Inspection on 03/05/07 for Grey Gables

This inspection was carried out on 3rd May 2007.

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 23/11/06

Grey Gables 03/05/06

Grey Gables 09/12/05

Grey Gables 07/06/05

Grey Gables 05/10/04

Grey Gables 29/06/04

Grey Gables 26/01/04

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

CARE HOMES FOR OLDER PEOPLE Grey Gables 39 Fox Hollies Road Acocks Green Birmingham West Midlands B27 7TH Lead Inspector Brenda O’Neill Key Unannounced Inspection 3rd May 2007 08:50 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.V334531.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.V334531.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.V334531.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home provide evidence that external support to the management of the home has been provided for the next three months, by 30 April 2006. 23rd November 2006 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. 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.V334531.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this key inspection over one day in May 2007. During the course of the inspection a partial tour of the premises was made, four staff files and four files for the people living in the home were sampled as well as other care and health and safety documentation. The inspectors spoke with the manager, three staff members and eight of the people living in the home. Prior to the inspection a pre inspection questionnaire was returned to the Commission which gave additional information about the home. Two completed questionnaires were returned by people living in the home and four from relatives. Comments included were generally very positive about the service offered. Some issues were raised including staffing levels and the laundry system in the home. These were explored during the course of the inspection. The Commission had received one complaint since the last inspection this was referred back to the registered individual to investigate. The issue raised concerned a visitor not being notified appropriately about the death of a person living in the home. A copy of the outcome of the complaint was sent to the Commission this had been appropriately investigated and there had been no beaches of regulations. There have been two adult protection issues raised at the home since the last inspection. One was resolved quickly once it had been referred to Social Care and Health. This involved allegations against staff that were not substantiated and were made due to the confused state of the individual involved. The second issue involved a person living in the home sustaining an injury from the use of a hoist. The district nurses raised this issue with Social care and health. The out come of quite a lengthy investigation deemed it to be a staff disciplinary issue and staff not following Manual Handling Regulations. What the service does well: On the day of the inspection the home had a relaxed atmosphere. There did not appear to be any rigid rules or routines and the people living in the home could choose how they spent their time and whether they took part in the organised activities or not. Some very positive comments were received from visitors to the home about how they were made welcome in the home and the activities available these included: ‘Outstanding activities arranged for people and family at the home, super food and entertainment always’ Grey Gables DS0000016772.V334531.R01.S.doc Version 5.2 Page 6 ‘The staff are always ready to share any concerns I have and act straight away.’ ‘Church services provided by local C of E parish. My ….. is Catholic and they have always welcomed visitors from the parish who call to give communion.’ ‘Social activities involving relatives such as Christmas/mother’s day meals they really do go the extra mile to make these events special’ ‘I am very pleased that they try to arrange events for the residents and also involve the relatives in these.’ One comment received suggested ‘many of the activities are not suitable for the age group.’ The needs of the people being admitted to the home were assessed prior to admission ensuring staff were aware of their needs. The people living in the home received attention from health care professionals as needed to help with meeting their health care needs. The people living at the home were happy with the meals and commented ‘ they feed us well’ and ‘super meals’. Menus were varied and nutritious and offered choices. Specific diets were being catered for. There had been little staff turnover at the home since the last inspection which was good for the continuity of care of the people living in the home. The interactions observed between the staff and the people living in the home were very positive. What has improved since the last inspection? The manager was obtaining copies of the social workers assessments prior to admitting people to the home. This ensured staff knew the needs of the people being admitted. At the time of the last inspection some of the personal files included forms stating when people’s bath/shower time was and if they refused at this time an alternative may not be offered. It was pleasing to note these had been removed and individual’s had more choice in relation to this. There had been some improvements to the environment improving the comfort and facilities for the people living there. There had been further redecoration to parts of the home, two new televisions had been purchased for the lounges, one bedroom had had new carpet, two new heated trolleys, three freezers and two fridges had been purchased. The dining room on bailey unit had been rearranged and had more space for the people using it. This room was also being used as a games room and library. Although the kitchen was not fully inspected during this visit it was clearly clean and well organised. It appeared the issues raised at the last inspection in relation to staff adhering to good food hygiene procedures had been addressed and a fridge had been designated for staff use. Grey Gables DS0000016772.V334531.R01.S.doc Version 5.2 Page 7 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.V334531.