Inspection on 07/09/07 for Grey Gables

This inspection was carried out on 7th September 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 11/07/06

Grey Gables 01/03/06

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

CARE HOMES FOR OLDER PEOPLE Grey Gables 1 Lodges Grove Bare Morecambe Lancashire LA4 6HE Lead Inspector Mrs Joy Howson-Booth Unannounced Inspection 7 September 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Grey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Grey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grey Gables Address 1 Lodges Grove Bare Morecambe Lancashire LA4 6HE 01524 425376 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ewood Residential Homes Limited Mrs Elaine Ann Wood Care Home 16 Category(ies) of Dementia (16) registration, with number of places Grey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only: Code PC, to service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Dementia: Code DE The maximum number of service users who can be accommodated is: 16 Date of last inspection 11th July 2006 Brief Description of the Service: Grey Gables is registered to accommodate up to 15 people who have dementia. The home is situated in a quiet residential area of Bare in Morecambe and is close to local shops and amenities. The home is a large detached dwelling, situated on a corner site, with a small car parking area in the ground to the front. In addition, there is a small, secure garden area to the rear and side of the building. The home is comfortably decorated and has adequate communal space. There is also a small extension on the ground floor with bedrooms. There are bathroom and toilets on this floor. The first floor houses bedrooms and a bathroom. The home has 11 single bedrooms and 2 double bedrooms, one of these has an ensuite facility. The registered provider/manager is experienced and qualified in the care of people with dementia. The current weekly fees range from £371.00 to £425.00. Further details regarding fees are available from the owner/manager. Grey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first site visit and was unannounced so the registered provider/manager, staff and residents were not aware of he visit. The inspector for the service carried out the site visit. The site visit forms part of the overall inspection for the home which makes sure people are being cared for properly and to make sure the home is a safe place for people to live in. As well as the site visit, judgements have been made about the service based on information supplied by the registered provider/manager. Comment cards were made available to residents, their relatives, GP surgeries and healthcare professionals who are involved with the home. Responses were received from 3 residents and 1 relative who were very satisfied with the service provided. Responses received from 1 GP and another professional who both expressed satisfaction with the service provided. The site visit took place over one day and included, spending time observing staff on duty performing the day-to-day care tasks, taking time to sit and speak with residents, speaking with staff and speaking with the registered provider/manager. The home’s registered provider/manager was available during the inspection to answer questions and provide additional information. The inspector looked around communal rooms, a small number of personal rooms to see first hand if the home was a comfortable, clean and safe for people to live in. Every year the registered person is asked to provide us with written information about the quality of the service they provide and to make an assessment of the quality of their service. This information, in part, has been used to focus our inspection activity and is included in this report. The site visit was enjoyable with everyone welcoming, friendly and cooperative during the visit. What the service does well: Most noticeable are the environmental changes to the home that have occurred over recent months. The registered provider/manager has continued with the refurbishment work to the home, currently a conservatory is being added with landscaped gardens so that this is an additional facility for the residents to use. A new additional extension has been added, some rooms Grey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 6 have been redecorated and the programme for the refurbishment of the communal rooms downstairs will be completed once the conservatory has been finished. The service is also including residents in this programme – one resident said they had been asked about the colour for their room. The home is situated in a quiet residential area, close to local shops and amenities and the inspection found that residents (with staff support) are encouraged to get out and about in the community. Individual comments from residents and their relatives confirmed that the managers and staff try hard to make the service homely, comfortable and reassuring for the people with dementia who live there. One resident commented “Mrs Wood looks after us very well”. Relatives’ comments included – “thank you so much again for all you did for mum while she was in your care”; “thanking you all so much for all your kindness to our relative. We appreciate all that was done for him” and “I think (the home) is excellent and there is no reason for improvement”. Professional comments included – “seems to be a caring and well run home” and “the home treat X as an individual and respect her individual needs and wishes where possible”. All registered care homes are expected to keep a written record for every resident, which describes their needs and how the care that is given meets these needs. These records are called care plans. A number of these were sampled and showed that a satisfactory system is in place so that staff know about individual residents needs and preferences and are informed as to how these are to be met. There is good communication in the home as staff spoken with were clear about individual residents’ current care needs and how they are to meet these. The home tries hard to make sure individual residents are supported in the way they wish to be. There is equality of care in the home in that all residents are encouraged and supported in their daily routines and are supported to take part in activities in the home. The registered provider is keen that the residents view