Inspection on 07/12/06 for Grassmere Residential Care Home

This inspection was carried out on 7th December 2006.

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 12/07/07

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 09:30 7th December 2006 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.V315458.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.V315458.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. 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.V315458.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) 28th September 2005 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 residents, together with a dining room on the ground floor of the home. Also located on the ground floor is a hair dressing salon, main kitchen 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. There is a small garden for use by residents to the rear and car parking facilities. The fees at the home range from £369.00 to £383.00 per week. Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this key inspection over one day in December. During the course of the inspection a tour of the home was undertaken, three resident and five staff files were sampled as well as other care and health and safety documentation. The inspectors spoke with the acting manager, the quality manager, two staff members and seven of the nineteen residents. Prior to the inspection the acting manager had forwarded a completed pre inspection questionnaire to the CSCI which gave some additional information about the home. As part of this unannounced inspection the quality of information given to people about the care home was looked at. People who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service user’s guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk. The home had had one complaint lodged with them since the last inspection. This was in relation to the systems in place for residents’ laundry and managing continence. The complaint records indicated this had been thoroughly investigated and was partially substantiated. Systems had been put in place to address the shortfalls. CSCI had had some anonymous concerns raised with them. The information received was quite vague but it was passed back to the home to look into. Issues raised were staff turnover, urine in the corridor and weak gravy. There were records on site that this had been investigated and some shortfalls were found in relation to the catering arrangements in the home and this had been addressed. What the service does well: Prospective residents could visit the home prior to admission to assess the facilities if they wished. Residents were issued with a contract at the point of admission to the home that detailed their terms and conditions of residence. Daily records and personal hygiene charts detailed that residents were receiving personal care from staff and they gave a general overview of the residents well being. The daily records also evidenced that staff were Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 6 identifying any health care issues and that these were followed up and monitored. There were no rigid rules or routines in the home and residents could spend their time as they wished. There was a programme of activities available in the home for those residents that wished to take part. The activities records documented when residents did not participate in the activities offered and when they did if they enjoyed them. There were no restrictions on visitors to the home during reasonable daytime hours. The menus at the home were varied and nutritious and offered choices. Cooked breakfasts were available on three days a week. The inspectors had lunch with the residents and the meal was nicely cooked and presented and the portions were ample. Residents spoken with who could express an opinion stated the food was good and there was plenty of it. Staffing levels met the needs of the residents. Relationships between the staff and the residents were good and friendly relationships were evident. Complaints lodged with the home were thoroughly investigated and any shortfalls noted in the outcome were addressed. The home was clean and comfortable. What has improved since the last inspection? What they could do better: The information about the home that was available needed to be updated to ensure prospective residents had all the relevant information to enable them to make an informed decision about where to live. Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 7 Copies of the assessments undertaken by social workers must be obtained prior to the admission of any residents to ensure the home has as much information about prospective residents’ needs as possible. Care plans and risk assessments needed to be further developed to ensure they included sufficient detail to enable the residents’ needs to be met and ensure all identified risks were minimised. The medication system needed to be improved to ensure the residents received all their medication at the appropriate times. Staff were not following the homes procedure for safe keeping of the keys to the medicines trolley. The keys were keptin an unlocked cupboard close to the pointwhere the medicines trolley was stored. Residents’ rights to privacy could not always be upheld due to some shortfalls in the facilities available to them, for example, no door on one of the toilets. These issues must be addressed. There were several wheelchairs in use in the home. All those seen on the day of the inspection were being used without foot rests. This is very dangerous practice and has the potential to cause injuries to the residents. A copy of the complaints procedure must be issued to all residents or their representatives to ensure they know who to contact if necessary. Staff needed to ensure that residents who preferred to spend time in their bedrooms were asked what their choice of meals were and that they were offered a drink in the evening. Further improvements were needed to the environment to ensure it was entirely safe for the residents, for example, access to an emergency call point from all toilet and bathing facilities. The registered person needed to ensure that staff received all the appropriate training they needed to care for the residents. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 8 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.V315458.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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. The information about the home needed to be updated to ensure prospective residents had all the relevant information to enable them to make an informed decision about where to live. The full range of needs of the residents were not always known by staff prior to their admission. Prospective residents were able to visit the home prior to admission to assess the facilities. EVIDENCE: There was a service user guide available at the home and the inspectors were told a copy was in each of the bedrooms so that residents had access to it at all times. The service user guide had not been updated as required at the last inspection to reflect the current service provided at Grassmere and it was also noted that there was insufficient information included in respect of the complaints procedure in the home. When updated a further copy of the service user guide should be issued to the residents or their representatives. Due to the memory loss of the residents recently admitted to the home it was not Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 10 possible to ascertain if they had received information about the home prior to moving in. There was evidence on the residents’ files sampled that they were issued with a comprehensive contract of terms and conditions of residence at the home. Three resident files were sampled. There was evidence on all 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. These care plans had very little information about the individual needs of the residents. However only one of the files included a copy of the full assessment undertaken by the social worker. Copies of the assessments must be obtained to ensure the home has as much information about prospective residents’ needs as possible. Two of the files did include a pre admission assessment undertaken by staff at the home the other included some information received from the hospital. There was evidence on the files that residents or their relatives/representatives could visit the home prior to admission to assess the facilities available. Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments needed to be further developed to ensure they included sufficient detail to enable the residents’ needs to be met and ensure all identified risks were minimised. The medication system needed to be improved to ensure the residents received all their medication at the appropriate times. Residents’ rights to privacy were not always upheld due to some shortfalls in the facilities available to them. EVIDENCE: Three residents files were sampled. All files included a booklet entitled ‘This is my life’ these included information on the residents’ past history, what they were able to do for themselves, who they did and did not want to see whilst in the home, their preferred name and mobility. The booklets had not been updated to reflect the current needs of the residents. For example, one stated the person walked unaided and was fully mobile and could dress themselves but they were no longer mobile and staff were giving full assistance with dressing according to the daily records. One of the booklets seen had not been Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 12 fully completed. There were also assessments for daily living needs which had generally been completed on the day of admission. These assessments also included some information on the needs of the residents. The care plans that were in place did not include all the relevant information from the booklets and the assessments. All the care plans were pre printed and the same for all the residents with just the odd comment added by staff in relation to the individual resident, for example, full strip wash daily, soak dentures overnight, likes external entertainers in the home. The care plans did not detail all the residents’ needs or how the staff were to meet the needs. It was evident from the observations made throughout the course of the inspection that the majority of the residents had a level of dementia and the needs resulting from this were not mentioned in the care plans. One of the residents was receiving a lot of support and assistance from staff during meal times and with mobility and none of this was mentioned in any detail on the care plans. One resident had lost their teeth another was wearing someone else’s glasses and carrying another pair that did not belong to them. These are issues that arise on an ongoing basis when people have dementia and staff need to be made aware of these needs in individual’s care plans and be alert to the issues on an ongoing basis. The care plans that were in place were being evaluated on a monthly basis but there was no evidence that the residents had been involved in them. The files sampled included manual handling, tissue viability and nutritional assessments. The manual handling assessments were not adequately detailed and stated ‘assistance x 1’ or ‘assistance x 2’ but there were no guidelines for staff to follow detailing what that assistance was. An issue was raised with the inspectors that one resident had been moved inappropriately which had left them in some discomfort. This was discussed with the acting manager and was to be looked into. Inconsistencies in the handling methods used will occur without specific guidance being given to staff however staff needed to ensure their practice complied with the manual handling regulations. Where a risk had been identified on any of the tissue viability assessments there were no corresponding care or management plans detailing how that risk was to be reduced. The nutritional assessments did include evidence that any weight loss had been followed up with the doctor but there needed to be further information for staff included. For example one nutrition care plan stated ‘needs encouragement to eat’ but this had not been included on the nutritional assessment nor was there any detail of how this was to be done. None of the files sampled included any personal risk assessments. There were falls management plans in place but again these were generic and did not specify any specific risks. One of the residents had had some falls but there were no specific plans in place to try and minimise these. Another resident had left the building during the night and gone into the garden during the night but no risk assessment had been undertaken for this. Some of the residents wandered around and could easily enter their own or other bedrooms without staff knowing and items such as steradent, creams and lotions were accessible to them. Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 13 Daily records and personal hygiene charts detailed that residents were receiving personal care from staff and they gave a general overview of the residents well being. The daily records also evidenced that staff were identifying any health care issues and that these were followed up and monitored. There were separate sheets for the recording of health care visits and appointments. These detailed that residents had access to chiropodists, community psychiatric nurses, district nurses, doctors and that hospital appointments were attended. The majority of the medication was being 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. All the medication being received into the home was being acknowledged by two staff and any balances held at the end of the cycle were being brought forward to the next medication chart. Several of the boxed medicines were audited and several discrepancies were found. The numbers remaining in the boxes did not correspond with the numbers received into the home and what had been signed for as administered. In most instances there were too many tablets left indicating staff were signing for medication and not administering it. The acting manager was advised she must undertake staff drug audits before and after medication rounds to assess the competency of staff and address any issues that arise during the audits. Staff were not following the homes procedure for safe keeping of the keys to the medicines trolley which was clearly displayed right by the medicines trolley. Keys were supposed to be kept in a locked key cupboard by the trolley however the key cupboard was not locked and keys were accessible to anyone. Eye drops in the medicines trolley were not being dated on opening. There was some controlled medication in the home and this was being administered and recorded appropriately. There was no indication on the training matrix received with the pre inspection questionnaire that staff had undertaken accredited medication training. No issues were raised by the residents in relation to their privacy or dignity. Staff were observed to be respectful in their terms of address and their interactions with the residents. Assistance with personal care was offered discreetly. The majority of the bedrooms had appropriate locks fitted however the four bedrooms in the part of the home termed the annex had not had locks fitted and this needed to be addressed. Some of the privacy locks on the toilets did not work and this needed to be addressed as soon as possible. One of the toilets in the entrance hall of the home did not have a door only a curtain for privacy this is not acceptable and must be addressed. All bedrooms had a lockable facility for residents to store any personal effects if they wished. Medical consultations took place in the privacy of the residents’ bedrooms. Residents could meet with their visitors in their bedrooms or one of the quieter areas of the home. Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 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 residents if they wished to take part. Residents 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 residents. EVIDENCE: There were no rigid rules or routines in the home. Residents were seen to wander freely around the home, spend time quietly in their bedrooms, sit chatting to each other take part in a sing-a-long and meet with their visitors. There was a programme of activities available in the home and individual records of what residents had taken part in were being kept. Recorded activities included, bingo, throwing bean bags, visiting entertainers, eye spy, hand and feet exercises and life stories. The activities records also documented when residents did not participate in the activities offered and when they did if they enjoyed it. There was some evidence that residents were taken out of the home, for example, to visit the Bull Ring and to see the Christmas lights. Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 15 Visitors were seen to come and go throughout the course of the inspection and were made welcome by staff. Daily records evidenced that visitors attend the home at various times throughout the day. There was some evidence in the daily records that residents were able to choose how they spent their time and if they chose to take part in organised activities or not. Residents were able to choose to stay in their rooms and have their meals taken to them if they wished. The majority of the residents were asked what they would like to eat prior to their meals and they could choose what time they went to be and got up. Residents were encouraged to personalise their rooms to their choosing and personal effects were observed in all the bedrooms seen. Copies of the menus for the home were sent to the CSCI with the pre inspection questionnaire. The menus were varied and nutritious and offered choices. Cooked breakfasts were available on three days a week. The inspectors had lunch with the residents and the meal was nicely cooked and presented and the portions were ample. Soft diets were being catered for. Where residents needed assistance from staff this was offered appropriately. Staff did not rush the residents and they were left to eat at their own pace. The majority of the residents seemed to enjoy the meal. Staff were aware of which residents needed encouragement to eat and those that preferred their sweet to their main course. There were no special diets being catered for at the time of the inspection. Residents spoken with who could express an opinion stated the food was good and there was plenty of it. Issues raised with the inspectors indicated that the residents who preferred to spend the majority of the time in their bedrooms were not always asked what they wanted to eat before a meal was served to them and did not always get a hot drink in the evenings. These issues were discussed with the acting manager who was going to explore with the staff. There were adequate food stocks in the home at the time of the inspection with fresh fruit and vegetables available for the residents. Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents had not received a copy of the complaints procedure and were not always 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 residents. EVIDENCE: There was an appropriate complaints procedure on display in the home but residents or their representatives had not received a copy of this. The acting manager and the quality manager were advised that the complaints procedure should be included in the service user guide to ensure all residents or their representatives had access to it at all times. Residents that were able to express an opinion were aware they could raise any concerns they may have but some were wary of raising concerns as they did not know how staff would react. The acting manager was surprised at this being an issue in the home. She was advised she must ensure there are systems in place in the home to ensure the residents are able to raise any concerns that they may have without worrying about the reaction of staff. The home had had one complaint lodged with them since the last inspection. This was in relation to the systems in place for residents’ laundry and managing continence. The complaint records indicated this had been thoroughly investigated and was partially substantiated. Systems had been put Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 17 in place to address the shortfalls. CSCI had had some anonymous concerns raised with them. The information received was quite vague but it was passed back to the home to look into. Issues raised were staff turnover, urine in the corridor and weak gravy. There were records on site that this had been investigated and some shortfalls were found in relation to the catering arrangements in the home and this had been addressed. The majority of staff had received training in adult protection issues since the last inspection. The acting manager was well aware of her obligations to report any concerns. An issue that had been raised in the home had been reported to the appropriate people and the appropriate action had been taken in house. There were adult protection procedures on site but these were not viewed at this inspection. Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provided residents with a generally comfortable and homely environment in which to live. Further improvements were needed to ensure it was entirely safe for the residents. EVIDENCE: There had been no changes to the layout of the home which was generally suitable for its stated purpose. The requirements made by the fire officer at a visit earlier in the year had all been met. There was some decoration taking place in the home and other areas were planned. Some of the corridors were in need of redecoration and some of the carpets in the home needed to be replaced. The carpet outside the kitchen was very badly worn and stained and the dining room carpet was frayed in parts and had quite a large gap in it. The acting manager stated that carpet samples Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 19 had been seen and she was in the process of ordering the new carpet. This must be addressed as soon as possible. It was also noted there was star lock on the kitchen door this must be removed and if the kitchen needs to be locked at any time a more appropriate lock must be fitted. The records for one of the residents indicated that they had gone out into the garden during the night without the knowledge of the night staff. The person had sustained some minor injuries and had to go to hospital for a check up. To avoid this happening again contact alarms must be fitted to the external exits of the home to ensure residents cannot go out 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. As previously stated the dining room carpet needed to be replaced. There were televisions, DVD players and music systems available in the lounge areas. The home had adequate numbers of toilets and bathrooms however not all the bathrooms were used. One had a parker bath installed and the inspectors were informed that this was really the only one in the home that was used by the residents. The other two bathrooms were not assisted and therefore not appropriate for the needs of the present resident group. It is strongly recommended that one of the bathrooms is converted into a floor level shower so that residents 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 for storage at the time of the inspection. For residents, 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 ensuite facilities of at least toilet and wash hand basin. It was noted that residents did not have access to en emergency call point in the en-suite facilities or from the parker bath. As previously mentioned one of the toilets did not have a door and some of the privacy locks did not work. 