Inspection on 11/04/07 for Grayling

This inspection was carried out on 11th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Grayling 26/10/05

Grayling 23/11/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 Grayling Back Lane South Middleton Pickering North Yorkshire YO18 8NU Lead Inspector Pauline O`Rourke Key Unannounced Inspection 11th April 2007 09:30 DS0000007836.V333202.R01.S.doc Version 5.2 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 DS0000007836.V333202.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 Adults 18-65. 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. DS0000007836.V333202.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grayling Address Back Lane South Middleton Pickering North Yorkshire YO18 8NU 01751 477209 F/P01751 477209 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) www.wilfward.org.uk The Wilf Ward Family Trust Mrs Mary Doreen Stannard Care Home 4 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (4) of places DS0000007836.V333202.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered for 4 Service Users with Learning Disabilities some or all of whom may also have Physical Disability Date of last inspection 26th October 2005 Brief Description of the Service: Grayling is registered to provide long term accommodation to 4 younger adults or older people who have a learning disability and/or a physical disability. Mary Stannard is the Registered Manager and the local health authority owns it with care provided by the Wilf Ward Family Trust a registered charity. Grayling is a large detached bungalow situated in the village of Middleton approximately one mile from Pickering. A former private dwelling it now offers suitable accommodation for four residents. There are gardens to the front and rear accessible to residents. There are four bedrooms offering residents single room accommodation, one of which has an en-suite facility. A communal lounge is provided with television, video and music system. There is a dining kitchen, communal bathroom and toilet facilities Information about the service is available on request and it can be provided in a variety of formats. On the 11th April 2007 the cost of the service was between £78.85 to £137.90 per week, the actual amount paid by a resident is determined through a financial assessment. This covers the accommodation costs, the local health authority meets the cost of the personal care. They and their carer are informed of this cost prior to their admission. DS0000007836.V333202.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on information gathered from the provider, service users and other professionals. A site visit to the home was carried out on 11th April 2007. It focused on the key standards. An inspection of some of the premises was undertaken. A number of records were also examined. Discussions were held with the Registered Manager and three members of staff on duty. The manager in the form of a pre-inspection questionnaire supplied information and surveys were sent out to health professionals and relatives. Feedback was received from 4 health professionals, 4 GP’s and 2 relatives. Time was also spent observing the interactions between the staff and residents. What the service does well: Anyone moving in to Grayling would have met the staff and other residents before they moved. They would be able to decide that they wanted to live there with the help of their families and/or the staff. The residents all have a care plan, this gives the staff detailed information on how they like to be helped when they are doing anything. The staff look at these plans every month to make sure they are right for the resident. The residents can see a doctor or nurse if they need to and are encouraged to make their own decisions every day. The current residents all have some difficulties in making the staff understand them but the staff are patient and take time to make sure they get their message across. The residents can go on outings and enjoy games, music and films at home and the staff make sure that they do the things they enjoy. One resident enjoys pampering and the staff make sure that they spend time with them at least twice a day on a one-to-one basis. Another resident likes a certain type of music and staff are organising a special holiday so they can enjoy that. The staff are always trying to arrange events based on what the residents like to do either as individuals or as a group. The staff keep families informed of what is going on and feedback from the families was very positive: I consider the care home responsible for my relatives care does a difficult job with a great deal of sensitivity and that they all do a great service for the relatives who are unable to. Well done and Thank you all. We are very pleased with the way our relative is looked after and think the home is well adapted to help in this and is very nicely decorated and the staff excellent. We have nothing but praise for them and are delighted our relative has such a lovely home. DS0000007836.V333202.R01.S.doc Version 5.2 Page 6 There is enough staff on duty and if anybody needs extra help then the manger will ask for more staff to be provided. Currently several of the residents need 2 staff to help them. The staff have plenty of training and supervision so that they have the skills to help the residents. The manager is approachable, and knows the residents very well. She is supported by the Wilf Ward Family Trust. What has improved since the last inspection? 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. DS0000007836.V333202.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000007836.V333202.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service People who decide to use this service have the information needed to ensure their needs can be met. EVIDENCE: There have been no admissions to the home since the last inspection, but a discussion was held with the Registered Manager about how a new admission would take place. The Wilf Ward Family Trust has a proven admissions policy and this ensures that a multi disciplinary assessment is undertaken prior to any admission. The home usually receives an assessment and makes as initial decision about suitability before the person who requires support and their family are contacted. The process then becomes a series of visits and short stays to determine whether the placement is suitable. A trial period is then planned and the length of this trial is dependent on the needs of the individual. As part of the assessment process the wishes of the established residents are taken in to account. The case files seen of current residents contained comprehensive assessments and evidence of regular reviews of the care plans. DS0000007836.V333202.