Inspection on 13/11/07 for Gresham Lodge

This inspection was carried out on 13th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Gresham Lodge 23/01/07

Gresham Lodge 02/03/06

Gresham Lodge 17/11/05

Gresham Lodge 03/03/05

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

CARE HOMES FOR OLDER PEOPLE Gresham Lodge Gresham Lodge 255 Ashby Road Scunthorpe North Lincs DN16 2AB Lead Inspector Mrs Jane Lyons Key Unannounced Inspection 13th November 2007 09:00 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 Lodge DS0000061798.V354946.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 Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gresham Lodge Address Gresham Lodge 255 Ashby Road Scunthorpe North Lincs DN16 2AB 01724 846504 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) Mr Sukhuinder Marjara Miss Suzanne Treece Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category. The maximum number of service users who can be accommodated is: 21 23rd January 2007 2. Date of last inspection Brief Description of the Service: Gresham Lodge is a well established home situated in a pleasant central location of Scunthorpe, it has access to local amenities and public transport. The home is registered to provide care for up to twenty-one residents with problems associated with old age. The home consists of two storeys accessed by stairs and a stair lift. There are thirteen single and four double rooms; none of these are en-suite. Communal areas are provided for residents to spend time in with others, and these include a conservatory and open plan sitting and dining areas. The home has pleasant rear gardens with ample parking to the front of the property. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home. A copy of the latest inspection report for the home is on display in the reception area of Gresham Lodge. The home charges a weekly fee of £347.86 per week. There are additional charges for hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these can be found in the Service User Guide. Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was unannounced took place over 1 day in October 2007. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key inspection of the home on the 23rd January 2007 including information gathered during a site visit to the home. • • • The visit to the home lasted from 9 a.m. until 8.00 p.m. Eight residents spent some time chatting to us. We also talked to three care staff, a visiting G.P., a care manager, representative from the advocacy service, five visitors, the manager, the provider and the administrator. Questionnaires about the home were sent to fifteen of the people who live at the home, all the staff, ten relatives and eight health/social care professionals. Five questionnaires from the people who live at the home, nine of the relatives ones, six of the staff ones and three from health care professionals were returned at the time this report was written. We also looked around the home and looked at lots of records including care plans, staff training records and other records about the running of the home. Information received by the Commission over the last few months was also considered in forming a judgement about the overall standards of care within the home. We observed how staff and people who use the service worked together throughout the day. People’s views about the home and what was found during the visit have been used to write the report and make judgements about the quality of care. • • • • What the service does well: Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 6 The staff were very friendly and helped the people who live there in a dignified and respectful manner. People who live at the home have good access to health professionals and are able to access external services such as dentists and opticians. Meals are well presented and offer people at the home a choice and variety of different foods. Visitors to the home are made welcome and the home has a relaxed, friendly atmosphere. All of the people admitted to the home had had their needs fully assessed to make sure that the staff are able to look after them properly. The management consult regularly with the people who live in the home so they can have a say in how the home is run. What has improved since the last inspection? What they could do better: The home produces care plans that state how peoples’ needs are to be met by staff. These must include the full range of needs with clear tasks for staff to ensure individuals are looked after properly. Medication recording must be improved to ensure all signatures are in place for medications administered by the staff, so that there is no mishandling of medication and the resident’s health is looked after. The carpet with a stale odour must be cleaned more regularly to ensure that the residents live in a home which is pleasant and comfortable. Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 7 They must provide adequate toilet facilities which will better ensure the residents comfort. They must provide a call bell in the conservatory which is linked to the call system to protect residents safety and welfare. The home needs to make sure there are enough staff on duty so the people who use the service are looked after properly. The management need to take steps to improve staff moral to ensure the staff feel they are valued and supported in their roles which will encourage them to stay working at the home and provide more continuity for the residents. They must make sure that recruitment processes protect people who use the service. They must obtain two written references before employment of staff. The supervisory arrangements for the home must improve to provide all the care staff with the necessary guidance, leadership and support to ensure people living in the home are safe and well cared for. They must make sure that the risk of assisting service users with mobility needs are reduced by ensuring all staff have had training to move and handle individuals safely. They must make sure that all staff have had training in fire safety to ensure the staff and resident’s safety is protected. Generally the home has good safety measures in place however staff need to carry out more regular checks and keep more detailed records on bed rails provided to individuals to protect their safety. 