Inspection on 03/10/06 for Graywood

This inspection was carried out on 3rd October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Graywood 21/07/08

Graywood 30/08/07

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 08/07/2008.

CARE HOME ADULTS 18-65 Graywood 10 Northdown Avenue Cliftonville Margate Kent CT9 2NL Lead Inspector Joseph Harris Unannounced Inspection 3rd October 2006 09:30 Graywood DS0000037757.V305460.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.V305460.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.V305460.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 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 Post Vacant Care Home 13 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (13) of places Graywood DS0000037757.V305460.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th November 2005 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. 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.V305460.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit for this key inspection took place on the 3rd October 2006. The visit lasted for approximately 6.5 hours, commencing at 10am and concluding at 4.30pm. Throughout the day evidence was gathered and observations were made by talking to service users individually and in a group setting, discussions with staff and observation of care practices and time spent with the owners and acting manager. A range of records and documents were examined including service user files, staff files, health and safety records and other information relating to the running of the home. Service user questionnaires were received prior to the visit, which provided positive feedback about the service and a pre-inspection questionnaire was completed by the registered provider and returned to the Commission. As a result of the inspection process 1 requirement and 1 recommendation was made. What the service does well: What has improved since the last inspection? The service providers have continues to make on-going improvements to the general environment continually redecorating and updating the premises. The home has continued to make improvements in respect of staff training needs and has implemented a positive programme enabling staff to gain NVQs. Graywood DS0000037757.V305460.R01.S.doc Version 5.2 Page 6 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. Graywood DS0000037757.V305460.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.V305460.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Prospective service users are given adequate information about the home services. Individual needs and aspirations are assessed prior to admission and service users know that the home can meet their needs. There are opportunities to spend time in the home prior to moving in. Service users are given an individual contract covering key terms and conditions. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has developed a statement of purpose and a service users guide, which provide good levels of detail regarding the home and the services that are provided. The home ensures that necessary information is received prior to admitting any service user into the home. This was evidenced through a number of service user plans that were examined. All files had relevant care programme approach care plans and risk assessments in place and additional background information covering likes, dislikes and history. It was reported that the service receives good support from the local community mental health services. The home provides good levels of training for staff. The assessment process, it was stated, starts from the point of referral receiving written information and then continues into the trial visits to the home where staff and the service user can become acquainted. The individual has the opportunity to spend time with Graywood DS0000037757.V305460.R01.S.doc Version 5.2 Page 9 other residents and become orientated to the environment. Trial stays can range from short visits to overnight stays dependent on individual needs and wishes. Each service user is given a contract stating the terms and conditions of residency. A signed copy is retained on each service user’s file. The contract adequately covers all the key issues of residency. Graywood DS0000037757.V305460.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Service users needs and goals are addressed through the individual plans. Residents are able to make decisions about their lives. Individuals are supported to take responsible risks. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 4 service user files were examined during the course of the visit. All files had a care plan in place, which addressed the main needs and goals of each service user. The plans are linked to the CPA care plans and other assessment information. The plans generally contained sufficient detail to enable staff to consistently meet individual needs, although a discussion was held with the acting manager/joint owner advising that the plans could provide additional detail in some circumstances and a pen portrait could also be introduced providing an overview of each individual. Refer to recommendation 1. The plans are regularly reviewed and updated as and when needed. Discussions were held individually and in a group with the majority of the service users. These discussions confirmed that residents feel able to make decisions regarding their lives. “It’s a comfortable home and I can choose what I want to do”, was one example of a comment made. Where any restrictions Graywood DS0000037757.V305460.R01.S.doc Version 5.2 Page 11 are made for the benefit of an individual these are discussed within the multidisciplinary care team and agreed, these discussions include the service user in question. The home encourages and supports service users to manage their own finances wherever possible. Where an appointee is required this role is undertaken by someone independent of the service. The home develops appropriate individual risk assessments for each service user, based on knowledge of the individual and care programme approach documentation. The assessments address key areas of concern and aim to promote independence rather than restrict it. The risk assessments are reviewed and updated regularly or as needs change. 4 risk management plans were viewed all of which showed evidence of a good risk management process. Graywood DS0000037757.V305460.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Service users are able to participate in a number of activities. Residents access local community resources regularly. Friends, family and visitors are welcomed into the home. Service user’s rights and responsibilities are recognised. A healthy and balanced diet is provided. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Graywood offers a relaxed and homely environment where service users are able to engage in informal activities and recreational pursuits. Some activities are organised in the home, but these are usually on an individual or small group basis. There opportunities outside the home available for people if they choose such as local community mental health day centres and resources. Some residents attend a bowling club and a badminton club; there are opportunities at the local college and other town centre facilities. Graywood DS0000037757.V305460.R01.S.doc Version 5.2 Page 13 Service users confirmed that they come and go from the home as they please. The town centre and seafront are nearby and a large park is adjacent to the home. There was not an opportunity to speak with any visitors, but residents confirmed that their visitors are welcomed into the home at all reasonable times of the day. There is adequate space within the home to enable people to meet in private. All service users have lockable bedroom doors and keys to the front door and staff knock prior to entering rooms. Staff were observed to spend time with service users interacting positively. Residents are able to choose when they wish to spend time on their own. Individuals are also encouraged to participate in the daily running of the home including household chores and other tasks. The home provides a healthy and balanced diet. Menu records demonstrated that there is a good variety of food served with available options. The food stores were well stocked with good quality foods and fresh fruit and vegetables. The kitchen is domestic in size, but is adequate for the needs of the home and has achieved the gold standard cleanliness award for a number of years running with the environmental health department. Residents stated that the quality of food is good and that food and drinks are available outside of mealtimes. Graywood DS0000037757.V305460.