Inspection on 26/06/08 for Greville

This inspection was carried out on 26th June 2008.

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

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 29/06/07

Greville 05/07/06

Greville 19/01/06

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Greville Lacey Road Stockwood Bristol BS14 8LN Lead Inspector Sandra Garrett Key Unannounced Inspection 09:00 26 & 27th June 2008 th 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.V364545.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Greville DS0000035878.V364545.R01.S.doc Version 5.2 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 Mr Michael Sullivan Care Home 35 Category(ies) of Dementia - over 65 years of age (35) registration, with number of places Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th June 2007 Brief Description of the Service: Bristol City Council run Greville and it’s registered with the Commission for Social Care Inspection (the Commission). The home gives personal care and support for up to 35 people with dementia that are over 65 years of age. The philosophy of the home is to meet peoples care needs as set out in its Statement of Purpose. Greville is situated in Stockwood, a large residential area in South Bristol. It’s a purpose built home on one level. It’s accessible to disabled people and visitors. It’s next door to a dementia care day centre that gives older people with dementia a supportive environment. Fees are £619.71 per week. This doesn’t include chiropody, hairdressing, newspapers etc. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority fees payable are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk http:/www.oft.gov.uk A copy of the last key inspection report was seen displayed in the entrance lobby of the home. Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was the first unannounced key inspection visit since June 2007. The manager was unavoidably absent and two assistant managers were running the home. The visit took place over two days. A further visit was made on 2 July to give feedback to the manager and team manager for the home. Before the visit, all information the Commission has received about the service since the last inspection was looked at and an inspection plan drawn up. This included information from the Annual Quality Assurance Assessment (AQAA) that the home had filled in before our visit, records of team manager supervision visits and any notices that we asked to be sent to us about incidents affecting people living at the home. At the visit we spoke to several people living there and nine staff. We looked at a range of records including: care, medication and staff records, complaints, health and safety, meals, activities, the Statement of Purpose and service users guide. Whilst we’d sent out a number of our ‘Have Your Say’ surveys to relatives to ask them about the home, only one was returned. Comments from this are included in the report. We also received a copy of the latest independent quality assurance survey that the City Council organise each year. Because people with dementia aren’t always able to tell us about their lives, we used a formal way of observing people to help us understand better. We call it the: ‘Short Observational Framework for Inspection’ (SOFI). This means using a methodical and structured way of watching people living at the home. We did this for 2 hours in the dining room and recorded peoples experiences at frequent intervals. It included looking at their wellbeing, how they interacted with, other people living at the home, staff members and the environment. We also saw how other people live their lives at the home. Information from the observation is included throughout this report. What the service does well: Greville provides a clean and hygienic environment for people to live in. The home is largely accessible for disabled people and includes aids, adaptations and equipment to make sure their individual needs can be met. Proper use of contracts that give clear information about terms and conditions, room numbers and fees makes sure relatives or representatives are aware of their rights and responsibilities. Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 6 People living at the home are looked after well in respect of their physical healthcare needs. Proper management of peoples cash makes sure they are protected from financial abuse. What has improved since the last inspection? What they could do better: This inspection gave us concern about the quality of care people with dementia get. Our concerns were about: - The functional way care is given that focusses on meeting basic needs only, - The lack of a clear person-centred approach (which means care that looks at a person’s whole life, history and needs. It recognises and values them as an individual with rights and choices), - The lack of meaningful activities, entertainment and outings that help keep people from being bored and under stimulated, - The lack of respect given that was seen in the way people were treated particularly at mealtimes, - The overall shabbiness of the décor that doesn’t help people with dementia and fails to respect their need for a pleasant environment, - The lack of sufficient training for staff in person-centred approaches to dementia care and activities, - The lack of clear supervision records that show staff are given support in their work and: - The failure to show that records are properly kept of e.g. daily care giving and fire drills. Requirements were made about all the above to make sure life for people living at the home improves and is given in a more person-centred way that gives them a better quality of life. Six requirements from the last visit were either not met or partly met. These included: - Reviews of staffing arrangements (particularly for weekend working) and catering arrangements weren’t seen to show what actions were being taken to address the issues raised, - A plan of outstanding redecoration work was also not seen that made it difficult to see what action had been taken and: Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 7 - Some incidents such as falls or other injury weren’t recorded in accident records to show that people were being cared for safely. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 8 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.V364545.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3, & 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst people and their relatives benefit from being given clear information about the home when they come into it, it may not meet their specialist needs e.g. to enable them to understand fully what the home can offer. Proper use of contracts that give clear information about terms and conditions, room numbers and fees makes sure relatives or representatives are aware of their rights and responsibilities. Clear and detailed pre-admission assessments make sure that the centre is the right place for people using the service and that staff are able to meet their needs. Whilst the home is registered to provide specialist care for people with dementia, the lack of a person-centred approach fails to meet peoples needs. Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 10 EVIDENCE: The Statement of Purpose was seen which is the latest version. It includes the aims and objectives of the home, a statement on equality and diversity and amended information on the range of care needs to be met. A service users guide was also seen that includes information as required under regulation. This had been a requirement from the last visit. The service users guide had been re-done in a more accessible format with pictures. However the pictures weren’t clear and may not meet the needs of people with dementia. A copy of the guide was seen in the entrance lobby together with the last inspection report and the home’s newsletter. This was also not fully accessible to people. A requirement made at the last visit about contracts was met. We saw copies of peoples individual contracts in their records. These gave details of the terms and conditions for living at the home. They also had the person’s room number recorded, the exact amount of fee to be paid and were signed (mainly by relatives). We case-tracked three people living at the home. Case tracking means looking at all records associated with the person. These include assessments, care plans, medication, cash, accident and healthcare records. We also track their care by talking with both them and staff caring for them. Each person had a pre-admission social work assessment done before they came to the home. The assessment gave information about their personal histories and backgrounds, their health and care needs and any cultural needs. Some had social work care plans. Information from these is then be transferred into the home’s care plan for the person after the end of the four-week trial period. Reviews for these were also seen. Greville is registered as a specialist service for people with dementia. Staff caring for them showed that they had been given training such as National Vocational Qualification in Care and were experienced to work with people living at the home. However, our findings from the visit showed that staff weren’t able to demonstrate that care given is based on current good practice. Of particular concern was the attitude towards meeting peoples needs. Peoples basic care needs are met but overall their care doesn’t consider all their needs e.g. social, recreational or respect their rights and choices. Evidence of this can be found throughout the report. Physical needs of disabled people are met by the home having level access, aids and adaptations and specialist equipment. Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans, whilst giving basic information about meeting peoples needs, fail to show good understanding of the difficulties people living with dementia have, or how their social and psychological needs will be met. Failure to make sure all care needs are put into the plans means people may not get the care they need. People living at the home are looked after well in respect of their physical healthcare needs. Failure to manage some medication properly doesn’t make sure people get the medication they need. Failure to treat people living at the home with respect and dignity ignores their value as individuals and can cause them harm. Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 12 EVIDENCE: Three peoples care records were looked at closely as part of the case-tracking process. A requirement made at the last visit about making sure an up to date care plan is in place was met. Each person case-tracked had a clear and up to date care plan. Records showed that these are looked at regularly and amended if any changes are needed. Reviews that include relatives or representatives were also recorded although it wasn’t clear if one review had taken place because the relatives couldn’t attend. A further requirement about making sure risk assessments are in place was also met. Each person had a moving and handling risk assessment that gave clear information about their physical needs and any other issues that could affect their mobility. Extra risk assessments were in place for anything that could pose a risk to the person e.g. smoking, falls etc. One person had a risk assessment for behaviour that had been updated and amended following a number of incidents. A relative commented in our ‘Have Your Say’ survey sent out before the visit: ‘The staff always listen to any worries about mum that I might have’. While this is commended, lack of attention to meeting all care needs plus emotional and leisure ones, doesn’t lead to a good quality of life for people. Please see below for more about our findings on this. Whilst care plans covered a range of care needs we found that for one person not all needs recorded in the pre-admission assessment had been transferred into her/his plan. Issues such as skin care, mouth care and management of a life-threatening illness weren’t seen at all neither were actions as to how to manage them. The person was still having treatment for a skin condition with prescribed medication. However there was nothing about this on the plan. There was no information as to how to manage another serious skin complaint, nor any actions to show the person was getting proper mouth care. On the whole care plans were basic and functional. This means that things such as activities, leisure and emotional support either weren’t recorded or given any sort of preference. Care plans focussed on needs such as mobility, washing and bathing, personal hygiene, diet, speech, hearing, family and friends and money management. One person had activities recorded with action to encourage her/him to take part. However we found no evidence to show this was happening. (Please see Standards 12-15 for more about this). Care plans weren’t written in a person-centred way. This means giving care that looks at a person’s whole life, history and needs. It recognises and values them as individuals with rights and choices, rather than just focussing on meeting basic physical care tasks. Further, the outcomes recorded also didn’t show that peoples needs were being met in person-centred ways. It wasn’t Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 13 clear how personal information and background histories supplied by their relatives were being used positively in the plans. One person had shown challenging behaviour to other people living at the home. The reason for this wasn’t picked up in the care plan. The manager later explained the person’s background that showed how the behaviour could be triggered. However this information wasn’t available to help staff understand and cope with the reason for the behaviour or protect other people from it. Care records did show however that physical healthcare needs were properly met. The chiropodist was visiting during the first day of our visit. Information was seen in one person’s care plan about sight difficulties that had been resolved by an operation. For another person pain management was clearly recorded and medication records matched the plan. The pain was being managed through regular hospital visits and contact with the GP. A requirement made at the last visit about management of medication controlled under the law was met. Only one person was having controlled medication for pain relief. This was stored properly and the right quantity was left in the cupboard. Records were kept on a separate sheet and double signed by staff. Medication Administration Sheets didn’t show any gaps in giving of medication. The assistant manager was seen getting specimens ready to send for analysis as infections were suspected for a couple of people. However, eye drops that were clearly labelled as needing to be refrigerated were in fact stored at room temperature in the medication cupboard. Further, an open bottle of the drops was also kept in the medication trolley instead of being put back in the fridge. The medication fridge was being controlled by a minimum/maximum thermometer and showed an acceptable temperature (2°c) that records showed is checked twice daily. A number of people were prescribed mild pain relief. However not everyone is and the home doesn’t keep ‘over the counter’ medicines to use as homely remedies. The