Inspection on 17/09/08 for Grey Gables

This inspection was carried out on 17th September 2008.

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 11/08/09

Grey Gables 01/11/07

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 13/11/2008.

CARE HOMES FOR OLDER PEOPLE Grey Gables 39 Fox Hollies Road Acocks Green Birmingham West Midlands B27 7TH Lead Inspector Brenda O’Neill Unannounced Inspection 17th September 2008 09:10 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.V371620.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.V371620.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 reception@greygables.org.uk www.greygables.org.uk Grey Gables Committee 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) 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.V371620.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP) 40 The maximum number of service users who can be accommodated is: 40 1st November 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. The range of fees charged at the home was not available in the service user guide. Grey Gables DS0000016772.V371620.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate outcomes. This inspection was undertaken by two inspectors over one day in September 2008. During the inspection a tour of the home was undertaken, four files for the people living in the home were sampled and four staff files as well as other care, health and safety and training documentation. The inspector spoke with the manager, three staff members and seven of the people living in the home. Prior to the inspection the manager had returned a completed Annual Quality Assurance Assessment (AQAA) to the Commission which gave some additional information about the home. Satisfaction surveys were sent to twelve of the people living in the home. Nine of these were returned and they indicated that generally the people living at the home were satisfied with the service they were receiving. Some issues were raised these have been further explored and commented on in this report. There had been four complaints logged at the home since the last inspection. These were in relation to heating in one of the rooms, money going missing, a call bell not working and the neighbours complaining about the new security lights being too bright. These had all been investigated and resolved. Two complaints had been lodged with us since the last key inspection. One was referred back to the registered individual for the home to investigate. This related to the outcome of a pre admission visit to the home. This had been investigated but the complainant was dissatisfied with the response and it had been passed back to the registered individual. The other complaint was dealt with via the adult protection procedures and investigated by the police and Social Care and Health and related to an intruder in the home. 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. There were activities available in the home these included, arts and crafts, knitting, quizzes, hand massages, music therapy, holistic therapy, bingo and so on. There was some activity almost every day and also regular outside entertainers. Grey Gables DS0000016772.V371620.R01.S.doc Version 5.2 Page 6 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. All the surveys returned indicated that the people living in the home knew how to make a complaint and that generally staff listened to them and acted on what they said. Comments received included: ‘The staff are always very caring and helpful and take pride in what they do.’ ‘I don’t have any need to complain as I am very happy.’ ‘Very happy, always have time to listen and chat.’ ‘Most staff do (listen) but some are not as experienced and do not always do as asked.’ Throughout the course of the inspection it was evident that there were friendly relationships between the staff and the people living in the home. Comments in relation to staff included: ‘Always have time to listen and chat.’ ‘Even if I have a late night staff always happy to help.’ ‘There are generally enough staff they will come quickly if the buzzer is used.’ ‘The staff are very friendly have time for my father to laugh and joke with.’ 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. Health and safety in the home were well managed and staff received training in safe working practices. What has improved since the last inspection? 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. A policy in respect of administering homely remedies had been drawn up. The security at the home had been improved. CCTV had been installed, additional external lighting had been installed, the fencing at the rear of the home had been extended and the home had increased their night staffing to three every night. Staff were also being much more vigilant about their checks at night. There had been some further improvements made to the environment and the aids available since the last inspection. Additional hand rails had been fitted throughout the home, wash hand basins had been fitted in all the bathrooms that were used, one of the kitchenettes had been refurbished, some Grey Gables DS0000016772.V371620.R01.S.doc Version 5.2 Page 7 redecoration had been undertaken and new free standing hoists had been purchased. Training for staff had been ongoing and topics covered included manual handling, adult protection, fire procedures, dementia care and first aid. Topics to be covered over the remainder of the year were care plans and risk assessments, food hygiene and infection control. The home had purchased a quality assurance system and this involved the agency concerned visiting the home three times throughout the year to do a full assessment of the service in the home. They had already undertaken a full health and safety assessment. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Grey Gables DS0000016772.V371620.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grey Gables DS0000016772.V371620.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 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 people living in the home indicated they received enough information before moving into the home so they could decide if the home was the right place for them. 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 service user guide for the home was viewed and included most of the information that would be required by people thinking of moving into the home to help them decide if the home could meet their needs. The surveys returned to us prior to the inspection indicated that people received enough information about the home before they moved in. It was recommended that the range of fees charged by the home was included in the service user guide. This would ensure people would have some idea of what they would be charged. Grey Gables DS0000016772.V371620.R01.S.doc Version 5.2 Page 10 The files for two people admitted to the home since the last inspection were sampled. One of these individuals had also had short stays in the home and was therefore known to staff. There was evidence on file that a pre admission assessment had been undertaken for the other person. The assessment covered all the required areas. People were able to visit the home prior to moving in to assess the facilities available to them. There was no evidence to suggest that placements at the home were 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. Grey Gables DS0000016772.V371620.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 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 needed to be further developed to ensure the people living in the home received person centred care and all risks were minimised. Some improvements were needed to the management of medicines to ensure it was entirely safe for the people living in the home. EVIDENCE: The care received by four of the people living in the home was tracked during this inspection. This involved looking at care files and observing practice and speaking to the people concerned. The four care files all included profiles of the individuals, care plans and some risk assessments. 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, for example one stated the person wore hearing aids this was not mentioned in Grey Gables DS0000016772.V371620.R01.S.doc Version 5.2 Page 12 the care plan. The heading for the profiles stated it was to be used to get to know the person in respect of their history, family, preferred hobbies and so on. It was strongly recommended that the profiles were used for this purpose only and that the care plans were used to detail the specific needs of the people living in the home and how they 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. This issue was also raised at the last inspection. If staff continue to use the profiles as part of the care plans they needed to ensure the information in both documents corresponded. For example one profile stated the person needed two carers to assist with walking and the care plan stated ‘walks well’. As at the last inspection the care plans varied in detail. For example one gave some good details of catheter care and dietary preferences and where the individual liked to eat their meals. Other areas of the care plans gave very little detail and stated such things as ‘washes and dresses himself’ there was no information to identify if this person bathed or showered, was able to shave themselves and so on. Another stated ‘needs a little assistance with bathing/showering’ but there was no detail of what the assistance was. It was concerning that in some instances the care plans were clearly not being followed. For example, one stated the person did not like water or hot meals. On the day of the inspection the individual had been given water and a hot cooked meal at lunchtime. The person also told us she did not like cooked meals and preferred sandwiches. Since the last inspection the people living in the home had been asked to sign agreeing to their care plans. Many of the people living in the home could have been fully involved in drawing up their plans. It did not appear this had been done, as there was little information about how people actually wanted their care delivered. As recommended at the last inspection the information no longer in use that had been kept on care files had been removed. There were risk assessments on all the files sampled for tissue viability, nutrition, manual handling and personal risks. Some of these were well detailed others needed to be further developed. Manual handling risk assessments did not detail the size of sling to be used when hoists were detailed. This was being addressed on the day of the inspection. There were personal risk assessments for such things as catheter care, use of walking aids and night checks which did detail the actions to be taken by staff to reduce the risks. Two of the people who were case tracked had some concerns about their nutritional intake. One refused food on some occasions but ate well at other times, the appetite of another had deteriorated. Although there was some information about this on care plans the nutritional assessments had not been reviewed and there were no specific management plans in place for the concerns. This was discussed