Inspection on 21/07/08 for Graywood

This inspection was carried out on 21st July 2008.

CSCI found this care home to be providing an Good service.

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

Graywood 30/08/07

Graywood 03/10/06

Graywood 17/11/05

Graywood 09/05/05

Graywood 09/11/04

Graywood 06/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Graywood 10 Northdown Avenue Cliftonville Margate Kent CT9 2NL Lead Inspector Joseph Harris Unannounced Inspection 21st July 2008 09:30 Graywood DS0000037757.V367462.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 Graywood DS0000037757.V367462.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. Graywood DS0000037757.V367462.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Graywood Address 10 Northdown Avenue Cliftonville Margate Kent CT9 2NL 01843 220797 F/P 01843 220797 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) Mrs Rassoolbie Haq Manager post vacant Care Home 13 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (13) of places Graywood DS0000037757.V367462.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th August 2007 Brief Description of the Service: Graywood is registered to provide accommodation and personal care to a group of thirteen adults who are under the age of 65 years on admission to the home. The residents have all had experience of mental health problems and require ongoing support. The home is located in a residential area of Margate, near to shops, local amenities and the sea front. There is good access to public transport. Close to the home there is a large park and gardens. The home is of a good size and arranged over 3 floors. All of the bedrooms are single occupancy and there is an adequate range of communal space available for the service users. To the rear of the property there is a large, attractive and accessible garden. The current fees for the service at the time of the visit range from £315.13 to £378.75 per week. Information on the Home services and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. Graywood DS0000037757.V367462.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key unannounced inspection process culminated in a site visit to the home on 21st July 2008. The site visit commenced at approximately 9.30am and concluded at 3.30pm, lasting for around 6 hours. During the course of the visit a tour of the premises was undertaken and discussions were held with the providers, manager (this person is responsible for the day-to-day management of the service but not registered with the Commission. For the purposes of this inspection they will be referred to as the manager), staff members and service users. A range of documentation was examined relating to the residents, staff, medication, health and safety and the day-to-day running of the home. The home also returned the Annual Quality Assurance Assessment (AQAA), which provides information to inform the inspection process. What the service does well: Graywood offers a relaxed and comfortable environment for up to 13 people with enduring mental health needs. The home is maintained to a good standard of cleanliness and hygiene. Prior to admission the home ensures that the needs of prospective service users are assessed including Care Programme Approach documentation and the homes own assessment forms. Staff are provided with a positive training programme that includes all mandatory training updated on annual basis and additional courses such as mental capacity act, palliative care and epilepsy amongst others. All of the staff team have achieved or are working towards National Vocational Qualifications at level 2 or above. The home has appropriate recruitment processes in place that are adhered to. Records relating to health, safety and welfare issues are well managed and up to date. The providers are in day-to-day contact with the service and there are methods to enable residents to have a say in the running of the service either through resident meetings, key worker meetings or annual satisfaction surveys. Graywood DS0000037757.V367462.R01.S.doc Version 5.2 Page 6 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. Graywood DS0000037757.V367462.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 Graywood DS0000037757.V367462.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): 1, 2 and 5. Quality in this outcome area is good. Prospective service users are given information about the home and their needs are assessed prior to moving in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has updated the statement of purpose and service user guide since the last inspection. These documents now contain all relevant information as set out in schedule 2 of the Care Home Regulations 2001. The manager stated that he is in the process of putting a service user guide in every room for existing and new service users to ensure that they have full access to this document at all times. 2 individual service user files were examined. There have been no new admission to the home over the past 12 months, however each file contained both Care Programme Approach (CPA) documents including care plans and risk assessments, care management joint assessments and the home’s own assessment information. The Annual Quality Assurance Assessment completed by the home confirms that all prospective service users have their needs thoroughly assessed prior to moving into the home. Graywood DS0000037757.V367462.R01.S.doc Version 5.2 Page 9 The home have updated the contract covering terms and conditions of residency as previously recommended including the responsibility of the home to notify relevant parties of any fee increases. Graywood DS0000037757.V367462.R01.S.doc Version 5.2 Page 10 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. Quality in this outcome area is good. A plan of care is developed for each service user including risk management plans. Residents are able to make decisions affecting their day-to-day lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two