Inspection on 12/07/07 for Grassmere Residential Care Home

This inspection was carried out on 12th July 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Grassmere Residential Care Home 17/06/09

Grassmere Residential Care Home 02/07/08

Grassmere Residential Care Home 07/12/06

Grassmere Residential Care Home 28/09/05

Grassmere Residential Care Home 24/05/05

Grassmere Residential Care Home 26/01/05

Grassmere Residential Care Home 21/07/04

Grassmere Residential Care Home 20/01/04

Grassmere Residential Care Home 25/09/03

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

CARE HOMES FOR OLDER PEOPLE Grassmere Residential Care Home 675-677 Washwood Heath Road Ward End Birmingham West Midlands B8 2XL Lead Inspector Brenda O’Neill Key Unannounced Inspection 09:00 12th July 2007 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 Residential Care Home DS0000016769.V334661.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 Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grassmere Residential Care Home Address 675-677 Washwood Heath Road Ward End Birmingham West Midlands B8 2XL 0121 327 3140 0121 327 3949 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) United Care Ltd Vacant post Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the home is registered to accommodate 26 adults over the age of 65 who are in need of care for reasons of old age and may include mild dementia. Registration category will be 26(OP) 7th December 2006 Date of last inspection Brief Description of the Service: Grassmere Residential Care Home is situated on Washwood Heath Road, close to shops, pubs, churches and Ward End Park. It is well served by public transport. The Home provides residential care for up to 26 older people and this may include people in need of care for reasons of mild dementia and memory loss. All rooms are for single occupancy and seventeen of these have en suite facilities. There are three linked sitting areas for the people living in the home, together with a dining room on the ground floor of the home. Also located on the ground floor is the main kitchen, a small office and staff facilities. The office and laundry for the home are situated away from the main building at the end of the garden. The home has two passenger lifts for access to the upstairs and a newer annex. There are some assisted toilet and bathing facilities in the home and emergency call facilities are available in most areas. At the rear of the home is a small garden for the people living in the home to use. There are also some car parking facilities available. The fees at the home range from £369.00 to £383.00 per week. Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this key inspection over one and half days in July 2007. The inspector returned for the second day as the manager was not on duty on the first day of the inspection and staff records and financial records could not be accessed. During the course of the inspection a partial tour of the home was carried out, three staff and three files for the people living in the home were sampled as well as other care and health and safety documentation. Prior to the inspection a completed Annual Quality Assurance Assessment had been returned to the Commission which gave additional information about the home. Several completed questionnaires were also received, which asked about the service at the home. Some had been completed by the people living in the home others by their relatives. The comments received were generally favourable and many are included in the text of this summary and the main report. The home had logged one complaint since the last inspection. The previous manager had reported this as an adult protection issue as it involved an accusation by one of the people living in the home of things missing from their room. The items were found in the individual’s room. No complaints had been raised with the Commission since the last inspection. One complaint had been raised with the health protection nurses in relation to the managing of an outbreak of scabies at the home. The Commission contributed to the investigation of this and no regulations had been breached and the home had followed all the advice given by the Health Protection Unit. What the service does well: People wanting to live in the home were able to visit the home prior to moving in and some of the completed questionnaires received prior to the inspection confirmed this. Staff were identifying any health care issues of the people living in the home. and these were being followed up and monitored. There were no rigid rules or routines in the home and there were activities on offer for the people living in the home if they wished to take part. People living in the home were able to exercise choice and control over their lives. One of the people living in the home commented: ‘ always something going on birthdays and visitors. Staff go out of their way to make it pleasant.’ A visitor to the home commented ‘they do organise events for other residents. My relative decides not to take part.’ Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 6 There were no restrictions on visitors to the home within reasonable waking hours. Staffing levels in the home were good and there were good relationships between the staff and the people living in the home. Some very positive comments were received about the staff team from the people living in the home and their relatives these included: ‘Staff are always nice to me and friendly.’ ‘Keep asking me how I am.’ ‘They look after me well.’ ‘They encourage mom to look nice and to have her hair washed.’ ‘They keep my uncle clean and smart and he always looks happy when I go to see him.’ Staff had received training in adult protection issues to ensure they were able to safeguard the people living in the home. There was also ongoing training for staff in safe working practices. Health and safety in the home was generally well managed. What has improved since the last inspection? The service user guide for the home had been updated and included a copy of the complaints procedure. This had been issued to all the people living in the home. At the time of the inspection the people living in the home appeared confident to raise any issues. Comments received included: ‘I can always complain to staff and once agreed no problem if we do not I talk to the manager.’ ‘They have always responded well.’ ‘ Things I wanted improved have happened. Place made to look brighter. Washing going missing has been sorted out as it was going to the wrong people.’ It was pleasing to note that the manager was putting short term care plans in place for health care needs as they arose. The acting manager had put new menus in place since being at the home that included more choice for the people living there. The issues raised at the last inspection in relation to privacy locks on toilets not working had been addressed and a door had been fitted to the toilet in the entrance hall replacing the curtain that was present at the last inspection. The safety of the people living in the home had been improved by the fitting of alarms to the fire exits, staff ensuring they used footrests on the wheelchairs and keeping the keys for the medication trolley secure. Training had been and still was ongoing for staff to ensure they could work safely with the people living in the home. Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 7 There had been some improvements to the environment including, redecoration of corridors, new flooring in some areas, the outside of the home had been painted and the dining room carpet had been made safe. There were also plans to establish a sensory room and fit handrails to both sides of the corridors. What they could do better: To ensure the home have all the required information to be able to make a decision as to whether they can meet the individuals’ needs a copy of the social worker’s assessment needed to be obtained prior to the admission of people to the home. All the people living in the home needed to have care plans that detail all their needs and how they are to be met. These needed to include the needs of the people living in the home in relation to their dementia. The care plans needed be updated regularly to reflect the current needs of the individual. This will ensure people receive person centred care. To ensure that the people living in the home and the staff are not put at risk there needed to be manual handling risk assessments in place that clearly detail any handling methods to be used and any necessary equipment. All the people living in the home needed to have comprehensive personal risk assessments that detail how any identified risks are to be minimised. These needed to include strategies for managing any challenging behaviours. To ensure the people living in the home are safeguarded there needed to be tissue viability and nutritional assessments in place with corresponding management plans for any identified risks. There needed to be some improvements to the medication administration system to ensure the people living in the home received their medication as prescribed. The registered person needed to ensure that any specific diets in relation to culture or medical needs were catered for. Some issues needed to be addressed to ensure good infection control in the home. New staff needed to undertake induction training in line with the specifications laid down by Skills for Care to ensure they were able to care for the people living in the home. The home needed to have in place a quality assurance system that is based on seeking the views of the people living in the home and culminates in an annual Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 8 development plan for the home. This will ensure the service is continually improved for the benefit of the people living in the home. 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 Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 9 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 Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 10 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): 1, 2, 3 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was information available for people wanting to live in the home to enable them to decide if the home was suitable. The full range of needs of the people being admitted to the home were not always known by staff prior to their admission. Prospective users of the service were able to visit the home prior to admission to assess the facilities. EVIDENCE: The service user guide for the home had been updated as required at the last inspection. The document reflected the service offered and a copy of the complaints procedure had been included. The service user guide did not include a copy of a standard contract but stated it could be viewed in the reception area of the home as it was too bulky to include. Consideration should be given to including a copy of this as it is information that anyone considering living in the home may want to take away and read. The manager had recently Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 11 left the home, any future copies of the guide must include the name of the current manager. The people living in the home at the time of the inspection had all been issued with a service user guide and these were seen in bedrooms. The files for two people admitted to the home since the last inspection were sampled. There was evidence on the files that social workers had been involved in the pre admission assessment process as there were copies of the initial care plans drawn up them. However only one included a copy of the full assessment undertaken by the social worker. As the initial care plans included very little information about the needs of the individuals it was important that a copy of the full assessment was obtained to ensure the home had as much information as possible about the needs of the people wanting to live in the home. There was evidence on both the files sampled that the individuals had been issued with a statement of the terms and conditions of residence at the home. People wanting to live in the home were able to visit the home prior to moving in and some of the completed questionnaires received prior to the inspection confirmed this. It was recommended that some details were recorded about how the pre admission visit went and if any issues arose that needed to be discussed. Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 12 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, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There had been some improvements in the care planning and risk assessments for the people living in the home. Further improvements were needed to ensure staff knew how to meet all the individual needs of the people living in the home and minimise any risks. Some improvements were needed in the management of the medication system to ensure it was entirely safe. EVIDENCE: A new manager had been appointed at the home and she was aware that the care plans in the home needed to be further developed and was in the process of undertaking this however she had only been in post for two weeks. Three files for people living in the home were sampled and all included care plans. The quality of the care plans varied and all needed to be further developed. The files included an activities of daily living assessment which had been completed on the day of admission to the home. These gave general details of the individuals’ needs, for example, ‘requires some assistance with Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 13 personal care’ and ‘speaks very quietly and has dementia’. There were also forms entitled ‘Things I am able to do, things I needs help with’ and ‘My life before I knew you’ only some of the information on these forms had been completed. The information gathered on these forms, the activities for daily living and the pre admission assessment should have informed the care plans with details of how any identified needs would be met however this was not happening. The care plans were generally brief and did not detail the abilities, likes, dislikes and preferences of the people living in the home. For example, one stated ‘assist to clean teeth’ but there were no details of whether the person had their own teeth or dentures and what assistance was required. One individual may have had specific cultural needs in relation to hair and skin care but these were mentioned only very briefly. Some of the care plans were pre printed and the same for some of the people living in the home with just the odd comment added by staff in relation to the individual. For example, ‘has agreed to have a bath every other day – Monday Wednesday, Friday, Sunday’ further down the care plan it stated ‘ensure.. is offered at least 1 bath a week.’ Some of the identified needs were clearly detailed, for example, ‘talks very quietly and with a strong …. accent. Staff to be patient and give …. time to express themselves, staff to actively listen.’ This person also had some good detail of one of his social needs included in his care plan. All the care plans were being reviewed on a monthly basis and on occasions there was more information in the review than in the care plan, for example, one care plan detailed that an individual was incontinent at night but there were no details of how this was managed. One of the monthly reviews gave details of how this was being managed but the information had not been updated in the care plan. All the files sampled included manual handling risks assessments however one of these was not fully completed. One of the others stated ‘Assistance of one carer for the toilet’ but there was no detail of what assistance was required. Any specific manual handling requirements needed to be clearly detailed in the manual handling assessments to ensure both the people living in the home and the staff were not put at risk. Two of the files included tissue viability assessments the other did not. One of the assessments stated the individual was at high risk of developing pressure areas however there was no management plan in place informing staff how they were to reduce the risk. All three files included nutritional assessments and individuals were being weighed on a monthly basis wherever possible. It was apparent from the weight records and the monthly reviews that one person had lost weight but the nutritional assessment had not been reviewed. There was evidence that where staff had identified an issue with the food and fluid intake for an individual charts for recording their intake were in place however it was not clear who was checking these and what for. There were some personal risk assessments in place for some of the people living in the home. These included assessments and management plans for Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 14 falls and leaving the home and not returning. The falls risk assessments were quite well detailed. The risk management plan for the individual who may leave the home and fail to return gave staff a detailed procedure for staff to follow which included the telephone numbers of who should be contacted. However it was not clear at what point the person would be deemed as missing. It was evident from the information on one of the personal files that one of the people living in the home had some challenging behaviours due to a mental health problem. There was no management plan in place for staff to follow should they encounter