Inspection on 31/08/05 for Grennell Lodge

This inspection was carried out on 31st August 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

Grennell Lodge 11/11/07

Grennell Lodge 15/01/07

Grennell Lodge 15/11/05

Grennell Lodge 02/03/05

Grennell Lodge 08/12/04

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Grennell Lodge 69 All Saints Road Sutton Surrey SM1 3DJ Lead Inspector Michael Williams Unannounced 31 August 2005 st 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 and 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. Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Grennell Lodge Address 69 All Saints Road, Sutton, Surrey, SM1 3DJ 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) 020 8644 7567 020 8644 2921 Care Unlimited Miss Teresita Calama-an Care Home 32 Category(ies) of Mental Disorder (MD), 25 in number aged 18 to registration, with number 65, and Dementia 7. of places Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: YES: In addition to the registration categories 8 specified service users are over the age of 65 years and two specified service users have learning disabilities and are over the age of 65 years. Date of last inspection 2/3/05 Brief Description of the Service: Grennell Lodge is located in the suburbs of Sutton. It is close to local amenities such as shops, newsagents, hairdressers, pubs and post office. There is a local bus service from outside the home, which will take passengers into the centre of Sutton. The home consists of a three-story building, plus a small mezzanine floor and a basement that is used for storage. Bedrooms are situated on all floors (except the basement). A shaft lift serves the basement and the ground, first and second floors, but not the mezzanine floor. There are a number of communal areas, including a smoking lounge, conservatory and a large sitting/dining room. There is garden to the rear of the house, in which there is a second conservatory and an occupational therapy room. The home provides care for 32 residents, 25 in the younger adult mental health category, and 7 in the older person dementia category. There is a mix of single and double bedrooms. Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was conducted from midday onwards and many of the services users contributed their opinions about the service, though none wished to be interviewed at length about the quality of care provided. Several of the management team were in attendance including two of the proprietors and the manager Mrs Calama-an, known more informally by everyone in the home as “Terri”. This is a well established care home that has been providing care for people with a variety of mental health problems for many years. Two main themes emerged; the first was about the home’s shift towards a younger client group, which will require an increased emphasis on rehabilitation work in the home, and secondly safety matters such as the excessive use of a deadlocking mechanism on most doors. What the service does well: What has improved since the last inspection? What they could do better: Whilst the wide ranging age and wide ranging care needs of service users has been seen as an asset it appears that the younger service users tend to accept care rather passively. When asked they said they “just watch television”, whilst it is clear they do more than that it does indicate, and the management team agree, that there needs to be a greater emphasis on rehabilitation, making better use of the excellent facilities in the annexe for example - where service users might practice daily living skills. A number of safety matters arose such as the use of inappropriate door locks in many locations and hazards such as chemicals not locked away and a trailing electrical wire. Medication, the number of tablets held by the home, also needs to accurately noted on medicine charts for auditing purposes. Privacy is also compromised in various locations; no curtain of glazed bedroom doors and unsuitable locks on bathrooms, showers and toilets. Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 6 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. Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Standards Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitablity of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 5 (3 6 for OP) Service users are being assessed prior to admission so as to assure prospective service users that all their health and social care needs can be met when admitted. Contracts are now given to all service users to ensure they know about the terms and conditions of their stay but the home’s own contract is being revised. EVIDENCE: A sample of case notes were checked and service users were observed but in most instances the service users with mental health problems did not wish to discuss their expectations in any great detail and the service users with dementia are quite unable to reflect on the arrangements for their admission. However, staff and the management team were interviewed and they advised the inspector about the arrangements for admission. The pre-admission Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 9 assessments, usually provided by a care manager in the form of a comprehensive assessment, include general information about each service user, details of their background medical and social history and details of specific issues such as mobility, nutrition, diabetes, continence, medication and so forth. From the case files it is clear that the home is well prepared for the admission of new service users, staff are there to meet them and to take down such details as their property list, food likes and dislikes and contact details for next of kin as well as more detailed information about their condition. In almost all cases the service user are funded, at least in part, by their local authority and this funding is sometime subsidised from other sources. The local authority contracts have supplements to add specific details and requirements for the named service user. The home itself has a contract that is used in the case of privately funded service users but this is being revised to ensure it contains all the details listed in the national minimum standards and to meet guidance issued by the Trading Standards Authority, in particular the need for a clearer explanation of fees. Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14, and 33 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 7 9 (7 14 33 for OP) Care Plans are in place for each service user to ensure their health and personal care needs are being met. Staff assist and encourage service users to make choices and to lead as fulfilled lives as they wish or their mental frailty allows. Service users have had individual risk assessments carried out thus enabling them to participate in activities in the home and in the community with appropriate support. EVIDENCE: Individual plans of care are in place for all service users and a sample was checked to confirm this. These documents include the initial assessments from which arise the care plan goals designed to meet the specific health and social Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 11 care needs of service users. These are now being reviewed at monthly intervals as previously required so that any changes and revisions can be made. This is a very supportive and caring establishment, clearly run in the best interests of the service users and service users lead a very relaxed and unhurried lifestyle and this seems to be what they choose. However, the younger service users in particular might benefit from greater involvement in the running of the home to give greater opportunities to make decisions and choices about their own daily lives and the general running of the home. This is dealt with in more detail under standard 11 below. Risk assessments are in place for service users and covers a variety of issues such as health risks and social care risks and more specific hazards such as how they may safely use travel in the community and use community resources. Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experiencd in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11 12 13 15 16 17 (10 12 13 15 for OP) Whilst service users have the opportunity for personal development and are free to lead a lifestyle that matches their expectations a suggestion is made to develop a more intensive rehabilitative programme, for younger service users Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 13 in particular, in order to ensure they encouraged and make better use of the home’s facilities for personal development. Lifestyle: The daily routines in this home are reasonably flexible, within the constraints of a large service, and the range of activities available, including social, religious and recreational opportunities is varied so as to meet the service users’ expectations, preferences and capacities. Community contact: those service users that wish to do so are assisted to maintain contact with the wider community and with their family and friends. No constraints are imposed on service users’ relationships unless in rare circumstances that it is in their best interests to do so and this is confirmed by external professional people such as a psychiatrist. Respect and privacy: When providing personal care staff are ensuring service users’ privacy and dignity is being maintained at all times so that service users feel their right to be treated with respect is upheld. There were however some instances when the service users’ right to privacy is compromised, for example a lack of curtains in some areas, and this is dealt with under environmental standards below. Meals: Service users are receiving a wholesome, appealing and well balanced diet in a congenial setting in accordance with their recorded requirements and preferences but a suggestion is made to offer at least two main choices for the midday meal. EVIDENCE: This home has a most useful resource in the form of an annexe with an open plan kitchen/dining area, toilet and small conservatory. Regrettably it is often locked, for example on the afternoon of the inspection, when greater use could be made of this facility to more effectively meet this standard and give service users increased opportunity to learn, relearn or practice daily living skills. Service users are free to engage in appropriate activities as they may wish so as to lead a lifestyle that suites them. On the day of inspection many service users remained in the home and watched television. Some sought peace and quite in one of the small conservatories set aside for smoking and just few chose to go out. The home has an activity coordinator and a weekly routine of in-house activities is available and is typical for this type of home, music, table-top games, gentle exercise, religious observance and so forth and this aims to met the social, cultural and religious needs of service users. This aspect of care was discussed in some detail because there are instances when service users need support, guidance and close supervision to ensure they are not at risk nor putting others at risk of unwelcome advances and relation ships that are deemed not to be in their best interests. Their case notes reflect the detailed discussions that have taken place to identify these specific needs and risks. In other respects service users are free to maintain and develop social and sexual relationships and they may wish or have the capacity to engage in and examples were given by staff about how this might happen including social events for service users. Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 14 Service users rights are protected in variety of ways, their legal status is made clear in their care plans, if for example they are subject to aftercare under the provisions of the Mental Health Act; they are supported in voting if they wish to exercise their civic rights and. The privacy of service users was however compromised in several ways, some toilets, bathrooms and shower-room did not have suitable door locks and many of the bedrooms have glazed doors with no curtain to ensure their privacy. The existing menu provides a range of homely and wholesome meal and the service users are pleased with the catering in this home which takes into consideration the age group of the service users, their preferences, religious and culture expectations. A suggestion is made to extend the choice of meals. A choice of one main meal is offered plus an alternative “if it is requested”. In addition special meals are provided for vegetarians and others health care needs such as those with diabetes. As this home caters for up to 30 service users a choice of two hot main meals would give greater choice. The wide range of service users is apparent at meal times; most remain in the large open plan lounge/dining area. The more dependent and frail service users remain in the lounge and are assisted to eat whilst the younger residents use the dining area. As an existing home there is limited choice of dining facilities to offer service users a different location to eat if they do not wish to eat in this large communal setting. In some instances it was not possible to audit the medicines held by the home so a recommendation is made to enter on the administration cart the exact number of tablets the home is holding, particularly when tablets are not delivered in dossette boxes. Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 19 20 (8 9 10 for OP) Care is being provided in the way the service users prefer so as to ensure their physical, social and emotional health needs are met. The home has in place procedures for ensuring the safe management of medicines. This includes, where appropriate, support and risk management for service users who wish to be responsible for their own medication so that they may do so safely. EVIDENCE: The care plans provide the primary source for this standard, they outline the care and health needs of service users. During this visit the inspector noted that service users chose where they spent the day, with the exception of the most frail and dependent who spent the day in the front lounge. The other service users had decided for themselves that they will receive support in their own bedrooms or in the conservatory; some wished to be alone whilst other sought the companionship of other service users. Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 16 Samples of case files were inspected to check how the care of service users is planned. In addition to the on site care and nursing staff the records show that specialists such as psychiatrists and General Practitioners are asked to provide health care when necessary. That some service users have made noticeable improvements in their physical and mental health, as noted in care reviews and the manager’s comments, indicates the home is able to met the needs of service users. In respect of medication, Medicine are usually administered by the care staff; rarely do service wish to hold and administer medication themselves but that can do so if they wish and will be supported to deal with their medicines safely. Of critical importance in this care home are the medicines taken by people with mental health problems, several service users confirmed that they dislike some of the side-effects but understand the importance of taking the prescribed medication regularly and they know they must keep in touch with their doctor, who monitors their response to medication, and they also confirmed this was the case. Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16, 18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are sageguarded. (OP NMS 35) The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 16, 18 and 35 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 23 (16 18 35 for OP) The key standards in this section, about complaints and protection, are 22 and 23 for Younger Adults (and 16, 18 and 35 for Older People) and not as highlighted above. Arrangements are in place for service users and their representatives to either complain or compliment the service. Effective procedures are in place to deal with complaints in a timely and professional manner. Policies and procedures are in place to ensure the protect service users from abuse. EVIDENCE: A record of complaints is in place. One complaint was sent anonymously to the CSCI about staffing levels and the care of service users. The issue of staffing is dealt with under the staffing section of this report and other matters were not substantiated. No other complaints are recorded in the home’s record of complaints and none arose during the course of the inspection. No matters have required to be dealt with under the procedures for dealing