Inspection on 21/06/07 for Greville House Care Home

This inspection was carried out on 21st June 2007.

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

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

Other inspections for this house

Greville House Care Home 28/04/09

Greville House Care Home 24/06/08

Greville House Care Home 21/06/06

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 21st June 2007 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Greville House Care Home DS0000065297.V338870.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.V338870.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 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.V338870.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. 12th January 2007 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.V338870.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection included an unannounced visit to the service on the 21st June 2007. Two Regulation Inspectors visited the home. We met with people who live there, staff and the Manager. We also looked at records, the environment and saw how people were being cared for. We wrote to the people living at the home, their visitors, staff and other professionals and asked them to complete short surveys about their experiences. We asked the Manager to complete a quality self assessment. We used all these pieces of evidence to help us form judgements about the home. 9 people who live at the home, 8 of their visitors and relatives, 18 members of staff and 1 other professional returned surveys to us. Most of the people living at the home were generally satisfied with the information they had, the food they ate and the staff. Most of the visitors said that they were made welcome and were happy with the care their relative or friend received. Some people said that they would like the staff to give more individual support. Some of the staff said that they didn’t always feel supported to and listened to. Some of the things people said about the home were: ‘Most of the staff are so kind and helpful.’ ‘I think this is an excellent home and am grateful to all the staff.’ ‘The home provides a safe environment.’ What the service does well: People living at the home are happy there and feel safe and well cared for. People like the staff. People who leave hospital and want to relearn skills and confidence to return to their own home are given the support they need. The environment is nicely maintained. Greville House Care Home DS0000065297.V338870.R01.S.doc Version 5.2 Page 6 People like the food. The staff feel that their training is useful and relevant. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Greville House Care Home DS0000065297.V338870.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greville House Care Home DS0000065297.V338870.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5 & 6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who are thinking about moving to the home have enough information and opportunities to visit. Sometimes people have needed a bit more support than they have been given. People who need support to get well enough to go back home after a hospital admission are given the help they need. EVIDENCE: There is a guide to the home, a philosophy of care and previous inspection reports available to people who live at the home. Everyone is given a copy of the service guide when they move to the home and copies of other documents are available in the entrance hall for people living at the home and their visitors. The majority of people told us that they had enough information to help them make a decision about moving to the home. Greville House Care Home DS0000065297.V338870.R01.S.doc Version 5.2 Page 9 Senior members of staff meet with potential residents to discuss their needs. They talk to them, their families and other important people to make an assessment. People who are interested in moving to the home visit and spend time there. Everybody makes a decision about whether the home is suitable. The professional who contacted us said that the staff did not always consult with other professionals to get a good understanding of individual needs before someone came to stay at the home for a short period of time. Some of the people who have stayed at the home for a short period have had concerns. Two people who were visiting the home were concerned that they were not given the support and attention from staff that they needed. One person who stayed at the home was not able to continue with their normal activities or have their normal level of personal care. Some people said that they felt staff were unfriendly and were too rushed to give them the help that they needed. The Manager said that they were trying to make sure everyone who visited the home was assigned a member of staff to offer them and their family support and information. She said that she hoped that this would mean people in the future did not experience the problems some people had when they visited. When people move in the staff continue to assess their needs for a few weeks. Then everyone meets to discuss whether the person wishes to stay living at the home and whether the home can continue to meet their needs. The home has a number of places allocated for people who have been in hospital and need support to get well enough to go home. The unit has a dedicated staff team and facilities to help people relearn skills and gain the confidence that they need. These staff work closely with other professionals to make sure everything the person needs is in place so that they can return to their own homes. People who have used this service have found it invaluable and said that they were very happy with the support they had received. Greville House Care Home DS0000065297.V338870.