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.V334531.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): 3 and 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The needs of people being admitted to the home were assessed prior to admission to ensure staff knew what these were. EVIDENCE: The pre admission assessments for three people admitted to the home since the last inspection were sampled. Two of the people had clearly had social work input during the admission period and copies of their assessments were on file along with an initial care plan. One assessment clearly stated the individual had dementia and was very confused. The home was not registered to admit people with dementia and if they wish to they must first contact the Commission to vary their registration to allow for this. This was to ensure that details were given of how the staff at the home were to meet the needs of people with dementia. Grey Gables DS0000016772.V334531.R01.S.doc Version 5.2 Page 10 The staff at the home had also undertaken assessments on the people being admitted to the home. In some instances the assessments had not been signed or dated and it could not be determined that they had been undertaken prior to admission. These assessment documents covered all the required areas. Grey Gables DS0000016772.V334531.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 poor. This judgement has been made using available evidence including a visit to this service. The care plans and risk assessments for the people living at the home did not detail how staff were to meet any identified needs or minimise any risks. The lack of detailed risk assessments and management plans were putting the people who live at the home at risk. The medicine management has deteriorated. Records did not always reflect practice and the medicines were not always administered as prescribed. EVIDENCE: At the time of the last key inspection improvements had been made to the care planning and risk assessments being undertaken for the people living in the home. This had not been sustained. During this inspection four of the people living in the home were case tracked which involved sampling their assessments, care plans, risk assessments and daily records. Three of these people had been admitted to the home since the last inspection, the other had been living at the home for over a year. Grey Gables DS0000016772.V334531.R01.S.doc Version 5.2 Page 12 Files included an assessment of daily living needs which was completed after admission to the home. These assessments covered a variety of areas including, 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. Information gathered from there and the pre admission assessment should have been used to write the care plan. This had not been done. One of the people being case tracked had no care plan and the care plans for the other individuals were not adequately detailed. For example: • The plans did not detail if the staff or the individuals who wore hearing aids were responsible for caring for them. • There were no details regarding the foot care given to another individual. • No specific social care needs were identified. • General comments were made such as ‘for all staff to assist with personal care when needed’ with no detail of the individual’s abilities to self care or their preferences. The risk assessments that were in place were not always adequate and not all the required risk assessments had been undertaken. One nutritional screening assessment form had not been completed properly which would have reflected on the outcome of the screening. The outcome of one tissue viability assessment indicated the person was at high risk of developing pressure areas but there was no management plan in place for this for staff to follow to reduce the risk. One of the people being case tracked had a problem with swallowing and the assessment stated refer to dietician, the person had attended a hospital appointment but it could not be discerned what the outcome of this was. Again there was no written management plan in place for this. One person did have some detail for staff to follow should they have a seizure. From the daily records sampled it was clear that some individuals displayed some behaviours that needed to be risk assessed and management plans put in place. One person clearly had an issue with showering there was no management plan in place for staff to follow in respect of this or any evidence that any other methods of washing had been explored. It was also clear that the same person was sustaining some unexplained bruising. It was of great concern that this had not been explored by the manager to ensure it was not happening when the person was agitated. The daily records for another person living at the home clearly detailed that the person was wandering around a lot of the time and that on occasions this distressed other people living there. There was no management plan in place for in relation to this detailing how they were to distract the person or intervene when other people were becoming distressed. Grey Gables DS0000016772.V334531.R01.S.doc Version 5.2 Page 13 Visits from health care professionals were recorded on a professional visit sheet for each individual person. However on occasions visits were being recorded in a communication book which not all staff would read and therefore would not know about the visit. Senior staff needed to ensure that record keeping was accurate so that it could be ensured that peoples’ medical needs were met. For example one set of notes did not identify whether nurses were dressing an individual’s toes, feet or