Inspection on 19/01/06 for Greville

This inspection was carried out on 19th January 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

Greville 26/06/08

Greville 29/06/07

Greville 05/07/06

Greville 06/09/05

Greville 29/01/05

Greville 18/06/04

Greville 29/02/04

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

CARE HOMES FOR OLDER PEOPLE Greville Lacey Road Stockwood Bristol BS14 8LN Lead Inspector Sandra Gibson Unannounced Inspection 19th January 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 Greville DS0000035878.V277413.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. Greville DS0000035878.V277413.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Greville Address Lacey Road Stockwood Bristol BS14 8LN 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) 01275 837034 01275 892007 Bristol City Council Sonia Moon Care Home 35 Category(ies) of Dementia - over 65 years of age (35) registration, with number of places Greville DS0000035878.V277413.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th September 2005 Brief Description of the Service: Greville is operated by Bristol City Council and is registered by the Commission for Social Care Inspection to provide personal care and support for up to 35 people who are over 65 years of age and who have dementia. Greville is situated in a residential suburb in South Bristol. It is a purpose built ground level home, and is fully wheelchair accessible. It is adjacent to a day centre, which provides a supportive environment for older people with dementia. Ms Sonia Moon and Mr Michael Sullivan jointly are registered by The Commission for Social Care Inspection to manage the home. Greville DS0000035878.V277413.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place midweek between the hours of 11.45am and 6.15 pm. Evidence was gathered from: talking to/observing residents, talking to one assistant officers/ talking to the one of the registered managers / talking to and observing staff, talking to one relative, talking to two visiting professionals, looking at the premises, examining records, policies and procedures. What the service does well: What has improved since the last inspection? Please see below Greville DS0000035878.V277413.R01.S.doc Version 5.1 Page 6 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. Greville DS0000035878.V277413.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 Greville DS0000035878.V277413.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): 1,2,3,4 There have been some improvements in the systems in place to ensure that potential new residents and their relatives can make informed choices about the home and their rights are safeguarded. However further work needs to be completed by Bristol City Council Social Services and Health to ensure that all residents’ rights will be safeguarded when accommodated at Greville. EVIDENCE: Greville is currently registered with The Commission for Social Care inspection to accommodate residents who are sixty-five years and over with a diagnosis of dementia. This information is reflected in the statement of purpose. During the course of the inspection the inspector had the opportunity to meet a social worker who was looking for a placement for a resident who was under sixty-five years but had a diagnosis of dementia. It was observed that the social worker had provided an up to date assessment and care plan and he was asking detailed questions from the management team about how they would meet this potential resident’s individual needs. Greville DS0000035878.V277413.R01.S.doc Version 5.1 Page 9 The management team demonstrated that they were fully aware of the process and if they felt they could meet this potential resident’s needs then the admission would be planned in consultation with the resident, his family and social worker following agreement with The Commission for Social Care Inspection. A sample of long-term residents’ contracts/ statement of terms and conditions were examined and it was noted that they still do not contain information about room number or who is responsible for the fee. The manger explained that no improvements to the contracts / statement of terms and conditions for residents’ who had no relatives had taken place since the since the last inspection. He said that Social Services and Health were planning to commission an independent advocacy service to support these residents with this process, but to date this arrangement had not been finalised. It was understood from information provided by the manager that those residents who were supported by relatives and new residents were provided with this information. . Greville DS0000035878.V277413.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): 7,8,10 Care plans and individual risk assessments have deteriorated since the last inspection . They need urgent attention to be ensure that residents’ needs and risks are fully identified by experienced , competent staff to ensure that residents and staff are fully protected at all times. The physical healthcare needs of residents continue to be well met with evidence of good multidisciplinary working taking place on a regular basis.However,a large percentage of the staff team may not have the experience and training to meet residents’ mental health needs. EVIDENCE: A sample of care plans and risk assessments were seen and it was observed that they were not always clear, or up to date. One care plan contained no information about a form of physical restraint being used on a resident and neither was this information found in a risk assessment. This will be discussed further in the standard on adult protection below (National Minimum Standard 18). Greville DS0000035878.V277413.R01.S.doc Version 5.1 Page 11 One manual handling risk assessment was very difficult to read because the print was so faint. It was also noted that one risk assessment referred to a resident using verbal abuse towards residents and staff, but there was no identified need recorded in the care plan. It was observed that the risk