the home as “their home” and continue do things as they would in their own homes. Observations during the inspection confirmed that the staff support the residents in a dignified and caring way, with no one being rushed or made to feel awkward. The staff spoken with were able to speak about their understanding of the needs of the residents, activities provided and how they meet these and ensure residents are cared for in a dignified and respectful way. Grey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? The management structure within the home has been improved with the appointment of an assistant manager. The registered provider/manager has also increased her knowledge and skills in managing a care home and this has built on her existing skills base. This means there is more monitoring and guidance to staff to ensure care provided to residents is at a high standard. Activities within the home and in the community continue to be developed so that residents are provided with stimulating and interesting things to do. The ongoing refurbishment means that the home is developing into a very homely and pleasant place for people to live in. The registered provider has developed a formal quality assurance system which seeks feedback on the service from the residents and their relatives. Staff are also provided with an opportunity to be involved and provide feedback as regular staff meetings are now held. Training has also improved, with the registered providers showing a commitment to making sure staff are trained and competent to do their job. As well as formal training sessions held externally (National Vocational Qualifications training), other key training has also been provided (moving and handling, food hygiene, etc.). The registered provider is also looking to provide specific training for the care of people with dementia, this is currently being organised. Medication is now being given according to the needs of the resident and not at set times (like lunch or tea). This is good practice and means the service is not task driven but needs led. Policies and procedures have been reviewed and updated so that staff are provided with up to date guidance. The management team also assess staff understanding of these during supervision. A recruitment checklist has been put in place to make sure that all the required checks are carried out on prospective staff before their appointment. Formal supervision is now provided to staff which means that staff have an opportunity to talk about their care practices, training needs and future support needs. Information provided by the registered provider also record that they promote both equality and diversity in the home by operating a ‘rigorous recruitment policy, uphold residents legal rights, deal with complaints quickly and Grey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 8 appropriately, safeguard residents from abuse and ensure staff are trained to know their obligations’. 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 DS0000066324.V344267.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 and 6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Anyone who is considering entering Grey Gables is supplied with enough information to help them make that decision. This means that people can make a choice about whether Grey Gables is the home for them. The home undertakes its own assessment of people who may like to live at the home which means the are clear that the prospective resident’s needs can be met. EVIDENCE: Information provided by the home confirmed that a full assessment of needs is carried out by people trained to do so. Further discussion confirmed that, whilst a personal visit is made to any prospective resident, this information is not recorded separately but put directly into a preliminary care plan. As well as this, the home uses information provided by the prospective resident’s Grey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 11 Social Worker. Additional information on needs, abilities, wishes, lifestyles, etc., is also gained during the four-week trial period in the home. Given the needs of the residents this is a useful way of developing knowledge and information about individual needs and wishes of the person concerned. Information provided by the home states “when people enquire about our home we send them an up-to-date statement of purpose which clearly explains to them all about us. We invite them to come and look around and ask questions. We give them as much information as they require to be able to make an informed choice about where they will live. . The last inspection report noted that trial visits are encouraged so that the home can get to know the prospective resident and they the home. The home also confirms that individual needs and wishes are included in individual care plans. The home does not offer an intermediate care facility. Grey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. A good level of care is provided to the people which means their health and personal care needs are met and people are treated with dignity and respect. Medication systems need some improvements to ensure residents and staff are fully safeguard. EVIDENCE: Information provided by the home states “the health and personal care a person receives is based upon their individual needs which will have been assessed prior to coming into the home. All this information is in the careplan and assessment is ongoing with all staff contributing to it.” This information continues “residents or their representitive are consulted on matters concerning their wellbeing and are actively encourage to assist in filling in their care plan”. Grey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 13 Care plans were examined for several residents and all confirmed that the information is sufficiently detailed to enable staff to know individual needs and how these are to be met. Risk assessments are also carried out although not all care plans evidenced that specific strategies as to the identified risk and how staff are to address this have been written into the care plans. Care plans are also reviewed on a monthly (or sooner if needed) basis. The home has a key worker system in place to ensure that the residents’ health and wellbeing is maintained. The key worker system also means there is a dedicated member of staff for each resident whose role is to build