Inspection on 06/09/05 for Greville

This inspection was carried out on 6th September 2005.

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

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

Other inspections for this house

Greville 26/06/08

Greville 29/06/07

Greville 05/07/06

Greville 19/01/06

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 6 September 2005 1.30pm th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Greville D56_D05_S35878_Greville_V246178_310805_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Greville Address Lacey Road Stockwood Bristol BS14 8LN 01275 837034 01275 892007 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Bristol City Council Ms Sonia Moon and Mr Mick Sullivan Care Home 35 Category(ies) of DE(E) Dementia - over 65, for 35 registration, with number of places Greville D56_D05_S35878_Greville_V246178_310805_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate one named person under the age of 65. The age range will revert back to 65 years and over when the named person`s needs can no longer be met at Greville EMI. Date of last inspection 29 January 2005 Unannounced 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. The home is jointly managed by Ms Sonia Moon and Mr Mick Sullivan. Ms Sonia Moon currently works part time at Greville and part time in another post within the local authority Greville D56_D05_S35878_Greville_V246178_310805_Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a Tuesday between the hours of 1.30pm and 5.30pm. Evidence was gathered from: talking to/observing residents, talking to two assistant officers/ talking to and observing staff, talking to two visitors, looking at the premises, examining records, policies and procedures and reading the comments from an independent survey carried out in June 2005 and the August addition of ‘Greville Gossip’ (Newsletter) What the service does well: People moving to Greville can be sure that their needs can be adequately met. Care plans and individual risk assessments are of a good standard ensuring that residents’ needs are fully identified and met. The health care needs of residents are well met with evidence of good multidisciplinary working taking place on a regular basis. The residents of Greville are given the opportunity to experience a stimulating and varied life where various informal activities and outings are regularly made available. Visitors are made very welcome and meals are well managed and provide daily variation good nutrition and social contact for residents. Residents and their relatives are confident that their concerns will be listened to and have been made aware of the complaints procedure. The staff at Greville are employed in sufficient numbers to meet the residents needs. They are trained and competent to do their job which ensures that residents are in safe hands at all times. Residents live in a home is which managed efficiently by two experienced managers and a team of assistant officers. Greville D56_D05_S35878_Greville_V246178_310805_Stage4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Greville D56_D05_S35878_Greville_V246178_310805_Stage4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Greville D56_D05_S35878_Greville_V246178_310805_Stage4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5, Information about the home for residents has improved . However, attention is needed to ensure that new residents and their relatives can make informed choices about the home and that they can be sure their rights will be safeguarded. People moving to Greville can be sure that their needs can be adequately met. EVIDENCE: The Statement of Purpose and Service User Guide were examined and were both found to be satisfactory following a recent review. However it was noted that some of the residents’ contracts/ statement of terms and conditions do not contain information about room number or who was responsible for the fee. There is a condition of registration that one named person who is sixty years old can be accommodated at Greville. The inspector was notified at the inspection that this resident has now moved and will not be returning to Greville. Following formal notification to the Commission for Social Care Inspection by the manager, this condition will be removed. Greville D56_D05_S35878_Greville_V246178_310805_Stage4.doc Version 1.40 Page 9 A sample of needs assessments obtained prior to residents being admitted to the home, were seen in care files. It was noted that they included full details of residents’ assessed mental health needs. This is good practice. Residents admitted to the home have the opportunity to have a formal review with the support of their relatives within 4-6 weeks to ensure that the quality, facilities and suitability of Greville meets their needs. A review was due to take place before a recent placement was to be made permament. Two relatives confirmed this information during the course of the inspection. Greville D56_D05_S35878_Greville_V246178_310805_Stage4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10 Care plans and individual risk assessments are of a good standard ensuring that residents’ needs are fully identified and met and that they are treated with dignity and respect. The healthcare needs of residents are well met with evidence of good multidisciplinary working taking place on a regular basis. EVIDENCE: A sample of care plans and risk assessments were seen and it was observed that they were very clear and well detailed. There was evidence in place to confirm that they were reviewed on a regular basis by the manager in consultation with the resident, their representative where possible and the resident’s named key worker. Greville D56_D05_S35878_Greville_V246178_310805_Stage4.doc Version 1.40 Page 11 Relatives consulted during the inspection confirmed that their relative was treated with dignity and respect. It was observed that members of staff knocked on residents’ bedroom doors and waited for an answer before they went in. One relative said “the staff are very jolly and respectful to my relative and other residents from what I have seen”. He is always well dressed and groomed”. 