Inspection on 09/01/08 for Greystone House

This inspection was carried out on 9th January 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Greystone House 30/05/06

Greystone House 13/03/06

Greystone House 02/09/05

Greystone House 07/03/05

Greystone House 19/05/04

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

CARE HOMES FOR OLDER PEOPLE Greystone House 319 Blackwell Road Carlisle Cumbria CA2 4RS Lead Inspector Mrs Margaret Drury Unannounced Inspection 9th January 2008 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Greystone House DS0000022656.V356368.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. Greystone House DS0000022656.V356368.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greystone House Address 319 Blackwell Road Carlisle Cumbria CA2 4RS 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) 01228 536349 Mr John Sibbald Ruddick Mrs Susan Ruddick Mr John Sibbald Ruddick Care Home 24 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (24), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (24) Greystone House DS0000022656.V356368.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Registered for 24 people with a mental disorder (MD) some of whom may be over 65 years of age (MD(E)) Two service users may only share the double room if both have made a positive choice to do so. 30th May 2006 Date of last inspection Brief Description of the Service: Greystone House is a large Victorian, two storey detached property on the outskirts of Carlisle city. It has been modernised and converted for its present use, including three purpose built extensions to the side and rear of the original building. Greystone House is home to twenty-four people who have difficulties maintaining aspects of their mental health. Two carers, a senior and the manager staff a normal shift, with two waking staff on duty at night. The Home has three lounges situated on the ground floor, one of which is a designated smoking area. There are also two dining areas. One of the three bathrooms is equipped with a hoist to safely assist people with physical needs. There are twenty-two single bedrooms and one twin bedded room. Fourteen of the single rooms have en-suite facilities. The Home has a central laundry and kitchen. Both laundry services and meals are provided to service users. There is a six-person passenger lift to the first floor. The Home has a private garden to the front and a s maller garden/patio area to the rear. The Home is well placed for local facilities including shops, post office and church. There is a regular bus service to the city that stops adjacent to the Home and Hammonds Pond Park is only a short walk away. The fees at this service are currently £422.00 per week with extra charges for hairdressing and personal toiletries. This home does not provide intermediate care. Greystone House DS0000022656.V356368.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This unannounced visit that forms part of the unannounced inspection took place over one day. We were in the home for five and a half hours. During the first visit to the home we were able to speak to members of staff and people living in the home in order to ask their opinions about the facilities on offer and the level of care provided. We were not able to speak to any visitors during the time we were in the home. Information about the service was also gathered in other ways: • The completed Annual Quality Assurance Assessment document. • Survey questionnaires returned by residents • The service history We looked at care planning documentation to ensure the level of care provided met the needs of those living in the home and a tour of the building to inspect the environmental standards was undertaken. Staff personnel files were also examined. What the service does well: The manager and staff take time to help people settle into the home and make sure it suits them and detailed information is readily available to help people decide about living in the home. Care planning and care practice supports people’s choice and independence. The service does regular audit work across all systems in the home to monitor the quality of the service and makes changes if needed. The environment is homely, clean, fresh smelling and comfortable and relatives commented on the high standard of cleanliness. There are good systems for handling medication to make sure medicines are managed safely and that residents receive the correct treatment. There is good communication with residents’ doctors so that health care needs are met promptly. The district nursing service visits the home when required. Greystone House DS0000022656.V356368.R01.S.doc Version 5.2 Page 6 Mealtimes are flexible with menus that offer choice and variety. Staff turnover is low, they are motivated to work to a high standard, and are well supported and supervised. Training and staff development is given a high priority in the home. All staff are aware of the residents’ needs and work closely with the relevant health care professionals to maintain an appropriate service for those living in the home. The service has suitable recruitment systems in place to ensure they get the right staff to promote the safety and wellbeing of people living there. What has improved since the last inspection? 