these behaviours. There was some evidence on the daily records of the personal care that the people living in the home were receiving however in most cases these were quite brief and it could not be evidenced that where there were any specific needs that these were being met. For example, one person had some specific skin and foot care needs detailed on their care plan however there was no evidence on the daily records that these were being met. Daily records needed to be further developed to ensure they included an overview of the individuals’ well being. The daily records did evidence that staff were identifying any health care issues and that these were followed up and monitored. There were several separate sheets for the recording of health care visits and appointments. These detailed that individuals had access to chiropodists, community psychiatric nurses, district nurses, doctors and that hospital appointments were attended. The new manager was in the process of changing the recording system for medical visits so that only one sheet was used. This would enable easier tracking of health care needs. It was pleasing to note that the manager was putting short term care plans in place for health care needs as they arose. The majority of the medication in the home was administered via a 28 day monitored dosage system. Some medication was in boxes or bottles, as they could not be put into the blister packs. A random audit was undertaken on the medication being administered for five of the people living in the home. Some discrepancies were noted in the boxed medications. Some of the MAR (medication administration records) charts had gaps but when counting the tablets and packets remaining it suggested that the medication had been administered at these times. Staff needed to be more vigilant to ensure they signed for all medication as it was given. In one instance there was one too many packets left in the box. This suggests a staff member had signed for the medication on one occasion but had not administered it. The staff were administering controlled medication to one of the people living in the home. The records were appropriate for the administration of this however it was medication that had a variable dose, one or two to be given, but there was no clear guidance for staff to follow as to when the individual should have one or two. Two were being administered at all times. There was one person living in the home that was self administering their medication but there was no Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 15 evidence that a risk assessment had been completed for this or that any compliance checks were being carried out. It was also noted that staff were not dating eye drops when they were being opened this issue was raised at the last inspection. One of the completed questionnaires received by the Commission prior to the inspection suggested that medication sometimes ran out and people had to go without until a new supply was received. No evidence of this was found at the time of the inspection. It was pleasing to note that the issue raised at the last inspection in relation to the safe keeping of the keys for the medication trolley had been addressed. The inspector was informed that staff had either undertaken accredited medication training or were undertaking it. No issues were raised by the people living in the home in relation to their privacy or dignity. Staff were observed to be respectful in their terms of address and their interactions with the people living in the home. Assistance with meals and personal care was offered discreetly. Some of the bedrooms remained without appropriate locks. The issues raised at the last inspection in relation to privacy locks on toilets not working had been addressed and a door had been fitted to the toilet in the entrance hall as at the time of the last inspection it had a curtain instead. All bedrooms had a lockable facility for the occupants to store any personal effects if they wished. Medical consultations took place in the privacy of the bedrooms. The people living in the home could meet with their visitors in their bedrooms or one of the quieter areas of the home. Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 16 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, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were no rigid rules or routines in the home and there were activities on offer for the people living in the home if they wished to take part. People living in the home were able to exercise choice and control over their lives. The meals served in the home met with the needs of the majority of the people living there. It could not be evidenced that specific diets in relation to culture or illness were being catered for. EVIDENCE: There did not appear to be any rules or routines in the home. During the course of the inspection the people living in the home were seen to wander freely around the home, spend time quietly in their rooms, sit chatting to each other and take part in activities. It was pleasing to see staff sitting with the people living in the home on several occasions and chatting with them on a one to one basis. One of the people living in the home commented: ‘ always something going on birthdays and visitors. Staff go out of their way to make it pleasant.’ A visitor to the home commented ‘they do organise events for other residents. My relative decides not to take part.’ There was a weekly activities programme in the home which included such things as exercise, bingo, group Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 17 discussion and reminiscence. The individual activity records that were being kept at the home at the time of the last inspection had lapsed therefore it was difficult to determine what individuals were taking part in and this information was not included in the daily records. It is important to ensure that staff record how the people living in the home are spending their time to evidence their social needs are being met. The home had recently appointed an activities coordinator to work at the home and this should improve the range of activities available. There was evidence on the minutes of the meetings held with the people living in the home that there were occasional trips out, for example, some individuals had been to a garden centre and for a meal out. During the last meeting people were asked for suggestions for outings but there was no evidence that any of these had taken place. There were no restrictions on visitors to the home within reasonable waking hours. Visitors were seen to come and go from the home and one spoken with was very satisfied with the service being offered at the home. Comments received from relatives on the completed questionnaires included: ‘Always phone to check if we are happy with mom’s needs and how they are met.’ ‘Sometimes they don’t pass on messages to let know her know I am unable to visit. This has happened more than once.’ ‘They always phone me straight away if anything has gone wrong.’ There was some evidence in the daily records that the people living in the home were able to choose how they spent their time and if they chose to take part in organised activities or not was respected by staff. Individuals were able to choose to stay in their rooms and have their meals taken to them if they wished. People were asked were asked what they would like to eat prior to their meals and they could choose what time they went to bed and got up. One of the people living in the home went out on a daily basis and her main meal was put aside for her. Individuals were encouraged to personalise their rooms to their choosing and personal effects were observed in all the bedrooms seen. The acting manager had put new menus in place since being employed at the home that included more choice for the people living there. The menus were varied and nutritious and offered choices at all meals. The inspector was in the dining room during lunchtime and the meal looked appetising and it seemed to be enjoyed. People were asked if they like second helpings. Staff assistance was available for those individuals who could not manage independently. The meal was served to some of the people living in the home in their bedrooms at their request. Comments received about the food in the home included: ‘Very good food, always choices and extras.’ ‘ Food could be better, choice of foods could be widened.’ ‘The food is always of good quality, served and cooked well.’ Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 18 The records of the food being served to the people living in the home were not always completed. There was no evidence on the records that the home were catering for medical or cultural diets as required. Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 19 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in the home had received a copy of the complaints procedure and appeared confident enough to raise any concerns they may have. Staff had received training in adult protection issues to ensure they were able to safe guard the people living in the home. EVIDENCE: The service user guide had been updated and included a copy of the complaints procedure. All the people living in the home had received a copy of this as required at the last inspection. At the last inspection it appeared that some of the people living in the home were wary of raising any concerns this seemed to have been addressed at the time of this inspection. Comments received included: ‘I can always complain to staff and once agreed no problem if we do not I talk to the manager.’ ‘They have always responded well.’ ‘ Things I wanted improved have happened. Place made to look brighter. Washing going missing has been sorted out as it was going to the wrong people.’ The home had logged one complaint since the last inspection. The previous manager had reported this as an adult protection issue as it involved an accusation by one of the people living in the home of things missing from their Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 20 room. The items were found in the individual’s room. No complaints had been raised with the Commission since the last inspection. One compliant had been raised with the health protection nurses in relation to the managing of an outbreak of scabies at the home. The Commission contributed to the investigation of this and no regulations had been breached and the home had followed all the advice given by the Health Protection Unit. The policies and procedures for adult protection were not viewed at this inspection but had been seen at previous inspections. Staff had received training in adult protection issues. This was ongoing training and more was planned a little after the inspection. Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 21 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, 20, 21, 22, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There had been some improvements to the environment which was comfortable, well maintained and safe. EVIDENCE: A partial tour of the home was undertaken which included some bedrooms. There had been no changes to the layout of the home which was generally suitable for its stated purpose. Decoration had been ongoing since the last inspection and other areas were planned. Some of the corridors had been redecorated and others were being done. The outside of the home had also been painted. The carpet outside the kitchen was very badly worn and stained at the time of the last inspection. This had been replaced with laminate flooring. The dining room carpet had been made safe. The star lock noted on the kitchen door at the last inspection had Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 22 been removed and a combination lock fitted. Contact alarms had been fitted to the fire exits in the home so that staff would be made aware when anyone went out of them. This had been raised as an issue at the last inspection as someone had gone into the garden at night without staff knowing. There was ample communal space at the home with three linked sitting areas and a separate dining room. The furnishings, fittings and decor in the lounges were of an acceptable standard. The dining room was in need of redecorating. There were televisions, DVD players and music systems available in the lounge areas. A mural had been painted on the wall between the linked sitting areas which brightened up the area and made it much more interesting for the people living in the home. The room previously known as the treatment room which had also been used for hairdressing had been taken out of use. This room was to be set up as a sensory room for the use of the people living in the home. All medical consultations and hairdressing was now taking place in individual bedrooms. As at the time of the last inspection the home had adequate numbers of toilets and bathrooms however not all the bathrooms were used. One had a parker bath installed and the inspector was informed that this was really the only one in the home that was used by the people living there. The other two bathrooms were not assisted and therefore not appropriate for the needs of the present group of people living in the home. It is strongly recommended that one of the bathrooms is converted into a floor level shower so that people have a choice of having a bath or a shower. There were also two shower rooms in the home one had a step tray to access the shower and the other was a floor level shower and was situated in the annex. This was never used and was being used by staff at the time of the inspection. For people, other than those whose bedrooms were in the annex, to use this room would mean quite a long walk for them. Several of the bedrooms had en-suite facilities none of these were equipped with an emergency call point for individuals to summon help if they required. Information received prior to the inspection stated this issue was to be addressed over the next year. It was also noted that some of the extractor fans in the toilets needed to be cleaned. There were some aids and adaptations around the home including, two shaft lifts, free standing hoist, emergency call system, assisted bathing facility and some hand and grab rails. The handrails along the corridors on the first floor were only on one side. Again information received prior to the inspection stated this was to be addressed. The issue raised at the last inspection in relation to staff using wheelchairs without footrests had been addressed. Five bedrooms were inspected they varied in size and were comfortable. Bedrooms were appropriately personalised to the occupants choosing. Some of the bedrooms in the home had been redecorated. Not all the bedrooms had appropriate locks fitted. Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 23 The home was clean and generally odour free. There were appropriate systems in place for the control of clinical waste and protective clothing was available for staff. The laundry was not inspected at this inspection but was appropriately located. Two issues were raised during the course of the inspection. The back of the bath seat needed to be thoroughly cleaned and some of the commodes were rusting and needed to be replaced. Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 24 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, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels were appropriate for the needs of the people living in the home. The manager needed to ensure that there was documented evidence that all new staff had undertaken appropriate induction training to ensure they were able to care for the people living in the home. Recruitment procedures were robust and ensured the people living in the home are fully safe guarded. EVIDENCE: Information received prior to the inspection indicated there had been considerable staff turnover over the last year. However they were fully staffed at the time of the inspection. The rotas indicated that the staffing levels were appropriate for the needs of the people living in the home. There were three care staff on duty throughout the day one of whom was a senior and two staff during the night. The manager’s hours were supernumery to the care rota. The home also employed catering, laundry, domestic and maintenance staff. Friendly relationships were evident between the staff and the people living in the home. Some very positive comments were received about the staff team from the people living in the home and their relatives these included: ‘Staff are always nice to me and friendly.’ ‘Keep asking me how I am.’ ‘They look after me well.’ Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 25 ‘They encourage mom to look nice and to have her hair washed.’ ‘They keep my uncle clean and smart and he always looks happy when I go to see him.’ The files for three staff who had been employed at the home since the last inspection were sampled. The files included the majority of the required recruitment documentation including completed application forms, POVA first checks, CRBs and two written references. One of the files did not include proof that the individual was eligible to work in this country. Only two of the files sampled included any evidence that the staff had undertaken any induction. For one of the staff members this was quite brief but it was adequate as the person was an ancillary worker. The other file, for a care assistant, included a training record that stated the individual had undertaken the majority of their regulatory training within two months of starting work at the home and a first day induction from had been completed. There was no evidence that the third person, a care assistant, had completed any induction training. The manager needed to ensure that induction training for new care assistants was in line with the specifications laid down by Skills for Care and completed within twelve weeks of them commencing their employment. There was a lot of ongoing training in the home at the time of the inspection. Topics scheduled to be covered in the training included fire, adult protection, manual handling, COSHH, pressure care and nutrition. There was also ongoing training for all the staff in relation to dementia care. The information received prior to the inspection stated that twelve of the nineteen staff had NVQ level 2, which is above the required fifty percent. Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 26 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 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was running smoothly and the health and safety of the people living in the home and the staff were well managed. The home needed to have in place a development plan based on seeking the views of the people living in the home with a view to continuous improvement. EVIDENCE: The manager that was in post at the time of the last inspection had left and a new manager had been appointed. She had only been in post for two weeks at this time. She had a lot of previous experience of caring for older adults and running care homes. She was a registered nurse and also had the Registered Manager’s Award. Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 27 The new manager was not on duty on the first day of the inspection but the inspector had a telephone conversation with her about the home and then met with her on the second day of the inspection. She was receptive to the feedback given about the inspection and was already aware of the shortfalls in the care planning and risk assessment processes in the home and had begun to address these. She had also begun staff appraisals. There was a quality assurance system on site however the last report that could be found was for January 2006. It could not be ascertained if any recent quality audits had been undertaken. The home needed to have a development plan in place based on seeking the views of the people living in the home. There was some evidence that meetings with the people who live in the home and the staff were taking place. Some health and safety audits were taking place, for example, checking water temperatures. Questionnaires were being given to the people living in the home and their relatives periodically. All the information received from these systems could be used towards the development plan. The responsible individual for the home had been making the required unannounced visits to oversee the conduct of the home however these had ceased in May 2007. The home was managing some money on behalf of the people living in the home. To avoid large amounts of money being kept in the home the system in place was based on a petty cash account method. All the people who had money managed by the home had individual records. The records for five people were sampled. Some issues were raised and these involved the dates on receipts not corresponding with the dates on the records and that some of the receipts for expenditure were not available. One of the people living in the home continued to manager their own money. Where an individual received money from the manager they were signing their own records. Health and safety in the home were generally well managed. Staff had received training in safe working practices and updates were ongoing. The information received prior to the inspection stated that the majority of the equipment in the home had been serviced with the exception of the gas equipment. This had been done just before the inspection. Some work had been identified during the service and evidence that this has been undertaken will need to be forwarded to the Commission on completion. The in house checks on the fire system were up to date and fire drills were being carried out as required. It was noted that the fire risk assessment was not the most up to date version and it was recommended that the fire officers were consulted about this. Accident and incident recording and reporting in the home were appropriate. Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 28 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 2 3 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 2 3 X 3 X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X 2 2 Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 29 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 OP3 Regulation 14(1)(b) Requirement A copy of the social worker’s assessment must be obtained prior to the admission of people to the home. (Previous time scale of 01/02/07 not met.) This will ensure the home have all the required information to be able to make a decision as to whether they can meet the individuals’ needs. 