assessment in place had been completed in June 2004 by another care home. No review of that risk assessment had been completed since the residents admission to Greville, despite further incidents of challenging behaviour including the resident trying to grab / hit residents and staff being recorded in the daily records. Following discussions with a member of the management team it was noted that this resident’s behaviour might be a result of long term mental health needs and dementia. It was noted that the majority of staff have not received training on working with residents with mental health needs. However, it was pleasing to hear that the advice / and training support of the In reach team (Mental Health services) had been previously been sought when staff had been working with another resident with mental health needs. It was noted that no contact had been made with the In reach team on this occasion. One relative consulted during the inspection confirmed that their relative was “well looked after and treated with dignity and respect”. He/she said, “the staff are pretty nice. They are very kindly towards my … No cause for complaint”. This same relative said, “ I have pointed out that my …. suffers with a skin condition and they immediately contacted the GP who prescribed a cream”. A visiting Court of Protection officer said, “ staff know residents’ individual needs….and they are very good at encouraging them to be independent. The inspector observed staff talking to residents and attending to their individual needs with dignity and respect and how they encouraged residents’ independence where appropriate. There was evidence in place to confirm that General Practitioners, Psychiatrists, Community Psychiatric nurses, District nurses, and chiropodists are all contacted at the appropriate time. Records all confirmed that residents were assisted to attend hospital appointments where planned. Equipment was observed to be in place to prevent pressure sores in residents who were at risk. It was noted that one resident has a sacral sore, which is being successfully managed by the district nurses. This same resident has recently recovered from a sore heel. A visiting podiatrist said, “Communication with staff is very good”. Carers are fantastic, very caring and we have a good working relationship” Greville DS0000035878.V277413.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): These standards were not inspected on this occasion. It was noted that they were all met at the last inspection in September 2005. Please see report for further details. EVIDENCE: Greville DS0000035878.V277413.R01.S.doc Version 5.1 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 the following standard(s): 18 Arrangements for protecting residents from harm are still not satisfactory. There has been some improvement since the last inspection, but there is still evidence of poor practice. Further work needs to take place to protect residents from possible risk or harm. EVIDENCE: A copy of ‘No Secrets in Bristol’ (Local authority Adult Protection procedure) is in place in the home. The two managers and the assistant officers have attended training provided by Social Services and Health on adult protection. It was noted that ten members of staff are due to attend or have already attended this training and that a rolling programme is in place. An adult protection coordinator employed by Bristol social service and Health is planning to attend a relatives meeting to speak about adult protection issues. During the inspection the inspector spoke to a couple of members of staff who demonstrated good awareness of what to do if they suspected that abuse had taken place. It was noted that a corporate policy on physical restraint is in the process of being developed by the senior management team in consultation with The Commission for Social Care Inspection. This is an outstanding requirement of the last two inspections. Following the inspection the inspector notified the adult protection coordinator about the need to develop this policy and explained that her knowledge may be beneficial to the further development of the policy on behalf of Social Services and Health. Greville DS0000035878.V277413.R01.S.doc Version 5.1 Page 14 During the course of the inspection it came to the attention of the inspector that a resident was being locked in their bedroom when they went for a rest during the day and when they went to bed at night. This information was found in the daily records. There was no information in the care plan and there was no risk assessment in place as discussed in the standard above about care plans / risk assessments. The inspector spoke to the management team and was told that this practice was carried out at the request of the resident’s family to protect the resident from harm from other residents. The member of staff explained that the staff team monitored the resident very closely and would regularly call to see the resident during the day and night. There was no record in place to confirm how often these visits took place. It was also noted that this resident would not be able to exit from the room independently as they were unable to use the lock facility. The management team were advised that this practice is physical restraint and must immediately stop and the reasons why must be explained to the family. A member of the management team agreed to speak to the family that evening. Greville DS0000035878.V277413.