Inspection on 02/07/08 for Grassmere Residential Care Home

This inspection was carried out on 2nd July 2008.

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

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

Other inspections for this house

Grassmere Residential Care Home 17/06/09

Grassmere Residential Care Home 12/07/07

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 27/09/2008.

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 Unannounced Inspection 2nd July 2008 09:30 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.V367334.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.V367334.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 Manager post vacant Care Home 26 Category(ies) of Dementia (21), Old age, not falling within any registration, with number other category (26) of places Grassmere Residential Care Home DS0000016769.V367334.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only (Code PC) to service users of the following gender Either Whose primary care needs on admission to the home are within the following categories: Older People (OP) 26 Dementia (DE) 21 The maximum number of service users to be accommodated is 26. 2. Date of last inspection 12th July 2007 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 dementia. 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 are 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 annexe. 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 were detailed in the service user guide and ranged from Grassmere Residential Care Home DS0000016769.V367334.R01.S.doc Version 5.2 Page 5 £361.14 to £417.00 per week at the time of the inspection. Grassmere Residential Care Home DS0000016769.V367334.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate outcomes. One inspector carried out this key inspection over one day in July 2008. During the course of the inspection the care for three of the people living in the home was followed this included meeting with them and sampling their care plans, risk assessments, daily records and so on and observing care practice. Two staff files were also sampled along with other training and health and safety documentation. We spoke with the acting manager, two staff members, three people visiting the home and five of the people living in the home. The pharmacist inspector visited the home on a different day to the main inspection to audit the medication system. Prior to the inspection the manager completed and returned to us an Annual Quality Assurance Assessment which gave us some additional information about the home. Satisfaction surveys were sent out to some of the people living in the home. The majority of these were returned and responses were mostly very positive. We had not received any complaints about the home and none had been logged at the home since the last inspection. There have been two adult protection issues raised at the home since the last inspection. One was raised by the acting manager in relation to money going missing from one of the accounts of the people living in the home. This issue was ongoing at the time of the inspection and in the hands of the police. The acting manager had reported this to the police and Social Care and Health when he realised what had happened. The other issue was raised by a relative in relation to alleged rough handling of one of the people living in the home. Social Care and Health investigated this and there was no evidence to support the allegation. It was thought the individual concerned might have been referring to past issues prior to him moving to the home. Due to the issues raised all relevant risk assessments were reviewed. What the service does well: The pre admission assessment procedure ensured the needs of people being admitted to the home were known to staff. Prospective users of the service were able to visit the home prior to admission to assess the facilities. 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. Grassmere Residential Care Home DS0000016769.V367334.R01.S.doc Version 5.2 Page 7 Daily records evidenced that relatives and friends were able to visit the home at all reasonable daytime hours. Several relatives were seen to come and go from the home during the day and all were made very welcome by staff. We spoke with three relatives and they were clearly very happy with the service being provided at the home and described staff as ‘very good’. The people living in the home were able to exercise some choice and control over their lives. For example, what time to go to bed and get up, what to eat, how they spent their time and so on. People were encouraged to join in with activities but if they declined this was respected by staff. The people spoken with during the inspection were satisfied with the meals being served to them. The surveys returned to us indicated that the people living in the home liked the meals being served. The completed surveys returned to us indicated the people living in the home know how to make a complaint or who to speak to if they are unhappy. One person commented they would: ‘Ask one of the carers if there is any problem’ There had been little staff turnover since the last inspection which was good for the continuity of care of the people living in the home. Staffing levels were good with four staff on duty during the morning, three in the afternoon and two on waking nights. All the people living in the home and the visitors that were spoken with described the staff as ‘helpful’, ‘very good’ and ‘very nice’. One person commented: ‘never been refused anything by staff.’ Throughout the course of the inspection it was evident there were very friendly relationships between the staff and the people living in the home. The health and safety of the people living in the home and the staff were generally well managed in the home. What has improved since the last inspection? The service user guide for the home had been updated and included all the information people would need to help them decide if the home was appropriate for them. The processes in place for care planning and risk assessments had improved ensuring that staff knew how to meet the needs of the people living in the home and minimise any risks. The care plans were much more detailed and included clear instructions for staff as to how they were to meet the needs of the people living in the home. Where a risk had been identified the management plan was generally included in the relevant care plan. There was evidence that medical diets were being catered for. Grassmere Residential Care Home DS0000016769.V367334.R01.S.doc Version 5.2 Page 8 Staff recruitment had been further improved by ensuring there was evidence that staff were eligible to work in this country. There had been further improvements to the environment including some redecoration and new furnishings, additional handrails had been fitted in corridors, a sensory room had been set up and one of the bathrooms was in the process of being refurbished. These improvements enhanced the comfort and the facilities available to the people living in the home. The issues raised at the last inspection about the back of the bath hoist needing cleaning and replacing rusting commodes had been addressed. This further enhanced the infection control in the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Grassmere Residential Care Home DS0000016769.V367334.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.V367334.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 good. 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 pre admission assessment procedure ensured the needs of being people being admitted to the home were known to staff. Prospective users of the service were able to visit the home prior to admission to assess the facilities. EVIDENCE: The home had had a change in the registration category since the last inspection and could now offer care to 21 people with dementia. The service user guide for the home had been updated to reflect this change and the recent change in the management of the home. All the required information was included in the service user guide that would enable people wanting to move into the home to decide if the home could meet their needs. Grassmere Residential Care Home DS0000016769.V367334.R01.S.doc Version 5.2 Page 11 The files for two people admitted to the home since the last inspection were sampled. Both the files included evidence that the acting manager had undertaken pre admission assessments on the individuals concerned to ascertain if the home could meet their needs. The assessments covered numerous areas of the individuals’ lives. Although the form used was mainly tick boxes there were spaces for additional comments if needs were identified. The acting manager stated that the assessments had been undertaken during the preadmission visits to the home. It was recommended that the location of the assessment was included on the form as evidence that people were able to have a pre admission visit to the home. A pre admission visit was being undertaken on the day of the inspection. The individual was considering a short stay at the home and was accompanied by a relative. The individual was from a different cultural background to the other people living in the home. Discussions with the acting manager showed that he had considered this carefully and had discussions with the family to ensure the home could meet the cultural needs of the person. The files sampled also included copies of the letters that had been sent to people after the assessments had been undertaken to verify that the home could meet their needs and offering a place. Some of the surveys returned to us prior to the inspection indicated that the people living in the home were not issued with contracts by the home. All the files sampled included copies of the signed and dated contracts that had been issued. The contracts detailed the terms and conditions of the individuals’ stay at the home these included the number of the room to be occupied and the fees to be paid. Grassmere Residential Care Home DS0000016769.V367334.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. The processes in place for care planning and risk assessments ensured that staff knew how to meet the needs of the people living in the home and minimise any risks. Staff needed to ensure they followed the risk management plans at all times so that the people living in the home were safeguarded. The medicine management was adequate. Further work was needed to ensure that all the medicines are administered as prescribed and records reflect practice at all times. EVIDENCE: The acting manager had changed the care planning process and all care plans had been updated. The care plans were much more detailed and included clear instructions for staff as to how they were to meet the needs of the people living in the home. During this inspection the care for three people was followed. Grassmere Residential Care Home DS0000016769.V367334.R01.S.doc Version 5.2 Page 13 The care plans covered numerous aspects of the lives of the people living in the home including, sight, hearing, communication, foot care, oral care, nutrition, mobility, history of falls, continence and social needs. The plans in place detailed what people were able to do for themselves, where they were able to make choices and what staff were to do to meet their needs. The care plans were clear about how people’s dementia affected them particularly in relation to communication. For example, ‘communicates clearly both verbally and with gesturing, struggles to make decisions on her day to day living needs due to her memory loss and dementia. Staff should be patient and give her time to understand and reply.’ Personal care needs were well detailed and included personal preferences, for example, ‘full dentures does not like to take them out at night, brushes them herself in the morning.’ One of the people whose care was followed was very dependent on staff for all their needs and this was very clear from the care plan. For example, ‘unable to communicate most of the time. She will smile if happy and keep her mouth closed if she does not want to eat. Staff still need to explain to …… exactly what they are doing for her at all times.’ Care plans also included some good detail of how relatives continued to be involved in the care of their relatives and this was clearly encouraged. All the files sampled had several risk assessments in place for such things as falls, manual handling equipment, nutrition and pressure care. Where a risk had been identified the management plan was generally included in the relevant care plan. One of the people living in the home had a high risk of developing pressure sores as they were immobile this was made clear in the care plan and the equipment used and checks to be made were detailed. The acting manager had sheets in place that were completed for all the people living in the home that detailed the most vulnerable areas and staff had to complete that skin was intact or otherwise. It was recommended that the sheet also included details of any areas that were discoloured or red. Manual handling needs were also detailed in the care plans, for example, for the person that was immobile the care plan stated that the hoist was to be used for all transfers however the size of the sling to be used was not detailed. There was also evidence that this individual was having a bed bath however the handling methods to be used for this were not detailed. Nutritional care plans included details of any risks that the people living in the home had. For example it was evident one of the people living in the home had to be fed by staff, she could not chew and food had to be liquidised. There had been some issues recently about this individual choking and losing weight. These had been followed up and a hospital appointment had been attended. The outcome of this indicated that the dietician was to visit the home to give advice. The food records for this person indicated that staff had still been giving the individual bread and biscuits which could potentially put her at risk. Staff needed to ensure they followed the risk management plan at all times to ensure the individual was safeguarded. Grassmere Residential Care Home DS0000016769.V367334.R01.S.doc Version 5.2 Page 14 The people living in the home were being weighed on a regular basis and where there were any issues these were noted and followed up. For example, one of the people living in the home had had some weight loss this was checked and it was felt the scales could be wrong. The scales were checked and a new set purchased as a repair would have been uneconomical. It was recommended to the acting manager that he had read and sign sheets for staff with the care plans and risk assessments which indicated they had read, understood and agreed to follow the plans in place. One of the G.P.s that visits the home attended the day of the inspection and there were clearly very good relationships with the staff at the home and she was very proactive in ensuring hospitals followed up her referrals. Records showed that people had access to health care professionals as needed including G.P.s, opticians, district nurses, chiropodists and continence advisors. Staff were not always recording the health care visits on the designated sheets but they were detailed on daily records. It was recommended that health care visits were recorded on the appropriate sheets so that it was easy to track health care needs. Staff were identifying health care needs and these were being monitored and followed up. For example, there were details of someone being sore and of this being monitored and the G.P. being called as the cream being used was ineffective. It was recommended that temporary care plans were put in place for short term needs such as skin integrity issues and infections. These should detail the additional needs at that time of the people living in the home and how they are to be met by staff. The pharmacist inspection took place at a different date from the main inspection. It lasted three hours. The medicines for nine of the people living in the home were looked at together with their care plans and medicine charts. The home currently stores all the medicines used on a daily basis in the medication trolley which is chained to the wall permanently in the dining room. Surplus medication was stored in the laundry store at the time of the pharmacist visit. They were not stored in a separate locked cabinet, so anyone who had access to the clean laundry also had access to medication. This issue had been addressed at the time of the main inspection and surplus medication was being stored in a safe in the office. The home has a Controlled Drug cabinet that should have been reserved for the storage of controlled drugs only but a box of paracetamol was also found in there for staff use only. Audits of the medicines counted on the premise and the medicine charts indicated that the majority of medicines had been administered as prescribed. A few errors were seen. Some medicines had been recorded as administered when they had not been. Not all the balances or quantities of medicines received into the home had been recorded so it was not possible to Grassmere Residential Care Home DS0000016769.V367334.R01.S.doc Version 5.2 Page 15 demonstrate that any of these medicines had been administered as prescribed. This had been recognised by the manager during weekly audits of the medication in the home. Concern was raised that one medicine dispensed for one person had the name crossed out and a new name hand written on the box. It was not possible to demonstrate that this medicine had actually been prescribed for this particular person. The manager explained that this had been bought into the home by a visiting nurse. Currently no system was in place for staff to correctly address this issue. The home has a system to check the prescription before it is dispensed and to check the dispensed medication and charts received into the home, but did not check new medication bought into the home or that was prescribed during the 28 day cycle by other