Inspection on 17/04/07 for Gresham Care Home

This inspection was carried out on 17th April 2007.

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 07/11/06

Gresham Care Home 13/02/06

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 Hilda Stephenson Unannounced Inspection 17th April 2007 09:30 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.V336627.R01.S.doc Version 5.2 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.V336627.R01.S.doc Version 5.2 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 greshamcarehome@internet.com shahaza@hotmail.com Mr. Naim Mohammud Ruhomutally Mrs. Vidia Ruhomutally Not applicable 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.V336627.R01.S.doc Version 5.2 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 7th November 2006 Brief Description of the Service: Gresham Care Home is a service 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.V336627.R01.S.doc Version 5.2 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 17th April 2007 as an unannounced inspection to check the key standards The evidence gathered to publish this report was obtained by speaking to six of the twenty six residents, three visitors, both proprietors, four 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. Despite the high level of dependence of most of the residents the majority were either in their bedrooms or sitting in the lounge areas, with several entertaining visitors. What the service does well: The proprietor and her team of staff displayed a very positive friendly attitude towards the residents and their families and should be commended on the standards of care. A full assessment of healthcare needs is undertaken prior to a resident being admitted to the home to ensure that the home can meet their individual care. The proprietors provide 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 such as ‘they cannot get better care anywhere else’. The home was clean with comfortable furnishings throughout. Staff are well trained and competent to care for residents; a trained nurse is on duty throughout the twenty-four hour day. Both proprietors are trained nurses and are supported by a consistent staff team. Gresham Care Home DS0000015640.V336627.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Gresham Care Home DS0000015640.V336627.R01.S.doc Version 5.2 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.V336627.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. Key standards 3 & 6 were inspected. All residents’ individual needs are assessed before moving into the home so staff know what support people need. EVIDENCE: Two residents were chosen at random to have their files case tracked. These confirmed that they were both visited by the proprietor who discussed the process of moving into the home. The files of the two named residents were checked and contained evidence that assessments of their individual needs were agreed upon prior to admission. The majority of residents had been referred to the home by Social Services. 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. Gresham Care Home DS0000015640.V336627.R01.S.doc Version 5.2 Page 9 Each resident is offered to stay for a trial period of 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 tends not to take short-term residents although arrangements have been made previously to care for those who require palliative care. Gresham Care Home DS0000015640.V336627.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. Key standards 7,8,9 & 10 were inspected. The residents’ health care needs are generally met. EVIDENCE: Two residents care plans were thoroughly examined and found to contain clear, concise information regarding the physical, mental and social needs of each individual. Each of the care plans contained risk assessments in relation to their moving and handling needs, medication involvement, with indicators in place to monitor nutritional needs by assessing pressure care, weight management and the home is proactive in the management of continence. Residents and their relatives spoken to confirmed that they were regularly kept up to date with their care needs and written aspects of the care plans. Evidence of specialist services such as chiropody, hearing, dental and psychiatric services were regularly sought for those who required these. Gresham Care Home DS0000015640.V336627.R01.S.doc Version 5.2 Page 11 The proprietor explained that expertise from the community nurses was sought when specialist pressure equipment was required. The trained nurse on duty administers all medication and the lunchtime round was partially observed. The medication records were checked for the two residents involved with case tracking and found to be accurate. Since the previous inspection the home has implemented the recommendation for the GP to acknowledge when residents require a change in their medication route. Residents confirmed that the staff at the home uphold their privacy and dignity at all times, assisting them back to their rooms or the quiet lounge if they require a quiet area. Six residents were spoken with and three relatives during this site visit. Several residents stated that they prefer to spend time in their own room and this was respected by the home. The home has several shared rooms and suitable screening is provided. Gresham Care Home DS0000015640.V336627.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. Key standards 12,13,14 & 15 were inspected. Residents are generally content with the food offered. Social activities are adapted to suit resident’s individual tastes. EVIDENCE: Care staff organised games, cards, bingo, singing, parties and the occasional outing in the garden or down to the local shop. It was observed that staff respected those residents who did not wish to take part in activities and preferred to stay in their room, although it was noted that some staff were sitting talking with residents at various times during the day. Many residents were too physically frail to take part in more organised activities and it was noted that the home provided talking books, music and reminiscence discussions. Those residents with a memory impairment had photograph albums of family and friends to help jog their memories of their past life. The care plans contained life histories to assist staff to raise topics with residents for reminiscence discussion. Gresham Care Home DS0000015640.V336627.R01.S.doc Version 5.2 Page 13 The comment cards that were returned confirmed that the content and quality of the meals continued to be very good. Nutrition takes a priority with the proprietor who explained that a balanced nutritional intake has an impact on recovery or maintenance for chronic illness. The kitchen was found to be clean and the chef was preparing lunch of steak pudding with two further alternative main courses. The last Environmental Health visit issued no requirements. Some residents were too frail to sit at the table in the dining room area, so staff respected their wishes to eat their meals where they sat in the lounge having adequate tables and equipment provided. Gresham Care Home DS0000015640.V336627.