legs or if they had been discharged by the nurse. There was evidence that the people at the home were being weighed on a monthly basis, attending hospital appointments as necessary, seeing the G.P. if needed and receiving a chiropody service. The inspectors sampled the records for the controlled medication in the home. Several issues were noted therefore the inspecting pharmacist was asked to visit the home and do a full audit of the system. The pharmacist inspector visited the home on a separate day to the main inspection. The inspection lasted two hours. Old medicine charts and the returns were inspected and one current medicine chart with its corresponding medication, care plans and daily records were also looked at. One member of staff was spoken with. Feedback was given to the manager. Storage facilities for medication were good and the home had a dedicated medication room and a cupboard for the second trolley. Audits indicated that the medicines had been given as prescribed for the current cycle. However only two doses had been administered from that 28-day cycle of medication so audits looking at the returns and old medicine charts were undertaken. There was a high quantity of medicines awaiting collection from the pharmacist for destruction. The audits showed that not all the medicines had been administered as prescribed if they had been dispensed in traditional boxes. Staff had signed to say that some medicines had been administered when they had not always been. This indicates that staff are not reading the medicine charts before administration on each occasion. The home had no quality assurance system to assess staff competence in the safe handling of medicines and also does not audit the quantity of medicines returned for destruction against the old medicine charts. The administration of Controlled Drugs (CD) was recorded in the CD register and the medicine chart. Some entries did not tally. Some medicines had been recorded as administered in the CD register but not the medicine chart and vice versa. This is of serious concern as staff should be recording the administration at the same time in both the register and medicine chart and obtaining a witness signature to say that the administration had taken place. One Controlled Drug strength was incorrectly recorded in the register. This should be a true record of what actually had been administered and one quantity had been incorrectly recorded as received resulting in a series of Grey Gables DS0000016772.V334531.R01.S.doc Version 5.2 Page 14 corrections once the problem was identified. As two care assistants check these medicines there should be no errors. This indicated that staff were not accurately checking the Controlled Drugs into the home. One Controlled Drug was missing at the time of the inspection. This was found in the box containing the medicines awaiting destruction. It had not been recorded as returned in the CD register and should have remained in the CD cabinet until the pharmacist collected it. It was advised that balances of CDs are carried over and these medicines only returned when they are no longer prescribed. The home operates a good system to check in the medication each month and chases up any discrepancies immediately. The care assistant spoken with during the inspection had a limited knowledge of what the medicines she administered were for but she did understand some of the clinical conditions of the people. Care plans and the daily records supported any healthcare professional visits and the medicines the people who live in the home were prescribed. The manager was keen to improve the service to its original standard and this was commended. No issues were raised by the people living at the home in relation to their privacy or dignity. It was noted that some personal information about the people living at the home was being written in the communication book which did not ensure confidentiality. This issue has been raised at the home before and had been addressed at the time of the last inspection. People living at the home could have keys for their bedrooms if they wished and had a lockable facility in their rooms. Some had their own telephones in their bedrooms and there was also a telephone for their use in a quiet area of the home. Medical consultations took place in the privacy of bedrooms and there were several areas in the home where people who were living there could receive visitors if they did not want to take them to their bedrooms. Staff were observed to knock on bedroom doors before entering and address the people living at the home respectfully. Grey Gables DS0000016772.V334531.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 but these did not cater for all individual 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 are happy with the catering arrangements. EVIDENCE: On the day of the inspection the home had a relaxed atmosphere. There did not appear to be any rigid rules or routines and the people living in the home could choose how they spent their time, whether they took part in the organised activities or not, when to go to bed and get up, what they ate and so on. The people living in the home at the time that were spoken with appeared content and satisfied with their lifestyles. The people living in the home were seen to take part in organised activities, reading, watching the television, having their hair done, chatting to each other, spending time quietly in their rooms and wandering freely around the home. On the day of the inspection a visitor to the home was facilitating a craft Grey Gables DS0000016772.V334531.R01.S.doc Version 5.2 Page 16 session and an aromatherapist was also in the home. Recorded activities included Easter party, exercise, physical motivation, dominoes, going out with visitors, watching a video, visits from family and sitting in the garden. There also needed to be some evidence that the people living at the home who did not participate in group activities had some one to one staff time. It was difficult to assess if the social needs of all the people being case tracked were met due to the lack of information in the care plans. This was particularly important where they were unable to voice their opinions and preferences due to having dementia. Some very positive comments were received from visitors to the home about how they were made welcome by staff and the activities in the home including: ‘Outstanding activities arranged for people and family at the home, super food and entertainment always’ ‘The staff are always ready to share any concerns I have and act straight away.’ ‘Church services provided by local C of E parish. My ….. is Catholic and they have always welcomed visitors from the parish who call to give communion.’ ‘Social activities involving relatives such as Christmas/mother’s day meals they really do go the extra mile to make these events special’ ‘I am very pleased that they try to arrange events for the residents and also involve the relatives in these.’ One comment received suggested ‘many of the activities are not suitable for the age group.’ It was evident from daily records that visitors were able to visit at all reasonable times. 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. It was noted on one of the assessments for one of the individuals being case tracked it stated they would like to self medicate. There was no evidence that this had been pursued or risk assessed to establish if this would be possible. At the time of the last inspection some of the personal files included forms stating when people’s bath/shower time was and if they refused at this time an alternative may not be offered. It was pleasing to note these had been removed and individual’s had more choice in relation to this. People living in the home had been encouraged to personalise their rooms to their choosing and personal effects were seen in all the bedrooms. The people living at the home were happy with the meals and commented ‘ they feed us well’. Menus were varied and nutritious and offered choices. Specific diets were being catered for. Comments received from relatives included: Grey Gables DS0000016772.V334531.R01.S.doc Version 5.2 Page 17 ‘Super food.’ ‘ My …… has had some problems eating and they have puréed food and taken time to feed her when she was unable to feed herself.’ ‘Standards of hygiene and food are excellent.’ Grey Gables DS0000016772.V334531.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 poor. This judgement has been made using available evidence including a visit to this service. Complaints in the home are appropriately investigated and responded to. Recent events in the home suggest that the people who live in the home are not always listened to or adequately safe guarded. EVIDENCE: The complaints procedure was not viewed as it had been seen at previous inspections. People living in the home received a copy of this in the service user guide and these were evident in their bedrooms. The Commission had received one complaint since the last inspection this was referred back to the registered individual to investigate. The issue raised concerned a visitor not being notified appropriately about the death of a person living in the home. A copy of the outcome of the complaint was sent to the Commission this had been appropriately investigated and no regulations had been breached. The complaints log at the home included an enquiry from a relative about fees when their relative was in hospital. This was being investigated at the time of the inspection. Two of the comment cards received raised issues over the laundry system at the home. Personal clothing has gone missing, no one seems responsible for the laundry and clothes regularly placed in the wrong bedrooms. These issues had been raised in the home and the manager had taken note of the problems. Grey Gables DS0000016772.V334531.R01.S.doc Version 5.2 Page 19 To try and resolve the difficulties a new system had been put in place. Name labels were being sewn into clothes, there was now only one laundry instead of two, the laundry from each unit was being done on specific days and a member of staff had been recruited to take responsibility for the laundry. There had been two adult protection issues raised at the home since the last inspection. One was resolved quickly once it had been referred to Social Care and Health. This involved allegations against staff that were not substantiated and were made due to the confused state of the individual involved. The second issue involved a person living in the home sustaining an injury from the use of a hoist. This issue was raised with Social care and health by the district nurses. The outcome of quite a lengthy investigation deemed it to be a staff disciplinary issue and staff not following Manual Handling Regulations. This issue could have been resolved much more quickly if the person who sustained the injury had been listened to when the injury occurred and the issue referred to Social Care and Health straight away. Several issues were raised with the manager and registered individual of the home during the investigation including, why the person was not listened to, discrepancies in recordings of events, omissions in recordings. The staff had had further adult protection training since this time and issues of recording accurately had been raised with them. Further training is also planned to be facilitated by the vulnerable persons officer. It does not appear that the staff and management of the home had understood the issues raised or learned from the training as the same type of issues were raised throughout this inspection, for example, poor recording and unexplained bruising. This raises issues as to whether the people living at the home are fully safe guarded. Grey Gables DS0000016772.V334531.