with the protection of vulnerable adults. In contrast several compliments were paid to the home by appreciative service users. Staff told the inspector that they have been given instructions about how they must conduct themselves - with respect for service users and staff have also received instructions about how to deal with allegations of abuse – by reporting it without delay; this includes a ‘whistle blowing’ policy if it proves Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 18 necessary to report their concerns to appropriate bodies outside their own organisation. The home has a copy of the local authority’s procedures for dealing with allegations of abuse. The management team has given staff a copy of the GSCC [General Social Care Council] Code of Conduct. Staff interviewed by the inspector were aware of the local procedures for reporting allegations of abuse. Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 19 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 27 30 (19 21 26 for OP) Premises: The layout of the home and the manner in which it is being maintained means that this is a safe, comfortable and suitable environment for the service users. There were however a number of matters requiring attention and they are outlined below. Hygiene: The premises are being kept clean, hygienic and free from offensive odours and systems are in pace to control the spread of infection. Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 20 EVIDENCE: Grennell Lodge is an “existing” home (one that was registered before 2002). Whilst a number of service users share a bedroom in this home it has been argued by some authorities that it is helpful for older people suffering dementia to share a bedroom. It will be for relatives and care managers to decide if this applies in individual cases. The home was neat and tidy and bedrooms are particularly well decorated with nice wallpaper, curtains and well constructed furniture. There is a homely atmosphere although the labyrinth of rooms can be a little confusing. A number of matters that need to be attended to under this heading include the need for all door locks to be reviewed. This process is already underway (at final exits) following the advice of the Fire Authority but all other door fittings need to checked for safety and privacy. ‘Star’ bolts, which use a universal key, are in use throughout the home and they are unsuitable in almost all cases. They are unsuitable in bedrooms because service users must be able to lock their door but leave without the use of key; they are unsuitable in doors leading to exits because they will impede egress. They are not suitable for most cupboards and sluice rooms because staff may forget to lock the door, as they did on the day of inspection. Those locks that may affect the safety of service users are reiterated in standard 42 and a requirement is made to address this matter without delay whilst locks that affect the privacy to which service users are entitled are dealt with under standard 27 in this section and again a requirement is made to provide more suitable locking mechanisms. Curtains need to be hung on bedroom doors that are glazed and in the few shared room that do not already have privacy curtains. The large number of signs instructing staff are unsightly and not suitable this type of care establishment - and some may compromise the dignity of service users when they display information about the service user. The home is generally maintained in very good order and it was clean, tidy and free of offensive odours when inspected. Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 21 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 34 and 35 (Adults 18-65) and Standards 27,29 and 30 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 34 35 (27 29 30 for OP) Recruitment: The required procedures are in place to ensure recruitment of staff protects service users. Training: The home has a staff induction, training, support and supervision regime in place to ensure they are competent in their jobs. Staff levels: The manager gave an assurance that the number of staff on duty and their skill mix are appropriate to the assessed needs of the current service users in this home - this ensures that their needs are being met. Minimum staffing levels for this home are under review by the CSCI. EVIDENCE: As an existing care home staffing levels are to be no less that proscribed by the previous registering authority. On the day of inspection it was noted that for 27 service users there were two registered Nurses and 4 carers, two of Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 22 whom were designated as senior carers. In addition there was the manager, who is also a Nurse, her personal assistant, ancillary staff such the cook and cleaners and from headquarters two personnel staff. Two proprietors also attended during the inspection. Also on site were maintenance workers. The manager states that there were sufficient ‘hands-on’ carers available to meet the needs of the current service users and that appeared to be the case but the local CSCI office is at present re-evaluating the minimum staffing levels required for this home which unusually has mixed registration categories. However, it was also noted, in respect of standard 33, that two nurses who due to be on duty for the afternoon shift were unable to attend but the manager did not replace them, instead she and the morning nurse intended to work long shifts to cover the shortfall; a requirement is made for the company to ensure it has adequate staff arrangements in place including suitable backup procedures to deal with such unplanned absences. The quality assurance officer was present during the inspection and she provided details of the training schedule for staff, which the staff themselves confirmed was available to them. In addition to basic and general training such as first aid, moving and handling, food hygiene, fire safety training and so forth staff have also undergone training specific to the service user group including care of older people and mental health training. Staff training is therefore to a satisfactory standard. Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 39 and 42 (Adults 18-65) and Standards 33,35 and 38 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 40 42 (33 37 38 for OP) This is a well- managed care home and the kind, caring ethos of this home was apparent throughout the inspection. It is clear the best interests of the service users are central to the running of this home and their views are seen as paramount. Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 24 Policies and procedures are efficiently organised and record keeping sound thus ensuring the administration in this home will safeguard service users’ interests. Health and safety: The home is ensuring that in so far as it is reasonably practical to do so, the health, safety and welfare of service users and staff is being promoted and protected but a number of matters of safety do need to be addressed, these are listed below. EVIDENCE: Whilst record is proficient two need to be improved, the medication record must provide enough detail to audit medication, by entering the number of tablets held by the home on the administration chart (this is dealt with under standard 20 above). The food record also needs to be more detailed so that the CSCI can assess from time whether or not service users are receiving an adequate diet (this is dealt with under standard 17 above). Unsuitable door locks, particularly bedroom doors; chemicals not locked away; vacuum cleaner blocking fire exit; trailing cable; bedrooms doors wedged open (despite having a magnetic door holder); access to roof space in service user bedroom is not locked. In addition to these specific problems in the home a number of safety certificates need to renewed including gas, electrical portable appliances and the six monthly passenger lift ‘thorough examination’ (if this has not already been done). Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 25 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x 3 Standard No 22 23 Score x x Score ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x 2 3 3 x 3 2 2 Standard No 24 25 26 27 28 29 30 STAFFING 3 x x 2 x x 3 Score 11 12 13 14 15 16 17 Standard No 31 32 33 34 35 36 x x 2 3 3 x x x 3 3 x 1 x Version 1.40 Page 26 CONDUCT & MANAGEMENT PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Grennell Lodge Score 3 3 2 x 37 38 39 40 41 42 43 G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 16 and 27 Regulation 12(4)(a) Requirement Privacy: the home must conduct the home in a manner that respects the privacy and dignity of service including the provision of curtains on bedroom doors and in shared bedrooms. Privacy: the home must conduct the home in a manner that respects the privacy and dignity of service including the provison of suitable door locks to all toilets, bathrooms and showerrooms. Medication: a note must be made of the number of tablets held by the home, on each chart, when medication is not in dosette packs. Staffing: The home must ensure that at all times there are staff in such numbers and suitably qualified and experienced to meet the needs of services users and in particular there must be adequate arrangements to replace staff who are absent without relying upon staff working excessivley long shifts. Health & Safety: The home must be coducted so as to protect service users from hazards: Timescale for action 30/10/05 2. 16 and 27 12(4)(a) 30/10/05 3. 20 13(2) 30/9/05 4. 33 18(1)(a) 30/10/05 5. 42 13(4)(a) 30/9/05 Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 27 6. 7. 42 42 13(4)(a) 13(4)(a) 8. 9. 42 42 13(4)(a) 23(4) 23(2) deadlcoks must not be used in any locations that would impede exit including bedroom doors and doors leading to exits. Health & Safety: Chemicals must be held safely in locked facilities. Health & Safety: The home must ensure hazards are avoided including trailing wires and equipment blocking exits. Fire Safety: fire doors must not be wedged open. Maintenance: equipment must be serviced and safety certificates issued at the proscribed intervals, including gas, electrical portable appliances and pasenger lift. 30/9/05 30/9/05 30/9/05 30/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 11 Good Practice Recommendations Personal Development: It is recommended that staff increase the opportunities for service users to maintain and develop social, emotional, communication and independent living skills. Meals: It is recommended that for the midday meal a minimum of two main choices are offered in addition to any other special meals; a record of those meals must be maintained in accordance with Schedule 4(13). 2. 17 and 41 Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 28 Commission for Social Care Inspection CSCI 8th Floor, Grosvenor House 125 High Street, Croydon CR0 9XP 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. Grennell Lodge G53-G53 S19093 grennell lodge V221885 310805 stage 4.doc Version 1.40 Page 29 - 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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