Inspection on 13/02/06 for Gresham Care Home

This inspection was carried out on 13th 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

Gresham Care Home 17/04/07

Gresham Care Home 07/11/06

Gresham Care Home 13/06/05

Gresham Care Home 18/01/05

Gresham Care Home 19/08/04

Gresham Care Home 03/02/04

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

CARE HOMES FOR OLDER PEOPLE Gresham Care Home 49 John Road Gorleston Norfolk NR31 6LJ Lead Inspector Maggie Prettyman Unannounced Inspection 13th February 2006 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Gresham Care Home DS0000015640.V282793.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 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. Gresham Care Home DS0000015640.V282793.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Gresham Care Home Address 49 John Road Gorleston Norfolk NR31 6LJ 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) 01493 661670 01493 658735 Mr. Naim Mohammud Ruhomutally Mrs. Vidia Ruhomutally Care Home 28 Category(ies) of Dementia - over 65 years of age (11), Old age, registration, with number not falling within any other category (28) of places Gresham Care Home DS0000015640.V282793.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Twenty eight (28) Older People may be accommodated. Eleven (11) service users may be accommodated within the categories of DE(E) or DE. From time to time the home may accommodate up to two service users under the age of 65 years. Total number not to exceed twenty-eight (28). Date of last inspection 13th June 2005 Brief Description of the Service: Gresham Care Home is a home that provides care with nursing to a maximum of 28 service users. Accommodation is situated on the ground and first floor in single and double rooms. There is a large lounge with a dining room attached and a small quieter lounge for those that prefer it. The home is situated close to Gorleston seafront and to the high street with shops and other facilities available within walking distance. Gresham Care Home DS0000015640.V282793.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A single inspector undertook this unannounced inspection on a busy Monday at the home. To gain evidence for the report, the inspector interviewed 14 service users and 10 visitors including relatives, friends and a visiting GP and speech therapist. Training records, staff and service user files and medication records were examined. Many standards were inspected, of those inspected, not all elements may have been examined. The home has a warm and friendly atmosphere and has a positive and cheerful feel. Despite the high level of dependency of many service users, the home was found to be clean and fresh, with all private and communal areas tidy and well organised. The manager and her team are to be commended on standards within the home, which is run in a professional, friendly and inclusive manner. The inspector would like to thank those working and living in the home for their hospitality and positive input into the compilation of this report. What the service does well: A full and comprehensive needs assessment is undertaken prior to admission of any new service user. Detailed individual health and social care plans are devised from information from a wide range of sources including the service user and their family. Service user health care needs are fully met. Service users are protected by an efficient and well-run system of medication administration. Service users are treated with respect and their privacy is upheld. People who are dying are treated with sensitivity and respect. The lifestyle of the home matches the expectations and wishes of service users. Social and cultural needs are met. Community contact is maintained where possible. Service users are able to exercise autonomy and control. Wholesome and appetising food is served in the surroundings of choice of service users. Very few serious complaints have ever been made by service users or their representatives. Service users are protected from abuse neglect and self-harm. The home is a safe and well-maintained environment, which is hygienic, clean and pleasant. Gresham Care Home DS0000015640.V282793.R01.S.doc Version 5.1 Page 6 A range of staff skills and abilities meets Service user needs. A strong emphasis on training and development exists within the home. The manager is a competent and capable person well suited to the demands of the home. Safe working practices and procedures are in place. 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. Gresham Care Home DS0000015640.V282793.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gresham Care Home DS0000015640.V282793.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users requiring intermediate care are not currently being admitted. EVIDENCE: A full and detailed assessment of each prospective service users needs is undertaken by the manager prior to any admission. Evidence of these assessments was seen in individual service user files. The manager consults with the service user, their family or representatives as appropriate, and involved social and health care professionals to gain a full overview of the needs of the prospective service user. In house documentation seen meets and exceeds the requirements of the standards. Full details of nursing, personal and social care input are recorded and form the basis of a daily living plan and personal goals. Changes in referred service users, and difficulty accessing adequate O.T. support mean that the home is not currently accommodating people needing intermediate care. Gresham Care Home DS0000015640.V282793.