Inspection on 15/11/06 for Greville House

This inspection was carried out on 15th November 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Greville House 19/06/08

Greville House 21/09/05

Greville House 27/04/05

Greville House 09/11/04

Greville House 28/05/04

Greville House 02/03/04

Greville House 04/02/04

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

CARE HOMES FOR OLDER PEOPLE Greville House 40 Streetly Lane Sutton Coldfield West Midlands B74 4TX Lead Inspector Amanda Lyndon Unannounced Inspection 15th November 2006 09:35 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 House DS0000016771.V318935.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 House DS0000016771.V318935.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greville House Address 40 Streetly Lane Sutton Coldfield West Midlands B74 4TX 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) 0121 308 8304 F/P 0121 308 8304 pamsanbren@aol.com Mrs Christina Sally Howard Mr Jonathan Keith Howard Pamela Thompson Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Greville House DS0000016771.V318935.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: A number of the conditions listed below had been addressed or were no longer applicable. 1. 2. 3. 4. The category of registration is OP (older people, over 65). The maximum number is 22 and the type of home is care home only. The registered manager develops and implements adult protection procedures for Greville House that incorporates Birmingham’s MultiAgency Guideline and those of Walsall MDC. Mrs Thompson must provide evidence of completion of a Management qualification at NVQ level 4 or equivalent at the earliest opportunity or before April 2005. One named person may be accommodated and cared for in this home for reason of Mental Illness (OP 21, MD 1) 21st September 2005 Date of last inspection Brief Description of the Service: The Home provides residential care for 22 people for reasons of old age only and there are currently no male residents living there or staff working there. Greville House occupies premises, which are approximately a century old, and many of the original features have been retained. The Home is located in a residential area to the north of Birmingham, overlooking Sutton Park and within a short drive or bus ride of Sutton Coldfield, Mere Green and Streetly. The building is a large, extended and attractive property, which is surrounded by attractive gardens that provide a pleasant and secluded outlook from most bedrooms. There is sufficient off road parking at the front of the Home. Bedroom accommodation is provided on both the ground and first floor, the upper floor being accessed by a stair lift. All bedrooms are for single occupancy and most have an en suite toilet facility. Other residents are allocated a toilet near to their bedroom for their own private use. The Home has two lounges situated on the ground floor and a separate well appointed dining room. Assisted bathing facilities were provided and staff were available to provide support in this area. The Home employs three trained nurses who between them provide the majority of the senior site cover including weekends and a night time on call service. One of the three nurses also has the role of Registered Manager. There is a comprehensive and interesting in-house and external activities programme. The Home is unable to accommodate wheelchair users and has a no smoking policy throughout. There is a notice board displaying forthcoming events and other information of interest to residents and their visitors. Copies of the most recent CSCI inspection reports are available within the service user guides. The weekly fee to live at Greville House is between £405 and £465. Items not covered by the fee include hair dressing, private chiropody, newspapers and magazines and private transport. Greville House DS0000016771.V318935.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report reflects the findings of a one day unannounced field work visit undertaken by one Inspector when there were twenty two residents living at the Home, one resident was in hospital. Information was gathered by speaking with a number of residents, staff and visitors, case tracking, examining care, medication and health and safety records and observing the staff perform their duties. A tour of the Home was undertaken. Prior to the field work visit positive comments were received from residents, visitors and Health Care Professionals about the service provided including: “ We receive care and support at all times. The staff are excellent” “The senior management communicate well at all times with the Doctors surgery and medical instructions are always followed through” “It is more like a family home” and “I am very happy living at Greville House and I am very well looked after in every way” No negative comments were received. Prior to the field work visit the Registered Manager and Registered Provider had completed a pre inspection questionnaire, giving some information about the Home, residents and staff which was taken into consideration. No immediate requirements were made on the day of the visit. Following the visit a satisfactory action plan was sent to CSCI by the Home’s Proprietor addressing requirements made at the time of the visit. What the service does well: Residents are encouraged to make informed decisions about whether they would like to live at the Home and are provided with enough information in order to make that decision. Residents have access to a range of Health and Social Care Professionals and staff provide support to ensure that any medical instructions are carried out and this ensures that residents’ health care needs are met. Residents have the confidence that medical advice is obtained by the Home’s staff on their behalf if they are