Inspection on 28/06/07 for Greyfriars

This inspection was carried out on 28th June 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

Greyfriars 11/05/06

Greyfriars 15/02/06

Greyfriars 29/07/05

Greyfriars 01/03/05

Greyfriars 30/06/04

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

CARE HOMES FOR OLDER PEOPLE Greyfriars 26 Clarence Gardens Shanklin Isle Of Wight PO37 6HA Lead Inspector Christine Walsh Unannounced Inspection 28th June 2007 10:20a 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 Greyfriars DS0000012495.V338726.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. Greyfriars DS0000012495.V338726.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greyfriars Address 26 Clarence Gardens Shanklin Isle Of Wight PO37 6HA 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) 01983 864361 david@greyfriarscarehome.co.uk Mr David Cable Mrs Ann Cable Mrs Ann Cable Care Home 9 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (9) of places Greyfriars DS0000012495.V338726.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th May 2006 Brief Description of the Service: Greyfriars is a home registered to provide care and accommodation for up to 9 older people, with some capacity for older people with dementia. The home is a small, detached property situated in a quiet residential area of Shanklin, approximately one mile from the town centre shops. The registered owner Mrs Cable also manages the home and lives close by. All rooms are for single occupancy and a stair lift affords access to the rooms on the first floor. To the front of the building are a small lawned garden with shrubs and flowers, and a patio with seating for the residents during the warmer months. Parking is limited to the road in Clarence Gardens. Weekly fees range from £349 to £420. The purchase of personal requisites, hairdressing and chiropody are additional to the stated fee. Greyfriars DS0000012495.V338726.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit formed part of the key inspection process and was carried over one day by Mrs C Walsh, regulatory inspector. The manager completed an Annual Quality Assurance Assessment (AQAA) document, which was returned to the Commission for Social Care Inspection prior to the visit to the home. In addition “Have Your Say” resident and relatives comment cards were sent of which seven residents comment cards were received in total. The information obtained to inform this report was based on viewing the records of the people who use and work at the service, speaking with the residents, visitors and staff and observing care and support practices. A tour of the home took place and documents pertaining to health and safety were viewed. At the time of the visit the registered manager was away on business and the senior carer and Mr Cable the other registered provider assisted Mrs Walsh. Verbal feedback was provided at the end of the visit and again to the registered manager Mrs Cable the following day. What the service does well: The home does well to undertake and obtain assessment information on prospective residents prior to them moving in to ensure they can adequately meet their needs. Once the residents has moved in the home as far as feasibly possible ensures their stay is as near to the way they have been used to living, respecting their individuality, likes and dislikes and hobbies and interests. A resident said: “I am well looked after and cared for”. A relative said: “Greyfriars is ideal, a small friendly home with genuinely caring staff and owner. The next best thing to remaining in ones own home”. Greyfriars DS0000012495.V338726.R01.S.doc Version 5.2 Page 6 The home promotes a lively atmosphere and encourages and supports the residents to participate in daily activities in and outside of the home, with regular trips to garden centres and in house entertainment from outside entertainers. Visitors and contact with family and friends is encouraged and always made welcome. A resident said: “There is a pleasant atmosphere at all times and visitors are always made welcome” A relative said: “The home is always a cheerful place and residents appear happy”. The food is of an excellent standard and the home has recently been a four star award for its preparation and presentation of its food. The home does well to listen to the residents’ views and ensures their concerns and complaints are quickly and appropriately dealt with. The home is domestic in style, portraying a family atmosphere and welcoming environment. The home is tastefully decorated and furnished throughout and hygienically clean. Residents have their own bedrooms, which are personalised and kept clean and tidy. The home has sufficient numbers of skilled staff who are recruited using robust recruitment procedures to safeguard residents from potential risk of harm and who receive regular training and support and supervision from the manager. What has improved since the last inspection? Following the last visit to the home four requirements and five recommendations were made, a number of these have been met. The manager has now started a national vocational qualification at level four (NVQ4), the staff have individual training profiles which provides evidence of what training staff have received and the staff are now receiving regular recorded support and supervision providing the residents with a qualified and competent workforce to meet their needs. . The complaints and adult protection procedures have been updated to reflect the correct procedures for reporting concerns, complaints and adult protection issues. Some areas of medication practices have been improved such as training for staff but not sufficiently to prevent further requirements being made and repeated. Greyfriars DS0000012495.V338726.