Inspection on 12/12/06 for Greswold House

This inspection was carried out on 12th December 2006.

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

Other inspections for this house

Greswold House 12/12/08

Greswold House 14/10/05

Greswold House 13/05/05

Greswold House 11/11/04

Greswold House 15/06/04

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

CARE HOMES FOR OLDER PEOPLE Greswold House 76 Middle Leaford Shard End Birmingham West Midlands B34 6HA Lead Inspector Amanda Lyndon Unannounced Inspection 12 December 2006 10:00 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 Greswold House DS0000016906.V321705.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. Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greswold House Address 76 Middle Leaford Shard End Birmingham West Midlands B34 6HA 0121 783 1816 0121 784 5194 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) Yardley Great Trust Miss Susan Kaye Taylor Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 14th October 2005 Brief Description of the Service: Greswold House is a purpose built residential home for older people situated within a residential area of the Shard End area of Birmingham. The premises are within close proximity to private households, a sheltered housing scheme and a nursing home. The accommodation comprises of 27 long stay places and two respite rooms. All bedrooms are for single occupancy and the long stay rooms have en-suite facilities consisting of toilet and wash hand basin and there are bathing facilities directly adjacent to the two respite rooms. The services are provided on three floors which are connected by stairs and two passenger lifts. There are lounge/dining area/kitchenette and bathing facilities on each level. The main kitchen provides meals to each floor and there are also dedicated laundry and hairdressing facilities. There are pleasant grounds to the rear of the premises that are accessible to residents via the ground floor lounge. A seating area is also available at the front of the premises. There is sufficient off road parking at the front of the building and the Home has its own mini bus. Security to the front of the building is maintained by close circuit television, this does not intrude upon the privacy of the residents and there is a secure intercom system at the front entrance. Assisted bathing and shower facilities are provided and staff are available to provide support in this area. There is a comprehensive and interesting in-house and external activities programme. There is a notice board displaying forthcoming events and other information of interest to residents and their visitors. A copy of the most recent CSCI inspection report is available in the foyer area. The weekly fee to live at Greswold House is between £355 and £380. Items not covered by the fee include hair dressing, newspapers, toiletries and private chiropody. Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report reflects the findings of a one day unannounced field work visit undertaken by one Inspector when there were twenty residents living at the Home, three residents were in hospital. Information was gathered by speaking with ten residents and a number of staff, case tracking, examining care, medication and health and safety records and observing the staff perform their duties. A tour of the Home was undertaken. The Manager and Deputy Manager were not available on the day of the visit due to training and holiday commitments, therefore the Inspector was assisted by two senior care staff and the domiciliary care Manager based on site, all of whom had a good knowledge of the services provided at the Home. Prior to the field work visit a positive comment was received from a visitor to the Home about the service provided there. No negative comments were received. Prior to the field work visit the Registered Manager had completed a pre inspection questionnaire, giving some information about the Home, residents and staff which was taken into consideration. No immediate requirements were made on the day of the visit. What the service does well: Residents are encouraged to make informed decisions about whether they would like to live at the Home and are provided with enough information in order to make that decision. Residents are encouraged to sample what life would be like to live at the Home prior to living there. One resident who had recently come to live at the Home said “ I came to look around, the staff made me feel so welcome, I was at ease”. Residents are involved in the planning of their care whilst living at the Home and this ensures that their preferred routines in respect of their daily lives are maintained. Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 6 Residents have access to a range of Health and Social Care Professionals and staff provide support to ensure that any medical instructions are carried out and this ensures that residents’ health care needs are met. Staff are proactive and assist in identifying residents’ health care needs. Residents are cared for in a respectful manner by staff working at the Home and this ensures that their self esteem and dignity are maintained. Residents are encouraged and supported by the staff team to maintain their independence based on their individual abilities. One resident said “ What I like about living here is that I have got my independence and the care as well” Residents are able to exercise control over their daily lives and the activities that they choose to participate in which promotes their individuality. One resident said “ We are so well cared for here. The staff don’t monopolise us, we can make our own decisions within reason”. There is a wide variety of activities on offer at the Home for the residents to participate in should they choose and visitors are made to feel welcome. There was a family atmosphere at the Home and a good rapport had been built up between residents, staff and their visitors. One resident said “ My visitors are made to feel welcome, they have a cup of tea with me”. Residents are supported to continue to practice their chosen religions whilst living at Greswold House and this ensures that their beliefs and individuality are respected. Residents are offered a choice of wholesome meals and these meet any special dietary requirements for reasons of health, taste or cultural/religious preferences. Residents and their visitors are encouraged to voice any concerns that they may have about the service provided at the Home and complaints are investigated in an appropriate and timely manner. Residents are provided with a clean, comfortable and well maintained living environment in which they feel safe and secure and their privacy is respected. Aids and adaptations are provided to ensure that residents’ independence is promoted whilst maintaining their safety. Residents are encouraged to personalise their bedrooms so that they feel comfortable in their surroundings. Residents receive a good standard of care from an adequate number of appropriately trained and vetted staff in order to meet their care needs. Staff turnover is low and this ensures continuity of care for residents. Staff are well supported by the senior staff and management team and this ensures that they have the confidence and support to work in a competent manner. Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 7 The management team are approachable and friendly, residents’ and relatives’ meetings are held regularly and there is evidence that any suggestions made by residents or relatives about the service provided at the Home are acted upon. There are regular maintenance checks and servicing of equipment used at the Home and this ensures that they are safe to use. What has improved since the last inspection? What they could do better: Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 8 Moving and handling risk assessments did not inform staff of the action to be taken should a resident fall and this may result in them sustaining further injuries. There were some poor practices in respect of the management of medication and these may result in medication administration errors. Vulnerable residents may be at risk of scalding themselves from the boiling water from the kettles located within the kitchenettes. Some refrigerated food stored in the kitchenettes was not labelled or dated and this may result in residents becoming ill from food that was no longer fit for consumption. Residents were not able to access the call bell cord within the shower room and this may put them at risk in the event of an emergency. A communal toilet facility was not provided on the ground floor of the Home so residents had to return to their bedrooms to use their own facilities. An administrator/receptionist was not employed at the Home and the care staff had the responsibility for covering these roles and this may result in their time being taken away from providing residents’ care. Residents were not able to access their money held for safekeeping outside of normal office hours. 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. Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 9 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 Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 10 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, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admission procedures are robust and prospective residents have enough information to make informed decisions about whether they would like to live at the Home. EVIDENCE: A comprehensive “welcome pack” had been produced and this included an informative updated service user guide and statement of purpose so that residents had information about the services on offer at Greswold House. One resident said “ They sent me a brochure in the post, I could easily understand it and it was in fine detail” The admission process had recently been revised and staff stated that this was user friendly. The written documentation regarding this was comprehensive and easy to read and ensured that detailed pre admission assessments of Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 11 prospective residents’ care needs were undertaken to ensure that these could be met whilst living at the Home. Following the pre admission assessment, a letter is sent to prospective residents confirming whether their individual care needs could be met at the Home. Prospective residents were encouraged to spend a day at the Home in order to sample what life would be like to live there. One resident who had recently come to live at the Home said “ I came to look around, the staff made me feel so welcome, I was at ease”. Staff stated that prospective residents were able to choose their bedroom if there was more than one available at that time, however one resident who had recently come to live there said “ I am quite pleased with the room I have got, I didn’t choose it”. Contracts were available on residents’ files and these were signed by residents and/or their representatives as confirmation that they agreed to the terms and conditions of residency whilst living at the Home. Residents come to stay at the Home on a four week trial period and on completion of this a social care review is undertaken involving the resident, their relatives, Home’s staff and the Social Worker. This provides all involved with the opportunity to discuss whether the resident’s individual care needs were being met at the Home and whether they wished to remain there. A private review is undertaken involving the resident, their relatives and the Home’s staff for residents who are privately funded. Intermediate care is not provided at Greswold House Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 12 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 good. This judgement has been made using available evidence including a visit to this service. Health provision and care delivery are good and residents are cared for in a respectful manner ensuring that their self esteem and dignity are maintained. EVIDENCE: On admission to the Home, comprehensive assessments of residents’ individual abilities, physical and mental health status, interests and preferences in respect of their daily lives were undertaken so that the support that they received from staff whilst living at the Home could meet their care needs and maintain their preferred routines. A new care planning system had recently been introduced in to the Home with full consultation of the care staff team. This system was found to be both comprehensive and easy to read and identified the specific support required by the staff team to meet each resident’s individual care needs. Social care needs Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 13 were identified and preferences in respect of the gender of staff providing personal care were recorded in individual care plans. Care