unwell. One resident said “ The staff support me if I am not well” Residents are cared for in a respectful manner by staff working at the Home and this ensures that their self esteem and dignity are maintained. Residents Greville House DS0000016771.V318935.R01.S.doc Version 5.2 Page 6 are encouraged and supported by the staff team to maintain their independence dependent on their individual abilities. One resident said “ There is always someone here to help me” Another resident said “ The staff help me in and out of the bath, I enjoy having as bath twice a week” Residents are able to exercise control over their daily lives and the activities that they choose to participate in which promotes their individuality. There is a wide variety of activities on offer at the Home for the residents to participate in should they choose and visitors are made to feel welcome. There was a family atmosphere at the Home and a good rapport had been built up between residents and staff. One resident said “There are activities every day, it is up to us if we take part, the staff quite understand if we don’t want to” Residents are supported to continue to practice their chosen religions whilst living at Greville House and this ensures that their beliefs and individuality are respected. Residents are offered a choice of wholesome meals and these meet any special dietary requirements for reasons of health, taste or cultural/religious preferences. One resident said “ The food is varied, it should suit everyone. It is cooked very well and presented well” Residents and their visitors are encouraged to voice any concerns that they may have about the service provided at the Home and complaints are investigated in an appropriate and timely manner. One resident said “ I would go to the manager if I wasn’t happy but I have been here four years and I have never had to complain” Residents are provided with a clean, comfortable and well maintained living environment in which they feel safe and secure and their privacy is maintained. One resident said “ Everywhere is kept so clean here” Another resident said “ I tidy my room and the housekeepers clean it everyday” Residents receive a good standard of care from an adequate number of appropriately trained staff in order to meet their care needs. Staff turnover is low and this ensures continuity of care for residents. Staff are well supported by the management team and this ensures that they have the confidence and knowledge to work in a competent manner. One staff member said “ It is more like your own home here, the staff and the residents get on so well” Another resident said “ The staff are very efficient” The management team are approachable and friendly, residents’ meetings are held regularly and there is evidence that any suggestions made by residents Greville House DS0000016771.V318935.R01.S.doc Version 5.2 Page 7 about the service provided at the Home are acted upon. Residents are encouraged to be involved in the running of the Home. One staff member said “ The management team are very well organised, anything that the residents ask for is purchased for them. Any suggestions put forward by residents or staff are followed up” A robust system for the safe keeping of small amounts of residents’ money is in place should residents choose to use this facility. There are regular maintenance checks and servicing of equipment used at the Home and this ensured that they are safe to use. What has improved since the last inspection? What they could do better: A pre admission reassessment had not been completed in respect of a resident who had come to live at the Home and this may prevent their individual care needs and preferences regarding their daily lives from being met. This lapse in procedure was on one occasion only. Residents were not involved in the planning of their care and some care plans did not identify the specific support required by staff for each resident and this may prevent their individual care needs and preferences about their daily routines from being maintained. Formal care reviews involving privately funded residents were not undertaken and this does not provide residents with the opportunity to discuss the care and support that they are receiving at the Home. Greville House DS0000016771.V318935.R01.S.doc Version 5.2 Page 8 There were some poor practices in respect of the management of medication and these may result in medication administration errors. There is no communal shower facility available at the Home and this does not provide residents with a choice about whether they would prefer to have a shower instead of a bath. Staff recruitment files did not include all information required by regulations and this may not safeguard residents. 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 House DS0000016771.V318935.R01.S.doc Version 5.2 Page 9 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 House DS0000016771.V318935.R01.S.doc Version 5.2 Page 10 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, 3, 4 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Admission procedures are generally thorough and prospective residents have enough information to make informed decisions about whether they would like to live at the Home. EVIDENCE: A statement of purpose had been produced however this required updating to reflect the current services provided at Greville House. Service user guides had been distributed to all residents and this ensured that they were informed about the services provided at the Home. The statement of purpose and service user guides were available in a large print format on request for ease of reading for people with poor eyesight. Prospective residents are encouraged to spend time at the Home and have a meal there in order to sample what life would be like to live there. During this