Inspection on 28/02/07 for Gresham Residential Care Home

This inspection was carried out on 28th February 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 Residential Care Home 09/02/06

Gresham Residential Care Home 30/08/05

Gresham Residential Care Home 17/01/05

Gresham Residential Care Home 01/06/04

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

CARE HOMES FOR OLDER PEOPLE Gresham Residential Care Home 47-49 Norfolk Road Cliftonville Margate Kent CT9 2HU Lead Inspector Christine Grafton Key Unannounced Inspection 28th February 2007 09:40 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 Residential Care Home DS0000035039.V306105.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 Residential Care Home DS0000035039.V306105.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gresham Residential Care Home Address 47-49 Norfolk Road Cliftonville Margate Kent CT9 2HU 01843 220178 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) Jonathan Anthony Smith Mrs Brenda Anne Smith, Anthony David Smith Jonathan Anthony Smith Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Gresham Residential Care Home DS0000035039.V306105.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: From time to time service users under the age of 65 may be accommodated. Date of last inspection 9th February 2006 Brief Description of the Service: Gresham Residential Care Home is a detached building with accommodation for residents on three floors. Bedrooms are mainly singles with some double rooms, currently occupied as singles. All bedrooms have ensuite toilet facilities, call bell, television point and some have telephone points. There is a shaft lift to all floors. There is a large lounge/diner, a separate TV lounge, a conservatory area, where residents may smoke and a small enclosed back garden with fish pond, raised flower beds and seating area. The home is located within easy reach of local shops and all public amenities, with the seafront at the end of the road. This is a family run business that has been operating as a residential care home for 14 years. The staff team consists of the registered provider/manager and a team of carers, who work a rota that includes one staff member on waking duty at night and one person on sleeping in duty. Additional staff are employed for cooking and cleaning. According to the homes statement of purpose, it aims to provide a good, safe environment, with a happy atmosphere, where residents are encouraged to be interested in each other and staff offer encouragement, to enable residents to maintain their independence, but offer care as needed. Information provided by the manager in October 2006 indicates that the fees for the home range from £303.25 per week to £343.25 per week. Gresham Residential Care Home DS0000035039.V306105.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report takes account of information obtained from various sources since the last inspection, including a visit to the home, telephone contacts and surveys from a sample of residents. The manager provided written information in a pre-inspection questionnaire, which was used for the planning of the visit. An unannounced visit took place on 28th February 2007 between 09.40 hours and 16.10 hours. The visit included talking to the manager, staff, residents and observing the interactions between residents and staff. An accompanied partial tour of the building was carried out and various records were checked. The care of three residents was case tracked. At the time of the visit there were 25 residents, including one in hospital. Eleven service user surveys were sent out and nine were returned. All indicated their overall satisfaction with the home and services provided. The outcome of this inspection indicates that residents are provided with good care and the quality of the environment is excellent. What the service does well: What has improved since the last inspection? When the providers and manager took over this home, they embarked upon an improvement programme that has almost been completed now. During the last four years the environment has been transformed, having an excellent effect upon residents’ quality of life. Gresham Residential Care Home DS0000035039.V306105.R01.S.doc Version 5.2 Page 6 Changes completed during the past year include further additions to the lounge areas to make them even more homely, for instance, the new flat screen television in the main lounge and new ‘ski’ chairs that match the dining tables. Residents commented that they like these chairs, as they are easy to move. A new fire alarm panel and new smoke detectors have also been installed since the last inspection, to improve safety for residents and staff. Internal decoration has continued with new carpets in some of the hallways and staircases. Seven more bedrooms have been completely refurbished to a high standard. As rooms have been completed, attractive new furniture, carpets and soft furnishings have been added, making the rooms look very homely. Three residents who occupy refurbished rooms said how much they like their bedrooms. A new shower room has been created and completed to a very high standard. It has been specially adapted to make it easier to use by people with disabilities. A resident commented on how much they like this facility. 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 Residential Care Home DS0000035039.V306105.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 Residential Care Home DS0000035039.V306105.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can move into the home knowing that their needs have been properly assessed and the home endeavours to meet their needs. The home does not admit people for intermediate care, so standard 6 was judged as not applicable. EVIDENCE: The assistant manager carries out pre-admission assessments of prospective residents, either at their own home, or at hospital. Evidence was seen of a thorough pre-admission assessment that had been used to inform the home’s assessment and care plan, documented following admission. Copies of care management assessments are obtained and evidence was seen in files examined as part of the case tracking. Gresham Residential Care Home DS0000035039.V306105.R01.S.doc Version 5.2 Page 9 Two new residents were spoken to and both confirmed that their needs are being met. One said, “Lovely place this is, can’t fault it, we’re looked after.” The residents confirmed they have settled in well. Copies of their terms and agreement of residence were seen in their care plan files. These provide a well-written overview of the services provided, what is included in the fees and any additional charges. Gresham Residential Care Home DS0000035039.V306105.