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. Further improvements had been made to the environment giving the people who live in the home a comfortable and safe place in which to live. EVIDENCE: Improvements to the environment were ongoing in the home. Since the last inspection there had been further redecoration to parts of the home, two new televisions had been purchased for the lounges, one bedroom had had new carpet, two new heated trolleys, three freezers and two fridges had been purchased. The dining room on Bailey unit had been rearranged and had more space for the people using it. This room was also being used as a games room and library. Some areas of the home remained in need of redecoration however it is recognised that in a home of this size this is an ongoing issue. There was one Grey Gables DS0000016772.V334531.R01.S.doc Version 5.2 Page 21 area in the home where the carpet was thread bare and fraying and a possible tripping hazard. This area was only used by staff however the carpet needed to be addressed and this had been outstanding since the last 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 people living in the home. Access to the garden was problematic for the people living in the home with mobility difficulties as the ramped access was quite narrow. Safe access to the garden for them 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. This is an ongoing requirement. It was also noted that there was some damaged plaster by the door in the bathroom on Maple unit. As at the last inspection some of the corridors had handrails others did not and were needed to ensure people living in the home could move around safely. Other aids and adaptations were available in the home including passenger lifts, hoists, wheelchairs hand and grab rails in the toilets and an emergency call system. The emergency call system was activated by the inspectors in the shower room. Staff did not respond to this. The manager with the inspectors stated this was probably because it was the old system that had been used. If staff are not going to respond to the old call system if it is activated the pull cords must be removed so that they are not used by the people living in the 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 bedrooms seen were comfortable. It was noted that one needed new carpet/flooring in the en-suite and another had water damage to the ceiling and the wall. Bedrooms were lockable and all had had a lockable facility installed. People living at the home who were spoken with were generally happy with their bedrooms and some had their own telephones, televisions and radios. Heating, lighting and ventilation in the majority of areas of the home was appropriate and the people living there were able to control the heating in their bedrooms. There were some exposed light bulbs in some of the wall lights around the home and some of the fittings were insecure. This must be addressed to ensure the safety of the people living in the home. Although the water temperatures were not tested during the inspection the staff at the home were monitoring these. The temperatures of the water on Cherry and Bailey unit that were recorded on April 20th varied from 24 degrees to 41 Grey Gables DS0000016772.V334531.R01.S.doc Version 5.2 Page 22 degrees. Some of these temperatures were too low for bathing and washing to be comfortable for the people living in the home. The home was found to be clean and odour free. The laundry system had been changed since the last inspection. There is now only one laundry and new machines were due to be fitted in this room that did not take up so much room. No personal toiletries were seen in the communal bathrooms which had been an ongoing issue at previous inspections. A trolley with COSHH substances had been left unattended on one of the units this was dealt with immediately. Staff must be mindful not to leave harmful substances unattended. Although the kitchen was not fully inspected during this visit it was clearly clean and well organised. It appeared the issues raised at the last inspection in relation to staff adhering to good food hygiene procedures had been addressed and a fridge had been designated for staff use. Grey Gables DS0000016772.V334531.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate staffing levels were being maintained to ensure the needs of the people living in the home could be adequately met. Staff were receiving some ongoing training but it could not be evidenced that all staff were fully equipped to deliver adequate and appropriate care. Recruitment procedures in the home were robust but needed to be applied consistently to ensure the people living in the home were safeguarded. EVIDENCE: There had been little staff turnover at the home since the last inspection which was good for the continuity of care of the people living in the home. Two of the comment cards received from relatives raised some issues about low staffing levels at the home. The rotas that were sent to the commission with the pre inspection questionnaire also indicated that staffing levels dropped below the required minimum at times. This issue was raised with the manager and she stated the home never operated below the required minimum of six staff throughout the waking day. This was also confirmed by two other members of staff spoken with. It was identified that when staff were off work and their shifts were being covered by overtime, bank or agency staff this was not always reflected on the rota. The manager was reminded that the rota must be a true reflection of who actually worked during that shift to evidence adequate staffing levels were being maintained at all times. As the occupancy levels had Grey Gables DS0000016772.V334531.R01.S.doc Version 5.2 Page 24 increased in the home and the home was large and spread out the issue of only two waking night staff being on duty was raised with the manager. She stated