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. Key standards 16 & 18 were inspected. Residents and their relatives are confident that the proprietors would deal with their complaints satisfactorily and residents are protected from abuse. EVIDENCE: Several visitors were spoken to during this visit and the majority stated 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 is included within the documents given out during admission. There have been no complaints since the previous inspection, although, the proprietor has used the adult protection procedure appropriately in recent months. A procedure for responding to allegations of abuse is in place. Staff have all been trained or attended the local adult protection training, and this issue was discussed and researched within the NVQ training. The proprietor has booked to attend a training session to become a trainer on adult protection issues. Gresham Care Home DS0000015640.V336627.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. Key standards 19 & 26 were inspected. Residents live in a safe, clean and well-maintained home. 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 recently developed patio for residents who require a wheelchair to access the garden from the lounge. In general the Proprietors decorate the bedrooms when they become vacant. The home smelled pleasant and is cleaned daily. Gresham Care Home DS0000015640.V336627.R01.S.doc Version 5.2 Page 16 The 3 lounges contained a variety of homely furniture. Relatives could use one of the lounges if they were staying with a frail SU. There are dining tables in two of these. A fire inspection was undertaken on 22/11/06 with no requirements issued. The home provides an extensive range of equipment designed for the comfort and safety of the residents in the form of specialist beds, chairs and hoists. There are four rooms which continue to be used as double rooms, although these are not always used as doubles, residents or their relatives express their opinion if they do not wish to share and this is respected by the proprietors. Gresham Care Home DS0000015640.V336627.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. Key standards 27,28,29 & 30 were inspected. Well-trained competent staff care for residents. EVIDENCE: There were sufficient staff on duty. Two members of staff were spoken to and both had achieved the NVQ level 2 and one had achieved level 3. They both spoke of the training courses they had attended with dementia care being the latest. The training records corresponded with the extensive training that they had undertaken. Thirteen of the fourteen staff have achieved or are undertaking the NVQ training and the home should be commended for this. The training and supervision records were seen along with the initial induction training records; these were particularly of a high standard. The last member of staff employed at the home was a carer and the proprietor had followed a good clear recruitment procedure, obtaining references and CRB before the member of staff commenced duty. Gresham Care Home DS0000015640.V336627.R01.S.doc Version 5.2 Page 18 The nurse in charge was spoken to about her responsibilities and she demonstrated the medicine administration process and discussed nursing tasks. It was noted that staff expressed their satisfaction of their job role and the amount of support they received from the proprietors. Staff meetings were held annually with smaller informal meetings during the year. Minutes were taken at all the meetings so staff could catch up. It was noted that staff responded promptly to service users who used their call bells. Gresham Care Home DS0000015640.V336627.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. Key standards 31,33,35 & 38 were inspected. The residents live in a home that is managed with their best interests at heart and their health, welfare and safety needs are promoted and protected. EVIDENCE: The proprietor is extremely well qualified to manage the home and leads by example. This was confirmed by discussions with residents and relatives who said that she has a high commitment towards both residents, relatives and the staff. Regular staff meetings are organised throughout the year, and staff attend supervision sessions with the Proprietors to check their progress, training and personal issues. The home is run in an ‘open and inclusive’ manner; feedback Gresham Care Home DS0000015640.V336627.R01.S.doc Version 5.2 Page 20 received from the numerous comment cards received prior to the inspection and comments received from the four relatives who spoke during the inspection confirmed this. The proprietor has developed the quality assurance system to ensure the feedback received is acted upon with the results displayed in the hallway. The home does not manage any resident’s finances. Records show that health and safety issues are attended to with regular maintenance of fire equipment and training. The accident and death rates at the home showed no abnormalities. Risk assessments for individual residents were seen in care plans with general assessments following the home’s policy and procedures to ensure the safety of the staff too. The regulatory records were also checked and there were no requirements outstanding from both the fire and environmental health inspections. The water, central heating, radiators, fire equipment and specialist equipment were 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 DS0000015640.V336627.R01.S.doc Version 5.2 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 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 X 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 3 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 N/A X X 3 Gresham Care Home DS0000015640.V336627.R01.S.doc Version 5.2 Page 22 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. Refer to Standard Good Practice Recommendations Gresham Care Home DS0000015640.V336627.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V336627.R01.S.doc Version 5.2 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. 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