Inspection on 11/07/06 for Grey Gables

This inspection was carried out on 11th July 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Grey Gables 07/09/07

Grey Gables 01/03/06

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

CARE HOMES FOR OLDER PEOPLE Grey Gables 1 Lodges Grove Bare Morecambe Lancashire LA4 6HE Lead Inspector Mrs Joy Howson-Booth Unannounced Inspection 11th July 2006 10:00 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 DS0000066324.V286288.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 DS0000066324.V286288.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grey Gables Address 1 Lodges Grove Bare Morecambe Lancashire LA4 6HE 01524 425376 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) Ewood Residential Homes Limited Mrs Elaine Ann Wood Care Home 15 Category(ies) of Dementia (15) registration, with number of places Grey Gables DS0000066324.V286288.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 15 service users in the category of DE (Dementia) The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Date of last inspection Brief Description of the Service: Grey Gables is registered to accommodate up to 15 people who have dementia. The home is situated in a quiet residential area of Bare in Morecambe and is close to local shops and amenities. The home is a large detached dwelling, situated on a corner site, with a small car parking area in the ground to the front. In addition, there is a small, secure garden area to the rear and side of the building. The home is comfortably decorated and has adequate communal space. There is also a small extension on the ground floor with bedrooms. There are bathroom and toilets on this floor. The first floor houses bedrooms and a bathroom. The home has 11 single bedrooms and 2 double bedrooms, none of these have ensuite facilities. The home has recently changed hands the new owner/manager being experienced and qualified in the care of people with dementia. The current weekly fees range from £293.00 to £405.00. Further details regarding fees are available from the owner/manager. Grey Gables DS0000066324.V286288.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first inspection that was unannounced so the owner/manager, staff and residents were not aware of the visit. The site visit forms part of the overall inspection for the home which makes sure people are being cared for properly and to make sure the home is a safe place for people to live in. The site visit took place over one day, although a further short visit was made to the home to provide feedback. The site visit included speaking with a small number of residents, observing staff on duty performing the day to day routines, speaking with staff, examining documents held in the home and speaking with the new owner/manager. The inspector looked around the home to find out about the improvements made and to see if the home was comfortable, clean and safe for people to live in. This inspection report contains evidence obtained from the site visit, from comment cards received from both residents and relatives and from a preinspection questionnaire completed by the owner/manager. Comment cards were also received from two Healthcare professionals, which were very positive about the care provided under this new ownership, the caring and sensitive approach by the owner and staff, the dignity and respect shown to the residents who were relaxed and happy The new owner/manager has made some significant changes to this service since registration in February 2006 and further details of these are contained in the following summaries and in the main report. The site visit was positive with everyone welcoming, friendly and co-operative during the visit. What the service does well: The service promotes equality by treating each resident with respect and dignity, with each person being cared for as an individual with their own personal needs and wishes being met. Staff are friendly and caring in their approach to care tasks. This was demonstrated during the site visit with residents being consulted with and staff looking after the residents in a positive and respectful way, offering choices and no one being hurried. Grey Gables DS0000066324.V286288.R01.S.doc Version 5.2 Page 6 Comments made by residents included “everything is good. I’d be hard pressed to find something wrong”; “Mrs Woods is lovely – nothing is too much trouble”; “Mrs Woods likes to run a good home and is always checking on things”. Overheard during lunchtime about the meal provided were the following comments “that was lovely”; “it was very nice”. Positive comments were also received from two relatives comment cards – one comment included “the care has much improved since the change of ownership”. There have been a number of improvements to the home, including some redecoration work, new stair lift, new kitchen and facilities and bathrooms being refurbished. The owner/manager has other plans for improvements to the home which are to take place in forthcoming months. The home itself has a friendly and relaxing atmosphere, very much as a small home where individual needs and wishes are catered for by the staff team. A tour of the home found it comfortable, homely, clean and hygienic. Furnishings and