CARE HOMES FOR OLDER PEOPLE
Grimsargh House Preston Road Grimsargh Preston PR2 5JE Lead Inspector
Susan Dale Announced 24 May 2005 10:00 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 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. Grimsargh House F57 F09 S9820 Grimsargh House V190265 240505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Grimsargh House Address Preston Road, Grimsargh, Preston, Lancashire, PR2 5JE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01772 651031 Stanner Manufacturing Limited Mrs Shirley Ithurralde Care Home 28 Category(ies) of Older People (28) registration, with number of places Grimsargh House F57 F09 S9820 Grimsargh House V190265 240505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The Registered Person shall at all times employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. 2. The home shall accommodate no more than 28 (twenty eight) service users within the category of Old Age not falling within any other category. Date of last inspection 13/12/04 Brief Description of the Service: Grimsargh House is situated within extensive grounds in the village of Grimsargh. The home is registered for 28 service users and provides personal care to older people over the age of sixty-five years both male and female. The home is not purpose built and has three floors accessible by a lift. There is ample communal space with two conservatories as well as a large dining room and lounge. Service users are only allowed to bring in pets after prior consultation with the manager.and there are two pet cats belonging to the home. The service provided is intended for service users who are fairly dependent but do not require nursing care. Grimsargh House F57 F09 S9820 Grimsargh House V190265 240505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was announced and during the inspection the inspector was able to speak to 10 service users, 3 care staff, a relative, the chef and the registered manager. Comment cards were sent prior to the inspection to service users, relatives/friends and General Practitioners/District Nurses. A response was received from 1 service user, 5 relatives/friends and 3 General Practitioners; all the replies were positive. The inspection took place over 4 hours and commenced at 10.00 a.m. Various records were examined during the inspection including all the records belonging to 4 service users and staff training and recruitment records. A partial tour of the premises took place. What the service does well:
Almost half the service users have dementia in varying degrees and a few are exhibiting extreme behaviour. The staff are managing to provide a high standard of care within a homely atmosphere; service users are allowed to have as much independence as possible. Staff were seen to work well as a team and voiced their appreciation of the leadership skills of their manager who encourages staff by providing training to assist them in their role of carers. There is constant striving for improvement and all the policies and procedures have been altered to meet the needs of the service user and become more `user friendly’. Since the current manager took over there has been a big improvement in the relationship with the local General Practitioners (GP’s) and District Nurses with very positive comment cards received from 4 G.P’s practices. 5 comment cards were received from relatives/friends and they were all very positive; one of the relatives made the following comment: “We as a family have nothing but praise for Grimsargh House. We feel Mum would not be here today if it was not for their love and care”. Grimsargh House F57 F09 S9820 Grimsargh House V190265 240505 Stage 4.doc Version 1.30 Page 6 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. Grimsargh House F57 F09 S9820 Grimsargh House V190265 240505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Grimsargh House F57 F09 S9820 Grimsargh House V190265 240505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, 4 & 5 Ample information is available about the services provided by the home and prospective service users are able to visit the home and try out the services before a final commitment is made. A full assessment is undertaken prior to commencement at the home in order to determine whether the services provided by the home are suitable. EVIDENCE: The Statement of Purpose and Service User Guide were reviewed and changed in April 2005. The documents seen are in large print and therefore User friendly and provide ample information about the services provided by the home. The service users files seen, indicated that an initial assessment is undertaken that covers all the areas required. As well as service users physical needs, the assessment also takes into account social interests, hobbies religious and cultural needs. The paperwork seen included assessments undertaken by hospital staff prior to discharge. The assessment leads to the compilation of a Care Plan, any risks involved in the provision of care or their ability to go out on their own alone are recorded. There was evidence that the service user had
