Inspection on 21/06/06 for Greville House Care Home

This inspection was carried out on 21st June 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 Care Home 28/04/09

Greville House Care Home 24/06/08

Greville House Care Home 21/06/07

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

CARE HOMES FOR OLDER PEOPLE Greville House Care Home Greville Road Richmond Surrey TW10 6HR Lead Inspector Sandy Patrick Unannounced Inspection 10:00 21st June 2006 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 Care Home DS0000065297.V299954.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 Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greville House Care Home Address Greville Road Richmond Surrey TW10 6HR 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) 020 8334 2890 TBA Care UK Community Partnerships Ltd Mrs Rea Bank Williams Care Home 59 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (59) of places Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Nursing Unit The second floor is solely used as a 22 bed nursing unit for older people. Intermediate Care A separate 12 bed unit on the first floor is used solely for Intermediate Care for Older People. Dementia Up to 25 of the residential care beds can be used for older people with mild dementia although this must not have a negative impact on the quality of life of other residents at the home. This is the first inspection of the service Date of last inspection Brief Description of the Service: Greville House was registered in October 2005 as a care home with nursing for up to fifty-nine residents. The home has separated units for up to twenty-two people with nursing needs and for up to twelve people needing intermediate care. There are also six bedrooms available for people to stay on a short term basis. The building is owned by the London Borough of Richmond and is leased to Care UK Partnership who manage and run the home. The home is located in Richmond, close to Richmond Park, local bus routes and a short drive away from Richmond town centre. The home is purpose built on three floors and all bedrooms have en suite facilities. Each floor has two lounges, a dining room, small kitchens, showers and bathrooms equipped with specialist baths. The intermediate care unit has its own facilities designed so that staff can support people living there to regain skills. The Registered Persons have produced a Service User Guide, which includes information on the aims and objectives of the service. The majority of residents are placed by the London Borough of Richmond. The weekly charges range from £515 - £850. Additional charges are made for hairdressing and any purchases from the home’s shop. Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the Inspector found during the inspection. The inspection took place over three days, 21st June, 22nd June and 20th July 2006, and was unannounced. The Inspection Team consisted of two Regulation Inspectors and a Pharmacy Inspector. The report of the Pharmacy Inspector is recorded within Section 2 of this report. The Inspectors met with a large number of residents, staff on duty and the Manager. The Manager was on annual leave at the time of the inspection but came to the home to meet the Inspectors. A senior member of staff was the delegated person in charge and assisted with the inspection during the visit. The Inspectors were made welcome by residents and staff and the Lead Inspector was invited to share a midday meal with residents on the second day the inspection. The Inspectors also spent time observing staff interaction with residents and the support being offered. The Inspectors looked at a range of records and evidence including care plans, staff records, medication records and storage, health and safety and quality monitoring documentation. The CSCI sent surveys to the home to distribute to residents, their relatives and staff. Surveys were also sent to a number of professionals who work with the home. The aim of this was to gain information on the experiences of those who use and work within the service and whether they feel the needs of residents are being met. The response to the surveys was good and the CSCI thanks all those who returned surveys. Eight residents completed surveys. In general residents were happy with the information they received when moving to the home and felt that staff were kind and supportive. Most residents like the food and some liked the activities, although some commented that they would like more variety of activities. The majority of residents who completed surveys were happy with the medical support they received. Five of the residents complained that there was insufficient hot water in their bedrooms or the WCs. Comments from residents included, ‘there is not always enough staff available’, ‘there are several very helpful and efficient staff but the majority are not’, ‘the staff do the best they can, some need more training’, ‘the home is better than I was led to believe’, ‘the staff are willing to serve us’, ‘meals are very good and varied’, ‘toilets are not cleaned every day’, ‘carers do not always wash their hands’, ‘it’s a very nice place and I am well looked after’, ‘some staff are better than others’ and ‘I am very disappointed with the lack of hot water’. Concerns raised by residents were discussed with the person in charge and are highlighted throughout the report. Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 6 Nine visitors completed surveys the Inspector to speak to them. clearly and that residents were there could be improvements. under pressure and insufficient accidents. Some of the surveys about the home and one relative telephoned In general they felt that staff communicated happy at the home, although most felt that One visitor raised concerns that staff were staffing in communal areas led to falls and said that some staff were better than others. Some of the comments from visitors included, ‘Greville House is one of the nicest homes we have visited’, ‘I can’t find fault’, ‘staff are always approachable’, ‘The primitive call system is intrusive for residents’, ‘complaints were dealt with defensively’, ‘more top quality, well trained staff are required’, ‘regular meetings between the service and residents would improve the residents’ perception of having some sort of control over their lives’, ‘laundry is not properly ironed’, ‘supper should have more variety’, ‘the staff are efficient but lack personal care’, ‘the staff need to be more patient and understanding’, ‘the staff should have more respect for relatives’, ‘staff treat residents with warmth’ and ‘there is a good homely atmosphere’. These comments were discussed with the person in charge and some of the areas of concern are addressed in the main report. Eleven staff completed surveys. All the staff felt that they had undergone thorough recruitment and