decoration are to a good standard but, as above, a programme for refurbishment is ongoing. What has improved since the last inspection? What they could do better: Attention needs to be given now to the paperwork side of things and the owner/manager has been provided with specific advice over what is needed in this report. Grey Gables DS0000066324.V286288.R01.S.doc Version 5.2 Page 7 The Statement of Purpose needs to include more information. The Service User Guide could be made easier to read for those people who may not be able to comprehend written information. A thorough assessment must be made by the home on any proposed new resident so that the home can be sure they are able to meet their needs. The care plans in place need to be reviewed on a monthly basis, or sooner if needed. Medication recording needs to be better. It was advised that the owner/manager should check on these records to make sure staff are recording accurately. A record of meals provided should be kept so that, if needed, information can be gained over what meals individual residents have eaten. This should also include any special diets or alternatives that are provided. The staff files need to show that all the required checks have been carried out on staff. It was advised that a recruitment checklist may be of use. Staff should have the opportunity to sit down with the owner/manager (or senior member of staff) to discuss the care they provide and also to identify if there is any training that may be of help. This should happen at least 6 times a year. Not all accidents have been recorded in the accident book. When an accident or incident has happened the Commission must be told about this. The owner/manager needs to put in place a formal quality system whereby residents, relatives, other professionals, etc., are asked about the care provided and if any improvements can be made. This should also include looking at the home to see if there are any improvements needed to the decoration or furniture, etc., in the home. Records on charges for residents are held but these are on a computer spreadsheet and may not be easy to get to if the inspectors need to look at them. A number of recommendations were also made which are included in more detail later in this report. Please contact the provider for advice of actions taken in response to this Grey Gables DS0000066324.V286288.R01.S.doc Version 5.2 Page 8 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Grey Gables DS0000066324.V286288.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 DS0000066324.V286288.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Anyone who is considering entering Grey Gables is supplied with enough information to help them make that decision. This means that people can make a choice about whether Grey Gables is the home for them. The home does not gather enough information about that person which means they cannot be clear that their needs can be met. Grey Gables does not offer an intermediate care facility. EVIDENCE: The home’s Statement of Purpose has been updated to reflect the new owner/manager and copies are available to prospective residents, although in reality it is usually the relatives who request this information. This document requires some additional information to be included. The Statement of Grey Gables DS0000066324.V286288.R01.S.doc Version 5.2 Page 11 Purpose recognises equality and diversity by stating individual needs will be met and confirms that staff will make sure residents rights are upheld. The Service User Guide is still being updated Residents are to be provided with a new Statement of Terms and conditions of residency once this has been completed for the new owner/manager. Contracts are provided from Social Services for those funded by them and the new owner/manager is to provide a contract for anyone privately funded. A new assessment format was seen, although an assessment undertaken by the owner/manager for a newly admitted resident was somewhat sparse and some information was not clear. However, the owner/manager had obtained a copy of the Social Worker’s Assessment. This was discussed with the owner/manager. It was also confirmed that trial visits are encouraged so that the home can get to know the prospective resident and they the home. Grey Gables DS0000066324.V286288.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s health and social care needs are met and residents are treated with dignity and respect at this home. EVIDENCE: New care plans have been put in place for residents – these were examined and found to be comprehensive. Individual needs about how staff are to support people with their dementia, impaired mobility and other needs are included. As these care plans are newly established there have been no reviews but the owner/manager is aware that monthly (or sooner) reviews need to take place. Healthcare monitoring is to be included in the daily diary entries and colour coded for ease of reference and audit. Daily diary sheet for each resident record day-to-day information. Other monitoring takes place and a sample of weight records were examined. Daily diary sheet for each resident record day-to-day information. Other monitoring takes place and a sample of weight records were examined. Discussion