time, senior staff undertake comprehensive assessments of residents’ individual care needs so that they can determine whether their individual care needs could be met living at the Home. Residents can choose their bedroom if Greville House DS0000016771.V318935.R01.S.doc Version 5.2 Page 11 more than one bedroom is available and this ensures that they can exercise control over their future living arrangements. Senior staff visit prospective residents in hospital if they are not able to spend time at the Home and a pre admission assessment is undertaken at this time. An exception to this was that a formal pre admission assessment had not been undertaken in respect of a resident who had recently been readmitted to the Home and written documentation in respect of this was not available and this may prevent the resident’s changing care needs form being met whilst living at the Home. This lapse in procedure was on one occasion. Residents come to stay at the Home on a four week trial period and on completion of this a social care review is undertaken involving the resident, their relatives, Home’s staff and the Social Worker. This provides all involved with the opportunity to discuss whether the resident’s individual care needs were being met at the Home and whether they wished to remain there. A private review is undertaken involving the resident, their relatives and the Home’s staff for residents who are privately funded. Respite care can be offered at the Home if a vacant bedroom is available. Intermediate care is not provided at Greville House Greville House DS0000016771.V318935.R01.S.doc Version 5.2 Page 12 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 good. This judgement has been made using available evidence including a visit to this service. Health provision and care delivery are good and residents are cared for in a respectful manner ensuring that their self esteem and dignity are maintained. EVIDENCE: Care plans were derived from the information obtained about the residents’ individual care needs on admission to the Home. These included good detail about the preferences of residents, their abilities and their health care needs, however did not always detail the specific support required by staff and were not always reviewed regularly. The care needs assessment and care plans pertaining to a resident who had recently been readmitted to the Home had been updated however the moving and handling risk assessment pertaining to this person had not been updated and this may prevent the Home’s staff from providing the correct support in this area if the resident’s care needs had changed. Moving and handling risk assessments did not identify the specific hoist and sling size to be used for individual residents should they fall and this does not provide staff with the relevant information to be used in the event of an Greville House DS0000016771.V318935.R01.S.doc Version 5.2 Page 13 emergency. Detail of the size of continence products to be used for individual residents was not recorded within the care plans and the Registered Manager stated that plans were in place to rectify this. There was no evidence that care plans were agreed and reviewed with the involvement of the residents however a number of these had been signed by relatives. This may prevent residents’ preferred routines in respect of their daily lives from being maintained whilst living at the Home. Residents had good access to a range of Health and Social Care Professionals including district nurses, social workers, dieticians and a chiropodist and it was evident that a good rapport had been built between the Home’s staff and the multi disciplinary team. Residents had the option of retaining their own General Practitioner on admission to the Home (if the GP was in agreement) There was evidence that the staff team referred to the multi disciplinary team for advice as required and that they followed any instructions given in order to promote the health and well being of residents. One resident said “ The staff support me if I am not well” A number of residents had very poor eyesight and appropriate talking watches and clocks had been purchased for these people in order to help maintain their independence and retain control over their daily lives. Staff provided support for a resident who was very hard of hearing in order to improve her quality of life and reduce the embarrassment that she had expressed about her disability. A number of residents were independent with their personal hygiene needs, other residents were well supported by the Home’s staff in this area to choose clothing, jewellery and make up appropriate for their age, gender, tastes and culture. Some residents chose to have a bath every day and the staff provided support in this area as required. One resident said “ There is always someone here to help me” Another resident said “ The staff help me in and out of the bath, I enjoy having as bath twice a week” The Home’s staff accompany residents to hospital in the event of an emergency and this ensures that residents feel supported, safe and secure. Formal care reviews of the care needs of privately funded residents living at the Home were not undertaken and a system for this must be introduced and written documentation must be maintained. This will ensure that residents have the opportunity to decide whether they would like to continue to live at the Home, whether their care needs could continue to be met there and any suggestions for improvements could be put forward. There was a generally robust system for the management of medication in place. The system for the ordering, administration and disposal of medication Greville House DS0000016771.V318935.R01.S.doc Version 5.2 Page 14 was comprehensive. Drug audits were undertaken to ensure that residents received the correct