Inspection on 20/07/05 for Grevill House

This inspection was carried out on 20th July 2005.

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

Grevill House 23/10/07

Grevill House 15/08/06

Grevill House 14/02/06

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 Gloucestershire GL52 6YL Lead Inspector Eleanor Fox Unannounced 20 July 2005, 09:30 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 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 D51_D03_S64592_Grevill House_v233517_200705_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Grevill House Address 279 London Road Charlton Kings Cheltenham Gloucestershire GL52 6YL 01242 512964 01242 512964 manager.grevill@osjct.glos.co.uk The Orders of St John Care Trust Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Joy Warren Care Home with Nursing 65 Category(ies) of OP old age (65) registration, with number DE(E) Dementia - over 65 (1) of places Grevill House D51_D03_S64592_Grevill House_v233517_200705_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1) Temporary Variation - Two named service users under the age of 65 years. 2) Temporary Variation - One named service user with Dementia (Cat DE/E). 3) Temporary Variation - One named service user under the age of 65 years Date of last inspection 1 February 2005 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; the Home has the option to admit three named persons under 65 years and one named person suffering from dementia. 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 D51_D03_S64592_Grevill House_v233517_200705_Stage 4.doc Version 1.30 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 7 hours. It consisted of discussions with the Manager, her recently appointed Deputy and the Care Leader in charge of Ashley Intermediate Care Centre; inspection of a selection of written care records; recruitment files and other available documents; plus a walk around the Home and the next door unit. The inspector had the opportunity to talk to nine of the service users and to six relatives who were present during her visit. She also attended a residents’ meeting, which had been scheduled to take place that morning. Management of the Home has recently become the responsibility of The Orders of St. John Care Trust; the Commission for Social Care Inspection has fully processed their application for registration. What the service does well: The Home provides an excellent intermediate care service in a separate purpose built unit, supported by a full multidisciplinary team. One lady was able to confirm that she felt much more confident following the care she had received in the Centre and was now looking forward to returning to her own home. A good choice of varied and appropriate activities is arranged. Some of the residents described a recent visit to the Cotswolds; they had particularly enjoyed the trip. Residents have the benefit of attractive well-maintained gardens, which have been equipped with strong supportive garden furniture. A large group of people sat out in shaded areas to enjoy the good weather. Meticulous administrative processes are followed in the Home, ensuring that all financial records are maintained correctly and residents’ financial interests safeguarded. Health and Safety issues are also addressed well in this Home. Grevill House D51_D03_S64592_Grevill House_v233517_200705_Stage 4.doc Version 1.30 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 D51_D03_S64592_Grevill House_v233517_200705_Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Grevill House D51_D03_S64592_Grevill House_v233517_200705_Stage 4.doc Version 1.30 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 standard(s) 2, 3, 5 and 6 Although there is provision of comprehensive literature about the Home, a thorough assessment process must be developed so that prospective residents are enabled to make an informed decision regarding their admission and be given the assurance that their needs will be met. Service users requiring intermediate care are provided with the care and support they require to return to independent living. EVIDENCE: The Home provides each service user or their advocate with a detailed contract outlining the terms and conditions for admission to the Home. Full details are also provided of the levels of any ‘RNCC’ financial contribution to which the resident may be entitled. Copies of the information supplied are also kept in the residents’ personal files. Although the Deputy Manager confirmed that full assessments are normally undertaken of each person who wishes to be admitted to Grevill House, there were no completed copies of this documentation available. A member of staff at the Home does not usually assess those requiring respite or emergency Grevill House D51_D03_S64592_Grevill House_v233517_200705_Stage 4.doc Version 1.30 Page 9 admission: the staff rely on the assessment provided by Social Services. The Deputy Manager admitted that they had had little prior knowledge about the care needs of one lady who had recently been admitted to the Home. The daughter of one person explained that she had been able to have a good look around the Home before a