up a special relationship with their named resident, and work with them on a one to one basis to ensure they receive a good level of care. Care plans evidenced healthcare needs are met, with involvement of healthcare specialists as needed. The home act as good advocates for the residents, taking action when they are concerned about any healthcare issues. There was also evidence of multi-disciplinary team working for residents with more complex needs. Additional records are also put in place if any specific concerns are raised, for example food and fluid monitoring charts if concerns over nutrition. Information provided by the registered provider indicates that “residents where appropriate are responsible for their own medication and all staff are trained in the administration and disposal of medicines and are aware of the homes policies and procedures for dealing with medicines”. At this inspection the medication records and stocks were examined and advice given to the registered provider that some improvement was required to safeguard both residents and staff. These improvements include the implementation of an audit system, specific guidance for any medications prescribed when needed (PRN), a controlled drugs register and obtaining further guidance. A referral has been made to the pharmacist inspector so that additional advice and support can be provided. The registered provider also confirmed that the staff no longer give out medications as part of the meal routine but do medications on an individual basis, as the prescription dictates. This is good practice and indicates a needs led service. Observations during the inspection noted that all the residents were treated with dignity and respect. Staff were caring and took the time and trouble to sort out issues and concerns. Staff spoken with were also able to describe how they maintain residents’ privacy and dignity. Grey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 14 Relative and external professionals raised no concerns about how staff care for the residents and all stated that dignity and privacy is maintained at all times. Individual comments included – “we appreciate all that was done for our relative” and “thank you so much again for all you did for mum while she was I your care”. Grey Gables DS0000066324.V344267.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): Standards 12, 13, 14 and 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents continue to be supported to enjoy their lifestyles, maintain contacts and have choices which means residents have a quality of life. Residents are provided with wholesome and nutritional meals in a relaxed and unhurried way. EVIDENCE: Information provided by the registered provider states that “daily life is flexible to all residents. Activities are available for all who wish to join in.” Care plans evidenced that individual routines and wishes are noted and staff were able to confirm how these are respected. As well as this there is an activity book which should be completed once activities have taken place. Unfortunately, this has not been consistently kept fully up to date so it is difficult to evidence what activities have been provided to which residents. Records indicate that the activities provided have included – music, taken shopping, birthday celebrations, walks out, spending time Grey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 16 talking, trips out in the car, going out with relatives and watching television. The registered provider endeavours to make sure that there is a homely environment where residents’ current abilities are recognised and supported. The registered provider confirmed that a volunteer had provided some valuable 1 to 1 work with residents and it was hoped this would be restarted soon. Confirmation was received from an external professional that individual activities are planned and take place – “the care staff have provide support to enable X to go out, choose her own clothes, have her hair and nails done at a local salon”. Staff spoken with also confirmed a range of activities are provided and how they try to help specific interests being continued. One member of staff spoke about how she had tried to help one resident do some sewing. Residents confirmed they enjoy activities – one resident commented “I like going out”. Residents also get 1 to 1 time by a named member of staff who takes them out for walks, visiting local shops, spends time talking, hand massages, etc., as they prefer. Religious needs are met with visits from a local Vicar. In addition, a singer visits the home, along with an arts and crafts lady once a month. Other activities include games, film afternoons and craft work. At the time of the inspection, a birthday celebration was being held for one resident . Residents are also involved in homely activities like cake baking and, during part of the inspection, one resident was sat with the cook in the kitchen as the lunchtime meal was being prepared. Some good progress has been made with the development of needs-led activities and this should continue, particularly by providing dedicated staff to enable activities to take place uninterrupted by care tasks. Advice was also given that activities need to be recorded and a newsheet or information board may be helpful to inform residents, relatives and other visitors of the types of activities organised by the home. The registered provider has confirmed that “residents can have visitors whenever they wish.” Comment cards completed by a resident confirmed that they are made welcome at any time. The Statement of Purpose outlines visits to the home but requests visits do not clash with mealtimes. Written information from the home states that “residents are encouraged and helped to make choices allowing them autonomy over their lives.”