have dementia understand where facilities such as bathrooms and toilets are located. Some bedrooms also had colourful name labels on but these were located at the top of the door where people might find them hard to see them. On the first floor a start has been made in trying to provide a more interesting environment for people who have dementia. Plaques with different colours and textures have been put up in corridor areas. These are however quite small and had small handwritten sticky labels on explaining what they were and what to look for next. This was hard to read and may not be relevant for people. The utilities of the home are on the third floor of the home. The laundry area was clean and well organised with sufficient equipment to meet the needs of current numbers of residents. Training records showed that since the previous inspection staff have undertaken training in infection control. This will help them to understand safe procedures and maintain good practice. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a generally well trained staff team but some of their specialist needs may not be fully met. Evidence: During the day we saw that overall, staff interacted in a kind and caring way with residents and were very attentive to their needs. On surveys residents said that staff were polite and helpful. One person spoken with said The staff are all very kind. Relatives felt that the staff had the right skills to care for people and comments included the staff are helpful to me regarding my relative and always ready to listen. At the previous inspection an area of concern was the high use of agency staff in the home. This affected the continuity of care for people. Since then management have been successful in establishing a permanent staff team. The AQAA said that in the previous three months only one nursing shift had been covered by an agency member of staff. This was confirmed by staff who said We dont use agency staff now and it is so much better for the residents. On surveys there was some feeling that staffing levels could be improved. At the time of the site visit ten people were being accommodated on the ground floor nursing unit. A Registered General Nurse (RGN) with three carers in the morning, two in the afternoon and evening and one at night were being provided. Upstairs on the unit for people with dementia, eighteen people were being accommodated. Staffing levels had been increased to four staff during the day, with another member of staff working one to one with one resident and two staff Care Homes for Older People Page 22 of 30 Evidence: at night. Rotas viewed confirmed these levels. Staff and management spoken with on the day were happy with current staffing levels and felt them to be sufficient to meet peoples needs. Staffing levels appeared sufficient on the day but a number of residents were out. The manager is aware of the need to continually keep staffing levels under review according to numbers and peoples level of dependency. Ancillary staff are provided for domestic, catering and administrative tasks. At the moment there are only three domestic staff to cover the laundry and cleaning tasks for the whole home. A further domestic person is soon to start. Again this will need to be kept under review as numbers in the home increase. When we looked at rotas we saw that it is practice for staff to work twelve hour shifts. This needs to be monitored to ensure that this work pattern suits the environment, particularly on the dementia care unit where residents can be challenging and sometimes noisy. Staff may become tired and not work as effectively. Information on the AQAA and training information viewed indicated that out of 26 care and senior care staff three have achieved a National Vocational Qualification NVQ in care. A further fifteen staff have an equivalent or nursing qualification from their country of origin. These and other staff twenty in all are currently undertaking NVQ training in care at various levels. This shows that the provider is committed to ensuring that people are looked after by well trained staff. The National Minimum Standards advise that at least half of a homes care staff are trained to NVQ at level two or above. Grapecroft has achieved this with its current workforce We looked at the files of three recently recruited staff to see if procedures that safeguard people are maintained. We saw that recruitment was carried out to a good standard with all checks, such as Criminal Records Bureau disclosures, (CRB) references, proof of identification and fitness being carried out before the person starts work. Files viewed showed that a good initial induction was undertaken using a set format. Those viewed had been fully completed and signed off. Although no completed documentation was seen information on files showed that people had gone on to complete a skills for care based induction. They had signed for the receipt of their skills for care book and letters were seen inviting people to attend Skills for Care induction meetings. Staff spoken with confirmed that their induction had been good and covered what they needed to know, such as care plans fire procedures residents needs procedures and routines. A training matrix provided and staff spoken with showed us that staff have opportunities to undertake a range of basic training. With many new staff recently Care Homes for Older People Page 23 of 30 Evidence: recruited, the home has done well in the amount of training provided but there are still gaps. In particular the home is registered to provide care for people who