they were looking into also having one member of staff sleeping in at the home in case extra help was needed. This should be reviewed as soon as possible to ensure the needs of the people living in the home can be met during the night. The recruitment documentation for four staff was sampled. Two of the files included all the necessary documentation including, application forms, two written references, CRB checks and medical declarations. The other two files were for staff who had worked at the home as agency staff and they had only one written reference and their POVA first checks had not been obtained until three days after they started their employment. Although these staff had already been working at the home from an agency the manager still needed to ensure she had all the required documentation prior to them being employed at the home. The pre inspection questionnaire stated the home had twenty-seven care staff seventeen of whom had achieved NVQ level 2, 63 in total which is over the required fifty percent. This was confirmed with the manager during the inspection. Induction training for new staff was quite thorough and followed the induction standards detailed by skills for care but it was not being completed within the specified time scale of twelve weeks. This needs to be achieved to ensure staff have all the necessary skills and knowledge to fulfil their roles within a reasonable time. The pre inspection questionnaire detailed numerous topics being covered in the last year including, manual handling, infection control, risk assessments, safe handling of medicines, abuse awareness and holistic assessment of needs. Future training was detailed as food and hygiene, first aid, infection control and safe handling of medicines. The training matrix for the home was not up to date therefore it was not possible to establish if all staff were up to date with all the required training. The manager needed to ensure the matrix was updated with all training information so that any updates needed could be arranged. Grey Gables DS0000016772.V334531.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, 32, 33, 35 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Improvements in the management of the home were needed to ensure the people living there were safeguarded. The home needed to have a system in place for reviewing the quality of the service based on seeking the views of the people living there with a view to continuous improvement. EVIDENCE: The improvements in the management of the home that were evidenced at the last inspection had not been sustained. Several issues were raised throughout the course of this inspection that needed to be improved to ensure the people living in the home were safe guarded, for example, risk assessments and accurate recording. Grey Gables DS0000016772.V334531.R01.S.doc Version 5.2 Page 26 The inspectors had extensive discussions with the manager during the inspection and it appeared that there were several shortfalls in the new management structure that had been put in place. Senior staff roles were not clear and communication channels between the staff team and the manager were not effective. This led to the manager not being aware of all occurrences in the home and issues not being addressed appropriately or in a timely manner. The management structure in the home needed urgent review and job roles needed to be clarified to ensure staff knew who to raise any issues with and who to approach with every day issues. The staff spoken with during the inspection felt that the team worked quite well together however the issues raised suggested there were some serious shortfalls. The responsible individual contacted the inspector after being made aware of the issues raised during the inspection and requested an urgent meeting to discuss the issues. There had been no further progress with the quality assurance system in the home. The home had had a quality audit conducted by an outside agency some time ago but the findings from this had not been pursued. The inspectors were informed that the responsible individual held meetings with the people that live in the home on a regular basis to find out their views on the service however there was no documentation to support this. The minutes for only one staff meeting were seen and this had been called to raise specific issues with staff. 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. The main issues in relation to health safety raised during this inspection were in relation to risk assessments and ensuring any incidents that could be deemed as abuse were recognised and reported appropriately. General health and safety checks were up to date including the servicing of equipment, all the in house checks on the fire system and a recent fire drill had been undertaken. The requirements made at the last inspection in relation to testing portable electrical appliances and fire drills had been met. Grey Gables DS0000016772.V334531.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 2 2 2 X 2 2 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 2 Grey Gables DS0000016772.V334531.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4 Regulation 12(1)(a) Requirement The registered person must ensure they do not admit people outside the registration category of the home. This will ensure the staff at the home are able to offer person centred care. The care plans for the people living in the home must clearly detail all the needs of the individuals and how their needs are to be met by staff. (This requirement has been outstanding since 21/07/03) Care plans must be reviewed on a regular basis and updated as necessary. This will ensure that the people living in the home receive person centred care. 3. OP7 13(4)(c) Care plans must include strategies for managing any difficult or challenging behaviours. This will ensure the people living in the home are safe guarded. DS0000016772.V334531.R01.S.doc Timescale for action 01/07/07 2. OP7 15(1)(2)b 01/07/07 14/06/07 Grey Gables Version 5.2 Page 29 4. OP8 13(4)(c) Where a risk is identified on tissue viability assessments or nutritional assessments there must be a plan in place to manage this. Any ongoing health concerns must have a management plan in place. This will ensure people living in the home have their health care needs met. Any unexplained bruising or injuries to the people living in the home must be fully explored. This will ensure the people living in the home are safe guarded. All staff that handle medicines must refer to the medicine chart before the administration of medicines and record the transaction directly afterwards. 