medication as prescribed. One resident had chosen to self medicate her own medication and the staff provided support to her in this area in order to ensure that her safety was maintained whilst promoting her independence. Stock balances of medication checked during the field work visit were found to be correct. Not all medication received in to the Home was signed in by staff as confirmation of receipt of this and second signatures were not always obtained in respect of handwritten entries on to medication administration charts (MAR) as confirmation that the administration instructions had been written correctly as per the prescription details. This may result in medication administration errors. There was a gap on one MAR chart and staff were unable to evidence whether the medication had been administered and this prevents the staff from monitoring the effectiveness of treatment prescribed. A drugs trolley is not provided at the Home and the senior staff had to stand on a stool to take medication out of the wall mounted drug cupboard and load it onto a hostess trolley prior to commencing each drug round. This is not considered to be good practice for reasons of the health and safety of staff and may prevent the medication from being quickly locked away in the event of an emergency or if the senior person is interrupted during the medication round. Following the visit the Home’s Proprietor confirmed that plans were in place to purchase a drugs trolley and that the existing drugs cupboard had been lowered for easier staff access in the interim. Staff had built up a good rapport with residents and residents confirmed that they were supported with respect and this ensures that their dignity was maintained. Residents stated that the staff knock on their bedroom doors and wait for permission before entering. A lockable facility was provided in each residents’ bedroom for the safekeeping of valuable and personal items ensuring that their privacy was maintained. There was a pay phone located in the reception area of the Home and a number of residents had chosen to have a telephone line in their bedrooms so that residents could make and receive calls in private. Residents also had the option of using the Home’s portable phone in the event of an emergency or if they wished to use the telephone in private. Greville House DS0000016771.V318935.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 excellent. This judgement has been made using available evidence including a visit to this service. Activities provided meet the needs and expectations of all residents living at the Home. Residents have control over their daily lives and are provided with a choice of healthy meals that meet any special dietary requirements. EVIDENCE: There was a variety of activities on offer for residents to participate in should they choose including monthly entertainers, clothes sales, quizzes, crafts and coffee mornings. There was a library of books and audio books available for residents to enjoy. On the morning of the field work visit the residents were enjoying exercises, a sing a long and bingo. One resident said “ The other ladies are friendly and approachable”. There was a noticeable family atmosphere at the Home and residents confirmed that this was the case. Christmas presents were currently being bought for the residents. A number of residents had chosen to have a daily newspaper delivered and this ensures that their interest in current affairs was maintained. A number of residents had recently been to the garden centre to choose plants for the Greville House DS0000016771.V318935.R01.S.doc Version 5.2 Page 16 garden and this ensured that they felt valued and involved in the running of the Home. A hair dresser visits the Home twice a week. One resident said “There are activities every day, it is up to us if we take part, the staff quite understand if we don’t want to” A Methodist Minister visits the Home each week and Holy Communion is also available at the Home each week. Songs of Praise is shown on the television on Sundays. Opportunities for worship for residents of non Christian faiths can be arranged as required and some residents are supported by their friends and family to attend their places of worship outside of the Home. There was an open visiting policy at the Home and visitors confirmed that they were made to feel welcome and could have a meal at the Home if they chose and this promotes a family atmosphere. One visitor said “ I am so pleased with the care here”. There were no rigid rules or routines at Greville House and residents had the freedom to choose how they spent their day. Some residents chose to go outside of the Home with their friends and family for short trips out and longer holidays. One resident chose to attend a day centre and this ensured that her individuality and link with the local community was maintained. A number of residents stated that they chose to go to their bedrooms after tea to relax and watch television, it was their choice. The menus identified a variety of nutritious meals and residents confirmed that they are offered a choice of these each day. On the day of the field work visit residents were served a variety of exotic and fresh fruits with their breakfast and residents confirmed that they were served these each day. A hot meal is available at tea time and hot beverages, light snacks and biscuits are available at supper time and overnight. Special diets can be arranged for reasons of health, taste and cultural/religious preferences however these were not required at the current time. Residents’ birthdays are celebrated with decorations, wine and their own choice of meal and this ensures that residents feel valued as individuals and as part of the family atmosphere within the Home. The main meals of the day were home made chicken pie, coq au vin or sausages/ pasties. These were well presented and were served with fresh vegetables, cold drinks and after dinner mints. Dining tables were laid attractively with good quality table linen, crockery, salt and pepper and fresh flowers. Residents served their own gravy and sauces. One resident said “ The food is very good, the chicken pie was nice for lunch” Another resident said “ The food is varied, it should suit everyone. It is cooked very well and presented well” Greville House DS0000016771.V318935.