Inspection on 23/11/06 for Grey Gables

This inspection was carried out on 23rd November 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Grey Gables 11/08/09

Grey Gables 17/09/08

Grey Gables 01/11/07

Grey Gables 03/05/07

Grey Gables 03/05/06

Grey Gables 09/12/05

Grey Gables 07/06/05

Grey Gables 05/10/04

Grey Gables 29/06/04

Grey Gables 26/01/04

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

CARE HOMES FOR OLDER PEOPLE Grey Gables 39 Fox Hollies Road Acocks Green Birmingham West Midlands B27 7TH Lead Inspector Brenda O’Neill Unannounced Inspection 23rd November 2006 09:25 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.V312531.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.V312531.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grey Gables Address 39 Fox Hollies Road Acocks Green Birmingham West Midlands B27 7TH 0121 706 1684 0121 706 2025 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.greygables.org.uk Grey Gables Committee Mrs Annemarie Hosty Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home provide evidence that external support to the management of the home has been provided for the next three months, by 30 April 2006. 3rd May 2006 Date of last inspection Brief Description of the Service: Grey Gables is a care home, which is registered to accommodate up to 40 residents. 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 residents may choose where they spend their time, residents 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 service users with mobility difficulties. The home has two passenger lifts that ensure all areas of the home are accessible. Fees charged at the home are £420 per week with the exception of eight beds which are let to individuals being funded by the local authority at their contract price. Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second key inspection for the service for 2006/2007 and was carried out by two inspectors over one day in November 2006. During the course of the inspection a tour of the premises was carried out, three resident and three staff files were sampled as well as other care, health and safety and training records. The inspector’s spoke with the manager, three staff members, a visitor and six residents. The home had also had a random inspection in August 2006 to assess the progress being made on some of the requirements made following the previous key inspection in May and to follow up some concerns that had been raised with CSCI. References will be made to this visit throughout this report. Three concerns had been lodged with CSCI since the last inspection. One was in relation to staffing issues and not directly related to the service being offered to the residents. This did not come within the remit of CSCI to follow up at an inspection but was responded to by senior managers. One concern was looked into at the time of the random inspection. This was in relation to the home’s failure to notify the Commission of two incidents that had taken place in the home. It was found that a regulation had been breached and a requirement was made of the home that they ensure all incidents were notified to CSCI. The third concern was lodged two days prior to the inspection and was about the home failing to notify the friend of a resident when the individual had been admitted to hospital and subsequently moved to a nursing home. This matter was referred back to the registered person for the home for them to investigate. No complaints had been lodged directly with the home since the last key inspection. The manager of the home had raised one adult protection issue. However after the involvement of social care and health and the vulnerable persons officer it was deemed to be a disciplinary issue and was dealt with by the home. What the service does well: Residents spoken with were satisfied with the service they were receiving. There were friendly relationships evident between staff and residents. The home had a comprehensive assessment document that covered all the required areas and that was used by senior staff to determine if the home could meet the needs of an individual. It was evident from the daily records that staff were identifying health care needs and that these were being followed up and monitored. Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 6 Several visitors were seen to come and go through out the course of the inspection and they were made welcome by staff. Residents spoken with were generally satisfied with the catering arrangements at the home. Copies of the menus were taken and they showed that the meals being offered to the residents were varied and nutritious with choices available. Residents received a copy of the complaints procedure in the service user guide and these were found in their bedrooms. Adequate numbers of staff were on duty to meet the needs of the residents. The home was clean, comfortable and had a good social atmosphere. Residents could have keys for their bedrooms if they wished, several residents had their own telephones in their bedrooms and there was also a telephone for their use in a quiet area of the home. bedrooms were nicely personalised. What has improved since the last inspection? A considerable amount of work had gone into making improvements to residents’ care plans and requirements in relation to health care had been undertaken at the home. The needs of the residents had been looked at again by staff. The assessments undertaken included an overall profile of the person which gave some detail of their likes, dislikes and where they required assistance, personal care and physical well being, mobility, dental and foot care, daily living and social activities. Included in this assessment was a section on consent which found that residents had been asked if they wanted a key to their room, the frequency of night checks, if they minded staff entering their room when they were not there and do they agree to having a photograph taken. Residents’ personal files that were sampled included personal risk assessments for such things as pressure care and falls. Tissue viability assessments had also been undertaken. The records for health care visits to the residents had been improved and they were much easier to follow. Residents were being weighed on a monthly basis to ensure they were not gaining or losing excessive amounts. The privacy and confidentiality of the residents had been further enhanced by the removal of the communal recording books. Staff turnover at the home had reduced which was much better for the continuity of care of the residents. Staff seemed much happier at the time of this inspection and were working together more as a team. The recruitment procedures for staff had improved and ensured the residents were safe guarded. Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 7 Induction training for staff had improved and this was now in line with the required guidelines. This would ensure all new staff had the appropriate knowledge and skills to care for the residents. There had been further improvements to the environment. There had been a lot of redecoration in the home and the outside had been painted. Some areas had had new flooring, six bedrooms had been decorated and carpeted, a new call system had been installed and the fire doors that lead out onto the stone steps had been alarmed during this installation. All this work had been done to provide residents with a safer and more homely environment. There had been further improvements in the management of the home since the last inspection. There were clear lines of accountability and senior staff had been given specific responsibilities that were overseen by the manager. The home was more organised and staff were more settled and working more as a team. The responsible individual for the home had been making the required unannounced visits to the home to oversee the conduct of the home. Improvements had been made to the management of health and safety in the home including, the safe storage of COSHH substances, liquid soap and disposable towels were available in all facilities and the in house checks on the fire system were being undertaken. These improvements were helping to ensure residents live in a safer home. What they could do better: All residents needed to have comprehensive care plans in place that detailed how all their identified needs in relation to health and welfare were to be met by staff. The manager needed to ensure that risk assessments were in place for all the residents’ identified risks and included full details of how the risks were to be minimised. This would ensure consistency by staff when managing risk and also that the residents were as safe as possible. Health and daily records needed to be cross referenced to each other to ensure important information about residents was not missed by staff. Some minor improvements were needed to the system for administering medication to ensure it was entirely safe and promote residents’ health and well being. There needed to be further consultation with the residents about the amount and variety of activities offered, as the programme did not meet the expectations of all the residents. Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 8 To ensure the protection of the residents all staff needed to receive training in adult protection issues and the procedures needed to be made available to them at all times. The manager needed to ensure that staff had all the up to date training necessary for them to be able to care for the residents appropriately. The home needed to have in place a system for reviewing the quality of the service they offered based on seeking the views of the residents. Further improvements were needed to the environment to ensure it was entirely safe for the residents and staff and that the standard of décor was acceptable. 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. Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grey Gables DS0000016772.V312531.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): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Prospective residents’ needs were assessed prior to admission to the home to ensure they could be met. EVIDENCE: The file for a person recently admitted to the home was sampled. The home had a comprehensive assessment document that covered all the required areas and that was used by senior staff to determine if the home could meet the needs of an individual.On this occasion the document had not been signed or dated and it could not be determined that the assessment had been conducted prior to admission. The individual concerned was admitted after a referral from social care and health but there was no evidence of the assessment undertaken by the social worker on the file. Grey Gables DS0000016772.V312531.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 at least once during a 12 month period. 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 the service. Improvements were needed to the care plans to ensure they included details of how all the individual needs of the residents were to be met. Risk assessments needed to be further developed to ensure safer outcomes for residents. The medication system was generally well managed and safe. Residents were treated with respect and their rights to privacy were upheld. EVIDENCE: At the random inspection in August 2006 the requirements made following the previous key inspection in May 2006 in relation to care plans, risk assessments and the health care of the residents were assessed. Little or no progress had been made at that time. At the time of this visit it was evident from the three files sampled that staff had undertaken a considerable amount of work to improve on the care plans and requirements in relation to health care. The files sampled included a comprehensive reassessment of the residents’ needs and covered all the required areas including, an overall profile of the Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 12 person which gave some detail of their likes, dislikes and where they required assistance, personal care and physical well being, mobility, dental and foot care, daily living and social activities. Included in this assessment was a section on consent