01/07/07 5. OP8 13(6) 01/06/07 6. OP9 13(2) 16/06/07 7. OP9 13(2) 8. OP12 16(2)(n) The right medicine must be administered to the right service user at the right time and dose and records must reflect practice All Controlled Drug transactions 16/06/07 must be accurately recorded in the Controlled Drug register and checked by a second member of staff for accuracy. The medicine chart must also accurately reflect the transaction People living in the home must 01/07/07 have their social and recreational needs met in a way that suits their needs. (This requirement has been outstanding since 31/08/05) This will ensure that people living in the home have their social needs met. Staff at the home must ensure they listen to what the people living there are saying and that DS0000016772.V334531.R01.S.doc 9. OP18 13(6) 14/06/07 Grey Gables Version 5.2 Page 30 10 OP19 23(2)(b) 11. OP22 13(4)(c) 12. OP25 13(4)(c) any adult protection issues are reported in a timely manner. This will ensure that the people living in the home are safe guarded. The thread bare/fraying carpet must be addressed. This will ensure staff are not at risk of tripping. The registered person must ensure that all activated emergency calls are attended to. This will ensure the people living in the home are not left unattended. People living in the home must be safe guarded from any risks from exposed light bulbs. Any lose wall light fittings must be addressed. This will ensure the safety of the people living in the home. Prior to new staff commencing work at the home the registered manager must ensure: Two written references POVA fist checks have been obtained. This will ensure the people living in the home are adequately safe guarded. There must be evidence on site that all staff have undertaken 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 and 01/03/07 not met.) This will ensure the staff at the 14/06/07 14/06/07 14/06/07 13. OP29 19(1) Sch2 14/06/07 14. OP30 18(1)(a) 01/07/07 Grey Gables DS0000016772.V334531.R01.S.doc Version 5.2 Page 31 home work safely and have the necessary skills to care for the people living in the home. 15. OP33 24(1) The manager must develop systems for improving the service at the home based on a yearly quality assurance review. (Previous time scales of 01/08/06, 01/10/06 and 01/03/07 not met.) This will ensure plans are in place to continuously improve the service for the people living in the home. 01/08/07 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. 2. Refer to Standard OP8 OP10 Good Practice Recommendations Staff needed to be mindful that any recordings made about the people living in the home were accurate and recorded in a consistent manner. Personal details about the people living in the home should be recorded in their personal files and not in the communication book. This will ensure the confidentiality of the people living in the home. It is recommended that the home installs a quality assurance system to confirm staff competence in the handling of medicines It is recommended that all controlled drug balances are carried over and not returned routinely each cycle and held in the CD cabinet until they are either administered or removed from the premise. Where people living in the home are unable to voice their opinions or preferences in relation to their leisure pursuits this should be explored with relatives/friends. This will ensure staff have as much information as possible to enable them to meet the social needs of the people living in the home. DS0000016772.V334531.R01.S.doc Version 5.2 Page 32 3. 4. OP9 OP9 5. OP12 Grey Gables 6. OP14 7. OP19 8. 9. 10. 11. OP20 OP21 OP22 OP27 12. 13. OP27 OP31 Where a person living in the home has expressed a specific choice, for example, to self medicate, this should be explored to establish if it would be possible. This will ensure that the people living in the home are enabled to exercise choice and control over their lives. Any areas of the home in need of redecoration and any minor repairs that were highlighted during the inspection must be addressed this will ensure the standards in the home are kept to an acceptable standard for the people living there. Access to the garden should be reviewed to ensure it is safe for the use of all the people living in the home. Wash hand basins should be provided in all bathrooms where there is a toilet. This will ensure good standards of hygiene for the people living in the home. The availability of handrails around the home should be reviewed to ensure the people living there can move around the home safely. The rotas in the home must be true reflection of what staff are on duty at any time. This will evidence staffing levels are appropriate for the needs of the people living in the home. Night staffing levels should be reviewed to ensure the needs of the people living in the home can be met during the night. The management structure in the home needed urgent review and job roles needed to be clarified to ensure staff knew who to raise any issues with and who to approach with every day issues. Grey Gables DS0000016772.V334531.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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