Inspection on 26/11/08 for Gretton Court Nursing Home

This inspection was carried out on 26th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Gretton Court Nursing Home 1 Heather Grove Hartlepool TS24 8QZ     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Date: 2     6 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Gretton Court Nursing Home 1 Heather Grove Hartlepool TS24 8QZ 01429862255 01429279005 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Hospital of God at Greatham Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 32 Number of places (if applicable): Under 65 Over 65 32 dementia Additional conditions: 32 The maximum number of service users who can be accommodated is: 32 The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Dementia, Code DE - maximum number of places 32 Date of last inspection Brief description of the care home Gretton Court is located in Heather Grove, Hartlepool. The home is now owned by The Hospital of God at Greatham and is registered to provide nursing care for up to 32 people with dementia. The home was purpose built approximately 15 years ago. It provides private bedrooms and a variety of communal facilities, such as bathrooms, lounge and dining areas and courtyard gardens. Up to date information about fees and terms and conditions should be sought directly from the home. Care Homes for Older People Page 4 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection, which took place on 26th November 2008. The inspection was completed by one inspector, who spent eight hours at the home. It was the first inspection the home has had since it was taken over by The Hospital of God at Greatham. Before the inspection we asked the home to complete a self-assessment, to provide us with information about the home and the people who live and work there. However, the self-assessment that was returned to us was very brief and had not been completed in the detail we would expect. We also sent a selection of surveys to the home, to be handed out to people who live and work there. Unfortunately none of these were completed and returned to us. Care Homes for Older People Page 5 of 30 During our visit to the home we spent time looking around and observing care practice. We spoke to some of the people living at the home, but because of their illness people found it difficult to tell us what they thought. We talked to staff about the home and the care people receive there. At lunchtime we watched how meals are provided, looked at the food people ate and talked to the cook. We also spent time talking to the acting manager and area manager. Staff showed us how medication is stored and administered and we looked at a selection of other records kept by the home. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: Although everyone at the home has their own care records, the records need to be more comprehensive. They should include more person centred information about peoples personal and social care needs and preferences. Evaluations and reviews need to be completed monthly, to ensure the records are up to date. We saw staff using unsafe manual handling practices. Staff had been trained in manual handling, but told us that they had difficulty putting this into practice because using manual handling equipment was very distressing for some the people they looked after. The management must make sure that staff have the training and guidance they need to safely look after people. Care Homes for Older People Page 7 of 30 At the moment people with less advanced dementia, who are easier to engage in activities seem to benefit most from the homes activities programme. The activities provided would benefit from being more varied and with more focus on the needs of people with advanced dementia. This would help to make sure that everyone at the home benefits from social stimulation, no matter what their needs are. People we spoke to felt that although people get enough food, more variety and flexibility in the menus would give people more choice. Staff were concerned that there often wasnt enough of each meal option provided to give all residents a choice and that the kitchen could be difficult to approach with special requests. Although the majority of the home was clean and tidy, we did notice that some peoples rooms smelled unpleasantly. Action needs to be taken to ensure that peoples rooms are pleasant and hygienic places for people to spend time. Some staff training needs to be updated and employment records need to improve. For example, we found that the homes employment records made it difficult to tell if staff had completed the required checks before they started work. This will help ensure that staff are suitable for their jobs and have the skills they need. Effective management arrangements have not been in place and this has impacted on the service people receive. For example, important management tasks, such as ensuring health and safety and completing necessary maintenance checks, have not been carried out as often as they should be. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff at the home gather information about people, before they come to live in the home. This helps to make sure that the home can meet peoples needs and provide the care they need. Evidence: In their self assessment the home told us that all potential residents are assessed prior to admission to ensure all needs will be met. We looked at some peoples care records. These contained assessments, including information from other professionals. For example, from a psychiatrist who was working with the person concerned. Care Homes for Older People Page 10 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive the health and personal care they need from caring staff and medication is managed safely. However, care records need to be more comprehensive and should include more person centred information about peoples personal/social care needs and preferences. Evidence: We spent time observing