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. Complaints are investigated in a timely manner and vulnerable residents are protected by the Home’s staff. EVIDENCE: Since the last field work visit, CSCI had received one complaint about the service provided at Greville House and this was found to be not upheld. The Registered Manager stated that no other complaints, concerns or allegations had been made since the last field work visit. A comprehensive complaints procedure was on display in a prominent position in the Home however this must be updated to identify the correct title of CSCI. A “grumbles book” had been introduced in order for residents, their visitors or staff to raise any concerns that they may have and no entries had been made in to this. One resident said “ I would go to the manager if I wasn’t happy but I have been here four years and I have never had to complain” The adult protection policy had been amended to include local multi agency guidelines and staff met during the field work visit had a good knowledge of this. Greville House DS0000016771.V318935.R01.S.doc Version 5.2 Page 18 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, 20, 21, 22, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a well maintained, clean and comfortable environment in which they feel safe and secure. The environment is designed to uphold the privacy and dignity of residents. Residents have a limited choice of bathing facilities. EVIDENCE: The external landscaped gardens were well maintained and an attractive area for residents to enjoy. Flowering tubs and hanging baskets were on display in the court yard area and the main garden was level, however residents had to negotiate a small step into this area. Following the visit remedial action had been taken to address this. The Home was warm and welcoming and was clean and fresh throughout. Decoration, floor coverings and furnishings were of a good quality and there was a rolling programme of redecoration and refurbishment in place. The main kitchen was clean, well located and well equipped for it’s purpose. Greville House DS0000016771.V318935.R01.S.doc Version 5.2 Page 19 There were two lounges and these were comfortable and decorated in a homely style in keeping with the age of the building. In addition to these there were smaller seating areas located in quiet areas of the Home and this provided residents with alternative choices of seating areas. The dining room was decorated to a high standard and was well lit and spacious so that residents could enjoy their meals in comfort. There were three assisted bathing facilities, however one of these was allocated to a resident for her own private use. There was no facility provided for residents to shower. Two bedrooms had an en suite shower facility but these were not in working order. New tiling and flooring had been fitted within the communal toilet areas located on the ground floor and one of the bathrooms had been redecorated so that residents could use these facilities in comfort. Wheelchair users could not be accommodated at Greville House and the Home does not provide a passenger lift. A stair lift was available for residents to access the first floor of the Home and the Registered Manager stated that some of the residents were able to walk up and down the stairs. Hand rails were provided in corridors and near to toilets and raised toilet seats were provided. There were two mechanical hoists to be used in the event that a resident fell and staff confirmed that these were appropriate to meet the needs of the residents currently living at the Home. All bedrooms were for single occupancy, some with an en suite toilet facility and others with a private allocated toilet located near to the bedroom. A number of bedrooms had lovely views of the garden areas and all were personalised to reflect the tastes and interests of individual residents to ensure that they felt comfortable and safe in their surroundings. A call bell facility was available in each residents’ bedroom for their use if they required assistance from staff. One resident met during the field work visit expressed her dissatisfaction about the noise from the water tank that could be heard at regular intervals during both the day and night time hours. This was brought to the attention of the Registered Manager and remedial action was taken in order to address this. A new appropriate washing machine was available with a sluice cycle for the hygienic washing of residents’ clothing and bed linen, however the staff were manually soaking residents’ underwear in a bucket and this is considered to be unhygienic. Appropriate red alginate bags were available for staff’s use to prevent the risk of cross infection. One resident said “ Everywhere is kept so clean here” Another resident said “ I tidy my room and the housekeepers clean it everyday” Greville House DS0000016771.V318935.R01.S.doc Version 5.2 Page 20 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. Residents are supported by an adequate number of appropriately trained staff. Lapses in staff recruitment procedures does not safeguard residents. EVIDENCE: There was a stable and loyal staff team at Greville House and all staff met during the field work visit were welcoming and approachable. Residents confirmed