Inspection on 29/07/05 for Grasmere Nursing Home

This inspection was carried out on 29th July 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Grasmere Nursing Home 11/01/07

Grasmere Nursing Home 28/11/05

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 Grassmere Nursing Home 51 Manor Road Worthing West Sussex BN11 4SH Lead Inspector Judith Farrell Announced 29 July 2005, 09.00am, V232755 th 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 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 H60-H11 S43632 Grassmere V232755 290705 Stage 4.doc Version 1.30 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 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 Claremount Care Services Limited Miss Yvonne Barbara Evans CRH 21 Category(ies) of OP-21 registration, with number of places Grassmere Nursing Home H60-H11 S43632 Grassmere V232755 290705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 07/12/04 Brief Description of the Service: Grasmere is a care establishment providing nursing care for twenty-one older people. Grasmere 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 H60-H11 S43632 Grassmere V232755 290705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on the 29th July 2005 and lasted five and a half hours. There were 18 residents living at the home at the time of inspection. The overall impression of this home is that there is normally a good level of knowledge and skills, enabling staff to care for the residents. A tour of the premises took place, rotas and care records were inspected. Seven residents, two relatives and seven staff members were spoken with. The Inspector received 4 relatives comment cards, which had positive comments about the home. The residents have different levels of communication ability and therefore it was difficult to ascertain all their views on how their needs are met. However some positive comments included ‘I feel I am always listened to’ ‘Staff are very kind and caring’. Two inspectors were involved in the inspection. Mrs Farrell who was the lead Inspector and Mrs Datoo was the second inspector. This is the first statutory inspection of this year. Mrs Datoo is a pharmacy inspector. She spent 3 hours examining medication procedures. What the service does well: What has improved since the last inspection? Grassmere Nursing Home H60-H11 S43632 Grassmere V232755 290705 Stage 4.doc Version 1.30 Page 6 The Care Manager for the home has now introduced a system to provide one to one formal support for staff and induction training has commenced for new staff. 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. Feedback from one relative included the comment that they had noticed a lot of improvements at the home over the last year. All communal areas seen by the Inspector were found to be clean and tidy. All relatives spoken with confirmed that the home was mostly clean and free from odour. A training programme introduced for aspects of care provided within the home has improved the outcomes for the residents. 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 H60-H11 S43632 Grassmere V232755 290705 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Grassmere Nursing Home H60-H11 S43632 Grassmere V232755 290705 Stage 4.doc Version 1.30 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 standard(s) 1,2,3,4 Prospective service users have the opportunity to see if the home will be able to meet their needs before they accept a permanent placement. Arrangements are in place to ensure that the health care needs of residents are identified and recorded. Staff have sufficient abilities to meet the needs of the residents admitted. However staff would like to have more training on particular mental health needs of the residents. EVIDENCE: Five pre admission assessment documents were looked at and they clearly showed that the admission procedure for personal care was thorough and well recorded. The staff members on duty were aware of the assessments but were not all able to fully undertake the care needs due to lack of understanding of the different conditions. This was particularly noted in relation to dementia and other mental health issues. Grassmere Nursing Home H60-H11 S43632 Grassmere V232755 290705 Stage 4.doc Version 1.30 Page 9 The nurse in charge was aware of some of the staff’s shortcomings and said that staff do need more training to improve their knowledge of the service users needs. This home does not provide intermediate care. Grassmere Nursing Home H60-H11 S43632 Grassmere V232755 290705 Stage 4.doc Version 1.30 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 standard(s) 7,8,9,10,11 Progress has been made on improving arrangements to ensure that health care need of the residents are identified and met, however there are still some shortfalls particularly in relation to risk assessments. The home demonstrated good medication handling practices. EVIDENCE: The care plans for four service users were viewed and there was evidence 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 identified care needs. There was evidence that service users have been consulted in developing their care plans and those who are able have signed their name in agreement with the information held on them. The Inspector spoke to two relatives, who confirmed that they were invited to participate in the care planning process. Care plans identify goals for individual residents, which are then monitored as part of the ongoing review process. At this time, the goals are fairly basic and Grassmere Nursing Home H60-H11 S43632 Grassmere V232755 290705 Stage 4.doc Version 1.30 Page 11 it is hoped that as this system develops, peoples’ experiences and aspirations will progress. The home has a range of risk assessments in place in respect of varying aspects of service users’ lives. Some further work in this area is required to ensure the risks associated with all activities are considered. The inspector observed staff members entering resident’s bedrooms. They knocked on the door and waited for permission before entering. Staff members said that there was strict guidance about respecting resident’s privacy. There is a variety of different pressure relieving equipment, however there is no evidence to link the risk assessments to the type of equipment being used. It was also noted that some of the equipment being used is not current good practice. The registered manager is aware 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. Residents spoken with discussed how they are assisted to attend all hospital outpatients, dentist, eye, and hearing appointments. Medication storage had been