This inspection was carried out on 20th April 2005.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.
CARE HOMES FOR OLDER PEOPLE
Grenham Bay Court Cliff Road Birchington Kent CT7 9JX Lead Inspector
Tina Taylor Unannounced 20 April 2005 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 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. Grenham Bay Court H56-H05 S34959 Grenham Bay Ct V222280 200405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Grenham Bay Court Address Cliff Road, Birchington, Kent, CT7 9JX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01843 841008 Grenham Bay Care Ltd CRH - OP 34 Category(ies) of Care home for older people - 34 registration, with number of places Grenham Bay Court H56-H05 S34959 Grenham Bay Ct V222280 200405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: One resident whose date of birth is 17/10/1941 Date of last inspection 7th March 2005 Brief Description of the Service: Grenham Bay Court is positioned on the seafront, with uninterrupted views of the grass promenade and the sea. It is within easy travelling distance of Birchington, with its variety of shops, public facilities, library, mainline station and bus services. The home has its own transport, which can assist residents to local or more distant places of interest. There is unrestricted on road parking to the front of the property. The home is owned by a private company. The home can provide care for up to 34 people aged 65 years and above. Grenham Bay Court H56-H05 S34959 Grenham Bay Ct V222280 200405 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and was carried out as a follow up to the last unannounced inspection of 7th March 2005. It took place over six and a half hours. During that time the views of five residents were sought. Residents commented that the staff were good to them and were “always busy”. Discussion was also held with the home’s manager, the company’s group manager, and four care staff. Time was spent in lounge areas observing care practice, in looking around ground floor communal areas, and checking medication and health care records. A complete tour of the home was not undertaken at this visit. The focus of the visit was to check on requirements made at the last inspection with regard to medication and health care issues, and to follow up on a recent adult protection meeting where new staffing arrangements were agreed with the company’s group manager. A further unannounced follow up inspection will be carried out to ensure the home complies with the requirements made in this report. What the service does well: What has improved since the last inspection?
Since the last inspection the company has provided the home with a new care planning format, and although these have not been fully completed yet, they should provide a far more comprehensive account of the care needs and wishes of the residents. The manager said that although the new documents were taking some time to complete, she believed that they would be very
Grenham Bay Court H56-H05 S34959 Grenham Bay Ct V222280 200405 Stage 4.doc Version 1.30 Page 6 beneficial. The manager said that key staff were in the process of completing a care plan in the new format in consultation with a new resident. 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. Grenham Bay Court H56-H05 S34959 Grenham Bay Ct V222280 200405 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Grenham Bay Court H56-H05 S34959 Grenham Bay Ct V222280 200405 Stage 4.doc Version 1.30 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 standard(s) These standards were not inspected at this visit. EVIDENCE: Grenham Bay Court H56-H05 S34959 Grenham Bay Ct V222280 200405 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7, 8, 9 The home still needs to improve the health care records of the residents, particularly those with specific health care problems. Risk assessments must also be improved. Medication storage has been improved but there remains concern about overall medication practice. EVIDENCE: Residents care plans are in the process of being replaced to a new format and the manager said that she had completed ten to eleven of these. However new care plans seen for two residents with particular health care needs had not been completed in full and they did not include full risk assessments. The associated risks for particular health problems had not been completed. The staff write daily notes and these showed that when staff had identified particular problems, the doctor or district nurse had been contacted. However care plans and risk assessments had not been updated or put into place following these visits to show what actions would need to be taken by staff. Where assessments have been completed that identified that a monitoring system needed to be in place, there was no monitoring system in place. The group manager said that monitoring charts had been completed by the company and would be provided to the manager for implementation.
