CARE HOMES FOR OLDER PEOPLE
Greys Residential Home Ltd Hook Heath Road Woking Surrey GU22 0JQ Lead Inspector
Helen Dickens Announced Inspection 16th January 2006 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 Greys Residential Home Ltd DS0000065590.V266918.R01.S.doc Version 5.1 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. Greys Residential Home Ltd DS0000065590.V266918.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Greys Residential Home Ltd Address Hook Heath Road Woking Surrey GU22 0JQ 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) 01483 771523 01483 771523 Greys Residential Home Limited Mr Stephen Phillip Kennedy Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Greys Residential Home Ltd DS0000065590.V266918.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th July, 2006 Brief Description of the Service: Greys care home is located in a quiet residential road in Woking. It is family owned and managed and is registered for 20 older people. Accommodation is on two floors and each resident has either en-suite or private facilities adjacent to their rooms. On the ground floor there is a large lounge with a period fireplace, and the main dining room. Upstairs there is also a small lounge area. There is a lift for the convenience of residents. The gardens are very well kept and contain several outdoor seating areas around the home. The main garden has a covered fishpond and rockery, giving a central focus for residents to enjoy. There is car parking space in the drive and on the road. Greys Residential Home Ltd DS0000065590.V266918.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place over five and a half hours and was the second inspection to be undertaken in the Commission for Social Care Inspection year April 2005 to March 2006. The inspection was carried out by Helen Dickens, Lead Inspector for the service. Stephen Kennedy, proprietor and Registered Manager, and Teresa Kelly, represented the establishment. A partial tour of the premises took place and the inspector interviewed six residents, and greeted all the remaining residents at some point during the day. A number of files and records were examined as part of the inspection process. A pre-inspection questionnaire completed by the home, and a number of comment cards completed by residents, were considered in writing this report. This was a positive inspection. The inspector would like to thank the residents, staff and the proprietor for their time, assistance and hospitality. What the service does well: What has improved since the last inspection?
Greys Residential Home Ltd DS0000065590.V266918.R01.S.doc Version 5.1 Page 6 All of the Requirements made at the last inspection have been met. Assessments for new residents will now include reports and input from other professionals; care plans now contain better information regarding residents social needs; the medicines cabinet has been reviewed and reorganised; all staff now receive regular supervision; residents have all been asked again about whether they would like locks on their bedroom doors and all their bathrooms now have locks, even though some residents do not wish to use them. The Residential Forum Guidance was used to calculate staff to resident ratios, and any new staff working before their Criminal Records Bureau check has been returned, only do so under supervision. Two health and safety requirements were also met. Some decorative improvements have been carried out and this includes decorating the hallway outside the dining room, and redecorating two resident’s bathrooms. A ‘daily specials’ menu has been introduced and displayed outside the dining room; this looks like a proper restaurant menu and is very professionally done. The home has made a number of improvements with regard to social activities for residents and a staff member has been allotted time to spend arranging activities for residents. This is discussed under Standard 12. The ‘day book’ at the home previously did not necessarily record an event for each resident every day but this has now been improved so that there is an entry every day. What they could do better:
To prevent the spread of infection, the home should not use cotton towels in any communal hand washing areas. One bedroom had a crack in the ceiling which needs to be reviewed regarding safety and redecoration. The home should obtain a copy of the Surrey multi-agency procedures for the protection of vulnerable adults, train all staff on this particular document, and ensure the in-house policy dovetails with the Surrey policy. The home should also ensure that new members of staff complete their induction within six months of starting work in the home. The home must make available for inspection any documents which would show they are meeting health and safety requirements, such as the electrical wiring safety certificate. Some issues regarding resident’s choices were discussed with the proprietor and he suggested raising these at the next residents meeting.