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 Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 8 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 Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3, 5 and 6. Quality in this outcome area is good. All people who use the service undergo a full needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met by the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose and service user guides have been updated and contain more current information about the services, facilities and management at the home. Advice was given to ensure the documents were written in plain English and to avoid the over use of “jargon” and management phraseology to ensure the information is clear. These documents are usually kept in the manager’s office and copies are available to interested parties on request. Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 10 The home has a good selection of leaflets and information regarding local agencies such as advocacy services available in the entrance hall, a copy of the latest inspection report (February 2007) is also provided. There are various notice boards situated in the hall areas, which provide people with a variety of information such as activities and results from the quality assurance programme. Information from the surveys shows that the people who use the service received sufficient information to make an informed choice about the service before accepting the placement offer. Most individuals spoken to by the inspector stated that they had been given the opportunity to visit the home before they were admitted to it. One relative commented that they had visited the home to view it before admission and was very satisfied and found staff very helpful. Each resident has their own individual file and four of those looked at had a need assessment completed by the funding authority and the home had also completed its own needs assessment before a placement was offered. The home’s assessment procedures were detailed and thorough. Letters were on file confirming that the home writes to potential residents following this assessment to confirm the home can meet their needs. These individuals have also received a contract/statement of terms and conditions from the home. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. Residents are now able to make a choice of staff gender when deciding whom they would like to deliver their care, as the home has now recruited a male care assistant. Records in care plans and discussions with residents demonstrated that their choices are recorded and upheld. The home does not accept intermediate care placements so standard six is not applicable to this service. Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 11 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): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users health and personal care needs on the whole are well managed, however the high turnover of staff has on some occasions compromised this. EVIDENCE: Care files for four of the residents living at the home were examined. There was good evidence that the health needs of the people living in the home were being well met and there had been improvements to the detail in some of the recording in the care plans, diary records, evaluations and photographs of the individual were now in place. However there remained some inconsistencies in the recording of identified needs and associated care support; for example one individual had been admitted for respite support following a bereavement yet this was not identified in the care plan although the daily records identified that she had been tearful and in low mood at times. Another resident displayed very agitated behaviour at times yet the plan did not clearly detail some of the Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 12 concerns which precipitated this behaviour or the staff support required although discussions with the staff, observation during the visit and the daily records indicated that staff were providing a lot of support with orientation, reassurance and behaviour management. Another resident who was receiving end of life care had no care plans in place, the manager had archived the care plans and replaced them in May with an assessment for palliative care document provided by the district nursing team, this could result in staff not having the information they need to offer appropriate care to meet the assessed needs of individual. The plans were retrieved and found in general to be detailed covering all aspects of care support, however those relating to tissue viability and mobility required updating. Information about the resident’s social interests, likes and dislikes, spiritual needs and wishes regarding death and dying are all included within the individuals care plan. Individual choices and decisions about how care is to be given were also documented and people who use the service said that staff respect their wishes. Risk assessments were in place for tissue viability, moving/ handling, nutrition, and falls; these had been reviewed regularly and all high-risk areas had associated care programmes in place. Advice was given to amend the moving/ handling risk assessment documentation so that it records the level of risk that has been assessed, such as high, medium or low. There was good evidence that the care plans and risk assessments had been signed by either the resident or their representatives to acknowledge their involvement in the development of them and their agreement to them. Continence care is promoted and the inspector observed documentation recording the continence products supplied to the individual. Any concerns regarding pressure care are recorded and risk assessments clearly detail the type of pressure relieving equipment provided. Residents spoken to by the inspector said that when they had appointments for their healthcare needs these were always carried out in private. Relatives commented that they are kept informed of their relative’s wellbeing by the staff; they are regularly consulted (were appropriate) on their care and feel involved in their lives. There was very good evidence that the home sought support from the health care professionals such as Community Psychiatric Nurses, dieticians, district nurses and falls co-ordinator when necessary. The local Primary Care Trust has set up a scheme whereby a specific team of district nurses is dedicated to the home, which the staff and manager confirmed worked really well. The inspector spoke to a General Practioner at the home during the visit who confirmed she had a number of patients currently residing at the home, she Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 13 was very happy