Grenham Bay Court H56-H05 S34959 Grenham Bay Ct V222280 200405 Stage 4.doc Version 1.30 Page 10 The medication system has just been changed to a method that uses blister packs; staff said that they thought this method would be better and should reduce mistakes. The manager said that the supplying company had provided training for staff and that written guidance was available. A staff member said she had just completed a medication-training course; other staff that administer medication have also been on this course. The group manager said that staff competence assessments are soon to be put in place following any training undertaken. The storage of medication has been improved since the last inspection, but the manager was asked to check the storage temperature for a particular medication. There were errors with regard to administration. The manager was asked to contact the pharmacist the same day to check on discrepancies. Most handwritten entries have now been signed but they should also be witnessed. There were still a number of gaps in the recording of medication record. The medication fridge has been kept defrosted but there should be a thermometer available to record temperatures. The manager is recording controlled drugs in a separate book and said she will be purchasing a bound book as soon as possible. Grenham Bay Court H56-H05 S34959 Grenham Bay Ct V222280 200405 Stage 4.doc Version 1.30 Page 11 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 standard(s) These standards were not inspected at this visit EVIDENCE: Grenham Bay Court H56-H05 S34959 Grenham Bay Ct V222280 200405 Stage 4.doc Version 1.30 Page 12 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 standard(s) 18 The home has not been maintaining systems and staffing levels to ensure the protection of the residents. EVIDENCE: The group manager said she is to attend a course in May 2005 on the Protection of Vulnerable Adults that will enable her to train staff. She is also booked to attend training in non-aversive intervention, also in May 2005. She said that this training would be cascaded to all staff. There was no staff member present in the main lounge/dining area to monitor the well being of residents. The manager said that changes to her duties and the staff roster had meant that this had not been possible in the mornings for the last week; another staff member confirmed that supervision documented in a residents care plan had not been able to be maintained. The group manager said that staffing levels would be increased in the mornings. Grenham Bay Court H56-H05 S34959 Grenham Bay Ct V222280 200405 Stage 4.doc Version 1.30 Page 13 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 standard(s) 19, 26 The home is providing a pleasantly furnished and decorated environment for the residents. The home is not maintaining safe hygiene practice. EVIDENCE: The lounges and dining rooms have been decorated and furnished to a good standard and create a warm and homely environment. The areas seen were in good repair and a maintenance person was working in the home; he carried out a fire system check during the course of the inspection. The residents have a variety of lounge areas to choose from to spend time in. There are notices on cupboard doors containing hazardous products stating they must be kept locked; one of these doors was not being kept locked. The home has procedures in place for the control of infection. A staff member did not follow safe hygiene procedures. The group manager said that more hand washing facilities were going to be provided around the home and more places were to be available where staff could access plastic aprons. Staff must also ensure they do not use the kitchen as a short cut.
Grenham Bay Court H56-H05 S34959 Grenham Bay Ct V222280 200405 Stage 4.doc Version 1.30 Page 14 Grenham Bay Court H56-H05 S34959 Grenham Bay Ct V222280 200405 Stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The staffing level did not meet the needs of the service users at the time of the visit EVIDENCE: The agreed staffing arrangements were not being maintained during the morning shift period. These staffing arrangements had been put in place for the protection of the residents. Arrangements were made straight away to put an extra staff member on duty in the mornings. Grenham Bay Court H56-H05 S34959 Grenham Bay Ct V222280 200405 Stage 4.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 The management of the home has not been maintained to a satisfactory standard. EVIDENCE: A number of requirements and recommendations made at previous inspections are still outstanding, particularly with regard to medication and health care needs. There is going to be a change of role for the manager and she said that she has been provided with good support from the owner and the group manager since she asked to change role. Grenham Bay Court H56-H05 S34959 Grenham Bay Ct V222280 200405 Stage 4.doc Version 1.30 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x 2 STAFFING Standard No Score 27 1 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 1 1 x x x x x x x Grenham Bay Court H56-H05 S34959 Grenham Bay Ct V222280 200405 Stage 4.doc Version 1.30 Page 18 yes 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 7 7 Regulation 15 15 Requirement Review and update of identified care plans (previous timescale of 1 April 2005 not met) Review and update of all care plans (previous timescale of 30 April 2005 extended to 30 June 2005) Review and update of identified risk assessments (previous timescale of 1 April 2005 not met) Review and update of all risk assessments (previous timescale of 30 April 2005 has been extended to 30 June 2005) Health care records to be improved (previous timescale of 31 March 2005 not met) Health care needs must be identified in care plans and risk assessments (previous timescale of 1 April 2005 not met) Associated health risks must be documented (previous timescale of 1 April 2005 not met) All medications to be correctly recorded (previous timescale of 18 March 2005 not met) Medication must be stored at the correct temperature (previous timescale of 7 March 2005 not
H56-H05 S34959 Grenham Bay Ct V222280 200405 Stage 4.doc Timescale for action 30 April 2005 30 June 2005 30 April 2005 30 April 2005 30 April 2005 30 April 2005 30 April 2005 20 April 2005 20 April 2005
Page 19 3. 7 13 4. 7 13 5. 6. 8 8 12 12 7. 8. 9. 8 9 9 12 13 13 Grenham Bay Court Version 1.30 met) 10. 9 13 There must be no gaps in the recording of medication (previous timescale of 8 March 2005 not met) Improved medication practice instruction to staff by Staff to receive appropriate training on behaviour management (previous timescale of 31 March 2005 not met) Hazardous products must be kept locked Correct infection control procedures must be maintained by staff Correct staffing levels must be maintained 20 April 2005 27 April 2005 30 June 2005 20 April 2005 21 April 2005 21 April 2005 11. 12. 9 18 13 18 13. 14. 15. 26 26 27 13 13 18 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 8 9 Good Practice Recommendations Healthcare monitoring charts to be in place Staff competence assessments to be provided for medication Grenham Bay Court H56-H05 S34959 Grenham Bay Ct V222280 200405 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection 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
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