that this was always the case. One staff member said “ It is more like your own home here, the staff and the residents get on so well” Another resident said “ The staff are very efficient” There were no staff vacancies and staff turnover was low. Agency staff are not used and this ensures continuity of care. The staff team cover periods of staff sickness and holidays to ensure that the staffing levels do not fall below acceptable levels. The Registered Manager stated that there was one senior staff and three care assistants on duty during mornings, one senior staff and two care assistants during afternoons, one senior staff and three care assistants during evenings and two care assistants on duty overnight. Staff met during the field work visit confirmed that these staffing levels were adequate to meet the needs of the residents living at the Home. Kitchen and cleaning staff provided ancillary support to the care staff on duty and this ensured that residents received support in all areas of their daily lives. Greville House DS0000016771.V318935.R01.S.doc Version 5.2 Page 21 The management team provide on call cover to the person in charge of the shift and this ensures that they feel supported at all times. The staffing rotas did not state the identity of the management staff on duty and did not identify the on call arrangements and this must be amended to reflect all staff provided. Previous staffing rotas were not available at the Home on the day of the field work visit and the Registered Manager stated that they were held at the administration office off site. Staff recruitment files sampled did not contain all information required by regulations. The start dates of one member of staff who had recently commenced employment at the Home was not available at the Home therefore it was not possible to determine whether the police check and references had been obtained for this person prior to commencing employment at the Home. It was requested that this information be forwarded to CSCI as soon as possible. Both references pertaining to a new member of staff were not considered to be satisfactory as one was from a family member and the other was written by a member of staff currently working at Greville House. Interview notes were kept in keeping with good practice New staff were given contracts of terms and conditions of employment and these were signed by the staff member to confirm that they were aware of the content of these. New staff undertake comprehensive “Skills For Care” induction training and this ensures that they have the appropriate knowledge to support residents in a competent manner. Staff had received training relevant for their job roles including infection control, safe handling of medication, sight loss awareness and dementia care so that residents were cared for by competent staff. The Home had recently been granted a Small Business Award for NVQ training and 65 of the staff team had completed a minimum of NVQ level 2 in care to ensure that they had the knowledge to work in a competent manner and provide a good standard of care for residents. Greville House DS0000016771.V318935.R01.S.doc Version 5.2 Page 22 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is a well managed Home and run in the best interests of the residents living there. Residents and the staff team are involved in the running of the Home and this ensures that they have the opportunity to put forward any suggestions for improvements. Residents’ health and safety is maintained. EVIDENCE: The Registered Manager had been in post for six years and had a good knowledge of working within a managerial role in a care setting. Residents and the staff team met during the field work visit made positive comments about her managerial style and an “open door” system was in place. The management office was well located opposite the communal living areas and this provided residents and their visitors with good access to this. The Registered Manager had completed the Registered Manager’s Award, was a moving and handling assessor and had undertaken recent refresher training in Greville House DS0000016771.V318935.R01.S.doc Version 5.2 Page 23 this area. She had also recently undertaken training about nutritional screening and this ensured that she had the appropriate up to date knowledge to cascade to the rest of the staff team. Each member of the management team had delegated responsibilities and it was apparent that they were enthusiastic and striving to improve the quality of the lives of the residents living at the Home. One staff member said “ The management team are very well organised, anything that the residents ask for is purchased for them. Any suggestions put forward by residents or staff are followed up” Another staff member said “ The managers are always there to support us, they are definitely approachable, at whatever time of the day” A residents’ meeting had been held recently and this provided residents with the opportunity to put forward their views about the service provided at the Home. The main topics for discussion were suggestions for forthcoming activities and menu options, the premises and staffing issues. New residents were welcomed. There was evidence that any recommendations made by residents were acted upon. The agendas of forthcoming residents’ meetings and the minutes of meetings were distributed to residents in a large print format for ease of reading. The minutes of the most recent residents’ meeting was also on display on the residents’ notice board. One resident said “ The meetings are very interesting, we find out what is going on” The senior staff informally met with residents on a daily basis and this contributed to the family atmosphere at the Home. Residents met during the field work visit confirmed that they had the opportunity to speak