have dementia. From the training matrix 23 nursing and care staff and the activities coordinator have yet to undertake training in this area. We saw that further training dates for dementia care are booked for July and August. The course details seen showed that the dementia care training offered was a basic introduction undertaken in a six hour workshop. Peoples knowledge and skills in relation to dementia may therefore need further development in the future. Staff training files showed that training in other areas such as dignity in care, continence promotion and person centred care planning have also been undertaken by some staff. Care Homes for Older People Page 24 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. Residents live in a home that is generally well run and where their input is valued. Evidence: The manager at Grapecroft is a qualified nurse with thirteen years nursing experience. She has also completed their Registered Managers Award, which is a recognised qualification for those managing care homes. The manager completed and sent in the AQAA when we asked for it. It was completed well and gave us the information we had asked for. The AQAA recognised both the homes achievements and where further improvements are needed. There are opportunities for people to express their views on the service. Minutes seen showed that regular residents relatives and staff meetings take place. Strategies are in place to monitor the quality of the service. The manager said that questionnaires are sent out to people living at the home or with an interest in the service, about every six months. This had last been done in January this year. Twelve responses had been received that were generally positive. We saw that the responses had been analysed. Care Homes for Older People Page 25 of 30 Evidence: The manager said that issues raised had been addressed. Quality assurance questionnaires are also permanently available in the entrance area of the home for both visiting professionals, relatives and other visitors. We saw that these were used and a number had been handed in. We saw that monthly visits were made by a senior person in the organisation as is required by Regulation. These visits included talking with people using the service. Records viewed showed that other systems were in place to monitor quality and good practice compliance. For example, medication, health and safety and care plan audits are undertaken to monitor working practices. People can be assured that if they wish the home to hold monies for them that this will be done in a way that protects their interests. Monies held at the home were sampled and correct and records were well maintained. The AQAA identified that systems and equipment are monitored and maintained. Fire records showed that regular drills are undertaken and that a fire risk assessment was in place. During the site visit no major health and safety concerns were raised, but it was advised that the building was properly monitored to make it as safe as possible for people living with dementia, who may wander and be unaware of hazards We saw that sluice areas, where disposable gloves and aprons are stored, may be a potential hazard that was not kept secured. We viewed accident records and saw that these were very well maintained with established arrangements being in place to carefully monitor peoples wellbeing after a fall or accident. A training matrix showed that levels of core training in areas such as first aid, moving and handling fire and health and safety are generally satisfactory. The manager conformed that staff have been trained by an in house trainer for moving and handling with formal training booked for June and July. New staff have yet to complete food hygiene training. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 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. 14/03/2009 Care Homes for Older People Page 27 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 Ensure that care plans are in 31/07/2009 place for all identified needs/risks - with particular emphasis to pressure sores and/or wounds. So that risks to residents are managed proactively and that the outcomes are they best they can be. 2 30 18 Staff must be trained so 31/08/2009 they can meet the needs of the residents and protect them as far as possible this primarily relates to training in the care of people with dementia. So that residents needs can be met by a competent staff team. Care Homes for Older People Page 28 of 30 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 1 Consider further development of the service users guide in order to make it more user friendly and accessible to all residents groups in the home. Continue to develop a person centered approach to care planning and the delivery of care in the home. Ensure that all risk assessments are sufficiently detailed to guide staff. Through training ensure that all staff are aware of the need to maintain residents dignity. Continue to develop social care planning so there is, where appropriate, an assessment of need and plan in place to address those needs. Update the complaints procedure so that residents and relatives are clear who they can contact. Make the garden a pleasant place in which to spend time and keep it maintained. Improve the signage around the home for residents to promote thier independance and wellbeing. Risk assess the storage of equipment to ensure that residents are safe. 2 3 4 5 7 8 10 12 6 7 8 9 16 19 19 38 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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