with the manager and she was advised that where there were concerns there should be clear guidance for staff about recording food and fluid intake, if people are to be weighed more frequently, Grey Gables DS0000016772.V371620.R01.S.doc Version 5.2 Page 13 when they should be given build up drinks and so on. One person had some information in her care plan about using a pressure cushion and mattress. This person clearly had some risk of developing pressure ulcers and there should have been a specific management plan in place for this. It was also noted that one of the profiles included details of how staff were to manage the challenging behaviours of one of the individuals. Although the details were adequate it was strongly recommended that this information was put with the risk assessments so that staff would know it was a risk. There was evidence on the daily records and checklists completed by staff that people were having their personal care needs met. Visits by health care professionals were being detailed separately from the daily records in most cases making them easy to track. Generally the outcomes of health care visits and appointments were detailed. Staff were also detailing contact with health care visits, for example, there was good detail of the tests for one person who was due to go into hospital being followed up staff. Records showed that the people living in the home had access to G.P.s, opticians, chiropodists, district nurses, dieticians and so on. The completed surveys received prior to the inspection indicated that the people living in the home were satisfied that they received the medical support they needed. The majority of the medication in the home continued to be administered via a 28 day monitored dosage system. The blister packs for the system were sampled and cross referenced to the MAR (medication administration record) charts and found to be generally correct. Medication had been booked into the home, signed for when administered and the appropriate symbols used when not administered. Some minor issues were raised, for example, there was one gap on the MAR charts and the MAR charts indicated six tablets had been received for one of the people living in the home and eight had been signed for. Some of the boxed medication in the home was also audited and all the balances were correct. There was some controlled medication being administered and the home had purchased a new controlled drug cupboard. The controlled drug register was not always being signed by two people as required. The register also indicated there were controlled drugs in the home that had actually been returned to the pharmacist or taken home by people who had been receiving respite care at the home. Staff must ensure the details in the controlled drug register are correct. Some of the people living in the home were self administering creams, inhalers and so on. There was no evidence that assessments had been undertaken to indicate people were able to do this safely and compliance checks were not being undertaken. There were some homely remedies in the home and a policy in respect of these had been written since the last inspection. It was not possible to audit Grey Gables DS0000016772.V371620.R01.S.doc Version 5.2 Page 14 the homely remedies as no records for them could be found. The manager was advised there must be records kept of all medication held in the home with a complete audit trail. Staff were observed to knock on bedroom doors before entering and address the people living at the home respectfully. It was evident throughout the course of the inspection that people were able to spend time privately in their bedrooms if they wished. There were keys available for the people living in the home so they could lock their bedroom doors and there was a section on their files stating they had been asked about this. One of the people we spoke with said she had not been asked if she wanted a key for her bedroom and it would be useful. She also stated she did not have a lockable facility in her bedroom. The manager should ensure the people living in the home are made aware they can have keys and where their lockable facilities are on an ongoing basis. Some of the people living in the home 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. Grey Gables DS0000016772.V371620.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. 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. It could not be evidenced that people’s preferred activities were being pursued. 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 satisfied with the catering arrangements. EVIDENCE: The home was quite relaxed throughout the course of the inspection. The people living in the home that we spoke with were generally very satisfied with the service they were receiving. Throughout the course of the inspection people were seen to wander freely around the home, watch television, spend time quietly in their rooms, sit chatting to each other and taking part in a musical activity which they seemed to enjoy. There were activities available in the home these included, arts and crafts, knitting, quizzes, hand massages, music therapy, holistic therapy, bingo and so on. There was some activity almost every day and also regular outside Grey Gables DS0000016772.V371620.R01.S.doc Version 5.2 Page 16 entertainers. Staff were recording one to one time with the people living in the home and had begun to document what they were doing during this time. However the records stated such things as ‘menu’ and ‘care plan’ and it could not be ascertained whether this meant just asking what they wanted for their meals or an in depth discussion to get their views on the menus or if people had been asked to contribute to care plans or just sign them. The surveys completed by the people living in the home or their relatives prior to the inspection varied in respect of activities. Some stated there were ‘sometimes’ activities arranged they could take part in, others stated ‘usually’ and others ‘always’. Written comments varied also these included: ‘Love to take part and enjoy all of them’ ‘The day time activities are very good.’ ‘Not always suitable for very old people.’ The profiles and care plans included some information about the social preferences of the people living in the home however there was no detail given of how the needs were going to be met by staff. For example profiles detailed, one person liked to watch snooker, another liked listening to classical music. These were not included in the individuals’ care plans and there was no evidence that these were happening. We were told by staff that before going into the home one of the people living in the home had a pet that she was extremely fond of and was very upset about having to leave someone else to take of. There was no mention of this in the person’s profile or care plan although it was evident from the daily records that she did see her pet. The care plans for the social needs needed to be further developed to include people’s preferences and how these were going to be enabled 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. As at the last inspection 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. Also where people were able they could self administer their medication. However as stated previously where someone had stated she disliked water and did not like cooked meals she was still being given these. The daily menu choice for this person stated she was to have soup and a sandwich. Clearly this had not been given. Where people are making choices staff must ensure these are given unless there is a good reason and this should be discussed with the individual and documented. The home had a three weekly rotating menu. The menus were varied and nutritious and offered choices at each meal. The people living in the home were asked before meals what they would like and a menu sheet was completed. This was seen in one of the dining rooms on the day of the inspection and some people had requested foods that were not on the menu, Grey Gables DS0000016772.V371620.R01.S.doc Version 5.2 Page 17 for example, egg on toast and this was seen to be served. Staff were aware of the specific diets of the people living in the home, for example, diabetics and pureed food. The people living in the home were able to have their meals in their rooms or the lounge if they preferred this. Staff were seen to be available to offer assistance to those people who needed it at lunchtime and sat with those who needed to be fed. The people living in the home told us they were generally satisfied with the food served in the home and that were offered choices at each meal. Some issues were raised on the returned surveys about the meat in the home being of ‘poor quality’ and ‘tough’. This issue was raised with the manager and she said that no one had raised this with her or the staff either after meals or at the meetings held with the people living in the home. It was suggested that the amount of waste meat be monitored over a period of time to see if this was just in relation to particular meat. The surveys returned to us before the inspections varied in relation to whether people liked the meals. Five people ticked ‘always’, two ticked usually and two ‘sometimes’. Comments received included: ‘There is sometimes an issue with how easy the meat is to chew.’ ‘Meat is very poor quality. A lot of the food is boring.’ ‘Very much so (like the meals) as you can see by my weight gain.’ ‘We get choices at meal times.’ Grey Gables DS0000016772.V371620.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living in the home were listened to and their views acted on. Staff had received training in adult protection issues and incidents were appropriately reported ensuring the people living in the home were safeguarded. EVIDENCE: All the surveys returned indicated that the people living in the home knew how to make a complaint and that generally staff listened to them and acted on what they said. Comments received included: ‘The staff are always very caring and helpful and take pride in what they do.’ ‘I don’t have any need to complain as I am very happy.’ ‘Very happy, always have time to listen and chat.’ ‘Most staff do (listen) but some are not as experienced and do not always do as asked.’ There had been four complaints logged at the home. These were in relation to heating in one of the rooms, money going missing, a call bell not working and the neighbours complaining about the new security lights being too bright. These had all been investigated and resolved. The issue in relation to money going missing had not been notified to us. This was discussed with the manager and she stated this had been at the tail end Grey Gables DS0000016772.V371620.R01.S.doc Version 5.2 Page 19 of a spate of thefts at the home the previous year which had been reported as an adult protection issue and it had been discussed with the police. As a result of this issue the home had set up a system where people could have their hair done and chiropody treatment and this could then be invoiced to relatives if they wished. One of the surveys received indicated that the people living in the home were not able to keep their own