which evidenced that residents had been asked if they wanted a key to their room, the frequency of night checks, if they minded staff entering their room when they were not there and do they agree to having a photograph taken. This section had been signed where possible by the residents verifying their answers. From these assessments care plans had been drawn up however these were not comprehensive and did not specifically detail how staff were to meet the identified needs. There was no indication of what the residents were able to do for themselves or the way they wanted their care delivered. The plans were general and stated ‘assistance with’ in a lot of areas with no indication of what assistance was needed. The new format being used for care plans was very restrictive and did not allow for much information to be included. These issues were discussed with the care manager. She stated that the senior staff had recently undertaken training in care planning and the trainer raised the same issues. A new format for the care plans was to be put into use. Residents had signed to say they had been involved in drawing up the care plans. Care plans were not being reviewed on a monthly basis. The files sampled included manual handling risk assessments and these had been improved but further development was required. The details given for staff to follow should a resident fall needed to include the sling size to be used where a hoist was indicated. One of the risk assessments seen stated in relation to a fall ‘discuss with care officer’ this was not appropriate as staff needed specific guidance of what to do. One resident’s needs in relation to moving and handling had changed recently and although this was recorded on their health care notes it had not been updated on the risk assessment. Risk assessments must be updated as the needs of the residents change. The files sampled had personal risk assessments in place which is a vast improvement since the last inspection. Issues detailed included pressure care and falls. The risk assessments needed to be further developed to ensure they included all risks, for example, there was a small note on the front of two files detailing what staff should do in the event of a seizure these needed to be included on the risk assessments. Tissue viability assessments had been undertaken for the residents since the random inspection however where a risk had been identified there was not always a management plan in place. Nutritional screenings had not been completed for the residents. An issue raised at the random inspection was that the monthly weighing of the residents was not consistent. This had been addressed by the time this inspection. Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 13 The records for health care visits to the residents had been improved and they were much easier to track. It was found from the daily records that staff were identifying health care needs and that these were being followed up and monitored. One of the files sampled included very good detail of the ongoing visits made by the district nurse to an individual and the progress or deterioration of the individual concerned. Staff needed to be mindful that all the outcomes of health care appointments were recorded on the health care visit sheets as on one occasion a resident had been to hospital and the outcome was recorded on the daily records. This information will be lost as more daily records are completed. The entry should have been made on the appropriate sheet and an entry on the daily records made referring the reader to this. All records must be cross referenced to each other to enable easy tracking and to ensure information is not lost over a period of time. The system in place for the administration of medication was generally well managed. Medicine audits were undertaken. It appeared the balance of some medication had not been carried forward from one month to the next. The dosage for this medication was variable and the amounts administered had not been detailed therefore the audit could not be completed. One type of medication required a risk assessment in place for the people handling it. The risk assessment that was in place was not robust however this was corrected before the end of the inspection. Hand written entries on the medication administration charts were not being signed by two staff as correct. This is an ongoing requirement. The issue raised at the random inspection in relation to staff scribbling out any errors had been addressed. A homely remedy policy had been put in place. No issues were raised at this inspection in relation to privacy and dignity. The issues that were raised at the previous two visits to the home had been addressed. The practice of writing personal information about residents in communication books had stopped. Personal information was not being routinely shared with relatives/representatives of the residents. Residents could have keys for their bedrooms if they wished, several residents 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 their bedrooms and there were several areas in the home where residents could receive visitors if they did not want to take them to their bedrooms. Staff were observed to knock on bedroom doors before entering and address residents respectfully. Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. 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 the service. Residents needed to be consulted about the amount and variety of activities offered in the home to ensure the activities programme met with their needs. 