with the standards of care and considered the management of medication and standards of communication with the staff and manager was good. Records of visits by external professionals were very detailed and well maintained. The inspector also spoke with a care manager during the visit who said that he had worked closely with the home to support a resident who had recently moved in, he was very satisfied with the level of communication, the standards of care provided and the resident was settled in the home. One of the surveys received from a health care professional detailed “They are very good at identifying the need for external/ specialist support and referring for it. When visiting Gresham Lodge it has been observed that various health care professionals are routinely involved to meet clients needs”. Medication systems were examined; policies and procedures were in place which covered all areas of management however some of them are limited and now need to be reviewed and developed to provide more detailed and up to date instructions and methodology for all aspects of the system. All staff administering medication to residents at Gresham Lodge have undergone medication training and the home uses a Nomad Cassette system supplied by a local chemist. A community pharmacist visits the home regularly to carry out audits. There was evidence that the staff are proactive in ensuring that residents medication is reviewed by the G.P. There was evidence that people who use the service are supported to self – administer their medications; risk assessments were used to support the practise. Examination of one care file demonstrated that staff are proactive in monitoring the individual resident’s ability to continue to administer their medications with effective recording systems in place. Regular audits of the medication records continue to take place, these evidenced that there were a number of gaps in the administration records, which had been identified and followed up. Transcribing recording had improved with two staff signatures supporting all written entries on the medication records. Storage of all medications was found to be satisfactory. Records of receipt and returns of medication were in place and up to date. Checks of the controlled drugs and register showed that these are up to date, accurate and well managed. A current British National Formulary should be provided for staff reference purposes. Resident and relative comments show they are generally very satisfied with the care and support offered by the staff, however there were numerous comments regarding the large turnover of staff, which has affected to some extent the continuity of care delivery at the home in recent months. Three of the residents told the inspector how much they missed particular staff members; it was evident that they had developed very positive relationships with these workers. Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 14 One resident has communication difficulties, he is profoundly deaf and blind, staff communicate using a form of sign language on his hand; although the manager, administrator and a number of senior care staff are competent with this communication method there was evidence from discussion with staff and his relative that the service user had really missed his key worker after she had left the home and the number of new staff starting and leaving the home in such a short time had affected his ability to communicate effectively at times. Chats with the residents revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Comments from surveys include: “My mother is well looked after, kept warm and offered a varied diet” and “On the whole they care for my relative very well, any issues have been responded to very well.” Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 15 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): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are supported to make choices about their day-today lives but some felt they would benefit from more opportunities to take part in social activities and individual interests. Visitors were made to feel very welcome in the home. People who use the service were provided with good quality, varied meals that were appropriate to their needs. EVIDENCE: Information from the resident and relative surveys and discussions during the visit identified that there is less satisfaction over recent months with the level of activities provided at the home. The home employs an activity organiser who works in the home for one and a half days per week; she is clearly a very popular member of staff and all the residents spoken with during the visit confirmed how much they enjoyed the activities, entertainment and trips out that she arranged for them. There was little evidence that staff provided any Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 16 support with activities at other times, also the activity co-ordinator had been absent due to sick leave for a number of weeks and records evidenced that few activities had taken place during this time. Staff should be encouraged to instigate activities; these need not necessarily require a lot of time input from staff. Some of the comments from relative surveys include: “More could be done to stimulate them” and “ My relative needs more activities to occupy her during the day, something to look forward to.” A mini bus has now been provided for the residents at the home, they have shared access for its use with the two other homes owned by the provider. The activities co-ordinator told the inspector how she had used the minibus to take individuals out for coffee and lunch recently and that a Christmas shopping trip was planned. Discussion with the residents indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family or staff would take them into the town. One of the residents is supported to visit a local public house and visit his daughter for lunch each day and another resident is regularly supported by staff to visit his wife who lives locally. Lots of visitors were seen coming and going during the day, staff were observed making them welcome and there clearly was a good relationship between all parties. The staff maintain very detailed records of contact with families. The atmosphere at the home was very calm and welcoming, residents appeared very settled and comfortable in their surroundings. Staff spoken to had an understanding of how to promote independence and choice “we make sure people have choices with clothes, meals, where to sit, leisure and when to get up and go to bed”. Residents confirmed this, one resident told the inspector “The staff help me back to my room when I want to go”. Individuals’ religious needs were identified on admission. Staff reported that people who use the service had the opportunity to access local churches or attend services held in the local community; staff feedback identified that none of the current residents followed any particular religious observances, this was confirmed with discussions held with four individuals. The home supports people to access advocacy services when needed, and there was good evidence that the manager had secured these services for a resident who required some independent support regarding important decisions in her life. The manager herself had accompanied the resident to numerous appointments and meetings at the request of the resident. Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 17 Comments from the surveys received from staff, residents and relatives indicate that overall there is a good level of satisfaction with the meals provided by the home. The home has again employed a new cook who has only been in post for a number of days; at the moment she is still getting to know the residents and their likes and dislikes. The lunch meal was observed during the site visit, this was well presented with good portion sizes and home baking was evident; residents commented after lunch that they had enjoyed their meal. Aids were provided to encourage people who use the service to maintain independence where possible and staff assisted individuals where required in a sensitive and discreet manner. Areas of the kitchen required more thorough cleaning, this is covered in the last section of the report. Food stocks and storage was seen to be satisfactory. Appropriate monitoring records for the storage and preparation of food were clearly maintained. There were no special diets required by the service users at the time of the inspection except low sugar and fortified diets. Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 18 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): 16 and 18. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system with evidence that people who use the service feel that their views are listened to and acted upon. Procedures are in place and training provided to staff to ensure a proper response to any suspicion or allegation of abuse. EVIDENCE: The home had appropriate policies and procedures for dealing with complaints and for the protection of vulnerable adults. The complaints procedure was made available to service users in information provided and was also displayed in the home. A “niggles” book and suggestion box had also been provided in the entrance hall although there was little evidence that individuals had used these in recent times. Information from the pre-inspection questionnaire and checks of the complaints records indicated that the home had not received any formal complaints since the last inspection. The commission had not received any complaints. Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 19 There was evidence that the home had consulted with the safeguarding team at the local authority earlier in the year, regarding a staff member’s practise and had taken appropriate action. Individuals said they could express their opinions in the satisfaction surveys they complete each year and that the manager is always available for them to talk to if needed. There was good evidence that the management take appropriate action to resolve concerns and issues identified through the surveys they issue for example one of the resident’s bedroom carpets had been changed following concerns raised. Adult protection training sessions were provided for staff earlier in the year by the adult protection co-ordinator from the local authority. Given the significant staff turnover since then the manager should arrange further sessions for the new staff at the home. In the surveys returned and from discussions during the visit the staff showed a good knowledge of the procedures. Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 20 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): 19, 21, 22, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service felt at home at Gresham Lodge and the home is generally well maintained however recent reductions in the number of toilet facilities available is placing the residents comfort and welfare at risk. EVIDENCE: The inspector made a tour of the premises. With the exception of the kitchen, all areas of the home were seen to be very clean and tidy. The home smelt very clean and fresh with the exception of one bedroom, where the carpet was malodorous. Numerous positive comments were received through surveys and during the visit about the standard of cleaning and odour control in the home. The home has a maintenance programme in place; the communal rooms have all been redecorated and new flooring has been provided. We observed that Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 21 the sitting area, dining area and conservatory were very light comfortable areas and well utilised during the visit. One of the residents showed us a hand bell, which the manager had provided following her request; the provider must ensure that a call facility is provided in the conservatory which is linked to the main call system. Several bedrooms had recently been decorated and had new carpets and furniture added to them; one resident told the inspector how they had been consulted about the choice of décor. Service users spoken to by the inspector were very happy with the environment provided for them at Gresham Lodge. Discussions with the provider confirmed that the plans he had submitted for major alterations to the facilities at the home had been refused and he was currently deciding on the next course of action. The plans had included the kitchen areas, however given the poor condition of many of the units (broken cupboards and drawers) it is clear that improvements will now have to take place in that area regardless of the bigger picture. Requirements were made at the previous inspection around the provision of locks and lockable facilities to service users rooms; all rooms have now been provided with locks for the doors however there are no lockable facilities in service users rooms for valuables or medication. Concerns were raised at the last visit regarding the sluicing facility being situated in the laundry area; the provider has had the sluice facility moved to a separate area which was