Inspection on 10/06/06 for Grasmere House

This inspection was carried out on 10th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Grasmere House 19/12/05

Grasmere House 14/06/05

Grasmere House 27/10/04

Grasmere House 13/05/04

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

CARE HOMES FOR OLDER PEOPLE Grasmere House 33 Cargate Avenue Aldershot Hampshire GU11 3EZ Lead Inspector Mr Rodney Martin Unannounced Inspection 10th July 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Grasmere House DS0000012106.V297976.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Grasmere House DS0000012106.V297976.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grasmere House Address 33 Cargate Avenue Aldershot Hampshire GU11 3EZ 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) 01252 328 052 Mrs Ramtohal Mrs Ramtohal Care Home 9 Category(ies) of Dementia - over 65 years of age (9), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (9), Old age, not falling within any other category (9) Grasmere House DS0000012106.V297976.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th December 2005 Brief Description of the Service: Grasmere House is a large house in a residential area of Aldershot. The home is a short walk from the local shops and close to the main shopping centre of Aldershot. The home is registered to provide care for nine older people including those with dementia. The home provides accommodation on two floors, with one shared and seven single bedrooms. There is a large lounge and separate dining room. There are gardens to the front and back of the home, with paved seating areas for the residents. The current fees are £327 to £500 per week. This information was contained in the pre-inspection questionnaire received in the Commission’s office on 25 May 2006. There are additional charges for hairdressing, chiropody, newspapers/magazines and toiletries. Grasmere House DS0000012106.V297976.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place between 9.30am and 1.45pm. An opportunity was taken to look around the home, view records and talk to a visitor, several service users and staff members, including the cook and the manager. On the day of the visit nine service users were accommodated, with the home full. Grasmere House has a waiting list. In line with the Commission’s policy, all the key standards were inspected on this occasion and the three previous issues identified at the last inspection, all relating to staff training, were followed up. The home was found to be meeting these. What the service does well: What has improved since the last inspection? Grasmere House DS0000012106.V297976.R01.S.doc Version 5.2 Page 6 Since the last inspection the home has complied with the issues raised over staff training, by ensuring the training is up to date, keeping a staff training record and ensuring all staff receive adult protection training. The registered manager, Mrs Ramtohal, has completed the registered managers award for NVQ [national vocational qualification] level 4 in both management and care. Over 50 of care staff have NVQ level 2 or 3. The inspector was shown a letter from Guildford College stating that the rest of the staff are shortly to be assessed to start NVQ level 2 or 3. 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. Grasmere House DS0000012106.V297976.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grasmere House DS0000012106.V297976.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have their needs assessed and are able to visit prior to admission to make an informed choice about whether Grasmere House is able to meet their particular needs. Grasmere House does not provide intermediate care. EVIDENCE: Grasmere House was accommodating nine residents, with four male and five female service users, whose ages range from 76 to 100 years. One resident has been in the home since 2001. It is noted that seven of the nine residents have a diagnosis of dementia and there was evidence that the home is able to meet residents’ needs. Since the last inspection, three new residents were admitted and there were two discharges. The last resident admitted was on 10 June 2006. The home has two prospective service users’ names on a waiting list. Grasmere House DS0000012106.V297976.R01.S.doc Version 5.2 Page 9 The majority of referrals come from Adult Services [previously known as Social Services]. Relatives usually visit first. Following an initial inquiry, the manager will visit the prospective service user in their own home or in hospital, to assess their needs. The majority of prospective service users come from the Aldershot/Farnborough area. The prospective service user can also spend some time in the home with a complimentary meal to see if Grasmere House is the type of home they are looking for. The assessment process also enables the home to determine whether they can meet the care needs of any prospective service user. Various residents’ assessments were sampled and these were found to contain relevant information. Pre-admission assessments were completed before residents move into the home. On the day of the visit the inspector met a visitor, who visits every day. They said that there was a nice atmosphere in the home and that her mother was very settled in Grasmere House. The inspector received a comment card, prior to the inspection, from another relative, who stated, I have nothing but praise for the quality of care that my stepmother is receiving at Grasmere House. She is clearly very happy and contented there and it would be a sad day should she ever have to be moved”. Two comment cards were also received from service users who both stated that they liked living in the home. However, the inspector was unable to obtain comments or opinions from most of the residents because of healthrelated communication problems. Through observation it was apparent that the residents were happy and had a good relationship with the staff. Grasmere House does not provide intermediate care, although prospective residents can come for a short respite stay, if there is a vacancy. Short stay residents are assessed in the same way as permanent residents. Grasmere House DS0000012106.V297976.