Inspection on 14/02/06 for Grevill House

This inspection was carried out on 14th February 2006.

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

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

Other inspections for this house

Grevill House 23/10/07

Grevill House 15/08/06

Grevill House 20/07/05

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

CARE HOMES FOR OLDER PEOPLE Grevill House 279 London Road Charlton Kings Cheltenham Glos GL52 6YL Lead Inspector Mrs Eleanor Fox Unannounced Inspection 14th February 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Grevill House DS0000064592.V283540.R01.S.doc Version 5.1 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. Grevill House DS0000064592.V283540.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Grevill House Address 279 London Road Charlton Kings Cheltenham Glos GL52 6YL 01424 512964 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) The Orders of St John Care Trust Mrs Joy Rosemary Warren Care Home 65 Category(ies) of Old age, not falling within any other category registration, with number (65) of places Grevill House DS0000064592.V283540.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Temporary Variation - Two named service users under the age of 65 years. Temporary Variation - One named service user under the years. The home will revert to the original service user category named service users no longer reside at the home. Temporary Variation - One named service user under the years. The home will revert to the original service user category named service users no longer reside at the home. 20th July 2005 age of 65 when these age of 65 when these 3. Date of last inspection Brief Description of the Service: Grevill House is a purpose built Care Home, providing nursing and personal care to 50 service users over 65 years of age. Grevill House is situated in the village of Charlton Kings, approximately 2 miles from Cheltenham Town centre. The Home has 50 single rooms, with comfortable homely communal accommodation on both floors. A shaft lift has been installed for easy access to the upper floor. Although only two of the rooms have en suite facilities, there are several assisted bathrooms and separate toilet facilities throughout the Home. Some of the bedrooms at the front of the property have the benefit of a small balcony. An additional superb independent facility known as the Ashley Intermediate Care Centre provides intermediate care for 15 service users. All the large comfortably furnished bedrooms have en suite facilities and the service users have the benefit of sunny open plan communal rooms. They have access to full rehabilitation support services during their short stay in the unit. The property is surrounded by landscaped gardens. Grevill House DS0000064592.V283540.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced inspection over a period of 6 hours. She selected five residents as part of a case tracking exercise. Their care records were read in detail; their medication documentation and records of any accidents relating to these people were also reviewed. The inspector visited each person, observed their bedroom accommodation and where possible, gained feedback on the care they were receiving. She watched the service of the mid-day meal, the administration of medications and some of the personal care given to the residents. Quality assurance processes in place were discussed. Personnel records and training provision were also inspected. The inspector had the opportunity to speak to three visitors and to staff in the main home and in the Ashley Intermediate Care Centre. Some of their views and comments have been reflected in this report. What the service does well: Service Users admitted to the Ashley Intermediate Care Centre have the benefit of full rehabilitation facilities and support prior to their return home to independent living. One lady was most appreciative of the care she had received and commented on her increased confidence following her stay at the unit. Residents are treated with courtesy and are shown respect by the staff. They also receive attentive and appropriate care when they reach the final days of their life. A good standard of food is served at this home. On the whole, residents enjoy the food they are offered. Members of staff are provided with the opportunity to attend a variety of training to equip them to care for each person appropriately. However, more carers should be undertaking a National Vocational Qualification in Care. Grevill House DS0000064592.V283540.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Grevill House DS0000064592.V283540.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grevill House DS0000064592.V283540.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 The provision of additional information about the Home and the introduction of a documented assessment procedure, would enable prospective residents to make a fully informed decision regarding their admission and give them assurance that their needs would be met at Grevill House. Service users requiring intermediate care are provided with the care and support they need to return to independent living. EVIDENCE: A Statement of Purpose and Service User Guide have been developed for this Home. However these have not yet been fully reviewed and updated to reflect the management changes in the Company early in 2005. These processes are now being undertaken. Prospective residents continue to be fully assessed by the Manager prior to admission to Grevill House. No written records are maintained of the processes although one member of the nursing team did acknowledge that the nurses are Grevill House DS0000064592.V283540.R01.S.doc Version 5.1 Page 9 given a verbal report so that they are aware of the new resident’s particular care needs. Intermediate care continues to be provided in the Ashley Intermediate Care Centre. This purpose built unit was opened two years ago and has been designed, equipped and staffed to provide short-term intermediate care to service users who require rehabilitation prior to returning to independent living in the community. The service users have the support of a fully multidisciplinary staffing team. Staff did report that the dependency levels of these people have increased in recent months. Grevill House DS0000064592.V283540.