Inspection on 28/04/09 for Greville House Care Home

This inspection was carried out on 28th April 2009.

CQC 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 24/06/08

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 09/07/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Greville House Care Home Greville Road Richmond Surrey TW10 6HR Lead Inspector Sandy Patrick Unannounced Inspection 28th April 2009 10:00 DS0000065297.V375258.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Greville House Care Home DS0000065297.V375258.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Greville House Care Home DS0000065297.V375258.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 manager.grevillehouse@careuk.com 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.V375258.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. 24th June 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 £887 - £997. Additional charges are made for hairdressing and any purchases from the home’s shop. Greville House Care Home DS0000065297.V375258.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. As part of the inspection we visited the home on the 28th April 2009. This visit was unannounced. The inspection team included a Regulation Inspector, a Pharmacy Inspector and an ‘Expert by Experience’. This is a lay person who helps to find out about whether people who use the service are getting good outcomes. We wrote to the manager and asked her to complete a quality self assessment. We wrote to people who live at the home, their representatives and staff and asked them to complete surveys about their experiences there. We looked at all the other information we had received about the home since the last inspection, including notifications of accidents and incidents. Some of the things people told us about Greville House were: ‘They look after me well.’ ‘People are happy here.’ What the service does well: People are happy living at the home and feel well cared for. The staff are happy and feel well supported. The environment is well maintained. The service is well managed and the manager is committed to continuous improvements. The manager works closely with other agencies to help keep people safe. There are good systems for involving people who live at the home in monitoring the quality of the service. What has improved since the last inspection? Greville House Care Home DS0000065297.V375258.R01.S.doc Version 5.2 Page 6 The manager and staff team have worked hard to improve the service since the last inspection. People who live at the home and staff seem happy there. The manager has met requirements we made at the last inspection and taken action to improve the service. She has plans for further improvements. Specific improvements include: The information in people’s care plans is clearer, more detailed and more about individual needs. There have been improvements to the way in which the nursing unit is managed. There have been improvements to organised activities. There is more information for people living at the home, including a pictorial menu and photographs of staff on display. There are plans to improve the environment and include a cinema room, prayer room and bar. There have been improvements to the way in which medication is managed. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Greville House Care Home DS0000065297.V375258.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.V375258.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have enough information about the home to make a decision about whether they want to move there. They have their needs assessed to make sure the home can meet these needs. EVIDENCE: Some of the things people told us about choosing the home were, ‘my son and daughter looked for a place for me and this one was recommended by a friend’ and ‘I came as a respite resident, I liked the place and now I am a permanent resident’. There is an information pack for people who are interested in moving to the home. This gives them a guide to the services and facilities that they would receive. The deputy manager told us that they were planning to create a DVD Greville House Care Home DS0000065297.V375258.R01.S.doc Version 5.2 Page 9 guide to the home. He told us that this would be played in the main foyer for visitors to view. The manager told us that they were planning to produce the welcome pack in Braille and large print. Senior staff at the home visit people and make assessments of their needs by talking to them and their representatives. The local authority make their own assessments and share this with the home. People are able to visit the home and spend time there to help them make a decision about moving to the home. There is an intermediate care unit for up to 6 people who are recovering from an operation, an accident or time in hospital. The aim of the unit is to support people to relearn and develop skills so that they can go back home again. The staff on the unit work closely with other professionals, such as the physiotherapist and occupational therapist to make sure they have all the support they need when they are ready to move back home. We saw that people in the intermediate care unit were being supported by a physiotherapist to take part in different exercises. People were also encouraged to make a hot drink and prepare lunch. This is part of the support they receive to regain skills confidence and independence in preparation for their return home. Greville House Care Home DS0000065297.V375258.