Grimsargh House F57 F09 S9820 Grimsargh House V190265 240505 Stage 4.doc Version 1.30 Page 9 been involved in the process by the inclusion of a signature on a separate sheet. The Terms and Conditions/Contract of the home contains information about trial visits by prospective service users. Emergency admissions are allowed according to the circumstances. This information is included within the Statement of Purpose and Service Users’ Guide. Grimsargh House F57 F09 S9820 Grimsargh House V190265 240505 Stage 4.doc Version 1.30 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 standard(s) 7, 8, & 10 An appropriate care plan is devised that ensures physical, health and emotional needs of service users are met. EVIDENCE: The initial assessment leads to a care plan and the records seen contained all the information as necessary for the staff to deliver appropriate care. The care plans seen had been reviewed on a monthly basis and there was evidence that the service user had been involved in the process. There was also evidence that relatives and health personnel had been present at reviews. A couple of the service users are exhibiting challenging behaviour and this has led to some aggression displayed to staff. The manager has taken appropriate steps to alleviate the problems and has held meetings with Health and relatives, which has led to a change in medication and the delivery of care. Staff are being provided with training on Challenging Behaviour. A recommendation was made that any risks associated with the behaviour of service users should be recorded and the strategies to deal with the behaviour should be reviewed each month. Prior to the inspection comment cards were delivered to General Practitioners (GP’s) for any comments they may have about the home. Three comment
Grimsargh House F57 F09 S9820 Grimsargh House V190265 240505 Stage 4.doc Version 1.30 Page 11 cards were returned from GP’s who confirmed that the staff worked in partnership with them and that staff demonstrated a clear understanding of the care needs of service users. All the GP’s were able to see service user in the privacy of their own room. Service users spoken to confirmed that staff are respectful towards them at all times and respect their privacy and staff confirmed that they are taught the importance of respect at induction training. Grimsargh House F57 F09 S9820 Grimsargh House V190265 240505 Stage 4.doc Version 1.30 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 standard(s) 12, 13, 14 & 15 The home provides activities that meet the expectations and capabilities of the service users and visitors to the home are made to feel welcome at all times. Meals are provided that are wholesome and appealing and provide choice. EVIDENCE: Various activities are provided and the details are recorded on a blackboard in the dining room; they include, Keep Fit, Bingo, Mobile Shop, Skittles, Wool Ball, Jigsaws, Board Games and Baking. Activities are recorded stating which service user attended and on what date and a photographic record is maintained of service users enjoying various activities. At Halloween, all the service users dressed up and there was a Tea Dance at Christmas. Outings are undertaken to the wider community with pub visits and service users are encouraged in fund raising such as on Red Nose day when there was also a cocktail party. A Summer Fayre is to be held in September. A visitor was spoken to who confirmed that he is always made to feel welcome when visiting the home. Five comment cards were returned from relatives/visitors who confirmed that they were made welcome and were kept informed of important matters affecting their relative. Information about visiting the home is contained within the Service User Guide.
Grimsargh House F57 F09 S9820 Grimsargh House V190265 240505 Stage 4.doc Version 1.30 Page 13 One of the relatives made a comment: “ It is a good home with a good reputation.” Meals are provided in a light and airy dining room in very pleasant surroundings. According to the service users spoken to the meals are excellent with ample proportions; snacks are available in between meals. The chef confirmed that there were no restrictions on the food budget and they are currently considering changing the menus to those more suited to summertime. The chef had received training in Food Hygiene, Health & Safety and First Aid and was able to attend staff meetings. Grimsargh House F57 F09 S9820 Grimsargh House V190265 240505 Stage 4.doc Version 1.30 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 standard(s) 16 & 18 Policies and procedures are in place to ensure that service users are protected from abuse and any complaints/concerns are recognised and acted upon. EVIDENCE: The home has a suitable complaints procedure that is recorded within the Statement of Purpose and Service User Guide. A record has been kept of all complaints and the subsequent investigation. A record has been kept of all complaints and the subsequent investigation. There were only 2 complaints recorded and these were connected with incidents that had affected staff. The manager had recorded the action taken following the complaints. The home has policies on `How to deal with Aggression’, Whistle Blowing and has a copy of the Department of Health’s Guidance, “No Secrets”. Evidence was provided from talking to staff and staff files that training has been provided in this very important area with regard to Adult Abuse and Whistle Blowing. The home has suitable policies and procedures with regard to the service users’ financial affairs and the non-involvement of staff benefiting from service users’ wills. Grimsargh House F57 F09 S9820 Grimsargh House V190265 240505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 Service users live in an environment that is clean, safe and well maintained. EVIDENCE: There is a routine maintenance plan for the home and the building complies with the requirements of the local fire service and environmental health department. A programme of refurbishment is in operation and bedrooms are being gradually decorated and provided with new carpets. The grounds of the home are large, well kept and are accessible by service users. A patio is available with tables and seating providing a safe sitting area protected by a fence from the driveway. Policies and procedures are in place for the control of infection. Laundry facilities are sited appropriately and do not require to be carried through areas of the home where food is prepared or eaten. The washing machine has the facility to wash soiled clothing etc., at an appropriate temperature. At the time of the inspection the home was warm clean and free from any obvious hazards.
