Inspection on 23/06/08 for Gresley House Care Home

This inspection was carried out on 23rd June 2008.

CSCI found this care home to be providing an Adequate service.

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

Gresley House Care Home 15/10/07

Gresley House Care Home 12/02/07

Gresley House Care Home 16/08/06

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Gresley House Care Home Market Street Church Gresley Swadlincote Derby DE11 9PN Lead Inspector Vanessa Davies Unannounced Inspection 23rd June 2008 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 Gresley House Care Home DS0000067515.V366882.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. Gresley House Care Home DS0000067515.V366882.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gresley House Care Home Address Market Street Church Gresley Swadlincote Derby DE11 9PN 01283 212094 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) gresleyhouse1@aol.co.uk Mrs Judith Dena Griffin Stewart Westley Barker Vacant Care Home 27 Category(ies) of Dementia - over 65 years of age (11), Old age, registration, with number not falling within any other category (14), of places Physical disability (2) Gresley House Care Home DS0000067515.V366882.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 2 places within the total of 27 can be used for (PD) either sex aged 50 - 65 yrs. Plus one (1) day care placement not regulated by Commission for Social Care Inspection. An additional PD place for CW - This person is named in the noticed of proposal (CW) this agreed place will cease on the termination of this person. For the home to accommodate one named person in the notice of proposal (PS) this agreed place will cease on the termination of this persons care at the home. 15th October 2007 Date of last inspection Brief Description of the Service: Gresley House care home provides personal care and accommodation for up to 27 people aged 65 years and over, including 2 places for persons 50 - 65 years and 1 day care place. Gresley House is situated in Church Gresley town centre, close to shops and local amenities; the home does not have a car park, however there is roadside parking outside the home. Residents have access to a well set out garden area. The home is situated on 2 floors and has 25 single rooms and 1 double room. Access to the first floor is by stairs and a passenger lift. The home has 4 lounge and dining areas. Copies of the most recent inspection reports are available on request from the office at the home. Gresley House Care Home DS0000067515.V366882.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for the service is one star. This means the people who use the service experience adequate quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, key minimum standards of practice; and focuses on aspects of service provisions that need further development. In order to prepare for this visit we looked at all the information that we received and asked for, since the last key inspection on 15th October 2007, this information includes a self assessment document called an Annual Quality Assurance Assessment, referred to within this document as an AQAA. During the site visit case tracking was included as part of the methodology. This involved the sampling of a total of four people representing a cross section of the care needs of individuals within the home. Discussions were held with those people able to do so. Their care planning and associated care records were also examined and their private and communal facilities inspected. Discussions were also held with staff about the arrangements for their care and also for staffs’ recruitment, induction, deployment, training and supervision. Following discussions it was agreed that the people who live in this service would be referred to as ‘residents’ for the purpose of this report. The fees for this home are between £333.85 - £365. What the service does well: What has improved since the last inspection? Gresley House Care Home DS0000067515.V366882.R01.S.doc Version 5.2 Page 6 The appointment of a new, very experienced manager has meant that various positive changes have been implemented. Although there were errors within the medication charts, the manager had seen this and she had addressed the issue. Residents are provided with a survey which can remain anonymous, one survey states “I am happy with the care my husband is receiving, he is very happy also it is nice to see him so contented”, also visiting professionals are given a survey form to complete, the results are then gathered and addressed by the providers and the new manager. An Activity Coordinator has been appointed and a clear activities programme is now in place trying to meet the needs of the residents, along with attempting to involve them in the community. The home now has a refurbishment plan and a number of rooms have been completed, rooms are clean and tidy and personalised. One lady spoken with was very happy with her newly refurbished room. Staff supervisions have started to occur. 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. Gresley House Care Home DS0000067515.V366882.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 Gresley House Care Home DS0000067515.V366882.