CARE HOMES FOR OLDER PEOPLE
Grassmere Nursing Home 51 Manor Road Worthing West Sussex BN11 4SH Lead Inspector
Judith Farrell Unannounced Inspection 28th November 2005 9:00 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.V268264.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V268264.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Grassmere 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 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.V268264.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 29th July 2005 Brief Description of the Service: Grasmere is a care establishment providing accommodation and nursing care for twenty-one older people. It is owned by Kargini Care Services Ltd for whom the responsible person is Mr M Rajan. Miss Yvonne Barbara Evans is the registered manager in charge of the day to day running of the establishment. Grasmere is situated in a residential area approximately one mile from the town centre of Worthing with its’ shops, train stations and other amenities. It is a two storey detached property and the accommodation is arranged in twenty one single rooms on the ground, first and second floors. There is a passenger and stair lift. Facilities include a spacious lounge and dining room on the ground floor and a quiet sitting room on the second floor. There is a pleasant patio garden to the side of the house which is accessible to and used by service users. Grassmere Nursing Home DS0000043632.V268264.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over three hours on 28th November 2005. This is the second statutory inspection of this year. The purpose of this inspection was to assess compliance with the requirements of the last inspection and to generally monitor care practices. This report must be seen in light of the previous inspection report, which was carried out in July 2005. At the July Inspection a full and robust assessment took place and though many of the standards were not inspected this time there was nothing to suggest that these standards should not be met. A tour of the premises took place, rotas and care records were inspected. Thirteen of the residents, four members of care staff and the Manager were spoken with. The residents have different levels of communication abilities and therefore it was difficult to ascertain all their views on how their needs are met. What the service does well: What has improved since the last inspection?
Grassmere Nursing Home DS0000043632.V268264.R01.S.doc Version 5.0 Page 6 The assessment process has improved which means resident’s who cannot be looked after safely or who do not fall within the homes registration will no longer be admitted. The standard documentation maintained has significantly improved. Care plans are now developing into workable documents that provide meaningful support plans. The homes’ understanding of and response to incidents has improved considerably. Both management and staff now demonstrate a reflective approach to dealing with incidents that occur in the home and discuss with other professionals the action needed to prevent future occurrences. There have been improvements to the lounge with the purchase of new chairs and curtons. One resident stated ‘its much more like home now’. The home has also purchased a new standing hoist which staff are very enthusiastic about. A new boiler has been fitted and is providing the resident with sufficient hot water. The one bedroom which has stairs leading down to it is now having the stairs modified to enable staff to us a stair walker to help resident in access to this area. Feedback from one relative included the comment that they had noticed a lot of improvements at the home over the last year. 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. Grassmere Nursing Home DS0000043632.V268264.R01.S.doc Version 5.0 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.V268264.R01.S.doc Version 5.0 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): 3,4 The documentation available does provide prospective residents’ with the information they need to make a choice about whether to live at Grasmere. The home is able to demonstrate that residents’ needs would be met prior to admission. Arrangements are in place to ensure that the health care needs of residents are identified and recorded. The home does not admit any resident for intermediate care. EVIDENCE: A copy of the terms and conditions (contract) was seen and residents and relatives said that it was clear and that they understood what was in it. Four pre admission assessment documents were looked at and they clearly showed that the admission procedure was thorough and well recorded. This procedure ensures that new residents needs are properly assessed and planned for. Six residents spoken to were able to provide significant information about their care needs, these had all been recorded. The staff members on duty were aware of the assessments and were able to fully undertake the care needs.
