CARE HOMES FOR OLDER PEOPLE
Greyrigg Rest Home 421 Garstang Road Broughton Preston Lancashire PR3 5JD Lead Inspector
Mrs Felicity Lacey Unannounced Inspection 8 November 2007 10:00 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 Greyrigg Rest Home DS0000050985.V346981.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. Greyrigg Rest Home DS0000050985.V346981.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Greyrigg Rest Home Address 421 Garstang Road Broughton Preston Lancashire PR3 5JD 01772 863202 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) greyrigg@nhsrecruits.com Dr Zakir Habib Patel Mrs Kathleen Johnson Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Greyrigg Rest Home DS0000050985.V346981.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 16 service users to include: up to 16 service users in the category of OP (Older people over 65 years of age) 30th August 2006 Date of last inspection Brief Description of the Service: Greyrigg provides residential care for up to 16 older people. The home is located on the outskirts of Preston, within reach of local bus routes, shops and amenities and provides a comfortable and homely environment for service users. Accommodation consists of ten single bedrooms and three double bedrooms, plus a good variety of communal areas and dining space, including a conservatory. Communal areas are domestic and homely in character. All service user accommodation is on the ground floor. The home is surrounded by extensive, well-maintained gardens, which are accessible to service users and include good parking areas for staff and visitors. Greyrigg Rest Home DS0000050985.V346981.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit to Greyrigg. Information was provided before this visit, by the registered manager, regarding how she felt the home met the required standards of care and administration. 5 surveys were received which had been completed by residents, relatives and a health professional. During the visit residents, relatives, staff members and a representative of the owner were spoken with. Records and documentation kept at the home were looked at, and a tour of the premises took place. What the service does well:
Greyrigg is a small home which is homely and welcoming. The people who live at the home feel that they are treated with respect and are satisfied with all aspects of the service and support they receive. The staff are held in high regard by the residents. The home has good staffing levels and low turnover of staff. The health and personal care needs of the people living at Greyrigg are understood and consistently met by the staff. All residents spoken with felt that they received very good quality care and that they were confident that the staff would recognise and act on any changes in health. The accommodation is accessible; all rooms are on the ground floor. There is ample space, which allows residents to choose if they wish to spend their time alone or in the company of others. There are gardens and outdoor seating areas. The home is clean and well decorated. Training is actively promoted. Staff have regular training opportunities, and the manager has provided handouts covering key topics, such as adult protection that act as reminders and are discussed with staff. 50 of permanent staff have achieved a National Vocational Qualification in Care. Comments from residents and visitors included: ‘I cannot fault the attitude of the staff, I can have anything I require. Nothing is too much trouble.’ ‘I choose to come here, the staff are lovely and spend time with me. The other residents are great, I am settled here, its marvellous.’ ‘ The staff are very quick to get the doctor if he is needed.’ ‘According to my father, its paradise in Greyrigg.’
Greyrigg Rest Home DS0000050985.V346981.R01.S.doc Version 5.2 Page 6 ‘We are confident that (our relative) will be safe and well looked after here. The staff are down to earth and honest. Its very good all round.’ ‘I think its excellent, the staff are very pleasant and helpful. The home is clean and there’s no smell.’ What has improved since the last inspection? What they could do better:
The owners of the home have not carried out formal monthly visits as required by the regulations. It is important that regular visits to monitor the standards of care and administration at Greyrigg are conducted, and this will ensure that the owners are fully aware of the working of the home. The owners must appoint a manager and submit an application for registration as soon as possible. In the absence of a registered manager is it important that roles and responsibilities are made clear with staff. Records such as the Medicines Administration Record and records of any accidents must be regularly monitored, to ensure they are completed properly and any required action is taken.
Greyrigg Rest Home DS0000050985.V346981.R01.S.doc Version 5.2 Page 7 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. Greyrigg Rest Home DS0000050985.V346981.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 Greyrigg Rest Home DS0000050985.V346981.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 Quality in this outcome area is good. All prospective residents are encouraged to visit the home and have their needs assessed before admission, this ensures that the home will live up to the expectations of the resident and their needs are fully understood. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some residents spoken with explained that they had the opportunity to visit the home before deciding to move in, and in some cases had come for short stays before moving in permanently. All residents had their needs assessed by a senior member of staff before being admitted to the home. The assessment used is basic but provides key information relating to health and personal care needs. New residents are given a ‘Welcome Note’ on arrival that gives key information and immediately provides them with some knowledge of the day-to-day happenings at Greyrigg. There is also a full Service User Guide and Statement of Purpose. Residents and relatives spoken with felt that the admission process had been useful and gave the opportunity to make an informed decision before moving permanently to Greyrigg.