took place with the owner/manager over the need to ensure that all aspects of care and Grey Gables DS0000066324.V286288.R01.S.doc Version 5.2 Page 13 healthcare input are fully recorded on each resident. In addition to this, to ensure that where a risk is identified a full risk assessment is carried out and recorded on the individual’s care file. Discussion with members of staff on duty indicated that although they felt they were able to meet the care needs of the new resident but were unable to detail some healthcare needs. The owner/manager confirmed the newly established care plans are to be a working document for staff and this, along with the key worker system, will ensure that resident’s needs are fully known and met. The owner/manager stated that a lot of input had been put into the hands-on care provided to residents, including working with existing staff and the emphasis is now to ensure the maintenance of the required records. Whilst talking with a resident the owner/manager noticed another resident who appeared to be in difficulty. Time was spent talking with the resident, helping her adjust her position and arranging for pain relief to be given. The owner/manager also discussed a situation whereby one resident had been particularly distressed. As a result, she had liaised with the GP who agreed the home could try a behavioural approach rather than immediately prescribing medication. The outcome had proved positive – the resident settling and medication not being required. The owner/manager felt this was due to the staff team using their skills and expertise to ensure consistent approach to provide the care and reassurance needed. Residents spoken with (who were able to say) were all very happy with the care provided, with staff being kind and caring – resident’s comments included - “everything is very good. I’d be very hard pressed to find something wrong.”; “we’re well looked after”; “Mrs Woods is lovely, nothing is too much trouble” Comment cards received from relatives also confirmed they were very happy with the care provided – one stated “the care has much improved since the change of ownership”. Only staff who have been trained administer medication to residents. Examination of staff files confirmed medication training has been provided. A new medication trolley has been purchased and medications are kept secure and safe in an organised and clean manner. Noted the daily diary notes have entries that state, for example, “painkillers given to F”. The question was raised over where the administration of homely remedies are recorded and it was advised that a homely remedies record sheet be include alongside the MARs sheets. Medication records were examined and a number of errors seen. It was advised to obtain a specimen list of staff initials in case of query in the future and the Medication. The owner/manager was advised to ensure a “declaration of wishes” is completed for each resident which indicates whether they are able to manage their own medication administration. There are no controlled drugs in this home. Grey Gables DS0000066324.V286288.R01.S.doc Version 5.2 Page 14 Observations of both the owner/manager and staff on duty confirmed that residents are treated with dignity and respect at all times. Staff spoken with were able to confirm how they ensure people are treated with dignity and their privacy respected and how this is an important part of their care. This is reflected in the home’s Statement of Purpose. The policy and procedure for a resident who is dying and when death occurs is currently being reviewed. The owner/manager confirmed that two staff have undertaken training in the new Liverpool Care Pathway approach to end of life and is hoping other staff will also do this training. The owner/manager is aware that information over personal preferences over last wishes are not contained in all the care files and this is something that is to be addressed. Discussion with a member of staff who was present when a resident recently passed away was spoken with and confirmed care was provided with dignity and respect. Support was also provided to her by the owner/manager. Grey Gables DS0000066324.V286288.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to enjoy their lifestyles, maintain contacts and have choices which means residents have a quality of life. Residents are provided with wholesome and nutritional meals in a relaxed and unhurried way. EVIDENCE: Discussions with the owner/manager confirmed that a range of activities are provided. It is the intention to update the care plans with information over activities, interests, etc. for each individual resident so that diverse range of activities based on personal likes, previous hobbies, etc., can be provided. Staff spoken with confirmed that activities are carried out as care tasks permit and that residents are taken out, sometimes by staff but usually be their relatives or friends. At the time of the site visit residents enjoyed watching morning programmes on the television and classical music was playing in the quiet room. The owner/manager felt activities are an area for development which she is addressing. Residents are provided with choices, according to their abilities, these tending to be on a more day-to-day