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 residents were happy with the catering arrangements. EVIDENCE: There were no rigid rules or routines in the home and the residents spoken with were happy they could spend their time as they chose. Residents could get up and go to bed when they wished, have breakfast in bed or in the dining room, spend time in their rooms throughout the day and take part in organised activities. At the time of the last inspection the home had an activities coordinator but at the time of this visit she had left. The home had a documented four week programme of activities and this included such things as arts and crafts, quizzes, going out shopping, church visitors, flower arranging and dominoes. Staff spoken to stated that the documented activities did not always take place. The manager stated the activities programme was due to be reviewed and that she was hoping to designate another staff member to overseeing activities. On the day of the inspection residents were Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 15 seen to take part in a game of dominoes, some were having their hair done and others were spending time in their rooms or watching television. The activities schedules for October, November and December were sent to the CSCI after the inspection. Several activities were included and many were facilitated by outside visitors to the home. As at the last inspection there was no evidence that the residents had been consulted about the amount and variety of activities offered in the home to ensure the activities programme met with their desires and wishes. Staff were not recording all activities that the residents took part in to evidence their social needs were being met. There also needed to be some evidence that the residents who did not participate in group activities had some one to one staff time. Several visitors were seen to come and go through out the course of the inspection and they were made welcome by staff. The visitor spoken with was generally happy with the service but did raise some issues about the bedroom allocated to her relative. These issues were discussed with the manager. She was aware of the issues and they had been discussed at the individual’s review. There was now another bedroom empty and this was to be offered to the individual. One of the residents continued to go out independently and on the day of the inspection was assisted by staff to get a taxi to take them to the dentist. Others regularly went out with relatives and friends and there were occasional trips out with staff for shopping, walks and so on. Not withstanding the matters surrounding activities raised above, residents were encouraged 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. Residents were now being consulted about the frequency of night checks which was an issue that had been raised at the previous inspection. Some of the personal files still included forms stating when the resident’s bath/shower time was and if they refused at this time an alternative may not be offered. This practice was not seen as offering choice and self-determination. Residents needed to be able to choose on an ongoing basis when they would like a bath or shower. Residents had been encouraged to personalise their rooms to their choosing and personal effects were seen in all the bedrooms. Residents spoken with were generally satisfied with the catering arrangements at the home. Copies of the menus were taken and they showed that the meals being offered to the residents were varied and nutritious with choices available. Food records were being kept but these did not detail what the residents were having for breakfast and this also needed to be included. Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents were issued with a copy of the home’s complaint procedure at the point of admission to the home. To ensure the protection of the residents all staff needed to undertake training in adult protection issues and how to report these appropriately. EVIDENCE: The complaints procedure was not viewed as it had been seen at the last inspection. Residents received a copy of this in the service user guide and these were evident in their bedrooms. Three concerns had been lodged with CSCI since the last inspection. One was in relation to staffing issues and not directly related to the service being offered to the residents. This did not come within the remit of CSCI to follow up at an inspection but was responded to by senior managers. One concern was looked into at the time of the random inspection. This was in relation to the home’s failure to notify the Commission of two incidents that had taken place in the home. It was found that a regulation had been breached and a requirement was made of the home that they ensure all incidents were notified to CSCI. The third concern was lodged two days prior to the inspection and was about the home failing to notify the friend of a resident when the individual had been admitted to hospital and subsequently moved to a nursing home. This matter was referred back to the registered person for the home for them to investigate. No complaints had been lodged directly with the home since the last key inspection. Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 17 The home’s adult protection procedures could not be found during the course of the inspection and were faxed to the CSCI by the manager. The manager needed to ensure the procedures were available to staff at all times in case any issues were raised when they were on duty. The manager had made the required amendments to the procedures since the last inspection. Some staff had received prevention of abuse training however the manager needed to ensure that all staff undertook this training to ensure staff were equipped with information to assist them in protecting residents from abuse. The manager of the home had a good understanding of the procedure to be followed in the event or suspicion of abuse. She had raised one adult protection issue since the last key inspection. After the involvement of social care and health and the vulnerable persons officer it was deemed to be a disciplinary issue and was dealt with in house. Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 18 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, 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 the service. A number of the required improvements had been made to the home’s environment. Further improvements were needed to ensure all areas promoted residents’ comfort and safety. EVIDENCE: Further improvements and remedial works had been undertaken in the home since the last key inspection. There had been a lot of redecoration in the home and the outside had been painted. Some areas had had new flooring, six bedrooms had been decorated and carpeted, a new call system had been installed and the fire doors that lead out onto the stone steps had been alarmed during this installation. Some of the rooms for the use of staff were being reorganised so that staff knew where to find documentation and equipment. The home have been asked over past inspections for a timed programme of refurbishment and redecoration that took into account all issues that have Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 19 been raised at inspections to be forwarded to the CSCI. This has not been addressed therefore all requirements within this report are being given specific timescales. Some areas of the home remained in need of redecoration and there were places where the plaster on the walls was in need of repair. Some of the small kitchen areas around the home remained in need of refurbishment. There was one area in the home where the carpet was thread bare and fraying and a possible tripping hazard. The manager stated this area was only used by staff however the carpet needed to be addressed. The manager had audited all rooms and made a list of what was required this was seen at the last key inspection. There were ample communal areas in the home and these were generally comfortable and well decorated. The home had a very pleasant, well maintained garden that had some seating available for the residents. Access to the garden was problematic for the residents with mobility difficulties as the ramped access was quite narrow. Safe access to the garden for all the residents must be explored. This is an ongoing requirement. The home had a number of bathrooms and one floor level shower where staff were able to give full assistance. The majority of the bathrooms had bath hoists installed. The shower room had a wash hand basin but the other bathrooms needed to have these fitted. The new emergency call system was accessible from all the bathing and showering facilities. Some of the corridors had hand rails others did not and were needed to ensure residents could move around safely. Other aids and adaptations were available in the home including passenger lifts, hoists, wheelchairs hand and grab rails in the toilets and an emergency call system. As the home was being redecorated different colours were being used and some signage being incorporated to make it easier for the residents to find their way around this large home. Bedrooms were all singles and all but one had en-suite facilities that included a toilet and wash hand basin. The bedroom without an en-suite had a toilet directly opposite solely for the use of the occupant of that room. The majority of the bedrooms seen were comfortable and spacious however some were in need of redecoration. Bedrooms were lockable and all had had a lockable facility installed since the last key inspection where residents could safely store personal effects. Residents spoken with were generally happy with their bedroom and several had their own telephones, televisions and radios. Heating, lighting and ventilation in the majority of areas of the home was appropriate and the residents were able to control the heating in their bedrooms. There were some areas of the home where the heating was not working efficiently however this was being addressed. Two of the bedrooms Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 20 had had supplementary heaters installed and the surface temperature of these could get very hot. A risk assessment needed to be undertaken to ensure their use did not put the residents at risk. The excessively high water temperature that had been identified at the last key inspection had been addressed at the time of the random inspection. The home was found to be clean and odour free. There were three laundries in the home two were equipped with sluice washing machines. One of these was out of order at the time of the inspection. One of these rooms had had a combination lock installed since the last inspection. The other two had bolts on the top of the doors. The flooring in one of the laundries had been replaced as required. Laundries did not have wash hand basins and all needed redecoration. The ventilation fans throughout the home had been cleaned since the last key inspection. COSHH substances were being stored securely. It was noted that personal toiletries had been left in some of the communal bathrooms. This is an ongoing issue in the home. All toiletries needed to be returned to the residents’ rooms after use. As stated previously the small kitchens were in need of refurbishment. The main kitchen was clean and well organised and had received a very good report from the environmental health officer on the most recent visit. It was noted that staff were entering the kitchen to wash their hands despite being told by the chef and the manager not to. The manager must ensure that staff follow food hygiene procedures to avoid cross infection that would put residents’ health at risk. Staff were keeping their own food in the fridge in the main kitchen. A different fridge must be designated for staff to use for this purpose so as to avoid the risk of cross contamination. One of the fridges in the small kitchen areas in the home was running at excessively high temperatures and needed to be checked to ensure it was working efficiently. Fridges that operate at over 5°c fail to store food stuffs at a safe temperature placing residents and staffs health at risk. It was also noted that some of the opened food in the fridges in the small kitchens had not been dated when opened. Grey Gables DS0000016772.V312531.