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given support to stay healthy and well cared for. People feel that they are treated with respect. EVIDENCE: Everyone has their needs recorded in a care plan, which staff refer to. We saw that improvements had been made to these records with more detail about people’s individual needs and wishes. We saw that information was clear and focused on the things that the person would want. Care plans reminded staff that they needed to give people choice and respect their privacy and dignity. We saw that care plans were regularly reviewed and updated. We saw that some of the information about people’s religion and culture in their care plans was brief and did not tell staff about specific needs relating to this. We discussed this with the manager who said that she had identified this Greville House Care Home DS0000065297.V375258.R01.S.doc Version 5.2 Page 11 problem. She told us that she planned to improve this information within care plans. We saw that people are given regular baths and support with personal care and that this is monitored. We met one person who was alone in a second floor room. She could not access the call alarm bell in her bedroom. When a member of cleaning staff entered her room they wound the cord of the call bell up so that it was even more difficult for her to access. The manager needs to make sure everyone can access their call bells and that all staff are aware of the importance of this. The staff monitor everyone’s health daily and keep records of this. Everyone is registered with local GPs who visit the home regularly. Some people told us that they liked the fact the GP visited. The staff work closely with other health care professionals and we saw evidence of guidelines and information from health professionals. We saw that all health care appointments were recorded. Some of the people who live at the home have nursing needs. Nursing staff are employed to care for them. We spoke to the head nurse. She had a good understanding of different people’s needs and told us how she leads the team of nurses to meet these. We saw that there had been improvements to the way in which nursing care was delivered and records kept about this. We looked at the recording, storage and handling of medication to see if residents were receiving their medication as prescribed. We looked at the medication administration records on all three floors and noticed that there were no gaps in the records of receipts and administration of medication or the allergy status of the residents. We counted several tablets in their original packs and quantities could be reconciled with signatures and the homes own audit. When tablets were left in the monitored dosage system a code was used to explain why the medicine was not given. We observed medication administration to three residents and noticed that it was given professionally and explained to the residents. One lady who was prescribed medicines for pain relief was asked if she was in any pain and whether she needed any of the additional prescribed analgesia. We observed a patch being applied and two nurses gave and recorded it in line with the homes policies and procedures and the Misuse of Drugs Act. We met two residents who were self medicating. There were risk assessments in place and we were shown where the medicines were kept in a locked drawer in their rooms. One lady explained to us how she took her medicines which included one where the dose changed frequently. Greville House Care Home DS0000065297.V375258.R01.S.doc Version 5.2 Page 12 We checked the storage and records of controlled drugs (CD). All balances were correct. We noticed however that the key to the inner CD cupboard was not kept securely. One resident was prescribed oxygen as required and the home kept two cylinders for her use. There were risk assessments in place and hazard notices but we noticed that the cylinders were not kept in a stand or attached to the wall to stop them falling over and causing injury or leakage. We looked at the storage of medication. All the clinical rooms were clean and tidy and well organised. Waste medicines were recorded and disposed of via a licensed waste carrier. Dates of opening were written on all liquids, eye drops and original packs. This meant that no medicines were used past their expiry date and the dating aided the auditing processes. Fridge temperatures were recorded. The home was aware that one fridge was recording too high a temperature. The fridge on the 2nd floor was also sometimes too cold. Several residents were diabetic and either the district nurse tested the blood glucose or in the nursing unit nurses used professional lancets and recorded the result accordingly. Professional lancing devices prevent the risk of transmission of blood borne infections. We looked at several care plans for residents in the rehabilitation unit. Medicines were recorded on admission and we were told that staff assessed and supported residents for the first few days if they were able to selfmedicate. One lady had resumed control, of her own medication and the appropriate risk assessments were in place. All the other residents were having their medication administered from original packs. We were not able to locate any written information in the care plans on how the medicines were taken by these residents before their admission or what the plans were for them after their discharge. We were also not able to see records of whether a blood test for blood glucose or blood coagulation had been carried out as requested in discharge letters from hospital. The manager has started talking to people and their representatives about the support they would like at the end of their lives, including specific religious and funeral arrangements. She is recording this information in a special care plan which will give everyone direction should they need this in the future. Greville House Care Home DS0000065297.V375258.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to participate in a range of organised group activities. They are able to entertain friends and families and have information which helps them have some control over their lives. People are offered a range of nutritious and well prepared food. EVIDENCE: There are 3 part time activity coordinators who plan and run organised activities throughout the week. There have been improvements in this area, including providing organised activities at the weekends as well as week days. We spoke to some of the activity coordinators and they had some good ideas about different future activities. They also told us about some successful recent activities, for example people were involved in making and tasting a tropical fruit salad. We saw that planned activities were well organised. The activities coordinators told us that they spent some time each day talking to people who did not want to join in with the organised activities. The improvements in this area are good, however, there is still limited recorded Greville House