plans were written and agreed with the involvement of residents and this was confirmed by one resident who said “ The staff have done me a care plan, I contributed and the staff asked me my opinion”. Care plans were reviewed regularly and included residents’ comments about the care that they were receiving and any amendments to the support required by staff were made as required. Relatives were formally invited to participate in this process so that they could put any suggestions forward about the care provided. Daily reports included detail of the activities that the residents had engaged in during the day and reflected the good standard of care provided. Personal risk assessments had been undertaken identifying any risks pertaining to falls, nutrition or sore skin for individual residents. Comprehensive moving and handling risk assessments had been undertaken however these did not identify the action to be taken should a resident fall and this may result in further injury. Residents had the option of retaining their own General Practitioner on admission to the Home (if the GP is in agreement). Residents had access to a variety of Health and Social Care Professionals that visit the Home on a regular basis, including, Social Workers, District Nurses and Chiropody services. The staff team were proactive and monitored the residents’ physical health, for example, their weight and blood pressure and informed their Doctor of the results of these so that any abnormalities were detected quickly and remedial action could be taken. Since the last visit, prescription cream administration charts had been introduced and were included within the care plans as evidence that the creams were applied as prescribed. These included skin condition assessments so that the effectiveness of the treatments prescribed were monitored. The homely remedy policy stated that any homely remedy must be verified by a General Practitioner before being administered to individual residents so that it was safe to give. Residents were able to self administer their own medication should they choose to do so and were supported by the staff team in this area, ensuring that their independence was promoted whilst maintaining their safety. Risk assessments were undertaken to ensure that the medication was being administered as prescribed and this safeguards residents. The system for the ordering of medication for new and existing residents was robust however improvements were required regarding some aspects of the management of medication. Medication is dispensed in a “cassette” style format and as a result of this it was not always possible for the Home’s staff to confirm that they were administering the correct medication, especially as the shape and colour of Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 14 some medication had recently changed. Senior staff stated that plans were in place to discuss this with the Pharmacist in order to safeguard both residents and staff. Prescription items no longer required remained on the medication administration charts (MAR) and this may result in administration errors. Countersignatures were not always obtained as confirmation of the accuracy of hand written entries on to MAR charts and a weekly dosage tablet was signed in error as being administered daily and these may adversely affect the health of residents. The daily temperature recordings of the fridge storing prescription items identified that it had been running too cold for a long period of time and remedial action had not been taken which may affect the effectiveness of the medication prescribed. There was a telephone booth for residents to use in private and in addition to this, a number of residents had chosen to have a private telephone line installed in their bedrooms. Residents were well groomed and supported by the staff team to choose clothing and jewellery appropriate for their age, gender, style and time of year. Residents stated that they felt safe and secure living at the Home. One resident said “ What I like about living here is that I have got my independence and the care as well” Staff were greeting residents by their preferred names and residents confirmed that staff knock on their bedroom doors and wait for permission before entering. Any post was delivered to residents unopened and this ensured that their privacy was maintained. Greswold House DS0000016906.V321705.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 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Activities provided meet the needs and expectations of all residents living at the Home. Residents have control over their daily lives and are provided with a choice of healthy meals that meet any special dietary requirements. EVIDENCE: The Home employes a part time activities co ordinator who had recently received training in this area. Activities were provided on a daily basis and included physical exercises, quizzes, handi crafts and bingo. Regular trips outside of the Home were arranged including shopping trips, coffee mornings and bingo at the sheltered accommodation near to the Home and this ensured that residents felt part of the local community. A number of residents said that they were looking forward to a Christmas pub meal and a pantomime had been arranged. The hairdresser visits the Home twice a week. Residents confirmed that they had a choice about whether to participate in the activities and written records of activities arranged, the success of each activity and who participated were kept. This assists in planning future events. Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 16 Forthcoming events were on display on the notice boards within the Home so that residents could plan whether they wished to participate. There was an open visiting policy at the Home, respecting the meal times of residents and visitors were made to feel welcome at the Home. One resident said “ My visitors are made to feel welcome, they have a cup of tea with me”. It was apparent that communication was good between visitors and staff by means of regular relatives’ meetings, notice boards and written correspondence via the post. The staff stated that a number of visitors put forward suggestions about the running of the Home and that a good rapport had built up between the staff team and the visitors. A number of residents regularly went outside of the Home with their families and friends and this ensured that their individuality and links with those important to them was maintained. Holy Communion was available at the Home every month and a monthly church service was also held. Opportunities for worship for residents of non Christian faiths were arranged as required and some residents were supported by their friends and family to attend their places of worship outside of the Home. Residents met during the field work visit confirmed that there were no rigid rules or routines at the Home and they were able to make decisions about their daily lives. Residents stated that they had the choice of how to spend their day and the time that they got out of bed in the morning and went to bed at night. One resident said “ We are so well cared for here. The staff don’t monopolise us, we can make our own decisions within reason”. The Cook and Deputy Cook had recently undertaken training about Nutrition in Care and in consultation with the residents, the menus had recently been revised. The menus identified a variety of wholesome and nutritious meals, including both traditional British dishes and foreign tastes and residents confirmed that they were offered a choice of these. The kitchen staff consulted with the residents daily to ensure that they were satisfied with the meal options of the day. Cooked breakfasts were available every day and a snack meal was available in the evening and during the night so that residents were not hungry and fresh fruit was available at all times. Special diets were arranged for reasons of health, taste and cultural/religious preferences including diabetic and low fat options. One resident said “ The food is excellent, I am having chicken casserole today”. The main meal of the day was home made chicken casserole or fish fingers and chips and these were well presented, dining tables were laid attractively and cold drinks were served with the meal. The staff team serve and plate the meals from the kitchenettes instead of residents serving their own portions, Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 17 however residents met during the visit expressed their satisfaction about this. A daily record of food eaten by each resident was maintained in order for staff to assess whether each resident was receiving adequate nutrition. Greswold House DS0000016906.V321705.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, 17 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are investigated in a timely manner and vulnerable residents are protected by the Home’s staff. EVIDENCE: A number of compliments had been received by the Home’s staff since the last visit and these were on display. In addition “comment books” were available in the communal areas of the Home and these included compliments from residents and their visitors about their experiences whilst living at the Home. A comprehensive complaints procedure was on display within the Home and was included within the residents “welcome pack” so that residents and their visitors were aware of how to make a complaint should the need arise. This included contact details of CSCI and other local agencies who may be involved in the complaint process. One resident said “ I would choose one of the care staff to speak to if I wasn’t happy about anything” Since the last visit, CSCI had not received any concerns, complaints or allegations about the service provided at Greswold House. Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 19 The complaints register identified one complaint made directly to the Registered Manager concerning confusion over the time of day that a resident was being collected by her friend to go outside of the Home. This was addressed in an appropriate and timely manner and procedures had been introduced to prevent further confusion. The adult protection policy had been updated to include local agency guidelines so that all staff were aware of the action to be taken in the event of incidents of alleged or actual abuse, should the need arise and this safeguards residents. New staff had not undertaken training about the protection of vulnerable adults and existing staff required refresher training in this area so that residents are safeguarded. Residents and their visitors were supported by the Home’s staff to access local advocacy services so that appropriate advice could be sought in a number of areas as required. Greswold House DS0000016906.V321705.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): 21, 22, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a well maintained, clean and comfortable environment in which they feel safe and secure. The environment is designed to uphold the privacy and dignity of residents. EVIDENCE: Greswold House was found to be safe, warm and inviting and had been attractively decorated to celebrate Christmas. The internal environment was well furnished, floor coverings were of a good standard and the Home was generally well decorated. There was a rolling programme of planned refurbishment and redecoration in place. Residents’ accommodation was spread over three floors, each being similar in layout and each floor had their own lounge/diner and kitchenette. It was apparent that friendships had been formed amongst residents from living Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 21 within smaller groups, however all residents from the Home had the opportunity to meet regularly as a larger group to participate in activities. Residents had a choice of lounges to use and these were homely in style and decoration. Open plan kitchenettes were adjoining the three lounges for staff, residents and their visitors to make hot beverages and the meals were served within these areas. Whilst these were useful facilities, risk assessments must be undertaken about the risk of vulnerable residents scalding themselves from the boiling water from the kettles located within these. Food stored within the fridge in the ground floor kitchenette was covered but not labelled or dated and this may result in out of date food being eaten by residents. There was an assisted bathing facility on each floor of the Home and since the last field work visit, the respite bathroom located on the middle floor had been converted into an assisted shower facility “wet room” and this enabled residents to have a choice of a bath or shower. Staff said that this new facility had proved to be very popular with residents. It was noted, however, that the call bell cord in this room