healthcare professionals, so it was not possible to confirm that this is what the doctor actually prescribed. One person had two similar medicines dispensed during a two month period for the same clinical condition and it was not possible to check that the newly prescribed medication replaced the existing one and currently both were being administered. The care plans were in the process of being updated. Together with the daily records they recorded external healthcare professional visits so it was clear why for example a doctor had been called. The care plans lacked information surrounding the underlying clinical conditions of the people living in the home and would not fully support care staff to look after the individuals as well as they should. One care assistant interviewed during the inspection did not know what the medicines she administered were for at all and further training is needed in line with the new knowledge sets published by Skills for Care. 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. 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. The acting manager was able to demonstrate how he had tried to enhance the privacy of one of the people living in the home. This individual wanted to be left alone in the bath but would have been at risk if this had been done. To try and accommodate this person’s wishes the acting manager had had a privacy curtain installed over the bath. Grassmere Residential Care Home DS0000016769.V367334.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 good. 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 people living there. EVIDENCE: The home had a relaxed atmosphere throughout the course of the inspection and no rigid rules or routines were seen. Some of the people living in the home were still having their breakfast late in the morning. People were observed wandering around freely, watching television, going outside for a cigarette, sitting chatting and taking part in an activity. Staff were seen to be available to the people living in the home at all times throughout the day. All the people living in the home that were seen or spoken to seemed very content. The daily records did not give a general overview of how the people living in the home were spending their time. Many entries stated things such as ‘all Grassmere Residential Care Home DS0000016769.V367334.R01.S.doc Version 5.2 Page 17 care given no concerns’. This does not reflect what people are doing to pass their time. The notice board in the hall of the home detailed when outside entertainers were coming to the home and this was generally once a month. There was also a person that visited the home on a weekly basis to do activities such as craft and music and movement. Staff also facilitated activities such as bingo, snakes and ladders, chess, joke telling, reminiscence and singing and dancing. The acting manager had involved the home with a day centre and some of the people living there went to this for up to three days a week. This gave them the opportunity to socialise with other people and have a meal out. Since the last inspection the home had set up a sensory room for the people living in the home. In the minutes of the last meeting with the people living in the home and their relatives this room had been discussed. Some of the people living in the home said that they knew about the room but had not used it as they thought it was an exercise room. The acting manager had explained to them that this was a quiet area they could go to relax and that it was open all the time. The use of the room was being monitored. The acting manager was looking for another staff member to be an activities coordinator to work with the people living in the home in the mornings when care staff were at their busiest in an attempt to increase the amount of activities available. All the files sampled had social needs care plans in place and some of these detailed very specific interests, for example, knitting, sewing, word searches and puzzles. However there was no evidence to suggest these had been pursued by staff with the people living in the home. The acting manager was aware of this and we discussed this being part of a key workers role. The acting manager was actively pursuing other activities for the people living in the home for example, having raised flowerbeds so that people could help with the gardening. One of the relatives spoken with was getting involved with the gardening as well and involving her mother with this. Several relatives were seen to come and go from the home during the day and all were made very welcome by staff. We spoke with three relatives and they were clearly very happy with the service being provided at the home and described staff as ‘very good’. Daily records evidenced that relatives and friends were able to visit the home at all reasonable daytime hours. The people living in the home were able to exercise some choice and control over their lives. For example, what time to go to bed and get up, what to eat, how they spent their time and so on. People were encouraged to join in with activities but if they declined this was respected by staff. The people living in the home were encouraged to personalise their bedrooms and personal possessions were observed in all the bedrooms seen. Grassmere Residential Care Home DS0000016769.V367334.R01.S.doc Version 5.2 Page 18 At the time of the inspection there were rotating menus in place for the main meal at lunchtime. There were varied and nutritious and indicated there were choices available. The teatime menu was done by the cook on a weekly basis. The acting manager stated that he was in the process of drawing up new menus that would rotate over four weeks to give more variety. Clearly the meals being served had been discussed with the people living in the home at a meeting with them and they had expressed satisfaction with the meals being served and that they got a good choice. The people spoken with during the inspection were satisfied with the meals being served to them. The surveys returned to us indicated that the people living in the home liked the meals being served. Staff were only recording what meals had been served and how much had been eaten for those people living in the home who were at risk of losing weight or who had diabetes. These records were quite comprehensive. The records of food for everyone else had lapsed. The acting manager was advised these should be recommenced so that it can be determined that all the people living in the home were receiving a varied and nutritious diet. Grassmere Residential Care Home DS0000016769.V367334.