Care Home DS0000065297.V375258.R01.S.doc Version 5.2 Page 14 information on people’s hobbies and interests. Where this information has been recorded we did not see evidence that people were supported to pursue their hobbies. The different organised activities should continue but staff also need to think about each person and whether they have specific needs which are not being met. The staff need to make sure they record when they have supported people to meet specific individual interests and to share this information with other staff so that people can enjoy the same opportunities in the future. This is something all staff should be involved with not just the activity coordinators. There is not much information on people’s lives before they came to Greville House, their particular social interests or dates which are important to them. The staff need to work with people and their families to get as much information as possible to help everyone who works with them to understand about the person and not just their care needs. Some of the things people told us about activities were, ‘I do not like to attend any activities but the girl comes to chat with me everyday’, ‘I do not always attend but I like the entertainers when they visit’ and ‘I go and play bingo every week’. On the day of our visit a pianist was playing to a group of people. People appeared to enjoy this. We did not see much evidence of people being supported to pursue individual activities and hobbies of their choice. There were bookcases in some communal rooms but these were not accessible to everyone and were sometimes situated behind furniture. Some people told us that they would like to use the garden more and other people told us that they wanted to go out to shops or use the local community. They told us that they were not supported to do this. One person said, ‘I haven’t been out since I came here a year ago’. Another person said, ‘I like cricket and horseracing and would like to visit a betting shop which I think is nearby’. Some people told us that they had been on trips to a local park and out for pub lunches. The manager told us that there were the lounges for weekly film viewings. to convert one of the lounges into planning to create a bar and library in plans to create a cinema room in one of She told us that they were also planning a quiet multi faith prayer room. And other areas of the home. The manager told us that she was finding out information about different faiths, cultures and religions and compiling a record for staff to refer to when supporting people. People told us that visitors were welcome at any time and we saw people visiting throughout the day. Family members told us that they were able to Greville House Care Home DS0000065297.V375258.R01.S.doc Version 5.2 Page 15 continue to be involved with caring for their relatives if they wished. Some people told us that they did not have any family and some of them said that they did not have visitors. The manager may wish to consider contacting befriending organisations. This may be useful for people who wish to use the community but do not have anyone to take them out. Some staff said that they would like to support more family members to be involved in activity provision. The staff in one part of the home said that they had monthly ‘surgeries’ where family members could meet with them to discuss any concerns they had and talk about the home and care of their relative. Some people are supported to take quite an active role in aspects of the home. One person has helped interview staff, other people have helped in the garden and some people help lay tables or with small household tasks. The staff should make sure everyone has the opportunity to take part in the day to day activities of the home if they wish to. We saw that there was a good range of information for people on notice boards around the home, including the complaints procedure, information on activities and the home’s newsletter. We saw some people’s poetry and craft work had been displayed for others to enjoy. There is a board showing staff photographs on display to help people to identify the staff who are supporting them. In general we saw that the staff were kind and supportive towards people. They spoke to people with genuine affection and listened to what people were saying. We saw some examples where the staff appeared rushed and preoccupied with specific tasks and this sometimes looked like they were not taking notice of the people they were caring for. In one instance witnessed a conversation where a member of staff did not understand what someone was asking them and after the person had repeated their question several times the member of staff just walked away without answering. This appeared to be frustrating for the person trying to communicate with them. The manager has arranged regular meetings for people who live at the home and their families. People told us that they generally liked the food. We saw that people were given a choice of drinks at mealtimes but that food, including vegetables, was plated up by staff and people were not able to make a choice about portion sizes or the vegetables they wanted. We saw that some hot food was delivered from the kitchen tightly wrapped in cling film. This practice may put people at risk, and hot food should not be covered with plastic wrapping. Menus were available on dining tables and people told us that they were able to choose what they wanted from the menu. The menus included pictures of each dish. This is good practice and helps people to have a better understanding of what food is being offered. They told us that they were able Greville House Care Home DS0000065297.V375258.R01.S.doc Version 5.2 Page 16 to order something different if they did not like what was on the menu. People told us that the chef visits them to discuss their enjoyment of each meal. Some of the things people said about food were, ‘food could do with updating’, ‘fish and chips is my favourite’, ‘I would like more choice of food’, ‘I am given a menu daily’, ‘the chef comes and asks me once a day about my meals’ and ‘food is nice’. Greville House Care Home DS0000065297.V375258.