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Service users receive support in the way they prefer and healthcare needs are met. Medication processes are well maintained. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of service users require minimal support with personal care needs. Where greater levels of support is required staff provide this in a sensitive and respectful manner. One service user said “the staff help me when I need it and they are very caring”. Residents are able to choose when they wish to get up and go to bed and routines are flexible enabling residents to choose how they wish to spend their time. Personal care needs are adequately reflected in the service user plans. There is a key worker system in operation. Service users have access to all necessary healthcare services and are supported to attend appointments when required. It was reported that good links have been established with local GPs and the community mental health team. Service users access complementary health services such as dentists and chiropodists as required. Medication administration records were examined and had been well maintained. Medication is regularly reviewed by the responsible medical officers and the home’s records updated. No errors were noted on the Graywood DS0000037757.V305460.R01.S.doc Version 5.2 Page 15 administration records. Storage facilities for medication were adequate and well organised. Staff are provided with training in medication issues before being allowed to administer medication. Graywood DS0000037757.V305460.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Service user’s views are listened to and acted upon. Adequate processes are in place to protect residents from forms of abuse. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear complaints procedure in place that is provided to service users and is on display covering all relevant details. Through discussion with a number of service users it was evident that they felt comfortable about approaching staff, the registered manager and the responsible individual with any concerns or complaints that they might have. There have been no complaints regarding the home since the last inspection. Adequate policies and procedures are in place relating to adult protection and abuse awareness. Staff also address such issues through the induction programme and by participating in additional training. Discussions with staff revealed that there is a good awareness of issues of abuse and how to report any concerns should they arise. Graywood DS0000037757.V305460.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. The premises and comfortable and safe. The home is clean and hygienic. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Graywood is set on a residential street in Margate close to the town centre and seafront with a large park nearby. The house is a good-sized property with a range of communal living space and all single bedrooms. There are domestic kitchen arrangements which are more than adequate for the needs of the service and a clean and well appointed laundry area. Throughout, the home has been well-maintained and attractively decorated. The owners have continued to update and improve the environment to good effect. There is a large and accessible garden to the rear of the property. The home was clean, hygienic and free from offensive odours. Staff are given instruction regarding issues of infection control and there are adequate policies and procedures in place in this respect. The laundry facilities are suitable for the needs of the home. Graywood DS0000037757.V305460.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. There is a competent, experienced and suitably qualified staff team in adequate numbers at all times. The home’s recruitment practices are thorough. Staff are provided with all necessary training needs. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is staffed by a relatively experienced team a number of which have worked at the service in excess of 3 years. 7 of the 10 staff members have achieved an NVQ level 2 or above and a number of staff have continued to work towards higher level NVQs. In discussion with staff it was demonstrated that there are positive attitudes and good working knowledge of the key facets of working with people with mental health problems. The home operates with a minimum of 2 staff on duty at all times. There is 3 staff throughout the morning and 2 staff in the evening. At night there is 1 waking and 1 sleep-in staff. The home also operates an on-call system 24 hours a day in case of emergency. The manager ensures that regular staff meetings take place and the minutes of these meetings are recorded. A number of staff files were viewed, which demonstrated that the home has satisfactory recruitment processes. All of the files viewed, including recent and established staff, contained all required information including two written Graywood DS0000037757.V305460.R01.S.doc Version 5.2 Page 19 references, proof of identity, CRB/POVA checks and completed application forms. The home provides staff with a good programme of training taking into account individual needs. All mandatory training has been provided and updates have been booked for those staff who require refreshers. New employees are working towards their mandatory training targets. The home also uses a common induction standard through Learn to Care and has a home specific induction checklist as well. Additional courses have also been provided including Adult Protection and abuse, care planning and loss and bereavement. It was suggested that a refresher course covering mental health awareness could also be considered in the future. Graywood DS0000037757.V305460.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. The home is well-run, but the manager needs to progress through the registration process. A good quality assurance process has been introduced. The health, safety and welfare of service users, staff and visitors is protected. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provider, Mrs Haq, is currently acting as the manager for the service. She has an SEN nursing qualification and is enrolled on the NVQ 4/Registered Managers Award. A discussion was held regarding the position of manager. It is necessary for the home to have a registered manager and Mrs Haq is currently considering whether to take on this role herself. Refer to requirement 1. The home has been well managed since the previous manager decided to leave and some staff commented on the positive working atmosphere in the home. The service providers have developed strong quality assurance processes including completing service user, family and staff questionnaires on an annual basis to feedback about the home. There is clear evidence of on-going Graywood DS0000037757.V305460.R01.S.doc Version 5.2 Page 21 monitoring regarding aspects of the home including the environment and record audits. Monthly monitoring also routinely occurs in respect of health and safety issues with any issues highlighted and appropriate action taken. All health and safety records and documentation was up to date including fire safety records, accident reports and routine maintenance checks such as Gas safety, NICIEC and other safety certificates. Staff receive mandatory training and safe working practices are instituted. Environmental risk assessments are in place. It was reported that home complies with all relevant health and safety legislation. Graywood DS0000037757.V305460.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 3 4 3 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 3 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 2 X 3 X X 3 X Graywood DS0000037757.V305460.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. 1. Standard YA37 Regulation 8, 9 Requirement The home is to appoint a fulltime manager and apply for registered manager status with the Commission. Timescale for action 01/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations To ensure all care plans have clear guidance to enable staff to meet service user’s needs. Graywood DS0000037757.V305460.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 Graywood DS0000037757.V305460.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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