Inspection on 07/02/06 for Gregory House II Care Home

This inspection was carried out on 7th February 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 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 II Care Home 30/07/07

Gregory House II Care Home 04/10/06

Gregory House II Care Home 15/03/05

Gregory House II Care Home 19/10/04

Gregory House II Care Home 20/10/03

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

CARE HOME ADULTS 18-65 Gregory House II Care Home Gregory House II 391/393 Mansfield Road Carrington Nottingham Nottinghamshire NG5 2DG Lead Inspector Andrew Sales Unannounced Inspection 7th February 2006 10:00 Gregory House II Care Home DS0000002231.V282855.R01.S.doc Version 5.1 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 II Care Home DS0000002231.V282855.R01.S.doc Version 5.1 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. Gregory House II Care Home DS0000002231.V282855.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Gregory House II Care Home Address 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) Gregory House II 391/393 Mansfield Road Carrington Nottingham Nottinghamshire NG5 2DG 0115 969 2320 0115 924 5232 gregoryhouse2@aol.com Mrs Pam McKale Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Gregory House II Care Home DS0000002231.V282855.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th June 2005 Brief Description of the Service: Gregory House II was originally a pair of semi - detached houses that have been converted into a care home to accommodate 12 people with mental health needs. It is located on a main road in the Carrington area of Nottingham, offering easy access to bus routes, shops a post office and local facilities and amenities. The house has a frontage laid to tarmac for car parking and there is a small, enclosed rear garden. Accommodation is provided on 3 floors and the premises are unsuitable for anyone with significant mobility problems. Gregory House II Care Home DS0000002231.V282855.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted by A.J.Sales on 7th January 2006. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. The primary method of inspection used was ‘case tracking’ which involved selecting residents and tracking the care they receive through review of their records, discussion with them, the care staff and observation of care practices. The manager was not present for the inspection. The inspector was assisted by the Senior Care duty manager and Care Staff present. The inspector spoke with two residents and made observations throughout the visit. A number of standards were not inspected on this occasion, due to records being unavailable. It is not considered that this has affected the overall inspection process. What the service does well: Staff interviewed were professional and committed. Feedback from residents was good and many were complimentary about the home, other residents were observed being supported by staff and general interaction with each other in the home. The home provides a comfortable domestic setting, and strives to be less institutional, with relaxed routines and flexible support systems. The staff are clearly committed to the residents. Interaction between staff and residents, along with evidence of training and guidance, support this. When assessing the residents abilities, the home balances well the level of risk with the need to promote independence and choice. Gregory House II Care Home DS0000002231.V282855.R01.S.doc Version 5.1 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. Gregory House II Care Home DS0000002231.V282855.R01.S.doc Version 5.1 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 Gregory House II Care Home DS0000002231.V282855.R01.S.doc Version 5.1 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): 2,3 Residents are fully assessed prior to admission in conjunction with referring professionals. The assessment process enables judgements to be made as to the homes ability to meet the needs of new residents. EVIDENCE: One recent admission to the home was discussed and assessment plans were examined. Evidence of the homes assessment and local health and social service personnel care management assessments were present. Potential restrictions on freedom, services or facilities that are likely to become part of a resident’s individual care plan were documented in care plans The home obtains specialist advise from Community psychiatric nurses and other health care professionals. This was supported by documentation in care plans. Residents also spoke of being supported to visit healthcare services. All residents spoken with felt the that staff were competent and professional. Staff discussed training events previously attended and courses they were due to attend. These were; mandatory health and safety training, the management of challenging behaviour, NVQ level 2 and Adult Protection. Gregory House II Care Home DS0000002231.V282855.