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. Greyfriars DS0000012495.V338726.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 Greyfriars DS0000012495.V338726.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 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home does well to undertake a thorough assessment process to ensure it can meet prospective residents needs. The home doe not provide intermediate care. EVIDENCE: The annual quality assurance assessment (AQAA) tool stated under “What we do well” To complete a full assessment of the clients needs, this may be at their home or hospital or another care home. The assessment is carried out by the home’s manager or in certain circumstances suitability trained people. The home recognises it needs to get better at obtaining information from care managers and has taken steps to discuss this with representatives of social services and intends to develop a new full questionnaire and assessment document covering emotional, behavioural, physical and medical needs. Greyfriars DS0000012495.V338726.R01.S.doc Version 5.2 Page 10 There was sufficient evidence to demonstrate that the home does undertake a full assessment of the residents needs prior to them moving into the home, and in some cases has obtained a care manager assessment. Three residents assessments documents were viewed and included the residents social, emotional and physical wellbeing, including mobility, communication, diet, health, skin integrity and likes and dislikes. However as already recognised by the home it would benefit from a full questionnaire and assessment document to pull all the information into one document for easy accessibility for the resident and staff to follow. The development of this will be viewed during the next visit to the home. At the time of the visit a prospective residents was being shown around the home with their family, it was observed that the residents and relatives were made very welcomed, introduced to other residents and staff and shown the available room. Residents and visiting friends and relatives confirmed that they had been given plenty of information about the home and loved its homeliness and the friendliness of staff. A visitor said: “We looked at lots of homes but knew as soon as we saw this one our friend would be very happy here and she is”. Relatives said: “My mother was placed as an emergency at short notice, but I did visit the home prior to mum moving in and I was very satisfied with the information given”. “My mother entered Geryfriars at very short notice – luckily it was the right place for her”. The home does not provide intermediate care for service users requiring rehabilitation back to their own homes, it does however provide respite care of which some residents go onto become permanent. People who use the home for respite care are afforded the same rights and support permanent residents receive. Greyfriars DS0000012495.V338726.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 people who use the service have individual plans that provides information about their health, personal and social welfare, however theses require further detail to support staff to carry out the care in the way the residents would prefer. The people who use the service has their health care needs fully met, however medication administration practices remain poor and potentially places residents at risk of harm. The people who use the service are treated with respect and have their dignity and privacy upheld. EVIDENCE: The annual quality assurance assessment (AQAA) tool stated under “What we do well” Care plans are enacted and reviewed after discussion with the residents and others involved. Proactive referrals are made if needed to the Greyfriars DS0000012495.V338726.R01.S.doc Version 5.2 Page 12 appropriate agencies – e.g. GP’s and District Nurses. Every member of senior staff who dispense medication have been on an accredited training course and all unused medications are recorded and returned to the pharmacy and client care plans reflect their choices and privacy and dignity is ensured at all times. This was tested by viewing three residents’ personal plans and “Have Your Say” comment cards received from residents, speaking with residents, visiting friends and staff and observing the day-to-day practice and interactions of staff and residents. Each resident has a personal file that provides general information about them such as next of kin and contact details, care plans, risk assessments and daily notes. The care plans and risk assessments are clearly written and in some instances provide staff with information about the support the resident requires and information to minimise risks, but lack detail in how these are to be carried out. Two members of staff gave very good descriptions about how they support a resident, with emphasises on encouraging independence and respecting their dignity and privacy. This was not written down and the members of staff could not be sure that other members of staff carried out a consistency of care in their absence. Although the home provides care and support to a small number of residents and staff become quickly familiar with their needs the home must be sure that the care is carried out the way in which the residents wishes and requires. Evidence in residents’ personal files, daily notes and comments from the residents and visitors confirmed that the health care needs of the residents are closely monitored and responded to if they become unwell. A relative said: “Staff have very good observation skills and pick up when medical attention is needed. This is very important, as mum is unable to verbalise symptoms of illness. They keep me well informed”. A health care professional said: “The staff seem to be caring and helpful” A good record of GP appointments/visits, hospital appointments and district nurse visits are kept, detailing the concern, the outcome and the treatment required, however this information is recorded in one book for all residents and compromises confidentiality. Greyfriars DS0000012495.V338726.R01.S.doc Version 5.2 Page 13 Following the last visit to the home it was issued with several requirements regarding its medication practices. The staff on duty and those administering the medication confirmed they had recently received training in medication, however some requirements will be repeated and further requirements made as poor practices were observed when administering the medication. 1. Signing for medications before administering. 2. Handling tablets. 3. Administering eye drops in communal area without consultation to move to a private place and without washing hands prior to administration. 4. Gaps in medication administration record. 5. Unclear on medication administration records why medications have been discontinued. 6. No evidence of over counter remedies policy as required following the last inspection. To ensure the home is following correct policies and procedures in the safe handling and administration of medication it is recommended that the manager seek advice and support from its Primary Care Trust. Throughout the course of the day staff were observed interacting with residents in positive, cheerful and respectful ways. The staff were readily available to support residents and to spend time interacting with them. The staff with whom were spoken with were very clear of the importance of treating residents with respect and up holding their privacy at all times. The home has a confidentiality policy placing great emphasis on respecting this, however administration procedures in the home comprise the residents’ rights to privacy. 1. Preferred times for residents getting up and going to bed displayed on kitchen door. 2. Residents preferred days for bathing displayed on kitchen wall. 3. Invasive treatments such as eye drops taking place in communal areas. 4. Personal detail of medical treatments documented in one book for all residents. Greyfriars DS0000012495.V338726.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. The people who use the service are supported to continue to maintain a lifestyle that matches their expectations and preferences. However the home could do better to obtain information on the residents’ personal histories to support staff to have an insight and understanding of the resident’s previous lifestyles and needs. The people who use the service are supported to maintain contacts with family and friends. The home does well to support the people who use the service to continue to exercise choice and control over their lives. The people who use the service are provided with wholesome, well-balanced and varied diet in appealing surroundings. Greyfriars DS0000012495.V338726.R01.S.doc Version 5.2 Page 15 EVIDENCE: The annual quality assurance assessment (AQAA) tool stated under “What we do well” To enable residents to continue with a full and interesting life as possible which includes after consultation with residents and families a monthly activity plan, regular contact with family, friends and outside organisations and visits to the local community. The home states that it will continue to listen to the residents’ needs and suggestions and act on them when they can. This was tested by viewing three residents’ personal plans, observing activity in the home, speaking with residents, staff and visitors. The three residents personal plans provided information on the residents likes and dislikes, hobbies and interests and cultural beliefs and the staff with who were spoken with appeared to be aware of these, however the files lack important information about the residents history and would benefit staff in understanding the needs and behaviours of the residents especially those who have dementia. The residents are supported to engage in a range of activities during the day, which includes listening to old time music, watching TV, tennis being a favourite at the time of the visit, spending time with staff in discussion and playing board games. The home has a monthly activity plan that is displayed for residents to see; these include visits from outside entertainers and visit to a garden centre. Photographs of a recent visit to a garden centre show the residents enjoying afternoon tea. A resident said: “There are regular activites available and a good variety, I enjoy our trips out to the garden centre” Another said: The girls (Staff) are very good, they will often spend time playing board games with me” At the time of the visit the inspector met with visitors who were very complimentary of the home and the welcome they receive each time they visit. “We are always made to feel welcome, and we get treated to tea and biscuits on nicely laid tea trays. We visit at anytime and always find our friend nicely dressed and clean and tidy”. Greyfriars DS0000012495.V338726.R01.S.doc Version 5.2 Page 16 A resident said: My friends and relatives are always made welcome” At the time of the visit residents were observed being offered choices of what they would like to eat, drink and do. Support from staff was immediate and choices honoured. In the plan of one of the residents it described the residents