decision was made about her Mother’s admission. The staff had readily answered her queries and provided full written information, which she could show her Mother in hospital. Intermediate care is provided in the Ashley Intermediate Care Centre. This purpose built unit has been designed, equipped and staffed to provide full short-term intermediate care to those elderly service users who require rehabilitation prior to returning to independent living in the community. The service users have the support of a fully multi-disciplinary staffing team. Grevill House D51_D03_S64592_Grevill House_v233517_200705_Stage 4.doc Version 1.30 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 standard(s) 7, 8, and 9 The care planning systems in place need some further improvement in order to provide the staff with the information they require to care for all the residents’ needs. However, the medication systems ensure that residents are not put at any risk of potential errors. EVIDENCE: Grevill House: Following admission of a resident, a care plan is developed based on an assessment of individual care needs. The plans seen on this visit were reviewed and amended in a timely fashion and, on the whole, did cover all the residents’ particular requirements. However there was no risk assessment completed for one person, for whom there was a special concern. This has now been addressed. Ashley Intermediate Care Centre: A full plan of care is developed for all the service users. Each medical professional maintains his or her own documented record on the progress of each service user; the completed documentation is retained in their bedroom. Care plans seen on this occasion clearly reflect all aspects of the service user’s needs. Grevill House D51_D03_S64592_Grevill House_v233517_200705_Stage 4.doc Version 1.30 Page 11 Specialist visits are recorded in the Care Plans. Some service users had received care from local General Practitioners, Community Psychiatric Nursing service, Physiotherapist, Chiropody, Dental Care and Opticians when required. A speech therapist visited one gentleman during the morning. Ashley Intermediate Care Centre: The majority of service users are assisted to self medicate; secure storage is provided in each bedroom. Carers, who have undertaken relevant appropriate training, take responsibility for drug administration in this unit. Grevill House: The Home has a fully detailed drug administration policy developed by the Orders of St. John Care Trust. Medications including controlled drugs, are ordered, stored, administered and recorded correctly. Some of the handwritten medications in the drug records were a little difficult to read; all were signed correctly. Grevill House D51_D03_S64592_Grevill House_v233517_200705_Stage 4.doc Version 1.30 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 standard(s) 12 and 13 Opportunities are provided for the residents for varied and stimulating activities and social contacts, as desired. EVIDENCE: A senior care leader takes responsibility for arranging social activities at Grevill House. She has prepared a varied programme to suit the tastes of the residents. They are also given the opportunity to take trips in the minibus; these are normally organised on Tuesday afternoons. Residents gave feedback, mostly very positive, on the provision of activities at a meeting in the dining room. Events are also arranged at the Home; a summer fete will take place next month. Residents’ families are invited to be involved if they wish. A monthly newsletter advises them of any plans for the Home. A large number of friends and relatives called in at the Home and at the Ashley Intermediate Care Centre during the day. They were welcomed by the staff and had the option to talk either in the privacy of a bedroom or in one of the many communal areas. Grevill House D51_D03_S64592_Grevill House_v233517_200705_Stage 4.doc Version 1.30 Page 13 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 standard(s) 16 A satisfactory complaints system enables service users and their families to feel assured that their views would be listened to and acted upon. EVIDENCE: The Home has a written Complaints Procedure, which is readily available to residents, their visitors and members of staff working at Grevill House and the Ashley Intermediate Care Centre. The processes are explained in the brochures and are also outlined in the Information folder, which is kept in the front hall of Grevill House. Inspection of the Complaints folder shows that any issues raised are addressed appropriately and within an acceptable time frame. If necessary, action is taken to try to prevent any repetition of the problem. Grevill House D51_D03_S64592_Grevill House_v233517_200705_Stage 4.doc Version 1.30 Page 14 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 standard(s) 19 and 26 A safe and well maintained environment provides residents in Grevill House and the Ashley Intermediate Care Centre with a good standard of accommodation. EVIDENCE: Both buildings are well maintained and furnished with strong comfortable furniture to meet the needs of the service users. The Ashley Intermediate Care Centre