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9. The assessment process is thorough and reflects the changing needs of residents. Residents are supported to make decisions and enabled wherever possible, to take risks appropriate to their lifestyle. EVIDENCE: One new care plan was examined and showed evidence of professional healthcare input and reviews involving the Community Psychiatric teams. The Care Plans include potential limitations on freedom / restrictions regarding interactions with other residents, pertinent to the individual. Behavioural assessments are present and utilised for all residents who display challenging / aggressive behaviour. Gregory House II Care Home DS0000002231.V282855.R01.S.doc Version 5.1 Page 10 Residents interviewed confirmed that they feel they are able to make decisions about their own lives in accordance with their assessed needs and capacity. Some described how they were supported with daily activities at times that suited them. Some residents were observed leaving and entering the premises going about their daily business. The staff also demonstrated how individual choices have been made in respect to daily routines when interviewed and were observed interacting with residents. Community Psychiatric nurses are also involved in Assessments associated with service user’s mental health formulating Risk The homes risk assessments were found to be well documented on care plans examined. Risk Assessments available in relation to relationships, behaviour, environment and action to be taken by staff, are well documented and reviewed regularly. Gregory House II Care Home DS0000002231.V282855.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17. Residents are supported to pursue, religious and social interests. Residents are helped to exercise choice and control over their lives. Residents and staff feel there is more social stimulation and recreational interest provided at the home. The home supports residents to maintain community and family links. The home provides a good catering service and caters for different diets and preferences. EVIDENCE: Residents spoken with felt they were happy with the level of activities within the home and outside. The staff reported that they encourage residents to participate in events and outings. Staff and residents spoke of planned trips and events that are organised within and outside the home. The proximity of the home to local shops, pubs, a library, medical centres, the post office and public transport routes means that most residents can easily access community facilities as they wish. The inspector observed residents going out to shops and local amenities. Residents stated that they are Gregory House II Care Home DS0000002231.V282855.R01.S.doc Version 5.1 Page 12 supported to go into town, visit shops, pubs and parks. Staff interviewed also supported this, stating that where possible residents are also supported to access college courses. Assessment plans examined also contained evidence of planning for individuals to integrate into the community. Residents commented favourably on the home’s food and stated meals are adequate in both quantity and quality. Meals are offered in the dining room on the ground floor. The daily menu is displayed, and alternatives are available as required. Care staff, as part of their role, undertake catering duties. Care Plans examined showed Action Plans regarding dietary needs, and weightmonitoring charts. Staff spoken with were well aware of residents individual preferences. Gregory House II Care Home DS0000002231.V282855.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. Residents feel they are treated with respect and receive support in an appropriate manner. The healthcare needs of residents are well planned for. EVIDENCE: During the inspection three residents were spoken with. The outcomes for residents receiving support were discussed and cross referenced with their assessment plans. The feedback was generally very positive. Of the three residents spoken with, all were very pleased with the standard of support. Due to communication issues some residents could not fully express their views, but further discussion and observation indicates that they reasonably content and feel safe and well supported at the home. Staff were observed interacting positively and sensitively with residents with care and social issues. Each residents care plan contains a thorough health needs assessment. Incidences of health care management, medication, cognitive and behavioural assessments, continence management and monitoring of nutrition were all evident and supported by comprehensive risk assessments. Gregory House II Care Home DS0000002231.V282855.R01.S.doc Version 5.1 Page 14 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): 22,23. Residents feel confident that their views are listened to. The home has policies and procedures in place for the protection of adults. The staff are aware of their responsibilities. EVIDENCE: A complaints procedure was observed, which includes timescales for any investigation and contact details for referral to the Commission For Social Care Inspection if needed. The procedure is also placed within the Service User’s Guide, and a copy displayed within the home. There are also copies of forms on which to make a written complaint displayed in the main entrance. Information on local Advocacy Services is displayed on the residents; notice board. Concerns and comments on the standard of service are discussed at residents’ meetings, and documented accordingly. The number and nature of complaints was not examined by the inspector. There are policies and procedures available at the home concerning adult protection issues including responding to suspicion of abuse/neglect, dealing with physical and verbal aggression and management of service user’ finances. The home has a policy that encompasses rights of residents. The staff team demonstrated an understanding of these policies. Both of the staff on duty spoken with said they had attended Adult Protection provided by the manager, training certificates were present. There is a policy for dealing with physical and verbal aggression, which is detailed and clearly written. There is information on how to deal with individual behaviour (including Risk Assessments) within Care Plans. Residents were observed as