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: We had not received any complaints about the home and none had been logged at the home since the last inspection. The completed surveys returned to us indicated the people living in the home know how to make a complaint or who to speak to if they are unhappy. One person commented they would: ‘Ask one of the carers if there is any problem’ The people living in the home were very comfortable in the presence of the manager and the staff which would give them the confidence to raise any concerns. It was suggested to the acting manager that the staff record any minor ‘grumbles’ that are made and how these are resolved to evidence they listen to people on an ongoing basis. There have been two adult protection issues raised at the home since the last inspection. One was raised by the acting manager in relation to money going Grassmere Residential Care Home DS0000016769.V367334.R01.S.doc Version 5.2 Page 20 missing from one of the accounts of the people living in the home. This issue was ongoing at the time of the inspection and in the hands of the police. The acting manager had reported this to the police and Social Care and Health when he realised what had happened. The other issue was raised by a relative in relation to alleged rough handling of one of the people living in the home this was investigated by Social Care and Health and there was no evidence to support the allegation. It was thought the individual concerned might have been referring to past issues prior to him moving to the home. Due to the issues raised all relevant risk assessments were reviewed. The training matrix for the home indicated that only the two care staff most recently employed had not had training in adult protection issues. The acting manager was addressing this. Some of the ancillary staff employed at the home had also had adult protection training it was recommended that this was extended to include all ancillary workers as they all have regular contact with the people living in the home. Grassmere Residential Care Home DS0000016769.V367334.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 further improvements to the environment which was comfortable, well maintained and safe. EVIDENCE: The home was comfortable, safe and generally well maintained. Improvements were ongoing to enhance the facilities for the people living in the home. 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. However it was noted that some of the armchairs were in need of cleaning. A large flat screen television had been purchased since the last inspection. The dining room had been redecorated and new flooring was to be laid during the evening on the day of the inspection. A mural had been painted on the wall between the linked sitting areas which Grassmere Residential Care Home DS0000016769.V367334.R01.S.doc Version 5.2 Page 22 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 set up as a sensory room. Although quite small this gave the people living in the home a quiet relaxing area to sit in. There were adequate numbers of toilets and bathrooms in the home however not all the bathrooms were used. One allowed for assistance from staff and was used regularly. Another was in the process of being refurbished so that this could also be used. The home also had a shower room but the shower had a step up tray and was not accessible to all the people living in the home. It was recommended that if possible the home had a floor level shower so that the people living there had the choice of having either a bath or a shower. At the time of the last inspection the extractor fans in the communal toilets were dirty. This had been addressed at the time of this visit. It was noted that the flooring in all the toilets was well worn and in need of replacing and all the skirting boards needed repainting. 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. The manager stated a survey had been undertaken to have these installed. 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. Additional handrails had been fitted in some of the corridors. The bedrooms seen varied in size and were comfortable. Bedrooms were appropriately personalised to the occupants choosing. Some of the bedrooms in the home had been redecorated. Two bedrooms had had all new furniture, beds, curtains and linen and another complete set was on order. Not all the bedrooms had appropriate locks fitted. It was also noted that one of the bedrooms had a Yale lock fitted and if the occupant had dropped the catch staff would not have been able to access the room in an emergency. When pointed out to the manager he was quick to act and the issue had been resolved before the end of the inspection. The home was clean and 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. The issues raised at the last inspection about the back of the bath hoist needing cleaning and replacing rusting commodes had been addressed. Grassmere Residential Care Home DS0000016769.V367334.R01.S.doc Version 5.2 Page 23 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. There were some shortfalls in the staff training that needed to be addressed to ensure staff had all the necessary skills and knowledge to care for the people living in the home. Recruitment procedures were robust and ensured the people living in the home were fully safe guarded. EVIDENCE: The acting manager had not been in post for long but he was very positive in his comments about the staff team. The home was fully staffed but was looking to recruit an additional staff member to be an activities coordinator to facilitate activities with the people living in the home in the morning when the care staff were at their busiest. There had been little staff turnover since the last inspection which was good for the continuity of care of the people living in the home. Staffing levels were good with four staff on duty during the morning, three in the afternoon and two on waking nights. The home also employed catering, domestic, laundry and maintenance staff. The manager’s hours were supernumery to the care rota. Grassmere Residential Care Home DS0000016769.V367334.R01.S.doc Version 5.2 Page 24 All the people living in the home and the visitors that were spoken with described the staff as ‘helpful’, ‘very good’ and ‘very nice’. One person commented: ‘never been refused anything by staff.’ Throughout the course of the inspection it was evident there were very friendly relationships between the staff and the people living in the home. The recruitment files for two staff that had been appointed since the last inspection were sampled. The files included all the required recruitment documentation including, application forms, medical check lists, POVA first checks, two written references and CRB checks. Both the files sampled included evidence of induction training. There was a checklist for the first weeks employment and staff were also completing the Skills for Care induction booklets. A copy of the training matrix was obtained. Although there were some gaps the manager had already started a programme of training to address the shortfalls. Staff had undertaken fire and food hygiene training and were to commence health and safety training. There had also been some adult protection and manual handling training this year. The manager needed to ensure that all planned training went ahead to ensure all the shortfalls were addressed. Not all staff had received training in dementia care. It was strongly recommended that now the registration category for the home was predominantly for people with dementia that all staff had training in this topic. The training matrix indicated that of the sixteen care staff employed four had NVQ level 2 and one had level 3. This is below the required 50 . Two staff were undertaking level 3 and other staff had been nominated for their level 2. Grassmere Residential Care Home DS0000016769.V367334.R01.S.doc Version 5.2 Page 25 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 acting manager had only been in post since March of this year but was clearly very knowledgeable about the needs of the people living in the home. He had recently started his Registered Manager’s Award training and was to apply for registration with the Commission. He was very positive about the support he had received from the provider and the manager’s of the other homes owned by the same provider. Grassmere Residential Care Home DS0000016769.V367334.R01.S.doc Version 5.2 Page 26 There had been several improvements in the home since he started his post including care planning and risk assessments. He was very receptive to the comments made during the inspection and very committed to meeting any requirements or recommendations made. He had acted very quickly in response to the visit from the inspecting pharmacist to put systems in place to address the shortfalls. The home had a quality assurance system in place but no audits had been undertaken since 2006. The home needed to have a development plan in place based on seeking the views of the people living in the home. There was evidence that the acting manager was having meetings with the people living in the home and their relatives which covered numerous topics including, meals, activities, furnishings and fittings in bedrooms, laundry, fund raising and so on. Satisfaction surveys were sent out to the people living in the home and their relatives on a quarterly basis. The information gathered from the meetings and the surveys could all go towards an annual development plan. There were also regular staff meetings, in house health and safety checks and medication audits all of which could contribute to a quality assurance system. The system being used in the home for managing money on behalf of the people living there had been changed. At the time of the last inspection it was run on the lines of a petty cash system. At the time of this inspection personal money was kept in the home in individual envelopes. A new safe had been purchased to ensure the money was safe. The records for three people were sampled. Receipts were available for virtually all expenditure and two staff had acknowledged the payments. All the balances checked were correct. Some of the people living in the home were going to a day centre and there were no receipts for the costs of this. It was also noted that the individuals attending the day centre were paying for their main meal while there. As this meal had already been paid for in their fees to the home consideration should be given to reimbursing this amount or at least discussing this with the people involved so that they were aware they were paying twice. The acting manager stated he would address this with the provider. Health and safety were generally well managed in the home. The information received on the AQAA indicated the majority of the equipment used in the home was serviced as required. At the time of the inspection the five yearly check on the wiring in the home had been completed and the remedial works were being undertaken. At the time of the last inspection the gas service had indicated some remedial work was necessary. This had been addressed. The in house checks on the fire system were up to date. The fire drill was a little overdue and this needed to be addressed. It was also noted that the water temperatures in the home were being checked but only one room a week which meant it took a considerable amount of time to get around the whole home. It was recommended that more than one room be checked to shorten Grassmere Residential Care Home DS0000016769.V367334.R01.S.doc Version 5.2 Page 27 the time between checks. Accident and incident recording and reporting were appropriate. Grassmere Residential Care Home DS0000016769.V367334.