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service The people who use the service are able to make decisions on a day-to-day basis about their lives and this allows them to remain as independent as possible. EVIDENCE: All the residents in the home have a comprehensive care plan and there is evidence to show these are reviewed when necessary. Other health professionals indicated that the staff are good at requesting reviews of specialist services and asking for help when the residents needs change. The staff spoken with were knowledgeable about the care plans and they involve the residents and their relatives, where appropriate, in all reviews. One relative said that they are always invited to the reviews and attend when they can. DS0000007836.V333202.R01.S.doc Version 5.2 Page 10 The questionnaires received from other health professionals indicated that the manager asks for help when necessary and will involve the health professionals even if it is to confirm that they are doing everything that they can for the residents. The residents were seen during the visit making their own choices about what they wanted staff to do for them. The staff have developed an understanding of the communication methods used by them and these are clearly identified in the care plans. Occasions where the residents may refuse to do something were highlighted and the plans reminded staff that they could refuse to do anything if they wish. A daily diary is maintained for each resident that informs the staff and the review process. All of the residents had up to date risk assessments in place in relation to their individual needs and their differing daily living abilities. These documents are reviewed regularly incorporating specialist assistance when necessary. The staff manage the variety of needs very well and endeavour to make all areas of the home, garden and community accessible to all. DS0000007836.V333202.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, and 17. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service Residents are encouraged to make decisions about their daily life and staff provide support and encouragement for them to remain independent. EVIDENCE: Each resident has an activity folder outlining a personal profile of likes and dislikes. A daily calendar is kept showing what the residents do each day. The activities available are pertinent to the individual and a health professional said ‘the staff demonstrate a clear understanding of the service users needs’. The activity files show that the ability of the residents to take part in a lot of external activities has changed along with their changing needs. The key workers know the likes and dislikes of the residents and activities planned are based on this knowledge. More activities are home based and staff said during the visit that they have the time to spend with the residents during the day. DS0000007836.V333202.R01.S.doc Version 5.2 Page 12 There is a visitor’s policy in place and this is included in the information available to potential residents and their families. Only two of the residents have visitors or contact with family members and for one of them this has been instigated by the home. Questionnaires received from relatives indicated that they are kept informed of any changes to their situation. During the site visit it was clear that the residents could choose their own daily routines and their preferences were identified in their care plans. Whilst not all of the residents communicate through speech their communication with the staff was clear. They have a varied diet and where necessary advise has been sought form the dietician and speech therapist to ensure that their needs are met. Specialist equipment was supplied and at all times the residents were encouraged to be independent. The menus are planned around the likes and dislikes of the residents and the staff have introduced a take-away night once a month. They try new foods and if the residents enjoy them then they are introduced in the main menu. The mealtime observed was relaxed and staff offered appropriate encouragement and support. DS0000007836.V333202.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service The residents’ health and personal care needs are met on an individual basis. The staff treat the residents with respect, dignity and privacy in all their interactions. EVIDENCE: Residents care plans seen were pertinent to the individual concerned. They are detailed and evidence was available to show they are reviewed on a regular basis. One family indicated that they are always invited to the review and staff do ask if they are meeting their relatives needs. The associated health professionals said that the manager is good at recognising when the staff require extra support especially as the needs of the residents are complex and changing, as they get older. They also indicated that the staff provide good care and understand the residents needs and act on the recommendations of the health professionals. Staff were observed treating the residents with respect and endeavoured to maintain their dignity at all times. DS0000007836.V333202.R01.S.doc Version 5.2 Page 14 The residents’ files also contained detailed health information and contained evidence that they access specialist health care when necessary. One resident has recently had a care plan provided by a health professional in relation to their mental health needs. Recently the manager attended some oral hygiene training following which she organised for the local dentist to visit the home to assess the residents even though not all of them have teeth or dentures The medication is stored in an individual locked cupboard. Medication is dispensed directly from the original packaging and the records kept were accurate and up-to-date. There is a stock control record and two members of staff sign all medication records. All staff have completed a learning distance course in The Safe Handling of Medicines, they also cover the topic on the LDAF Nation Vocational Qualification level 2 training. The Wilf Ward Family Trust has also provided supplement training for the staff to ensure they continue to manage the medication appropriately. Staff encourage the residents to take their medication and are aware that they are allowed to refuse it. DS0000007836.V333202.