Greys Residential Home Ltd DS0000065590.V266918.R01.S.doc Version 5.1 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. Greys Residential Home Ltd DS0000065590.V266918.R01.S.doc Version 5.1 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 Greys Residential Home Ltd DS0000065590.V266918.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: For assessment of these Standards, please see the previous report. Greys Residential Home Ltd DS0000065590.V266918.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 8 Care plans provide a good overview of residents health and personal care needs. EVIDENCE: Resident’s care plans provide a good overview of resident’s needs and resident’s interviewed confirmed that their care needs were being met by the staff. Some issues raised by the registered manager regarding special needs were discussed and advice given. Care plans were reviewed monthly and now the ‘day book’ does record an entry for every resident every day and this ties in with their care plans. Resident’s had signed the care plans themselves, or had asked staff to sign for them. A new sheet containing information about social needs and activities has been included on each resident’s plan and this also notes the aims and objectives regarding their ongoing social needs. Health needs are taken into account and, of the care plans sampled, there was evidence of health needs being recorded and specialist advice taken, together with guidance for staff. One resident who had needed a specialist nurse assessment had this noted on the file, and staff were currently carrying out instructions from a community nurse regarding the ongoing care of this resident. The home already has a monthly word quiz in their newsletter, and
Greys Residential Home Ltd DS0000065590.V266918.R01.S.doc Version 5.1 Page 11 has just introduced a ‘games afternoon’ to help residents who want to keep their brains active (as one resident remarked). Greys Residential Home Ltd DS0000065590.V266918.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15 Resident’s opportunities for social and recreational activities continue to improve at this home. Meals are constantly kept under review to ensure resident’s have an appealing and nutritious diet. EVIDENCE: Since the last inspection, the home has joined NAPA, an organisation committed to improving activities for residents in care homes – their newsletters and other written information have already given the home new ideas which they are gradually implementing. A member of staff has been given responsibility and time to work on activities and recreational opportunities for residents. Wednesday afternoons now provide opportunities for residents to take part in table top games for example. Regular activities include the monthly visits such as ‘Art Attack’ and ad hoc events such as flower arranging. The home records which residents take part in the various activities and how often they take part; this enables them to concentrate more on those who need extra encouragement, or more one to one activities. Aims and objectives are being recorded with regard to activities. The activities organiser said the home was about to purchase carpet skittles as a result of suggestions from residents about activities they would like to be involved in. This member of staff was very enthusiastic and though this is still early days, good progress has been
Greys Residential Home Ltd DS0000065590.V266918.R01.S.doc Version 5.1 Page 13 made. Activities are listed in the monthly newsletter and circulated to all residents. The home are just introducing internet access (and support) for any residents who want to contact their relatives by e-mail, or use the web for information gathering. Staff at this home work hard to provide a pleasant meal time experience and nutritious food for residents. The meal sampled on the day of the inspection was a home cooked savoury mince with dumplings, and homemade fruit crumble and custard. Both were tasty and nicely presented. As well as the fresh cabbage served with the mince, there were vegetables cooked in with the meat. Residents in the dining room all commented favourably on their lunch and the ambience generally in the dining room provided a pleasant mealtime experience. Some issues raised during the inspection regarding the suitability of the suppers, and some residents commented that sometimes they found there was too much food (one said they often had to leave their potatoes) or on occasion, too little food, and this was discussed with the proprietor. Given the varying appetites of residents, he suggested putting to residents (at their meeting later in the week), whether they would like vegetables put on the table in serving dishes for residents to help themselves. The cook prepares special diets where necessary, and menus are discussed in detail (and this is recorded) at residents meetings. Greys Residential Home Ltd DS0000065590.V266918.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Resident’s know how to make comments and complaints at this home, and they are protected from abuse. However, further work need to be done to meet this standard in full. EVIDENCE: All residents receive a copy of the complaints procedure with their introductory pack about the home. In addition, it is highlighted on the notice board and there is a suggestions box in the hallway by the front door. There was plenty of evidence from the notes of resident’s meetings that comments and complaints were raised in this forum and the owner also documented what the action points were regarding each issue – notes of the meeting were then made available to residents, who sign to say when they have seen them. The home also provides one to one sessions were residents can raise any concerns with a senior member of staff. One complaint made since the previous inspection was properly investigated by the home using its complaints procedure, and the outcome sent to CSCI. Resident’s are protected from abuse in a number of ways. Staff do not get involved with residents financial affairs and this is a condition when entering the home – this is discussed under Standard 35 below. Staff have had training in the previous Surrey multi agency procedures for the protection of vulnerable adults, and two have had training in the more recent version. The proprietor was asked to obtain the new version, the February 2005 policy, ensure that all staff receive some training/guidance on this, and that the in-house policy