very forthcoming in raising issues with the staff on the day. Gregory House II Care Home DS0000002231.V282855.R01.S.doc Version 5.1 Page 15 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): 24,30. The home’s premises are suitable for its stated purpose, accessible, safe and well maintained. The premises are kept clean and hygienic. EVIDENCE: There are systems in place to control the spread of infection. The care staff have attended training on Infection Control issues. Evidence of this was found on staff files and from speaking with staff. There is a separate laundry that has an impermeable floor covering. The premises appeared to be generally well maintained and homely. There is a maintenance / renovation schedule in use. Parts of the home were being decorated on the day of the inspection. Residents commented that they felt comfortable with the surroundings. All communal areas were observed and found to be very domestic and comfortable with ample room. Personal rooms were observed on previous inspections. Gregory House II Care Home DS0000002231.V282855.R01.S.doc Version 5.1 Page 16 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): 32,34,35. The home provides training and induction at appropriate intervals. Supervision frameworks are in place. Residents are safeguarded by the homes recruitment procedures. EVIDENCE: The home’s recruitment process was considered satisfactory at the previous inspection. The manager was not present for the inspection and the duty manager was unable to access recruitment documentation. The home’s induction and training programs were observed. Training is provided in all mandatory Health and Safety subjects. Certificates were observed. Care specific training is also provided to respond to the particular care needs of each individual. Induction and Foundation training are provided within requisite timescales. Evidence of the induction process was supplied by staff interviewed. A Training Needs Analysis document is used to determine training needs for staff. Staff spoken with felt adequate and relevant training is provided by the manager. Gregory House II Care Home DS0000002231.V282855.R01.S.doc Version 5.1 Page 17 Staff stated they had attended courses in management of aggression, and various mandatory health and safety subjects. Both members of staff demonstrated a strong understanding of the needs of the residents and a strong commitment to their role. Certificates were observed posted on notice boards. Staff commented they were studying NVQ level 2 and one was studying for level 3. Residents interviewed felt the staff were professional and supportive. Gregory House II Care Home DS0000002231.V282855.R01.S.doc Version 5.1 Page 18 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): 37,39,42. The home is well managed and the Health, Welfare and Safety of residents is promoted through policy and practice. The manager is clearly competent and experienced in managing the home. Health and Safety issues are generally well managed, but specific risk assessments required at the previous inspection remain outstanding. The home also is required to address other Health and Safety issues. EVIDENCE: Residents commented that they felt issues were dealt with promptly raised. Staff commented they felt well supported by the manager. when Staff have access to regular, care specific and mandatory training sessions on health and safety related subjects. Numerous training certificates were observed. Residents commented that they liked the home and felt safe living there. Gregory House II Care Home DS0000002231.V282855.R01.S.doc Version 5.1 Page 19 The registered manager ensures safe working practices through provision of training in mandatory health and safety subjects. Abuse awareness training is also including within the staff induction programme. Fire systems and lift servicing was observed. Records were observed for the appropriate testing and servicing of the general systems and appliances. Procedures for recording water temperatures and water system maintenance are now in place, but temperatures were observed to exceed the required level considerably. The inspector was unable to locate the homes Fire Risk Assessment and at the time of the producing the report, one had not been provided. The inspector could not evidence the testing of portable electrical appliances in the last twelve months. The home has appropriate Health and Safety policies and procedures in place. Staff spoken with, demonstrated a good understanding of Health and Safety issues and their responsibilities. Gregory House II Care Home DS0000002231.V282855.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 3 4 X 5 X 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 2 X Gregory House II Care Home DS0000002231.V282855.R01.S.doc Version 5.1 Page 21 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 2 Standard 42 42 Regulation 13 (1) (a) (b) (c) 13 (1) (a) (b) (c) 13 (1) (a) (b) (c) 13 (1) (a) (b) (c) Timescale for action Ensure a Fire Risk Assessment is 07/02/06 conducted for the home. Ensure Risk Assessments are 28/02/06 conducted for all residents in respect of hot water temperatures. Consult the E.H.O. over 30/03/06 management of hot water temperatures. Ensure Portable Electrical 30/03/06 appliances tests are conducted at the appropriate frequency. Requirement 3 4 42 42 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 II Care Home DS0000002231.V282855.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 II Care Home DS0000002231.V282855.R01.S.doc Version 5.1 Page 23 - 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. 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