basis with more taxing issues being left with their Grey Gables DS0000066324.V286288.R01.S.doc Version 5.2 Page 16 relatives. Six comment cards were received from residents, four stating they felt the home provided suitable activities but two indicating that activities were only suitable sometimes. Staff confirmed that there are no restrictions on family members or friends visiting and, indeed, a number do and take out their respective relative. The Statement of Purpose outlines visits to the home but requests visits do not clash with mealtimes. The pre-site visit questionnaire confirmed that there are range of things to eat during the day. A new four weekly menu is now in place. Two new cooks have been appointed who are reviewing the current menus and replacing some choices with others preferred by residents. The owner/manager spoke about the involvement in residents in choosing a meal and felt that this was a positive experience and something which would be done again. The menu list provided was discussed with the owner/manager as it was felt to be nutritionally balanced but advice was given to review the fruit and vegetable provision for some days. It was advised that a record of meals taken needs to be maintained for the residents, particularly for alternatives provided or for anyone on a special diet. Written guidance over nutrition was left with the owner/manager. A resident spoken with stated that staff come round regularly with drinks and they are always offered a biscuit. The owner/manager is looking at practical ways to offer the residents choices for both meals and drinks. There are no special diets for health, cultural or religious reasons but these would be identified at the point of assessment and catered for. Observations at lunchtime confirmed that residents are now all provided with knives and forks, tables with tablecloths and residents were given their meals with courtesy. Staff asked residents about their preference for sauces and, importantly, where they wanted the sauce to be put! Residents were also asked if they had finished before their plate was removed. The atmosphere in the dining room was relaxed and unhurried and a small number of residents were overhead to be talking with each other. Comments overhead included “that was lovely”; “it was very nice”. Five of the six comment cards received from residents indicated they felt they liked the food, with one stating that they only liked the food sometimes. Staff spoken with confirmed that personal likes and choices are always respected and alternatives are offered. Grey Gables DS0000066324.V286288.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to the home. Policies, procedures and practices within the home make sure that residents and their relatives are able to make their views known and residents are protected EVIDENCE: There have been no complaints since registration. The home has a written complaints procedure that is on display in the hallway. It was advised that the Statement of Purpose should also include more detail about making a complaint as otherwise relatives would have to visit the home in person to know what to do or whom to contact. Residents who were able to say, said that they had never had to make a complaint. One resident said “everything is very good. I’d be hard pressed to find something wrong.” Comment cards received from residents all indicated that if they were unhappy with their care they knew who to speak to. Comment cards received from relatives indicated they were aware of the home’s complaints procedure but had not had to make a complaint. Staff on duty confirmed that they knew the home’s complaints procedure and if anyone was unhappy they would make sure the owner/manager was informed. Staff spoken with were aware of abuse and what to do should they suspect abuse had occurred. The Vulnerable Adult Abuse (VAA) procedure was seen Grey Gables DS0000066324.V286288.R01.S.doc Version 5.2 Page 18 and advice given over the guidance it gives does not completely follow the formal VAA procedures. Staff are also undertaking both Skills for Care Induction and also National Vocational Qualification training and confirmed that abuse awareness is covered within this training.. Grey Gables DS0000066324.V286288.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to the home. The residents live in a comfortable, clean and hygienic home which is well maintained and has a range of aids which assist in maintaining their independence. EVIDENCE: Since registration, the new owner/manager has improved the facilities within the home, as follows : A new stair lift is in place in the home and additional aids have been purchased. This means that the home is able to meet the impaired mobility needs of residents. A new heating system has been installed – water temperature was checked in one bathroom. The kitchen has been upgraded with new furniture and equipment and has also been redecorated Grey Gables DS0000066324.V286288.R01.S.doc Version 5.2 Page 20 One bathroom has been redecorated with new tiling and units Renovation work has started on the shower room in the home All rooms have been thoroughly cleaned with some redecoration work being done One room is awaiting new flooring Training has been provided to some staff