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9, 10 and 11 The care planning systems in place do not adequately provide staff with the information they need to satisfactorily meet residents’ needs. Medication systems also require some minor improvements to ensure that residents are not put at any risk of potential errors. However, the people living here are treated with respect and courtesy. They also receive attentive care when they reach the final days of their lives. EVIDENCE: The care records relating to five selected residents were read on this visit to Grevill House. The home continues to provide care plans for each person, based on an assessment of care needs. On the whole, these contain explicit instructions to address any specific requirements. Appropriate risk assessments are also prepared as required. However, in two instances, although it had been identified that the person concerned was at risk of developing a pressure sore, no care plan had been developed to address this need. Grevill House DS0000064592.V283540.R01.S.doc Version 5.1 Page 11 Care plans provided for people in the Ashley Intermediate Care Centre show significant improvement. The examples seen on this occasion give clear direction to the carers, reflecting the service user’s current condition. Medications in Grevill House are ordered and stored correctly. The medication records relating to the five selected residents were read in detail. It appeared that drugs had been administered as prescribed for each person. Where known allergies have been identified in the care plans, these had also been correctly identified on the medication sheets. There were four examples where the person making the record had not signed handwritten entries on the drug administration sheets. Also any instructions should be written clearly, rather than just ‘once a day’ and English terminology should be used. The majority of service users in the Ashley Intermediate Care Centre are facilitated to self administer their medications, based on a risk assessment. Each person has the means to lock away drugs securely. However, the Unit does not have an approved drug store cupboard to store Controlled Drugs although this issue is now being addressed. Throughout the day, members of staff were observed and overheard addressing the residents in a respectful but friendly fashion. All personal care appeared to be given in privacy. One resident had passed away the previous night. Records showed that this person had received attentive care during her final days. The Home had also ensured that the resident had received medical attention as required, and that family members were aware of the deteriorating condition. The resident’s and the family’s wishes were clearly documented in the records Grevill House DS0000064592.V283540.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 and 15 The consideration and respect that is shown by staff towards people living at the home ensures that they are able to exercise control and choice in their daily lives. Dietary needs of residents are well catered for with a balanced and varied selection of food available that meets residents’ tastes and choices. EVIDENCE: Discussions with four residents in Grevill House and two in the Ashley Intermediate Care Centre revealed that all were able to exercise some choice in their daily lives. They get up and retire when they wish, one person preferring to go to bed after 11pm, and spend their day where they choose within their own limitations. Some people are happy to join their colleagues in one of the communal areas; others prefer the peace and privacy of their own bedrooms. All were given the option to attend a short religious service on the day of the inspection. Most people eat their meals in one of the communal rooms. These spacious light rooms are pleasantly furnished and on this occasion the main dining room was decorated with hearts and balloons to celebrate St Valentine’s Day. Residents are offered a choice of food from the daily menus and it was observed that one person was given additional vegetables, at her request. It was also observed that those people who required assistance were helped in Grevill House DS0000064592.V283540.R01.S.doc Version 5.1 Page 13 an unhurried fashion. One carer talked encouragingly to a lady, gently coaxing her to eat her lunch. Two residents confirmed that the lamb was very tender and that they were enjoying the meal. They were also looking forward to the celebration tea, which was planned later in the day. The service users in the Ashley Intermediate Care Centre also spoke positively about the meals served. These people are also supported to prepare their own food as part of their rehabilitation programme in preparation for discharge back to their own homes. Grevill House DS0000064592.V283540.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The implementation of the Home’s robust policies and procedures gives residents the assurances that they may expect to live in a safe environment. EVIDENCE: The Orders of St. John Care Trust have developed comprehensive policies to address all forms of abuse. These are readily available for members of staff to read. Whistle blowing procedures are also included in this documentation. Staff in the home have recently had the opportunity to attend abuse training; three two-hour courses were arranged. Further tuition on dealing with ‘Challenging Behaviour’ has been arranged in March. The Manager ensures that POVA (Protection of Vulnerable Adults) legislation is implemented when necessary. Grevill House DS0000064592.V283540.