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. Greystone House DS0000022656.V356368.R01.S.doc Version 5.2 Page 7 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 Greystone House DS0000022656.V356368.R01.S.doc Version 5.2 Page 8 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): Standards 3, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a thorough admission process in place, including detailed assessment documentation. This helps to ensure each individual’s needs are evaluated and met. EVIDENCE: The admission policy and procedures were examined and found to be up to date and relevant. The manager ensures that individual care needs assessments are carried out for each prospective resident. Admissions are not made until this assessment has been carried out and considered by the manager. This helps to ensure that the home will be suitable and able to meet the needs of the prospective resident. Assessment details are kept on file and form the basis of the individual plan of care. Greystone House DS0000022656.V356368.R01.S.doc Version 5.2 Page 9 Many of the residents have lived in Greystone House for a number of years and those we spoke to confirmed how happy they were and “would not like to live anywhere else”. Relatives and /or advocates are welcome to visit before an admission is completed. This gives opportunity to look at the facilities, meet the staff and residents and discuss the level of care provided. Greystone House DS0000022656.V356368.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. This judgement has been made using available evidence including a visit to this service. People who use this service are supported to remain independent with care plans showing specific health and personal care needs. EVIDENCE: We looked at the care plans for four residents and found them to be detailed, showing goals and outcomes for each person. Review dates were clearly noted and all reviews were up to date. Personal healthcare needs were recorded, together with any specialist intervention that may be required. All changes in the level of care are noted and staff are given sufficient information to ensure the changes are dealt with. Most of those living in the home have retained their own doctor, which means there are eight who visit and support when required. The district nursing service is currently visiting to attend to dressings. Greystone House DS0000022656.V356368.R01.S.doc Version 5.2 Page 11 There is a policy in place for the staff responsible for medication to adhere to with regards to the receipt, recording, storage, handling, administration and disposal of all medications coming into the home. All medication, which is received from the pharmacy in a weekly monitored dosage system, was securely stored in a locked cupboard. All staff who handle medication have completed training and regular audit checks are completed to ensure the safety of those living in the home. The medication administration records (MAR) were examined and found to be accurate with medication being correctly administered. Members of the staff team were observed demonstrating a caring and sensitive attitude towards the residents, whilst at the same time enjoying a warm and friendly relationship. There is a low staff turnover, which means that those living in the home have good relationships and respond positively to those who work in the home. Privacy and dignity training forms part of the induction programme and it was evident that all who live in Greystone House are looked upon very much as individuals and treated accordingly. Greystone House DS0000022656.V356368.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. This judgement has been made using available evidence including a visit to this service. People who use this service are encouraged to make choices about their lifestyle and are supported to develop their life skills. Recreational activities are tailored to individual likes and expectations. EVIDENCE: The atmosphere in this home is very relaxed and informal with residents choosing exactly how they wish to spend their day. Some group activities are organised but these are limited, as those living in the home prefer to spend time with staff on a one to one basis. Outings are enjoyed and many of the residents are able to go into Carlisle or just to the local shops. One of the residents goes swimming on a regular basis. Pets as Therapy dogs visit the home each week and this has proved to be very therapeutic for many of the residents. It has become a social event and has introduced “new faces” into the home. Visitors are plentiful, there being no restrictions when they come but residents are always given the choice when, where and if they meet them. Greystone House DS0000022656.V356368.R01.S.doc Version 5.2 Page 13 Some residents go out to their local church on Sunday and during the week. Communion is available for any who wish to take part. The manager recently conducted a poll among the residents regarding the menus. This resulted in a number of changes, the most popular being “the allday breakfast”. We observed lunch being served and found the time to be warm and relaxed. The residents had all made their choice although they do sometimes change their minds on the day. We spoke to the cook, who has worked at the home for some time. She knows the residents well and their likes and dislikes. The kitchen was clean and well kept with the stores well stocked. All records were in place and up to date. When speaking to residents it was obvious they all enjoyed their food especially the home baking. Greystone House DS0000022656.V356368.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): Standards 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home know their concerns will be listened to and acted upon. Detailed policies and procedures protect residents from harm. EVIDENCE: The manager has recently updated the complaints procedure to make it as clear as possible. This is also included in the information pack that is given to all who visit the home looking for accommodation. There was a copy on display on the notice board in the hall. There have been no complaints to record in the log and The Commission for Social Care Inspection (CSCI) has not received any. The manager has recently completed a “training the trainers” course on adult protection organised by Social Services. She is currently preparing training for all staff and hopes to present this during February and March this year. Staff are aware of adult protection issues and keep a careful watch on the interaction between the residents. They also know what to do should this be necessary and have access to a copy of the multi-agency protocol. Greystone House DS0000022656.V356368.