Inspection on 11/01/07 for Grasmere Nursing Home

This inspection was carried out on 11th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Nursing Home 28/11/05

Grasmere Nursing Home 29/07/05

Grasmere Nursing Home 07/12/04

Grasmere Nursing Home 14/06/04

Grasmere Nursing Home 25/06/03

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

CARE HOMES FOR OLDER PEOPLE Grasmere Nursing Home 51 Manor Road Worthing West Sussex BN11 4SH Lead Inspector Mrs S Gawley Unannounced Inspection 11th January 2007 09:00 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 Grassmere Nursing Home DS0000043632.V326562.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. Grassmere Nursing Home DS0000043632.V326562.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grasmere Nursing Home Address 51 Manor Road Worthing West Sussex BN11 4SH 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) 01903 201281 F/P 01903 201281 Kargini Care Services Limited Miss Yvonne Barbara Evans Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Grassmere Nursing Home DS0000043632.V326562.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th November 2005 Brief Description of the Service: Grasmere is a care establishment providing nursing care for twenty-one older people. Grassmere is situated in a residential area approximately one mile from the town centre of Worthing with its shops, train station and other amenities. It is a two story detached property and the accommodation is arranged in twenty-one single rooms. There is a passenger lift, which makes most rooms accessible. Some other rooms can be reached by a stair lift. Facilities include a lounge and dining room on the ground floor and a quiet room on the second floor. There is a patio garden at the side of the house, which is accessible to and used by the service users. Grassmere Nursing Home DS0000043632.V326562.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit as part of the inspection process was carried out on 11 01 07. The registered manager facilitated the inspection. The Commission was in receipt of a Pre Inspection Questionnaire together with a Statement of Purpose, Service User Guide and policies and procedures as requested. The home was inspected against the National Minimum Standards. Documents and information held on file at the Commission were perused prior to the inspection and were considered when compiling judgements. On inspection policies, procedures and documentation were inspected. Three residents were case tracked; the building was inspected including the laundry and kitchen. Residents and staff were spoken to elicit their opinion on the home. A General Practitioner who many of the residents are registered with was spoken to and he stated that the home is very organised, that staff are reliable, there is continuity of care from reliable staff and instructions are carried out exactly. He further stated that it is one of the best care homes in Worthing. The majority of the National Minimum Standards were met, mainly judged as having good outcomes, with the exception of standards on staff supervision and the completion and recording of regulation 26 visits. The fees charged range between £575 and £650 per month. What the service does well: The home has been redecorated and is pleasantly furnished throughout. Residents and staff stated that this is a pleasant home. Residents stated that the care is very good and that all of the staff are very kind. All residents stated that they enjoyed the food. Visitors are made welcome and are offered refreshment. Links are maintained with the local clergy and an activities programme is in place. Staff feel well supported by the management. Grassmere Nursing Home DS0000043632.V326562.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Grassmere Nursing Home DS0000043632.V326562.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 Grassmere Nursing Home DS0000043632.V326562.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 Standard 6 is not applicable Residents have a written contract/ statement of terms and conditions with the home. Residents moving into the home have needs assessed and are assured that these will be met. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Grassmere Nursing Home DS0000043632.V326562.R01.S.doc Version 5.2 Page 9 EVIDENCE: Three residents were case tracked. All had evidence of pre admission assessment in their care plans showing that the admission procedure is thorough. They also contained contract and terms and conditions. When spoken to these, and other residents, stated that they felt they had enough information on the home and that their needs are met by caring staff. They also stated that were kept well informed about their health needs. Service user guides were available in resident’s rooms. Grassmere Nursing Home DS0000043632.V326562.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11. The resident’s health, personal and social care needs are set out in an individual plan of care and resident’s health care needs are fully met. Residents, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Residents feel they are treated with respect and their right to privacy is upheld. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service Grassmere Nursing Home DS0000043632.V326562.R01.S.doc Version 5.2 Page 11 EVIDENCE: Care plans were inspected. The manager residents and staff were spoken to. Three residents were case tracked and all aspects of need and care provided were recorded. Care plans are in place based on a comprehensive assessment. Health professionals are consulted as required and this is clearly recorded. There is evidence of risk assessment. Policies and procedures on administering medicines are in place to ensure the safety of residents. Medicine storage was inspected and is suitable. Medicine Adiministration charts were inspected and were up to date. Residents spoken to stated that their needs are met in a respectful manner. Staff spoken to stated that they are kept aware of resident’s needs and feel they are well supported by the homes policies, procedures and training to meet these needs in full. One relative spoken to stated that the care offered in the home is very good and feels that the home consults well with relatives regarding changing needs. A General Practitioner who many of the residents are registered with was spoken to and he stated that the home is very organised, that staff are reliable, there is continuity of care from reliable staff and instructions are carried out exactly. He further stated that it is one of the best care homes in Worthing. Interaction between staff and residents was observed and was seen to be appropriate and respectful. Resident’s wishes on death are recorded in the care plans. Grassmere Nursing Home DS0000043632.V326562.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 Resident find the lifestyle experienced in the home matches expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Residents maintain contact with family/ friends/ representatives and the local community as they wish. Residents confirmed that they are helped to exercise choice and control over their lives and that they receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Grassmere Nursing Home DS0000043632.V326562.R01.S.doc Version 5.2 Page 13 EVIDENCE: The home provides entertainment in the afternoons and residents stated they enjoy this. Outside entertainers come approximately twice or three times a fortnight. A programme for this was seen and a party is planned for February with a magician. Residents spoken to confirmed that visitors are welcome and are offered refreshment. Two residents have regular visits from clergy. The home maintains a record of the contact each resident has with his or her relatives and friends. The cook was spoken to. Menus are in place and were seen to be varied and nutritious. A recent environmental health report noted the “high standards of hygiene and good practices being carried out in the kitchen”. This was observed during the inspection with the exception of meat being stored above salad and vegetables. This was discussed with the cook who immediately provided a solution in that the meat can be stored in a separate small fridge. The lunchtime meal was observed and found to be appetising and well presented. Residents spoke positively about the food they receive. The home does not hold any bank accounts for residents. They do hold small allowances for two residents, which is held securely and properly recorded and receipted. These records were available for inspection. Residents stated that they are able to handle their own finances; they are also able to bring in personal possessions with them to the home if these can be accommodated. Residents are facilitated to vote either by postal vote and one resident stated that she went to the poling station. Grassmere Nursing Home DS0000043632.V326562.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Residents and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Residents are protected from abuse Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents spoken to stated that they felt they could complain and that it would be addressed. Complaints to the home aree recorded and appropriately dealt with. One complaint was recorded for this year. Policies and procedures are in place on the protection of adults and the manager and staff spoken to confirmed that training was in place. Training records were inspected to evidence this. Staff spoken to also demonstrated respect for the residents and an awareness of adult protection and procedures for reporting incidents. Grassmere Nursing Home DS0000043632.V326562.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22, 24,26 The home is mostly well maintained. The safety of residents may be compromised by the practice of wedging doors open. Specialist equipment is in place to meet resident’s needs. Residents have their own belongings around them The home is clean and hygienic Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Grassmere Nursing Home DS0000043632.V326562.R01.S.doc Version 5.2 Page 16 EVIDENCE: The home is generally well maintained, with the proprietor carrying out repairs himself. Records of servicing for fire, gas and lift systems was inspected and were found to be up to date. There is maintenance book, which did not have an entry since July 06. The manager stated that most issues are raised verbally with the proprietor. One resident commented that her room was cold and on inspection the thermostat on her radiator was broken. This was discussed with the manager who stated that the proprietor was aware of this. The need to record this was discussed with the manager. Only two doors have door guards fitted which allows the to be kept open but which will close in the event of fire. Door wedges were seen in use. The hazards of this practice in relation to fire safety were discussed with the manager. Residents have the specialist equipment to meet their needs and call bells are in place Residents bedrooms inspected showed their own belongings around them. Residents spoken to confirmed that their rooms were comfortable. The home was neat and clean throughout and free from offensive odours. Grassmere Nursing Home DS0000043632.V326562.