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for care planning are good, ensuring that the residents’ physical and emotional health needs are met. Medication practices and procedures ensure that residents are protected. Working practices in the home ensure the promotion of privacy and independence for service users. The home has clear arrangements in place for supporting terminally ill residents in the way they prefer. EVIDENCE: Each resident has an individual file, which is indexed for ease of reference. The file contains the personal details of the resident including a life history, the pre-admission assessment, day and night report, weight chart, risk assessments, and a record of medical appointments, a night care plan, the care plan and review of the care plan. Grasmere House operates a keyworker system, enabling staff to get to know certain residents much better, which in turn helps in the delivery of care to the individual resident. Several residents were tracked and although the records gave a clear indication of the care required; the inspector discussed developing the care plan further to include how the various aspects of dementia affect the individual resident, in respect Grasmere House DS0000012106.V297976.R01.S.doc Version 5.2 Page 11 of mood, orientation, wandering, sociability et cetera. This information was contained within the file but it was agreed that the care plan would be extended to include the above detail. The personal and oral hygiene of each service user is maintained and recorded. A record is kept of all health professional visits. The majority of residents are registered with Aldershot Health Centre; one resident is registered with North Lane surgery and one resident with Alexandra surgery. The manager reported that there is very good support from the surgeries, including community psychiatric nurses, although none of the residents are currently involved with a community psychiatric nurse. The home has a relevant medication policy, which satisfactorily details the receipt, recording, storage, handling, administration and disposal of medicines. Although residents are able to self medicate within the home’s risk management framework, including a self-medication risk assessment from their GP to be obtained, currently none are self-medicating. All, bar two residents, are on some form of medication. The home operates a ‘Nomad’ system for administering medication. This is kept in a locked drugs’ cupboard. The home does not currently have any controlled drugs. The drug administration sheets, which included a photograph of the resident, were found to satisfactorily recorded, with no omissions. The drugs’ cupboard was found to be clean, tidy and safe, with only four nonNomad prescriptions. Relevant staff have received medication training. Staff have received palliative care training in their NVQ [national vocational qualification] courses. The home has a relevant policy on death and dying and a procedure, for staff to follow, of what to do in the event of the death of a resident. Two residents have died in Grasmere House within the last year. It was noted that the service users wishes concerning terminal care and arrangements after death are routinely recorded. Grasmere House DS0000012106.V297976.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to engage in a variety of appropriate age-related activities in the home. Residents are supported to maintain contact and positive relationships with family and friends. Nutritional needs of residents are well managed and offer variety and choice. EVIDENCE: The home provides various activities for residents to participate in. As previously noted, the majority of the residents have a diagnosis of dementia and maintaining interest and concentration span is important in providing a fulfilling life, as the use of activities can significantly improve the quality of people’s lives. A full list of activities for the week of the inspection was on display on a blackboard in the lounge. The home is involved with the Alzheimer Society and makes use of their excellent material on providing activities for people with dementia. Staff are able to take individual residents out shopping or to the local park. Grasmere House DS0000012106.V297976.R01.S.doc Version 5.2 Page 13 Contact with family and friends is maintained and all, bar two, residents have visitors. One resident is subject to the Court of Protection and the other advocacy is being sought. A notice is displayed in the hall, stating “we welcome visitors at all times”. On the day of the visit the inspector met a relative and spent some time with them. They were very complimentary about the home, and having previewed other residential care establishments before deciding on Grasmere House, were more than satisfied that the home was meeting her mother’s needs. Residents are encouraged by the staff to make choices in their daily life and these choices include choosing which clothes they will wear and what time they get up and go to bed, this information is contained in the care plans. The menu for the day is displayed in the dining room. Residents had beef burgher, mashed potato and mixed vegetables for lunch. One resident had also requested a fried egg with their meal, which was cooked for them. Residents had lemon torte for dessert. One resident has their meal liquidised. It was confirmed that the various portions are liquidised separately. Residents, spoken to, were happy with the meals and had no complaints about the quality or quantity of the food provided. Refrigerator and freezer temperatures are routinely recorded, along with the temperature of the main meal. The food in the refrigerator was stored correctly. The environmental health officer visited the premises on 30 January 2006 and the home was awarded a ‘four star’ certificate to ‘demonstrate your commitment to high standards of food hygiene’. Grasmere House DS0000012106.V297976.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure, which residents feel able to use and an adult protection procedure, which protects and safeguards residents from abuse. EVIDENCE: The complaints procedure is displayed on the hall notice board and is in the statement of purpose. The procedure includes appropriate timescales. The home has a complaints log although no complaints were recorded. The comment cards received prior to the inspection indicated that residents were aware of whom to complain to should they have a need to raise a complaint or issue. The relative spoken was aware of the complaints procedure but had nothing but praise for the home. The Commission has not received any complaints. Grasmere House has an adult protection policy and staff, spoken to, were aware of the issues involved. Staff have received adult protection training. There have been no incidents of abuse recorded in the home. Grasmere House DS0000012106.V297976.