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care planning system provides staff with the information they need to meet residents’ needs. Residents can be confident that their health care needs are being properly managed. Medications are on the whole well managed and promote good health. Residents’ privacy and dignity is respected. EVIDENCE: Three residents’ care pathways were case tracked. This included discussion with two of those residents and a staff member about their care. A comprehensive care planning system has been established. Care plans contain details including: personal profiles, full needs assessments, dependency assessments, risk assessments and monthly weight records. Doctors and other health care professionals are contacted where necessary and their visits Gresham Residential Care Home DS0000035039.V306105.R01.S.doc Version 5.2 Page 11 recorded. Key workers complete monthly review records and where necessary update the care plans. Daily records are used to inform the care plans and there is appropriate cross-referencing between the different sections of the care plans. Medication administration records were checked and found to be on the whole well recorded. Medications are provided in a monitored dosage system, with some tablets bottled. Medication storage includes a purpose made metal drugs cabinet, a lockable drugs fridge and another lockable cupboard. The lunchtime medication administration was observed and seen to be handled in an appropriate manner. Staff responsible for giving out the medications have completed a medication course. Staff spoken to had a good understanding of residents’ needs and several of those residents spoken to were appreciative of the healthcare support provided. A resident described how the staff had arranged a doctor’s visit for them and had followed it up when they wanted to know some test results. Residents said that staff treat them well and respect their privacy and dignity. This was supported by the observations of staff practices during the visit to the home. Gresham Residential Care Home DS0000035039.V306105.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from being given opportunities to take part in a variety of leisure activities. Residents are provided with an appealing, varied and balanced diet. EVIDENCE: Residents spoke about their various interests and occupations. One resident enjoys doing the flowerbeds in the back garden and is encouraged with this pastime. Some residents go out to the local shops and one resident enjoys doing errands for some of the other residents. A manicurist visits weekly and two ladies spoke about having their nails done. There were a number of favourable comments about the weekly armchair exercise sessions to music put on by “a lady that visits”. Several residents spoke about a show put on by an amateur dramatic group that was put on over the Christmas period. It was clear that this was very Gresham Residential Care Home DS0000035039.V306105.R01.S.doc Version 5.2 Page 13 popular and residents commented that another show has been booked for the Easter holiday. Residents confirmed that their daily routines are flexible and a resident spoke of liking to spend most of their time in their room. Several residents spoke about their visitors and confirmed that they are always welcomed. Residents spoke of trips out with relatives, or sometimes with staff. Mini bus outings take place during the summer months. Residents spoke about the meals provided, describing what was on the day’s menu. They all confirmed there are choices available and knew what the alternatives were. One resident said “We always have a three course lunch – we can have soup or fruit juice and then we have two choices of main meal and three choices of dessert. Individual menu choice lists are taken round each day for the following day’s choice. A resident described their breakfast, “I had grapefruit, bacon & egg and toast.” Other comments included: “the food is very good,” and “the food is nice, I can’t fault it.” The lunchtime meal was observed and consisted of home cooked ham, egg, chips, peas and carrots, or chicken kiev with boiled potatoes and vegetables. This was attractively served and looked and smelled appetising. Gresham Residential Care Home DS0000035039.V306105.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents know that their complaints will be listened to and acted upon. Suitable arrangements are in place for protecting them from abuse. EVIDENCE: A complaints notice is prominently displayed in the entrance hall with the address of the registered providers and details of who else to contact, such as social services and the commission. There is also a suggestions box in the hall. Residents spoken to praised the home, saying that the staff are good and listen to them and that they have no complaints. Residents knew who to talk to if they had a concern, saying they would speak to the manager, the assistant manager, or any of the staff. It has previously been seen that the home has a detailed policy and procedures on abuse and adult protection. There is also a ‘whistle blowing’ policy and a policy on restraint. A staff member spoken to demonstrated understanding of these policies and knew what to do if there was a suspicion of abuse. The manager confirmed that abuse and adult protection procedures are covered in the induction training of new staff. Gresham Residential Care Home DS0000035039.V306105.