Inspection on 13/06/05 for Gresham Care Home

This inspection was carried out on 13th June 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

Gresham Care Home 17/04/07

Gresham Care Home 07/11/06

Gresham Care Home 13/02/06

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 Hilda Stephenson Announced 13 June 2005 9.30am 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. Gresham Care Home I55 S15640 Gresham V225238 130605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Gresham Care Home Address 49 John Road Gorleston Norfolk NR31 6LJ 01493 661670 01493 658735 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) Mr Naim Mohammud Ruhomutally Mrs Vidia Ruhomutally Care Home 28 Category(ies) of Old Age (28) registration, with number of places Gresham Care Home I55 S15640 Gresham V225238 130605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Twenty eight (28) Older People may be accommodated. 2. The total number not to exceed twenty eight (28). Date of last inspection 18 January 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 I55 S15640 Gresham V225238 130605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit to Gresham Care Home took place during the day on 13th June 05 as an announced inspection. The evidence gathered to publish this report was obtained by speaking to nine of the twenty five residents, nine visitors, both proprietors, seven staff, checking through care records, policies and procedures and comments received through the numerous comment cards that were returned to the office prior to the visit. The home was found to be clean, tidy and free from odour. The majority of residents were either in their bedrooms or sitting in the lounge areas, with several entertaining visitors. The home provides both nursing, residential and re-enablement facilities within the twenty-eight places. What the service does well: The proprietors are both trained nurses and are supported to manage the home by a loyal team of staff. The standard of care within the home is good with the proprietors developing a balance between good training and support for both the care and nursing staff. They have invested in providing specialist equipment to enable the residents to be cared for adequately to ensure that nutritional needs, pain relief and pressure care is in place for those who are frail, within a homely environment. The home has an ‘open’ policy for the inclusion of views from residents and relatives, this was observed by the number of visitors seen during the day, with comments provided by relatives ‘they cannot get better care anywhere else’. There is also a section of the home that provides facilities for up to two residents who require re-enablement back into the community. Gresham Care Home I55 S15640 Gresham V225238 130605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Gresham Care Home I55 S15640 Gresham V225238 130605 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 Gresham Care Home I55 S15640 Gresham V225238 130605 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) 1,2,3,4,5,6 Written information is given to residents prior to admission to define the facilities offered at the home. All residents are admitted after an assessment of their needs. The home offers intermediate care for up to two residents for a period of six weeks. EVIDENCE: The proprietors send out their own brochure to residents who enquire about the home. The proprietor goes to assess their care and nursing needs and visits residents who wish to move in. Copies of the assessment documents were seen and contained in-depth details regarding the daily living activities. The statement of purpose and guide and terms of residency is explained to residents or their relatives during this initial visit. Copies are displayed in the entrance hall and left in bedrooms for residents to read. Gresham Care Home I55 S15640 Gresham V225238 130605 Stage 4.doc Version 1.30 Page 9 The proprietor encourages the resident or their relative to visit the home prior to admission so they can see their room beforehand. Several residents who spoke to the Inspector knew the home beforehand and just moved straight in. Each resident is offered to stay for a trial period for a month when a review meeting takes place and the resident can make their mind up whether they wish to stay, and whether the home can meet their individual needs. The home offers independent living within the re-enablement unit that can accommodate up to two residents who wish to go back home or to sheltered accommodation. The facilities include a separate lounge and kitchen area. Care staff and an occupational therapist assist the residents with their daily living activities as well as supervising the residents. One of the residents who was using this facility stated ‘the staff help me with my clothes and when I want to make a cup of tea, so I can get back on my feet, to go home again’. The re-enablement terms of residency can accommodate residents for up to six weeks to assist them in gaining confidence to go back home. Gresham Care Home I55 S15640 Gresham V225238 130605 Stage 4.doc Version 1.30 Page 10 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) 7,8,9,10,11 Care plans and health needs of residents are identified, reviewed and are met, with knowledgeable staff having a good understanding of the residents needs. Safe procedures are in place for the administration of medicines. EVIDENCE: Three care plans were examined during this visit for two residents with nursing needs and one of the re-enablement residents. The Proprietor devises the care plans after admission with help from the resident or a close relative to ensure that all details are recorded. The care plans were detailed containing personal, health, nursing, and social needs, with