. Care plans evidence that choices are offered. Staff spoken with were able to outline how they enable the residents to make choices in their day to day lives. Generally people are not able to manage their own finances and this role is given to either a relative or representative. It has already been confirmed that residents are encouraged to bring in personal possessions to make their rooms more familiar and homely. Grey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 17 Comment from professional regarding “close proximity of kitchen” was discussed with registered provider who advised that residents are actively encouraged to go into the kitchen as this is considered to be their home and many enjoy taking part in baking, etc. Indeed, a couple of residents had just enjoyed helping to bake a fruitcake which is to be eaten at teatime. However, she recognises the concern and confirmed that residents are not allowed into the kitchen unsupported or when the cook is not there and there are always staff around to ensure the safety of the residents. The registered provider confirms that “home cooked food is available daily with residents individual tastes taken into account”. One care plan states “likes egg and chips” and individual food requests on the day are usually met. Residents who completed survey forms confirmed that they are satisfied with the meals provided. Staff stated that meals are usually flexible with breakfast and teas generally being based on “what people fancy”, although there is one main meal at lunchtime. Likes/dislikes are known and respected. Drinks and snacks are available during the day. Records are maintained for residents whose nutrition is of concern, with supplements being organised as needed. There are no special diets at present in the home. Records seen evidenced that one resident has been supported with his nutrition so that they now eat a normal diet. One professional commented “the meals have always looked appetising and well prepared”. Menus were seen and advice given to the registered provider that, particularly, the evening teatime meal is repetitious and needs to be improved. The registered provider has also confirmed that they are looking at providing pictures/photographs of meals so that residents can make a more informed choice of things to eat. Staff supported residents in an unhurried way, although the dining room was somewhat dark – the registered provider was advised that the lighting in the dining room needs to be improved. Grey Gables DS0000066324.V344267.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): Standards 16 and 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The registered provider ensures that concerns can be voiced and residents are safeguarded. EVIDENCE: The registered provider confirmed that five complaints have been made since the last inspection, with 2 being received by the commission. Of these 3 were investigated and upheld and 2 not upheld. The complaints procedure remains the same and is on display in the hallway. It was confirmed that information over complaints has now also been included in information given out so that both prospective residents and their relatives have first hand the complaints procedure. Residents confirmed that they knew who to speak with if they were not happy with any aspect of their care – “see Mrs Wood”. Relatives and external professionals also confirmed that they were aware of the homes complaints procedure and the home has responded appropriately if any concerns have been raised. Advice given that the complaints procedure could be produced in a format for people with dementia, particularly those people who are no longer able to Grey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 19 comprehend written information. Discussions with the registered provider indicated that as she is working at the home on a full-time basis, she is able to pick up on things quickly and address them as they arise. A safeguarding issue raised recently highlighted that not all staff were clear about the homes safeguarding adults’ procedure. Following this, the registered provider confirmed that staff induction and training procedures have been improved so that all staff are now informed of the safeguarding adults procedure to be followed should any concerns be raised. In addition, the registered provider confirmed that the home has reviewed its policies and procedures to ensure these meet with local safeguarding adults protocols. Discussions with staff during the inspection confirmed that they are aware of different forms of abuse, their responsibility to protect vulnerable people from abuse and safeguarding procedures. Advice given that anyone left in charge of the home needs to be clear and confident bout the safeguarding adults procedure that must be followed. Further advice and guidance was provided to the registered provider over their responsibilities regarding notifications under the safeguarding adults protocols and the procedure that must be followed should an incident occur. It was also noted that an incident had not been notified to the commission as required under the Care Homes Regulations. The registered person was again reminded of her responsibilities to notify the commission of events, etc. affecting residents in the home. Grey Gables DS0000066324.V344267.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): Standard 19 and 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People live in a well-maintained and safe environment which provides a very pleasant and homely place for them to live in. EVIDENCE: Not all areas of the home were seen but clearly a number of environmental improvements have been made which have improved the facilities within the home for the residents. The registered provider has also confirmed that “an ongoing refurbishment is currently in place and all bedrooms have been redecorated. All bathrooms have beem upgraded. a new kitchen put in situ. A more appropriate heating system has been introduced. A stair lift has been put in situ. An extention has been built which provides another bedroom with enGrey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 21 suite facilities and an office. The existing roof has been replaced as have the gutters and downspouts and the outside has been has been painted. All relevant environmental health and safety requirements are met. Residents were asked about the work done in the home and said it was “very good”. One resident said that they had been asked about the colour for their bedroom – “I like blue” but hadn’t yet decided. The communal and other rooms seen were clean and tidy and providing a homely and pleasant environment for the residents to use. The registered provider was advised that the lighting in the dining room was poor and needed to be improved. Current work includes a conservatory for use by residents, along with landscaping of the garden area. Once finished, this will provide a positive and welcome facility which will