money due to the earlier thefts in the home. The manager stated this was not the case and people were able to hold their own money if they wished. It was recommended that the people living in the home and their relatives were made aware of this. Two complaints had been lodged with us since the last key inspection. One was referred back to the registered individual for the home to investigate. This related to the outcome of a pre admission visit to the home. This had been investigated but the complainant was dissatisfied with the response and it had been passed back to the registered individual. The other complaint was dealt with via the adult protection procedures and investigated by the police and Social Care and Health and related to an intruder in the home who injured one of the people living there. In response to this the security at the home had been improved. CCTV had been installed, additional external lighting had been installed, the fencing at the rear of the home had been extended and the home had increased their night staffing to three every night. Staff were also being much more vigilant about their checks at night. There had also been a previous incident in the home where there had allegedly been an intruder in the home. This was reported appropriately and investigated by the police. Staff at the home had received training in adult protection issues and this was updated regularly. Grey Gables DS0000016772.V371620.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 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 generally well maintained environment in which to live. EVIDENCE: There had been some further improvements made in the home since the last inspection, including some redecoration. Additional hand rails had been fitted throughout the home, wash hand basins had been fitted in all the bathrooms that were used, one of the kitchenettes had been refurbished and new free standing hoists had been purchased. As mentioned previously the security at the home had been improved. Closed circuit television had been installed, additional external lighting had been installed, the fencing at the rear of the home had been extended and the home had increased their night staffing to three every night. Grey Gables DS0000016772.V371620.R01.S.doc Version 5.2 Page 21 Some areas in the home were in need of redecoration and some of the carpets needed to be replaced, particularly in two of the unit corridors. On one corridor the carpet was not wearing well and had begun to fray and lift in parts. This was being made safe on an ongoing basis. Contractors came into the home to give quotes for new flooring on the day of the inspection. The carpet on another corridor was very heavily stained and cleaning did not remove the stains this should also be replaced at the earliest opportunity. As recommended at the last inspection the manager had drawn up a yearly improvement plan for the environment that prioritised what was to be done. After discussions with the manager it was apparent that she did not have an allocated budget for refurbishment and redecoration which makes planning difficult. She did state that the Committee do not usually refuse when she requests money but planning would be much easier if there was an allocated budget for this purpose. This would allow much more detailed planning for redecoration and new furnishings on an ongoing basis and the manager would know exactly what she could afford to do. There had been ongoing issues with one of the lifts in the home breaking down and on occasions being out of action for a few days. The lift was working at the time of the inspection and quotes had been obtained for a complete refurbishment of both lifts. This would mean whilst being refurbished each one would be out of action for a considerable amount of time. This was discussed with the manager and she had suggested to the Committee that a stair lift be fitted to ensure that the people living in the home could access the communal areas while the work was being carried out and were not left isolated in their rooms. We had an e-mail from the registered person after the inspection which indicated this had been agreed. 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 was being explored at the time of the inspection. 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. Wash hand basins had been fitted in the bathrooms that did not have these. One of the bathrooms in the home was never used, the flooring by the door of this room was lifting and there tiles off the wall. It was recommended that this room be locked off. There were some aids and adaptations available in the home including, shaft lifts, emergency call system, wheelchairs and grab rails. Additional handrails had been fitted around the home and new hoists had been purchased. Grey Gables DS0000016772.V371620.R01.S.doc Version 5.2 Page 22 Some bedrooms were seen during the tour of the home. They varied in size and were generally comfortable and the decoration was adequate in most however some did need repainting. There were also some pieces of furniture with handles missing and the odd broken drawer. These issues needed to be addressed. All but one of the bedrooms in the home have en-suite facilities of toilet and wash hand basin. The one without this facility had a toilet directly opposite. The records in the home indicated that the water temperatures were still fluctuating from quite hot to luke warm. The manager was well aware of this and was addressing it. The temperatures that we checked were appropriate on the day of the inspection. The home was clean and odour free and COSHH storage was appropriate. The laundry was appropriately located and equipped. The kitchen was not inspected during this visit. Grey Gables DS0000016772.V371620.