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9, 10 and 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 are protected by the homes’ policies and procedures for dealing with medicines. Service users feel that they are treated with respect and that 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. Gresham Care Home DS0000015640.V282793.R01.S.doc Version 5.1 Page 10 EVIDENCE: Evidence of comprehensive and regularly reviewed care plans and risk assessments was seen during the inspection. The home works hard to fully meet the needs of service users. Evidence of many items of specialist equipment to meet the differing and changing needs of service user was seen. Input from specialist nurses is regularly sought as appropriate. Service users and relatives spoken to confirmed that their opinion and involvement is sought in all aspects of the care plan. The nursing standards provided by the home are clearly exemplary. A visiting GP confirmed that the nursing and personal care provided by the home is consistent and enables service users to regain health lost in other settings. The home is proactive in the management of pressure sores, promotes continence, monitors the weight of service users and provides access to specialist services such as chiropody and hearing services. Evidence of these aspects of the standards was seen in individual files, as well as during discussion with service users and their relatives. The registered nurse on duty administers all medication in the home. Pare of the lunchtime drugs round was observed. A good standard of storage and handling of medication was seen. Medicine charts were checked for accuracy and completion. A controlled drugs register and storage facility exists. At the time of inspection, no controlled drugs were in use. Medication is regularly reviewed. A private contractor is used to dispose of unwanted medication. Interviews with service users and their families demonstrated that privacy and dignity is upheld at all times and in all circumstances. Details of people’s name of choice were seen on individual rooms. Service users have their own clothes and were dressed in ways of their own choice. Several service users were spoken to who prefer to spend time in their own rooms, and this individual choice is supported by the home. Suitable screening was seen in shared rooms to preserve privacy. Management of palliative care was discussed with the manager. The description given included use of appropriate pain relief, dignity, comfort and company, spiritual support if desired, privacy, and the appropriate involvement of family and friends. Those service users without close family and friends have their wishes discussed with them, and on occasion have taken out appropriate plans to ensure their requirements are met. Gresham Care Home DS0000015640.V282793.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14 and 15 Service users find their lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users retain their family and community contacts. Service users are helped to exercise choice and control in their lives. Service users receive a wholesome, appealing balanced diet in pleasing surroundings at times convenient to them. EVIDENCE: The routines of the home are necessarily structured because of the high dependency needs of service users. Within this structure however, service users confirmed that their daily lives and activities are flexible if they wish. Several people come into the home to offer entertainment and activities, and evidence of care staff regularly playing cards and undertaking individual activities with service users was seen. Good contact is maintained with local churches, with people attending services as wished and ministers visiting when requested. Gresham Care Home DS0000015640.V282793.R01.S.doc Version 5.1 Page 12 During the inspection, many visitors were seen. They confirmed that the home is a warm and welcoming place and that their visits are encouraged and not placed under any restriction. One service user is being supported to access community links with their own culture with a 1:1 worker. As far as possible service users are able to exercise choice and control. The home does not hold or manage money on anyone’s’ behalf. The detailed needs assessment undertaken prior to admission ensures that individual choice and taste is recorded. Records of food likes and dislikes are given to the chef, and meals are served on individual trays to ensure that people get the food of their choice. Without exception, all service users and their relatives spoke highly of the chef and the standard of food and choice that is available. Nutrition takes a high priority with the manager, with an understanding of its impact on long-term health and recovery from illness. During the inspection the individual nature of food provided and the individual care and support given by care workers during mealtimes was observed, and seen to be of the highest standards. When needed appropriate advice and support is provided by a dietician. Gresham Care Home DS0000015640.V282793.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse. EVIDENCE: Discussion with service users and their relatives demonstrated that there is a very high level of satisfaction with the home and the services that it provides. Minor day-to-day issues are dealt with efficiently, with the manager and staff ready to listen and to effect change if necessary. The complaints procedure is available in the hallway of the home. Very few formal complaints have been received, with none in the past twelve months. Many cards and letters of thanks were seen in the hallway. The manager will place records of individual compliments in workers files in future. The home is well supervised and monitored to ensure consistent good practice and protection from abuse. Since the last inspection there has been further training in adult protection as recommended. The staff team is long term and stable, with confidence in whistle blowing. The home does not currently accommodate service users with behaviour that challenges, because of the potential risk to the frail and vulnerable members of the existing service user group. Gresham Care Home DS0000015640.V282793.