selection. Eight of the staff said that they felt supported and that they had received good training and inductions. Four of the staff were not happy with the support and training they had received. One person said that they undertook induction training two months after they started work at the home. One person said that they had never had an induction or support for their role. Five of the staff said that they believed there was insufficient staffing. Four of the staff said that they were not consulted about the service development. Comments from staff included; ‘The intermediate care manager encourages us to make suggestions about improving the service’, ‘I have never had supervision’, ‘my unit is always short staffed’, ‘the managers do not allow staff to have an influence over how the home is run’, ‘we are always understaffed’, ‘care staff are never asked their opinions’, ‘we sometimes have to work without the proper equipment’, ‘there is not enough hot water’, ‘there are not enough activities or outings’, and ‘there is a good atmosphere at the home’. These comments are very mixed. Some of the concerns are addressed in the main report. Seven visiting professionals completed surveys. The majority said that staff communicated well with them and followed their guidance. One person said that communication with some staff could be improved. The team who work closely with the intermediate care unit spoke positively about this and the hard work of the team. Other professionals generally thought the Manager was very good and worked well with them. One survey clearly stated that they felt some staff did not work as well as others and did not always follow advice. Three of the professionals praised the work at the home and said that they felt Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 7 residents were very well cared for and that the Manager was warm and efficient. Most of the professionals felt that residents were happy at the home. The Inspectors also spoke to residents, staff and visitors throughout the inspection. Residents were generally happy although many felt that there were areas where the home should improve. Their views and comments have helped to form part of the evidence for this report. What the service does well: What has improved since the last inspection? The home was registered in October 2005 and this is the first inspection. Many of the residents and staff were transferred from another Care UK home which was closing. The transition went well and residents who spoke to the Inspectors said that they were happy with the support they had received during this move. The intermediate care and respite unit are working well and have offered support to people who do not want permanent residential placements. New residents to the service have been supported in their move to the home. The home has developed good links with other professionals and the Manager attends allocation panels with the local authority. Residents and staff who spoke to the Inspectors were settled and felt happy at Greville House. Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 8 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 House Care Home DS0000065297.V299954.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 Care Home DS0000065297.V299954.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 & 6 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. Residents are given information to help them make the decision about whether they would like to live there. Residents are able to visit the home and have a trial stay there. There are procedures to make sure residents needs are assessed and that the home can meet these. Residents have a written contract with terms and conditions of the home. EVIDENCE: The Manager has developed a welcome pack for the home which incorporates the Statement of Purpose, Service User Guide and aims and objectives of the home. All residents are given a copy of this and copies are available in the home’s reception. A range of leaflets and information about local services and activities are available in the foyer and on notice boards around the home. Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 11 The home was newly registered in October 2005 and many of the residents transferred from another Care UK home which closed shortly after Greville House was opened. The Manager oversaw the transition and worked with local advocacy groups to make sure residents received the information they needed to make decisions about their move. Residents who spoke to the Inspectors said that they had been happy with the move and now felt very much at home at Greville House. There is an appropriate procedure for assessment. Senior staff meet with prospective residents and discuss their needs. Assessments also include information from families and other professionals where relevant. Potential residents are invited to spend time at the home before making a decision about moving there. All residents are admitted for a six week trial stay which helps them decide whether they want to live there, and the home to decide if they can meet their needs. Copies of assessments and reviews held after six weeks were seen by Inspectors. These included the residents’ views and feelings about the home. There are six bedrooms dedicated for residents wishing to stay at the home on a short term basis. A senior member of staff is allocated to manage this unit and to help residents settle in when they arrive at the home. There is a separate intermediate care unit for up to twelve people. The unit is managed by a senior member of staff and has a dedicated staff team. The staff work closely with the Primary Care Trust to support people who have been in hospital to regain skills and confidence so that they can return home. The unit has its own facilities and residents are involved in using kitchen equipment and practicing on the stairs. Residents of this unit have regular input from an Occupational Therapist and a Physiotherapist. When they are ready to leave they are reassessed and support is organised by the Primary Care Trust for them when they get back home. Other processionals have praised the work of the unit, which plays an important role in the local community by offering people the chance to return home rather than moving into residential care permanently. The home currently offers nursing care for up to twenty-two residents in a separate nursing unit. A dedicated Nursing Manager runs this unit. Residents who live at Greville House when become ill and need nursing care have to move from their room to the Nursing Unit when a place becomes available. Sometimes residents may have to wait in hospital until a place is available. The Inspectors and Manager talked about this issue at some length. The Manager said that this has caused distress to some of the residents as they had to move away from their friends, familiar staff and their bedroom. Care UK should consider how best they can adopt a more person centred approach to nursing care where residents could receive nursing care whilst remaining in their original bedrooms. Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 12 Contracts outlining the terms and conditions of residency are issued to all residents. Copies of these were seen to be held on file. Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 The overall quality in this outcome group is poor. This judgement has been made using evidence including a visit to the service. Individual care plans are in place and generally reflect an accurate record of needs. However, some information on health care and personal care are not appropriately recorded. Some unsafe practices put residents at risk. Staff do not always treat residents with dignity and respect. The overall quality of the medication standard is poor. Records showed good monitoring of resident’s medical condition. Poor record keeping and medication administration practices could put the residents at risk and need to be improved. EVIDENCE: Individual care plans are in place for all residents. Care UK have adopted a new computerised system of care planning and plan to introduce this to the home later in the year. The current care plans are recorded on paper. The Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 14 home must make sure paper care plans continue to be held once the system is computerised as residents, their relatives and temporary staff cannot access the computer. The Inspectors looked at a sample of care plans from each floor. In general care plans were detailed with clear information. Areas where there was an identified risk had been fully assessed. Residents’ consent had been given where adjustable bed rails were used. Information was easy to understand. Individual cultural needs were addressed. Care plans focused on choice and independence. There was a good record of health care needs and input from health care professionals. Some of the care plans on the Nursing Unit contained inappropriate terminology and statements. One care plan stated, ‘avoid sugar as he is diabetic and has been made to understand the implications’. It is not the responsibility of staff to ‘make’ residents understand anything. Daily recording notes on the Nursing Unit were often short and did not make sense. They were task orientated and did not comment on the well being of the resident. At one point a resident asked a member of staff if they could have a cigarette. The staff member agreed and took them outside to have one. There was no care plan or risk assessment in place regarding smoking for this resident and there should be. All residents are registered with local GPs. A dental, chiropody and optician service visit the home and residents can use these services if they wish. Managers and staff said that they had a good working relationship with other health care professionals and felt that they communicated well with them. There are good procedures for monitoring falls and looking at ways for fall prevention. However, one resident had recently fallen and broken their wrist. The moving and handling assessment had not been updated. The Manager said that all staff have received training in manual handling techniques, however two members of staff were seen supporting a resident by holding them under their armpits. This is not approved practice and puts the resident at risk. Wound care recording within care plans on the Nursing Unit was insufficient and did not state where wounds were, what treatment had been prescribed, when the treatment had been given and the effectiveness. None of the wound charts indicated that their dressings had been changed in May 2006. Each wound must be monitored on separate wound monitoring charts. Care plans indicated where same gender carers were preferred. The organisation should aim towards providing same gender carers wherever possible and not just when a person has specifically requested this. Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 15 The inspectors witnessed a number of incidents where staff behaved inappropriately and did not show respect to residents. In one case a member of staff walked into a resident’s room to start putting laundry away. The staff member did not knock. The resident could not see them and asked who was there and what they were doing. The staff member responded by saying, ‘just drink your tea’. The resident continued to ask the staff member what they were doing but the staff member did not tell them and continued to tell them to drink the tea whilst they walked out of the room and into the corridor. In another incident the Activities Officer tried to involve a staff member in the quiz he was running by asking them one of the questions when they entered the room. Their response was dismissive and belittled the question being asked. The same member of staff was later rude to a visitor who had come to collect their relative after a period of short stay. The visitor wanted to know how her relative was and what the procedures for picking them up were. The staff member told them to wait in the resident’s bedroom. They then forgot to go and see them or alert another member of staff and the visitor had to try and find another member of staff themselves sometime later. In another incident residents in one lounge told the Inspector that they wanted a drink. The Inspector went to find a member of staff. The staff member responded by saying that the residents had just had a drink. Another resident was calling for assistance from their bedroom. When the Inspector alerted a member of staff they responded rudely saying, ‘what does she want now’. Some staff on the Nursing Unit spoke to residents in a patronising way and some staff spoke to each other about residents in front of them and other residents. At one point a resident on the Nursing Unit complained of chest pains. One member of staff walked out of the room laughing and another member of staff offered the resident some ice cream. The Inspector spoke to the nurse in charge about this and they responded that the resident was very confused but that they had never complained of chest pain before. Staff must not ignore residents who say that they are in pain even if they are confused. These kind of incidents are unacceptable and whilst they relate to a minority of staff, residents should not have to put up with this treatment at all. Senior staff were not present in the areas where these incidents occurred and were not really seen throughout the home at all during the inspection. Without proper guidance and supervision unacceptable staff behaviour is going unchecked. The Inspector told the person in charge about all these incidents and they responded appropriately by speaking to staff. However, the staff should be aware that they must not behave in this way and that they should respect residents and respond to their requests appropriately. Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 16 Some residents said that they had a good relationship with staff and the Inspectors saw examples of positive and kind interactions. Residents mentioned some staff by name and said that they felt supported by them. The Inspectors witnessed some staff sitting with residents, being patient and helpful. There were other times when residents made requests which the Inspector relayed to staff and they attended to these immediately. However the staff at the home are very task orientated. Only once during the inspection did Inspectors see a staff member sitting and just chatting with residents. The Inspectors spent long periods of time in the different lounges with residents and the staff hardly came into these rooms. When they did it was to bring drinks or attend to some other task. Even at these times the staff did not really talk to the residents. One member of staff spent about ten minutes cleaning tables in a lounge where five residents were sitting, at no point did she speak to any of the residents. This issue is discussed further in the Activity Section of this report. The Manager must look at ways she can support staff to be less task orientated and spend time initiating conversations and chatting with residents. One relative who contacted the CSCI said that call bells on the Nursing Unit were often left unanswered for long periods of time. They said that on one occasion their relative pressed the call bell which still had not been answered fifteen minutes later. The relative said that they had gone to find staff who were making themselves a cup of tea. The Inspector on the Nursing Unit observed call bells being left unanswered for over two minutes. One resident on the Nursing Unit told the Inspector that they were not offered regular baths. Their bathing record indicated that they had not had a bath since February 2006. Other bath records for residents on this unit were periodic. All records relating to receipt, storage, administration and disposal of current medication were examined on two floors. Three staff member were interviewed. A sample of the current medication in stock was compared to the records, counted and compared to the amount that should be in stock. All medication was stored securely and in the correct conditions. The communication books showed staff awareness of medication and monitoring of residents. In eight instances the amount of medication in stock did not agree with the amount that should be in stock from the records of receipt and administration. This indicated that medication had either not been given correctly or had been recorded incorrectly. Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 17 One resident had not been given their lunchtime medication by half past two in the afternoon on the day of the visit. The medication was due to be given half an hour before food. The receipt of medication had not been recorded accurately in three cases. The amount of medication given was not recorded in three instances. Four residents had missing entries on the current administration records. Two residents records did not match what was currently being given. Dosage directions were not available on the administration record in two instances. It was not possible to see if medication had been given correctly in these cases. No records were available for medication returned to the pharmacy or being returned to residents after respite on the residential unit. Two unlabelled items were found in the fridge that staff said belonged to a resident on respite care who had gone home. One other item was found that was for a resident no longer in the home. One staff member said that they sign their medication records before the medication is given to the resident and this is how they were trained. This was not what the procedure described. The local medication procedures were not available on the first floor and the staff member could not produce a copy. A copy was seen on the second floor. Only one member of staff was trained to give medication on the residential unit. The residential unit covers two floors. At 10.30 the morning medication was still being given. It was recorded as being given at 08.00 hours. One staff member was seen only giving about 50mls of water in a plastic measuring cup to help swallow the medication. Training records seen did not describe any of the training that staff had received. Medication audit records and profiles are supposed to be in place for each resident. The audit records did not contain information to be able to audit the medication. The profiles in six out of seven looked at did not match the current medication administration records. This would mean accurate information might not be available to health professionals. The controlled drug cupboard on the nursing unit is not attached to the wall in accordance with the Misuse of Drugs, Safe Custody Regulations 1973. The Manager said that she has started to develop an end of life pack which would give information on the care of people who are dying. The pack would also include information to help the bereaved make a decision about funeral arrangements. The Manager should consider organising training for staff in this area so that they can feel confident in their work and support of relatives at these times. Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The overall quality in this outcome group is adequate. This judgement has been made using evidence including a visit to the service. There is a planned programme of activities but this does not meet everybody’s needs or interests. Residents are able to see visitors when they want. There is a varied menu offering choice but not all residents were getting the support they needed at mealtimes. EVIDENCE: The home employs one full time Activities Officer. The Manager wants to recruit a second Activities Officer to work during the evenings. This post had been advertised at the time of the inspection. The planned programme of activities meets the needs of some residents. Regular activities include bingo, quizzes, music, games and a weekly trolley shop. The Inspector spent time with some residents whilst they participated in a quiz. The Activities Officer was kind and involved all residents who were present in the activity. Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 19 Some residents have helped with gardening and others said that they were able to help with setting the tables and tidying their own rooms. Sometimes visiting entertainers and special events are organised and there were photos on display from some of these. However many of the residents who spoke to the Inspectors said that they did not like to participate in the activities which took place. Some mentioned alternative activities such as cooking, more trips out and flower arranging which they would like to do. One resident said that they enjoyed finding out about different cultures and the Inspector suggested that this was a topic which could be included within the activity programme. Some residents said that the needs of everyone varied so much that they could not participate in activities which other residents were involved in. For long periods of time over the inspection residents were sitting in lounges without staff support. The staff who came into the rooms did not generally chat to residents. In one lounge where five residents were the TV was turned on but there was no sound. Staff who came into the room did not ask residents if they wanted the sound up or the TV off. Some residents said that there was nothing to do at the home. There were limited resources such as games, craft equipment, books and magazines for residents to use and although some equipment is held centrally residents need to request this. The lounges should be equipped with things that residents would find interesting and stimulating. There is a regular church service at the home and the Catholic Priest visits to offer communion to those who want this. The staff are starting to build links with local places of worship to see what other services they can offer the home. The Manager said that one resident goes to a local church independently. The Inspectors met with one resident who had a different religion and cultural needs. They told the Inspectors that they were happy that they had a specialist diet and that their cultural needs were being met. They said that they had satellite television from their country of origin in their bedroom. The Inspectors spoke to one resident who was blind and looked at their care plan. The resident had been consulted about their care and there were systems put in place to support them taking into account their disability. The Manager said that a small number of residents travel independently and that risk assessments are in place regarding this. The Inspector spoke to one resident who said that they liked taking bus rides to local shops and Richmond Park. A hairdresser visits the home twice a week. hairdresser is good and offers value for money. Residents said that the Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 20 There is an open visitors policy and visitors were seen at the home throughout the inspection. Most visitors completing surveys and those who spoke to the Inspectors said that they were made welcome. A small number said that they found some staff rude and others said that staff did not always understand the feelings of relatives. The home aims to welcome visitors and allow them to continue to be involved in the care of relatives if they wish. The Manager should look at whether some staff need training and support so that they can show more empathy towards relatives. Some residents and their relatives said that they wanted there to be more frequent meetings and better consultation. There is an appropriate menu and all food is prepared by qualified staff. The kitchens are well stocked and food is freshly prepared. The Inspectors saw breakfast being served in one unit. Residents were offered choices and were able to dine at a time which suited them. One Inspector joined the residents on one floor for their midday meal. The meal was tasty and well prepared and there was a nice atmosphere and some of the residents were enjoying the social aspect of dining. There is a wellprepared menu which offers a choice of meals and residents said that they could request a salad or omelette if they did not want anything from the menu. The staff offered choices of drinks and most staff were attentive and asked if residents enjoyed their meals. Residents were able to help themselves to salt and pepper. The Cook visited the dining room during the meal to make sure everyone was enjoying it. Most of the residents could not remember what meal they had chosen and did not know what they would be eating until it was served to them. There were a number of incidents where the staff behaved inappropriately or did not respect residents’ choice. One resident needed support to eat their meal. The staff member assigned to support them began helping them whilst standing up and sat down next to them a few minutes later. The staff member did not talk to the resident and at points during the meal she got up and walked away to attend to other tasks. At times she looked bored and rapped her fingers on the table. The resident was on a soft diet which was divided into different types of food, but the staff member mixed it all together before starting to serve. The staff member offered large forkfuls to the resident and held them to their mouth before they had finished the previous mouthful. Staff supporting residents at mealtimes should make it a pleasant experience, talking to them, offering them choices, respecting their dignity and feelings and making sure they offer food appropriately. They should also understand that large mouthfuls and eating too rapidly could be dangerous for the resident. The Manager must make sure Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 21 staff fully understand this and any inappropriate support must be addressed. Some staff need training in this area. Another resident said to the staff that they did not want their meal. They were given a large plateful of food, which was left in front of them for fifteen minutes before the staff came to ask if they were alright and offer them an alternative. If residents say they do not want food the staff should spend time finding out why. Where staff want to encourage residents with poor appetites to eat they should offer smaller platefuls and should offer encouragement and support. All the food was plated up by staff without choice of portion sizes or vegetables. Pudding was dished up with custard and left on the worktop until diners were ready to eat. Residents should be given a choice about how much and what they want to eat. They should be able to help themselves to condiments and sauces or these should be served up in front of them so that they can say how much they want. Food should be stored within heated trolleys until residents are ready for it. All this things are important to meet individual care needs and make dining more pleasant for residents. They are also changes that staff could easily make. One of the Inspectors observed lunch in the Nursing Unit and was very concerned about practices there. At one point seven residents were left in the dining room with no staff for a period of more than five minutes. Four residents were left in wheelchairs at the dining table and were not offered the choice of a dining chair. One resident requested a drink of lemonade and staff gave them a drink