assistant manager was unable to say what could be done if someone not prescribed it complained of pain late at night. The current policy in use and seen at the home states that homely remedies can be used. However we are aware that managers have been given different information and can no longer give it. This must be addressed as each person is entitled to have pain relief if and when they need it. We looked at the medication returns book. This was dated and signed with a list and quantity of medication returned to the pharmacy. The pharmacy had also signed to say the medication had been received ensuring a safe returns system that would be considered good practice. We spent time observing people throughout the two days of our visit. Part of the observation was two hours spent in the dining room before and after lunch. Whilst a number of staff interactions with people were positive, a greater Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 14 number were neutral. This meant that people weren’t always given the respect they deserved. (Please see standards 12-15). During the two-hour period we saw staff coming into the dining with protective gloves already on, to take people to the toilet. Sometimes staff told them this but sometimes they didn’t, then led them by the hand out of the room. They later brought the person back into the dining room still with their gloves on. The gloves were only removed at the last minute before the meal was served. This both compromises good infection control measures and takes away the dignity of the person being helped. Another issue that takes away peoples dignity is the use of the stable type office door, which is kept bolted even when staff are in there. People were seen coming up to the door and being talked to over it. This indicated institutional practice. Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Lack of opportunity or effort to give people quality and meaningful social time fails to make sure they are stimulated and occupied. Further, a lack of suitable objects and materials for people to engage with, leads to boredom and poor quality of life. Failure to maintain contact with the local community stops people from enjoying religious or other cultural and social experiences. Lack of choice and freedom fails to keep people happy and contented and could lead to behaviours that challenge. Institutional practices and failure to give people choices means that they don’t get enjoyment from mealtimes that affect their quality of life. EVIDENCE: From our observation we saw that several people had good levels of wellbeing. These were largely seen in their relationships with each other. Some were positively engaged with objects or tasks. A number of people like to sit in the Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 16 entrance hall outside the office and we heard them talking and laughing together. We saw people helping each other with meals at lunchtime. Because the chiropodist was visiting the home on the first day we were told there would be no organised activity. We saw a plan of regular activities for staff to follow. These included: Reading magazines, ‘Hockey’ and ‘parachutes’ and Connect 4 games among others, Reminiscence, Knitting and: Social time in the bar (although staff said this only happens if they have time). We saw a small group of people playing dominoes (with extra large pieces) in the dining room on the second day. Although five or six people were at the table only one or two were able to join in. We observed staff interactions with people over the two days. Some staff showed kindness and were positive in their contact with people but others were more neutral and simply focussed on tasks to be done with each person such as toileting. Staff told us they struggle with activities because of ‘staff shortages’ that means they have little time to give to doing them. We looked at the activities diary. Throughout May and June a number were recorded. These included some of the above but also darts, music and movement, dancing, singalongs, a quiz and manicures. Fourteen people had taken part in music and movement, hockey and a singalong, although for other activities a core of seven to nine people had taken part. However, nothing was written about peoples enjoyment of any of them. We didn’t see staff spending quality time with people who don’t join in organised activities. We saw no magazines although the assistant manager said there were always lots about the home. We didn’t see things such as scrapbooks, rummage boxes (with items in people can touch, engage with and talk about), soft toys or large print books. There were some books in the dining room but most of these were ordinary print novels that people with dementia may not be able to read or understand. A few large, picture type books were seen e.g. of the Royal Family and World War 2. One person had been brought back from the toilet and was sitting in the dining room. The book on the War that was big and heavy was put in front of him but he didn’t look at it. We case tracked the person and found that he doesn’t like to join in with activities, preferring to spend time in his room. However there were no records of any activity that he took part in or of staff efforts to do things with him that would give him enjoyment of daily life. The person was seen in the dining room just sitting for almost the whole of the observation period. Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 17 At first the person showed signs of wellbeing by looking around and taking interest in his surroundings. However, staff only spoke to him when they brought him his meal or medication. By the end of the period he had become more passive although restless and fidgeting at times. Staff told us that the person engages with them and is able to understand a lot. They also said he is able to say when he wants to move. However nothing was being done to positively engage with him. We also saw him on the second day and he smiled and spoke to us. Again he was sitting alone with no contact from anyone. Other people showed engagement with objects. One person was moving a chair around both before and after lunch. S/he was purposefully moving and touching the chair. The first time s/he did this a staff member came and took the chair away without speaking to her/him at all and sat another person in it. The second time it happened (after lunch) a staff member came and dissuaded her/him from moving the chair that was then put away under a table. On both occasions the person was left without a purpose or enjoyment. Some people were seen walking around the corridors. Several came to spend time with us while we were looking at records in one of the lounges. They chatted to us easily and readily. However, they each told us they either wanted to ‘get out’ or go home. We also noticed low self-esteem expressed e.g. when we told someone how nice she looked she denied this and put herself down. Some doors particularly leading to the garden had been frosted over that staff said was to stop one person repeatedly trying to get out. However this has a negative effect on everyone else who might like to go out into the garden or just look out. Outside the dining room there were a number of photographs of Bristol now and then. These were interesting but were hung in a dark part of the corridor that didn’t show them off very well. Other pictures in corridors were faded and bland. In one lounge we saw the games and knitting equipment but in others there was very little to engage people. A sheet of planned entertainments was seen. Entertainers from outside visit once a month. However the programme showed the same entertainers visiting