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 good. 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: The manager told us that the home was fully staffed at the time of the inspection. New staff had been recruited since the last inspection and the home were trying to ensure that the staffing levels did not fall below six care staff during the waking day and 3 waking night staff. Three weeks rotas were seen and these indicated that there were occasions when the home were falling below these levels particularly during the afternoon and evening. The people living in the home did not raise any issues about the availability of staff with us and the completed surveys returned to us indicated that there were generally staff available when needed. Comments received included: ‘Always have time to listen and chat.’ ‘Even if I have a late night staff always happy to help.’ ‘There are generally enough staff they will come quickly if the buzzer is used.’ ‘The staff are very friendly have time for my father to laugh and joke with.’ There were also one or two comments that indicated staffing levels were not adequate at times for example: Grey Gables DS0000016772.V371620.R01.S.doc Version 5.2 Page 24 ‘On occasions staffing in the early evening (7-9pm) is not adequate. On these occasions it is sometimes necessary to wait until after the 9pm handover before a carer is available to help.’ ‘Recently the home has been short staffed with staff on holiday and so on although they have engaged some relief staff to help them.’ The shortfalls on the rotas were discussed with the manager. She stated that during the evening the home did occasionally have only five staff on duty, this was usually due to staff sickness, but there were always six until 6pm. The home was not full at the time of the inspection and on the whole staffing levels appeared to be appropriate. Throughout the course of the inspection it was evident that there were friendly relationships between the staff and the people living in the home. The recruitment files for four staff that had been appointed since the last inspection were sampled. All the files included all the required documentation and evidence that all the required checks had been undertaken prior to the new staff starting work in the home. Files included completed application forms, two written references, medical questionnaires and declarations of fitness and CRB checks. The manager was reminded to ensure that all documents were dated as one application form and one reference were not. Staff were undertaking induction training in line with the specifications laid down by Skills for Care and the manager stated she was ensuring this would be completed within twelve weeks as required. The training matrix for the home indicated that training for the staff group was ongoing throughout the year. Topics covered this year included manual handling, adult protection, fire procedures, dementia care and first aid. Topics to be covered over the remainder of the year were care plans and risk assessments, food hygiene and infection control. The rotas indicated that the home employed twenty five care staff at various levels of responsibility. Eighteen of the staff had either NVQ level 2 or 3 giving the home more than the required fifty percent. Grey Gables DS0000016772.V371620.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. The home was being managed in the best interests of the people living there. The home needed to have in place a yearly development plan to ensure the service was continuously improved. EVIDENCE: The manager had been employed at the home for a considerable amount of time and generally had a good knowledge of the needs of the people living in the home. The management of the home had improved over a period of time. Things such as care plans and risk assessments were continuing to be improved but still Grey Gables DS0000016772.V371620.R01.S.doc Version 5.2 Page 26 needed to be further developed in some areas. Some issues were also raised at this inspection in relation to the management of medicines. The home had purchased a quality assurance system and this involved the agency concerned visiting the home three times throughout the year to do a full assessment of the service in the home. They had already undertaken a full health and safety assessment. After any of the assessments a full report was given to the manager with action points that needed to be addressed. The home were sending out satisfaction surveys twice yearly to the people living in the home these asked about food, activities, laundry services and other services such as dentistry. There were regular meetings with the people living in the home to update them with what was happening in the home. Topics covered included forthcoming activities, their views on activities and the menus in the home, the issues with the lift and new staff. This was also an opportunity for the people living in the home to raise any issues. There were also regular staff meetings. The manager needed to collate all the information from the surveys, meetings, audits and assessments undertaken over a period of time and produce an overall report on how the service was to be improved or the people living in the home. 