on infection control within the Skills for Care and National Vocational Qualification training programmes A maintenance book is in place for staff to use for work needing to be done. Discussion with staff confirmed that if any repairs, health and safety issues, etc., are notified to the owner/manager these are addressed promptly A tour of the home found all rooms to have good furnishings, with aids and adaptations in place. The home is clean and well maintained with an ongoing refurbishment programme in place. Over time, the owner/manager is to consult with residents and/or their relatives over individual colour schemes in private bedrooms so that each resident can have room decoration, etc., of their choosing. One resident spoken with confirmed their room is always clean and tidy with the bed changed regularly – the comment made was that “Mrs Woods likes to run a good home and is always checking on things”. Grey Gables DS0000066324.V286288.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to the home. There are sufficient staff employed at the home with experience who are also being provided with training to ensure residents needs and requirements are met. EVIDENCE: Staffing levels have been increased by the owner/manager and copies of rotas were seen. A new rota has recently been implemented and appears to be working well. It was advised that the management hours need to be included in the rota for the home. Staff confirmed that staffing levels are additionally increased if there is a need. Residents who were able said that they didn’t have to wait for staff to help them. Comment cards received from relatives both stated that they felt there was always sufficient staff on duty. Observations of staff on duty indicated that staff were always around to help residents and interaction was excellent. Staff spoken with said that felt they were able to care for residents appropriately in a dignified and unhurried manner. The owner/manager is also considering employment of male staff so that the needs and dignity of the male residents can be recognised and met. Three staff files were examined and did not evidence that all the required information had been obtained. For one member of staff there was no Grey Gables DS0000066324.V286288.R01.S.doc Version 5.2 Page 22 information apart from a POVA first check and a CRB form. The owner/manager confirmed that all the required checks had been done on this person but was unable to find the documentation. For the other two staff files, both had an application form, one had one reference and the other had no written references, although a verbal reference was noted. For one member of staff the last employer had not been approached for a reference. Only one had a health declaration on file. It was advised that the application form should request a full employment history and indicate that the last employer would be approached for a reference. Criminal Record Bureau (CRB) disclosure forms were seen for all staff employed – further advice was provided to the owner/manager regarding CRB disclosures. Staff spoken with confirmed they had completed an application form, attended for interview and provided names of referees. Training in this home is now ongoing with 3 members of staff having completed the Skills for Care training, two members of staff completed the National Vocational Qualification (NVQ) Level II, and four other members of staff either doing or about to start NVQ Level II. The owner/manager is aware of the need to have 50 of staff trained to NVQ level II and is working towards this. Staff spoken with confirmed they had enjoyed doing this training and were positive about other training to be done. The owner/manager has also provided some in-house training via videos, etc., and is intending that all staff will undertake training in the care of people with dementia. Discussions are underway regarding this training. Training records for staff were also examined. It was advised a training matrix may be of help. Grey Gables DS0000066324.V286288.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to the home. The residents are supported by an experienced manager to ensure the service is well managed and residents are protected. EVIDENCE: The owner/manager is currently undertaking the Registered Managers’ Award and is hoping to complete this by December 2006. Discussions with staff on duty and from comments by residents and on comment cards confirmed that the owner/manager is competent and provides good leadership and direction. Currently there is no formal quality assurance system in the home but the owner/manager is looking to achieve the ISO award by 2006. However, since registration, the owner/manager has involved staff and residents in developing the home, seeking feedback and self-monitoring. Grey Gables DS0000066324.V286288.R01.S.doc Version 5.2 Page 24 Financial records were seen for the charges and payments made in respect of residents at the home. It was advised that as these are held on the computer a hard copy or some system should be introduced so that, if necessary, these records can be accessed for site visit. In addition, all charges and payments are on one spreadsheet which would not respect the privacy and confidentiality for individual residents