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a home where the routine maintenance, decoration and renewal of furnishings is completed to a high standard. Recent investment and the on-going improvement programme have enhanced residents’ quality of life. EVIDENCE: The registered providers have an annual improvement programme that has been completed throughout the past year. Since the last inspection changes include: a new flat screen television in the main lounge and new ski chairs have been added to the dining tables that were new at the last inspection. New pictures have been added in the dining room with picture lights above them, which is an attractive feature. Gresham Residential Care Home DS0000035039.V306105.R01.S.doc Version 5.2 Page 16 New carpets have been fitted in some of the hallways and staircases. Seven bedrooms have been completely refurbished with new ensuite facilities, new beds, furniture, fixtures and fittings. These have been completed to a high standard. For example two of the bedrooms seen had large double fitted wardrobes with sliding doors, drawers and television fitted inside, plus a sturdy lockable facility. The radiators in these rooms have been guarded, with the thermostatic valve at the top for better access, so that the residents can easily adjust the bedroom temperature. A new fire alarm panel and new smoke detectors have also been added since the last inspection. A specially made slim radiator guard has been fitted in an upper floor narrower corridor. The new shower room on the ground floor has been completed to a very high standard, with non-slip flooring, walk-in shower, pull down shower seat, grab rails, screen and shower curtain. The adapted toilet in this room has a pull down grab rail with two grab rails on other the wall. There are also liquid soap, paper towel and toilet roll dispensers. The Parker bathroom has similarly been fitted out. One resident spoke of liking to have a shower and was appreciative of the facility. Another resident said they prefer a bath and stated that they enjoy being assisted to use the specially adapted bath. On the tour of the building various mobility aids were seen, such as grab rails, raised toilet seats and frames, individual aids such as walking frames and wheelchairs. The home has a mobile hoist, which is not being used currently as there are no residents who need this facility. Several residents commented that they like their bedrooms and it was seen that bedrooms have been personalised and arranged to suit residents’ individual needs. Good standards of cleanliness and hygiene were observed. All areas seen were clean and where there are problems with odour, appropriate systems are in place to deal with them. The provider/manager has plans to upgrade the laundry room next. This is well equipped with suitable washing machines and tumble driers, but it has been recognised that it would benefit from more work surfaces and a new wash hand basin is to be added. The manager stated that this would be completed by the end of March. This is to be followed with plans to better separate the smoking area by June 2007. Gresham Residential Care Home DS0000035039.V306105.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff are appropriate to meet the assessed needs of residents in this home. Residents are protected by the home’s recruitment procedures and commitment to staff training. EVIDENCE: Staff rotas seen and observation at the time of the visit indicated that the numbers of staff on duty were sufficient to meet the needs of the current resident group. Staff on duty at the time of the visit consisted of the manager, assistant manager, three carers, a cleaner and a kitchen assistant. The manager uses the Residential Forum Guidance recommended by the Department of Health to calculate the numbers of staff required. Since the last inspection, dependency assessments have been completed for all residents and it was seen that these are regularly reviewed. The home has benefited from a stable staff team. Of the eleven carers employed, six staff have completed their National Vocational Qualification (NVQ) level 2 and two more staff are currently working towards their award. No new staff have commenced since the last inspection, but the assistant Gresham Residential Care Home DS0000035039.V306105.R01.S.doc Version 5.2 Page 18 manager said that the Skills for Care induction programme would be used for any new staff that start. At the last inspection, it was seen that thorough recruitment procedures were in place and the assistant manager said the home is currently recruiting for two new carers. She confirmed that new staff would not commence until all the required checks have been completed. One staff file was checked and seen to contain all the required records. Information in the pre-inspection questionnaire and discussion with the manager indicates a commitment to staff training. Courses completed include: first aid, basic food hygiene, moving and handling, fire safety and infection control. Future plans include NVQ level 3 for senior carers, a four-day first aid course for all seniors, supervisory courses and effective communication in care. Gresham Residential Care Home DS0000035039.V306105.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a well run home, where their best interests, health, safety and welfare are promoted and protected. EVIDENCE: The provider/manager has been running this home for four years and during that time has successfully completed each year’s annual development plan, working to clear goals that are prioritised and cover environmental and care objectives. He is currently working towards an NVQ level 4 in management and care. This had been started with one training organisation but due to problems, he has had to change to a local college and re-start the course. He is committed to completing this as soon as possible. Gresham Residential Care Home DS0000035039.V306105.R01.S.doc Version 5.2 Page 20 Residents spoken to were appreciative of the regular contact they have with the manager during the week and stated that the other family members (including the registered providers) have regular contact with the home. Residents’ comments indicated that they feel the home is well managed, stating that the manager involves them in any plans for changes and keeps them informed about things that affect their daily lives. Staff were also complimentary about the home, saying that this is a good place to work where there is a good team spirit and nice atmosphere in the home. Staff receive regular formal supervision and occasional residents’ meetings and staff meetings are held. Records of residents’ monies were checked and seen to be appropriately kept. The fire safety logbook contained records of weekly fire bell tests, regular staff fire instruction and fire drills. The staff-training matrix indicates that sufficient staff have been trained in fire safety, first aid, health and safety and moving and handling. Gresham Residential Care Home DS0000035039.V306105.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 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 3 4 3 4 4 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 3 3 Gresham Residential Care Home DS0000035039.V306105.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 Residential Care Home DS0000035039.V306105.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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. 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