Grassmere Nursing Home DS0000043632.V268264.R01.S.doc Version 5.0 Page 9 In discussion with the manager and documental evidence no person is admitted to the home without a full assessment. In the event of an emergency the manager still goes to see and produces a written assessment before a potential resident is admitted. Grassmere Nursing Home DS0000043632.V268264.R01.S.doc Version 5.0 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): 7,8,11 Residents are involved in developing the plans in place to support them. Progress has been made on improving arrangements to ensure that health care needs of the residents are identified and met. EVIDENCE: Five care plans were examined and it was found that significant improvements had been made since the last inspection. The system of care planning now provides support plans to guide staff in the delivery of most identified care needs. This includes how staff can support the resident’s wishes and their relatives in the event of the resident’s death. One member of staff in particular, has invested a lot of time reviewing and updating care plans. She acknowledges there is still work to be done and indeed it is required that all care plans provide a comprehensive plan of how residents should be supported. All residents spoken with confirm that health care needs were always addressed and they were kept well informed about their health needs. The manager advised that there is a now a very good working relationship with the residents GPs, the district nurse service and specialist nurses. The resident’s can choose which GP they wish to register with, in the locality.
Grassmere Nursing Home DS0000043632.V268264.R01.S.doc Version 5.0 Page 11 Residents spoken with discussed how they are assisted to attend all hospital outpatients, dentist, eye, and hearing appointments. Grassmere Nursing Home DS0000043632.V268264.R01.S.doc Version 5.0 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): 12,14,15 Resident’s benefit from a robust programme of fulfilling activities. The home promotes positive relationships between service users and their relatives. Service users enjoy a range of appealing and nutritious meals. EVIDENCE: Residents told inspectors that they are able to handle their own finances if they wish. They are also able to bring in personal possessions with them to the home if these can be accommodated. Residents have access to personal records if requested, but the nurse in charge told the Inspectors that the current group of people living at the home have not requested to do so. Currently all the residents, have family or friends to assist them, but if advocacy assistance was required this would be sought from an external agency. The home provides entertainment on most afternoons, one resident particularly like’s the exercise classes. Grasmere promotes an open door policy during the day. Residents spoke of visitors they had received and the home maintains a record of the contact each resident has with his or her relatives and friends. The lunchtime meal was observed and found to be appetising and well presented. Menus viewed were varied and service users spoke positively about the food they receive. One service user told the Inspector that they regularly had there favourite meal cooked for him. The five residents spoken to said
Grassmere Nursing Home DS0000043632.V268264.R01.S.doc Version 5.0 Page 13 they had never heard any complaints about the food at Grasmere and that personal choices and preferences were always respected. Grassmere Nursing Home DS0000043632.V268264.R01.S.doc Version 5.0 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): 17 The residents right to participate in the political process is upheld. EVIDENCE: Residents are encouraged to vote and postal votes are provided. The two other standards were assessed at met at the last inspection in July. The Commission has received one complaint, which was investigated and found to be not upheld. Grassmere Nursing Home DS0000043632.V268264.R01.S.doc Version 5.0 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): 19,25,26 The environment is subject to ongoing improvement, which is needed to maintain and raise the standard of accommodation. Specialist equipment has been obtained to meet resident’s needs. More equipment could be provided to maximise resident’s independence. Bedrooms are furnished with some items of resident’s own belongings and meet their needs. The home is clean and hygienic. EVIDENCE: At the time of the inspection, all communal areas and the ten bedrooms seen by the Inspector were found to be clean, tidy and well maintained. All relatives spoken with confirmed that the home was always clean and free from odour. Substantial work has been done to improve the appearance of the home and the surroundings and create a homely environment. Some residents were using a pleasant lounge on the day of the inspection. However, residents rooms have been made comfortable with their own belongings and residents who spoke with the inspectors were happy not to