service user files were examined. Both contained updated and significantly improved plans of care. The manager stated that he has reviewed all service user plans, working with individuals and their key workers, developing improved guidance. An additional care plan form has also been introduced providing an overview of the individual needs, preferences and abilities of each service user. The plans themselves provide clear and direct guidance addressing a range of needs. The plans are reviewed at regular intervals and when needs change. Service users are involved in the care planning process. Graywood DS0000037757.V367462.R01.S.doc Version 5.2 Page 11 Residents confirmed that they are able to take decisions affecting their day-today lives and that they receive their full financial entitlements. One service user said, “I like to go to Ramsgate market most weeks, I use my bus pass because it’s free.” The home providers do act as appointee in a limited number of cases, where this arrangement is in place this has been agreed within the multi-disciplinary team. Similar to service user plans, risk assessments have been developed in greater levels of detail clearly outlining the actions staff and the service user need to take in order to minimise the perceived risks. A wide range of potential risks were assessed within the service user files examined and there was evidence of regular review. Graywood DS0000037757.V367462.R01.S.doc Version 5.2 Page 12 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. Quality in this outcome area is good. Service users have a lifestyle that suits their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home achieves a balance of activities for service users. There is a range of ages amongst the service user group and some of the residents are less active than others. People who use the service are free to spend their time as they wish and come and go at their leisure. The manager and staff provide some formal activities in the home mainly of a social nature. Some people access local community resources such as Adult Education, shops and sports facilities. There are available mental health facilities in the area for more therapeutic pastimes. Graywood DS0000037757.V367462.R01.S.doc Version 5.2 Page 13 All of the residents are able to access the local community independently, but staff will accompany residents when required and support service users at appointments and consultations when necessary. Visitors are welcome to visit the home at all reasonable times. There is adequate space for people to meet in private should they wish to do so. Service users commented that they are free to meet with friends and family. No visitors were available at the time of the site visit. The home is aware of religious and cultural preferences and issues. Service users are supported to attend appropriate places of worship. Residents are able to determine how they spend their time, although where activities are having a detrimental impact on the life of an individual the home have put measures in place to work with them, involving other services where necessary. The manager stated that the impetus of the home is to move further away from institutional practices and involve residents more in the running of the home to promote independence. Service users commented that the quality of food in the home is generally good. One person said, “I had a problem with the bread, but I spoke about it in a resident’s meeting and it was dealt with.” The food stocks were of good quality, appropriately stored and sufficient for the planned menu. Service users are able to have a choice of meals and mealtimes are relatively sociable, relaxed affairs. Graywood DS0000037757.V367462.R01.S.doc Version 5.2 Page 14 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. Quality in this outcome area is good. Service user’s health and personal care needs are met. Medication is managed safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home develops clear support plans providing good guidance to enable staff to meet service user’s needs and to be aware of their preferences. The vast majority of residents require only encouragement with personal care issues, but the manager acknowledged that a number of the service users are approaching older age and the staff have to be aware of increasing limitations in self-care for some people. Residents confirmed that staff are respectful to their needs and wishes. The healthcare needs of service users are considered and met. Records of appointments and outcomes of consultations are recorded. One service user said, “I’ve had my eyes done at hospital and the Chiropodist is coming on Thursday about my feet.” Residents are supported to attend doctor and Graywood DS0000037757.V367462.R01.S.doc Version 5.2 Page 15 hospital appointments where required. Staff have completed training in a number of healthcare topics such as epilepsy, diabetes and palliative care. All service users are registered with a local GP and there was evidence of CPA reviews held on file. The manager stated that the home receives good support from the local mental health services in general. Medication systems are in place including policies and procedures to ensure the safe administration of prescribed drugs. Storage facilities are adequate for the needs of the home and include a suitable controlled drugs cabinet. Administration records were up to date and records retained of medications, received, returned and destroyed. Staff undertake medication training as appropriate. The manager stated that the home aims to assist more service users in becoming self-administering. This was re-asserted in the AQAA submitted by the home. Currently one service user is self-medicating and another individual partially selfadministering. It is advised that the manager introduces a self-medication assessment and process using measurable targets and outcomes to ensure tracking of progress and understanding of risk factors. Refer