Greyrigg Rest Home DS0000050985.V346981.R01.S.doc Version 5.2 Page 10 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, 10 Quality in this outcome area is good. Care plans detail the individual personal care and health needs of residents and are regularly reviewed, this promotes consistency of care and support. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans seen during this visit to the home were concise and written in consultation with residents. The plan is reviewed monthly or as needed. The staff had a sound understanding of resident’s individual needs and preferences. The residents confirmed that they felt the support they received encouraged continued independence and that assistance was given where needed. The choices of residents are respected, for example residents can choose whether they wish to have regular night time checks and can choose if they wish to self medicate. Records are kept of key events on the resident’s individual diary sheets; these also contain information regarding medical visits and advice. The care staff have daily handover periods where any changes to the care or health needs of a resident would be discussed. There was evidence on files and through discussion with residents and relatives that health needs were monitored and appropriate referrals were made.
Greyrigg Rest Home DS0000050985.V346981.R01.S.doc Version 5.2 Page 11 Residents are supported in times of ill health and recovery. The staff have good relations with the local GPs and district nursing services. Residents are able to choose their own GP and if a change is necessary information is provided about the surgeries, which serve the area. The staff are active in promoting the health and welfare of residents. For example, each resident has recently had a fall assessment completed and this has lead to a review of medication for some residents with Osteoporosis to ensure they receive the supplements they need. The registered manager reviewed the incidence of falls on a regular basis, and it is important that this review continues in the absence of a registered manager. Residents are weighed monthly, with their agreement, and any significant changes are identified and acted upon. Residents are also encouraged to take part in Gentle Exercise sessions provided by a staff member each week. Staff who administer medication have received training to ensure they are aware of good practise and safe procedures. There are policies in place regarding the dispensing and administration of medication. The records of medication taken were completed correctly, apart from one morning on which some medication had not been signed for. It is important that the Medication Administration Record is monitored by senior staff in the absence of a registered manager, and any omissions are accounted for. Residents are able to self medicate if they wish, and a risk assessment is completed to support this decision. Residents and relatives spoken with felt that the staff acted in ways that respected privacy and dignity. The atmosphere of the home was described as ‘ welcoming’, ‘homely’ and ‘friendly’. The staff use the preferred names of residents and were considered to be courteous and understanding. The relationships in the home appeared to be warm and informal and based on mutual respect. Greyrigg Rest Home DS0000050985.V346981.R01.S.doc Version 5.2 Page 12 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, 15 Quality in this outcome area is good. Social activities and contact with family and friends is encouraged, the cultural and recreational preferences of residents are respected and this ensures that daily life at Greyrigg meets the expectations of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The daily routines in the home are in line withy the preferences of residents. Some people choose to get up early, other prefer a lie in, some residents like to spend time in company others choose to spend time enjoying their own company. All residents spoken with said they were encouraged to be as independent as possible and to follow their own interests. There are organised activities, which include gentle exercise, quizzes and crafts. Trips out are usually arranged by family and friends. Planned activities are advertised around the home. Resident’s involvement in religious observance is discussed at the time of admission. Staff will accompany residents to church or make arrangements to allow attendance. Visits by local clergy can also be arranged. Visitors are made very welcome. 3 relatives were spoken with at the time of the visit to the home. They were positive in their views and would recommend
Greyrigg Rest Home DS0000050985.V346981.R01.S.doc Version 5.2 Page 13 the home to others. They felt able to visit at any time and were confidant that they would find the staff welcoming and their relative being well care for. The staff provide opportunities for involvement with the local community, for example children from the local high school are coming to perform a Christmas carol concert. Residents are encouraged to maintain independence in their own private affairs. In most cases finances are managed by the resident or their representative. In exceptional cases the manager may act as an appointee. In all cases any transactions undertaken on behalf of a resident are recorded. The standard of food at the home is considered to be good. There is a choice at meal times. The menu is displayed to allow for personal choice. There are snacks and drinks available through the day. Fresh fruit is readily available following requests by residents and is proving popular. Some residents like to help around the home and are involved in preparing the dining room for meals and serving. Special diets are provided and made as appealing as possible. Resident’s birthdays are celebrated with a special tea and birthday cake. The dining room has been redecorated and residents were involved in choosing the colour scheme. New matching crockery has also been purchased and the residents are pleased with this. Greyrigg Rest Home DS0000050985.V346981.R01.S.doc Version 5.2 Page 14 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): 16,18 Quality in this outcome area is good. Policies, good practice and training promote the protection and welfare of residents living at Greyrigg. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a clear and concise complaints procedure, which details how to make a formal complaint and timescales for response. The staff understand their responsibilities when dealing with concerns and complaints. Residents and relatives were confident that they could raise any matter that caused concern and the staff would do their best to resolve it. There is also a suggestions box in the hall of the home, which can be used to raise a concern anonymously. There are adult protection policies in place and a Whistle blowing policy. Staff spoken with confirmed that they were aware of their responsibilities in any case of suspected or alleged abuse. The manager has distributed an additional handout as a reminder to all staff of their role in ensuring welfare is promoted and protected. Greyrigg Rest Home DS0000050985.V346981.R01.S.doc Version 5.2 Page 15 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, 26 Quality in this outcome area is good. The home is clean and well maintained this provides a pleasant place for residents to live. This judgement has been made using the available evidence including a visit to this service. EVIDENCE: Greyrigg is situated in its own grounds in a secluded cul de sac. The home is easily accessible by car and is situated close to the motorway. Many original features of the house have been preserved and this gives the home character. There has been on going decoration and the residents have been involved in choosing colour schemes. There is a range of communal areas and there is a large garden. The residents spoken with liked using the garden and walking in the grounds, the close proximity of the home to the motorway does cause high levels of noise but the people living at the home do not see this as a problem. Portable ramps have been purchased to improve access to the garden using the front and side doors. The safety rails at the front entrance and entrance to the courtyard are to be replaced, and new garden furniture is to be provided. Greyrigg Rest Home DS0000050985.V346981.R01.S.doc Version 5.2 Page 16 The home was clean and warm. Residents were very pleased with the standard of cleanliness. There are infection control measures in place and all staff have completed infection control training. Greyrigg Rest Home DS0000050985.V346981.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. The numbers and skills of staff meet the need of the residents at the home, training is encouraged and this ensures that the staff are competent in their job roles. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is staffed in accordance with the needs of the people living at Greyrigg. Staffing levels have remained constant even when the number of residents has dropped. The residents and relatives spoken with and who completed surveys considered the staff to be available when needed. Residents commented on the friendly, dependable and caring attitude of the staff. Staff have time to complete their duties and can also spend time with residents. Currently 46 of staff hold a National Vocational Qualification at level 2 or above. Staff spoken with felt that they were actively encouraged and supported to undertake training and that the training was useful. The home operates a recruitment procedure that ensures that all required checks are completed before a person starts work at Greyrigg. Staff files seen contained completed application forms, which include a full employment history, references and evidence of Criminal Record Bureau disclosure check. Staff files also include training certificates and supervision records. Greyrigg Rest Home DS0000050985.V346981.R01.S.doc Version 5.2 Page 18 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, 38 Quality in this outcome area is good. Greyrigg is well managed, residents feel their views are taken account of and are pleased with the standard of care. The health and safety of residents and staff are promoted through the policies and practice of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of Greyrigg has recently retired from her full time post, however she continues on a part time basis whilst a new manager is recruited. Residents, relatives and staff consider the home to be well managed. Staff are keen to continue providing a high standard of care and are keen to reduce any anxiety that residents may feel with a change of manager. Greyrigg Rest Home DS0000050985.V346981.R01.S.doc Version 5.2 Page 19 The owners of the home are not in day-to-day control and should ensure that they are active in overseeing the day-to-day operation of Greyrigg whilst it is without a registered manager. It is important that staff are kept informed of progress and that monitoring of standards of care and administration at the home is undertaken. The owners are required to conduct quality monitoring visits once a month by regulation 26 of the Care Homes Regulations. A copy of the reports of these visits should be made available to the Commission, this was a requirement of the last inspection, and to date these reports have not been received. It is very important that the good standard of care established at the home is maintained whilst the management arrangements of the home are sorted out. The owners must be able to demonstrate that they are aware of standards at Greyrigg and must support staff and reassure residents during this time of change. The home has Investors in People Award and a quality survey is conducted annually. There is a high level of daily contact between residents and staff, and information is passed over at handover times. Residents felt that their views were valued and were acted upon. Residents and relatives felt the home was run in an open and inclusive way. The information provided by the manager indicates that all health and safety checks have been complied with. Accidents are recorded. Risk assessments are in place to help provide a safe environment in which to work and live. Greyrigg Rest Home DS0000050985.V346981.R01.S.doc Version 5.2 Page 20 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 4 9 3 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 3 X X 3 Greyrigg Rest Home DS0000050985.V346981.R01.S.doc Version 5.2 Page 21 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 OP31 Regulation 26 Requirement The registered provider must conduct a monthly visit to the home and supply the CSCI with a copy of the report. (Previous timescale of 30/09/06 not met) Timescale for action 08/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP28 OP31 Good Practice Recommendations A minimum ratio of 50 of staff should hold a National Vocational Qualification in Care at level 2 or above. A manager should be appointed and registered with the Commission for Social Care Inspection. Greyrigg Rest Home DS0000050985.V346981.R01.S.doc Version 5.2 Page 22 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
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