Grassmere Nursing Home DS0000043632.V268264.R01.S.doc Version 5.0 Page 16 have a lock on their bedroom door, one resident said she was happy with the arrangements for respecting her privacy and dignity. Residents have access to all parts of the building via a passenger and stair lift, with the exception of one room, which is not accessed by these. That room is now being modified to improve the stair rise and allow it to be accessed by a stair walker. Aids and equipment are in use in the home to aid independence and support staff with good moving and handling. However it was noted that there are no hand rails in corridors and one resident said she would like a grab rails in her bedroom. The premises were clean and tidy on the day of the inspection. Grassmere Nursing Home DS0000043632.V268264.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28,29 The procedures for the recruitment of staff are robust and ensure that sufficient staff are on duty throughout the day and night. Staff are trained and competent to do their jobs. EVIDENCE: To adequately reflect the dependency of residents, particularly those with dementia who were observed to need more support during the afternoon and early evening, staffing levels should be reviewed. Most residents spend most of the daytime in communal areas and not all have access to a call bell during this time, therefore some residents have to find staff to assist others, a review of the deployment of staff should address this issue. In discussion with the manager it was confirmed that 90 of the homes current care staff hold NVQ level 2 or above in care. I member of staff spoken to is on her last unit and is hoping to finish her award in the next month. Staff talked of the benefit of the NVQ in care system and how it has helped them to understand and help the residents. Grassmere Nursing Home DS0000043632.V268264.R01.S.doc Version 5.0 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): 31,32,36,38 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 her responsibilities fully. Training staff who undertake supervision of junior staff could improve practice and potentially reduce risks to the residents. Staff must have regular mandatory training to safeguard residents and themselves. EVIDENCE: Staff spoken with told the inspector that the registered manager gives clear direction and they felt well supported by her. They said that she is always very accessible, ready to listen and they felt their views and suggestions were valued. Much of the time she works alongside staff. Service users spoke well of her and again said that she is very accessible. The manager was interviewed and described herself as part of the workforce, apart from approximately nine hours a week and therefore had limited time to carry out any management tasks such as staff meetings, supervision and
Grassmere Nursing Home DS0000043632.V268264.R01.S.doc Version 5.0 Page 19 paper work. The manager is a 1st level nurse who has many years of experience working with the older person. There are clear lines of accountability within the home and with external management. The manager demonstrated that she has undertaken periodic training to update her skills and knowledge. The manager is aware of the need to obtain an NVQ Level 4 in management and is working towards completing her Registered Managers Award in December 2005. The staff on duty demonstrated that they were aware of their responsibilities under Health & Safety. A maintenance person is employed to undertake a variety of checks and audits and to keep the home in a good state of repair. Policies and procedures are in place to ensure the smooth running of the home. Staff confirmed that there are some meeting, handovers and one-to ones were held where the manager informed them of any changes in legislation. Full staff meetings are not held on any regular basis and some of the staff spoken with said that they would welcome these. Supervision has started but there is insufficient evidence to show this is occurring six times a year. This standard will be assessed on the next inspection. Access to individual training records and audits was not available at this inspection. Grassmere Nursing Home DS0000043632.V268264.R01.S.doc Version 5.0 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 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 3 18 x 3 x x x x x 3 3 STAFFING Standard No Score 27 x 28 4 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x x 2 x 3 Grassmere Nursing Home DS0000043632.V268264.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? YES 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 Standard OP38OP11 OP7 Regulation 15,23(4)( a-c) Requirement To ensure all care plans cover all aspects of health, personal and social care needs of the service user and reflect actual current practice. That care plans include all aspects of Standard 7, 11. The level of risk must be clearly identified on all risk assessment, this includes the risk of scalding from hot water. The responsible individual or one 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 and to the Commission. The registered person shall maintain a system for reviewing the quality of care. That all care staff receive formal
DS0000043632.V268264.R01.S.doc Timescale for action 01/01/06 2 OP37 26 01/01/06 3 4 OP33 OP36 24(1)(2)(3) 18(a) 01/01/06 01/01/06 Grassmere Nursing Home Version 5.0 Page 22 supervision at least 6 times a year. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP31 OP37 Good Practice Recommendations That the manager is given sufficent time to undertake managerment duties. Hold formal staff meetings on a regular basis. Grassmere Nursing Home DS0000043632.V268264.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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