preference for getting up in the morning. The home should consider developing personal plans in this way, especially for those residents who have dementia and may have difficultly in making choices and expressing their wishes. The staff were aware of the importance of respecting individual choices and encouraging residents to make them. The home has achieved a “four star” award from environmental health for its food preparation, presentation and storage and award the staff and residents are proud of. The food is prepared and cooked by staff that have achieved food hygiene certificates. Everyone who was spoken with at the time of the visit were very complimentary of the quality and variety of the meals. Residents are asked on a daily basis what they would like to eat from a number of choices; this is recorded in order that staff can keep a check on resident’s individual dietary intake. The residents receive regular drinks and snacks as well as a main course and desert for the main meal of the day. Staff were observed assisting residents where required and providing encouragement for residents whose diet is poor. The home will provide for special diets but this is not required at present. Meal times are undertaken in a congenial and well-presented dining room, resident receive drinks and meals on bone china crockery, cotton tablecloths and napkins. This demonstrates that the home places importance on making mealtimes pleasant and conformable. Comments received from residents and relatives: “Mum appears to enjoy the food and it is always well presented” “I always like the meals, they are plentiful and there is choice for main meals”. Greyfriars DS0000012495.V338726.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 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 home does well to ensure the people who use the service and their friends and family are provided with appropriate information on how to make a complaint. The home as far as feasibly possible protects the people who use the service from potential risk of abuse. EVIDENCE: The annual quality assurance assessment (AQAA) tool stated under “What we do well” to make all new residents and their families aware of the complaints procedure which is clearly displayed on the residents information board and ensuring all staff attend regular and updated adult protection training. This was tested by viewing the complaints procedure, the adult protection procedure, viewing comment cards and speaking with residents and staff. The home complaints policy is clearly displayed on the resident’s information board, on the office wall and each member of staff receives a copy. Greyfriars DS0000012495.V338726.R01.S.doc Version 5.2 Page 18 The staff with whom were spoken with were aware of what to do if a residents or their representative raised a concern or complaint. The staff were aware of the importance of recording complaints, however the complaints log could not be found at the time of the visit. Five comment cards received from residents, some completed by relatives on behalf of the residents stated they always know who to speak to if they are unhappy and always know how to make a complaint. A relative said: “I am very happy with the care given to my mother, the manager and her staff are very caring and attentive to her needs. The home is always a cheerful place and the residents appear happy”. The manager is advised to change the name and address of the reporting office of the Commission for Social Care Inspection following the closure of the Isle of Wight Office. The manager agreed to do this and this will be viewed during the next review of the service. The home has the appropriate policies and procedures in place for providing staff with information on how to recognise and report suspected and witnessed abuse. Staff receive training and were able to feedback what they considered constitutes abuse, signs and symptoms of abuse and how they would report these. Both staff spoken with at the time of the visit showed no hesitation in reporting concerns to the manager or other authorities. Also stated in the AQAA the home said it will continue to monitor all changes in legal requirements, implement when needed and staff will continue to be supported by management to attend training. The Commission will monitor this during the next review of the service. Greyfriars DS0000012495.V338726.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service live in a warm, welcoming and hygienically clean environment. EVIDENCE: The annual quality assurance assessment (AQAA) tool stated under “What we do well” The home continues to provide a family atmosphere within a small environment, which meets the residents needs. To test this a tour of the home was undertaken, residents and relatives views were sought at the time of the visit and through comment cards and staff were spoken with in respect of hygiene and infection control. Greyfriars DS0000012495.V338726.R01.S.doc Version 5.2 Page 20 The home has is tastefully decorated and furnished throughout and spotlessly clean. The home has an adequate sized lounge and separate dining room, a downstairs bathroom and each resident has a room of their own. All bedrooms were nicely decorated, furnished and personalised reflecting the residents’ history and individuality. Comments received from residents and family and friends indicated that the home was always fresh and clean, providing a friendly and family orientated home environment. In the AQAA the owners recognise some areas of the home are in need of improvement and redecoration such as the downstairs bathroom, new windows and rendering to the back of the house