2. OP7 15(1) All the people living in the home must have care plans that detail all their needs and how they are to be met. (Previous time scale of 01/02/07 partially met.) Care plans must include the needs of the people living in the home in relation to their dementia. The people living in the home or their representatives must be consulted about the care plans. (Previous time scales of 15/11/06 and 01/02/07 not Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 30 Timescale for action 31/08/07 31/08/07 met.) Care plans must be updated regularly to reflect the current needs of the people living in the home. (Previous time scale of 01/02/07 not met.) This will ensure the people living in the home receive person centred care. The people living in the home 31/08/07 must have manual handling risk assessments that clearly detail any handling methods to be used and any necessary equipment. (Previous time scale of 01/02/07 not met.) This will ensure that the people living in the home and the staff are not put at risk. All the people living in the home must have comprehensive personal risk assessments that detail how any identified risks are to be minimised. These must include strategies for managing any challenging behaviours. (Previous time scale of 01/02/07 partially met.) This will ensure that the people living in the home and the staff are not exposed to any unnecessary risks. All the people living in the home must have tissue viability assessments in place. Where a risk is identified on a tissue viability or nutritional assessment there must be a corresponding care/management plan detailing how the risk is to be reduced. Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 31 3. OP7 13(5) 4. OP7 13(4)(c) 31/08/07 5. OP8 12(1)(a) 31/08/07 (Previous time scale of 01/02/07 not met.) This will ensure the people living in the home are safeguarded. Staff must ensure they sign for medication as it is administered. There must be clear guidance for staff to follow for the administration of any controlled medication with variable doses. Any individuals that self administer medication must be risk assessed and compliance checks undertaken. Eye drops must be dated on opening. (Previous time scale of 18/12/06 not met.) This will ensure that the people living in the home receive their medication as prescribed and are safe guarded. The registered person must ensure that any specific diets in relation to culture or medical are catered for. This will ensure that the nutritional needs of the people living in the home are met. The people living in the home must have access to emergency call points from all bathing and toilet facilities. (Previous time scale of 01/02/07 not met.) This will ensure the people living in the home can summon assistance when needed. All internal extraction fans must be kept clean. (Previous time scale of 01/01/07 not met.) DS0000016769.V334661.R01.S.doc 6. OP9 13(2) 31/08/07 7. OP15 16(2)(i) 14/08/07 8. OP21 23(2)(n) 30/09/07 9. OP26 13(3) 14/08/07 Grassmere Residential Care Home Version 5.2 Page 32 The back of the bath seat must be thoroughly cleaned. Any rusting commodes must be removed from bedrooms. (Previous time scale of 18/12/07 not met.) This will ensure good infection control in the home. There must be evidence in staff files that they are eligible to work in this country. This will ensure the law is complied with. Staff must receive induction training in line with the specifications laid down by Skills for Care. (Previous time scale of 31/03/07 not met.) This will ensure staff are able to care for the people living in the home. The home must have in place a quality assurance system that is based on seeking the views of the people living in the home and culminates in an annual development plan for the home. This will ensure the service is continually improved for the benefit of the people living in the home. Receipts for any expenditure made on behalf of any of the people living in the home must be kept. The records for expenditure on behalf of the people living in the home must correspond with the dates on the receipts. This will ensure the people living in the home are safeguarded. Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 33 10. OP29 19 schedule 2 14/07/07 11. OP30 18(1)(c) (i) 31/08/07 12. OP33 24 30/09/07 13. OP35 17(2) schedule 4(9) 14/08/07 14. OP38 23(2)(c) Evidence must be forwarded to 14/08/07 the CSCI that the remedial works on the gas equipment have been carried out. This will ensure the safety of the people living and working in the home. 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. Refer to Standard OP1 Good Practice Recommendations Consideration should be given to including a copy of the terms and conditions of residence at the home in the service user guide. This will ensure any prospective users of the service have all the necessary information. It is recommended that some details are recorded about how any pre admission visits to the home go and if any issues arise that need to be discussed. Daily records should be further developed to ensure they give an overview of the individuals’ well being. This will ensure that there is evidence of personal care needs being met. To ensure the privacy of the people living in the home all bedroom doors should have appropriate locks fitted. Staff should record how the people living in the home are spending their time to evidence their social needs are being met. Records of the food being served to the people living in the home must be kept in sufficient detail to evidence that they are receiving a varied and nutritious diet. To ensure the home is kept to an acceptable standard for the people there the dining room should be redecorated. It is strongly recommended that one of the bathrooms is converted into a floor level shower so that the people living in the home have a choice of having a bath or a shower. There must be evidence on site that the responsible individual for the home has been making the required unannounced visits to oversee the conduct of the home on DS0000016769.V334661.R01.S.doc Version 5.2 Page 34 2. 3. OP5 OP8 4. 5. 6. 7. 8. OP10 OP12 OP15 OP19 OP21 9. OP37 Grassmere Residential Care Home 10. OP38 an ongoing basis. It is recommended that the manager discusses the current fire risk assessment with the fire officer to ensure it complies with their requirements. Grassmere Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Residential Care Home DS0000016769.V334661.R01.S.doc Version 5.2 Page 36 - 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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