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Adequate staffing levels were being maintained to ensure residents’ needs could be adequately met. Staff training needed to be regularly updated to ensure staff were fully equipped to deliver adequate and appropriate care. Overall recruitment procedures were robust and safeguarded the residents. EVIDENCE: Staff turnover at the home had improved since the last inspection which was good for the continuity of care of the residents. Staff seemed much happier at the time of this inspection and were working together more as a team. The rotas evidenced that adequate numbers of care staff were on duty throughout the waking day and there were always senior staff on duty. The manager’s hours were supernumery to the care rota. The home also employed domestic staff, housekeeper, chef and kitchen assistant. Three staff files were sampled. The recruitment procedures had improved and all the required documentation was available including current CRBs, POVA first checks and two references. One issue raised was that one of the application forms had not been fully completed and did not detail any past experience or who the referees were to be. Induction training for new staff had improved and was in line with the specifications laid down by skills for care. There was a training matrix for the Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 22 home and a training file which detailed a variety of training being undertaken, for example, manual handling, health and safety and dementia care by staff but some of this was out of date. As previously stated not all staff had undertaken training in the prevention of abuse. The numbers of staff qualified to NVQ level 2 or the equivalent did not meet the required fifty percent. Grey Gables DS0000016772.V312531.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, 34, 35, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The management of the home had improved providing residents with better quality of care. Further improvements were required to ensure it was consistently managed in the best interests of the residents. There were clear lines of accountability in the home and senior staff had delegated responsibilities. The home needed to have a system in place for reviewing the quality of the service based on seeking the views of the residents. EVIDENCE: There had been further improvements in the management of the home since the last inspection. There were clear lines of accountability and senior staff had been given specific responsibilities that were overseen by the manager. The home was more organised and staff were more settled and working more as a team. Further improvements were needed in the systems in place for care planning and risk assessments for the residents. Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 24 The manager of the home had still not been allocated with any budgets for food, maintenance, redecoration and so on therefore it was difficult for her to plan for the needs of the home. The responsible individual for the home needed to ensure the manager was aware of what money was available for her to spend on specific items and over what period of time. This was outstanding from the previous inspection. At the time of the last inspection the home had a formal quality assurance system in place that been audited by an outside agency who then prepared a report of their findings. This was discussed with the manager at the time, as it did not appear that any recommendations or findings in their report were being followed through. There had been no change to this and the manager stated that the quality assurance system had been a one time only and was not ongoing. The inspector was informed that the responsible individual held residents meetings on a regular basis to find out their views on the service however there was no documentation to support this. The home did not handle any finances on behalf of the residents and the manager was satisfied that residents got access to as much money as they required. When residents had their hair done or purchases were made on their behalf their relatives/representatives were invoiced direct. There was no evidence on the staff files sampled of any structured supervision sessions being conducted with staff. Since the last key inspection the responsible individual for the home had been making the required unannounced visits to the home to oversee the conduct and management of the home. She was sending her written reports about the outcome of the visits to the CSCI. There had been further improvements to the management of health and safety in the home. At the time of the random inspection previous requirements made in relation to COSHH storage, supplying liquid soap and disposable towels, completing accident forms fully and undertaking a fire risk assessment had been met. It was noted at the time of the random visit that the in house checks on the fire system were not always being completed this had been addressed at the time of this visit. There was evidence on site of the up to date servicing of equipment in the home with the exception of the gas appliances, which was forwarded to CSCI after the inspection, the portable electrical appliances and the testing of the water system for the prevention of legionella. CSCI received evidence that the water system had been tested on 29/11/06. It was also noted that the fire drill was out of date. The manager must ensure fire drills are carried out every six months so that staff were familiar with what is required of them the case of a fire. Grey Gables DS0000016772.V312531.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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 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 2 2 X 3 2 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 2 3 1 X 2 Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1)(2) Requirement Where applicable a copy of the assessment undertaken by social workers must be obtained prior to residents being admitted to the home. The pre admission assessment documentation completed by the home must be signed and dated. Residents who are receiving regular respite at the home must have their needs reassessed on a regular basis and prior to a permanent placement being offered. (Previous time scale of 01/09/06 not assessed as no residents on respite care.) All residents must have 01/01/07 comprehensive care plans that detail how all their needs in relation to health and welfare are to be met by staff. (This requirement has been outstanding since 21/07/03) Care plans must be reviewed on a monthly basis. Timescale for action 01/01/07 2. op7 15(1)(2)b Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 27 3. OP7 13(5) The manual handling risk assessments must detail the action to be taken by staff in the event of a fall. (Previous time scale of 14/06/06 and 01/09/06 not met.) Where the use of a hoist is indicated the type and sling size must be detailed. (Previous time scale of 14/06/06 and 01/09/06 not met.) 01/01/07 4. OP7 13(4)(c) 5. OP8 12(1)(a) Manual handling risk assessments must be updated as the needs of the residents change. Personal risk assessments must 01/01/07 be further developed to ensure they include all identified risks and how these are to be minimised by staff. 