and plan to do this in the next twelve months, this will be monitored during the next review of the service. The home is free from unpleasant odours and the staff work to a clear cleaning rota where all areas of the home are cleaned daily but specific attention being paid to certain areas of the home on a daily basis. The home has a separate laundry with washing facilities to wash at high temperature if required. Notices around the home and discretely displayed remind staff of the importance of washing hands and staff have access to liquid antibacterial soaps and paper towels. The staff are provided with disposable aprons and gloves. However staff must be reminded of the importance of washing hands and wearing protective clothing when undertaking invasive treatments such as administering eye drops in order to prevent the spread of infection. Greyfriars DS0000012495.V338726.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, and 29. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels and the skills mix are suffient to meet the needs of the people who use the service. The home supports the staff to undertake a national vocational qualification (NVQ), and ensures they are trained and competent to do their job. However the home must ensure 50 of its staff are NVQ trained. Robust recruitment policies and practices support and as far as feasibly possible protects the residents from potential harm of harm. EVIDENCE: The annual quality assurance assessment (AQAA) tool stated under “What we do well” To continue to give importance to training of staff so they can deliver the required level of care. Adjusting staffing levels to meet the needs of the residents and keeping staff. To test this the inspector met with staff, observed practice, viewed recruitment and training records and spoke with residents. The home has a dedicated and stable staff team who have worked in the home for a number of years; the home does not call upon agency staff relying on Greyfriars DS0000012495.V338726.R01.S.doc Version 5.2 Page 22 regular staff to cover absences such as sickness and holidays. At the time of the visit a member of staff who has retired but still works on the bank was acting in the absence of the manager as a senior member of staff. All staff work part time but the home has sufficient numbers of staff to meet the current needs of the residents. The staff were observed going about their daily tasks and supporting the residents in a clam and relaxed way, tending to their needs efficiently and promptly. A resident said: “When I call the bell the staff respond promptly”. Another said: “I am well looked after and cared for” A relative said: “The girls are extremely pleasant and are always willing to do anything for me” The home has twelve part time staff of which four have achieved a national vocation qualification (NVQ) level two. This falls short of the recommended 50 , which was mentioned in the last report. The home has not recruited new staff to the home since the last visit to the home. However the home supports overseas students who are learning English, all necessary checks are in place and the provider is fully aware of the importance of checking Home Office documents and the students permission to work. Two staff personal files were viewed and all necessary documentation including references, criminal record bureau (CRB) and protection of vulnerable adult (POVA) checks were in place. The staff spoken with said they had completed an application, attended an interview and provided names of referees and provided identification for necessary checks. The inspector was unable to access at- a-glance evidence of training as discussed following the last visit to the home, but spoke with staff and viewed certificates of training in their personal files. The two staff spoken with at the time of the visit said they had received a comprehensive induction when they first started working in the home and have since received regular training such as mandatory training which includes first aid, fire, moving and handling and food hygiene and training specific to the residents such as medication. Greyfriars DS0000012495.V338726.R01.S.doc Version 5.2 Page 23 The home provides care and support to residents with dementia and therefore would benefit from such training. Greyfriars DS0000012495.V338726.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who use the service live in a well run and managed home by a manager with the relevant qualifications. The home is run in the best interest of the residents by seeking and listening to the views of the people who use the service daily. The home has no involvement with the people who use the service finances, other than to provide a place for safekeeping. The manager does well to supervise and monitor the performance of her staff. The homes policies and procedures ensure so far as reasonably practicable the health, safety and welfare of the people who use and work in the home. Greyfriars DS0000012495.V338726.R01.S.doc Version 5.2 Page 25 EVIDENCE: The annual quality assurance assessment (AQAA) tool stated under “What we do well” is to have a manager who is a registered nurse and who has managed the Greyfriars and only Greyfriars for more than ten years. The manager does well to be available for discussion of various problems/issues with residents, visitors, relatives and staff. This was tested by speaking with people who use the service, relatives and staff, viewing records and speaking with Mr Cable the registered owner. The manager confirmed in the AQAA that she is now undertaking a NVQ 4 and will continue to upgrade to improve. This will be monitored during