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 Adequate members of staff are on duty to meet residents needs Recruitment procedures are robust to ensure safety of residents Staff are trained and competent to do their jobs. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents are protected and have their needs met by the provision of suitable numbers and appropriately trained staff. The staff rota inspected showed this. Two carers have NVQ level 3, six carers have NVQ Level 2 and three newer carers have not commenced this award as yet. Staff confirmed induction is in place and induction records were seen to support this. Staff records were inspected and showed that staff is commenced in employment following receipt of an enhanced Criminal Records Bureau clearance and POVA check and the receipt of two written references. Staff were spoken to and they stated that they feel well supported in the home and that training needs are met. They do not however have regular, Grassmere Nursing Home DS0000043632.V326562.R01.S.doc Version 5.2 Page 18 formal supervision. There is a training programme in place covering mandatory training as well as updates on issues such as dementia and training records inspected showed that this training occurs. Grassmere Nursing Home DS0000043632.V326562.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Residents 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. However, some issues raised at the last inspection remain outstanding. Effective quality assurance systems are not yet in place to ensure the home is run in the best interests of residents. Residents’ financial interests are safeguarded. Staff are not appropriately supervised. The health, safety and welfare of residents and staff are mostly promoted and protected. An issue in relation to fire safety was raised. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Grassmere Nursing Home DS0000043632.V326562.R01.S.doc Version 5.2 Page 20 EVIDENCE: Residents spoken to stated that the manager is approachable and will sort out any problems for them. Staff spoken to stated that the registered manager is accessible, gives clear direction and they felt well supported by her. There are regular staff meetings. The manager has not however, ensured that the requirements of the last inspection have been addressed Questionnaires are available for residents or relatives to fill out but the manager stated that they rarely do. She will consider taking a more structured approach to this by posting them to relatives and collating the responses for future inspections. There is a monthly newsletter in place. The proprietor is not at present completing and recording regulation 26 visits to the home. This was raised at the last inspection and remains outstanding The home does not hold any bank accounts for residents. Small allowances are held for three residents and these are held securely and transactions are recorded and receipted. Staff supervision is not in place. Discussion was held with the manager on the importance of putting this in place. This was also raised at the last inspection and remains outstanding The health, safety and welfare of residents and staff is ensured through the provision of staff training and the maintenance of utility systems by qualified persons. Taps are fitted with temperature control valves to prevent scalds. There is however a risk to the health and safety of staff and residents, in the case of fire, by the use of door wedges. Grassmere Nursing Home DS0000043632.V326562.R01.S.doc Version 5.2 Page 21 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 3 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 2 X X 3 X 3 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 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 X 3 2 X 2 Grassmere Nursing Home DS0000043632.V326562.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP19 OP37 Regulation 23(C)(i) 26 Requirement Timescale for action 30/04/07 3 OP33 24(1) Fire doors must not be wedged open. Advice must be sought from a fire officer. The responsible individual or one 30/04/07 of the partners is required to conduct unannounced monthly visits to the establishment, produce a written report in accordance with this regulation and supply a copy of that report to the registered manager (which should be in the home available for inspection) to each of the directors or other persons responsible for the management of the organisation. This was a requirement of the previous inspection and a new timescale has been given. 30/04/07 The registered person shall maintain a system for reviewing the quality of care. This was a requirement of the previous inspection and a new timescale has been given. Grassmere Nursing Home DS0000043632.V326562.R01.S.doc Version 5.2 Page 23 4 OP36 18(2) Care staff must receive formal 30/04/07 supervision at least 6 times a year. This was a requirement of the previous inspection and a new timescale has been given. 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 Grassmere Nursing Home DS0000043632.V326562.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Grassmere Nursing Home DS0000043632.V326562.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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