Inspection on 03/03/09 for Gregory House

This inspection was carried out on 3rd March 2009.

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

Gregory House 06/12/06

Gregory House 15/02/06

Gregory House 20/09/05

Gregory House 30/03/05

Gregory House 26/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Gregory House Welby Gardens Grantham Lincs NG31 8BN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alison Jessop     Date: 0 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Gregory House Welby Gardens Grantham Lincs NG31 8BN 01476562192 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): manager.gregory@osjctlincs.co.uk The Orders Of St John Care Trust Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 32 Number of places (if applicable): Under 65 Over 65 32 old age, not falling within any other category Additional conditions: 0 The home is registered to provide personal care for service users of both sexes whose primary needs fall within the following category:- Old age, not falling within any other category (OP) - 32 The maximum number of service users to be accommodated is 32 Date of last inspection Brief description of the care home 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. It was built in the 1960s 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 32 service users over the age of 65 years, category OP. There are 28 single bedrooms and 2 shared bedrooms and Care Homes for Older People Page 4 of 25 Brief description of the care home several lounge and dining areas. The home is one of a group of homes run by the Orders 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. The range of fees is from £351 to £525 per week. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit which formed part of a key inspection, focusing on key standards, which have the potential to affect the health, safety and welfare of the people who use the service. Throughout this report the terms we and us refer to The Commission for Social Care Inspection (CSCI). The visit lasted approximately six hours and we took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since the last inspection. Before we made our visit the provider had returned the Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting the standards and their plans to improve aspects of the service. We Care Homes for Older People Page 6 of 25 also sent out surveys to a sample of residents and staff, the feedback we gained is included in this report. The main method used to carry out the inspection is called case tracking, this includes following the care of a sample of three people through their care records and assessing their care. We spoke to six people who use the service, two relatives and three members of staff. The Registered Manager was present throughout the visit and the general outcomes of the visit were discussed with her. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 Care Homes for Older People Page 8 of 25 7535. Care Homes for Older People Page 9 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission procedure is robust and helps to ensure that peoples needs can be met before they move into the home. Evidence: The manager told us that needs assessments for prospective residents are carried out by either the Manager or Care Team Leader. The assessment is comprehensive and asks for information about the persons health, social, cultural and spiritual needs. A letter of confirmation is sent out to the prospective resident to tell them that their needs can be met. The people that we gained feedback from told us that they received information about the service before they moved in. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Gregory House can expect to receive good quality, person centred care. The staff are now more aware of how to identify risks and prevent pressure sores. Closer working relationships between staff and district nurses means that residents health care needs are more closely monitored. Evidence: We looked at the care records of three residents. Each persons care plan included information about their health care needs, including nutritional risk assessment tools, a moving and handling risk assessment, falls risk assessment and skin integrity assessment. The plans include information on how to promote the residents independence and how to promote choice and preferences. The records had been reviewed each month and the manager stated we ensure care records are audited and they are now outcome based. We review more regularly if it is felt necessary or if there is a change to the residents care needs. The service has recently been subject to an investigation by the Lincolnshire County Care Homes for Older People Page 12 of 25 Evidence: Council Adult Safeguarding Team. This was due to alerts made following the admission of two residents from the home into hospital who had grade 4 pressure sores. A protection plan was put in place and new procedures have been introduced to prevent further issues in relation to pressure sores and their prevention. The manager stated we monitor the residents weight very closely and if a weight loss is identified or we spot signs of sore skin we put systems in place immediately to prevent this from deteriorating. We now use clinical triggers when we are assessing peoples needs and work more closely with the district nurses. We looked at the care records for two people who have pressure sores and saw that staff are recording food and fluid intake, completing turning charts and are using specialist equipment. Visits from district nurses and GPs are also recorded along with detailed daily notes on the care provided. We looked at the medication procedures and medication records for three residents who require support with their medication. The service has its own auditing system to monitor medication procedures and the pharmacy that supplies the medication to the home also carries out regular audits. The records and storage systems were found to be adequately maintained. All the residents that we gained feedback from said that they are treated with dignity and respect. One person said the staff are very gentle and caring. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 actively enjoy an excellent range of social events and activities, which are tailored to suit their individual wishes, needs and preferences. Evidence: On entry to the home there was a notice board which advertised a daily activity programme. This included arts and crafts, card making, bingo, nail manicures, flower arranging, games and entertainment. The activity co-ordinator said its vital that we make sure that all residents get some form of stimulation. For those people that prefer not to join in with group activities, I go to see them individually and manicure their nails or even clean their jewellery for them which means we can have a chat. I can get to find out what they like to do and find out about their life history. We also show slide shows of the past, we had Morris Dancers and Irish Dancers that performed to the residents. There are also two volunteers who work in the home two days a week who take residents outside for a walk and offer one to one time. One resident said the staff are always friendly and encourage us to take part in activities. A relative said there is a very well organised activity group, theres plenty of events organised with people coming in. Care Homes for Older People Page 14 of 25 Evidence: The residents are encouraged to feel part of the local community and outside services are brought into the home such as local schools, choirs and a beautician that comes to give the ladies a makeover once a month. On entry to the home there are certificates displayed as the home won the largest pumpkin and sunflower competitions. A religious service is also held in the home. Residents told us that the food and choice of food is very good. One resident said the food is great, its like my mothers cooking which was always the best. Another resident said yes, the food is really nice and a really good choice is available. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The outcomes from adult safeguarding investigations have been managed well and issues have been resolved in order to protect the safety of the residents. Evidence: All of the people that gave us feedback said that they are aware of how to make a complaint if they are unhappy. A copy of the complaints procedure is included in the residents handbook. The service reports that it has received two complaints in the last 12 months. One complaint was upheld but has since been resolved. The manager keeps a record of any complaints received and the outcomes. There have been two investigations by the Lincolnshire County Council Adult Safeguarding Team. One was in relation to poor pressure sore prevention and care. Another was in relation to a specific member of staff who was later referred to the Protection of Vulnerable Adults Register (POVA). Staff spoken to were aware of the procedures relating to safe guarding adults and were aware of the whistle blowing procedure. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Gregory House provides a clean, homely and safe environment to the people who live there. Evidence: In the last 12 months there have been some improvements made to the environment. The downstairs bathroom has been refurbished and additional disabled toilet has been added. Some of the bedrooms have been refurbished and include full ensuite facilities. One of the bedrooms has a sitting area and an ensuite accessible shower. The garden has been redeveloped where a new patio and seating area has been provided. The manager stated we have a rolling programme of redecoration and refurbishment and we plan to refurbish the lounges soon. The service was inspected by the fire safety officer several months ago. Several requirements were made , however the manager informed us that there is now full compliance with Fire Safety Regulations. The people who live at the home said that the home is always clean and fresh. We did not detect any malodours on the day of the inspection, and we saw that staff are aware of current good practice infection control procedures. Care Homes for Older People Page 17 of 25 Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a good skill mix of dedicated staff. Staff receive training which is relevant to their role which means they are aware of good, up to date practise and procedures. Evidence: All of the residents said that they feel their needs are met and that they do not have to wait long periods of time if they ask for help. Two staff who sent surveys to us said that more staff are required on the early morning shift between 7am and 10am, this is when residents are getting up and may require assistance with breakfast. One member of staff said I love working in the caring profession, we are a dedicated and caring bunch however we do struggle with staff shortages at times. A relative said the staff put the individuals first and do their work to the best of their ability. Over 80 of care staff have a National Vocational Qualification (NVQ). All housekeepers have an NVQ 2 award. Staff spoken to said that they get plenty of training. We looked at the training records for staff who had completed courses on moving and handling, first aid, food hygiene, health and safety, infection control, safeguarding adults, dementia care, customer care, medication and the Mental Capacity Act. The manager stated that e learning courses which can be completed on the internet are also being completed as part of the training programme. Care Homes for Older People Page 19 of 25 Evidence: We looked at the recruitment files of three staff and found that new staff had been subject to enhanced Criminal Record Disclosures and were not employed until satisfactory references had been received. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is well managed and closely monitored by the organisation to ensure procedures are being followed. Evidence: The manager who has worked at the home for many years is due to be transferred to one of the sister homes within the organisation. A manager from another of the groups homes is due to start managing the home from April 2009. Residents and staff spoken to said that they will be sorry to see the current manager leave. The service has a quality assurance system which has many strands. There are several auditing processes both internally and by the organisation. One of the staff said I have never seen so much auditing, Its really good as it means we keep on top of things. Residents spoken to said that they are asked for their views and opinions. The results of the quality assurance audit are displayed so that resident and visitors can see the outcomes and action taken. Care Homes for Older People Page 21 of 25 Evidence: The service employs an administrator who manages residents personal finances and carries out accounting procedures in order to protect the money for those who may not want to or are unable to so this themselves. The systems are also audited internally and externally by the organisations accounts department. For those residents who prefer to manage their own money, lockable facilities are available. Health and safety audits and equipment testing is carried out on a regular basis and equipment is regularly serviced. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 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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