Inspection on 24/06/08 for Greville House Care Home

This inspection was carried out on 24th June 2008.

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

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 21/06/07

Greville House Care Home 21/06/06

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

CARE HOMES FOR OLDER PEOPLE Greville House Care Home Greville Road Richmond Surrey TW10 6HR Lead Inspector Sandy Patrick Key Unannounced Inspection 24th June 2008 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.V364510.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.V364510.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.V364510.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. 9th January 2008 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 people. 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 people are placed by the London Borough of Richmond. The weekly charges range from £880 - £980. Additional charges are made for hairdressing and any purchases from the home’s shop. Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The inspection included two unannounced visits to the home on the 24th ad 26th June 2008. Two Regulation Inspectors visited the home. We met with people who live there, staff, the Manager and visitors. We looked at the environment and records that are used for running the home. We also wrote to people who live at the home, their visitors, staff and other professionals and asked them to complete surveys about what they thought about the home. 25 people who live at the home, 8 relatives and 5 members of staff returned surveys. The local authority who fund the majority of people living at the home gave us information about their contract monitoring. We asked the Manager to complete a quality self assessment of the service. We looked at all the information we had received since the last key inspection. This included an unannounced visit on 22nd January 2008 to check the requirements we had made at the last key inspection were being met. Most people who we spoke to and who contacted us were happy with the care at the home. A small number of people said that they felt the quality of support from staff varied. One person told us that they thought the home did not offer value for money as the care was sometimes poor. Some people felt there should be more personalised care and attention. Some of the things people told us about the home were: ‘This is a lovely home and it has improved since the Manager and Nursing Manager started work here.’ ‘I recommend here – absolutely. We were really lucky to get in. I am very happy.’ ‘I have friends here.’ ‘People are helpful and interesting’ ‘It is lovely here. I really like it – they make you comfortable’ Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 6 ‘I would highly recommend someone coming to a safe place like this when you get older.’ ‘I have faith in the home as I have been here for a short stay before I moved in.’ ‘A very caring home.’ ‘So far as I am aware they do everything well and it pleases me that my mother is in their care.’ What the service does well: What has improved since the last inspection? The Manager has worked hard to make improvements to the service and has plans for further improvements. There have been improvements to the information given to people coming for a short stay at the home. There have been improvements to care plans. There have been improvements to the way in which medication is managed. Group activities have improved and are better planned and organised. There are regular opportunities for relatives to meet with each other and staff. The Manager works well with the local authority and other agencies to help make sure people are safe. Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 7 There has been a lot of staff training. Some new senior staff, including a new Deputy Manager have been employed. There has been improvements to record keeping, quality monitoring and health and safety checks. 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.V364510.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are given enough information to help them make a decision about moving to the home. People’s needs are assessed to make sure these needs can be met at the home. EVIDENCE: There is a welcome pack given to everyone who lives at the home and people who are interested in moving there. This includes the home’s Statement of Purpose, Service User Guide, Complaints Procedure and the aims and objectives of the service. There is a range of information on display in the main foyer and on notice boards around the home. The Manager has created a photographic board showing activities and a photo album which celebrates special events and life at the home. Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 10 Since the last inspection the Manager has developed information especially for people who are staying at the home for a short time. This includes information on who to speak to if they need advice or have any concerns, and on what to do with clothing, medication and personal money. People who are interested in living at the home are invited to visit and meet with others. During their visit they can have a meal and senior staff assess their needs through discussion and observations. The person moving to the home, their family and professionals involved in their care contribute to the assessment. Following a move to the home, people’s needs are reassessed after 6 weeks and they meet with senior staff and other relevant people to decide if they want to continue to live at the home and if the home can meet their needs. People told us that they were generally happy with the information they had when they moved to the home. They said that they or their relatives had made the choice to move there. According to the home’s own customer satisfaction surveys the majority of people felt that they were given support to personalise their bedroom and being involved in planning their care. One person told us, ‘I came here for an assessment and I like it’. There is a contract, stating the terms and conditions of residency, in place for everyone. People told us that they had seen these and had copies. 