Grimsargh House F57 F09 S9820 Grimsargh House V190265 240505 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 Service users are cared for by appropriate staff who have been provided with training that enables them to meet their needs. EVIDENCE: The staffing rota shows that there are adequate staff on duty at any time of the day or night. Comment cards from relatives/visitors confirmed that when they visited the home there were enough staff on duty for the needs of the service users. Staffing records were examined; the home has an appropriate recruitment policy and the records seen showed that new staff had not commenced duties until references had been received including clearance from the Criminal Records Bureau (CRB) and a check undertaken of the Protection of Vulnerable Adults Register (POVA). Each staff member has an Individual Training Profile that was up to date and signed by the staff member and the manager. Staff training includes, Moving and Handling, Food Hygiene, Health & Safety, Fire Safety, First Aid and Parkinson’s Disease awareness. The training meets the National Training Organisation’s specifications. There are 14 care staff and 10 staff have achieved NVQ level 2 or above, 2 more staff have commenced NVQ 2. Grimsargh House F57 F09 S9820 Grimsargh House V190265 240505 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 36 & 38 The service users benefit from the competency and leadership of the manager and are given every opportunity to participate in the running of the home. EVIDENCE: The registered manager has obtained N.V.Q. level 4 in Management and has lengthy experience in the provision of care. There are clear lines of accountability within the home. Evidence was provided from talking to staff and service users that the manager communicates a clear sense of direction and regular meetings are held between the staff. Meetings are also held between service users at which they are given an opportunity to have a say in the running of the home. All staff employed within the home has to comply with the Code of Practice published by the General Social Care Council. Grimsargh House F57 F09 S9820 Grimsargh House V190265 240505 Stage 4.doc Version 1.30 Page 18 Staff spoken to confirmed that they receive one to one supervision every two months and that supervision covers all aspects of practice; the philosophy of care within the home and any training needs. Staff also confirmed that they can speak to the manager at any time and that they feel well supported by management staff. Policies and procedures have been put into place to ensure the safety of the staff and service users. Staff are instructed in the techniques of moving and handling and are provided with information so that they are able to develop an understanding of fire procedures and food hygiene. Regular servicing takes place of the boiler and central heating systems. Risk assessments are conducted on all safe working practices and any significant findings recorded. The home is covered by Insurance valid until the 9th September 2005 and all other systems such as the gas and fire extinguishers have been checked. Grimsargh House F57 F09 S9820 Grimsargh House V190265 240505 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x x 3 x 3 Grimsargh House F57 F09 S9820 Grimsargh House V190265 240505 Stage 4.doc Version 1.30 Page 20 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 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. 1. Refer to Standard Good Practice Recommendations Grimsargh House F57 F09 S9820 Grimsargh House V190265 240505 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Unit 1, Tustin Court Portway Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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