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Service users live in a safe, well-maintained environment. The home is clean, pleasant and hygienic. EVIDENCE: The layout of the home and its layout are suitable for its purpose. The areas within the home were found to be accessible and well maintained. The inspector saw many items of individual furniture and pictures, which make the home comfortable and homely. The home was tidy and well maintained. The home was seen to be clean, pleasant and hygienic. Laundry facilities are well organised with an effective system of sorting individual service users clothes. The washing machine is of an industrial nature with appropriate wash programmes for the range of washing required by the home. Gresham Care Home DS0000015640.V282793.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The numbers and skill mix of staff meets service users’ needs. Service users are in safe hands at all times. The homes recruitment policy could be strengthened in terms of validating references. Staff are trained and competent to do their jobs. EVIDENCE: During the inspection there was a high level of staffing observed in the home. Qualified nursing staff and care staff were on duty, along with domestic and catering staff. Agency staff are not used. The long-term stable staff team have enough flexibility to cover both planned and unplanned absence. The home runs with good numbers of competent qualified and trained staff. Evidence of regular and consistent training was seen. Staff files were examined and met the standards. However following discussion, the manager decided to further strengthen the recruitment procedure by validation of references. Gresham Care Home DS0000015640.V282793.R01.S.doc Version 5.1 Page 16 Since the last inspection more care staff have been accepted on to NVQ level 2 and 3 courses. Staff receive recognition of training by enhanced pay and responsibility. Training records were seen, and it is clear that a great emphasis is put on constantly training and updating of skills at all levels in the home. The induction-training programme was seen, and found to be of a high standard. Gresham Care Home DS0000015640.V282793.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 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 her responsibilities fully. The home is run in the best interests of the service users. Service users’ financial interests are safeguarded. The health, safety and welfare of service users and staff are promoted and protected. Gresham Care Home DS0000015640.V282793.R01.S.doc Version 5.1 Page 18 EVIDENCE: The manager of the home demonstrated during the inspection her absolute commitment to the running of a quality service. She is qualified, experienced, competent and has high expectations of her staff. She leads by example and service users and visitors confirmed her dedication to the home and its service users and staff. The manager is not only a qualified nurse but has numerous other training qualifications including an NVQ Level4 in Management as required by the standards. Her own training is updated as well as that of her staff team. Discussion with service users and their visitors demonstrated that the home is run in the best interests of service users at all times. Informal review and monitoring of satisfaction of service users is an integral feature of daily life in the home. Some quality questionnaires and individual testimonials are available for inspection. The home could improve its quality procedures by formalising an annual quality survey, and writing a report that current and prospective service users and their families could read. The home does not hold or manage money on behalf of any service users. Secure facilities are available in each room for personal items and money to be kept. Safe working practices were observed during the inspection. Hoists and other specialised equipment are in place and regularly maintained by external contractors. Risk assessments for individual service users were seen in care plans. Water temperatures are checked weekly, the record book was unavailable for inspection due to the handyman being off the premises. Hazardous materials were seen to be safely stored. Records of recent fire drills and fire safety training were seen. The building was secure, and corridors were free of any rubbish or obstruction. Gresham Care Home DS0000015640.V282793.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Gresham Care Home DS0000015640.V282793.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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. 3. Refer to Standard OP16 OP29 OP33 Good Practice Recommendations Compliments about individual staff practice could be recorded in individual files. References should be validated prior to acceptance. An annual formalised quality service may benefit prospective service users and their families. Gresham Care Home DS0000015640.V282793.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Gresham Care Home DS0000015640.V282793.R01.S.doc Version 5.1 Page 22 - 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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