the care that people were given. Staff spent time supervising people, chatted with people and helped them in friendly and nice ways. People were treated kindly and personal care was carried out in private. The staff we spoke to had a good understanding of dementia. For example, one staff member told us how important it is to spend time observing people, how they cant always tell you if something is wrong and how you sometimes need to learn about them in other ways. A health professional told us that they think the care is excellent and that staff are very personal. They said they (the staff) know their (the residents) little ways, know their families, its their home and thats how its treated. The people we spoke to said they were happy with their care. Care Homes for Older People Page 11 of 30 Evidence: Each person who lives at the home has a record of the care they need. This includes assessments, care plans, risk assessments and records of the care people receive. We looked at a selection of these records. One person had in place a number of risk assessments, which identified where they needed help and support to prevent accidents or a deterioration in their health and wellbeing. However, these risk assessments had not been reviewed since they had been completed in March. This means that the information in them might not be up to date. We also found that one person had lost quite a bit of weight recently. However staff had not completed a nutritional assessment and there was no care plan in place providing information about this persons nutritional needs. For example, if the weight loss was intended and due to a special diet or if staff needed to take action to prevent further weight loss. Some care plans were in place and evaluated regularly. However, we found that these focused on peoples nursing needs, such as the management of diabetes and behaviour. There were no care plans providing information about the support people needed with their personal and social care needs or about peoples wishes and preferences. The records would benefit from being more person centred in approach. The records showed that people had help from other health professionals when they needed it. For example, there were records of visits from doctors, psychiatrists and the health liaison officer. One person was in the process of being reviewed by their psychiatrist, because the home was concerned about some of their behaviour. Feed back we received from a health care professional was very positive. They told us that the home seeks and acts on advice when needed, saying they are good. We looked at the way the home managed medication. The home had an inspection by a pharmacist from the local Primary Care Trust (PCT) in June and the care services manager followed this up with her own inspection in July. We saw the reports from both of these inspections, which told us that medication procedures are safe, but that some recording practices could improve. We checked a number or records and storage arrangements with one of the nurses on duty at the time of this inspection. We found that medication was being stored safely and appropriately. The fridge and room temperatures were checked regularly and records showed they were maintained at appropriate temperatures. Controlled drugs were being stored securely and a controlled drugs register was being used to record the use of controlled drugs. The medication administration records we looked at suggested that medication was being given in accordance with peoples prescriptions. However, sometimes where medication was being carried over from one month to the next the balance of medication being carried over was not always being recorded on the medication administration record (MAR). Care Homes for Older People Page 12 of 30 Care Homes for Older People Page 13 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are some activities provided at Gretton Court, but more variety and focus on the needs of people with advanced dementia would help to make sure that everyone benefits from social stimulation. People are provided with a good diet, although more variety and flexibility would give people more choice. Evidence: The home shares an activities coordinator with another home. This means that the coordinator shares her time between the two homes. In their self-assessment the home told us that one of the things they would like to do better was encourage a wider range of activities within the programme. We talked to staff about activities at the home and observed what was happening during our visit. Staff told us that they thought people who were easier to engage or had the earlier stages of dementia got the most attention from the activities coordinator. For example, manicures always tended to happen to the same people. Staff felt that the home could do better at providing stimulation to people who were more difficult to engage in activity and in organising trips outside of the home. We looked at the activities timetable, but were disappointed to see that it was made up of things like Care Homes for Older People Page 14 of 30 Evidence: hairdressing, pie and pea supper and hot dog tea. These are the types of things that people should be engaging in as part of the homes normal routines, rather than as special activities. Staff told us that people enjoy it when the musicians come in to entertain people with concerts and that people respond well when staff try to do oneto-one activities such as chatting, singing and dancing. During our visit we saw staff chatting with people, music playing and people watching the television. The homes self assessment told us we provide a homely environment, encouraging relatives to visit as they would at home. Staff and people visiting the home during our visit confirmed this. Staff we spoke to knew people well and were focused on providing people with the care they needed. They told us that they try to make routines flexible, such as letting people go to bed or get up when