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People need to be more involved in planning their own care. People do not always feel that their wishes and needs are being met. People are at risk because medication procedures are not always being followed. Most people feel that their personal and health care needs are met. EVIDENCE: The staff have written a care plan for everyone who lives at the home. We looked at some of these. The care plans are recorded on computer and this is not accessible to the people who they are about. The plans must be printed and people must have their own copy of their care plan. The layout of some of the information makes it hard for the people the care plans are about to understand. The organisation needs to think about ways to present information in a way which is easier to understand. Some of the care plans had examples using different names in and this was confusing. Greville House Care Home DS0000065297.V338870.R01.S.doc Version 5.2 Page 11 Some of the language used in care plans is negative or indicates that staff are not supporting people in a way which they would chose. For example one care plan said that staff should ‘make’ the person aware of something. The staff should not be ‘making’ anyone do anything. Another care plan stated that someone was ‘unable to meet their work or play needs.’ This statement was not explained further. Some care plans and risk assessments referred to ‘the resident’ not the name of the person. Care plans also referred to people being ‘creamed’ and ‘toileted’. These phrases should not be used and the staff should think about the terminology the person the plan is written about would like. The information on social needs and the life of people before they moved to Greville House was very brief. Some care plans only talked about the events in someone’s life immediately before they moved to the home. Where interests and hobbies had been identified there was no evidence that staff supported people in these areas. Some care plans said that people’s only interest was ‘watching TV’. The staff need to spend more time getting to know about the people they are caring for and not just focusing on what their care needs are now. Care plans and daily records made by staff focused on the tasks of care giving and not on the individual needs and wishes. Where there was an identified risk, the staff had completed a form asking questions about this risk. However, there was no information on whether the person was supported to take this risk, how adverse effects should be minimised or what kind of support was needed to make sure the person remained safe. Some care plans indicated that restrictions were made on people without proper assessment. For example one care plan said that the person must be reminded not to lock the bathroom door when they had a bath. There was no assessment to indicate that this restriction was necessary and there was no evidence that the person had been able to make their own mind up about this. Each care plan contained a record of personal belongings. However some of these were very detailed while others just mentioned electrical items. One person told us that their care plan had not been reviewed regularly. All residents are registered with local GPs. One GP surgery visits the home to offer a weekly surgery for people living there. Other health professionals, including community nurses, visit as required. People told us that they received the medical support they needed. One person said that they felt the staff did not always support people to get out of their chairs and to stand up the right way. Some other people said that Greville House Care Home DS0000065297.V338870.R01.S.doc Version 5.2 Page 12 they wanted more opportunities for exercise and to be supported to walk around. The Manager keeps records to show where and how people are having accidents and how these are dealt with. One person told us that they did not have enough opportunities for showers and that the staff did not always wash them properly. A hairdresser visits the home but her availability is limited. The Manager told us that she is recruiting a new hairdresser who will work longer hours and will offer a service to people who are unable to leave their rooms, who currently do not have a hairdressing service. We saw that the support people had to eat their meals had improved. We saw that the staff offered people more choices and sat and talked to them if they needed any help during the meal. However, we saw that some people were given plastic aprons to wear. They were not given a choice about this. We also saw that some staff stood next to people when helping with an aspect of their meal instead of sitting with them. There is a medication procedure. Staff who are responsible for supporting people with their medication have training. The senior staff make checks on medication storage and the way staff are handling medication. We looked at the way some medication was stored and the records for this. We found that there were a number of problems that needed to be addressed. Some of the medicines were not labelled with the type of medicine they were, the name of the person they were prescribed to or the administration instructions. There were some medicines belonging to people who no longer lived at the home. Some of the administration records had not been completed properly. Some people had medicines that were not recorded anywhere. One person did not have a record of administration for their medicines. Greville House Care Home DS0000065297.V338870.R01.S.doc Version 5.2 Page 13 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 good This judgement has been made using available evidence including a visit to this service. People feel that organised activities have improved, but some people want more stimulation and support to help them meet their needs. Visitors feel welcome at the home. Most people are happy with the food. EVIDENCE: The home employs two Activity Officers. They have a planned programme of different activities. During the last year these have improved and there have been some new regular organised activities. These have met the needs of some people. Some local religious groups visit the home and hold services or individual sessions for people who wish for these. The staff help people to celebrate birthdays and special events. There are some special events and parties planned for later in the year. The Activities Officers have ideas for more special events. Some people said that they were happy with the activities at the home. Other people said that they wanted more or different activities. People told us that their individual needs and interests were not always catered for. Some people Greville House Care Home DS0000065297.V338870.R01.S.doc Version 5.2 Page 14 were not able to pursue hobbies and interests when they moved to the home. People told us that they would like more opportunities to go out. Some people said that they would like support to be more active. People told us that they would like the staff to spend more time with individuals having a chat. They said that the staff were not around when they wanted them to socialise. Two visitors said that they had often had to help or reassure other residents because the staff were not available. When we spent time at the home we found that some people were left in lounges and that the staff did not come to see if they were alright or needed anything. Some people were left and had no one to talk to and nothing to do. The televisions were left on in all the lounges even when no one was in the room and no one asked people who were in the lounges if they wanted to watch the television, if they wanted a different programme or if they wanted to do something different. Some of the things which people told us were: ‘The activities Monday to Friday are very good. But there is no activities at the weekend and I miss them.’ ‘The staff who give individual activity support are very good.’ ‘My relative would like to go to church and likes reading. They cannot do these things now and would be happier if they could.’ ‘I wish it was possible to have outings.’ ‘Activities are arranged but I do not take part because of my disability.’ Visitors can come to the home at any time. People who visit relatives and friends told us that they were made welcome and that the staff kept in touch about important matters. One person said, ‘I am always greeted warmly’. One of the people who lives at the home has been involved with interviewing staff. The Manager said that she wants to get more people involved with this. There are notice boards around the home giving people information on activities, forthcoming events and minutes from the residents’ meetings. Menus are on display. One person told us that they did not always know who the staff were. The Manager said that she wants to display named photographs of staff to help people recognise them. One person said, ‘the senior staff listen but often not carried out by carers due to lack of supervision’. Greville House Care Home DS0000065297.V338870.R01.S.doc Version 5.2 Page 15 There is a varied menu which is regularly reviewed. Specialist diets are catered for. There are dining rooms on each floor, although people are able to eat elsewhere if they choose. The chef meets with people living at the home to discuss their dietary needs and to get their comments on the food. People told us that they liked the food and most people felt that they the able to make choices. Some people felt that the food at supper time was not as good as the main meal and some people said that they felt the food was not always stored in a hazard free way when it was brought out of the main kitchen to the dining rooms. Some people have asked that mealtimes can be changed and this has happened. Some of the things people told us about meals were: ‘I can always ask for anything I particularly like.’ ‘The chef is very attentive and comes and says hello to us all.’ ‘I gave enjoyed the food supplied and found the catering staff very helpful, as I am on a special diet.’ ‘I do not always have a choice of the menu. There are some things I would like which the home does not provide.’ ‘I would like healthier supper time foods.’ Greville House Care Home DS0000065297.V338870.R01.S.doc Version 5.2 Page 16 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, 17 & 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There are appropriate complaints and protection procedures. Most people feel confident that these are implemented. EVIDENCE: There is an appropriate complaints procedure and copies of this are given to people who live at the home and their visitors. A copy is displayed in the entrance hall. The Manager should make sure copies in large print are available for people who find the small font hard to read. Most people said that they knew who to speak to if they were unhappy about anything. But some people said that they did not know how to make a complaint. One person said that they felt there were not improvements when they raised concerns. A local advocacy group have attended a resident meeting to offer support. There is information on advocacy services available to residents. There are records of complaints and the action taken to investigate these. Greville House Care Home DS0000065297.V338870.R01.S.doc Version 5.2 Page 17 The home has adopted the local authority protection of vulnerable adults procedure. The organisation has procedures on abuse and whistle blowing. Copies of these are shared with the staff. Not all staff have been given training in protection of vulnerable adults. The Manager said that she is trying to organise for all the staff to have this training. Greville House Care Home DS0000065297.V338870.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 & 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People live in a safe, well maintained and clean environment. However there have been continued problems with the hot water system for some people. EVIDENCE: The home is purpose built and all rooms have en suite facilities. People living at the home have personalised their bedrooms with furniture, pictures and personal items. People can lock their own rooms. Some bedroom doors had stickers and pieces of paper to identify who the room belonged to. This did not look very nice. The staff should ask individuals how they would like to identify their room. If they would like their name on their door then this should be presented in an attractive way of their choosing. People should also be given the option to identify their rooms with different pictures, numbers or not have anything if this is what they want. Greville House Care Home DS0000065297.V338870.R01.S.doc Version 5.2 Page 19 The home has a number of communal areas, including lounges, dining areas and quiet rooms. These have been attractively decorated and furnished. However some rooms include small hospital type tables. It would be nicer if there were other more homely coffee tables. The Manager said that she is hoping to turn one of the communal lounges into a sensory room. There is a small garden. The Manager said that some people who live at the home are helping to choose new plants and flowers to make this area more attractive. People told us that they thought the home was bright and cheerful. They said that they liked the fact there were lots of small communal lounges. Some people were concerned that there was not enough fresh air and ventilation. A number of people said that they were unhappy because the hot water system did not work properly. Some people had told us about this before and we had made a requirement that the organisation sorted out this problem. The Manager said that there were plans to resolve this in the near future. Some of the things people told us were: ‘There is no hot water at my end of the building in the morning and staff have to carry hot water to our rooms.’ ‘I am disappointed with the hot water system.’ There are dedicated cleaners and a maintenance worker. On the day of the inspection the home was clean and odour free. Most of the people who contacted us said that this was usually the case. A few people wanted cleaning of certain areas to be improved. Some of the things which people said about the cleanliness of the home and the way clothes are laundered were: ‘The home is always very clean and fresh.’ ‘The home appears clean and tidy.’ ‘The laundry is done by staff who know how to operate a washing machine! Nothing is shrunk to half its original size.’ Greville House Care Home DS0000065297.V338870.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. People do not feel safe or confident that there are enough staff. The staff are recruited appropriately and are offered a range of training. However, it is not clear whether the staff have had all the training they need. EVIDENCE: People told us that they felt there were not always enough staff around. They were particularly concerned that staff did not check on residents in communal areas or spend time with them. They felt that the staff were always busy doing other tasks. Some people felt that this problem was worse at the weekends and in the evenings. One visitor said that they never saw any staff when they visited at the weekends. Some members of staff said that there was not enough staff in the mornings and that this made their jobs difficult. Some of the staff felt very strongly about this and were concerned that the wellbeing of people at the home was in jeopardy. Some members of staff said that they did not always get opportunities for a break when they were working and this made them very tired. Shortly before we visited a person was employed to manage the nursing unit. This unit had been without a manager for some time and there had been Greville House Care Home DS0000065297.V338870.R01.S.doc Version 5.2 Page 21 problems because of it. The new Nurse Manager spoke to us. She is introducing changes which she hopes will improve the unit. She is also hoping that higher staffing levels will be arranged, the organisation is currently reviewing this. The staff working on this unit and some of the relatives of people living there feel that more staffing is needed to make sure people have good quality support. Some of the people who we met said that they really liked the regular staff. Some of the things they said were: ‘The staff are very caring and we get everything we need.’ ‘The present staff team work hard and are always pleasant.’ ‘The staff are always kind and helpful.’ ‘I have found all the staff very nice.’ However some people did not like having different or unfamiliar staff and one person said, ‘There are too many staff changes’. There is an appropriate recruitment procedure and checks are made on all staff before they are employed. Potential staff have to attend an interview. The staff who contacted us confirmed that they had been recruited appropriately and that a number of checks had been made. We looked at some staff recruitment records and these showed evidence of checks, including criminal record checks. All new staff are given an induction and undertake a range of training. The staff who contacted us said that they had training to do their jobs. Some of the individual staff training records did not show that people had undertaken training in first aid, food hygiene, fire safety or dementia. The Manager needs to make sure everyone’s training is up to date and that they complete their training records. One of the senior staff is a qualified trainer in moving and handling. She makes sure all the staff have regular training in moving and handling techniques. Some staff have started to undertake training provided by the Alzheimer’s Society which helps them to improve the way they communicate and work with people who have dementia. The organisation has introduced a new way of training staff using computers in the home, so that everyone can learn at their own pace. The organisation supports people to undertake NVQ awards. Greville House Care Home DS0000065297.V338870.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. The Manager has introduced some positive changes which benefit the people living in the home. Some staff would like to feel more supported and like more say about how the home is run. There are systems to monitor quality and health and safety. EVIDENCE: The Manager was employed earlier in 2007. She has had a full induction, including shadowing a Registered Manager at another home. She is experienced in the caring profession and has managed another service. She is qualified to NVQ Level 4 and has the Registered Managers Award. Greville House Care Home DS0000065297.V338870.R01.S.doc Version 5.2 Page 23 Some people said that they felt the Manager was supportive and making positive changes to the home. Others felt that they would like more support from the Manager. Some staff said that they would like more opportunities to tell managers what they felt. Some staff said that they did not think the Manager listened to them and that they did not feel valued. One person told us, ‘The new Manager is making improvements which is positive and I hope it will continue.’ The Manager appeared keen to make improvements to the home and told us about some of the things she had done since she started working there. She listened to the things we suggested and took action to rectify some of these while we were still at the home. Some of the staff said that they had not had enough support with only a few team meetings and no individual supervision with their line managers. They said that they would like more opportunities to voice their views and opinions and a way to voice their concerns. All staff need the opportunity to participate in regular, planned individual meetings with their manager. The organisation makes sure a senior manager visits the home every month to look at how things are being run. They make suggestions for improvement and follow these up at the next visit. They write a report about these visits and send copies to the Commission for Social Care Inspection. The local authority arrange for regular quality inspections of the home to make sure the standards they expect for the people they fund are being met. They produce a report of their findings and make suggestions for improvement. There is a suggestion box in the main foyer at the home and people who live at the home and their visitors are encouraged to use this if they would like to suggest any changes. There are no systems for the Manager to make regular checks on the quality of the service and what people think about different aspects of their care. The Manager should think about how regular in house checks could be made alongside the monitoring by the organisation and the local authority. The people living at the home have made their own arrangements for managing their finances. However, the home offers to hold small amounts of their cash in a safe place, which they can access when they need to. We saw that there are accurate records of this money and of all transactions made. The staff make regular checks on health and safety and these are recorded. The London Fire Authority carried out an inspection of the fire safety systems shortly before we visited. They were satisfied with the systems and precautions taken to prevent fire. Greville House Care Home DS0000065297.V338870.R01.S.doc Version 5.2 Page 24 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 X 3 X 3 4 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 3 Greville House Care Home DS0000065297.V338870.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12 15 Requirement The Registered make sure: 1. Person Timescale for action must 30/09/07 Residents are involved in planning and reviewing their own care. Care plans are presented in a way which the person they are about can understand. Residents have a copy of their care plan. Care plans use words and terms which the resident would choose and which are positive. 2. 3. 4. Previous requirement 31/08/07 2. OP7 OP12 12 15 The Registered Person must 30/09/07 make sure there is detailed information on individual social needs. The staff must support people to Greville House Care Home DS0000065297.V338870.R01.S.doc Version 5.2 Page 26 pursue individual hobbies and interests. People who are not participating in organised activities must be supported to pursue their interests. The staff must focus on individual needs and wishes and not just completing tasks. Previous 31/10/06 3. OP7 12 13 requirements made The Registered Person must 31/08/07 make sure risks are properly assessed. Assessments must show how the person is supported to make choices and take risks and what action the staff need to take to minimise adverse effects. There must be a full assessment to indicate why restrictions are placed on people. 4. OP9 13 The Registered Person must 31/07/07 make sure medication procedures are followed. In particular: All medication must appropriately labelled. be Medication administration records must be in place and must be completed. Medication which is no longer in use must be disposed of appropriately or returned to the pharmacy. Previous requirement 20/08/06 Greville House Care Home DS0000065297.V338870.R01.S.doc Version 5.2 Page 27 5. OP18 13 18 The Registered Person needs to 30/09/07 make sure everyone is trained in protection of vulnerable adults. The Registered Person must 31/08/07 make sure all resident bedrooms, WCs and bathrooms have a supply of hot water. Previous requirement 31/07/06 6. OP19 23(2)(j) 7. OP27 19 The Registered Person must 31/07/07 make sure that there are enough staff on duty at all times so that people are safe and their needs can be met. The Registered Person must 31/10/07 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. Previous requirement 31/08/07 8. OP30 18 9. OP36 12 18 The Registered Person must 31/07/07 make sure all staff have regular planned supervision meetings. Greville House Care Home DS0000065297.V338870.R01.S.doc Version 5.2 Page 28 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 OP3 Good Practice Recommendations The staff should consult with relevant professionals when assessing people for short stay as well as long stay care. Everyone who visits the home should be allocated a member of staff who will make sure they are looked after and have the information they need during their visit. Records of personal belongings should be sufficiently detailed. The staff should make sure people feel confident and happy with the way they are being supported each time they help them to move. People should be supported to stay mobile and walk around if they wish. The staff should make sure people feel confident and happy with the personal care they receive each time they are offering this support. People should always be given a choice as to whether they wish to wear aprons at mealtimes. There should be more appropriate alternative to plastic and paper aprons. 8. OP10 The staff should make sure they do not stand over DS0000065297.V338870.R01.S.doc Version 5.2 Page 29 2. OP5 3. OP7 4. OP10 5. OP10 6. OP10 7. OP10 Greville House Care Home residents when offering them assistance to cut up food. 9. 10. 11. OP12 OP12 OP12 People should be supported to go out more if they wish to. The staff should make time to sit and talk to people. Televisions should only be left on when people are watching them. The staff should regularly check with people about whether they want to watch TV and if they need channels changed. The proposed staff photo board should be made available soon so that people can recognise who each member of staff is. Food should always be stored safely and at the correct temperatures. The Manager should make sure that everyone can access the complaints procedure and that they have sufficient information so they know how to make a complaint. People should be given a choice about how they want to identify their bedroom. Nameplates and pictures should be attractive. The Manager should think about ways she can support the staff to contribute their ideas and opinions and to voice their concerns. People living at the home should be consulted about the services they receive on a regular basis. 12. OP14 13. OP15 14. OP16 15. OP19 16. OP32 17. OP33 Greville House Care Home DS0000065297.V338870.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Care Home DS0000065297.V338870.R01.S.doc Version 5.2 Page 31 - 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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