if viewing, for example, by a relative was required. No personal monies are held for residents – one resident has their own money but generally relatives manage personal monies. The home has a system whereby individual residents’ spends are invoiced on a monthly basis. There is no formal supervision of staff in place in the home, although staff confirmed the owner/manager works full-time in the home and is always available providing advice and guidance, particularly for on-hands care. All the required policies and procedures are in place although these are being reviewed to reflect the new ownership, current legislation and good practices. The owner/manager was advised to ensure that confirmation is gained that staff have read and understood pertinent policies and know where to find information, if needed. This could be carried out within supervision or at staff meetings. Certificates not seen at the last site visit were examined – these included the electrical hard wiring and portable appliance testing certificates. Also seen, was the gas installation certificate and employers liability insurance. The accident book was seen - from examination of daily diary notes some accidents are not being recorded in the accident book by staff. These included – one resident falling out of bed, a resident trapping his hand. One accident where the resident had been taken to the local casualty department had been recorded but had not been reported to the Commission. Advice was given to the owner/manager over this. Mandatory training is being provided to staff via in-house and Skills for Care induction training. Grey Gables DS0000066324.V286288.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 2 3 2 2 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 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 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 2 3 2 Grey Gables DS0000066324.V286288.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4(1)(c) Requirement The Statement of Purpose to include all the required information as outlined in Schedule 1 of the Care Homes Regulations A thorough assessment of any proposed resident must take place by someone qualified to do so at the home so that needs can be identified and a decision made that the home can meet these needs. The care plan to be reviewed on a monthly basis or before, if needed. Risk assessments must be completed as risks are identified Medication records in the home must be accurately maintained Records of meals provided must be maintained, along with a record for any special diets Recruitment records must be maintained to demonstrate that a thorough recruitment procedure has been followed Formal supervision must be provided to staff at least 6 times a year DS0000066324.V286288.R01.S.doc Timescale for action 31/08/06 2. OP3 14(1) 11/07/06 3. OP7 15(2)(b) 31/08/06 4. 5. 6. OP9 OP15 13(2) 17(1)(a) 19(1)(b) 11/07/06 11/07/06 31/08/06 OP29 7. OP36 18(2) 31/12/06 Grey Gables Version 5.2 Page 27 8. 9. OP38 OP38 17(1)(a) 37(1) 10. 11. OP33 OP35 24(1) 17(2) Accidents must be recorded in the accident book The Commission must be notified of incidents, accidents and occurrences in the home, as outlined in Regulation 37 of the Care Homes Regulations The home must implement a formal quality assurance system Financial records must be available for inspection at any time 11/07/06 11/07/06 31/03/07 31/08/06 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. 4. Refer to Standard OP1 OP1 Good Practice Recommendations The Service User Guide could be user friendly for people with dementia An admission checklist may be of use to ensure residents and/or their relatives are provided with the required information and information is obtained by the home Financial records should be maintained separately to protect confidentiality Specimen signatures should be obtained for staff who administer medication. A separate MARs sheet should be put in place for homely remedies. The pharmacist should be asked to date individual columns on the MARs sheets. A declaration of wishes form should be completed for residents regarding medication administration. Specialist organisations should be contacted for further ideas for activities, outings, etc. A recruitment checklist may be helpful to ensure all the required information is obtained prior to commencement of employment of future staff Continue with staff training, particularly NVQ training to ensure the home has 50 of staff trained to Level II. A training matrix may be helpful to identify staff training needs and record training undertaken Continue to review the meals provision to ensure all areas of nutrition are provided consistently DS0000066324.V286288.R01.S.doc Version 5.2 Page 28 OP35 OP9 5. 6. 7. OP12 OP29 OP30 8. OP15 Grey Gables 9. 10. OP38 OP31 Once reviewed, the owner/manager should ensure staff are conversant with the homes policies and procedures and these are accessible at all times The registered owner/manager to continue with the Registered Managers Award to hopefully complete by 2006 Grey Gables DS0000066324.V286288.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Grey Gables DS0000066324.V286288.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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