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. We met some people who were staying on the unit when we inspected. They said that they were happy and that the staff had helped them regain their confidence and skills. Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have their individual needs recorded. The staff help them to meet their health and personal needs and treat them with respect. The staff manage people’s medication safely and appropriately. EVIDENCE: The Manager told us that the staff aim to complete all initial care plans within 24 hours of someone moving to the home, this includes all initial assessments of their health and wellbeing. All care plans are reviewed after 6 weeks. Everyone has been given a copy of their own care plan. We looked at a sample of care plans. We saw that the information and detail in care plans had improved. We saw that care plans gave staff good, clear instructions on how to meet individual needs. Some of care plans had good examples of individual care and choices being recorded. Care plans are regularly reviewed and Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 12 updated when needed. We saw that the staff had undertaken assessments of risk, health and personal care needs. Some of the care plans we looked at did not always have consistent information, for example one person’s night care plan, risk assessment and care plan all said different things about this person. We saw that sometimes the things people had identified in assessments were not always recorded in care plans. Therefore staff may not know about these particular needs if they were just referring to the care plan. The words and terminology staff use in the care plans had improved since the last inspection, but we felt in a very small number of cases the wording may not have been what the person who it was written about would like to read. In one care plan someone had used the wrong name for the person it was about. The computerised system used for recording care plans and assessments is sometimes confusing. It sometimes gives examples of how to complete sections and these examples cannot be deleted so that the actual assessment or care plan may record a fictional name and situation. The system for recording risk assessments also needs to be improved because the computer system asks a series of questions to identify risks but does not record how these risks will be minimised. The staff have helped one person create a short leaflet about their life, interests and things which are important to them. They need to help as many people as possible to create something like this so that the staff have a good understanding about the person’s whole life not just their life since they moved to Greville House. Some people told us that the staff were attentive and kind. Others said that only some staff were good and that others did not always give the best care and attention. Some people told us that they would like there to be more individual care and attention and for staff to get to know people’s personal needs better. One person told us, ‘the staff need to give more personal attention and more care assistance. There needs to be more one to one support, my relative sits in their room all day and the other people do not talk or hold a conversation’. Everyone is registered with local GPs and other health care professionals as needed. Some of the local GPs visit the home for weekly surgeries. One person told us, ‘my doctor visits me here and I can see him when he comes to the home’. One part of the home is dedicated for nursing care. This unit is staffed by registered nurses and carers and managed by a nurse. People in other areas of the home have their nursing needs met by visiting nurses. Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 13 Some relatives felt they were not always informed about changes in need. Some people felt that their relative did not always see the medical professionals they needed to. One person said that they did not think that their medical dressings were put on very well. The Manager must make sure these concerns are addressed and that relatives are appropriately involved and informed. One person told us that they were concerned that their relative had had a lot of falls since they moved to the home. They felt that they should be better supported so that they did not fall so much. The staff monitor all falls and record these. They work with other professionals to minimise the risk of people falling. The Manager needs to make sure everyone is kept safe and action is taken to prevent falls wherever possible. All the staff have had regular training in manual handling. Medication is stored securely. The staff who are responsible for administering medication are all trained by the pharmacist and regularly assessed by Managers. The way in which medication is recorded stored and administered had improved since the last inspection. We saw that there needed to be some improvements to the way in which medication which had been refused and was awaiting disposal is stored and recorded. For example, this medication was stored in three different places and there was no clear record of it. People’s personal care needs are appropriately recorded, including preferences for same gender carers. The staff we spoke to demonstrated that they had a good understanding of how to support people respectfully and privately. Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 14 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. There have been improvements to the group activities organised for people living at the home but there needs to be further improvements to make sure people’s individual interests and needs are being met. People living at the home are able to see visitors when they want. There is nutritious and varied food available. EVIDENCE: There are two activities officers whose role it is to coordinate and plan activities for everyone. One activity officer works on the nursing floor. She told us about some of the activities she planned which are varied and include music sessions, reminiscence, flower arranging and entertainers visiting the home. Special cultural awareness days are organised where people can try different foods and learn about different cultures. There is a leaflet advertising planned activities. Some people felt they would like more information on planned activities, like their own personal timetable in their bedrooms. Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 15 There are photographs displayed on boards and in an album for people to see some of the different activities which have taken place. There is a display of craft work people have made at the home. Activities are advertised on notice boards. People generally felt that organised group activities had improved. We saw evidence of a number of events and that care staff, as well as activity coordinators, were involved in providing activities. We saw some people taking part in a quiz run by care staff. Some people told us that the activities coordinator visited them in their bedrooms to give them individual support with activities. They said that they liked this. Religious services are held at the home for people who wish to take part in these. The staff help people to celebrate birthdays. One person told us that they had recently celebrated their birthday and the staff had held a surprise party. Another person said, ‘there was a birthday yesterday and the chef baked a special cake’. Some of the things people told us about activities were, ‘I went out to play dominoes in the garden recently. I also do flower arranging – the flowers are displayed and make the hallways look nice’, ‘I like one to one activities like manicures’ and ‘the activities have improved but I would make a plea for more live music’. The Manager told us that the staff were learning about a new kind of support where they gave people living at the home more opportunities to be involved in household tasks, such as laying the tables, making their beds and making their own tea or breakfast, if they want to. One person told us that they enjoyed being able to do things for themselves. We felt that there was not enough information on people’s individual interests and likes. Most care plans contained very little information in this area and about people’s lives before they moved to Greville House. Where information was recorded this was not reflected anywhere else. For example where people had told staff about certain interests and hobbies there was no evidence that they were supported to pursue these interests. Records of activity participation were varied and often showed that someone ‘declined to take part’. However, the activity offered was often not something they had identified as an interest. Some people said that there was no one to talk to and that other people they lived with could not communicate with them. Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 16 Some people told us that they would like there to be more outings. One person said that they would like someone to take them to the shops every now and then. Some people said that they would like there to be more opportunities for exercise. Some people said that they felt the staff did not always know about the British culture of the people who live at the home, including their eating habits. One person told us, ‘the spoken English of some of the staff is not good enough for my relative to understand’. From our observations we felt that the staff seemed kind and polite to people living at the home. We saw that they showed them respect and listened to them. However, we felt that sometimes the staff seemed rushed and this gave people the impression that they did not have time for them. For example, we heard a member of staff just saying, ‘finished?’ to a person when taking their plate away after a meal. They did not ask the person what they had thought of the meal or enter into any other conversation. We felt that staff supporting people with a quiz did not really provide sufficient information on what they were doing, they left the room half way through without any explanation of where they were going and they left the TV on while the quiz was taking place so that it was hard to concentrate on what everyone was saying. We also saw staff standing in the doorways to communal lounges telling people it was time for a meal and telling them that they would take them ‘to the toilet in a minute’. We heard a person asking the staff for a cup of tea several times but the staff member did not hear because they were rushing about doing other things in the room. The staff need to think about how they can support people better so that the people living at the home know and feel they are the most important part of the care workers job. Relatives and visitors are welcomed at any time and we saw lots of people visiting the home while we were there. People told us, ‘visitors can come at any time’, ‘I am always welcome to visit my relative’, ‘I always get a friendly welcome and know I can see my relative’s care worker, team leader or manager at any time’, ‘I attend regular relative evenings or coffee mornings’ and ‘I feel able to visit and spend time with my relative whenever I want’. There are a number of communal rooms where people can entertain visitors as well as their own bedrooms. There are monthly open days where relatives can meet and share ideas and concerns with the managers and each other. There is a newsletter for people who live at the home and their relatives. This gives information on changes to the people living at the home, staff and the environment and lets people know about planned events. Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 17 Over the past year, people living at the home have become involved in recruiting staff, by sitting on the interview panel and giving feedback on their thoughts about the candidates. Food is freshly prepared each day. There is a menu offering two main choices at lunch time and a variety of other things if people do not want one of these. The chef caters for people who have different diets because of their cultures and beliefs and details of these are included within care plans. We saw that mealtimes were relaxed and that people were not hurried although we saw that in some areas of the home the staff did not really talk to people about their enjoyment of their meal. Menus were not displayed on individual tables and we saw that the menus in two different dining rooms were showing the previous days choices. When we asked a member of staff who had just served a meal what they had served they were unable to tell us what the meal was. Some people were wearing blue plastic aprons at mealtimes. The Manager said that this was not normal practice and alternatives should be provided at all times. People are able to take their meals in the main dining rooms or in their own bedrooms. Some people said that they would like more flexibility regarding mealtimes. Some people said that the evening meal was given at 5pm and therefore there was a very long gap between this and breakfast. The Manager said that snacks were available in between meals. Most of the people were happy with the food at the home. Some of the things people told us about meals were, ‘the food is nice’, ‘very nice food. The chef is so helpful – he softens my food as I told him I had trouble chewing. He will serve you what you like and ask what you like’, ‘I always have a water jug and am offered lots of drinks’ and ‘the food is very nice and there is plenty to drink’. People told us that the chef came to see them and asked them about their enjoyment of meals and if they had any special requests. Some people said that they did not like all the food at the home. One person said, ‘the food does not appear that interesting’. Another person said that the tea and coffee they had was cold by the time it was given to them. Some people said that the evening meals were not as good as lunchtime food. One person told us that they could not see the menu and ate what was put on front of them. Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 18 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 procedures designed to protect people against harm and abuse and allow them to make complaints. EVIDENCE: People told us that they knew who to speak to if they had a complaint. People who had made a complaint said that they felt these had been dealt with to their satisfaction. We saw evidence that the Manager had made changes and put in place different things after there had been complaints or concerns raised about practice. The complaints procedure is displayed around the home and is available in large print if people need this. Complaints and concerns and the action taken to investigate these are recorded. There is a record of compliments and thank you cards. The folder in which these are stored is a bit confusing and contained complaints, concerns and compliments. The Manager said that she was planning to sort this out so that information is more clearly presented. Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 19 The Manager told us that everyone is registered to vote. Some people have support from advocacy services and there is information on how to contact these services displayed within the home. There are procedures designed to safeguard people made by the local authority and the organisation. The staff we spoke to showed that they were aware of these. We saw that the Manager and staff have followed these procedures over the last year when there have been concerns about people’s wellbeing. The Manager has worked closely with the local authority to make sure there is a multidisciplinary investigation into all safeguarding alerts. All staff have had training in protection of vulnerable adults. The Manager told us that the staff discussed concerns and safeguarding situations in team meetings so that everyone can learn how to manage these situations. Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 20 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, clean and well maintained environment. EVIDENCE: We saw that the building was nicely decorated and well maintained throughout. Areas of the home were personalised and people have personalised their own bedrooms. Some of the things people told us were, ‘my room is lovely’, ‘the home is in a good location’, and ‘ the staff moved my bed for me so that my room is better arranged and I can sit by the window. I like my room’. Everyone has their own room with en suite toilets. There are bathrooms and showers, communal lounges and dining rooms on each floor. The intermediate care unit has separate facilities. Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 21 The garden is nicely maintained and has areas where people can sit and relax. Some of the people living at the home have been involved in choosing, buying and planting flowers for the garden. People told us that they found the home was always clean and fresh. People told us, ‘it is nice and clean here’, ‘the home is absolutely clean’, ‘my room is always clean’, ‘the standard of cleanliness is high and the laundry is excellent’ and ‘it is very clean - -spotless’. Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. People are cared for by staff who are well supported and trained. Recruitment and selection of staff includes checks to help safeguard the people living at the home. EVIDENCE: Most people told us that the staff were generally kind and attended to their needs. Some people felt that not all the staff were attentive and some did not know their needs well, they said that this was particularly true of temporary staff. One person said, ‘the nursing staff are good but not all the carers are good or as thoughtful as they could be’. Another person said, ‘in general the staff are very cheerful and try their best, there have been times when we thought they could have done more for my relative but in recent months it has got better.’ One person said that the staff did not always have time to attend to them. Some of the other things people said about the staff were, ‘they are very good here’, ‘the nurses are brilliant. They are always there if you need them and give you advice’, ‘the staff are excellent, they are happy and waiting to help you’ and ‘the staff are caring and active in helping’. Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 23 Since the last inspection a new Deputy Manager has been employed. This person is a Registered Nurse and manages the nursing unit in the home. There have been some changes to the staff team including new senior members of staff since the last inspection. There were some care worker vacancies at the time of the inspection and these were being recruited to. Vacant posts were filled by staff overtime or the organisation’s own temporary staff. The Manager said that no agency staff had been used at the home for a long time. The staff who we spoke to and who contacted us told us that they had enough support and training to do their jobs. Some of them said that the induction was very good. They said that they attended meetings and met with their line manager to discuss their work. Some people told us that under the previous management of the home they did not get the support they needed. However, they felt things had improved with the new manager and nursing manager. One person told us, ‘the nursing manager is highly professional and experienced, if there is a problem the carers are able to sit down and discuss this with her freely.’ There are appropriate procedures for the recruitment and selection of staff. Representatives of the people who live at the home are involved in staff interviews. There are a range of checks on potential staff including reference checks and criminal record checks. We looked at a sample of staff records and saw evidence of these checks. A new computerised training system for staff has been introduced. This includes training in food hygiene, health and safety and control of substances hazardous to health. There is also training provided by the organisation, local authority and other agencies. Some staff have undertaken specialist training in dementia. Senior staff have been trained in management skills. All staff have to complete training in protection of vulnerable adults, fire safety and infection control within 6 weeks of starting work at the home. All training is recorded in staff individual training profiles. We saw these records. All staff undertake a range of training and complete an assessed workbook as part of their induction. They shadow permanent staff before they start work on their own. We saw the Manager and a member of senior staff discussing a new member of staff’s induction and then we saw the member of staff working with permanent staff in the home. The Manager told us that only 4 care staff have achieved NVQ Level 2 or higher. Many more staff working at the home are undertaking these qualifications. The Manager needs to make sure the majority of staff achieve NVQ qualifications. The Manager has recently introduced a new staff newsletter which gives the staff information on changes, training and key things they need to know. Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 24 Each staff has regular supervision meetings with their line manager and an annual appraisal which reviews their work and capabilities. There are regular meetings for the staff team. All meetings are recorded. Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is well managed and people are able to contribute their ideas to the running of the home. EVIDENCE: The Registered Manager left the service in 2007. The new Manager has been in post for over a year. She needs to apply to be registered with the CSCI. She has her Registered Managers Award and has experience managing another residential home. Local Care UK Managers meet regularly and share ideas and expertise. Those who manage homes within the borough of Richmond Upon Thames meet with the local authority. Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 26 The Manager has worked hard to improve things at the home and has put in place some good systems for monitoring care. The Manager tries to create an open atmosphere where people who live at the home, their relatives and staff can talk to her about issues and concerns. One person told us, ‘the Manager is trying her best to bring the home up to best standards, we have regular staff meetings where we can air our views’. Another person said, ‘she is an approachable manager who listens, gives suggestions and advice’. Care UK give quality satisfaction surveys to people living at the home and their relatives every six months. There is a suggestion box in the main entrance hall where people can put anonymous ideas and suggestions. There are regular meetings for people living at the home, staff and relatives where people can make suggestions for change. One person told us, ‘When I make suggestions at meetings they respond.’ The findings of the organisations own customer satisfaction surveys in October 2007 have been complied into a document which lays out actions for the home and areas where people feel the home is doing well. The Manager’s quality assessment of the home showed us that there are plans for further changes and improvements. These include setting up a committee to represent the people living at the home, improving staff training, redecorating areas of the building and improving person centred planning. The Manager has created an improvement plan for the home which shows how she hopes the home will improve in all outcome areas. The local authority undertake quarterly contract monitoring checks on the home. They look at staffing, resident care, the environment and health and safety. They record their findings and the home has to action any recommendations they make. The local authority also meet with a representative of the people living at the home, their relatives and staff to discuss what areas they would like to see improve at the home. Each month a manager from another Care UK home undertakes a quality assessment of the home and records their findings. Records at the home are well organised, up to date and accurate. Everybody living at the home has representatives external to the home who help them manage their finances. Small amounts of cash are held by the Manager for safekeeping and for small purchases, such as the hairdresser and toiletries. There are good systems for keeping this money safe and recording it. We looked at a sample of records and found them to be accurate. We could see a clear audit trail and receipts for all purchases. Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 27 There was a fire risk assessment on the building undertaken in April 2007. All the actions which were identified in this had been addressed by the time of this inspection. The Manager is updating the risk assessment to make sure it is still accurate. There are regular recorded checks on fire safety equipment and fire drills. We saw that some fire safety doors were obstructed by furniture preventing them from closing if they needed to. There are regular recorded checks on health and safety, including water safety, electricity and gas safety. We saw evidence of certificated checks on equipment and supplies. Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 28 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 X 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 3 3 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 4 X 3 3 3 2 Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Timescale for action The Registered Person must 31/08/08 make sure each individual’s care plans, risk assessments and other assessments are consistent with each other and record the same needs. The Registered Person must make sure the wording and terminology in care plans is appropriate and that the correct (preferred) name of the resident is always used. 2 OP7 13 15 The Registered Person must 30/09/08 make sure all risk assessments clearly show how risks can be minimised. The Registered Person must 31/07/08 make sure medication awaiting return to the pharmacy and disposal is stored appropriately and recorded accurately and clearly. 3 OP9 13 Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 30 4 OP12 12 16 The Registered Person must 31/10/08 make sure people’s individual interests and hobbies are identified and that they are supported to pursue these. The Registered Person must 31/07/08 make sure the Manager applies to be registered with the Commission for Social Care Inspection. The Registered Person must 31/07/08 make sure fire doors are unobstructed at all times. 5 OP31 8 6 OP38 23 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 OP7 Good Practice Recommendations The Registered Person should consult with appropriate parties to make improvements to the computerised care planning system so that it is clearer. 2 OP7 The staff need to help people to record information on their lives and important events so that they have a better understanding of people’s whole life and not just their life since they moved to Greville House. The Manager needs to make sure all the staff are kind and attentive to people’s needs and that people get the individual care and support they need. DS0000065297.V364510.R01.S.doc Version 5.2 Page 31 3 OP10 Greville House Care Home 4 OP10 The Manager needs to make sure relatives are always informed about changes in need for their relatives living at the home. The Manager needs to make sure people have appropriate medical support whenever they need this. The Manager needs to make sure everyone is kept safe and action is taken to prevent falls wherever possible. The Manager should arrange for people to be supported to go out more and to go to the shops if they want to. The Manager should make sure all the staff have a good understanding of the culture and traditions of the people they are supporting and can communicate clearly with them in English. The Manager must make sure the staff have the time to listen and talk to people living at the home and focus on their needs and not a series of tasks. The staff should make sure the correct menu for the day is on display for people to see and must make sure they know and understand the menu choices so that they can explain these when serving meals. People should be given the choice about whether they wish to have protection for their clothes at meal times. They must be offered alternatives to blue plastic aprons. People should be able to take their supper later if they wish to. The staff need to make sure everyone has seen a copy of the menu or is given information about the menu so that they can make choices. DS0000065297.V364510.R01.S.doc Version 5.2 Page 32 5 OP8 6 OP8 7 OP12 8 OP14 9 OP14 10 OP15 11 OP14 12 OP14 13 OP14 Greville House Care Home 14 OP15 The Manager and Chef should think about ways that they can address some of the concerns people raised about food and mealtimes. The Manager needs to make sure all the staff are kind and attentive to people’s needs and that people get the individual care and support they need. The Manager needs to make sure the majority of staff achieve NVQ qualifications. 15 OP27 16 OP28 Greville House Care Home DS0000065297.V364510.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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.V364510.R01.S.doc Version 5.2 Page 34 - 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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