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. Greville D56_D05_S35878_Greville_V246178_310805_Stage4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 The residents of Greville are given the opportunity to experience a stimulating and varied life where various informal activities and outings are regularly made available. Visitors are made very welcome and meals are well managed. They provide daily variation, good nutrition and social contact for people EVIDENCE: There is a programme of activities twice daily e.g. one hour mornings and evenings (Monday to Friday) and once a day (in the evening) at weekends. Care staff also work with individual residents (key time) twice a day. It was noted that individual key workers are now making themselves known to family members which had been a recommendation of the last report. Two relatives confirmed this during the inspection. Monthly entertainment is held in the home, which is usually musical. There is a diary of activities available to view on the notice board in the dining room. This information was confirmed by photographs of residents in the Easter bonnets they had made, displayed in the home. One relative also spoke about her brother who enjoyed visiting the bar and listening to music on an evening. This relative also spoke about games her brother had been involved in such as throwing sponge balls to staff and residents. Regular outings to places of interest such as local garden centres and to coastal resorts such as Weston-Super-Mare. Greville D56_D05_S35878_Greville_V246178_310805_Stage4.doc Version 1.40 Page 13 All residents observed during the inspection looked relaxed with the staff providing their care, who were observed to respond to the residents in a respectful unhurried manner. It was noted that residents consulted said that “I like it here, the staff are very kind to me, they look after me and the food is excellent”. Residents were observed enjoying a cup of tea and a peach melba at tea time and noted from the menu that the lunch that day had consisted of roast lamb and trimmings and the evening meal consisted of corn beef and chips. One relative said: “The food seems good here”. She indicated she had seen the menus and also said “the roast meals are very nice and you can have a meal with residents if you wish”. Another resident said “the staff are lovely and the food is good”. It was noted from the independent quality assurance survey conducted in June 2005 that some people had who responded to the survey had questioned the amount of fresh fruit available. One of the manager’s reported that it is available as an alternative but in view of the comments they propose to make fresh fruit available with the afternoon cup of tea. Overall the score was satisfactory. Comments were noted such as: “It all looks very nice. My relative is a diabetic and they cater for this with special desserts etc”. “I have not seen any meals but my relative is putting on weight since being at Greville and I am informed she enjoys her meals. Provision of in between drinks etc is very good as are facilities for visitors”. Relatives’ meetings continue to be held on a regular basis to which all relatives, and carers are invited. There is also a regular newsletter which is sent to everybody involved with Greville. Greville D56_D05_S35878_Greville_V246178_310805_Stage4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Residents and their relatives are confident that their concerns will be listened to and have been made aware of the complaints procedure. Arrangements for protecting residents from harm is good and has improved since the last inspection but further work needs to take place to protect residents from possible risk or harm. EVIDENCE: Residents, relatives and staff told the inspector that they were comfortable talking to the management team about any concerns. One relative said: “If I had a complaint I would talk to one of the officers. The staff seem okay with everyone. Mum would tell me if she was not happy .She has never said she does not like it here” The resident in question said “I would talk to the head one if I had a complaint”. No complaints have been received either by the manager, the complaints officer for Bristol Social Services and Health or the Commission for Social Care Inspection since the last inspection. ‘No Secrets in Bristol’ (Local authority Adult Protection procedure) is in place in the home. The two managers and the assistant officers have recently attended training provided by Social Services and Health on adult protection. It was noted that ten members of staff are due to attend this training in the next few months. Greville D56_D05_S35878_Greville_V246178_310805_Stage4.doc Version 1.40 Page 15 The inspector noted that the policy on physical restraint that had been developed by the senior management team was still not adequate and that further work on this policy must take place before it meets the National Minimum Standards. This is an outstanding requirement of the last inspection. However it was pleasing to hear that a member of the In Reach mental health team had recently provided staff training on physical restraint. This training was organised following the need for a gentle form of restraint being used on one of the residents for their safety and protection. This situation is being carefully monitored by the managers and risk assessments are in place which are regularly reviewed. Greville D56_D05_S35878_Greville_V246178_310805_Stage4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26 Greville continues to be a clean, comfortable, safe home .There has been an improvement in the storage and maintenance of equipment since the last inspection which ensures that residents are kept safe from harm. EVIDENCE: In general, the environment is well maintained and suited to residents’ needs. Greville is decorated and furnished to a standard that creates a comfortable homely atmosphere. There is a further programme of redecoration and refurbishment planned to improve the environment. During the tour of the communal areas of the home it was noted that a cover had been removed from a radiator in the hallway. This was immediately replaced by one of the assistant officers and the inspector was informed that this problem would be reported to the maintenance section that day. It was observed that the storage area for wheel chairs has now been made safe . The wheel chairs have been cleaned and the foot rests have been put back in place. There is a sign to remind staff not to remove the footrests unless a risk assessment demonstrates otherwise. Greville D56_D05_S35878_Greville_V246178_310805_Stage4.doc Version 1.40 Page 17 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 consulted during the inspection was of the opinion that the lounges were now starting to need some updating. Residents’ bedrooms looked homely and were personalised with personal possessions and furniture. The toilet and bathroom facilities are sufficient to meet residents’ needs. The toilet doors