to recommendation 1. Graywood DS0000037757.V367462.R01.S.doc Version 5.2 Page 16 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. Quality in this outcome area is good. Service user’s views are listened to and acted upon. They are protected from forms of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear complaints process in place that is included in the service user guide and displayed within the home. A number of residents spoken to said that they feel comfortable in raising any concerns or complaints in the home safe in the knowledge that their views will be taken seriously. The home keeps a record of complaints and actions taken regardless of the nature of the complaint. Residents said that they have resident meeting once a month and issues are discussed and documented. No formal complaints about the service have been received in the past 12 months. Adult protection processes are in place and understood. Policies and procedures have been developed in relation to this topic. All staff are given instruction in abuse awareness issues through the induction programme and additional training. Staff have recently attended a course on the Mental Capacity Act 2005. No adult protection alerts have been raised in relation to the service the past months. Graywood DS0000037757.V367462.R01.S.doc Version 5.2 Page 17 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. Quality in this outcome area is good. The home environment meets the individual and collective needs of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Graywood provides a comfortable, homely and clean environment for the service user group. The home is situated on a residential road in the Cliftonville part of Margate. The house is arranged over three floors, with communal space on the ground floor and most of the bedroom accommodation on the other floors. All of the bedrooms are currently used for single occupancy. There are sufficient toilets and bathrooms located throughout the house. There is a large lounge/dining room and a domestic style kitchen and laundry area. To the rear of the house there is an attractive and accessible garden with some shed space. Graywood DS0000037757.V367462.R01.S.doc Version 5.2 Page 18 The home is kept in a clean and hygienic manner and is odour free. It is reported that the service meets with the requirements of the environmental health and fire departments. Graywood DS0000037757.V367462.R01.S.doc Version 5.2 Page 19 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. Quality in this outcome area is good. Service users benefit from a competent and well trained staff team. The home follows recruitment processes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of the staff team have achieved National Vocational Qualifications (NVQ) in care at level 2 or above. The remainder of the staff are working towards these qualifications. Staff have also attended mental health awareness training and demonstrate a good understanding of the needs of the service user group. 2 staff files were examined that contained all required information including CRB and POVA checks, two written references and proof of identity. The home maintains the training of all staff updating courses as required on an annual basis. All mandatory training has been provided and staff work through an induction process in the first months of employment. Additional training has also been provided including topics such as the Mental Capacity Act, Medication, Palliative Care, Diabetes and Epilepsy amongst others. Graywood DS0000037757.V367462.R01.S.doc Version 5.2 Page 20 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. Quality in this outcome area is good. The home is well-run and in the best interests of the service users. The health, safety and welfare of residents is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is a family run business with both proprietors taking an active part in the day-to-day running of the service. The manager, who is the son of the providers, has just completed his NVQ level 4 and is completing his Registered Manager’s Award. He has not yet applied for registration, but a discussion was held about this and he has agreed to put forward his application for registration as the manager in the near future. He has demonstrated good Graywood DS0000037757.V367462.R01.S.doc Version 5.2 Page 21 abilities in the role of manager looking to develop record keeping, improve the range of activities and increase the independence of the service users. Refer to recommendation 2. The home has continued to develop quality monitoring processes. Annual surveys are sent out to service users, staff, relatives and professionals involved with the home. The home providers spend time in the home throughout the week and audits of key records including health and safety, medication and finances are regularly carried out. A range of documents were examined relating to health and safety issues including fire safety records, accident book, service and maintenance certificates and environmental risk assessments. All this documentation was up to date and reviewed at regular intervals. There are safety systems of work outlined in the policies and procedures of the home and all required training is provided. Graywood DS0000037757.V367462.R01.S.doc Version 5.2 Page 22 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 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Graywood DS0000037757.V367462.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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. 1. 2. Refer to Standard YA20 YA37 Good Practice Recommendations To develop a self-administration of medication programme. The manager is to continue with plans to register with the Commission for Social Care Inspection. Graywood DS0000037757.V367462.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Graywood DS0000037757.V367462.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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