of orange cordial over ten minutes later. Staff did not check what choices people wanted for their meals and no choice was given for pudding. A carer removed a resident’s plate without asking if they had finished. After lunch residents were returned to the lounge. The staff on duty said that they would bring them tea and coffee but they did not and no cold drinks were offered either. On the first day of the inspection staff were not proactive in offering drinks and residents inn lounges and participating in the quiz were without drinks. On the second day of the inspection staff were more attentive in this area but residents told the Inspector they could not request drinks and they were never allowed a second cup of tea. Staff bringing tea to residents had already added the milk and residents were unable to choose the strength of their tea. The Manager said that residents could request drinks and snacks after supper during the evening but these were not offered. Many of the residents who spoke to the Inspectors did not know that they were able to request additional snacks in the evening. Some residents said that they got hungry because supper was early and they did not have any food until breakfast. The Registered Person must make sure residents are aware that they can request food at any time. Sandwiches and snacks should be offered to residents who Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 22 are awake in the evening rather than expecting residents to ask as they may not feel confident in doing this. Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 23 Complaints and Protection The intended outcomes for Standards 16 – 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 & 18 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. Residents are protected by sound complaints and protection of vulnerable adults procedures. EVIDENCE: There is an appropriate complaints procedure which details timescales and how complainants can contact the Commission for Social Care Inspection. There had been four recorded complaints since the home opened. Records showed that these had been fully investigated and the complainant been informed of the outcome and any action plan. The person in charge said that all residents were registered to vote. An advocacy worker and consultant to Care UK has helped facilitate resident and relative meetings. She also aims to visit the home regularly and offer individual support to residents who wish for this. Earlier in the year a resident made an allegation which the Manager reported to the London Borough of Richmond and the Commission for Social Care Inspection. Adult protection procedures were appropriately followed, the allegation was investigated and measure put in place to safeguard residents. The home has adopted the London Borough of Richmond Protection of Vulnerable Adults procedure. Care UK has its own procedures on abuse and whistle blowing. All staff are required to attend training in this area. Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 24 Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 25 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. The environment is generally safe and comfortable. Although delays in meeting some maintenance needs has put residents at risk. Some of the residents do not have a supply of hot water to their rooms. Residents have unrestricted access to communal areas and are generally happy with the environment. EVIDENCE: The building was purpose built in 2005 and is three storeys. One storey is dedicated to a Nursing Unit. The other floors include the short stay and intermediate care units. All bedrooms are for single occupancy and have en suite facilities. There are two lounges, a dining room, kitchen and specially equipped bathrooms on each floor. Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 26 Residents are able to personalise their bedrooms and the Inspectors saw that they were well equipped. The home is nicely decorated and homely touches and features add to the ambience of communal areas. There is an attractive and well kept garden which is accessible from different points on the ground floor. Some of the residents have been involved in the upkeep of the garden. Over the past eight months the company have made regular checks on the building and attended to ‘snagging’ problems. Further work to decorate areas damaged by ‘snagging’ will take place in August. The sluice on the Nursing Unit was broken for a period of three months and the Manager said that it was frustrating because Care UK did not act quickly in fixing this problem. Staff on this unit had to take soiled linen to other units to be cleaned and this causes a serious risk of cross infection. The Manager said that work to repair the sluice only took place after a series of requests and her directly contacting the relevant director. One resident told the Inspector that a burst pipe in their room had not been fixed for three days and that their carpet and personal items had been water damaged. The fire system was broken at the time of the inspection (See Management Section) and had been broken for a week. This was only repaired in response to an immediate requirement made by the Inspector. Delays in repairing areas relating to health and safety and essential equipment are unacceptable and repairs must be carried out in a timely fashion so that broken equipment does not put residents and staff at risk. Many of the residents told the Inspectors and wrote in surveys about the home that there was problems with the hot water supply to their rooms. The Dedicated Manager in charge told the Inspectors that the boiler had been broken but that it had been repaired. However, residents in one area of the house said that the problem persisted and they could not get hot water to their bedrooms. The Registered Person must address this and make sure the system is able to deliver hot water to all residents’ bedrooms. Some of the residents raised concerns that cleaning was not always sufficient. The home was clean and tidy throughout the inspection. There are appropriate procedures for laundering clothes and storage of cleaning products. Greville House Care Home DS0000065297.V299954.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. Recruitment procedures do not always safeguard residents and should be more vigorous. Staff training records do not evidence a thorough package of training although the procedures for training staff are generally good. EVIDENCE: The Manager informed the Inspectors that the organisation wants to change the staffing and reduce the number of qualified staff in the Nursing Unit. Any reduction in the establishment figures must be agreed by the Commission for Social Care Inspection. The observations made during the inspection were that the Nursing Unit did not meet required National Minimum Standards and Registered Person must focus on bringing the unit up to standard rather than reducing staffing. There have been problems with communication and team work on the Nursing Unit. These have led to disagreements and standards not being met. The Manager and Nursing Manager are aware of this and have been working with the team to try and resolve these issues. Further work in this area is planned. The staff on this unit should take responsibility for their actions and aim to provide the best care to residents as a team and when working individually. Problems with staff dynamics have a detrimental effect on the care of residents and these issues must be resolved. Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 28 Some of the residents, relatives and staff commented that staffing levels were too low. The organisation must keep staffing levels under review. The Inspectors felt that the allocation of staff needed to be looked at. For long periods of the day staff were not available where residents were and were attending to other tasks. The Inspectors did not see senior staff working on the units and there was no obvious direction or supervision of staff. The home plans to introduce a computerised system of care planning which they have adopted in other Care UK homes. Staff were attending training sessions in basic computer skills during the inspection as the first stage in making sure they have the skills and confidence to use the computerised care plans. The home has a thorough recruitment and selection procedure which includes making pre employment checks on staff. The Inspector examined five staff files and four of these contained the required information. However, one staff file did not contain a criminal record check and both references were from individuals who the applicant had worked for in their own homes. The member of staff had worked at the home since January 2006. Failure to undertake thorough checks on staff puts residents at risk. Criminal record checks must be in place for all staff and in this case the delay in receipt of this check for over five months should have been chased up. The organisation employs a training manager who oversees the staff training for the home. There is a comprehensive induction training schedule and staff are supported to undertake NVQs. There was a package of training for all staff who were employed before the home opened which covered some basic training and information about the building and equipment. The Inspectors examined a sample of staff training files. Some of these were not completed and indicated that staff had had little or no training. The Manager must make sure all staff have had mandatory training and that training records are accurate. Some of the staff files did not include training in dementia or protection of vulnerable adults. From observations made during the inspection, this is an important training need for some staff. There was evidence of staff meetings for all staff and within teams. Two members of staff who completed surveys said that they had never had supervision and three members of staff said that their induction was insufficient or they did not have this when they first started. The Manager must make sure all staff receive a prompt induction and are supported through regular supervision and team meetings. Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 36 & 38 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. The home is appropriately managed and there are good systems for quality monitoring and health and safety. However, two serious health and safety failures were identified by the Inspector and residents were put at risk. EVIDENCE: The Manager is experienced and appropriately qualified. Previous to this role she managed another Care UK home which closed shortly after Greville House was registered. The majority of residents and staff transferred to Greville House with the Manager. This period of change and resettlement has been managed effectively and residents and staff have been supported and consulted appropriately. Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 30 The Manager has consistently demonstrated a commitment to the service. She has a good knowledge of individual residents and was able to talk about particular residents and their needs. The Manager said that she attends the local authority allocation panel which helps her to understand how this process works and is also a good way of building a positive working relationship with the authority. The Manager has clear plans for further development of the service. She said that these include updating all care plans to the new computerised system, focusing on supporting staff to achieve NVQs, developing quality monitoring, meeting with relatives and improving work in the Nursing Unit. Four of the staff completing surveys about the home said that the managers did not allow staff to contribute their ideas and opinions. Some felt strongly that they were not listened to. The Manager should make sure residents and staff are consulted about the development of the service and are able to contribute their ideas and opinions. The organisation has good systems for quality monitoring. Monthly visits are made by senior managers and reports of these visits are forwarded to the Commission for Social Care Inspection. There is an annual quality audit which looks at different outcomes for residents and the general management of the home. Recommendations for the audit are recorded within an action plan agreed by the Manager. The organisation has also introduced a new quality monitoring tool which is designed so that the Manager and staff can self audit practice. The Manager said that she would be discussing this with the staff team and they would begin the exercise by looking at record keeping within the home. Residents are expected to make their own arrangements for the management of their financial affairs. However, the home offers a service of holding small amounts of cash on behalf of individual residents. This money is used for the purchase of small items, personal shopping, the hairdresser and any additional expenditure. Residents and their representatives are able to access the records of these finances. The system used for managing these monies is appropriate. Records are highly organised and show a clear audit trail. Receipts for expenditure are kept. There are good systems for recording health and safety checks. On the first two days of the inspection fire doors throughout the home were wedged open because the system which holds them safely open had broken. These doors were prevented from closing automatically in event of the fire alarm being activated. The person in charge said that the system had been Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 31 broken for about a week. This is unacceptable and residents and staff were put at risk. An immediate requirement was made and the organisation notified the CSCI that the system was repaired within twenty-four hours. The fire alarm system and automatic door closures are in place to safeguard residents and staff. Failures in these systems must be repaired immediately. On the first day of the inspection a maintenance worker was working on cables in the ceiling in preparation for the new computer system which was being installed. His equipment including a large box, wires and ladder were left in the corridor. The box was a serious trip hazard. The maintenance man only moved his equipment when the Inspector alerted senior staff that this was a hazard. Staff need to be vigilant of potential risks and should have acted on this themselves. Any maintenance workers who are in the home should be briefed on potential risks and should be asked to take responsibility to keep their residents safe from their equipment and tools. Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 32 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 3 3 4 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 X 3 X 2 Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? N/A 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 12 15 Requirement Timescale for action The Registered Person must 31/08/06 make sure care plans are clear, make sense and do not use inappropriate terminology. The Registered Person must 31/07/06 make sure care plans indicate if a resident smokes. A plan of care and risk assessment must be in place for this. The Registered Person must 31/07/06 make sure risk assessments are updated following a fall or accident. The Registered Person must 31/07/06 make sure all wounds are monitored on separate wound monitoring charts. The Registered Person must 31/07/06 make sure staff follow safe and approved manual handling DS0000065297.V299954.R01.S.doc Version 5.2 Page 34 2. OP7 12 13(4) 15 3. OP8 12 13(4) 15 4. OP8 12 13 5. OP8 12 13 Greville House Care Home procedures at all times. 6. OP8 12 13 The Registered Person must 31/07/06 make sure staff respond immediately if residents inform them that they are in pain. Call bells promptly. 7. OP9 13(2) must be answered The Registered make sure: Person must 01/09/06 1. All medication is given as directed by the prescriber unless otherwise recorded by 21/07/06. 2. The administration /nonadministration of medication is recorded accurately by 21/07/06. 3. All medication coming into and leaving the home is recorded appropriately by 21/08/06. 4. All medication no longer needed is disposed of appropriately by 21/08/06. 5. All records relating to mediation are accurate and up to date by 21/08/06. 6. Sufficient quantities of appropriately trained staff are on duty at all times to safely administer medication by 01/09/06. 7. The controlled drug cupboard is attached to the wall in accordance with the appropriate regulations by Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 35 01/09/06. 8. OP10 12 The Registered Person must 31/07/06 make sure the staff respect residents and respond appropriately when addressed by a resident. The staff must not patronise or belittle residents. The Registered Person must 31/08/06 consider ways to support staff to be less task orientated and adopt a more person centred approach where they spend time sitting and chatting with residents. The Registered Person must 31/07/06 make sure all residents are offered regular baths or showers and this is recorded. The Registered Person must look 31/10/06 at how activities can be improved at the home. The activity programme should offer more variety and should be designed to meet the different needs of residents. Activity resources and equipment should be available for residents to help themselves. The social needs of residents who are not participating in planned activities should be met. 12. OP15 12 18(1)(c) The Registered Person must 31/07/06 make sure staff supporting residents at mealtimes do so appropriately, offering choices, respecting their dignity and rights and attending to their needs. DS0000065297.V299954.R01.S.doc Version 5.2 Page 36 9. OP10 12 10. OP10 12 11. OP12 12 16(2)(m) Greville House Care Home Staff training in this area is essential for some staff. 13. OP15 12 16(2)(h) The Registered Person must 31/07/06 make sure residents are aware that they can request drinks and snacks at anytime. Staff should be proactive in offering these. The staff must offer residents a choice of how they wish to take their tea. The Registered Person must 31/07/06 make sure residents in wheelchairs are offered the opportunity to sit in other chairs. The Registered Person must 31/07/06 make sure repairs are attended to promptly and residents and staff are not put at risk for delays to maintenance work. The Registered Person must 31/07/06 make sure all resident bedrooms, WCs and bathrooms have a supply of hot water. The Registered Person must 31/07/06 make sure thorough checks are made on all staff and any delays in receiving criminal record checks are followed up. The Registered Person must 31/08/06 make sure staff training profiles are up to date and there is a plan in place to make sure staff have undertaken all essential training. DS0000065297.V299954.R01.S.doc Version 5.2 Page 37 14. OP8 12 15. OP19 13 23(2)(b) 16. OP25 23(2)(j) 17. OP29 13 19(1)(a) 18. OP30 18 Greville House Care Home 19. OP38 13 23(4) The Registered Person must 31/07/06 make sure failures in the fire alarm system are repaired immediately. The Registered Person must 31/07/06 make sure staff are vigilant and take action to reduce the risk of any hazards. Maintenance workers must be alerted to the need for good health and safety practices. 20. OP38 13 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 OP4 Good Practice Recommendations The Registered Person should consider how best they can adopt a more person centred approach to nursing care where residents could receive nursing care whilst remaining in their original bedrooms. It is strongly recommended that details of training in medication handling be recorded. The Manager should consider organising training for staff in this area so that they can feel confident in their work and support of relatives at these times. The Manager should look at whether some staff need training and support so that they can work better with relatives. 2. OP9 3. OP11 4. OP13 Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 38 5. OP27 The Registered Person should look at the allocation of staff to make sure the staff are working in areas the residents are. Senior staff should be available on the units to offer support, direction and supervision to staff. Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greville House Care Home DS0000065297.V299954.R01.S.doc Version 5.2 Page 40 - 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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