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are protected by procedures designed to safeguard them and regular training and information for staff. People know how to make a complaint and feel confident that these will be dealt with appropriately. EVIDENCE: There is an appropriate complaints procedure and this is displayed around the home. People we spoke to knew how to make a complaint. There is a record of all complaints and how these are investigated and resolved. The organisation has procedures on protecting people and whistleblowing. The home has a copy of the local authority procedure on safeguarding adults. All the staff have had training in this area and the manager told us that this training had recently been updated for everyone. Some of the people who live at the home have attended an information session about safeguarding so that they have an understanding of the staff’s roles and responsibility in keeping them safe. Some of the people told us that they had enjoyed this session and found it very useful. This is good practice and the manager told us that they were considering giving people training sessions in other areas, such as health and safety and food hygiene. Greville House Care Home DS0000065297.V375258.R01.S.doc Version 5.2 Page 18 There have been a number of incidents which led to safeguarding referrals since the last inspection. The manager has responded well to these and worked closely with us, the local authority and other agencies to make sure people are protected and any poor practice is addressed. Greville House Care Home DS0000065297.V375258.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well maintained, attractive and clean environment. EVIDENCE: The building is generally well maintained and decorated. Communal areas are attractively furnished and the home is light and spacious. People are able to personalise their own rooms. We saw a range of pictures, ornaments and other personal items throughout the home. The clock in one lounge was telling the wrong time. Staff should be vigilant to check clocks are correct. We saw that in many of the communal lounges televisions were left on when no one was in the room throughout the day. The staff should make regular checks to make sure televisions are switched off when no one is watching them and that Greville House Care Home DS0000065297.V375258.R01.S.doc Version 5.2 Page 20 people are able to chose whether they want them on or not when they are in a room. There is an attractive garden with seating areas and raised flower beds. All bedrooms have en suite toilets and en suite showers were being installed at the time of the inspection. One person told us they were, ‘looking forward to having this additional facility.’ Each person has their own bedroom which is identified with a name label. Some labels have pictures on but these were not always something that was meaningful to the person. The layout of the house can be confusing to some people trying to identify their bedroom and rooms should be labelled with something meaningful to that individual. The manager told us that she planned to create a ‘memory box’ for people who wanted. This would be a collection of photographs and other memorable items designed to help people locate their own room. We found that in a number of communal bathrooms and WCs the paper towels were situated high up on the wall and were inaccessible to wheelchair users. Some call bell cords were also inaccessible. Kitchen surfaces were not adjustable and therefore might be difficult for some people to access these. The home was clean and fresh throughout our visit. People told us that the home was always clean and fresh and that the laundry service was good. One person said, ‘they keep the place clean’. Greville House Care Home DS0000065297.V375258.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by well trained and appropriately recruited staff. EVIDENCE: Some of the things people said about the staff were, ‘some of the staff are very friendly’, ‘the staff are nice’, ‘I like the older staff’ and ‘some care staff are good at caring’. We spoke to some of the staff at the home. They said that they really enjoyed their roles, and that they wanted to help give people confidence. Some of the things they said were, ‘I have updated training in every aspect of my job’ and ‘we have a handover every day where we share information about residents’. Shortly before the inspection a new deputy manager was employed. We spoke to him. He said that they had had a good induction and was well supported in his role. The deputy manager had some good ideas for the development of the service and showed a very good knowledge of the people who live there and staff. Greville House Care Home DS0000065297.V375258.R01.S.doc Version 5.2 Page 22 The home is appropriately staffed and there is a good range of information for the staff on their roles and responsibilities. There are appropriate procedures for recruiting new staff. One of the people living at the home has helped to interview staff. We saw a sample of staff records. These showed that thorough pre employment checks had been made. The staff told us that they had a good range of training which was relevant to their jobs and which helped them. We saw records of up to date training for staff and saw that the manager monitored when staff needed to have retraining. There have been a number of incidents at the home where the manager has identified that certain staff should have more training in a specific area. We saw that this had been provided and their practice assessed. All the staff have recently had training in safeguarding adults. Some of the staff who do not speak English as a first language have been supported to attend courses to help them improve their language skills. There are regular staff meetings and a meeting to handover information every time the staff shift changes. In one area of the home the staff told us that these handover meetings were very helpful and they used this opportunity to discuss different procedures and quality care issues. Greville House Care Home DS0000065297.V375258.