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. If any of the residents had a weakness down the same side as the handrails they would have nothing to hold as they walked along. It was strongly recommended that hand rails were fitted both sides of the corridors wherever possible. The issue raised at the last inspection in relation to staff having to negotiate a step on the first floor when accessing lift with people in wheelchairs had been resolved with the fitting of a ramp. There were several wheelchairs in use in the home. All those seen on the day of the inspection were being used without foot rests. This is very dangerous practice and has the potential to cause injuries to the residents. This issue was raised Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 20 with the acting manager who stated this had been addressed with staff on previous occasions. Footrests were replaced during the course of the inspection. Unless specifically detailed in a resident’s care plan footrests must always be used on wheelchairs. Bedrooms varied in size and as stated the majority had en-suite facilities. Bedrooms were appropriately personalised to the occupants choosing. Some of the bedrooms had had new flooring fitted. One room in particular needed to have the carpet replaced. The furniture in the bedrooms was generally of an acceptable standard. The four bedrooms in the annex did not have appropriate locks fitted to the doors. All rooms had a lockable facility for personal effects. The heating, lighting and ventilation in the home met the needs of the residents. Radiators had all been guarded and widows had been restricted as necessary. On the day of the inspection the supply of hot water to the residents was very variable some had hot water others did not. The inspectors were informed this was not normally the case. The plumber had visited the home in the morning to carry out some work and it was not known if this had been the cause. The issue did appear to have resolved itself prior to the inspectors leaving the home but needed to be closely monitored. 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 appropriately equipped with a sluice washing machine and the home had a mechanical commode pot washer. Two issues were raised during the course of the inspection. The underside 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.V315458.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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 residents. 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 residents. Recruitment procedures needed to be consistent to ensure the residents were fully safe guarded. EVIDENCE: There had been a very high turnover of staff at the home since the last inspection and several new staff had been appointed. Minimum staffing levels at the home were being maintained at three staff throughout the waking day one of whom was a senior and two waking night staff. The manager’s hours were supernumery to the care rota. There were also catering, domestic and laundry staff employed at the home. Staffing levels appeared to meet the needs of the residents. Relationships between the staff and the residents were good. The files for five staff recruited since the last inspection were sampled. All the files had completed application forms and evidence of POVA first checks and CRBs being obtained, this was an issue raised at the last inspection. One of the files had only one written reference the others all had two. The acting manager Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 22 stated she had received two references. One of the files did not include evidence that the person was eligible to work in this country. Only two of the files sampled included evidence that staff had undertaken induction training. The induction was in the form of checklists and the majority of the topics were covered within the first few days of employment. Staff must receive induction training as detailed by Skills for Care within the first twelve weeks of their employment. A training matrix for the home was sent to the CSCI with the pre inspection questionnaire. The matrix evidenced that some staff had completed all their regulatory training including, fire, moving and handling, health and safety and food hygiene. It also detailed that several staff had completed dementia care training. Some staff had not completed all their regulatory training, particularly newer staff. The inspector was informed that the organisation had employed a trainer who would be addressing the shortfalls. Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 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. There was no registered manager in post at the home. In order for the residents to be assured that someone is accountable on a day to day basis a manager must be appointed. The health and safety of the residents and staff were generally well managed. EVIDENCE: The home had not had a registered manager in post for a little over a year. The acting manager had been in post since the previous manager had left but as she was going to leave had not applied for registration with the CSCI. The quality manager informed the inspector that the manager’s post had been Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 24 advertised. The responsible individual for the home needed to ensure a suitably qualified manager was appointed as soon as possible. The acting manager had a good knowledge of the needs of the residents in her care. Relationships between the acting manager and the residents and staff were good. There was a formal quality assurance system in place in the home which was audited by an outside agency. The manager was undertaking the internal audits included in the quality system. At the time of the inspection the most recent report following the quality audit could not be found. A copy was to be forwarded to the CSCI. The home did have quality questionnaires for the residents and occasional residents’ meetings. The responsible individual for the home was making the required unannounced visits to oversee the conduct of the home and the reports for these visits were on site. A new system for managing money on behalf the residents had been put in place, as there had been a theft from the home. The new system avoided large amounts of cash being kept in the home. The system was based on a petty cash account method however all residents had individual records with receipts were available for any money spent on their behalf. It was strongly recommended that the acting manager audited the system with someone else on a regular basis to ensure all the balances were correct. Health and safety in the home were generally well managed. There was evidence on site of the up to date servicing of all equipment, with the exception of the emergency call system. The electrical wiring in the home had been checked. The report for this indicted that several issues needed to be addressed however there was no evidence on site that the work required had been carried out. All the in house checks on the fire system were up to date and fire drills were carried out regularly. The water system was regularly checked for the prevention of legionella. Accident and incident recording and reporting were appropriate. Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 25 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 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 2 2 2 X 2 2 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 26 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 OP1 Regulation 5 Requirement The service user guide must be updated to: Reflect the current service provided at Grassmere. (Previous time scale of 30/11/05 not met.) Include the complaints procedure. A copy of the social worker’s assessment must be obtained prior to the admission of residents to the home. All residents must have care plans that detail all their needs and how they are to be met. Care plans must include the needs of the residents’ in relation to their dementia. Residents or their representatives must be consulted about the care plans. (Previous time scale of 15/11/06 not met.) Care plans must be updated Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 27 Timescale for action 01/02/07 2. OP3 14(1)(b) 01/02/07 3. OP7 15(1) 01/02/07 4. OP7 13(5) 5. OP7 13(5) 6. OP7 13(4)(c) 7. OP8 12(1)(a) 8. OP9 13(2) regularly to reflect the current needs of the residents. Residents must have manual handling risk assessments that clearly detail any handling methods to be used and any necessary equipment. The registered person must ensure that staff follow manaual handling regulations at all times when moving residents. All residents must have personal risk assessments that detail how any identified risks are to be minimised. Specific areas that must be addressed are: Falls. Leaving the building. Safe storage of medication. Storage and use of steradent tablets. 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. Staff must follow the home’s procedure for the safe keeping of the keys to the medicines trolley. Regular staff drug audits before and after a medicines round must be undertaken to confirm staff competence in medicine management and appropriate action must be taken if these fail. Eye drops must be dated on opening. 01/02/07 31/12/06 01/02/07 01/02/07 18/12/06 9. OP9 13(2) 10. OP10 12(4)(a) Staff must receive accredited training in the safe handling of medicines prior to administering medication. The door to the toilet by the front door of the home must be DS0000016769.V315458.R01.S.doc 01/03/07 01/01/07 Page 28 Grassmere Residential Care Home Version 5.2 put back on. All toilets and bathrooms that the residents use must have appropriate privacy locks that work. Bedrooms identified that do not have locks to the doors must have them fitted. Staff must ensure that: All residents consulted about their choice of meals. All residents are offered a hot drink during the evening. A copy of the complaints procedure must be issued to all residents or their representatives. There must be sytem in place to ensure that residents are able to raise any concerns they may have without worrying about the reaction from staff. Carpets in the Home must be of a good standard. (Previous time scale of 30/11/05 not met.) The star lock must be removed from the kitchen door. If the kitchen needs to be locked a safe, appropriate lock must be fitted. Contact alarms must be fitted to exit doors to alert staff when residents are leaving the building. Residents must have access to emergency call points from all bathing and toilet facilities. All internal extraction fans must be kept clean. Footrests must be used on wheelchairs at all times unless otherwise is specifically detailed in a resident’s care plan. DS0000016769.V315458.R01.S.doc 11. 12. OP10 OP15 12(4)(a) 16(2)(i) 01/03/07 14/12/06 13. OP16 22(5) & 12(5)(b) 01/01/07 14. OP19 16(2)(c) 01/02/07 15. OP19 23(2)(a) 01/01/07 16. OP19 13(4)(c) 01/01/07 17. 18. 19. OP21 OP21 OP22 23(2)(n) 23(2)(d) 13(4)(c) 01/02/07 01/01/07 01/01/07 Grassmere Residential Care Home Version 5.2 Page 29 20. OP25 23(2)(j) 21. OP26 13(3) A system must be put in place to ensure the temperature of the water available to the residents in their bedrooms is closely monitored to ensure it is warm. The underside of the bath seat must be thoroughly cleaned. Any rusting commodes must e removed from resident’s bedrooms. There must be evidence on site that prior to employment: Two written references have been obtained for all staff. (Previous time scale of 28/09/05 not met.) Prospective staff are eligible to work in this country. Staff must receive induction training in line with the specifications laid down by Skills for Care. Staff must receive all regulatory training and updates as necessary. A suitably qualified manager must be recruited for the home and registration with the CSCI must be applied for. The system for formal staff supervision and appraisal must be up to date. (Previous time scale of 01/12/0/5 not assessed for compliance at this visit.) Evidence must be forwarded to the CSCI that: The emergency call system has been serviced. The remedial works on the electrical wiring to the home have been carried out. 18/12/06 18/12/06 22. OP29 19 schedule 2 18/12/06 23. OP30 18(1)(c) (i) 31/03/07 24. OP31 8(1)(a) 01/03/07 25. OP36 18(2) 01/02/07 26. OP38 23(2)(c) 31/12/06 Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP21 OP22 OP35 Good Practice Recommendations It is strongly recommended that one of the unused bathrooms is converted into a floor level shower room. It is strongly recommended that hand rails were fitted both sides of the corridors wherever possible. It is strongly recommended that the system in place for managing residents’ money is regularly audited by two people. Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Grassmere Residential Care Home DS0000016769.V315458.R01.S.doc Version 5.2 Page 32 - 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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