time after time with little variety. A large board had photos of a party held at Easter with an Easter bonnet parade and a Halloween party held last October. Such parties are held quarterly in line with special dates or events. We saw the activities room that was locked. When we were able to get in to it we found it had been turned into an overspill office/meeting room, although it was still labelled ‘activity room’. The visitors’ lounge with tea and coffee making facilities was also locked. The manager later said there is another room for storing activities equipment but this is also kept locked. Activities are done in one of the other lounges or in the dining room. From all the above there is a lack of person-centred activities that are meaningful to people with dementia. Such activities could include gardening, Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 18 baking, rummage boxes and scrapbooks etc. Further, the lack of detailed personal histories means that staff may not be able to help people keep their remembered skills or likes such as dusting, cooking, flower arranging etc. We asked the assistant manager about contact with the local community. She told us that ‘it used to happen’ but had stopped. This had been because of the death of a chaplain that used to visit the home and the school that had stopped students visiting at Christmas because parents didn’t give their agreement. The manager later said that they were waiting for news of a replacement vicar or chaplain but hadn’t heard anything. We recommend making positive efforts via the diocesan office to try and get services or visits re-started. Staff told us that they do take individual people out to a local coffee shop or pub but can’t do this often as they don’t have time or staff available. They also told us they’re not able to have ‘key’ or ‘quality time’ individually with people for the same reason. We saw little evidence in records of this time being spent with people. Unlike all the other homes Greville has the use of its own minibus and a photograph of this was seen in the entrance hall. However staff said that no trips out had been organised or happened this year. When we asked them about trips they said they’d like: ‘to take them to the zoo and for fish and chips on Weston seafront – they like going there’. Staff said they felt the problem was that they don’t get enough chance of using the minibus as its always being hired out by other groups. However the manager later denied this. From all the above people living at the home are limited in their choices. They’re able to choose when to get up and can move about in some areas of the home freely. However on the issue of whether people could get into their rooms, staff told us different things. We found that doors were largely kept unlocked during the two days of our visit. However, one staff member told us that rooms are usually kept locked throughout the day and people are ‘let back into their rooms at night’. Another staff member told us that rooms are kept locked because people wander in and out of them and take things. We asked the assistant manager about it who said that rooms are definitely not kept locked! Later, the manager admitted that a number of bedrooms are kept locked. We suggest that if people had more to look at, touch and do or staff spent more time on a one to one basis with them, doors wouldn’t need to be kept locked. Because we spent the time watching people in the dining room we were able to observe their lunchtime experience. People were shown a choice of two plates of food and indicated which one they wanted. Some were given tabards to wear to keep their clothes clean. Some of these were just put on them without getting their permission. The dining room itself looked institutional. Wooden tables were bare, without tablecloths, cutlery, condiments or table decorations. Some people had been sitting at the bare tables for some time before the Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 19 meal. Staff told us that they had to stop using tablecloths as people kept pulling them off and it was ‘dangerous’. One person had a rolled up magazine that s/he continually rolled round and round. Others had nothing to occupy them until everyone was in the room and the meal was served. As meals were taken to each person cutlery was given to them at the same time. No cold drinks were offered with the meal unless someone was having medication. Throughout the period we saw one person struggle with the meal of liver and vegetables. S/he had difficulty eating it but wasn’t given a drink at all. Another person had a coughing fit but wasn’t given a drink. Staff told us that people get plenty of drinks and have them in the early morning, at breakfast, at 11am, then tea after lunch etc. They told us that they can’t give people cold drinks with meals as they ‘pour it over the tables or in their food’. However drinks should not be regimented or limited to people who are more at risk of dehydration. We saw one staff member bring a meal to someone, put it down in front of them with the cutlery and leave it, all without speaking. The same staff member later spoke to a person that didn’t want a first course. The staff member then, in front of the person, told other staff very loudly: ‘She only wants a pudding’. Most people showed enjoyment of the meal and finished whatever was on their plates. One person was being helped to eat by a staff member. Some people kept getting up and leaving the room then coming back again later. Some people were moving around the room but encouraged to return to their seats. This was accepted and staff acted properly in encouraging them to eat. People sitting together also encouraged each other to eat. One person wanted her/his food taken away but was ignored. Another asked for a cup of tea but was last to be served due to the way the trolley was taken around and had to wait longer than anyone else for it. Of the six care staff on duty three were assisting in the dining room. The person being helped to eat was given the first course. At a certain point however the three staff left and three others took over. There was no handover to let them know if anyone was in difficulty or needed help and another staff member took over helping the person to eat. This isn’t consistent for people and could make them more confused. Six-weekly menus were seen that showed a choice of main meal on two days only. The menus were largely meat based with only the odd vegetarian choice e.g. once a week. Tinned meats, fruit and vegetables were also seen on several days e.g. tinned grapefruit, tinned carrots or tinned fruit salad among others. Further, sometimes chips were frozen or fresh (specified on the menu) and synthetic dessert sauces were being regularly used. The menus were traditional English fare with roast dinners, stews, faggots, corned beef and luncheon meat etc. It wasn’t clear how menus were decided or whether Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 20 peoples preferences had been gained from relatives to help make the meals enjoyable experiences. Comments from the home’s own quality assurance survey report showed relatives’ concerns about all the above: ‘I don’t think there is enough stimulation. Not really the fault of staff - mostly lack of time. Would benefit from outside bodies providing activities’, ‘Enough staff time is needed to enable trips out in the minibus and more time in the garden’, ‘Activities could be expanded with more one to one support’ and: ‘Staff find it hard at mealtimes to give enough time to residents’. Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Adequate management of complaints makes sure peoples concerns will be dealt with properly and in good time. Failures in dealing with abusive incidents or inform the Commission of them doesn’t make sure people are kept safe. Further, improper use of restraint and locking of bedroom doors doesn’t respect peoples rights and dignity. EVIDENCE: The complaints log was looked at. A copy of the complaints procedure that had been put into a format with pictures was seen on display. However again it wasn’t clear if this was accessible to people with dementia. Two complaints had been received since the last inspection. One of these was about continence issues and one about overhanging trees from a neighbour. Both complaints had been properly dealt with within reasonable timescales. Comments from relatives about complaints from the home’s quality assurance survey were mixed: ‘I have no complaints about of the home at all’, I am able to ask questions and raise any concerns I have’ and: ‘Complaints are listened to and dealt with appropriately although it’s not always easy to discover exactly what the reality of the situation is because of the nature of the client group’. However, one person felt there should be more Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 22 attention to keeping bedroom doors locked because of peoples ‘magpie’ tendencies that take up a lot of staff time when trying to find objects that go missing. However another commented: ‘Only by knowing residents really well and building good relationships is it possible to ensure that complaints can be thoroughly investigated. The only way this can be improved is to have more staff’. A requirement made at the last inspection was partly met. We had received some notices from the home about incidents that had happened. However, when looking at care records, one person we case-tracked had several episodes of behaviour that challenges. These were abusive to other people and injuries had been caused. The Commission hadn’t been told about any of the incidents or what action had been taken. From another person’s records we saw that s/he had been pushed over by someone else. Again we hadn’t been notified of this and in fact had received very few notices this year. We looked at the home’s accident records. Although these went back some years there weren’t very many of them. We found that some incidents we had picked up hadn’t been recorded. We met the chiropodist who was visiting the home on the first day of inspection. Whilst we were in the medication room he was treating people next door. We heard someone shouting loudly: ‘please stop - you’re hurting me’. This went on for some minutes. When we investigated we found the person was distressed and unhappy but her/his toenails were still being cut. A care staff member was with her/him and trying to give reassurance whilst still allowing the procedure to go on. We discussed it with the staff member and the assistant manager. Both gave different opinions on what should happen. The assistant manager was clear that if a person is distressed by any action it should stop immediately and be tried again later. The staff member however didn’t show she was clear about what constitutes restraint or abuse and was in fact colluding with poor practice. Forcing someone to have a procedure against their will is unacceptable practice and must be stopped. Further, the issue of keeping bedroom doors locked as well as doors to other places including the garden that people should have access to, stops them being free to use the home as they would their own and could be considered a restraint. Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22,24 &26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A lack of respect for individual choice in the home fails to give people any choice or control over decoration, access, improvements or facilities. Failure to make sure the home is being made more accessible in personcentred ways for people with dementia, leads to them being disadvantaged. Proper cleaning to make sure the home is hygienic and protects people from infection fails to be followed in bathrooms. EVIDENCE: Greville is a purpose built one storey care home that can house thirty-five people with dementia. The home was built many years ago before current practice for meeting peoples specialist needs was defined. The home is however physically accessible for disabled older people or disabled visitors. Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 24 The main areas of the home are adequately decorated and in good order. We saw that people like to sit in the entrance hall where there is an in-set shelving unit with ornaments that gives a homely impression. A small lounge to the side of this leads into the large dining room. An area used as a sun lounge that leads into the courtyard is bright and sunny although we didn’t see anyone sitting there during our visit. The chairs in this area are wooden with no cushions or padding to support older people’s joints. Relatives had commented positively about the environment (which scored 85 in the home’s quality assurance survey). Comments included: ‘Nice quiet setting in pleasant grounds’, ‘We’re impressed by the cheerful bedrooms and cleanliness’, ‘There is a tea room where my relative can entertain us’, ‘There are places where residents can sit quietly as well as others where they can have company if they want it’ (2 similar comments), ‘The design of the building allows circular routes for residents with toilets well marked’ (2 similar comments), ‘Security of the building is very good to ensure safety’ and: ‘The home provides the perfect environment for my relative’. People were seen walking about the corridors. However it wasn’t clear how people are helped to find their way around when they come to the home as there is nothing to help them e.g. with use of bright colours. Further, one of the reasons bedrooms are kept locked is because people go into others’ rooms and take things. We saw good size framed nameplates on each door that could be used for pictures or photographs that are meaningful to the individual. However each frame was decorated with a flower motif that was exactly the same for each room. Small photos of the person as they are now were above the frame and their names were in it but they may not recognise either. Attention should be given to making the frames personal to each with photos that mean something to them. Some areas had been recently decorated. We sat in one lounge that staff said had been decorated two years earlier and new, comfortable furniture had been bought. This lounge was away from the main part of the home and some of the wallpaper had been peeled off making it look tatty and uncared for. Similarly in some bedrooms we saw the same thing had happened. It was clear that people had picked off border wallpaper. However some wallpapers were already peeling that might tempt people to pick at them. Some bedrooms were dark with old-fashioned wallpaper and old curtains. In one room we saw a broken socket cover. The cover had been broken across and left a jagged edge as well as a piece that could be harmful to the person in the room. We immediately required this be repaired and it was done the same day. We asked staff about the peeling off of wallpaper and why they thought this happened. Staff said they thought people could be bored. However the manager later said that one person regularly does this. We recommend that ways are found to give this Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 25 person meaningful activity so that s/he doesn’t have to resort to peeling off wallpaper. We saw toilets that in contrast with other areas were bright and fresh looking. Toilet doors are painted red with a picture to help identify