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): Standards 19, 20, 21, 23, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home is clean, hygienic and well maintained, helping to ensure that people live in a safe, comfortable environment, EVIDENCE: We conducted a tour of the building and found it to be of a very good standard. It was clean and hygienic with ample communal space for the residents to enjoy. The home employs a maintenance person who is responsible for the upkeep of the building and grounds. A record is kept of work to be done, which is signed and dated when the work is completed. New dining furniture and arm chairs have recently been purchased and the dining area to the rear of the building has recently been re-organised to make it more friendly as well as practical. Greystone House DS0000022656.V356368.R01.S.doc Version 5.2 Page 16 There is a small smoking lounge on the ground floor that has been redecorated. This room has adequate ventilation to meet the required standards. There is a large garden to the front of the home that is used extensively during the warm weather. Garden furniture is also available. The two ground floor bathrooms and separate toilet have been fully refurbished and now provide very pleasant surroundings for the residents to enjoy. All bathrooms are adapted to ensure the residents are fully supported with their personal care needs. Residents’ bedrooms are personal to each individual and we were invited by one resident to “go and look at my room”. There are pictures on the walls and evidence of any hobbies residents may have. Greystone House DS0000022656.V356368.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): Standard 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are competent and well trained. This helps to ensure that the needs of people living at the home are met in a safe and appropriate way. EVIDENCE: The home has recently started to use a professional training provider for the induction of new staff. The manager confirmed that this is proving to be both cost effective and beneficial. The same organisation is also working with the home to provide National Vocational Qualification (NVQ) training. We looked at samples of staff recruitment records during this visit to the service. Prospective staff are required to complete application forms and undergo special checks such as Criminal Record Bureau (CRB) checks and Protection of Vulnerable Adults (POVA) list checks. This helps to ensure that only suitable people are employed to work at the home. Files were well kept and easy to read. Training records were also discussed and the manager confirmed that more “train the trainer” courses are being undertaken this will enable staff training to be delivered “in-house” in a more cost effective and flexible manner. Greystone House DS0000022656.V356368.R01.S.doc Version 5.2 Page 18 Training recently completed includes, prevention and management of violence and aggression, medication, food hygiene and fire safety. Training planned for the near future includes, moving and handling updates, infection control, adult protection and ongoing NVQs. There were sufficient numbers of staff on duty on the day of the visit with two care staff, a senior carer and the manager plus ancillary staff. Greystone House DS0000022656.V356368.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35, & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of this home is based on openness and respect. This means that is run in the bet interests of those living there. EVIDENCE: The registered manager of Greystone House hoping to retire in the near future but works closely with his daughter to ensure the home is run in the best interests of those living there. As she is taking responsibility for the home she is currently applying to The Commission for Social Care Inspection to become the registered manager. She was present during the visit and assisted us with the inspection. She has already completed the Registered manager Award is about to start her NVQ level 4 in health and social care. Greystone House DS0000022656.V356368.R01.S.doc Version 5.2 Page 20 She participates in regular training to help ensure that her knowledge is kept up to date. There are clear lines of accountability in the home, which helps to ensure the open and positive atmosphere at all times. The atmosphere in the home is one of warmth and friendliness, which suits well those living there. The home holds small amounts of money on behalf of residents with records and receipts kept of all transactions. Annual quality questionnaires are sent out to residents for comments about the running of the home with the manager acting on suggestions wherever possible. Future plans include the introduction of small discussion groups with the residents to obtain even more feedback from residents. Records indicated that all inspection certificates were in place with all equipment maintained under annual service level agreements. There is a health and safety policy in place and all risk assessments are in place. Policies and procedures are updated each year to ensure they are always in line with current legislation. Greystone House DS0000022656.V356368.R01.S.doc Version 5.2 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 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 3 3 X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Greystone House DS0000022656.V356368.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Greystone House DS0000022656.V356368.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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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