they want. However, a lot of the people who live at Gretton Court cant tell staff about their wishes and preferences. This means that it is important that their care records contain detailed information about peoples wishes and preferences, so that staff can tailor routines and care to their individual preferences. We observed the lunch time meal. People eat in three different dining areas, depending on their needs and preferences. The main dining room was a pleasant place to eat, with tables nicely set with tablecloths and a relaxed atmosphere. We asked one man if his dinner was nice and he said yeh, beautiful. It was either braised steak or sausages, served with gravy, creamed potatoes, buttered leeks, cabbage and carrots. However, the other dining rooms appeared to be less organised and relaxed. For example, tables were not set with tablecloths, staff were busy helping people eat, trying to serve meals from the trolley and trying to keep people interested in their food and stop them wandering away. Some people who were not getting staff attention (because they were busy helping other people) were shouting, which was distracting to other residents. Some of these difficulties were because the people eating in these areas had more advanced dementia. However, management need to review mealtime arrangements and try to make meal times a more pleasant and relaxed experience for people. The food we saw being served during our visit looked appetising and nice. We talked to the cook, who told us how she caters for special diets, such as diabetics and people who can not chew very well. However, staff told us how there sometimes wasnt enough of each meal to offer everyone a choice, saying we tend to give the option to those who can tell you what they want. There was also the feeling that more variety and flexibility was needed. For example, staff said that the alternative meals were often the same for two days in a row, commented that you feel like your asking the Care Homes for Older People Page 15 of 30 Evidence: world if someone wants a bacon sandwich (for breakfast) and described the kitchen as not over generous. We looked at the homes current menus. These did not always show what the alternative meal was and we noticed that the alternative to the Sunday roast usually seemed to be minced beef. However, overall the menus appeared to show a traditional and varied diet. Care Homes for Older People Page 16 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and safeguarding procedures are now being followed, ensuring that peoples concerns are dealt with properly and people are protected. Evidence: The home has a complaints procedure and we looked at the record of recent complaints. Four concerns or complaints were recorded. They appeared to have been investigated appropriately and action had been taken to improve things where this was necessary. Since the last inspection we know that some safeguarding issues have not always been reported in accordance with local safeguarding procedures. However, this has now improved. Recent incidents have been reported properly and we saw records of a staff meeting where safeguarding procedures had been discussed. Some staff have received training on safeguarding and abuse and more training is planned. Staff we spoke to said that they would report any concerns they had to nursing staff and would not tolerate anyone being mistreated. There have been a lot of incidents in the home between the people who live there. This is because the home offers dementia nursing care and lots of the people who live there can behave in a challenging way. We looked at the incident and accident records and watched the supervision that staff gave people. We saw that staff usually supervise Care Homes for Older People Page 17 of 30 Evidence: the main communal areas and records showed that staff were usually present and had intervened when incidents occurred in these areas. We also saw staff interacting nicely with people and trying to prevent incidents occurring. For example, staff moved one person who was shouting and annoying other residents, taking him to a quieter space and sitting and chatting to him so that the shouting stopped. Care Homes for Older People Page 18 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the home provides a comfortable environment for people to live in. Work is being undertaken to update the furnishings and fittings, some of which are looking a little dated and worn. Evidence: Gretton Court was purpose built approximately 15 years ago. The new owners have recognised that the home needs some investment to maintain it and to make sure that people have a pleasant place to live. In their self assessment they told us that they have already spent money redecorating, putting down new carpets in some parts of the home and working on the homes gardens. The staff room was in the process of being refurbished when we visited. They have also identified a budget for next year and plan to continue updating the homes facilities. We looked around the building with the acting manager. Peoples rooms were comfortable and contained peoples personal belongings. For example, pictures, ornaments and small pieces of furniture people had brought with them. However, we did notice some unpleasant odours in some peoples rooms. Communal areas were comfortable, but some furnishings looked a bit worn. For example, some of the dining furniture and chairs in the communal lounges and the bathroom fittings. Staff told us that they thought it was good that the new owners were investing money in the home. Care Homes for Older People Page 19 of 30 Evidence: The Hospital of God at Greatham employs a full time proterty manager, who deals with day to day maintenance for the organisation. A range of contractors of all trades are used by the property manager to deal with most repairs. Some staff told us that waiting for a visit, rather than having a maintenance man on site, can sometimes be problematic. However, the