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): 19,20,21,22,25,26 Greville continues to be a reasonably clean, comfortable, safe home, which has recently benefited from improvements in disability access arrangements. However there has been some deterioration in cleanliness since the last inspection, which needs to be urgently addressed to ensure that residents and their relatives are comfortable at all times. EVIDENCE: On arriving at the home it was noted that parts the out side of the front of the home were in need of attention. For example there was litter scattered in the car park and under the surrounding trees. It was observed that homes refuse bins were over overflowing and this had probably been the direct result. During the inspection the staff members responsible were spoken to and it was agreed that this litter would be attended to. In general, the environment is well maintained and suited to residents’ needs. It is decorated and furnished to a standard that creates a comfortable homely atmosphere. Greville DS0000035878.V277413.R01.S.doc Version 5.1 Page 16 There are a number of small lounges throughout the home, which residents and relatives were seen using and they appeared comfortable and relaxed. One relative spoke very positively about the visitors room where he/she enjoys spending time with …. and their pet dog. The relative said, “I cannot fault the place. I am impressed by the cleanliness in this home despite all the residents who have continence issues”. It was noted that all care staff consulted spoke positively about the standard of cleanliness in the home and said that the agency domestic support were very conscientious. Unfortunately unpleasant smells were found in one room, the small lounge at the front of the home in the home. It was noted that the carpets were badly stained and due to the colour these stains were very visible. Access arrangements have been improved since the last inspection to meet the needs of disabled people: These improvements include: access to main entrance, widening of doors to one lounge to establish a designated lounge for disabled visitors, disabled persons’ toilet facilities. Greville DS0000035878.V277413.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected during this inspection. They were all met at the last inspection in September 2005 except Standard 29. This was not inspected on either occasion as the information is held with Social Services and Health Personnel Department. Please see previous report for details. EVIDENCE: Greville DS0000035878.V277413.R01.S.doc Version 5.1 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 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): 31,38 Communication with the Commission for Social Care Inspection must improve regarding who is currently responsible for managing the home in order that residents and staff benefit from a well managed home at all times. EVIDENCE: There are two managers jointly registered by The Commission for Social Care Inspection to manage Greville. One of these managers is currently working as the sole registered manager. The Commission for Social Care Inspection has not been formally informed of this situation. Consequently the other manager is still legally responsible for the management of this home Greville DS0000035878.V277413.R01.S.doc Version 5.1 Page 19 There was evidence in place to confirm that fire precaution checks and training are now taking place on a regular basis. It was noted that the staff training records in respect of fire safety training are held in a different place to the fire log, which made it difficult to inspect. It was also noted that the fire risk assessment conducted on the 3.09.04 was still due for an annual review despite a recommendation being made at the last inspection. Greville DS0000035878.V277413.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 3 x x 2 3 3 3 x x 3 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 1 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x x x x x x 2 Greville DS0000035878.V277413.R01.S.doc Version 5.1 Page 21 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 OP2 Regulation 5 Requirement Timescale for action 31/05/06 2. OP18 13(7) 3 OP7 15 4 OP8 13(4) All residents must be provided with a contract/statement of terms and conditions, which stipulates their room number and fees payable. This requirement is outstanding from the last inspection conducted on 6/09/05 The physical restraint policy 31/03/06 must be reviewed to ensure that it complies with The Department of Health Statutory Guidance This requirement is outstanding since the last inspection conducted on 6/09/05 Up to date care plans must be in 31/03/06 place for all residents and must be completed in consultation with residents where possible and relatives where appropriate and signatures obtained Up to date risk assessments 31/03/06 must be in place for all residents. All identified risks from care plans and what actions must be taken by staff to eliminate or reduce the risks must be clearly recorded. Risk assessment must be reviewed on a regular basis DS0000035878.V277413.R01.S.doc Version 5.1 Greville Page 22 5 OP8 12(1) 6 OP18 13(4) 7 8 9 10 OP19 OP26 OP38 OP31 23(2)(d) 23(2)(d) 23(4) 38 Training in working with residents with mental health needs must be provided for all staff to ensure that residents mental health needs are met Residents must not be locked in their bedrooms. This is physical restraint and this practice must stop immediately The litter from the outside area at the front of the house must be tidied up. The carpets in the lounge at the front of the house must be deep cleansed or replaced The fire risk assessment must be reviewed at least on an annual basis Written formal clarification must be sent to the Commission for Social Inspection about the current management arrangements and who is legally responsible for the home. 31/07/06 19/01/06 15/03/06 31/03/06 31/03/06 31/03/06 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. Refer to Standard OP18 Good Practice Recommendations It is recommended that consultation be sought from the Adult Protection Coordinator employed by Social Services and Health regarding the corporate Physical Restraint policy that is in the process of being developed. It is recommended that the fire safety training documents for all staff is held with the fire log for inspection purposes 2 OP38 Greville DS0000035878.V277413.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Greville DS0000035878.V277413.R01.S.doc Version 5.1 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. 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