risk assessments written to ensure that residents overall lifestyle had been reviewed. One resident stated ‘I was asked my opinion when I first came here, and I am happy and content’. Gresham Care Home I55 S15640 Gresham V225238 130605 Stage 4.doc Version 1.30 Page 11 The care plans are reviewed each month to measure the quality of care given. The home has purchased several air mattresses and other pieces of equipment to continue to care for frailer dependent residents to ensure skin remains intact. The home has a good history for treating and caring for residents who are admitted with pressure sores. The Proprietors keep up to date with current nursing trends and ask specialist nurses to visit to update their own nurses skills. This is extremely good practice; the last training was on palliative care and pain management for those who are dying. The home is supported by the local GP practices and residents are encouraged to register with a local surgery. The policies for the dying were read and the home can accommodate residents with different religious or spiritualist needs. Several letters and cards were seen from past visitors with one stating ‘I cannot thank the staff enough for the care and support they gave me and my mother’. As far as it was able to tell, taking into account the comments from several relatives, the home cares and supports those who are dying meeting their final wishes. The home has a safe procedure in place for the storage and administration of medicines. The trained nurse demonstrated the medication procedure and explained the policy. There is a safe procedure in place for residents who wish to self-administer with lockable facilities for storing medicines, taking into account any risks. The medication including controlled drugs are administered by trained nurses who also oversee the ordering and returning of medicines, some records were seen and found to be satisfactory. Gresham Care Home I55 S15640 Gresham V225238 130605 Stage 4.doc Version 1.30 Page 12 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) 12,13,14,15 Social activities are well managed with several group and individual interests for residents living in the home, with lunch and teatime included as a sociable event. Residents are offered a varied and wholesome menu. EVIDENCE: During this visit it was observed that several residents were entertaining their visitors. Some residents were sitting in the lounge while others preferred to stay in their own rooms. The home has a visitor who organises individual games or chats with residents, offering cards, dominoes, chatting about past events or current affairs. A musician visits once a week to play the piano and organises singing sessions. The Proprietor organises outings such as shopping trips, rides to the seaside, or local attractions. It was evident that the home has many visitors and several commented that they like to help with these outings and parties, one stating ‘It makes me feel like part of the home when I help’. Comments received from residents indicated that they choose when they want to go to bed or what they would like for their meal, and this individual information is included within the care plans. Gresham Care Home I55 S15640 Gresham V225238 130605 Stage 4.doc Version 1.30 Page 13 A chef is in the kitchen during the day, the kitchen was clean and lunch was being prepared during the tour of the premises. Copies of the menu were supplied and contained a wide variation of meals taking into account seasonal changes and special occasions such as birthdays. The main lounge contains dining facilities, which was used by a few residents, although the majority used the individual tables provided in front of them or ate in their rooms. Staff were very discreet when assisting residents with their lunch and drinks. The two re-enablement residents have their main meal in the home but can cook a meal if this is included as part of their routine. One resident stated ‘the food always smells good’ and another stated ‘my appetite was poor until I came here’. The chef caters for special diets including a vegetarian, diabetic and soft foods and has a list of residents’ preferences. The Proprietor takes advice from a dietician when a resident has no appetite or requires input with their nutritional needs, which is good practice. Gresham Care Home I55 S15640 Gresham V225238 130605 Stage 4.doc Version 1.30 Page 14 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) 16,17,18 The home has a satisfactory complaints system with evidence that residents’ views are listened to and acted upon. EVIDENCE: Several visitors were spoken to during this visit and the majority stating that they would speak to the Proprietor if they had a complaint. A copy of the complaints procedure was on display in the entrance hall and included within the documents given out during admission. There have been no complaints since the previous inspection. Any complaints are investigated using the complaints procedure and the Proprietors continue to seek residents and relatives opinions throughout the year either verbally or through a questionnaire. This proves the home is managed in an ‘open and inclusive’ manner. No complaints were received during this visit. Evidence was seen that residents’ legal rights are protected with several using the postal voting system at the previous election, and several have input from an advocate. A procedure for responding to allegations of abuse is in place, although some staff would benefit from updating their knowledge on adult protection training. Gresham Care Home I55 S15640 Gresham V225238 130605 Stage 4.doc Version 1.30 Page 15 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) 19,20,21,22,23,24,25,26 The residents live in a well maintained