Inspection on 01/11/07 for Grey Gables

This inspection was carried out on 1st November 2007.

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

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

Other inspections for this house

Grey Gables 11/08/09

Grey Gables 17/09/08

Grey Gables 03/05/07

Grey Gables 23/11/06

Grey Gables 03/05/06

Grey Gables 09/12/05

Grey Gables 07/06/05

Grey Gables 05/10/04

Grey Gables 29/06/04

Grey Gables 26/01/04

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

CARE HOMES FOR OLDER PEOPLE Grey Gables 39 Fox Hollies Road Acocks Green Birmingham West Midlands B27 7TH Lead Inspector Brenda O’Neill Key Unannounced Inspection 1st November 2007 09:30 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 Grey Gables DS0000016772.V353510.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. Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grey Gables Address 39 Fox Hollies Road Acocks Green Birmingham West Midlands B27 7TH 0121 706 1684 0121 706 2025 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) www.greygables.org.uk Grey Gables Committee Mrs Annemarie Hosty Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home provide evidence that external support to the management of the home has been provided for the next three months, by 30 April 2006. 23rd August 2007 Date of last inspection Brief Description of the Service: Grey Gables is a care home, which is registered to accommodate up to 40 elderly people. It is close to public transport links. It is set in a large, extended property. The home is owned and run by an unincorporated registered charity, Grey Gables Trust, and representatives of the committee visit the home regularly. The home has a selection of sitting rooms and dining rooms and although the people living at the home may choose where they spend their time, they are grouped in units according to their level of dependency. The home had one double bedroom and the rest were single rooms, the vast majority have en suite facilities. The home has ample assisted bathing facilities including one assisted shower. There are parking spaces at the front of the building and to the rear is a large, accessible and well-maintained garden. The homes main entrance has steps but there is a separate access point for people with mobility difficulties. The home has two passenger lifts that ensure all areas of the home are accessible. Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this key inspection over two days in November 2007. A pharmacist inspection took place on a separate day to the main inspection which lasted just over two hours. During the course of the inspection a tour of the home was carried out, the files for four of the people living in the home and three staff were sampled as well as other care and health and safety documentation. The inspectors spoke with the manager, four staff and six of the people living in the home. Some surveys were completed by the people living in the home during the course of the inspection. Prior to the inspection an Annual Quality Assurance (AQAA) had been completed by the manager and returned to the Commission. This gave some additional information about the home. A random inspection had also been carried out at the home in August 2007. this inspection took place to assess the progress being made on some of the requirements made following the key inspection in May 2007. During this inspection care plans, risk assessments, health care and daily records were sampled and a random audit of the medication system was undertaken. The findings from this inspection are commented on throughout this report. No complaints have been raised with the Commission since the last key inspection. There had been one complaint lodged with the home by a relative in relation to the decoration of a bedroom. This had been responded to by the manager and a compromise had been reached. There have been two adult protection issues at the home since the last inspection. Both were reported appropriately by the staff in the home to Social Care and Health after issues had been raised by the people living in the home. Both issues were investigated and resolved satisfactorily. What the service does well: The needs of the people being admitted to the home were assessed prior to admission ensuring staff were aware of their needs. People could visit the home prior to admission to assess the facilities available to them. The people living in the home received attention from health care professionals as needed to help with meeting their health care needs. People living in the home could have time in private if they wished. Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 6 The home was very calm and relaxed throughout the course of the inspection. The people living in the home appeared quite content. Comments received included: ‘They are wonderful could not do anymore for you.’ ‘They are very good.’ ‘It is a very good home.’ There were organised activities available for people to take part in if they wished. There were several organised events in the home, for example, a summer meal, Chinese meal, Easter party and so on. Relatives were invited to the larger organised events and these were well attended. Visitors were seen to come and go from the home and were made welcome by staff. The menus in the home showed that the meals were very varied and nutritious and that there were choices available at every meal. The people living in the home seemed generally happy with the meals. Comments received included: ‘We get two choices, we get enough. I don’t like some of the meat.’ ‘We are given a choice.’ ‘Food is very good.’ Complaints in the home are appropriately investigated and responded to. Staffing levels were appropriate for the needs of the people living in the home. Throughout the course of the inspection it was clear that staff had good relationships with the people living in the home. Individuals remarked ‘they are very good’, ‘they are very helpful’ and ‘they are wonderful’. What has improved since the last inspection? Staff at the home were being more vigilant to ensure they were not admitting people to the home whose needs could not be met. There had been further improvements to the systems in place for care planning and risk assessments ensuring the people living in the home received better person centred care. Further improvements were still required. Records detailing the health care needs of the people living in the home had improved. . From the records seen health care needs were being followed up and visits from health care professionals and their outcome were clearly detailed. The medicine management has improved to a good standard. Some good systems have been installed to ensure that all the medicines are administered as prescribed. Efforts were being made to ensure the social needs of all the people living in the home were met. Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 7 There was evidence available at this inspection to suggest that the people living in the home were listened to and their views acted on. Staff were recognising and reporting any adult protection issues appropriately ensuring the people living in the home were safe guarded. The home was being more vigilant about reporting any injuries sustained by the people living in the home to the Commission. This provided evidence that incidents and accidents were being managed appropriately. There had been further improvements to the environment and all the safety issues raised at the last key inspection had been met. This ensured the people living in the home had a comfortable and safe home in which to live. Staff had undertaken training in numerous topics ensuring they were equipped with necessary skills and knowledge to enable them to care safely for the people living in the home. The management of the home as a whole had improved ensuring the people living there were better safe guarded. What they could do better: Care plans must detail how any identified needs are to be met by staff, include strategies for managing any difficult or challenging behaviours and how any other identified risks are to be minimised. This will ensure the people living in the home receive person centred care and are fully safe guarded. To ensure any significant weight loss or gain is noted at an early stage the people living in the home must be weighed on a regular basis. Staff must ensure that where individuals make choices these are respected unless there is a specific documented reason either written in the care plan or as part of a risk assessment about the restriction. This will ensure that people living in the home do not have their choices restricted without good reason. To ensure staff are equipped with all the necessary skills and knowledge to care for the people living in the home new staff must complete their induction training within the time scales specified by Skills for Care. To ensure plans are in place to continuously improve the service for the people living in the home the manager must develop systems for improving the service at the home based on a yearly quality assurance review. Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 8 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. Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of people being admitted to the home were assessed prior to admission to ensure staff knew what these were. People could visit the home prior to admission to assess the facilities available to them. EVIDENCE: The file for one person admitted to the home since the last key inspection was sampled. The file included a pre admission assessment that covered all the required areas including, personal care and physical well being, communication, oral health, mobility, mental state and social needs. This form was not signed or dated. There was also another form entitled ‘Pre-assessment form’ this was signed and dated and included details on the individuals daily routines, likes, dislikes and allergies, medication, personal hygiene, relationships and favourite activities. Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 11 The manager sated that the form that was signed and dated was the newer form and the one that was being used in the home. The individual concerned had had short stays at the home prior to her permanent admission and the unsigned form had been used for these. Clearly this person had visited the home prior to her permanent admission as she had had some respite care. She also confirmed that she had been going to the home once a week for a while. There was no evidence to suggest the placement at the home had been reviewed after the 28-day trial period. It was strongly recommended that reviews took place to ensure the individual was satisfied with the service they were receiving and that they were assured the home could continue to meet their needs. There were some issues raised at the last key inspection about the home admitting people with dementia that they were not registered to care for. This had been addressed and much more attention was being paid to the needs of people referred to the home to ensure the staff at the home could meet them. Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The systems in place for care planning and risk assessments had improved. Further improvements were required to these documents to ensure staff knew how they were to meet the needs of the people living in the home and minimise any risks. The manager has worked hard to put in good systems to ensure that all medicines are administered as prescribed. Staff were well trained and the medicines are monitored on a regular basis. EVIDENCE: At the time of the last key inspection several concerns were raised about the systems in place for care planning and undertaking risk assessments. For example, the needs identified in pre admission assessments had not been carried forward to the care plans and all the required risk assessments were not in place. A random inspection was undertaken in August 2007 and some improvements had been made. It was clear that staff had been working hard to update the files and they were well organised and easy to follow. Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 13 All the files included detailed profiles of the individuals providing some useful information for staff about the people being cared for. All the files sampled included care plans but these varied in quality and the detail included. Although there had been some improvements in the risk assessments being undertaken not all the required risk assessments were in place on the files sampled and those that were varied considerably in quality and detail. At the time of this inspection four care files were sampled and further improvements had been made. All the files included profiles of the individuals and care plans, one of the care plans was an old type and was just being updated. The profiles of the individuals included some good detail of their abilities, preferences and preferred daily routines and in many instances how their needs were to be met. Some gave more detail than the care plans. It was strongly recommended that the profiles were used as general overviews only and that the care plans were used to detail how any specific needs were to be met by staff. This would ensure that the profiles were not too long and staff would know exactly where to look for detail of how to meet a specific need. Care plans varied in detail. Some areas were well detailed, for example, there was good detail on one of how an individual’s short term memory affected them and on another how a person’s diabetic diet was to be met. Other areas on the care plans stated such things as ‘needs a little assistance’ with no detail of what the assistance was and ‘provide with activities’ with no further explanation. In some instances details on the profiles and assessments were not included in the care plans, for example, one assessment detailed one person wanted 3 pillows this was not included in the care plan. It was also detailed that the same person wanted small meals and did not like onions this had not been included in the care plan. Staff needed to ensure that the care plans included all the needs of the people living in the home and details of how these needs were to be met. It appeared that staff were signing the care plan agreements where they should have been signed by the individual concerned or their representative. Some of the files included care plans that were no longer in use and it was strongly recommended that these be removed so that staff were only working with the most current information. There had been some improvements in the risk assessments undertaken for the people living in the home but further improvements were required. All the files included personal, manual handling, tissue viability and nutrition risk assessments. The personal risk assessments that were in place were generally adequate and covered such things as mobility, falling out of bed and so on. It was noted that one of the people living in the home did have some challenging behaviour. There was no management plan in place for this for staff to follow. Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 14 The manual handling risk assessments needed to detail the type of hoist and sling size where these were referred to. It was noted that one of the tissue viability risk assessments highlighted the individual was at high risk of developing pressure sores but there was no plan in place to detail how this risk was to be minimised. At the time of the random inspection daily records had improved and were cross referenced to health care records on most occasions, but not always, and on occasions health care needs were being identified and not followed up. This appeared to have improved at the time of this inspection. From the records seen health care needs were being followed up and visits from health care professionals and their outcome were clearly detailed. Records showed that the people living in the home had access to medical professionals including G.Ps, district nurses, opticians and psychiatrists as required. The people living in the home were being weighed. This was supposed to be undertaken monthly but the frequency of this needed to be improved for some. If an individual is not weighed the reason must be recorded. No issues were raised by the people living at the home in relation to their privacy or dignity. Staff were observed to knock on bedroom doors before entering and address the people living at the home respectfully. People living at the home could have keys for their bedrooms if they wished and had a lockable facility in their rooms. Some had their own telephones in their bedrooms and there was also a telephone for their use in a quiet area of the home. Medical consultations took place in the privacy of bedrooms and there were several areas in the home where people who were living there could receive visitors if they did not want to take them to their bedrooms. As several concerns were raised over the medicine management in the home at the time of the random inspection the pharmacist inspector was asked to audit the medication system as part of this inspection. The pharmacist inspection took place on a separate day to the main inspection. It lasted just over two hours. The medicines for three of the people living in the home were looked at together with the corresponding medication to assess whether the medicines had been administered as prescribed. Care records were also checked to see if they supported the individuals’ clinical needs. One member of staff and one of the people living in the home were spoken with during the inspection. The medicine management was good. Records were clear and the manager had installed some very good systems to ensure that all staff was accountable for their actions. The majority of medicines had been administered as prescribed and records supported practice. The people living in the home were supported if they wished to sell adminsiter all or part of their medication but a more robust risk assessment was required to ensure their needs were fully met. Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 15 The people living in the home were encouraged to leave the home on social leave. Currently staff secondary dispense their medicines into medi-dose packs. One medicine had not been included in one pack and it was unlabelled. No policy could be found to support this practice. Liaison with the pharmacist was advised to address this issue. The home had one Controlled Drug on the premise. The cabinet did not comply with the new regulations for storage of Controlled Drugs. One mistake was seen in the CD register but this was corrected during the inspection. The home offers a good choice of medicines for the people living in the home to be offered to treat mild symptoms. The policy was very general and did not support each individual medicine purchased. The medication policy was brief and all staff were aware of it. In house training had been given to all staff that handle medicines in addition to a training course provided by the community pharmacy. One staff member spoken with during the inspection had a reasonable knowledge of the medicines she handled. The manager was very keen to improve practice further and this was commended Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 16 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 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were organised activities available for people to take part in if they wished and efforts were being made to ensure the social needs of all the people living in the home were met. The arrangements for visiting the home enabled visitors to come at any reasonable hour. The menus at the home were varied and nutritious and the people living in the home were generally happy with the catering arrangements. EVIDENCE: The home was very calm and relaxed throughout the course of the inspection. The people living in the home appeared quite content comments received included: ‘They are wonderful could not do anymore for you.’ ‘They are very good.’ ‘It is a very good home.’ During the course of the inspection the people living in the home were seen to take part in a church service, have hand massages and have their hair done. Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 17 Others were watching television, reading, chatting in small groups, sitting outside and spending time quietly in their rooms. Visitors to the home facilitated knitting and craft sessions. One of the people living in the home spoke to the inspector of knitting squares that had been made into a blanket that was to be raffled at the Halloween/Bonfire party shortly after the inspection. Records showed that there were activities available for the people in the home to take part in, for example, watching films, music and movement, dominoes and aromatherapy. Staff had begun to record one to one time given to those people who could not or did not want to take part in the organised activities but they did not always record what had been done during this time. The inspector was also informed that staff were starting to spend time with individuals to write up their life stories and this appeared to be enjoyed by both the people living in the home and the staff. There were several organised events in the home, for example, a summer meal, Chinese meal, Easter party and so on. Relatives were invited to the larger organised events and these were well attended. Outside entertainers also visited the home. Visitors were seen to come and go from the home and were made welcome by staff. Daily records showed that visitors attended the home at varying times throughout the day and many of the people living in the home went out with relatives. One person continued to go home every weekend. In the main the people living in the home appeared to be able to exercise choice and control over their lives in such things as choosing what they did during the day, what to wear, when to get up and go to bed and what to eat. At the previous inspection an issue had been raised about the people being admitted to the home not being able to self medicate despite their assessment stating they would like to. This had been addressed at the time of this visit and at least one of the people living in the home had self administered their medication after admission. It was noted that in one person’s daily records some of the requests that had been made by the individual had been denied by staff, for example, to have breakfast in bed. Staff had recorded ‘wanted breakfast in bed but not allowed because of choking’ there was no risk assessment in place that detailed the individual was at risk and when speaking to the manager about this there did not appear to be a risk. Staff must ensure that where individuals make choices these are respected unless there is a specific documented reason either written in the care plan or as part of a risk assessment about the restriction. The menus in the home showed that the meals were very varied and nutritious and that there were choices available at every meal. The home also had an emergency menu that was used if the cook was ever off work at short notice. The inspectors were shown a copy of the Christmas menu that had been drawn up so that it could be discussed with the people living in the home. Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 18 There was evidence that meals were discussed at the meetings held with the people living in the home and that where necessary the menus were changed. The people living in the home seemed generally happy with the meals comments received included: ‘We get two choices, we get enough. I don’t like some of the meat.’ ‘We are given a choice.’ ‘Food is very good.’ One of the comments stated the food was not hot enough for the individual concerned and the manager was to look into this. Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 19 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints in the home are appropriately investigated and responded to. Staff had received further training in adult protection and any issues were being reported appropriately ensuring the people living in the home were safeguarded. EVIDENCE: The complaints procedure was not viewed as it had been seen at previous inspections. No complaints have been raised with the Commission since the last inspection. There had been one complaint lodged with the home by a relative in relation to the decoration of a bedroom. This had been responded to by the manager and a compromise had been reached, new curtains were to be fitted, as the individual concerned did not want to move out of the room while it was redecorated. There was evidence to suggest that the people living in the home were listened to and their views acted on. Some issues about the laundry system in the home had been raised at the meetings with the people living in the home. These had been addressed and improvements were noted in the minutes of the following meetings. Menus had been changed as a result of the comments made by the people living in the home. The six completed surveys received from the people living in the home all indicated that staff always listen to them and act on what they say and that they knew who to go to if they were unhappy about anything. Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 20 At the time of the last inspection issues were raised about staff failing to listen to the people living in the home, recognise adult protection issues and report them appropriately. Since then staff have received further training and the issues have been addressed. There have been two adult protection issues at the home since the last inspection. Both were reported appropriately by the staff in the home to Social Care and Health after issues had been raised by the people living in the home. Both issues were investigated and resolved satisfactorily. The home was being more vigilant about reporting any injuries sustained by the people living in the home to the Commission. This provided evidence that incidents and accidents were being managed appropriately. Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provided the people living there with a safe, comfortable and well maintained environment in which to live. EVIDENCE: There had been further improvements in the home since the last key inspection. New boilers had been installed and work was ongoing on these to ensure the heating and water temperatures were appropriate for the people living in the home. New flooring had been fitted in the two lounges and the dining area and there had been some decoration. The issues raised at the last inspection in relation to the wall lights being unsafe had been addressed and quotes had been obtained to have the old call system removed, in the mean time the system had been made inaccessible to the people living in the home. Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 22 Also the carpet that was fraying and a potential tripping hazard had been addressed. The manager also informed the inspector that one of the kitchenettes was to be refurbished and new flooring was to be fitted in the main kitchen. Some areas of the home remained in need of redecoration and some carpets were in need of replacing however it is recognised that in a home of this size this is an ongoing issue. It was strongly recommended that the manager had a yearly improvement plan for the environment that prioritised what was to be done in the environment. Some minor repairs were noted during the tour of the home which need to be addressed, damaged plaster by one of the bathroom doors, a small area of fraying carpet by the lift and some lose carpet on one of the stairs. As at the last inspection there were ample communal areas in the home and these were comfortable and well decorated. The home had a very pleasant, well maintained garden that had some seating available for the people living in the home. Access to the garden was problematic for the people living in the home with mobility difficulties as the ramped access was quite narrow. Safe access to the garden for them should be explored. This is an ongoing recommendation. The home had a number of bathrooms and one floor level shower where staff were able to give full assistance. The majority of the bathrooms had bath hoists installed. The shower room had a wash hand basin but the other bathrooms needed to have these fitted. This is an ongoing issue. As at the last inspection some of the corridors had handrails others did not and were needed to ensure people living in the home could move around safely. Other aids and adaptations were available in the home including passenger lifts, hoists, wheelchairs hand and grab rails in the toilets and an emergency call system. Some bedrooms were seen during the tour of the home. They varied in size and were generally comfortable and well decorated. Most of the bedrooms in the home have en-suite facilities of toilet and wash hand basin. The people spoken with stated they were happy with their bedrooms. Although the water temperatures were not tested during the inspection the staff at the home were monitoring these. The records showed the water temperatures were still fluctuating despite the new boilers being installed. This problem was being addressed at the time of the inspection. The home was found to be clean and odour free. COSHH storage had improved since the last inspection. The laundry was appropriately equipped and there were systems in place for the disposal of clinical waste. The kitchen was clean and well organised. It was noted that there were some foods stored in the fridge that had not been dated on opening. Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 23 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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Appropriate staffing levels were being maintained by a well trained staff team enabling the needs of the people living in the home to be met. Recruitment procedures were robust and safeguarded the people living in the home. EVIDENCE: Discussions with the manager showed that there had been some staff turnover at the home however there were a core group of staff who had worked there for a considerable amount of time. This was good for the continuity of care of the people living in the home. There were some staffing vacancies and the manager had had a big advertising campaign to try and attract recruits but this was to little avail. The manager was now looking at using a recruitment agency to cover the vacant posts. Staffing levels at the time of the inspection were on occasions dropping below the recommended minimum of six care assistants throughout the waking day however occupancy levels in the home were down. The levels at the time appeared to meet the needs of the current people living in the home. Night staffing levels remained at two waking care staff however the manager was still pursuing an extra member of staff sleeping in the home. Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 24 She is aware that when the occupancy in the home reaches 35 an extra member of staff is required to be in the building throughout the night by the fire service. The home also employed several domestic, catering, laundry and administrative staff. Throughout the course of the inspection it was clear that staff had good relationships with the people living in the home. Individuals remarked ‘they are very good’, ‘they are very helpful’ and ‘they are wonderful’. The recruitment records for three staff who have been appointed since the last key inspection were sampled. All the required documentation and checks had been obtained prior to them starting work at the home. Files included completed application forms, two written references, medical questionnaires and declarations of fitness and CRB checks. There was some evidence that the new staff had undertaken some induction training. The induction procedure in the home did comply with the specifications laid down by Skills for Care however this was not being completed within 12 weeks as required. New staff must cover all the required training within the first 12 weeks of their employment to ensure they are equipped with all the necessary skills and knowledge to care for the people living in the home. The manager had compiled a training matrix for the home and as staff had not been able to evidence some of their past training she had started afresh. A lot of training had taken place in the home throughout this year topics included, food hygiene, manual handling, infection control, dementia awareness, adult protection, medication, first aid, fire procedures, care planning and customer care. The manager was making every effort to ensure that each staff member had undertaken all the required. The inspector was informed that of the twenty six care staff employed at the home fifteen had NVQ level 2 and eight of those people also had NVQ level 3. Grey Gables DS0000016772.V353510.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, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management of the home had improved ensuring the people living there were better safeguarded. The home needed to have a system in place for reviewing the quality of the service based on seeking the views of the people living there with a view to continuous improvement. EVIDENCE: The manager was not on duty on the first day of the inspection but she was contacted and was present for the majority of the inspection. The manager had been employed at the home for a considerable amount of time and had a good knowledge of the needs of the people living in the home. Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 26 Several concerns were raised about the management of the home at the last key inspection. At the time of the random inspection several improvements were noted however there were major concerns about the medication management. At the time of this inspection the improvements had been sustained and further progress had been made particularly in relation to the medication management, care planning and risk assessments. Clearly the manager had been working very hard to try and ensure the outstanding requirements were met and she was very committed to improving the standards in the home. The home still did not have a formal quality monitoring system in place however the manager had been in touch with an outside agency to come and talk to the staff about putting a system in place. Meetings with the people living in the home were being held once a month and the manager stated attendance at these had improved. Clearly issues raised at the meetings were followed up, for example, the laundry system had been improved and menus were changed after comments received. The manager was keen to involve the people living in the home in any quality monitoring systems that were put in place. There were also regular staff meetings where any issues about the service offered in the home were discussed and any staff unable to attend the meetings were expected to read the minutes to ensure they all had the information. As at the last inspection the home did not handle any finances on behalf of the people living there. The manager was satisfied that they got access to as much money as they required. When individuals had their hair done or purchases were made on their behalf their relatives/representatives were invoiced directly. Health and safety in the home were well managed and staff received training in safe working practices. The fire officer had raised several issues on his last visit to the home. The majority of these had been addressed and any remaining were being pursued by the manager. The time scale given for following up all the issues had not expired at the time of the inspection. General health and safety checks were up to date including the servicing of equipment. Evidence that the bath hoist had been serviced could not be found at the time of the inspection however the inspector was informed this had been carried out at the same time as the mobile hoist service. All the in house checks on the fire system and regular fire drills were taking place. The issues raised at the last key inspection in relation bare light bulbs, unsafe light fittings and frayed carpet had been addressed. Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 27 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 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 2 2 X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement The care plans for the people living in the home must clearly detail all the needs of the individuals and how their needs are to be met by staff. (This requirement has been outstanding since 21/07/03) This will ensure that the people living in the home receive person centred care. Care plans must include 16/12/07 strategies for managing any difficult or challenging behaviours. (This has been outstanding since 14/06/07.) This will ensure the people living in the home are safe guarded. Manual handling risk assessments must be specific about the equipment to be used when moving people. (This has been outstanding since 14/09/07) This will ensure the people living in the home are moved safely. Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 29 Timescale for action 31/12/07 2. OP7 13(4)(c) 3 OP7 13(5) 16/12/07 4 OP8 13(4)(c) Where a risk is identified on tissue viability assessments there must be a plan in place to manage this. (This has been outstanding since 01/07/07 not met.) This will ensure people living in the home have their health care needs met. The people living in the home must be weighed monthly or a reason detailed as to why this has not happened. This will ensure any significant weight loss or gain is noted at an early stage. Staff must ensure that where individuals make choices these are respected unless there is a specific documented reason either written in the care plan or as part of a risk assessment about the restriction. This will ensure that people living in the home do not have their choices restricted. Opened foods that are stored in the fridge must be dated on opening. This will ensure the people living in the home are not exposed to the risk of infection. Staff must complete their induction training within the time scales specified by Skills for Care. This will ensure the staff at the home have the necessary skills to care for the people living in the home. 16/12/07 5. OP8 13(4)(c) 16/12/07 6. OP14 12(3) 16/12/07 7. OP26 13(3) 16/12/07 8. OP30 18(1)(a) 31/12/07 Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 30 9. OP33 24(1) The manager must develop systems for improving the service at the home based on a yearly quality assurance review. (This has been outstanding since 01/08/06) This will ensure plans are in place to continuously improve the service for the people living in the home. 01/02/08 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. 2. 3. Refer to Standard OP3 OP7 OP7 Good Practice Recommendations It is recommended that placements at the home are reviewed after 28 days to ensure people living in the home are satisfied with the service being offered. It is recommended that all old care plans are removed from working files to ensure staff have only the current documents available to them. Care plans should be agreed with the people living in the home and signed by them or their representatives. This will show individuals or their representatives have been consulted about how their care is to be delivered. It is recommended that the profiles for the individuals living in the home are used to give a general overview of the individuals living in the home. Specific needs should be detailed in the care plans. This will ensure staff know exactly where to find information. It is recommended that the home installs a quality assurance system to individually assess staff competence in the handling of medicines. 4. OP7 4. OP9 Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 31 5. OP9 6. 7. 8. 9. OP9 OP9 OP12 OP19 10. OP19 11. 12. 13. OP20 OP21 OP22 It is recommended at all homely remedies are supported by a policy detailing their individual use. It is advised that a risk-assessed self administration policy is written to support service users to self administer their own medicines It is recommended that the home purchases and installs a Controlled Drug cabinet that complies with the Misuse of Drugs (Safe Custody) Regulations 1973 It is recommended that all medicines for social leave are dispensed by the community pharmacy where possible and secondary dispensing is avoided. Staff should record what has taken place during one to one sessions with people living in the home. This will help to evidence their social needs are being met. Any areas of the home in need of redecoration and any minor repairs that were highlighted during the inspection must be addressed this will ensure the standards in the home are kept to an acceptable standard for the people living there. The home should have a yearly improvement plan detailing what areas of the environment are to be redecorated, refurbished and so on. This will ensure acceptable standards are maintained in the home. Access to the garden should be reviewed to ensure it is safe for the use of all the people living in the home. Wash hand basins should be provided in all bathrooms where there is a toilet. This will ensure good standards of hygiene for the people living in the home. The availability of handrails around the home should be reviewed to ensure the people living there can move around the home safely. Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Grey Gables DS0000016772.V353510.R01.S.doc Version 5.2 Page 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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