Greys Residential Home Ltd DS0000065590.V266918.R01.S.doc Version 5.1 Page 15 dovetails with the county-wide policy. Staff spoken to were clear about their responsibilities if an allegation of abuse was made to them. Greys Residential Home Ltd DS0000065590.V266918.R01.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 21 Greys offers a safe and well maintained environment for residents, and provides suitable lavatories and washing facilities. EVIDENCE: The location and layout of the home is suitable for its stated purpose and is accessible and well maintained throughout. The home has had regard to the Standards when furnishing and maintaining the home, for example the owner has fitted very tasteful radiator covers to protect residents. He is also continually up grading resident’s individual bathrooms to provide ‘walk in’ shower and bathing facilities which are more popular with residents than baths they need to climb, or be hoisted, into. Residents who do not have ensuite facilities have their own bathroom in close proximity to their bedrooms, usually on the opposite side of their corridor. The grounds, as mentioned in the previous report, are very well maintained. The recent environmental health inspection (last month) found only minor concerns, and these recommendations have already been dealt with. Greys Residential Home Ltd DS0000065590.V266918.R01.S.doc Version 5.1 Page 17 The owner was asked to review a hairline crack in the ceiling of one room which was noted during the inspection. For the remainder of these Standards please see the previous report. Greys Residential Home Ltd DS0000065590.V266918.R01.S.doc Version 5.1 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 and 30 Residents at this home are in safe hands and staff are trained and competent to do their jobs. EVIDENCE: The pre-inspection questionnaire shows that 60 of care staff will have reached NVQ2 or above by early 2006. The home’s latest recruit is already studying for NVQ level 3. This home does not use agency staff. The owner outlined the staff training and development programme and confirmed that all staff were paid to attend a minimum of four training days per year; this exceeds the three days minimum set down in Standard 30. New staff receive induction training and the new staff member outlined what she was currently doing. The induction partly consists of watching some videos (TOPS standard) and answering a questionnaire (on care needs, the care worker’s role and health and safety etc), as well as familiarisation with the home’s own policies and procedures. However, the home was asked to ensure that all new staff complete their ‘induction’ within the timeframe set down in the National Minimum Standards. Greys Residential Home Ltd DS0000065590.V266918.R01.S.doc Version 5.1 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 and 38 Residents live in a home managed and run by a person who is fit to be in charge and carries out his responsibilities fully. Resident’s financial interests are protected. Health and safety are promoted at this home though some further actions are needed to meet this Standard in full. EVIDENCE: The Registered Provider is also the Registered Manager. He has been managing this home for five years, and was in a senior deputising position for two years prior to that. He completed his Registered Managers Award in 2004, and has an NVQ4 in care. He also has a degree in management. He continually up-dates his training and joins staff on most in-house training courses such as first aid, food handling and hygiene, and fire safety. He is responsible for only one registered establishment. The manager and senior staff are familiar with the conditions of old age and he commented ( and gave examples) that the internet is a good way of keeping up to date with
Greys Residential Home Ltd DS0000065590.V266918.R01.S.doc Version 5.1 Page 20 information on various conditions relevant to residents. There are clear lines of accountability within the home. Residents control their own finances at this home, though some are assisted by their relatives or friends; the home do not allow staff to get involved in resident’s finances. Sometimes the owner sends off resident’s cheques to the newsagent who delivers papers but this is the only involvement. The staff do not act as Agents or Appointees for welfare benefit purposes, nor do they get involved in distributing resident’s personal allowances. There is a safe in the home for residents to keep money or valuables though this is rarely used as residents have facilities in their own rooms. Residents who prefer a lock on their rooms have had them fitted, though some expressed a wish not to have them at all. The health and welfare of residents is promoted at this home and previous requirements on health and safety issues have all been met in a timely fashion. On the day of the inspection a number of certificates and records were checked and found to be satisfactory including the recent environmental health visit noted earlier; the annual electrical appliance test; and the employers liability insurance certificate. Care plans contained risk assessments regarding the various activities in which residents might be involved. The hazardous substances cupboard was securely locked. A sample of water temperatures were taken and found to be satisfactory. As already mentioned, tasteful radiator covers are fitted for the protection of residents. On the day of the inspection it was noted that the toilet by the front door contained a cotton towel, rather than disposable hand towels. This toilet is for visitors though residents may also use this toilet facility when they are downstairs. The owner was asked to ensure that disposable towels and individually dispensed soap (ie not bars of soap) are always used for communal hand washing facilities. Residents are free to use their own towel and bars of soap in their own bathrooms, but shared facilities should always follow the above advice to minimize cross infection. There were also some health and safety certificates which were not available on the day of the inspection and the owner was asked to ensure that these are available for inspection. The inspector noted that a couple of resident’s bathrooms needed to have the toilet roll holders attended to and this was discussed with the owner. Greys Residential Home Ltd DS0000065590.V266918.R01.S.doc Version 5.1 Page 21 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 4 X 3 X X X X X STAFFING Standard No Score 27 X 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 2 Greys Residential Home Ltd DS0000065590.V266918.R01.S.doc Version 5.1 Page 22 No Are there any outstanding requirements from the last inspection? 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 OP18 Regulation 13(6) Requirement The home must obtain an up-todate copy of the Surrey multiagency procedures for the protection of vulnerable adults (February 2005 version) and ensure all staff are familiar with these procedures. The home must also ensure that their own policy dovetails with the countywide procedures. The home must ensure that new staff members follow a structured induction programme and complete this according to the timescales set down in Standard 30. The home must ensure that evidence of health and safety checks are available to be inspected, and should send confirmation of the legionella testing, and the electrical wiring safety certificate to CSCI. The home should ensure that communal hand washing facilities use individually dispensed soap and disposable towels in order to minimise cross-infection.
DS0000065590.V266918.R01.S.doc Timescale for action 16/02/06 2. OP30 18(c ) (i) 16/02/06 3. OP38 12(1)(a) 13(4)(c ) 01/03/06 4. OP38 13(3) 17/01/06 Greys Residential Home Ltd Version 5.1 Page 23 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 OP19 OP38 Good Practice Recommendations The home should keep under review the hairline crack in the ceiling if one residents bedroom. The home should check that all toilets in residents rooms currently have a working toilet roll holder as two were found to need repair. Greys Residential Home Ltd DS0000065590.V266918.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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