the next review of the service. The manager was away on business at the time of the visit, a senior member of staff and Mr Cable the registered owner supported the inspector with the inspection. The manager must be sure that in her absence the staff placed in charge have an awareness of where all polices and procedures and documents are kept. Residents, staff and visitors spoke highly of the manager, saying how attentive, supportive and approachable she is. A staff member said: “ The manager is very approachable and is very aware of the daily needs of the residents” A resident said: “The manager is very kind and makes sure we are all okay”. The home informally seeks the views of the people who use the service daily, and listens to their relatives, the manager states in the AQAA “We have listened to the residents and families and incorporate their wishes into daily life where possible and will continue to listen and liaise with them”. The inspector did not have access to any quality audits or questionnaires but through discussion and observation established that the people who use the service are happy living at Greyfriars. The home does not hold or have dealings with resident’s personal monies other than to provide a safe place for it to be stored. Residents have lockable storage of their own. Greyfriars DS0000012495.V338726.R01.S.doc Version 5.2 Page 26 The staff confirmed that they receive regular supervision, working a long side the manager on a daily basis and formal recorded supervision at least once every three months. A staff member allowed the inspector to view supervision notes, which included topic led discussion of everyday practice and what if scenario’s. The home has systems in place to protect the people who use the service from potential risk of harm from their environment. There was evidence of staff receiving fire safety training and fire fighting equipment being checked as required and evidence of the owners knowing the new Fire Safety regulations implemented on 1st October 2006. Harmful substances are safely stored and staff are reminded daily of their roles and responsibilities in the respect of health and safety. Health and safety policies and procedures are clearly displayed in the kitchen for staff to read on a daily basis. However hot water outlets when tested registered above the normal safe levels, this was rectified at the time of the visit by turning down the boiler, however the home must ensure they test the water daily to ensure it is not exceeding the required level of 43 centigrade. Greyfriars DS0000012495.V338726.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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 3 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 3 X 3 X 3 3 X 2 Greyfriars DS0000012495.V338726.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 OP7 Regulation 15(1) Requirement To ensure the people who use the service receive their care in the way that they prefer and wish, their care plans must provide specific detail on how their care must be carried out. Timescale for action 31/08/07 2. OP9 13(2) 03/08/07 The people who use the service must be safeguarded by robust medication administration procedures including: producing an ‘over the counter remedies’ policy in respect of residents own remedies not prescribed by the GP. This requirement has been repeated. 3. OP9 13(2) The people who use the service must be safeguarded by robust medication administration procedures including: Ensuring staff are appropriately signing for medications when given or record reasons for admission. This requirement has been 03/08/07 Greyfriars DS0000012495.V338726.R01.S.doc Version 5.2 Page 29 repeated. 4. OP9 13(2) The people who use the service must be safeguarded from robust administration procedures: Therefore the manager must ensure all her staff are fully aware of the correct procedures for administering and signing for medication the administration of eye drops. 5. OP10 17 To protect the people who use the service privacy and dignity the home must ensure confidential information is safely and appropriately stored. To ensure the people who use the service have their specific needs met the manager must ensure her staff receive dementia training. The people who use the service must be safeguarded from potential harm of scolding from hot water outlets. 03/08/07 03/08/07 6. OP30 18 30/08/07 7. OP38 23 03/08/07 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. Refer to Standard OP9 Good Practice Recommendations To ensure the home is following correct policies and procedures in the safe handling and administration of medication it is recommended that the manager seek advice and support from its Primary Care Trust. Greyfriars DS0000012495.V338726.R01.S.doc Version 5.2 Page 30 2. OP7 To assist staff to have a better understanding of the residents the home is advised to consider developing a pen picture of the resident’s history and important events in the resident’s lives. To support residents and their relatives to seek support from the appropriate agencies in respect of making complaints the home is advised to change the contact address of the Commission for Social Care Inspection on the current complaints procedure. To ensure the home is run well in the absence of the manager, the manager should consider informing her staff of the whereabouts of important policies and procedures and documents relating to the residents in their care. 3. OP16 4. OP31 Greyfriars DS0000012495.V338726.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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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