was inaccessible from the shower and this may place residents at risk. Staff stated that residents were not left unattended whilst using this facility, or staff positioned themselves directly outside of the room if the residents wished to use this facility in private, however the emergency cord must be accessible for residents’ use in the event of an emergency. Each bedroom, apart from the two bedrooms allocated for respite care residents, had an en suite toilet facility. In addition to this a communal toilet was located next to the lounge on the middle and upper floors. There was no communal toilet facility available for residents’ use on the ground floor so residents had to return to their bedrooms to use their own facilities, however building plans had been submitted in order to rectify this longstanding lack of provision. Staff confirmed that aids and adaptations available at the Home met the needs of the residents living there. There was one hoist, however only one resident required this at the current time. Specialist equipment was available to assist residents from the floor should they fall, pressure relieving cushions and mattresses were obtained from the community care team if residents were developing sore skin, raised toilet seats and hand rails were provided near to toilets and hand rails were provided in corridors. This promoted the independence of residents whilst maintaining their safety. There was a hearing loop system linked into the lounges so that residents who had hearing impairments could enjoy the television. Talking books were available, obtained from the Royal Institute For The Blind and the local library and one resident had a talking clock so that she independently knew what time it was. Large face clocks were on display throughout the Home for ease of reading by residents with poor eyesight. Each bedroom was for single occupancy and these contained residents’ personal items that reflected their interests, gender and culture so that they Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 22 felt comfortable in their surroundings. Residents were offered a key for their bedroom door and these could be overridden in the event of an emergency so that residents’ privacy was respected whilst maintaining their safety. Since the last visit, appropriate bedroom furniture with a lockable facility had been purchased so that residents could store any valuable or private items securely. A call bell facility was provided in each residents’ bedroom and in addition to this a number of residents had chosen to wear a pendant style call facility so that they could summons assistance in an emergency. Fluorescent lighting had been replaced with domestic style lighting within communal areas on the ground floor of the Home and this enhanced the homely atmosphere at Greswold House. Plans were in place to replace the fluorescent lighting on the middle and upper floors of the Home. There was an effective and hygienic system in place for the laundry of residents’ personal clothing and bed linen. The Home was found to be clean and fresh on the day of the visit. One resident said “ They clean my room every day”. A member of housekeeping staff was observed wearing gloves around the Home, this may cause the spread of infection and was brought to the attention of the Domestic Supervisor. Greswold House DS0000016906.V321705.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by an adequate number of appropriately vetted and trained staff. EVIDENCE: Senior staff stated that there was one Manager, one senior and four care assistants on duty during mornings, one senior and three care assistants on duty during afternoons and two care assistants with one senior for “sleep in” support during the night. Residents and staff confirmed that these staffing levels met the needs of the residents living at the Home. The management team were available at the Home during weekends so that residents and staff were supported and visitors had the opportunity to meet with them during that time. Staff turnover was very low and agency staff were not used at the Home, ensuring continuity of care for the residents living there. Kitchen, housekeeping and laundry staff provided ancillary support for the care staff so that residents received support in all areas of their daily lives. An administrator/receptionist had not been employed at the Home for a long period of time and the senior staff were responsible for the undertaking of this Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 24 role which may result in their time being taken away from providing residents’ care and a review of this must be undertaken. Staff recruitment files sampled contained all information required by regulations including satisfactory criminal record checks, employment histories and references in order to safeguard residents. One reference pertaining to a new staff member had not been dated or date stamped on receipt therefore there was no evidence that this had been obtained prior to the person commencing employment at the Home. Interview notes were kept in keeping with good practice. New staff undertake an in house induction covering health and safety issues and following this they complete comprehensive “Skills For Care” induction training ensuring that they have the appropriate knowledge to support residents in a competent manner. One induction record sampled had not been dated as confirmation of when it was undertaken. Staff had undertaken training relevant to their job roles including appraisal and supervision, the safe handling of medication, eye care, infection control and mental health awareness. Training videos had recently been purchased and were available for staff to refer to. An individual training record was available for each staff member and a staff training analysis identified individual staff member’s training needs so that any gaps in knowledge could be rectified. Over 50 of the staff team had completed a minimum of NVQ level 2 in care and all other care staff were currently working towards this. Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 25 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, 32, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is a well managed Home and run in the best interests of the residents living there. Residents, their relatives and the staff team are involved in the running of the Home and this ensures that they have the opportunity to put forward any suggestions for improvements. Residents’ health and safety is maintained. EVIDENCE: The Registered Manager had been in post for eighteen months and positive comments were received about her approachable and proactive management style. She had achieved the Registered Managers Award and had previous managerial experience in order to lead the staff team at Greswold House. Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 26 The managerial team and senior care team were located in an office adjoining the main foyer area and were easily accessible to residents, their visitors and visiting Health and Social Care Professionals. There was a comprehensive system for formal quality assurance at the Home involving residents, their visitors, the staff team and external Managers and independent agencies so that the standard of service at the Home was regularly monitored for quality. This included regular relatives’ meetings and monthly quality monitoring visits undertaken by Senior External Managers. Reports of these meetings and visits were available ensuring that residents received a good standard of service. A report based on the findings of the annual residents’ satisfaction survey was available on display for residents and their visitors to refer to. Residents’ meetings were held regularly in order for individual residents to put forward their suggestions for improvements about the services provided at the Home and there was evidence that these were acted upon. The minutes of these were on display in the Home and some were produced in a large print format for ease of reading for people with poor eyesight. Staff meetings were held regularly and this ensured that staff were informed about any new procedures or services provided for residents living at the Home and gave staff the opportunity to put any suggestions forward. There was a safe facility available for the safekeeping of small amounts of resident’s money and residents had access to this between 8am and 4pm Monday to Friday. It is recommended that a review of this be undertaken so that residents had access to their money at other times. Separate transaction records were maintained for money held on behalf of individual residents and signatures confirming all monies in and out of the safe were obtained, safeguarding both residents and staff. Receipts of items purchased from shops out of residents’ money were not always available and this would prevent an accurate audit trail from being undertaken. Cash balances of residents’ accounts checked on the day of the visit were correct. A system for formal staff supervision and appraisal had commenced and senior staff had responsibility for supporting staff members so that their work performance and individual training needs were monitored and identified in order to provide a good standard of care. Staff had undertaken training in health and safety issues including fire safety, moving and handling, food hygiene and first aid and this safeguards residents. A fire drill had been undertaken recently so that staff knew the procedure to follow in the event of an emergency. Fire risk assessments had been undertaken over twelve months ago and these were due for review to ensure that they identified any new hazards and thus safeguard residents. Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 27 Regular maintenance checks of equipment used at the Home were undertaken ensuring that they were safe to use. Accident reports were completed for all accidents involving residents and there was evidence that staff sought medical emergency advice as required. Accident reports were not stored securely and this did not uphold residents’ confidentiality. Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 28 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 3 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 2 2 2 2 x 3 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 x 3 Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 13(5) Requirement Moving and handling risk assessments must identify the action to be taken should a resident fall. Medication administration charts (MAR) must clearly identify if medication is no longer required Countersignatures must be obtained for all hand written entries on to MAR charts Medication must not be signed for unless administered The temperature of the drugs fridge must be within safe limits New staff must undertake training about the protection of vulnerable adults and existing staff must undertake refresher training in this area. Fluorescent lighting must be replaced with domestic style lighting on the middle and upper floors of the premises. (previous timescale of 31/03/06 Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 30 Timescale for action 01/03/07 2 OP9 13(2) 23/01/07 3 OP18 13(6) 01/04/07 4 OP19 23(2)(p) 01/06/07 5 OP20 13(4) not met) Risk assessments must be undertaken about the risk of vulnerable residents scalding themselves from the boiling water from the kettles located within the kitchenettes. Food stored within the fridge in the ground floor kitchenette must be labelled and dated The emergency call bell must be accessible to residents from all areas of the shower room There must be sufficient communal toilets available for residents on the ground floor. (previous timescale of 31/03/06 not met) 23/01/07 6 OP20 16(2)(j) 23/01/07 7 8 OP21 OP21 13(4) 23(2)(j) 01/02/07 01/08/07 9 OP27 18(1) The registered person must ensure that staff roles are appropriate by the recruitment of an administrator. (timescale of 31/12/05 not met) 01/07/07 10 11 OP29 OP38 19(1) 23(4) References pertaining to prospective staff members must be dated Fire risk assessments must be reviewed and updated 23/01/07 01/03/07 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 OP9 Good Practice Recommendations A review of the current system for the administration of DS0000016906.V321705.R01.S.doc Version 5.2 Page 31 Greswold House 2 3 OP30 OP35 4 OP38 medication should be undertaken. Induction records should be dated on completion A review of the system for residents accessing their money held for safekeeping should be undertaken Receipts of shop bought purchases out of residents’ money must be kept Accident records should be stored securely Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Greswold House DS0000016906.V321705.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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