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home which is well managed. EVIDENCE: The manager has been in post for 2 years. She is appropriately qualified and has experience managing another care home. She has shown a commitment to improving the service and working closely with other agencies to make positive changes. She demonstrated a very good knowledge of the service and about the individual people living there and the staff. People told us that they felt supported by the manager and could approach her with concerns or suggestions. One member of staff said that the manager was, ‘brilliant’. Greville House Care Home DS0000065297.V375258.R01.S.doc Version 5.2 Page 24 The Manager is not yet registered with the Care Quality Commission and needs to make an application for this. The organisation arranges for regular monitoring checks on the service, including visits from the area manager. Reports of these visits are kept and an action plan is developed where there are any areas of improvement. The local authority have a contract with the home to provide care for people from the borough. They regularly visit the home and monitor the home’s success in meeting their contract. The local authority contract monitor was visiting the home on the same day as our visit. The organisation writes to people who live at the home and their representatives and asks them to complete surveys about the home. The manager told us that these surveys were sent directly back to the organisation’s head office. The manager told us that they were creating in house questionnaires about specific aspects of the home, such as food, activities and cleanliness. She told us that they planned to give these to people at regular intervals to gain feedback on the different services and facilities. The manager told us that they had sent questionnaires to the staff asking for their views on the home and how things could be improved. Staff have opportunities to meet their manager regularly to discuss their work practice. The manager has created a record to monitor these and make sure they are taking place. People are able to leave small amounts of cash for safekeeping at the home. There are appropriate procedures for keeping this safe and keeping accurate records of expenditure and receipts. We looked at a sample of records and saw that these were accurate, clear and regularly checked. There are regular recorded checks on health and safety and fire safety and we saw evidence of these. We saw that any concerns were rectified. Staff have had training in these areas and there are a range of policies, procedures and guidance for all staff to maintain health and safety. The fire risk assessment and building risk assessment are up to date. Some of the staff told us about recent fire training they had had which showed them how to evacuate people in an emergency. During our visit we found that a cleaning and electrical cupboard which had a sign stating it must be kept locked shut was open. We alert staff to this and they assured us that the cupboard would be locked. However, later in the day we found that this was still unlocked and the door was slightly open. Greville House Care Home DS0000065297.V375258.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 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 X 2 Greville House Care Home DS0000065297.V375258.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 Requirement Timescale for action The Registered Person must 14/06/09 make sure oxygen is stored securely in the home so that there is no risk of cylinders falling over and causing leakage or injury. The Registered Person must 14/06/09 make sure the controlled drug key on the second floor is kept securely. This is to comply with the Misuse of Drugs Act 2. OP9 13 3. OP10 13 The Registered Person must 14/06/09 make sure call bells are accessible and all staff know the how important it is that people have call bells within reach. The Registered Person must 31/08/09 make sure people are support to pursue their individual interests and hobbies and that there is a DS0000065297.V375258.R01.S.doc Version 5.2 Page 27 4. OP12 16 Greville House Care Home record of these and events which are important to that person. 5. OP15 13 The Registered Person must 14/06/09 make sure hot food is not wrapped in cling film plastic as this may put people at risk. The Registered Person must 31/07/09 make sure the manager makes an application to register with the Care Quality Commission. The Registered Person must 14/06/09 make sure electrical and cleaning cupboards are kept locked shut. 6. OP31 8 7. OP38 13 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations There should be clear and detailed information on people’s cultural and religious needs. The manager needs to make sure procedures for recording the presentation and method of handling medication for residents admitted into the rehabilitation unit and also on their discharge are reviewed. This is to ensure continuity of individual needs of residents in handling medication. 3. OP12 The staff should make sure bookcases are accessible to everyone. DS0000065297.V375258.R01.S.doc Version 5.2 Page 28 2. OP9 Greville House Care Home 4. OP12 The staff should offer people opportunities and support to use the garden and to go out in the local community. The manager should consider contacting befriending organisations who might be able to offer support to some people who do not have relatives or regular visitors. The staff should make sure everyone at the home has opportunities to be involved with day to day tasks, selecting staff and making decisions about the running of the home. The staff need to make sure they do not appear distracted and rushed when attending to tasks and give their attention and time to supporting and caring for people. The staff should offer people a choice of vegetables and portion sizes at meal times before serving. The staff should make sure clocks in communal areas tell the right time and that TVs are turned off when no one is watching them. The registered person should make sure everyone’s door is labelled with a sign which is meaningful to them to help them identify their own room. The registered person should make sure hand towels and call bells are accessible for wheelchair users. 5. OP13 6. OP14 7. OP14 8. OP15 9. OP19 10. OP19 11. OP19 Greville House Care Home DS0000065297.V375258.R01.S.doc Version 5.2 Page 29 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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