environment. The home was clean and tidy and has well maintained gardens. The bedrooms contain residents’ personal possessions and are tastefully decorated. EVIDENCE: The premises consist of a two-storey building with an extension added in recent years. The building is surrounded by well-maintained gardens with a recent patio for wheelchairs users to access the garden from the lounge. In general the Proprietors decorate the bedrooms when they become vacant. The home smelled pleasant and was cleaned daily. Gresham Care Home I55 S15640 Gresham V225238 130605 Stage 4.doc Version 1.30 Page 16 The residents’ bedrooms looked homely with the majority containing personal items and furniture, there is a mix of single and shared bedrooms throughout. There is a separate lounge and small kitchen for the use of the re-enablement residents. The home carries out all of their own laundry and residents’ personal laundry by a dedicated member of staff. Gresham Care Home I55 S15640 Gresham V225238 130605 Stage 4.doc Version 1.30 Page 17 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) 27,28,29,30 Sufficient numbers of staff are on duty to meet residents’ needs with extra staff brought in to cover busy periods. Good recruitment procedures are in place. EVIDENCE: Copies of the rota were provided prior to the inspection with evidence that four care staff and one trained nurse is on duty during the day reducing to three care and one trained nurse in the afternoon, with two care staff and one trained nurse overnight. An extra member of staff is brought in to cover busy periods and special events. Both Proprietors also work at the home. There is a chef on duty during the day with an extra member of staff to cover the tea time period, which is good practice. Domestic staff clean the home each day. Gresham Care Home I55 S15640 Gresham V225238 130605 Stage 4.doc Version 1.30 Page 18 Staff files were checked and the Proprietors ensure safe practices when recruiting new staff, ensuring they follow the homes own induction training programme. The mandatory training is carried out by the Proprietors organising special interest training for both nurses and care staff such as pain management, nutritional needs in cancer care and supervising syringe drivers, as well as first aid, food hygiene, moving and handling and infection control. One of the Proprietors is a moving and handling trainer and includes staff from other homes with any ‘in house’ training and should be commended for this. The numbers of care staff who have the NVQ training have reduced and the Proprietors should encourage care staff to undergo the recommended NVQ level 2 training in care. Gresham Care Home I55 S15640 Gresham V225238 130605 Stage 4.doc Version 1.30 Page 19 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) 31,32,33,36,37,38 The home is well managed by both Proprietors with both residents and staff’s views listened to and acted upon. Resident’s best interests are safeguarded. EVIDENCE: Both Proprietors are trained nurses and manage the home between them. They attend training courses to keep their own skills up to date and regularly hold training courses within the home inviting other care home staff to join in. Regular staff meetings are organised throughout the year, and staff attend supervision sessions with the Proprietors to check their progress and training or personal issues. The home is run in an ‘open and inclusive’ manner, feedback received from the numerous comment cards received prior to the inspection and comments received from the nine relatives who spoke during the inspection confirmed this. Gresham Care Home I55 S15640 Gresham V225238 130605 Stage 4.doc Version 1.30 Page 20 The Proprietors support the trained nurses to achieve their professional PREP requirements to keep their skills up to date, this was seen when examining some of the nurses records. A quality assurance system is in place with care reviews taking place, staff supervision and training and questionnaires given out to visitors and residents as well as verbal feedback during meetings. A copy of last years published report was seen and should be commended on how the home monitors the standard of care. A sample of health and safety procedures was checked including fire records, monitoring accidents, staff training, risk assessments and infection control which were all satisfactory. The regulatory records were also checked with no requirements outstanding from both the fire and EHO inspections. The water, central heating and radiators, fire equipment and specialist equipment and the upstairs windows were also satisfactory. The registration and insurance certificate was valid and displayed in the entrance hall. Overall, the home is managed in a safe and satisfactory manner putting residents and staff’s health and safety first. Gresham Care Home I55 S15640 Gresham V225238 130605 Stage 4.doc Version 1.30 Page 21 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 3 3 4 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 2 3 3 4 x x 3 3 3 Gresham Care Home I55 S15640 Gresham V225238 130605 Stage 4.doc Version 1.30 Page 22 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 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. Refer to Standard 18 28 Good Practice Recommendations Staff should update their Adult Protection training in line with the new legislation of Protection of Vulnerable Adults POVA. The Proprietors should encourage care staff to undertake the recommended NVQ 2 training in care. Gresham Care Home I55 S15640 Gresham V225238 130605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 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 I55 S15640 Gresham V225238 130605 Stage 4.doc Version 1.30 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!