have all been painted in red and signposted following consultation with Dementia Voice. There were no unpleasant smells in the home and the rooms were cleaned to a high standard. It was noted that the recent independent Quality Assurance survey completed in the home in June 2005, scored quite highly in the environment section. Comments received were noted such “as general hygiene is very good. Residents’ rooms are kept clean and the staff do lots of small things to make the atmosphere homely and welcoming” and: “They have had some recent refurbishment which has brightened up the home”. Greville D56_D05_S35878_Greville_V246178_310805_Stage4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,30 Staff numbers at Greville are sufficient to meet residents needs. Residents health and safety is ensured by having trained and competent staff. EVIDENCE: Staffing levels in the home remain satisfactory. It is acknowledged that there are a number of agency staff used to fill any recruitment gaps. However, it is noted that these staff are used regularly at Greville and have experience of working with people with dementia. On the day of the inspection the care staff on duty were all permanent. There is a programme of statutory training which includes basic food hygiene, first aid, manual handling and protection of vulnerable adults . Communication between residents and staff was noted to be very good and all staff observed were very sensitive to residents’ needs and spoke to them with respect and understanding of those needs. Training in this care home also includes dementia care, mental health and loss and bereavement training. It was also noted that the staff team are making progress with NVQ training. Several members of staff have already completed NVQ 2 and there are currently five members of staff participating in NVQ 2. Two of the assistant officers are supporting staff with this training and have recently become NVQ Assessors. Greville D56_D05_S35878_Greville_V246178_310805_Stage4.doc Version 1.40 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,37,38 Residents live in a home is which managed efficiently by two experienced managers and a team of assistant officers which ensures residents’ rights and best interests. Improvements in record keeping and implementation of policies and procedures needs to be maintained. Attention needs to be given to improving fire safety procedures to ensure residents are fully protected at all times. I EVIDENCE: Greville is jointly managed and both managers are registered with the Commission For Social Care Inspection, as one of them is seconded to a more senior post in with the local authority on a part time basis. They are both very experienced officers having worked for the local authority for a number of years. Greville D56_D05_S35878_Greville_V246178_310805_Stage4.doc Version 1.40 Page 20 One manager has completed her NVQ 4 in management and the other is in the process of completing the NVQ 4 / Registered Managers Award. The joint management of the home is currently working well with the support of four assistant officers. This information was confirmed by two assistant officers seen at the time of the inspection, the team manager’s monthly reports sent to The Commission for Social care Inspection and from the Quality Assurance survey conducted in June 2005. Comments were noted such as: ‘I consider it very well run. The staff treat my relative with respect and the other residents. I have been telephoned on occasions when my relative has been distressed and have been able to talk to her which has calmed her down (and me!). I consider she is in very good hands, of people to whom it is not just a job” and: “I am very happy with the Officers in charge who are very friendly” Progress has been made with the completion of records since the last inspection. It was noted that notifications of any events that affect the welfare of residents are now being sent to The Commission for Social Care Inspection at the appropriate times. It was also noted that daily running records are maintained much better now. However, it was very concerning to note that the fire precaution checks are still not taking place on a regular basis despite an immediate requirement being made following the last inspection. It was observed from the fire log that the checks are not done consistently. For example there were gaps in the records. These included: emergency lighting which is not checked monthly, fire alarms are not checked weekly, fire fighting equipment is not checked monthly and care staff that provide care at night do not have three monthly fire safety training. It was also noted that the fire risk assessment in place was due for an annual review. A further immediate requirement was made at this inspection. However, the managers are advised that enforcement action may take place if the requirement is not followed up and actioned immediately. Greville D56_D05_S35878_Greville_V246178_310805_Stage4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 3 3 x x x 3 1 Greville D56_D05_S35878_Greville_V246178_310805_Stage4.doc Version 1.40 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4 Requirement The registered managers must formally notify the Commission for Social Care Inspection that the resident aged 60years who was previously admitted is no longer returning to the home, in order that the temporary condition to the registration can be removed All residents must be provided with a contract/statement of terms and conditions which stipulates their room number and fees payable The physical restraint policy must be reviewed to ensure that it complies with The Department of Health Statutory Guidance All fire records must be checked in accordance to Avon Fire Brigade guidelines :Emergency Lighting must be checked monthly, fire alams must be checked weekly and fire fighting equipment must be checked monthy All night staff must receive fire safety training three monthly Timescale for action 6th November 2005 2. 1 2 6th December2 005 6th December 2005 Immediate 3. 18 13(7) 4. 38 23 (4)(c ) 5. 6. 7. Greville 38 23(4) (d) Immediate D56_D05_S35878_Greville_V246178_310805_Stage4.doc Version 1.40 Page 23 8. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 38 Good Practice Recommendations The fire risk assessment in place should be reviewed at least annually Greville D56_D05_S35878_Greville_V246178_310805_Stage4.doc Version 1.40 Page 24 Commission for Social Care Inspection 300 Aztec West Almondsbury Bristol 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. 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