Inspection on 20/09/05 for Gregory House

This inspection was carried out on 20th September 2005.

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 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

Gregory House 03/03/09

Gregory House 06/12/06

Gregory House 15/02/06

Gregory House 30/03/05

Gregory House 26/05/04

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

CARE HOMES FOR OLDER PEOPLE Gregory House Welby Gardens Grantham Lincs NG31 8BN Lead Inspector Mr David Bacon Unannounced Inspection 20th September 2005 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 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. Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Gregory House Address Welby Gardens Grantham Lincs NG31 8BN 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) 01476 562192 The Orders Of St John Care Trust Mrs M Cooke Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Gregory House is a purpose built care home situated in a quiet residential area within Grantham and is set in its own grounds having landscaped gardens with several seating areas and a summer house. It was built in the 1960’s for the Local Authority and since then has been registered by the Orders of St Johns Care Trust. Grantham town centre is within close proximity. The home is registered to provide residential care for 37 service users over the age of 65 years, category OP. There are 23 single bedrooms and 7 shared bedrooms and several lounge and dining areas. The home is one of a group of homes run by the Order’s of St John Trust and its stated aim is to provide a homely, relaxed and caring environment that takes into account the individual needs of the residents. Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 4 hours; it was unannounced and was carried out by one inspector. A tour of the premises was conducted, service users care records and staff records were inspected along with the homes provision of activities. The inspector spoke with the registered manager, four service users, three service users representatives, five staff members, a visiting community nurse and pharmacist. What the service does well: What has improved since the last inspection? What they could do better: The service users and representatives and staff with whom the inspector spoke were not fully satisfied with the homes current provision of activities although it is acknowledged that an activity co-ordinator is due to commence work at the home. The staff spoken with did not feel supported to express their views regarding the home and staff said that morale overall was low following there being a recent overall shortage of staff and a perception that some staff were not treated equally or having their concerns responded to. The manager Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 Page 6 acknowledged that some staff morale is low and said that staff supervision and a staff meeting are due to be held to address the issues. A review of the homes aids and adaptations is needed to ensure that there is sufficient provision for service users and service users must be fully supported to express their views regarding the home. 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. Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 Page 7 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 Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 Page 8 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, 4, 5, Satisfactory procedures and administrative systems are in place for the introduction of residents to the home. Information is provided to prospective service users to enable each individual to make informed choices about admission to the home. EVIDENCE: The service users and representatives spoken with confirmed that they were satisfied with the homes admission arrangements. Comments included: “They were welcoming from the start, which made things a lot easier”. “They were very supportive to the whole family and we knew we had made the right decision”. “They certainly helped me settle here”. “You were given all the information you needed and they were always happy to help you”. A service users guide and a statement of purpose detail the services provided by the home and its terms and conditions and these are provided to service users and updated as required. Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 Page 9 Three service users personal files were seen, which evidenced where preadmission assessments had been undertaken including identifying risks. Care records documented where service users or their representatives had been consulted with regarding the plan. The home sends formal notification to each service user prior to admission where the home is able to meet an individuals care needs and signed terms and conditions of residence contracts were maintained on each of the service users files inspected. Admission policies and procedures are in place giving guidance to staff, which are discussed as part of induction to the home. The home does not provide intermediate care services. Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 Page 10 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, 10, 11 Care records are well maintained overall and the service users spoken with feel that they are treated with respect and they are satisfied with the care provided. EVIDENCE: The service users and representatives spoken with confirmed that staff respected their privacy and dignity. Comments included: “The staff are generally very good and if they weren’t then I would tell them”. “Yes, they are respectful, treating you how you should be”. “Yes, they are excellent, they do look after you properly”. “I visit often each week and they have always been kind, yes always”. The visiting health professional spoken with said they were aware that conditions for staff had been difficult recently due staff shortages but that staff appropriately followed any given advice or instruction and there were no concerns regarding overall standards of care. A care plan is completed for each service user and information within these clearly documents individuals care needs and instructs staff as to how these are to be met. The risk assessment information identifies potential risks and the action required to be taken by staff to minimise these. Care records document how individual health care needs are met. Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 Page 11 Care records are generally updated daily and are mostly reviewed and updated as service users care needs change. During the visit she staff were observed carrying out care tasks and they were respectful to the service users. Service users wishes regarding death are recorded and policies and procedures are in place regarding this giving guidance to service users and staff. Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 Page 12 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 The service users and representatives spoken with are satisfied overall with life within the home, the care provided and they can maintain and develop community links, as they prefer although minor adjustments are needed to provide an appropriate variety and amount of activities and stimulation. EVIDENCE: The service users and representatives spoken with confirmed that service users are able to spend their time as they like, that there are no real restrictions and that any visitors were made welcome. Comments included: “Apart from the door security systems to protect some residents you can walk around as you please, there are no restrictions”. “I would do as I liked anyway, but there’s no real rules I’m aware of”. “We visit regularly each week and have been made welcome from the beginning”. “The staff make you welcome, always”. “It’s a nice place but there’s not been a lot to do recently”. “There used to be more things to do, to stimulate people”. “I may not want to get involved with activities but it would be better if there was more on offer”. Information regarding the homes care philosophies, service users rights and advocacy is provided to service users, who confirmed that they are generally consulted with about their preferences but they had not had recent opportunity to express these as formal residents meetings had not been held. Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 Page 13 Service users interests are recorded and a record is maintained of the activities provided although the current provision of activities is not sufficient. The manager said that an activity co-ordinator is due to commence working at the home to address this. Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 Page 14 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, 18 The home has policies and procedures regarding complaints and abuse and service users and staff are aware of these. EVIDENCE: Complaint policies and procedures are in place and information regarding these is provided to service users. A record of informal complaints is maintained and the service users and representatives spoken with said that they felt able to voice any concerns regarding the home and that these would be acted upon. The care staff spoken with were familiar with complaint, whistle blowing and abuse policies and procedures and awareness training has been provided recently regarding this subject matter. Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 Page 15 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, 25, 26 The home is clean, tidy and maintained to a very good standard overall although a review of the overall provision of aids and adaptations available for service users is needed. All private and communal space is suitable for the residents and is homely and comfortable and service users are able to personalise their own accommodation as they prefer. EVIDENCE: The service users and representatives spoken with were satisfied with the physical environment. Service users can gain access to all areas of the home although the external doors are alarmed to minimise risks to service users who may be prone to wandering. The fifteen service users rooms viewed identified that rooms are personalised and contained individuals personal effects. Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 Page 16 The home has two fixed bath-hoisting chairs, one portable hoist and one rotunda although staff said that these were insufficient and that an additional hoist was required to adequately meet service users care needs. Maintenance records of adaptations are maintained. The home complies with national minimum space requirements for service users, as agreed for care establishments registered prior to 1st April 2002. There are 7 toilets and 1 bathroom downstairs and 3 toilets, 2 bathrooms and 1 shower room upstairs. There are 23 single bedrooms and 7 doubles, 3 of which are smaller than 16 sq.m. Domestic staff keep the home clean and odour free and health and safety policies and procedures give guidance to staff. Hot water temperatures within the home are monitored and regulating valves are fitted to water outlets. Systems are in place to prevent risks from legionella. Protective covers are fitted to radiators. The manager confirmed that any requirements placed upon the home following the most recent inspection visits from the fire safety officer and environmental health officer inspections had been met. Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 Page 17 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, 30 Recruitment procedures are in place and the staff are trained, competent and they receive induction when starting at the home. There are insufficient numbers of staff overall, which is putting pressure on existing staff and the manager, who have occasionally worked increased hours to address this. EVIDENCE: On the day of inspection the manager was in the process of recruiting 2 staff members although the manager and staff acknowledged that there had been an overall shortage in staffing numbers and some staff were working increased hours to maintain adequate care, health and hygiene levels in the home. The staff records viewed were well maintained and clearly evidenced that appropriate recruitment procedures had been followed overall although no record of the home receiving POVA clearance was maintained in the files inspected. The service users spoken with confirmed that their care needs were met. Comments included: “They have been short of staff recently, which has made things more difficult but everyone is kind and caring”. “They always treat you well”. “They have been very busy recently due to being short staffed, several have left, which is a shame because they are all good and look after you”. Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 Page 18 A rolling programme of training is in place and most staff have been trained to National Vocation Qualification levels and records of the training undertaken by staff are maintained. Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 Page 19 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): 32, 33, 38 The service users are satisfied with the overall standards of care and that they are mostly supported to contribute to the running of the home although minor adjustments are needed. The staff spoken with feel that they are not fully listened to and some staff morale is low. The health and safety of service users is promoted overall. EVIDENCE: The service users and representatives spoken with confirmed that they were satisfied with the management of the home, the care provided and that they felt able to express their views regarding life within the home and that these would be acted upon. Comments included: “If I had concerns then I would approach the staff or the manager and I’m sure things would be sorted”. “I have had a few concerns but generally things seem to be going well, the manager is approachable”. “They all seem helpful and the care is good, I’ve Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 Page 20 no major complaints”. “We used to have regular meetings to discuss things but no recently”. Residents meetings are not held regularly, which would further enable service users to express their views regarding life within the home although information regarding the seeking of views about the service is displayed in the main hall. Quality satisfaction questionnaires have been devised and these were sent earlier in the year although copies were unavailable for inspection. The staff spoken with said that they did not feel that their views about the home were listened to, that some staff were not being treated equally and that staff shortages had resulted in low morale. Staff have not recently received formal supervision although the manager said that this is due along with holding a staff meeting in the aim of addressing some potential staffing issues. Health and safety policies and procedures are in place, giving guidance to staff and risk assessments have been completed for all service users and of the premises, which is well maintained. Systems are in place to minimise risks to residents prone to wandering, which includes the fitting of door alarms to external doorways. Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 2 X X 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 2 X X X X 3 Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 Page 22 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 OP12 Regulation 15 and 16 (2) (n) Requirement The registered person shall prepare a plan as to how the service users needs in respect of health and welfare are to be met. Therefore, it is required that care records demonstrate fully how the daily living and recreational needs of service users are met. A review of the homes hoists and lifting equipment is required and action must be taken following this to meet service users mobility care needs. Sufficient numbers of staff must be deployed within the home. A record of POVA clearance must be maintained as part of the staff recruitment procedure. It is required that a formal system of reviewing the service provided is implemented and that service users and their representatives are involved where possible. Timescale for action 31/12/05 2 OP22 23 (2) (n) 31/12/05 3 4 5 OP27 OP29 OP33 18(1)(a) 12(1)(a) 19 24 30/11/05 30/11/05 31/12/05 Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 Page 23 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 Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Gregory House DS0000002367.V251757.R01.S.doc Version 5.0 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!