has been equipped to a particularly good standard. The garden area has been fully landscaped and is accessible to the service users. The garden was being inspected for a competition on the day of the visit. Some of the residents chose to sit outside in the shade to enjoy the good weather. Both buildings were fresh and clean. There was no evidence of any offensive odours in any area visited on this occasion. Laundry processes are addressed correctly. Grevill House D51_D03_S64592_Grevill House_v233517_200705_Stage 4.doc Version 1.30 Page 15 Grevill House D51_D03_S64592_Grevill House_v233517_200705_Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 Skill mix and staffing numbers are adequate to meet the needs of the residents living in the Home and the service users in the Ashley Intermediate Care Centre. Recruitment processes are in place to ensure the protection of the people living here. EVIDENCE: Grevill House: There were forty-nine residents living in the Home, one of whom was in hospital; it was anticipated that the remaining room would be filled shortly. In the morning, the Manager, her deputy plus two other nurses and ten carers were in the Home to look after the people living there. One nurse and six carers were due to be on duty in the evening; with a nurse and three carers working at Grevill House overnight. Comments from some of the residents and their relatives, suggested that these numbers were usually adequate to meet the care needs although the staff were “often very busy.” Ashley Intermediate Care Centre: There were eleven service users in the Centre. The Senior Care Leader was working in a supernumerary role and was accompanied by a care leader and two care assistants; a care leader and two care assistants were due to be on duty in the evening; with a care leader and a care assistant overnight. These numbers also appeared adequate to meet the needs. Grevill House D51_D03_S64592_Grevill House_v233517_200705_Stage 4.doc Version 1.30 Page 17 Inspection of the personnel records showed that careful recruitment procedures are followed when employing new members of staff. On most occasions, all the required employment checks are undertaken before the member of staff joins the team. Current application forms for prospective new employees do not request a full employment history, as must be obtained. Grevill House D51_D03_S64592_Grevill House_v233517_200705_Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 36, 37 and 38 Service users’ financial interests are safeguarded but some improvements to the management systems are required to safeguard the welfare of the people using the service. EVIDENCE: The Administrator takes responsibility for the personal monies for the majority of the residents; three were randomly selected for inspection. The money is maintained in individual secure storage and the records maintained correctly. Staff supervision processes have been commenced but, in the files seen on this occasion, there were only limited records of any supervision meetings in the last twelve months. Grevill House D51_D03_S64592_Grevill House_v233517_200705_Stage 4.doc Version 1.30 Page 19 All records were stored securely with due attention to data protection legislation. There were no photographs provided for at least four of the residents. Health and safety issues are addressed well in this Home. Members of staff have access to all mandatory training. Necessary maintenance of equipment is undertaken in a timely fashion. Grevill House D51_D03_S64592_Grevill House_v233517_200705_Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 2 x 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x 3 2 2 3 Grevill House D51_D03_S64592_Grevill House_v233517_200705_Stage 4.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? 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. 2. Standard 3 7 Regulation Requirement Timescale for action By 30.9.05 By 31.8.05 3. 29 4. 5. 36 37 Regulation The care needs of each resident 14 (1a) must be fully assessed prior to admission to the home. Regulation Any risks to the health or safety 13(4c) of service users must be eliminated. (Previous time scales of 31.8.04 and 28.2.05 not met). Schedule Each employee must provide a 2.6 full employment history plus a satisfactory explanation for any gaps in employment Regulation Supervision processes must be 18(2) undertaken regularly Schedule A photograph must be provided 3(2) of each service user By 30.9.05 By 31.10.05 By 31.8.05 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. Refer to Standard 3 9 36 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 capital letters to assist legibility Supervision processes should be undertaken six times a year D51_D03_S64592_Grevill House_v233517_200705_Stage 4.doc Version 1.30 Page 22 Grevill House Grevill House D51_D03_S64592_Grevill House_v233517_200705_Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucestershire 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. Extracts may not be used or reproduced without the express permission of CSCI Grevill House D51_D03_S64592_Grevill House_v233517_200705_Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!