homes management have assured us that repairs are dealt with quickly once they are reported. We found that some maintenance checks were not being completed as often as we would expect, but this is covered in the management and administration section of this report. In their self assessment the home told us that they had in place procedures to help prevent the spread of infection and that staff had received training in infection control. We spoke to the laundry staff at the home, who confirmed they had the equipment they needed (including gloves and aprons) and had received infection control training. Domestic staff were on duty when we visited and the home was generally clean and tidy. Care Homes for Older People Page 20 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff on duty and the staff team is well qualified and has a good understanding of the needs of people with dementia. However, some staff training needs to be updated and employment records need to improve. This will help ensure that staff are suitable for their jobs and have the skills they need. Evidence: Staff told us that they thought there was a good staff team working at Gretton Court. A lot of the staff have worked at the home for a long time and staff said that there is a low turn over of staff. Staff comments included I enjoy my job and on the whole I think its a fantastic home. Staff said that they know people well and have had a lot of training in caring for people with dementia. Staff told us that staffing levels at the home worked well. We saw that staff had time to provide the supervision and care people needed. Staff rotas also showed us that appropriate numbers of staff are usually on duty at the home. In their self-assessment the home told us that all staff who have started to work in the home in the last twelve months have had satisfactory pre-employment checks. We looked at some of the recruitment records that are kept by the home. We found that these need to be improved, so that the home can prove that the required checks have been completed before new staff start work. For example, one persons records didnt Care Homes for Older People Page 21 of 30 Evidence: include the date their criminal records bureau (CRB) disclosure had been completed or the disclosure number and one of their written references had not been dated. This made it impossible to tell if the person had started work before or after these important checks were completed. The care services manager told us that the Hospital of God at Greatham thinks that training is very important. We looked at training records and saw that training during 2008 had included infection control, pressure care and safeguarding adults. However, the records also showed that a number of staff needed training updates in subjects like manual handling and fire safety. In their self assessment the management told us that 14 out of 17 of the homes permanent care workers had completed a national vocational qualification (NVQ) in care. The care services manager confirmed this during our visit. Care Homes for Older People Page 22 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Unfortunately effective management arrangements have not been in place and this has resulted in important management tasks, such as ensuring health and safety, have not been carried out as often as they should be. Evidence: At the time of this inspection there was no registered manager for this service and there hadnt been for some time. The homes management was being undertaken by an acting manager, who had been given three supernumerary days of managerial time each week. The Hospital of God at Greatham had recognised that additional management support was needed and had created a senior management role (the care services manager) to visit the home regularly and provide support to the acting manager. The self-assessment that we asked the homes manager to complete was returned to us. However, it had not been completed very thoroughly and did not provide us the Care Homes for Older People Page 23 of 30 Evidence: information we would expect. We sent a selection of surveys to the home for the manager to distribute to staff and people who use the service (or their relatives if more appropriate). However, none of these were completed and returned to us. We also found that other aspects of homes management had not always been done as we would expect. For example, important health and safety checks were not taking place as often as they should and some of the staff we spoke to felt that there seemed to have been a lack of management/communication recently and were looking forward to having a full time, permanent manager again. We spoke to the care services manager, who was already aware of these problems. She told us that a new manager has now been appointed for the home and is expected to start work in the near future. We were told that the new manager will apply for registration with CSCI as soon as possible and that team building training is being provided to support staff. The home only helps a very small number of people manage their personal money. Most people are assisted with this by their families. We looked at how the home helped one person manage small amounts of personal money. This was stored securely, but there was no formal recording system showing what money was being used for. Formal records must be kept (including receipts where appropriate) to ensure that money is being used appropriately and to protect people from financial abuse. We found a number of health and safety issues that need to be addressed. We saw staff helping people to move about the home. However, staff did not always use appropriate manual handling equipment. For example, we saw two staff lifting someone whose legs could not hold their own weight, using an underarm lift to get them from their wheelchair into an armchair. This is not safe practice and increases the risk of injury to staff and the person being lifted. When asked about