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 we were told that all these had been addressed. The AQAA received prior to the inspection indicated that the equipment in the home is regularly serviced. The in house checks on the fire system were all up to date and fire drills were taking place at the required intervals. Accident and incident reporting was generally satisfactory however as mentioned earlier in this report there had been one occasion when we had not been notified of a theft in the home. All incidents such as this must be notified to us so that we can be assured they are being managed appropriately and in the best interests of the people living in the home. Grey Gables DS0000016772.V371620.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 2 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 3 2 X 2 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Grey Gables DS0000016772.V371620.R01.S.doc Version 5.2 Page 28 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 OP8 Regulation 13(4)(c) Requirement Nutritional assessments must be reviewed when the dietary needs of the people living in the home change. Where there is any concern about the dietary intake of the people living in the home there must be a management plan in place detailing how any risks will be reduced. This will ensure people living in the home have their nutritional needs met. The management plans for people at risk of developing pressure ulcers must be further developed to detail all the actions to be taken by staff to reduce any risks. This will ensure the people living in the home have their health care needs met. Two staff must sign the controlled drug register when the medication has been administered. DS0000016772.V371620.R01.S.doc Timescale for action 20/10/08 2. OP8 13(4)(c) 20/10/08 3. OP9 13(2) 20/10/08 Grey Gables Version 5.2 Page 29 When controlled medication is returned to the pharmacist or taken home by a user of the service the details must be entered in the controlled drug register. There must be risk assessments undertaken to ensure anyone living in the home who wishes to self administer medication is capable of doing so. There must be evidence that compliance checks have been undertaken for those people self administering. There must be records of all medication held in the home with a complete audit trail. This will ensure the medication management in the home is safe. The manager must ensure that any incidents that could be deemed as adult protection are notified to the Commission. This will assure the Commission that incidents are being managed in the best interests of the people living in the home. 4. OP18 13(6) & 37 20/10/08 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. Refer to Standard OP1 Good Practice Recommendations It is recommended that the range of fees charged by the home is included in the service user guide. This would DS0000016772.V371620.R01.S.doc Version 5.2 Page 30 Grey Gables 2. 3. OP3 OP7 4. OP7 5. 6. 7. OP7 OP8 OP9 8. OP9 9. OP10 10. OP12 ensure people would have some idea of what they would be charged. 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. The care plans for the people living in the home should clearly detail all the needs of the individuals and how their needs are to be met by staff. This will ensure that the people living in the home receive person centred care. 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. Staff should ensure they follow the care plans in place for the people living in the home. This will ensure individuals receive their care in a way they prefer. Risk management plans should all be together on the files of the people living in the home so that staff know where to find them. It is recommended that the home installs a quality assurance system to individually assess staff competence in the handling of medicines. Not assessed at this inspection. It is recommended that all medicines for social leave are dispensed by the community pharmacy where possible and secondary dispensing is avoided. Not assessed at this inspection. The manager should ensure the people living in the home are made aware they can have keys and where their lockable facilities are on an ongoing basis. This will ensure the people living in the home have privacy. The care plans in place for the social needs of the people living in the home should be further developed to detail their preferred hobbies and pass times and how staff are to enable these. Staff should record what has taken place during one to one sessions with people living in the home. This will ensure the social needs of the people living in the home are met. 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. DS0000016772.V371620.R01.S.doc Version 5.2 Page 31 11. OP14 Grey Gables 12. OP15 13. OP19 14. 15. 16. 17. OP19 OP20 OP21 OP33 As some issues were raised about the quality of the meat being served in the home it is recommended that the waste after mealtimes is monitored to identify if there are any problems. Any areas of the home in need of redecoration and new flooring 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. It is recommended that the manager be given a yearly budget for the general redecoration and refurbishment of the home to make planning and prioritising easier. Access to the garden should continue to be explored to ensure it is safe for the use of all the people living in the home. It is recommended that any bathrooms that are not in use are locked off. The home should have in place a yearly development plan to ensure the service was continuously improved. Grey Gables DS0000016772.V371620.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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.V371620.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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!