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a clean, safe and pleasant environment, where they have individualised their bedrooms, to meet their needs. EVIDENCE: A tour of the building was undertaken involving seeing all of the bedrooms, the sitting room, the kitchen and the dining room. There is also a small area at the back of the home for residents who smoke. All were clean, pleasant and free from odour. Grasmere House has seven single bedrooms, three provided with en suite toilet facilities and one double bedroom. There are two bedrooms on the ground floor, with the rest on the first floor. The home has a stairlift, which is regularly serviced. There have been no changes to the building, since the last inspection. There was evidence of residents’ personal belongings in the rooms. The home has a separate laundry room, which is situated away from food preparation. Grasmere House DS0000012106.V297976.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s recruitment practices ensure the safety of service users. Residents are supported by sufficiently trained and supervised staff, to ensure that their needs are met. EVIDENCE: Grasmere House employs nine care staff, two of whom are full-time. Since the last inspection the home has recruited three care assistant and the manager reported that the home has a full compliment of staff. There were two carers on duty, plus the manager and staffing levels were sufficient to meet the needs of the residents. One resident had written on the comment card that the Grasmere House was “an excellent home and staff”. Five of the nine care staff have NVQ [national vocational qualification] at level 2 or 3 or equivalent. The inspector was shown a letter from Guildford College stating that the rest of the staff are shortly to be assessed to start NVQ level 2 or 3. A senior care assistant, who currently has NVQ level 3, has commenced an NVQ level 4 in care course. New staff complete the Skills for Care induction standards, which has replaced the Topss [the national training organisation for social care] induction and foundation standards. Staff, spoken to, were appreciative of the manager’s style and the support and training they received. Grasmere House DS0000012106.V297976.R01.S.doc Version 5.2 Page 17 A system of supervision is in place. Staff have received supervision and there was evidence of this. A senior care assistant, who is on an NVQ level 4 course, has started to do joint supervision with the manager, as an introduction to taking on some of the care staff. Staff files were viewed. These contained the application form, which included a signed declaration under the Rehabilitation of Offenders Declaration, two written references, a returned negative CRB notification and proof of identity. Since the last inspection the home has complied with the action required to develop training for staff and to record the training received. Staff have received training in manual handling, first aid, food hygiene, infection control, fire safety, adult protection and dementia training. As noted above, staff appreciated the training they had received so far and that they had the opportunity to go on further external courses. Although the home has a small staff group, a number of the carers have worked in the home for sometime and know the residents very well. There was positive feedback about the staff and the care they gave to the residents. Grasmere House DS0000012106.V297976.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager provides good leadership, which ensures staff are supported and residents’ health, safety and welfare promoted through the home’s practices. EVIDENCE: Mrs Ramtohal has managed Grasmere House since 1989 and is suitably qualified to run the home. She is a qualified nurse and keeps her registration going as well as having completed the registered managers award for NVQ level 4 in both management and care. Two assessors for NVQ training visited on the day of the inspection and “signed off” her assignments. The manager communicates a clear sense of direction and leadership within the home. She has been able to cascade relevant training to the staff. There is an open, Grasmere House DS0000012106.V297976.R01.S.doc Version 5.2 Page 19 friendly and transparent atmosphere within Grasmere House. Residents and a visitor spoke warmly of staff and the way the home is run. There is business plan and the home is financially sound. The employers liability insurance is due for renewal on 23 April 2007. The home is not appointee for any service user. Seven residents are subject to power of attorney orders; one resident is subject to the Court of Protection and for another resident appointeeship is being sought with Adult Services. The home does look after small amounts of pocket money for some of the service users, but are not responsible for the resident’s financial affairs. A record is kept of all money that is spent, usually for the hairdresser and newspapers, and receipts are given to the nominated friends or relatives of the resident. The fire log was inspected and the records indicated that the fire safety equipment had been tested and serviced within the guidelines. Staff have received fire safety training and the home had a fire drill on 12 June 2006. A current fire risk assessment is in place. An environmental health officer inspected the home on 30 January 2006 and the report stated, “Good standards noted”. A ‘Food Standard Award’ was given [Four stars] to ‘demonstrate your commitment to high standards of food hygiene’; the award is current for one year. Grasmere House received a three star award last year. The manager ensures the safe working practices by planning courses on health and safety within Grasmere House, including first aid, adult protection, manual handling, food hygiene, fire and medication. Risk assessments are in place. There are current and up to date contracts on electrical equipment as well as kitchen and domestic appliances et cetera. COSHH [control of substances hazardous to health] policies and procedures are in place. Window restrictors are in place on the windows above ground level, to ensure safety for residents. From a check of the records and practices observed in the home during the inspection, the health and safety measures taken in the home ensure the welfare and safety of the residents. Grasmere House DS0000012106.V297976.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Grasmere House DS0000012106.V297976.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Grasmere House DS0000012106.V297976.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Grasmere House DS0000012106.V297976.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!