01/01/07 All residents must have nutritional screenings undertaken. If any risks are identified there must be a plan in place to manage these. (Previous time scales of 01/07/06 and 14/09/06 not met.) Where a risk is identified on the tissue viability assessments there must be a plan in place to manage this. Health care and daily records 01/01/07 must be cross referenced to each other where necessary. 6. OP8 12(1)(a) Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 28 7. OP9 13(2) Two staff must verify as being correct any hand written entries on the MAR charts. (Previous time scales of 26/05/06 and 01/09/06 not met.) Any balances of medication held in the home at the end of the monthly cycle must be carried forward to the next medication chart. Where variable doses of medication can be administered to the residents the amounts given must be detailed. Residents that are unable to enjoy group activities must have some one to one staff time on a routine basis and this must be recorded. (This requirement has been outstanding since 31/08/05) The residents must be consulted about the amount and variety of activities offered in the home. (Previous time scales of 31/07/06 and 01/10/06 not met.) The manager must ensure that residents are encouraged and enabled to make decisions in respect of the care they are to receive. (Previous time scale of 01/10/06 partially met.) Records of food being served to residents must include details of what they have for breakfast. The adult protection procedures must be available to staff at all times. All staff must receive training in all aspects of adult protection. (This requirement remains outstanding from 01/03/05.) 01/01/07 8. OP12 16(2)(n) 01/02/07 9. OP14 12(2) 01/02/07 10. 11. 12. OP15 OP18 OP18 17(2) schedule 4(13) 13(6) 13(6) 01/02/07 01/01/07 01/03/07 Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 29 13. OP19 23(2)(a) (b) All parts of the home must be reasonably decorated. Any repairs needed to the plaster in home must be carried out. The thread bare/fraying carpet must be addressed. The small kitchen areas around the home must be refurbished. The registered provider must ensure safe access to the garden. (This requirement remains outstanding from 30/11/04) Wash hand basins must be provided in all bathrooms where there is a toilet sited. (This requirement remains outstanding from 22/07/05) Corridors must have appropriate rails to assist residents. (This requirement is outstanding since 28/02/05) The supplementary heating identified during the inspection must be risk assessed to ensure it is safe for the residents to use. Laundry areas must have wash hand basins. (This requirement remains outstanding since 30/11/04) All laundry rooms must be redecorated. (Previous time scale of 01/08/06 not met.) 31/03/07 14. 14. 15. OP19 OP19 OP20 23(2)(b) 23(2)(b) 23(2)(o) 31/12/06 01/04/07 01/04/07 16. OP21 13(3) 01/04/07 17. OP22 23(2)(n) 01/05/07 18. OP25 13(4)(c) 01/01/07 19. OP26 13(3) 01/04/07 20. OP26 23(2)(d) 01/04/07 Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 30 21. OP26 13(3) Staff must ensure food hygiene procedures are followed in relation to entering the main. Kitchen. All opened foods being stored in fridges must be dated on opening. An alternative fridge must be designated for staff use. The fridge identified during the inspection as running at a high temperature must be checked. All personal toiletries must be returned to residents’ bedrooms after use. 50 of staff must be qualified to NVQ level 2 or the equivalent. All prospective employees must fully complete an application form. All staff must undertake all regulatory training. As a minimum this must include: Fire procedures Manual handling Basic food hygiene First aid Health and safety Infection control (Previous time scale of 01/09/06 not met.) This training must be regularly updated. The manager must develop systems for improving the service at the home based on the yearly quality assurance review. (Previous time scales of 01/08/06 and 01/10/06 not met.) 01/01/07 22. 23. 24. OP28 OP29 OP30 18(1)(a) 19(1) Sch2 18(1)(a) 01/04/07 01/01/07 01/03/07 25. OP33 24(1) 01/03/07 Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 31 26. OP34 25(1) 27. OP36 18(2) 28. 29. OP38 OP38 23(4)(e) 23(2)(c) 30. OP38 13(4)(c) The responsible individual must ensure she discusses with the manager the budgets available to her for the running of the home. (Previous time scales of 01/06/06 and 01/09/06 not met.) All care staff must have recorded supervision not less than 6 times a year. (This requirement remains outstanding since 30/11/05.) Fire drills must be undertaken every six months. There must be evidence on site that the portable electrical appliances have been checked to ensure they are safe to use. The premises risk assessments must be further developed to show the action taken and when any issues had been resolved. (Previous time scale of 01/09/06 not assessed for compliance at this visit.) 01/01/07 01/02/07 01/01/07 01/02/07 01/02/07 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 OP32 Good Practice Recommendations It is strongly recommended that minutes are kept of any meetings held with residents. Grey Gables DS0000016772.V312531.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 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. 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