clearly improve the environment. The conservatory links with the other communal areas and, once completed, it is the providers’ intention to use wooden flooring through to enhance the look and brighten up the home. Advice was given that any flooring used must not pose a risk to residents. As part of the ongoing refurbishment, new carpets are being ordered, along with a redecoration programme for the communal areas. The registered provider confirmed that one bedroom is to have vinyl flooring put in to meet the needs of the resident. Provider advised that this needs to be replaced with carpet once the current occupant moves from the room. Comments provided to the registered provider raise concerns over the external areas of the home. Plans are in hand to address these external areas but, understandbly, until the interior upgrading has finished, this has not been possible. It is anticipated the external areas will be improved in the next couple of months. Staff confirmed that there is an ongoing maintenance book which is used daily to address any maintenance or safety issues. There is a small, separate laundry and it has previously been confirmed that the washing machine conforms to the requirements for washing foul laundry. The home has confirmed that there are “policies and procedures are in place to control the spread of infection”, with 13 members of staff trained in infection control. The home has policies and procedures in place for infection control, safe handling of clinical waste. The home has accessed the Department of Health’s guide ‘Essential Steps’ to assess current infection control management but currently does not have an Grey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 22 action plan for work on infection control management. This may be something for the home to address as the service develops. The home should consider providing paper towels and (mounted) soap dispensers to aid infection control. Grey Gables DS0000066324.V344267.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): Standards 27, 28, 29 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There are sufficient staff employed at the home with experience who are also being provided with training to ensure residents needs and requirements are met. EVIDENCE: The registered provider confirmed that staffing levels are maintained according to the needs of the residents. The registered provider confirmed that the current staffing levels are meeting needs but confirmed this would be increased if residents’ needs required this. The only area of concern that was raised with the registered provider was the period between 3.00 p.m. and 9.00 p.m. and weekends when there are only two staff on duty – this is of concern given that some residents need support of 2 carers and may mean that there are insufficient staff to supervise the remaining residents. This is something that the registered provider needs to review. Information supplied by the home states that 17 staff are currently employed. 6 members of staff have achieved National Vocational Qualification (NVQ) Level II, with a further 10 working towards this award. The assistant manager Grey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 24 is expecting to start NVQ Level IV in October 2007. This means that the home have a number of staff trained to meet the needs of the residents. The home should continue this programme to ensure a minimum of 50 are trained to NVQ Level II. Staff files examined contained the required information is obtained prior to commencement of employment. All staff have had a Criminal Records Bureau check which means the registered provider has confirmed that they are safe to work with vulnerable people. One file noted that a full employment history had not been given, nor had a reference been obtained from the person’s last employer. Advice was again given to the registered provider to make sure all reasonable steps are taken to ensure prospective members of staff provider full information before their employment commences. This was also raised in the previous inspection report. Staff spoken with confirmed the home’s recruitment procedure. Information provided by the home confirms that in the last 12 months “all staff have received mandatory training. All staff have or are training to do their NVQ level two or higher, provide in-house training on a regular basis. We now have a deputy manager who is in the process of training for her NVQ4.” Staff files examined evidenced that training, including induction training, is provided to staff and files evidenced certificates. The registered provider also confirmed that she is looking for staff to develop areas of specialism (e.g. nutrition, diabetes, continence care) so that the member of staff can pass on and use this to benefit the service provided the residents. Liaison is also taking place with dementia training providers to provider training in dementia care to staff at the home. Staff spoken with also confirmed training is ongoing in the home. Grey Gables DS0000066324.V344267.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): Standards 31, 33, 35 and 38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is well managed and provides a safe environment for the residents and staff. EVIDENCE: The previous inspection report notes that the registered owner/manager is currently undertaking the Registered Managers’ Award (RMA) and was hoping to complete this by December 2006. Discussions during this inspection confirm that the RMA is nearly completed and it is intended that this will be awarded by December 2007. The registered manager is a qualified social worker within the mental health field and has direct experience working Grey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 26 directly with clients in the community and of management, and states that she “provides good leadership and direction to staff and the home has a positive open atmosphere”. Discussions with staff confirm that they feel the home is well managed – comments included “the home is well managed, the residents are well cared for and the staff get on and work as a team”. Comment card from external professional “seems to be a caring and well run home”. In addition to this, the registered provider is developing the management team – she has currently appointed an assistant manager (who is also about to start NVQ Level IV) and works alongside the