it. This is good practice and helps people to find them more easily. The toilets themselves all had grab rails and radiator covers. However we saw that one of these was broken that could be a hazard. This must be repaired as soon as possible. Toilets were painted bright yellow with blue stencilling and pictures that give a raised effect. This helps people whose dementia may affect the way they see objects and colours. However the bathrooms, all of which were locked, were dull and in need of cleaning. A new, walk or wheel-in shower room had been put in place that was accessible and clean. However two other bathrooms were seen. In one, used disposable gloves were left in the corner on the floor. The floor covering was coming up that could be a hazard. An ambulift chair had a notice on it which said ‘do not use’. This was dirty on the underside. Sprays, creams and powders etc were seen in the bathroom cabinet. In another bathroom used gloves were seen in the sink. A tap was dripping and the ambulift chair was again dirty on the underside of it. The bathroom had last been used four days earlier but looked as if it hadn’t been cleaned since then. The courtyard area is of a good size and has garden furniture including tables and chairs. No one was seen using the space over the two days. People can get into the courtyard from the sun lounge by a ramped area. Flowerbeds are raised and include bushes and plants. However, the home also has a goodsized secure garden that goes around three sides of the home. This is mainly laid to lawn with a few trees and mature bushes. No attempt has been made to make this a pleasant space for people to use or be interested in. No benches were seen or things such as bird feeders or bird tables that might interest them had been put up. Apart from the courtyard area it was hard to see how people might get out to the garden as doors were frosted over or locked. Staff said that they did sometimes take people into the garden but they panicked or got frightened and wanted to come back in. We suggest that if people don’t get the chance to go out very often they won’t be used to being in a garden with little to engage them. Relatives commented on this in the home’s quality assurance survey: ‘Access to enclosed garden not often available in good weather; doors are kept locked’ (3 similar comments). Apart from the bathrooms the home was clean and hygienic and smelled fresh and pleasant. We saw staff cleaning bedrooms and toilets. Bedrooms were cleaned soon after people got up. The laundry area was clean as was the kitchen. No substances that could harm people were seen left out. However bathrooms need to be cleaned regularly and ambulift chairs cleaned underneath. Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 26 Because of issues such as: - The locking of doors preventing access to several areas of the home as well as bedrooms, - Updating of bedrooms and communal areas, - Lack of access to a secure garden, and: - Failure to do routine maintenance that will keep people safe, the quality of life is being made worse for people with dementia by the environment they’re living in. Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate numbers of staff should lead to a relaxed and positive standard of living for people. However development of a risk avoiding, ‘safe’ culture, stops them from living life with the quality of person-centred care they’re entitled to expect. Adequate recruitment practices make sure people are kept safe. The majority of staff have recognised qualifications in care. However, lack of training in person centred approaches to caring for people with dementia has led to a culture based on only meeting physical care needs. EVIDENCE: At this visit twenty-eight people were living at the home. From the home’s Annual Quality Assurance Assessment (AQAA) filled in and sent to us before we inspected, dependency levels (showing the amount of care people individually need) were mixed. Current rotas showed six care staff on each morning although staff said there were only five at weekends. We followed up a requirement from the last visit about reviewing weekend staffing levels and sending us a copy of the review. We hadn’t received this although at the feedback visit the team manager said that extra staffing for weekends had been agreed and she would supply further evidence of this. Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 28 Staff kept telling us that there are staff shortages which stopped them doing key time or taking people out. We heard ‘we used to’ frequently when we asked questions. We asked about staff daily routines and they were able to tell us about tasks such as giving personal care, baths, dealing with incontinence, making beds etc that take up the time. Staff also said they would like more staff, equipment and more time with people. However the number of staff to the number of people living at the home should be adequate to do more person-centred activities and give quality time to people. Therefore patterns and routines of working should be looked at to see if they could be better managed. A relative who filled in our survey before the visit commented: ‘they treat my mum like a member of their family. Mum is always well cared for, well fed. The staff can always find time to talk to my mum - she’s not just left on her own and forgotten. The staff are always happy to help with any problems I might have with mum. Nothing is too much trouble. I couldn’t wish for nicer people looking after her’. When we asked staff about activities or taking people out they told us: ‘we take them to the shops if we have time’, ‘It’s hard to get people to cover’, ‘Sometimes we only have a few staff and agency staff who have never been here before, ‘Last year we took someone shopping and they really enjoyed it’. Reasons for not being able to do things were: ‘by the time we’ve been out we have to get back by certain times i.e. for lunch’ and: ‘We get worried keeping track of them, so we don’t feel safe’. From our discussions with staff it was apparent that they’ve got used to way of working with people that is focussed on tasks, is overly ‘safe’ and avoids any possible risk. However there is a degree of collusion with poor practice (as shown above with the issue of the person distressed at having her/his toenails cut). This way of working denies people living at the home their rights and freedoms and doesn’t lead to a good quality of life for them. Good progress has been made with National Vocational Qualification in Care training. The majority of care staff have Level 2 or are doing it. Some domestic staff have level 1. Assistant managers have either done Level 3 or are doing it. We had recently done an inspection of recruitment records at the City Council’s personnel department headquarters. A sample of Greville staffing records was looked at during the inspection. These showed actions taken in recruitment were adequate and properly vetted staff make sure people are protected. We looked closely at staff training records. We saw a sheet with names of staff that need to do safeguarding adults from abuse training and dates were being Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 29 booked for this. In individual files however one staff member didn’t have this training recorded at all. The manager said he was sure the person had done it and would check. Other training done this year was a two-day course in supporting people with dementia. Staff were in the process of doing this. Those that had already done it gave mixed comments about it. Some said they enjoyed it but others said it was repetitive, boring or not stimulating. They had however enjoyed a video and discussion about sexuality for people with dementia that had led to a debate on the subject. With regard to the issue of forcing people to have care tasks done despite them clearly showing distress, training in person centred care approaches would help staff be able to handle such situations in more positive ways e.g. by using distracting techniques. From a sample of staff training records seen it was clear that they hadn’t done much more than basic essential training such as moving and handling, food hygiene and first aid. Training in person-centred approaches to caring for people with dementia, doing meaningful activities with them and managing behaviours that challenge must be done to start changing the culture from an institutional to a more person-centred one. Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 30 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33, 35, 36, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Lack of clear person-centred management fails to make sure the home is run in the best interests of people living there. Proper follow up of quality assurance surveys don’t make sure people get the best possible care. Proper management of peoples cash makes sure they are protected from financial abuse. Failure to record proper supervision records doesn’t show that issues affecting people are picked up and dealt with. Failure to keep proper records required under regulation and that show peoples progress may put them at risk of harm. Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 31 EVIDENCE: The manager Mr Mick Sullivan was unavoidably absent during the two-day visit. We met with him and his team manager the following week to give him feedback and discuss our findings. Mr Sullivan is trained to National Vocational Qualification in Care Level 4 and is experienced in his role. Staff said of him that ‘he’s really good and will help us when we’re struggling’. Relatives had commented in the home’s quality assurance survey: ‘high standards are due to good management and hard work by the team’ (two similar comments). The manager had followed proper procedures in recruiting staff to make sure people are protected. However areas covered in this report show a failure of management to make sure the home is run in the best interests of people living there. These include: - Failure to make sure the home is run in a clear person-centred way that respects peoples rights and values them as individuals, - Failure to make sure staff routines are properly managed so that they have time to meet peoples whole needs that include activities and outings, - Collusion with a ‘locked door’ policy that denies people their right to freedom and choice and: - Failure to make sure records required under regulation are kept and copies sent to the Commission as regulator of services in a timely manner. Responsibility also rests with the registered person in charge of the home as the responsibility for making sure it’s properly managed and peoples needs are met rests with him. Assistant managers in charge of the home during our visit were seen doing tasks such as medication and supporting staff. We saw them spending time around the home and not in the office away from people. We observed good interactions with people and staff alike. Examples were: spending time with people when giving medication, making good eye contact with people, not standing over them and giving clear instructions and support to staff. The City Council commissions independent yearly surveys on all its homes to measure quality of care given. The most recent survey of Greville had been done in June 2008 and we were sent a copy of the report. A group of relatives or representatives plus other stakeholders were sent questionnaires. The average scores for each part of the survey ranged from 79 to 88 . Daily life and social activities scored lowest and management scored highest. An action sheet has been introduced this year so that managers can pick up points from comments made that need further work. The report had just been published and this year an action sheet has been put in place to help managers’ focus on what needs to be followed up. However, we saw no evidence that issues raised Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 32 from the home’s survey, some of which were borne out by our own findings, had been addressed. A manager from the Elderly Person’s Homes team oversees and supports the home. She also has responsibility for making sure National Minimum Standards and any requirement made under them are met. The team manager visits monthly, supervises the manager and sends copies of her report to the Commission. She told us she is aware of some of the issues picked up at this inspection and the team has been working over the past year to bring about changes needed. However, this work has inevitably been affected by the threat of home closures that people, their relatives and staff have had to face for a number of years. This has further led to de-motivating staff and lowering of their morale. A check of peoples cash held at the home was done. All amounts held on cash sheets was correct and sheets were filled in properly. Receipts were attached for items bought and weekly balance checks are done to make sure no errors are made. A sample of staff supervision records and yearly reviews were looked at. These showed that staff are getting supervision as laid down in the Council’s own policy. A number of staff had three sessions recorded for this year and some had more. Each member of staff had had a performance review that is a formal review done each year. Supervision records were brief and were general statements of the person’s ability rather than a full discussion of issues affecting people being worked with, that would make sure their needs were continuing to be met. We looked at records including accident reports, daily records, complaints and health and safety. Daily records were brief and lacked detail of peoples enjoyment of life in the home. As staff said no key time is done because ‘those hours have been lost’ there were few if any, positive records to show what they were doing with people. Records were factual, medicalised and focussed on care given, bodily functions and behaviours. There were a number of gaps seen that ranged from ten days to over a fortnight. One person had a gap of some time between records that wasn’t accounted for. Records required from the last inspection hadn’t been sent to the Commission. These included reviews of staffing arrangements and notices of incidents affecting people. Health and safety records were looked at. Regular checks of fire safety equipment and alarms are done together with checks of water temperatures and other routine maintenance needed. We saw records of staff fire safety training and a fire safety risk assessment done in 2007. However we couldn’t find any records of full fire evacuations done regularly to make sure staff keep people safe. We saw that each week the fire alarm is tested and the manager said staff use this as a fire drill. However in all records the time recorded was five minutes. This isn’t long enough to make sure staff are aware of and follow Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 33 the right procedures to keep people safe. Further, the outcome or lessons to be learned from the drills weren’t recorded. We asked about various issues during the two days and at the feedback session. The manager and team manager said they would supply further evidence e.g. about weekend staffing levels, fire drills and a care plan review but none of these had been received before this report was written. Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 34 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X 3 3 X 1 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 1 3 X 3 2 2 2 Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 35 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Timescale for action 30/08/08 2. OP8 16(2)(i) 3. OP8 12(4)(a) 4. OP9 13(2) Clear information from preadmission assessments, must be recorded in care plans. Care plans must also include social and psychological needs and show how they will be met. This will make sure that all needs picked up will be met. Drinks must be made 15/08/08 available to people at any time throughout the day including lunchtime. This will make sure that people are protected from effects of dehydration. Protective gloves must only 15/08/08 be used as necessary to maintain proper infection control measures and not when giving social care to people. This will make sure peoples dignity is respected and they are protected from risk of infection. 1.All medication that 15/08/08 requires to be kept at low DS0000035878.V364545.R01.S.doc Version 5.2 Greville Page 36 5. OP12 16(2)(n) 6. OP15 23(2)a) 7. OP18 12(3) 8. OP18 37 temperatures must be properly stored and handled. 2. When medication is returned to the pharmacy the reason for its return must be recorded. This will make sure medication is handled, stored and managed properly so that people are protected. Meaningful activities suitable for people with dementia must be provided having regard to their specialist needs. This will make sure that people are kept free from boredom and frustration in their daily lives. The dining room must be made comfortable and more appealing to people when having meals. This will give people a more homely and relaxing environment in which to have their meals. Where people clearly show distress at any stage of the care giving process, person-centred techniques must be used to distract and keep them safe from risk of abuse. This will make sure people are given treatment and care that protects them. The registered manager must make sure that any incident affecting a person living at the home is recorded properly and details sent to the Commission. This will make sure that all incidents will be dealt with DS0000035878.V364545.R01.S.doc 31/08/08 30/08/08 15/08/08 15/08/08 Greville Version 5.2 Page 37 9. OP19 23(1)(a),(2)(a) properly and the person involved kept safe from harm. (Timescale not met from the June ’07 inspection) Specialist advice from an organisation expert in dementia care and registered to give such advice, must be sought on: -Use of lighting -Style and content of communal rooms -Proper use of directional signs, or use of colours to help people find their way - More person-centred ways of using nameplates on bedroom doors to help people find their rooms. This will make sure that people are kept safe in the home, don’t get bored or frustrated and will be able to keep their independence for as long as possible. 01/09/08 10. OP22 23(1)(a) 1.People must be able to get into their rooms at any time of the day. 2.Bedrooms must only be kept locked if there is clear safety reason for doing so. Where bedrooms or other rooms need to be locked a proper risk assessment must be put in place. 3.Unnecessary locking of communal rooms must stop. All the above will make sure people living with dementia are able to use all parts of the home freely 30/08/08 Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 38 the September ’06 inspection ) and without restraint. (Timescale not met from A number of bedrooms and some communal areas must be redecorated particularly with regard to décor and furnishings that meet the needs of people living with dementia. This will make sure that people will have homely and comfortable rooms that meet their needs. (Timescale not met from 30/09/08 11. OP24 23(2)(b)(c) the September ’06 inspection) 12. OP27 18(1) 13. OP30 18(1)(c)(i) Adequate staffing levels must be available at all times including weekends. (Timescale not met from June ’07 inspection) 1.Each staff member must have regular training in safeguarding adults from abuse. 2.All staff including domestic and regular agency staff must have dementia awareness training delivered by a specialist dementia care provider. 3.Care staff must be given training in how to provide meaningful activities for people with dementia. 4.All staff must have training in person-centred care. 5. Agency staff that work at the home very regularly must have regular 06/08/08 30/09/08 Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 39 supervision and be able to attend staff meetings. This will make sure people get a consistent service from all staff that are properly trained and supported. All the above will make sure people living in the home are cared for by staff that understand their needs and are able to help, protect and keep them safe. Records of supervision must be kept in enough detail to show that people are able to discuss issues affecting their work with people in their care. This will make sure that staff are able to think about their work practice and have opportunities to discuss issues and get support for them that will help them care for people living at the home. 14. OP36 18(2) 31/08/08 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. 1. Refer to Standard OP7 Good Practice Recommendations All care plans should be written from a person-centred perspective and clearly set out to show positive outcomes for people living at the home. Photographs of people on their bedroom doors should be chosen carefully to maintain their dignity and help them DS0000035878.V364545.R01.S.doc Version 5.2 Page 40 OP10 Greville 2. OP12 3. OP15 4. OP19 5. OP32 6. OP37 recognise themselves better. This will make sure people are able to access their rooms more independently. A new and extended range of person centred activities, entertainment and outings should be put in place so that people have more stimulating and enjoyable ways of passing the time. A copy of the activities programme should be sent to the Commission. Menus should be re-done with choice of main meal for each day, use of fresh ingredients and more frequent vegetarian options. Where people have a clearly indicated wish for vegetarian food this should be provided. The garden area should be improved to enable people to use it as an extra space to enjoy their time. All garden areas should be made more interesting and accessible to people with dementia by better use of plants, flowers, seating and opportunities for gardening. 3. Communal corridors would benefit from newer, more colourful pictures displayed for people to look at. This will give people a more enjoyable, interesting and homely space in which to live. The management team should all have training in personcentred care approaches. This will make sure they are able to lead and support the staff team in effecting changes that will benefit people living at the home. 1.Information for personal profiles of each person living at the home should include as much detail as possible. Family and friends should be regularly asked to give information that will help make sure people get the person centred care and support they need. 2. Progress records should be kept at a minimum weekly and give person-centred details of how people enjoy their life in the home. Records of fire drills should be properly and regularly kept so that they show people are protected from risk of fire. 7. OP38 Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 41 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greville DS0000035878.V364545.R01.S.doc Version 5.2 Page 42 - 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. 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