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): 3 Quality in this outcome area is adequate. Detailed assessments and relevant risk assessments help to ensure that nursing needs are met. However lack of information relating to personal history potentially prevents all needs from being met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents’ care records were examined and all had an admission assessment in place and information from external professionals, where applicable. It was evident that since the appointment of the new manager the files have been reviewed and revised. Each file included information relating to hobbies, professionals involvement, medical history etc. However there was still limited information relating to the personal history within one file and no history within a second file. There was no evidence of any input from either the resident or the family in the files examined. Gresley House Care Home DS0000067515.V366882.R01.S.doc Version 5.2 Page 9 A range of risk assessments had been completed. These included pressure sore risk assessments, falls risk assessments and nutritional risk assessments. Gresley House Care Home DS0000067515.V366882.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): 7,8,9,10 Quality in this outcome area is adequate. Detailed medical information helps staff to meet health needs of the residents. However failure to administer medication appropriately potentially puts residents are risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three files examined each held details within the assessment relating to health needs and other professionals involved with the residents in order to meet their needs. One file held an assessment of need completed by the mental health assessment team. Each file evidenced input from dentist, optician, district nurse and GP. Risk assessments seen were written May 2008. Two of the three files contained a face (social services) care plan. Weight charts were evident and started May 08. Residents spoken with were not clear about what a care plan was, however they were aware that the home held a file containing information about them. Gresley House Care Home DS0000067515.V366882.R01.S.doc Version 5.2 Page 11 There was relevant information regarding medication and whether the resident self medicates. Medication charts were examined and still contained errors, this was highlighted at the previous inspection. Medication had not been signed for on the 20th am medication round and there was no explanation, and out of stock medication had being signed for on two occasions. The manager had completed a medication audit and recognised that there are still errors being made, and was taking appropriate action. One survey received stated that staff listen sometimes, and that this person usually receives the care and support needed. Staff were seen knocking on doors prior to opening them. The information provided by the manager states that good links have been built with all other relevant professionals. Gresley House Care Home DS0000067515.V366882.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): 12,13,14,15 Quality in this outcome area is good. Offering a variety of activities including involvement within the local community helps to ensure that residents expectations are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA states that the Activities Coordinator documents residents’ preferences and abilities and this was evident when speaking with her. Routines and mealtimes are flexible in order to meet residents’ needs, this was confirmed when speaking with a resident, she said ‘I am not able to get to the dining room so I eat in here (the lounge), the staff are lovely especially Wendy’, Wendy is the new manager. The Manager states that the home could improve their contact within the local community and to try to do this there was evidence of a Spring fair on 30.05.08 and a Spring Newsletter which detailed proposed trips to Bretby Garden Centre and Rosliston Forestry Centre, gentle exercise 20.05.08, coffee morning 30.05.08. The home also has a weekly lottery lucky numbers game, which raises funds. The Activities Coordinator is now well acquainted with the Gresley House Care Home DS0000067515.V366882.R01.S.doc Version 5.2 Page 13 residents. One residents survey was received and it states that he/she is happy with the care provided and that staff are usually around when needed. One of the surveys seen states “I am very happy with the care my relative is receiving, is very happy, also it is nice to see them so contented”. Gresley House Care Home DS0000067515.V366882.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): 16,17 Quality in this outcome area is adequate. A clear, concise complaints procedure and rigorous recruitment procedure helps to ensure the safety of the residents. Although a monitoring system is now in place, the lack of a suitable quality monitoring system for finances implemented within the previous timescale has put residents at risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA states that the home has a clear concise complaints procedure and that staff are encouraged to see complaints in a positive way. Residents are able to access advocacy services. Records of complaints are kept along with subsequent responses. Residents are made aware of the complaints procedure and this was evident when speaking with one. The questionnaire received states that staff sometimes listen and that the resident concerned is aware of the complaints procedure and able to make a complaint, although he/she has not had to complain about anything yet. It is clear that the new manager and providers have worked hard to develop monitoring systems to ensure the safety of the residents. However prior to the manager arriving at the home, residents were at risk of financial abuse due to lack of rigorous monitoring systems. An incident of financial abuse was reported and is being dealt with by the relevant authorities following the dismissal of the previous manager. Gresley House Care Home DS0000067515.V366882.R01.S.doc Version 5.2 Page 15 All staff have a completed Criminal Records Bureau (CRB) check in place prior to commencing work at the home. All staff have