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service Residents and their representatives are able to express their concerns through the complaints procedure and are protected from abuse, so their rights are protected. EVIDENCE: There is a robust complaints procedure in place, a copy of which is available in the residents file. They are in large print and picture format. The Wilf Ward Family Trust also has a resident Group, which meets to discuss how residents might like to improve the services available. A representative is named and contact details are displayed in the hallway of the home. The Wilf Ward Family Trust or the Commission has received no complaints. An Adult Protection protocol is in place and staff were aware of their responsibilities under this procedure. Staff have received training through Nation Vocational Qualification and their induction and foundation training. The manager also reinforces the training in the monthly staff meetings. DS0000007836.V333202.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service The residents live in a well-maintained, clean property that allows them to access all areas, promoting their independence EVIDENCE: The home is a 4 bed-roomed bungalow and is clean, comfortable and well maintained. The residents each have their own rooms and the rooms seen during the visit were personalised and reflected the interests and personality of the occupant. All of the residents are able to access all areas of the home and there is appropriate equipment available to ensure their needs can be met. The staff were aware of the infection control policy and were seen to be implementing this during the visit. DS0000007836.V333202.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, and 35. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service The residents are supported by well-trained staff in sufficient numbers that they are seen as individuals and the care provided is pertinent to their needs. EVIDENCE: There has been no one new employed at the home since the last inspection. The Wilf Ward Family Trust has a well established and robust recruitment process and all necessary checks would be carried out prior to anyone being deployed in the home. The rota’s received prior to the inspection indicated that the home is staffed appropriately. During the site visit the residents plans provided the staff with clear instruction including where two members of staff were required for one resident. The staff spoken with said that they felt the staffing was adequate and that they had time to spend with the residents on a one-to-one basis. The whole routine during the visit was relaxed and staff were seen interacting positively with the residents. The pre-inspection questionnaire showed that the staff have received training in Safe Handling of medicines, fire training, first aid, food hygiene and use of DS0000007836.V333202.R01.S.doc Version 5.2 Page 18 wheelchairs in a mini bus. Future planned training includes epilepsy and rectal medication, dementia training, manager to complete the Registered Managers Award and the assistant manager to start this award. During the site visit 2 members of staff were enrolled on to the Nation Vocational Qualification level 2. Feedback received from other professionals confirmed that the manager seeks training support from them when a residents needs change. Staff spoken with said that they had access to training on a regular basis. Staff have monthly supervision where they are expected to set their own learning goals and identify training needs. Team meetings are an opportunity to ensure everyone is aware of any changes to the residents’ plans and to put forward ideas for future activity plans. One of the relatives said ‘and the staff are excellent. We have nothing but praise for them’ DS0000007836.V333202.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service The residents live in a well managed home where the administration of the home is based on openness and respect. This allows the residents to retain their individuality and independence. EVIDENCE: The Registered Manager is in the process of completing the registered managers award and is an experienced manager. The staff said that she operates an open door policy and she works with the staff. The staff said that she asks for their ideas and opinions on issues and listens to what they say, but they also said that if she needs to make a decision she does. This opinion was supported by the feedback received from other professionals connected with the home. DS0000007836.V333202.R01.S.doc Version 5.2 Page 20 ‘The manager recognises when further training is required and involves external services appropriately’. The Wilf Ward Family Trust has a thorough quality assurance programme within the trust and where possible involves residents as much as possible. The individual homes carry out small quality checks and these are carried out by the visiting manager. The records seen during the site visit were maintained to high standard and contained detailed and pertinent information. They were stored securely and the staff could access them when necessary. The records for the resident’s monies were found to be accurate and up-to-date. Someone from outside the home checks the accounts on a regular basis. All the working practices within the home are safe and staff keep accurate accident records, this information is used to inform the care plan and in requesting specialist input. Staff have received training in the health and safety procedures and all the policies are read by the staff. The records relating to health and safety issues that were seen during the visit were up to date. DS0000007836.V333202.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 4 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 4 33 X 34 4 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 X 4 X 4 X X 4 X DS0000007836.V333202.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000007836.V333202.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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. 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