manager currently learning the role and responsibilities. Discussions with the assistant manager evidenced that she is committed and enthusiastic about ensuring the welfare of the residents, and also is capable of supervising the day-to-day running of the home and staff. Information from the home confirms that an external quality assurance system has been implemented - “United Registrar of Systems”. This involves monitoring of documents, systems within the home and also seeking feedback via questionnaires to residents, relatives and external professionals. A selection of these were seen and generally provided either “very good” or “good” responses in all areas. Some questionnaires commented about the grounds of the home being in a poor condition - this is being addressed. The home is also on the local authority’s preferred provider list. Staff were able to confirm that staff meetings are held every 2 months, senior staff meetings every 2 weeks, daily shift handovers and the registered provider is on duty on a daily basis to ensure any areas of concern are promptly addressed. The registered provider confirms that “suitable accounting is in place and the manager ensures that residents have access to money when needed”. Financial records are appropraitely kept and residents money is safeguarded and used appropriately for their benefit. Information from the home confirms that all necessary equipment and facilities have been tested or serviced as recommended. Also, risk assessments are in place, although advice given that these must be updated and included as clear instructions in individual care plans. Record keeping and document control is also carried out by the registered provider. Regulation 37 notifications are being submitted but at least four incidents have not been reported to commission. Information from the home indicates that policies and procedures are in place and these have been reviewed. Staff were able to confirm the contents and location of policies and procedures for the home. Staff have had training in mandatory areas, this is ongoing within the home. Grey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 27 The accident book was seen to be accurately maintained, with appropriate actions being taken, but a number of accidents in daily records had not been recorded. The registered provider also confirmed that staff were familiar and confident to ring paramedics if needed. Staff spoken with confirmed that any issues or concerns regarding safety or maintenance are dealt with promptly. The registered provider has had keypads installed to ensure safety and protection for residents in the home. Information from the home confirmed that there is a fire risk assessment in place, along with fire detection and fire fighting equipment in place. However, a number of fire doors were seen wedged open – advice given that the registered provider should look at purchasing automatic door release mechanisms to avoid this and further advice should be sought from the fire safety officer. Staff confirmed that fire drills are held within the home. Grey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X X X 2 Grey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 29 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 OP9 Regulation 13(2) Requirement A controlled drugs register must be obtained for all controlled drugs held. The home should ensure an audit of all medications takes place. Timescale for action 30/09/07 2. OP38 37 The registered provider must 07/09/07 ensure that the commission is notified of any events affecting the residents or the home as outlined within Regulation 37 of the Care Homes Regulations 2001 (previous timescales of 11/07/06 and 25/01/07 not met) The registered provider must review staffing levels for those times when only two care staff are on duty to ensure the supervision and protection of residents All accidents must be recorded in the accident book. (Timescale 11/07/06 and 25/01/07 not met) Fire doors must not be wedged open – advice of the fire safety department should be sought DS0000066324.V344267.R01.S.doc 3. OP27 18(1)(a) 07/09/07 4. OP38 17(1)(a) 07/09/07 5. OP38 23(4)(c)(i ) 07/09/07 Grey Gables Version 5.2 Page 30 over this (possible provision of automatic door release mechanisms on fire door) 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 OP7 Good Practice Recommendations The home should complete a separate assessment which indicates the areas assessed that enables a judgement to be made that the service can meet the needs of the prospective resident The Service User Guide and complaints procedure could be in a more user friendly format for people with dementia An admission checklist may be of use to ensure residents and/or their relatives are provided with the required information and information is obtained by the home Specialist organisations should be contacted for further ideas for activities, outings, etc. A means of informing residents and their relatives about the activities in the home should be developed Continue with staff training, particularly NVQ training to ensure the home has 50 of staff trained to Level II. A training matrix may be helpful to identify staff training needs and record training undertaken Continue to review the meals provision, particularly at tea time, to ensure all areas of nutrition are provided consistently The registered owner/manager to complete the Registered Managers Award by end 2007 Eye drops should be dated on opening Patient information leaflets should be obtained with any medications so that staff are aware of the medication prescribed, its functions and possible side effects. Medication administration records should be dated at the head of each column to avoid confusion DS0000066324.V344267.R01.S.doc Version 5.2 Page 31 2. 3. OP1 OP1 4. OP12 5. OP30 6. OP15 7. 8. OP31 OP9 Grey Gables 9. 10. 11. 12. OP38 OP29 OP38 OP26 Risk assessments should be reviewed to ensure the are transferred into the care plan and updated as needs change The registered provider must ensure prospective staff provide full information before a decision to appoint is made. The lighting in the dining room should be improved The home should consider the use of paper towels and liquid soap to help prevent infection control Grey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Grey Gables DS0000066324.V344267.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!