improved. Medication administration record charts are printed in the pharmacy every four weeks, with the information on the medicines dispensed. Medicines that needed to be handwritten, were initialled by two nurses. The home operates a homely remedy policy. Grassmere Nursing Home H60-H11 S43632 Grassmere V232755 290705 Stage 4.doc Version 1.30 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 standard(s) 12,13,15 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: Conversations with residents highlighted that community presence and participation in social activities was varied across the home. Some residents are able to go out in the garden and do so frequently. For others, staff support is required for all parts of daily living The home provides entertainment on most afternoons, one resident particularly like’s the exercise classes. Grassmere 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. Both breakfast and the lunchtime meal were observed and it was evident that choice and flexibility are paramount. Residents, if able, choose where to take their meals; this is seen as a social time by staff and relatives. The dining Grassmere Nursing Home H60-H11 S43632 Grassmere V232755 290705 Stage 4.doc Version 1.30 Page 13 room is arranged into small tables and lots of positive interaction was noticed at this time. The food itself was appetising and nicely presented. Grassmere Nursing Home H60-H11 S43632 Grassmere V232755 290705 Stage 4.doc Version 1.30 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 standard(s) 16,18 Residents and relatives are assured that their complaints would be taken seriously and dealt with promptly. The recruitment process protects residents from abuse. EVIDENCE: There is a clear complaints procedure, which is included in the Service Users Guide. Relatives said the manager re-iterates the need to inform her if they have any complaints. The complaints record was examined and the outcomes were discussed with some of the residents. It was apparent that any sign of dissatisfaction is taken seriously and acted on. A relative visiting the home said she could not imagine ever having cause to complain, but that she would not hesitate if the need arose. Robust procedures are in place for responding to any allegations or suspicions of abuse. Staff members told the inspector that they had received training in recognising the different forms of abuse. The manager informed the inspector that all staff were having up-to-date training in how to recognise signs of abuse. Each member of staff has an enhanced Criminal Record Bureau check. Residents said they the home had no dealings with their personal finances. Grassmere Nursing Home H60-H11 S43632 Grassmere V232755 290705 Stage 4.doc Version 1.30 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 standard(s) 19,20,23,24,26 Service users benefit from a clean, comfortable and well-maintained home. 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. Since the last inspection the home has continued with the redecoration and refurbishment programme. There were numerous pleasant floral displays around the outside of the building. Some residents were using a pleasant lounge on the day of the inspection. Outdoor space is a safe environment and was easily accessible to residents and staff confirmed that a number of residents enjoy being taken outside if the weather is fine. Grassmere Nursing Home H60-H11 S43632 Grassmere V232755 290705 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 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: There is a cohesive staff group who have worked in the home for several years. Staff file checked at random showed that the home had undertaken all the necessary checks to ensure protection of residents. Staff members spoken with said that they had been asked to complete an application form and obtain a Criminal Records Bureau checks before starting work in the home. All but one member of the care team hold National Vocational Qualification level 2 or 3. Visitors said that staff were kind and attentive whenever they visited the home. During the inspection staff were seen to go about their duties in an unhurried manner. The five relatives who provided feedback about the home, said they were happy with the number of staff at the home and found them to be kind and knowledgeable. Grassmere Nursing Home H60-H11 S43632 Grassmere V232755 290705 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,36,38 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. EVIDENCE: 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 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. Grassmere Nursing Home H60-H11 S43632 Grassmere V232755 290705 Stage 4.doc Version 1.30 Page 18 Staff confirmed that they receive clear direction from the registered manager and found her approachable and accessible. Four staff files randomly selected gave indications of induction, supervision, training and development staff had received. Most staff interviewed reported to the Inspectors that they had had supervision and their entire mandatory training. The files indicated that supervision had been started but there was insufficient evidence to show that it was occurring six times a year. 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. 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. Grassmere Nursing Home H60-H11 S43632 Grassmere V232755 290705 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 x x 3 3 x 3 STAFFING Standard No Score 27 3 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 2 3 x x 2 x 2 Grassmere Nursing Home H60-H11 S43632 Grassmere V232755 290705 Stage 4.doc Version 1.30 Page 20 yes 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. Standard OP7,11,38 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. Timescale for action 01/10/05 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. 3. 4. Refer to Standard OP32 OP36 OP32 OP24 Good Practice Recommendations Hold formal staff meetings on a regular basis. That all care staff receive formal supervision at least 6 times a year. That the manager is given sufficent time to undertake managerment duties. That service users assessed as requiring nursing care are provided with nursing beds. Grassmere Nursing Home H60-H11 S43632 Grassmere V232755 290705 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Address 1 Address 2 Address 3 Address 4 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 Grassmere Nursing Home H60-H11 S43632 Grassmere V232755 290705 Stage 4.doc Version 1.30 Page 22 - 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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