with the management team every day. Staff meetings were held regularly and this ensured that staff were informed about any new procedures or services provided for residents living at the Home. The minutes of these confirmed that staff were consulted about any changes that were introduced at the Home. Staff had the opportunity to discuss their personal development and training needs through formal staff supervision and the system of this was up to date. Regular auditing of the systems in place at the Home were undertaken in order to monitor the Home for quality. Service satisfaction questionnaires were distributed to residents, visitors and Health Care Professionals and a report based on the findings of these was produced. A robust system was in place for the safekeeping of small amounts of residents’ money and residents had access to this at all times via the person in charge of the shift. A separate transaction record was maintained for each person and these identified all monies in and out of the person’s allowance, however signatures in respect of this were not always obtained. Receipts and invoices of most items purchased out of residents’ money were kept with the Greville House DS0000016771.V318935.R01.S.doc Version 5.2 Page 24 exception of the “Monday Shop” as items were bought in bulk and sold to residents at the discounted rate. A system for evidencing the cost of these items must be introduced in order to safeguard both residents and staff. On the day of the field work visit the balances of money held for two residents were found to be correct. This system had not been audited for over two months and more frequent auditing of this must be undertaken in order to identify errors, if any, so that corrective action could be taken. Staff had received recent training about health and safety issues including moving and handling, food hygiene, health and safety, first aid and fire safety. A fire drill had been held recently so that staff had the appropriate knowledge about the action to be taken in the event of an emergency. Regular maintenance checks of equipment were undertaken to ensure that they were safe to use. An environmental health inspection had been undertaken recently and the outcome of this was positive. Accident records were generally well maintained, medical advice was promptly sought as required and CSCI were informed of any accident or incidents that may affect the health or welfare of residents. Accident records included detail of any injuries sustained however did not always detail any follow up action taken and the incidences of accidents were not being audited to identify any trends, thus minimise the risk of further occurrences of the same. Greville House DS0000016771.V318935.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 3 3 X 3 3 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 2 3 X 2 Greville House DS0000016771.V318935.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 Requirement The statement of purpose must be amended to include: Details of the current staff list • Detail that there is a no smoking policy at the Home Formal pre admission assessments and reassessments of resident’s individual care needs must be undertaken prior to admission and a written record of this must be available. The care planning system must be further developed to include: • • detail of the specific support required by staff moving and handling risk assessments must be reviewed regularly and include detail of the specific support required by staff should a resident fall care plans must be agreed and reviewed regularly Version 5.2 Page 27 Timescale for action 31/01/07 • 2 OP3 14 07/12/06 3 OP7 13(5) 15 31/12/06 • Greville House DS0000016771.V318935.R01.S.doc 4 OP8 12 14(2) 5 OP9 13(2) with the involvement of residents A system for the formal care reviews of privately funded residents must be introduced and written documentation in respect of this must be maintained. The management of medication must be improved to include: • A medication trolley that is fit for purpose must be available (an action plan must be submitted to CSCI regarding this by) Hand written entries on to medication administration charts (MAR) must be countersigned All medication received into the Home must be signed for on receipt 01/03/07 15/12/06 • • 6 OP16 22 Any reasons for medication omitted must be recorded on the MAR charts The complaints procedure must be updated to identify the amended title of CSCI. • 15/12/06 7 8 9 OP26 OP27 OP29 13(3) 17(2) 13(6) 19 Staff must not manually soak 07/12/06 soiled items of residents’ personal clothing Staffing rotas must identify the 07/12/06 names of all persons on duty and providing on call support New staff must not commence 07/12/06 employment at the Home without two satisfactory appropriate references. The start dates of staff employed at the Home must be available A system for evidencing the cost of bulk buy items purchased out DS0000016771.V318935.R01.S.doc 10 OP35 16(2)(l) 01/02/07 Page 28 Greville House Version 5.2 of residents’ money must be introduced and receipts must be kept. The system for the management of monies held by the Home on the residents’ behalf must be audited regularly Signatures confirming all monies in and out of residents’ personal allowance accounts must be obtained 11 OP38 12(1)(a) 13(4) Accident records must detail any follow up action taken and these must be audited regularly 31/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP21 Good Practice Recommendations It is recommended that consideration be given to installing a communal shower facility for residents’ use Greville House DS0000016771.V318935.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 House DS0000016771.V318935.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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