completed training in Safeguarding Adults. Staff spoken with were aware of what to do in the event of an allegation being made and appeared confident that they would deal with it appropriately. Gresley House Care Home DS0000067515.V366882.R01.S.doc Version 5.2 Page 16 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): 19,26 Quality in this outcome area is good. A well maintained home helps to ensure the safety of the residents This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA states that there is a refurbishment programme in place and this was evident when being shown around the home by the provider on the day of the visit. Each of the rooms has been personalised to the taste of the resident within the room and one resident spoken with said, “it’s lovely in my room now” Other areas of the home have been refurbished and the provider has plans to improve the home throughout, taking into consideration the thoughts and needs of the residents. The home was clean and tidy on the day of the visit. Gresley House Care Home DS0000067515.V366882.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 adequate. Not all staff have received all of the mandatory training, and this potentially puts residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The information provided by the manager states that the duty rota is arranged to ensure that there are enough staff on duty to meet the needs of the residents and this was evident on the day of inspection and when speaking with staff. Staff spoken with felt that they now received the support needed and the training in order to undertake their duties. The manager states that 75 of the staff team have achieved NVQ2 and that 75 of those remaining were now completing NVQ2. 31 of the staff team have achieved NVQ 3 and 25 are completing NVQ 3. The home employs 24 staff plus the manager, staff have training in Safeguarding Adults, Infection Control, First Aid, Manual Handling, Dementia Awareness, medication safety and Fire Safety. However, a number of staff still need to complete this training. Gresley House Care Home DS0000067515.V366882.R01.S.doc Version 5.2 Page 18 Staff supervisions have started but a number of staff are still to receive one to one. The manager arranges regular staff meetings and senior staff meetings in order to ensure that communications remain open. Gresley House Care Home DS0000067515.V366882.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): 31,33,35,38 Quality in this outcome area is adequate. Positive management changes help to ensure that the service changes with the changing needs of the residents. However lack of staff supervision and up to date training potentially puts residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The providers state that they have a consultant developing an audit tool for the home. The home employed a new manager 18th February 2008, however she was dismissed soon afterwards and another manager has since started, the Deputy Manager has remained in post to offer support. The new manager was on annual leave at the time of the visit. The information provided states that there are systems in place to safeguard residents monies. Although there was an issue with the previous manager prior Gresley House Care Home DS0000067515.V366882.R01.S.doc Version 5.2 Page 20 to her dismissal as stated earlier within this report, it is evident that there are now systems in place to protect residents. The providers have worked hard to find a suitable manager for the home and it is evident that she has started to make positive changes to ensure that the home is staffed by suitably qualified staff and that residents are safe and feel safe. All of the staff team now need to receive up to date training and regular supervision. The staff complete regular fire checks. The lift was serviced January 2008 and the hoists serviced July 2007. Gresley House Care Home DS0000067515.V366882.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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 3 Gresley House Care Home DS0000067515.V366882.R01.S.doc Version 5.2 Page 22 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 OP9 Regulation 13 (2) Requirement Systems must be in place to ensure that a sufficient supply of medication prescribed for each person in the home is available, to maintain their health and wellbeing . People must receive their medication as prescribed, in order to maintain their health and wellbeing. A manager must become registered with the Commission for Social Care Inspection to meet legal requirements and to ensure the home is well run. A system for reviewing and improving the quality of care must be implemented to ensure improvement takes place. (Previous timescale of 31/12/07 extended) All staff must receive supervision to ensure that they are working in a way that meets people’s needs. Staff who have not yet attended must receive all mandatory health and safety training to ensure staff and residents’ DS0000067515.V366882.R01.S.doc Timescale for action 31/08/08 2. OP9 13 (2) 31/08/08 3. OP31 8 (1) (a) 31/10/08 4. OP33 24 (1) (a) & (b) 31/12/08 5. OP36 18 (2) 31/10/08 6. OP38 18 (1) (c) (i) 31/12/08 Gresley House Care Home Version 5.2 Page 23 safety. 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. Refer to Standard OP7 Good Practice Recommendations Detailed social histories should be sought for all residents to assist staff with meeting needs. Old beds should be replaced. 2. OP23 Gresley House Care Home DS0000067515.V366882.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Gresley House Care Home DS0000067515.V366882.R01.S.doc Version 5.2 Page 25 - 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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