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 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 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 2 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 Grassmere Residential Care Home DS0000016769.V367334.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13(5) Requirement Where a manual handling risk assessment details the use of a hoist the size of the sling to be used must be included. The risk assessment for the individual identified during the inspection must detail how staff are to carry out bed baths. This will ensure that the people living in the home and the staff are not put at risk. The registered person must ensure that staff follow the risk management plans that are in place at all times. This will ensure the people living in the home are safeguarded. The right medicine must be administered to the right person at the right time and at the right dose as prescribed and records must reflect practice. All medicines must be administered from a pharmacy labelled box for the individual they are dispensed to only. Grassmere Residential Care Home DS0000016769.V367334.R01.S.doc Version 5.2 Page 30 Timescale for action 14/08/08 2. OP8 13(4)(c) 14/08/08 3. OP9 13(2) 25/07/08 4. OP9 13(2) This will ensure that the people living in the home receive their medication as prescribed and are safe guarded. Training is required to ensure that all staff that administer medicines know what they are for and their common side effects in line with the Skills for Care knowledge sets for medication. This will ensure that the people living in the home receive their medication as prescribed and are safe guarded. All planned training must take place to ensure the shortfalls in staff training are addressed. This will ensure staff have all the necessary skills and knowledge to care for the people living in the home. Fire drills must be carried out every six months. This will ensure the safety of the people living and working in the home. 25/10/08 5. OP30 18(1)(c) (i) 30/11/08 6. OP38 23(4)(e) 14/08/08 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 OP3 Good Practice Recommendations It was recommended that the pre admission assessments included the location of where it was undertaken to evidence that people were able to have a pre admission visit to the home. It is recommended that the recording sheet in place for DS0000016769.V367334.R01.S.doc Version 5.2 Page 31 2. OP7 Grassmere Residential Care Home 3. OP7 OP8 4. OP8 5. 6. 7. OP10 OP12 OP12 8. OP15 9. OP18 10. 11. 12. OP21 OP21 OP21 13. 14. OP24 OP28 15. OP30 skin checks be further developed to include details of any areas that were discoloured or red. This will ensure that any issues in relation to skin integrity are noted. It was recommended that there were read and sign sheets with the care plans and risk assessments for the people living in the home that indicated staff had read, understood and agreed to follow the plans in place. It was recommended that health care visits are recorded on the appropriate sheets at all times so that it is easy to track the health care needs of the people living in the home. 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. There should be evidence that the social care plans of the people living in the home are being followed. This will ensure the social needs of the people living in the home are met. There should be records of the food being served to all the people living in the home. These should be kept in sufficient detail to evidence that they are receiving a varied and nutritious diet. It is recommended that all ancillary workers undertake training in adult protection issues as they all have regular contact with the people living in the home. This will ensure the people living in the home are fully safeguarded. It is strongly recommended that the home has a floor level shower so that the people living in the home have a choice of having a bath or a shower. It is recommended that the flooring in the toilets is replaced and that the skirting boards are repainted. This will ensure the home is kept to an acceptable standard. The people living in the home should have access to emergency call points in the en suite facilities. This will ensure the people living in the home can summon assistance when needed. All bedrooms in the home must be kept decorated to a reasonable standard. This will ensure the home is kept to an acceptable standard for the people living there. It is recommended that 50 of staff are qualified to NVQ level 2 or the equivalent. This will ensure staff have all the necessary skills and knowledge to care for the people living in the home. It is recommended that all staff at the home undertake dementia care training. This will ensure staff are fully DS0000016769.V367334.R01.S.doc Version 5.2 Page 32 Grassmere Residential Care Home 16. OP33 17. OP35 18. OP35 19. OP38 equipped to care for the people living in the home. The home should 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 the costs of the people going to the day centre should be obtained to ensure there is a clear audit trail for all financial transactions made on behalf of individuals. Consideration should be given to reimbursing the amount of money individuals are paying for their meal at the day centre or discussing this with the people involved so that they are aware they are paying twice. It was recommended that the frequency of the checks on the water temperatures was increased to ensure the people living in the home were fully safeguarded. Grassmere Residential Care Home DS0000016769.V367334.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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.V367334.R01.S.doc Version 5.2 Page 34 - 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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