this staff told us that they had received manual handling training and were aware that they shouldnt be lifting people like this. However, they also told us that a lot of the people at the home get very distressed when using manual handling equipment, such as a hoist. Staff said that they were trying to minimise this distress. It is very important that staff are given training and clear guidance on how to move people safely, while minimising the distress that this causes people. At the moment staff and people living at the home are at risk of injury because people are not being moved using safe manual handling practice. We looked at the records for regular maintenance and safety checks. We found that a number of important safety checks were not being completed as often as they should be. For example, the homes fire risk assessment says that the fire alarm should be tested weekly and that the emergency lights should be tested monthly, but the records showed that this was not happening. There were also no records of any recent fire drills taking place. We have informed the local fire authority about these issues. In Care Homes for Older People Page 24 of 30 Evidence: addition we found that the water temperature at hot water outlets wasnt being regularly tested to make sure that people are protected from scalding risks and the home needs to develop a formal system to check that bedrails are correctly fitted and maintained. The care services manager, director and trustees visit the home regularly and complete monitoring checks (sometimes called regulation 26 visits) to monitor the homes performance. We looked at the records of these visits. They seemed thorough and included consultation with staff and people who live at the home. They also picked up on things that were not being done properly, including some of the things that we have identified during this inspection. We also saw minutes from staff meetings, which showed us that problems were being raised with staff. The care services manager was able to tell us what the Hospital of God at Greatham was planning to do about the problems and already had plans in place to make improvements. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 Staff recruitment records must demonstrate that the required checks (CRB and 2 written references) have been completed before staff start work in the home. Unless checks are completed before staff start work the management can not be sure that staff are suitable to work with vulnerable people. 31/01/2009 2 31 8 Appropriate management arrangements must be put in place to ensure the safe and effective running of the home. Important management tasks have not been done effectively. This has impacted on the service people are receiving, including important things relating to health and safety. 31/01/2009 Care Homes for Older People Page 27 of 30 3 38 23 Appropriate fire safety systems must be put in place. Appropriate safety tests and checks are not currently being carried out. This means that people could be put at unnecessary risk in the event of a fire. 31/12/2008 4 38 13 A formal system for the safe 31/01/2009 fitting and maintenance of bedrails needs to be put in place. Bedrails should only be used in accordance with current good practice guidance. Regular checks are needed to ensure that bedrails are fitted correctly and safely. If they are not maintained properly they can become loose and the risk of injury is increased. 5 38 13 Hot water temperature at hot water outlets must be regularly tested to ensure that thermostatic valves are functioning correctly. Without regular checks the manager can not be sure that hot water is at a safe temperature and people may be put at unnecessary risk of scalds. 31/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. Care Homes for Older People Page 28 of 30 No. Refer to Standard Good Practice Recommendations 1 7 Risk assessments should be regularly reviewed to ensure the information in them (and in relevant care plans) is up to date, accurate and reflects peoples needs. Care plans and records should be developed to be more person centred. They should include more detailed information about peoples personal/social care needs, including their wishes and preferences. Nutritional assessments should be completed on admission and should be reviewed regularly. Where people need help and support to maintain an appropriate nutritional intake (for example, due to difficulty eating or weight loss) the support they need should be clearly recorded in their care plans. Activities and opportunities for social stimulation need to be developed further. The activities should be varied and take into account the needs of all residents, so that everyone living at Gretton Court benefits from regular social contact and stimulation. Sufficient food should be provided to enable all residents to have a choice of meal. The current arrangements at meal times need to be reviewed to see if a more relaxed dining experience can be acheived for all residents. Staff should receive training on safeguarding and abuse within 6 months of employment. The training should also up dated every 2 years. The planned refurbishment of the home should take place, including the replacement of bathroom fittings and the furniture used in communal areas. Unpleasant smells should not be present in peoples bedrooms. The cleaning or replacement of furnishings that is necessary to get rid of such smells should be undertaken promptly. Where the home helps people to manage small amounts of personal money clear records (including receipts) should be kept. This is important in demonstrating that peoples money has been used appropriately and protecting people from financial abuse. Safe and effective arrangements for manual handling should be put in place. 2 7 3 7 4 12 5 6 15 15 7 18 8 19 9 26 10 35 11 38 Care Homes for Older People Page 29 of 30 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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