previously a resident’s toilet; consequently this has significantly reduced the number of toilet facilities available for the service users on the ground floor from three down to two. One staff survey commented “There are not enough toilet facilities for the residents, they often have to wait”. No action has been taken regarding the bathroom that was used as a storeroom in November 2005 and subsequently cleared of all waste items (March 2006). The recommendation made in the March 2006 report for ‘the provider to consider how the bathroom used as a storeroom could be adapted to provide residents with a suitable bathing facility’ will remain in this report. Following a visit from the fire officer in December 2006 the manager has made a number of improvements to the fire safety systems in the home. The risk assessment had been updated to include the stair lift, those individuals with mobility problems have been provided with accommodation on the ground floor and all service users now have risk assessments in place to identify the level of support required in the event of an evacuation. Staff confirmed that two residents were using the stair lift independently; advice was given for staff to complete risk assessments to confirm that this practise is safe for them. Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 22 Discussion with the staff indicates that there is a good range of equipment to help with the moving and handling of the residents and to encourage their independence; this includes hoists and handrails. The garden at the home is attractive with many mature plants and trees, it is generally well maintained; residents stated that they had a lot of pleasure from walking and sitting out when the weather was nice. Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 23 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): 27,28, 29 and 30 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are cared for by a group of staff who demonstrate a very caring manner however significant turnover, variable recruitment, shortages of staff and inadequate training has meant that residents have been put at risk of not receiving all the care they need and staff have felt very overstretched. EVIDENCE: Since the last inspection in January 2007 there has been a significantly high turnover of staff; eighteen members of staff have left since the last inspection in January. Inspection of the duty rota and discussion with the manager indicates that the staffing levels at the home remain the same as at the last inspection. There are three care staff on duty during the day shift and two care staff at night, however there is evidence that the management have struggled to provide appropriate staffing levels and skill mix on a number of shifts due to the staff turnover; for example on the afternoon/evening shift prior to the inspection visit only two staff were rostered. At the time of the visit three care staff on the day rotas had been working in the home for three weeks and two care staff on the day rotas had been working in the home for two weeks; this Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 24 has meant in recent weeks that senior staff have had at times to work a shift with two new members of staff rostered. There is evidence from staff surveys and discussions that staff moral amongst the existing staff group has been very low. Staff have felt pressured to cover shifts and their workloads have been overstretched in trying to support all the new staff. Staff comments include: “We have been short staffed for a long time, night staff have to come in early or stop late in a morning” and “Quite a few times the workplace has been short staffed which means that some staff do double shifts or work extra hours on top of their shifts”. The overall quality of care for residents has been affected during this time in that staff have struggled to provide continuity, this said it is clear that the staff’s dedication and hard work has meant that the home has maintained overall a good standard of care for the residents. Residents told the inspector how much they missed certain members of staff and that there had been so many new faces to get to know they couldn’t keep up with all the changes. Comments from residents and relatives about the staff include “They need more staff on the floor at all times, the home needs to keep the staff, always having to train up the new, why don’t staff stay?” “The staff are very friendly as are the management, my only concern is how quickly their staff turnover, staff don’t want to stay for long and I feel this upsets the residents as they just get to know someone and they are gone” and “Senior carers do a first class job, my main concern is the turnover of new carers, also cooks.” The manager had developed earlier in the year a staff training overview record to help her plan the training needed, however this had not been maintained and it was not clear what training some current staff members had accessed. Many of the staff identified on the record had left the home and new staff were not detailed. Records evidenced that only one existing member of staff had accessed fire safety training in the last twelve months. There were gaps in other mandatory courses in moving/ handling and first aid. Five staff surveys commented on the lack of formal moving/ handling training provided to new staff; the manager confirmed that either herself or one of the senior care staff provides practical training for the new staff however this has not always been recorded formally. One of the health professional surveys detailed “On one occasion incorrect use of a moving and handling aid was noted, this was reported and acted on appropriately”. All moving and handling support observed during the visit was managed appropriately. There was some evidence that individual staff members had accessed training in areas such as palliative care, care planning, wheelchairs and use of the “profile bed”. Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 25 There was good evidence that new staff work through an in house induction programme and the skills for care induction programmes; four staff at the home were currently working through the course. There were no current statistics for staff qualified to level 2 NVQ available, the provider confirmed that the home was below the target of having 50 of the care staff trained to this level. Four staff personnel files were checked at this visit, this showed that generally the home operated robust recruitment procedures. Records showed that all workers had Protection of Vulnerable Adult register checks (POVA 1st) or Criminal Records Bureau check (CRB police check) in place prior to commencing employment. Two references were in place for three staff members however one staff member had only one reference in place; staff not having two written references in place prior to employment had been a requirement at the previous inspection. All staff had completed an application form including a health declaration form and the manager had maintained a record of the interview. Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 26 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): 31, 33, 35,36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In recent months the management of the home have experienced difficulties with the retention of staff, which has placed the residents welfare at risk; this said residents were satisfied that they were consulted regularly and they considered the home to be generally well run. EVIDENCE: The home manager, Ms Suzanne Treece gained registration with the commission in July 2007. This is her first home managers appointment, she commenced the Registered Managers Award earlier in the year and has completed two units of the course so far. Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 27 There is evidence from turnover statistics, surveys and discussions with staff that there are concerns around some of the current staff management practices in the home. A number of staff surveys identified that they considered the manager did not communicate effectively with them on a dayto-day basis, other staff said that they felt their work was not valued. There was good evidence however that staff meetings had been held regularly and a number of staff spoken to during the visit said that they had regular handovers and they felt the manager was very supportive. A survey from one of the relatives detailed “The staff don’t stay, I do feel this is a management problem, from the top, in the time that my relative has been in care all the staff she knew and trusted, and there must have been a dozen, have all left one-byone. I do feel some staff are put upon and maybe not appreciated for their care and dedication.” Discussions were held with the manager, provider and administrators around issues such as staff moral, communication issues between the management and staff, and how undervalued some of the staff were feeling. The management accept that the turnover statistics have been very high, and stated that many of the staff have left for genuine reasons such as relocation, retirement and personal changes. They consider that the recent recruitment programme has been very positive; they had reviewed their recruitment strategies and as a consequence they have been able to employ a number of experienced care staff who are settling into their role very well and that the existing staff will benefit from this. It is vital now though that the management make efforts to improve the communication systems and review their retention practices to improve staff moral ensuring the future stability of the workforce at the home. Certificates on the wall of the home and discussion with the Provider and Manager indicate that the North Lincolnshire Council has awarded the home its Gold Standard for Quality Assurance, this award was achieved in 2004 and has been reaffirmed by the council since this time. The home is also accredited with Investor in People Status, and this too has been reaffirmed. The home has maintained an internal quality assurance programme; feedback is sought from the residents and relatives through regular meetings and surveys; staff complete regular audits on key areas of service in the home. Results of the surveys and audits have been analysed and where deficiencies have been identified, action plans have been drawn up. The results of the audits and surveys have been published in graph form on a notice board for residents and visitors to see. An annual development programme has yet to be developed for this year. Although the policies and procedures are reviewed annually, a number of the documents were found to be limited in the depth of information they gave and advice was given to review them ensuring that they clearly reflected current practices in the home and that they were updated to meet current legislation and good practice. Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 28 Records where the home was assisting service users with finances were clearly maintained with receipts held for any transactions on behalf of the service users. Those checked balanced with the cash held. Staff interviews and personnel files provided evidence that they are receiving supervision from the manager however not all staff had received the recommended minimum of six formal recorded supervision periods per year. There was evidence that all existing staff had accessed an appraisal this year. Examination of maintenance records identified that checks and certificates were in place for installations and equipment. The fire safety equipment and checks were all in place and up to date and the fire risk assessment had been updated. General environmental risk assessments were in place. The handyman completed regular checks of hot water temperatures in the home, which were found to be within an acceptable range on the tour of the building. A number of residents have bed rails fitted to their beds. There was evidence that risk assessments were in place however these were found to be very basic and did not cover all areas identified in the guidance issued from the medical devices agency to ensure the residents safety. There was no evidence that the rails were being checked on a regular basis in line with this guidance. As detailed in the previous section of the report there are gaps in the staff’s mandatory training in fire safety, moving/handling and first aid. There was good evidence that staff had completed appropriate accident records and these records were reviewed by the manager and records of further management action to prevent reoccurrence were in place. Areas in the kitchen required more thorough cleaning such as the deep fat fryer, cupboards, drawers, shelves and flooring. Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 29 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 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 2 2 X 2 X 2 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 2 X 2 Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES 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 OP24 Regulation 12 Requirement Each resident must be provided with lockable storage space for medication, money and valuables and is provided with the key, which he or she can retain (unless the reason for not doing so is explained in the care plan). Given timescale of 01/06/06 was not met. The registered person must ensure that care plans detail all service users individual needs identified from assessment and associated care interventions. They must be updated to reflect changing needs. This will ensure staff have the information they need to offer appropriate care to meet the assessed needs of individual. The manager must ensure that two written references are obtained before appointing a member of staff which will better protect the people who use the service. Timescale 01/06/07 not met. DS0000061798.V354946.R01.S.doc Timescale for action 15/02/08 2. OP7 15 15/01/08 3. OP29 19 15/01/08 Gresham Lodge Version 5.2 Page 31 4. OP9 13(2) 5. OP22 23(1) and (2) 6. OP26 16(2)k 7. OP21 23(2)j 8. OP19 16(2)g 9. OP27 18(1)a 10. OP27 18 (1)a The registered person must ensure that staff complete the medication administration charts in accordance with the homes procedures, this will better ensure that residents receive the medication they need. The registered person must ensure that a call bell connected to the main call system is provided in the conservatory. This will better protect the welfare of the people who use the service. The registered person must ensure that that the carpet in the identified room is cleaned regularly and replaced if it remains odorous. This will improve the quality of the environment for the individual. The registered person must ensure that an adequate number of toilet facilities are provided for the people who use the service, this will ensure their welfare and comfort is maintained. The registered person must ensure that cupboard doors and drawers to the kitchen units are repaired or replaced to ensure the kitchen facilities are safe and fit for purpose. The registered person must ensure that adequate numbers of staff are employed and rostered to meet the dependency needs of the service users. This will better protect the health and welfare of the people who use the service. The registered person must ensure that the skill mix on each shift is adequately maintained which will better protect the health and welfare of the people who use the service. DS0000061798.V354946.R01.S.doc 15/01/08 15/02/08 31/01/08 30/03/08 28/02/08 01/01/08 01/01/08 Gresham Lodge Version 5.2 Page 32 11. OP30 OP38 18(1) c 12. OP30 OP4 18(1)c and 12 12. OP30 OP38 23(4) 13. OP30 OP38 18(1)c 14. OP33 24(1)(2) 15. OP36 18(2) The registered person must provide evidence to the Commission that all staff have received training in moving and handling this will ensure the safety of the residents and staff. The registered person must provide evidence to the commission that staff have received training in the specific sign language communication for the identified service user. The registered person must provide evidence to the commission that all staff have received training in fire safety this will protect the safety of the residents and staff. The registered person must provide evidence to the commission that adequate numbers of staff have received appointed persons training in first aid to ensure there is a suitably qualified person on each shift which will protect the safety and welfare of the residents. The registered person must ensure that an annual development plan for the home is produced. This must show how people who use the service, relatives and other key people are consulted about the services provided by the home and any action taken to address any issues raised by these individuals and any internal or external audits. The registered person must ensure consistency with supervision to enable all care staff to receive at least six formal sessions per year. This will provide care staff with the necessary guidance, leadership and support to better ensure residents living in the home are DS0000061798.V354946.R01.S.doc 28/02/08 30/01/08 15/01/08 15/02/08 15/02/08 28/02/08 Gresham Lodge Version 5.2 Page 33 16. OP38 13(4) 17. OP38 16(2)j safe and well cared for. The registered person must ensure risk assessments accurately determine whether a service user initially requires bed rail provision and evaluations must determine the continued need for them. Bed rails and protectors must be fitted and checked in line with manufacturers instructions and Medical and Healthcare products Regulatory Agency (MHRA) guidelines. This will ensure the safety of the people who use the service is better protected. The registered provider must ensure that the standard of cleaning in the kitchen areas is improved. This will ensure that the health and safety of the people who use the service is better protected. 15/01/08 15/01/08 Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 34 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. 4. 5. 6. Refer to Standard OP21 OP28 OP31 OP1 OP8 OP12 Good Practice Recommendations The provider should consider how the bathroom used as a storeroom could be adapted to provide residents with a suitable bathing facility. 50 of the care staff should have achieved an NVQ 2 by July 2008. The registered manager should achieve an NVQ 4 in management and care by August 2008. The statement of purpose and service user guide should be written in plain English to ensure the information is clearly presented. The moving and handling risk assessment documentation should be amended so that the level of risk is identified, this will provide clearer information for staff. Service users should be provided with more opportunities to take part in their chosen leisure activities or interests, to ensure they have the opportunity to experience a full life. Risk assessments should be put in place to support the independent use of the stair lift by persons living at the home which will better ensure their safety. Review all the homes key policies and procedures to ensure they are comprehensive, comply with current legislation and demonstrate current good practice. The management need to take steps provide more support for the care staff, improve communication systems and review the staff retention practices within the home to promote an improved moral amongst the staff. 7. 8. 9. OP38 OP33 OP37 OP32 Gresham Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Lodge DS0000061798.V354946.R01.S.doc Version 5.2 Page 36 - 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!