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 A homely well maintained environment continues to provide those living in Grevill House and the Ashley Intermediate Care Centre with a reasonable standard of accommodation. EVIDENCE: Grevill House and the Ashley Intermediate Care Centre are decorated, furnished and maintained to meet the needs of those living there. The Ashley Intermediate Care Centre has been equipped to a particularly good standard. The handyman is responsible for addressing maintenance and decorative requirements. The ground floor corridor of the main home was being painted on this day. A new assisted bath is about to be installed in one of the bathrooms. Additional rehabilitation facilities are also being considered for the Ashley Intermediate Care Centre. Adequate parking is provided around the properties. Grevill House DS0000064592.V283540.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 and 30 Staff employed at the home must be subject to robust recruitment procedures and receive care training to ensure that the residents are fully protected at all times. EVIDENCE: Of the thirty-nine care staff employed at Grevill and in the Ashley Intermediate Care Centre, eleven hold a National Vocational Qualification in Care; seven more are working towards a qualification. Six members of staff are waiting to commence the training. Three records relating to members of staff employed since the last inspection were read in detail. Although some recruitment processes were followed, it was observed that one person only had one reference provided; another had commenced duties ten days prior to the POVA (Protection of Vulnerable Adults) clearance had been received; and there were no interview notes completed for a third applicant. Each person was inducted to his or her respective roles. The member of staff with delegated responsibility for arranging training was not on duty but records were available to show that staff had received instruction in care planning processes, abuse, diabetes, fire prevention, and manual handling. A course on dealing with challenging behaviour had been booked for March. One member of staff did confirm that a training need had been identified during her supervision meeting and was now being addressed. Grevill House DS0000064592.V283540.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 36 and 37 Although there is a programme of self-review and consultations in place at the Home, some additional details are required to ensure that residents gain full benefit from these processes. All staff require supervision to ensure that the residents are not put at any risk. Records are stored securely to safeguard the residents’ confidentiality. EVIDENCE: The home has processes in place to monitor quality improvement. Any complaints, accidents or adverse incidents, and satisfaction with the provision of food are all monitored closely. The home has recently been audited for the ISO 9001 award. A plaque confirming their successful completion will be hung in the main hall. However, a quality improvement report has not been provided for the Home in the last twelve months, as is required. This is now being developed. Grevill House DS0000064592.V283540.R01.S.doc Version 5.1 Page 18 Supervision processes are undertaken more regularly now although this improvement is not consistent throughout the care team. One senior member of staff had not attended a formal supervision meeting since April 2005. All the records seen on this occasion were maintained correctly and stored securely. Photographs were provided for each person selected as part of the case tracking exercise. Residents do have access to their records if they wish. Grevill House DS0000064592.V283540.R01.S.doc Version 5.1 Page 19 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 2 x 1 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 3 x x x x x x x STAFFING Standard No Score 27 x 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x x 2 3 x Grevill House DS0000064592.V283540.R01.S.doc Version 5.1 Page 20 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 OP1 Regulation 6(a & b) Requirement The Statement of Purpose and Service User Guide must be reviewed and updated to reflect the changes in the home. A copy must be provided to the Commission The care needs of each resident must be fully assessed prior to admission to the home. (Previous time scale 30/9/05 not met) Care plans must be provided to address residents’ care needs, particularly in relation to pressure relief. A Controlled Drug storage cupboard must be provided in the Ashley Intermediate Care Unit The person making the record in the drug administration documentation must sign any handwritten amendments. These must also be countersigned by another witness. All instructions for administration must be explicit. Two written references must be obtained prior to the DS0000064592.V283540.R01.S.doc Timescale for action 30/04/06 2. OP3 14(1a) 01/03/06 3 OP7 15(1)&(2) 31/03/06 4 OP9 13(2) 31/03/06 5. OP9 13(2) 31/03/06 6 OP29 Sch 2.3 01/03/06 Grevill House Version 5.1 Page 21 7 OP29 19(6) 8 4. OP33 OP36 24(2) 18(2) commencement of employment POVA (Protection of Vulnerable Adults) clearance must be obtained before a new recruit commences duties A quality improvement report must be provided for the home Supervision processes must be undertaken regularly. (Previous time scale 31/10/05 not met) 01/03/06 30/04/06 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3 4 Refer to Standard OP3 OP9 OP28 OP36 Good Practice Recommendations A copy of the initial assessment should be retained on the residents care file to assist with the admission processes Any handwritten medications on the administration records should be written in English to assist clarity At least 50 of care staff should be trained to NVQ in care, level 2 or equivalent. Supervision processes should be undertaken six times a year Grevill House DS0000064592.V283540.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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