Inspection on 12/11/08 for Grisedale Croft

This inspection was carried out on 12th November 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

Grisedale Croft 07/11/06

Grisedale Croft 08/03/06

Grisedale Croft 22/08/05

Grisedale Croft 16/03/05

Grisedale Croft 28/07/04

Grisedale Croft 15/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Grisedale Croft Church Road Alston Cumbria CA9 3QS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Margaret Drury     Date: 1 2 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Grisedale Croft Church Road Alston Cumbria CA9 3QS 01434381221 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Sandra Shepherd Type of registration: Number of places registered: Cumbria Care care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The home is registered for a maximum of nineteen service users to include: - up to 19 service users in the category of OP (Older people not falling within any other category) - up to 2 service users in the category of DE(E) (Dementia over 65 years of age) The manager has no responsibilities, other than in an emergency for any other flats or accommodation attached to the home. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The staffing levels for the home must meet the Residential Forum Care Staffing Formula for Older Adults. This registration includes a total of 6 residents accommodated as follows: Flat 1 - 1 Resident Flat 2 - 1 Resident Flat 3 - 1 Resident Flat 4 - 1 Resident Flat 6 - 2 Residents When single rooms of less than 12sqm usable floor space become available they must not be used to accommodate wheelchair users, and where existing wheelchair users Care Homes for Older People Page 4 of 26 Over 65 2 19 0 0 are in bedrooms of less than 12sqm they must be given the opportunity to move to a larger room when one becomed available. Date of last inspection Brief description of the care home Grisedale Croft is a care home offering accommodation and care for up to 19 older people, two of whom may have varying forms of dementia. Cumbria Care, an internal business unit of Cumbria County Council, operates the home, which is run on a day-today basis by Ms Sandra Shepherd. Grisedale Croft is situated on two floors, the upper being served by a passenger lift and a stair lift. All the rooms are for single occupation, six of them having a small kitchen and toilet. There are bedrooms on the ground floor, together with a lounge/diner, smoking lounge, a bathroom and toilets. On the first floor there are bedrooms, a lounge/diner, bathroom and toilets. The six rooms with the kitchen and toilet are situated on the mezzanine floor that is accessed by a short flight of stairs and the stair lift. There are well kept gardens and car parking at the front of the building. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This site visit that forms part of the key inspection took place over one day in November and we The Commission for Social Care Inspection were in the home for six hours. On this occasion the lead inspector Mrs Margaret Drury was accompanied by Dr John Spencer in his capacity as an expert by experience. His findings are reflected in the main body of this report. Information was gathered about this service in different ways, Annual Quality Assurance Assessment document completed by the manager, Survey questionnaires returned by staff and residents, Interviews with residents and staff on the day of the visit, Looking at any information received from other professional bodies, Details of the monthly visits made by the operatios manager. Care Homes for Older People Page 6 of 26 We looked at the care files for five residents to ensure the care provided met all the assessed needs and a tour of the building looking at the envionmental standards was undertaken. Medication records were examined and staff training records and personnel files were also inspected. As the manager was not in the home on the day of our visit we discussed the running of the home with the supervisors on duty. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All those wishing to use this service are fully assessed prior to admission. This ensures all assessed needs are recognised and fully met. Evidence: Comprehensive needs assessments are completed before anyone is admitted to Grisedale Croft to ensure that the home is suitable and able to meet the level of care needed in an appropriate manner. The manager was not available on the day of the visit but the supervisors on duty assisted with the inspection. They confirmed that the needs of those people already living in the home are taken into account before a place is offered to any prospective resident. We looked at the assessments and care plans of five residents and found the documentation to be relevant and informative. This information is then used when drawing up the initial care plan after admission. All of the care plans have been transferred over to the new format recently introduced throughout Cumbria Care. Care Homes for Older People Page 10 of 26 Evidence: No resident is admitted without an management assessment received from Social Services, after which the manager meets with the prospective resident and family members if this is considered appropriate. All residents have a contract with the home and with the Social Services Department. This home does not provide intermediate care. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The provision of health and personal care people receive is based on their individual needs, with the principles of respect, dignity and privacy maintained at all times. Evidence: We looked at the care plans for five of the people living in the home and found them to be informative, detailed and up to date. Cumbria Care has recently introduced a new care plan format that includes a more person centred approach to personal and social care and concentrates on providing care in the way in which those using services wish. All the care plans at Grisedale Croft have been transferred to this format and the supervisors and staff we spoke to all agreed that there is now much more imput from the residents and their families. Each care plan is a working tool that includes an admission assessment, risk assessment and a full dietary and nutritional screening assessment tool. The plan puts emphasis on what is important to the individual and how best their needs can be met. All the plans reflect the changing needs of the residents and can be easily updated to take into account those changes. All healthcare needs are met through good working relationships with the local healthcare Care Homes for Older People Page 12 of 26 Evidence: professionals and we were able to speak to 2 of the district nurses who were visiting the home on the same day. They spoke very highly of the care provided to those living in Grisedale Croft and said they had a very close working relationship with the manager and staff at the home. They commented that the care staff were wonderful and gave excellent care. We checked the records for the receipt, recording, handling and disposal of medication. These were correctly completed and up to date. The home follows the corporate guidance and uses a second checker when medication is administered to ensure the safety of the residents. Medication that is prescribed to be taken as and when necessary is recorded on separate sheets and although there are no controlled drugs currently prescribed there is a recording procedure in place for such medication. Observations during our visit evidenced that the staff were extremely polite and respectful when caring for those using this service. This was confirmed when we spoke to residents who commented on how kind and thoughtful the staff were. Comments such as, the girls are lovely, they cant do enough for you, and they always welcome my visitors were made. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines in this home are sufficiently flexible to meet the changing needs of those living there. Activities are available for those who want to take part. Evidence: The routines in this home are very flexible and allow residents maximum choice about how they wish to spend their days. There are no set times for getting up and going to bed and some residents told us they sometimes liked to have a lie in. Preferences about daily routines are recorded in care plans and on the daily notes. When staffing levels allow residents are taken out into the local community and many of them took part on the float the staff organised for the local Gala that was held in the summer. There is a lovely picture record of this event on the wall in the hall. Residents do like to go out but this is not always possible as it depends on the staffing levels on any particular day. Entertainment is booked at regular intervals and there are some activities arranged by the care staff. There is a group of ladies that enjoy a game of dominoes and a chat in the lounge every evening after their meal. There is no restriction on visitors coming to the home and Alston is a close knit community so there are visitors in on most days. Unfortunately we were unable to meet with any visitors on the day of our visit. There is a varied and nutritious menu in place with Care Homes for Older People Page 14 of 26 Evidence: meals that are freshly prepared. Special diets and requests are also catered for. We were able to discuss the likes and dislikes with the cook who knew all the residents well. She often goes to speak with the residents to see if there are any dishes they would like to try. There is a choice at each meal with different options also available. Meals are served on each of the wings but residents are given the choice where they wish to eat. Some choose to have their meals in their rooms whilst others always eat in the communal rooms. We were able to observe lunch being served and found it to be a pleasant and relaxed time with residents chatting between themselves. The expert who accompanied us to the home enjoyed his lunch with the residents. He commented that the food was hot and well prepared and everyone had exactly what they wanted as choices had been made the day previous. The residents he spoke to ate well and seemed to enjoy their lunch. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those living in the home know any complaints or concerns they have will be listened to and acted upon. Residents are kept safe at all times. Evidence: There is a comments and complaints procedure in place at the home and this is displayed around the home and forms part of the resident guide and statement of purpose. Some of the people participating in this inspection told us that they are aware of the process and know who to raise their concerns with. They also think that any concerns they might raise will be dealt with properly and as soon as possible. They did, however tell us that they had never had cause to complain. There were no complaints to record and we (CSCI) have not received any. Staff have regular training on how to recognise and prevent any signs of abuse and how to proceed if they notice anything untoward. Staff we spoke to confirmed they knew what to do if they saw anything suspicious. We have not received any complaints about or reports of any adult protection issues at this home. There is a corporate adult protection process in place, which includes the process for reporting concerns to internal managers, social services, the police and the Commission for Social Care Inspection. This procedure also forms part of the staff recruitment process and this helps ensure that suitable people are employed after all the necessary checks have been made. Care Homes for Older People Page 16 of 26 Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a home that is safe, warm, clean and, on the whole, fit for purpose. Evidence: Although the manager was not in the home on the day of our visit we were able to undertake a tour of the building inspecting the environmental standards. The standard was, on the whole, good although some of the bedrooms are rather small. As the home employs domestic staff it was clean and hygienic and has a fully equipped, spacious and clean kitchen area. There is a lounge and dining room in each of the wings where residents spend their days. They are not always suitable for activities if many wish to join in although the residents told us they enjoyed meeting their friends there. Some bedrooms and lounge areas have been re-decorated since the last inspection and new carpets have been laid. We were also able to speak to some residents who were in their rooms at the time. They were all pleased with their accomodation and all had brought in personal items from home such as photographs, pictures televisions and radios. One lady said, it helped me to settle down. Athough the rooms with en-suite facilities are very limited there are sufficient communal bathrooms and toilets to meet the needs of those living in Grisedale Croft. Care Homes for Older People Page 18 of 26 Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team have been correctly recruited and have the necessary skills and experience to provide a good standard of care to vulnerable people. Evidence: The staffing levels were checked and found to be generally sufficient to meet the needs of the people living in the home. Staff did however, tell us that there were times when they were short due to sickness or holidays and it could be difficult to find replacemts at short notice. At the time of our visit the situation was fairly stable as there were some vacant rooms but staff shortages can be a problem when the home is full. The residents we spoke to had nothing but praise for all the staff. comments such as, the girls are lovely and so helpful, the carers are very kind and help me a lot and they cant do enough for you were made. The kindness and professionalism of the staff was also commented on by the visiting district nurses we spoke to. Staff training is up to date with subjects such as dementia care, safeguarding of vulnerable adults, moving and handling, medication and special diets and nutrition completed. Details of training are held on the staff development files but thse are not currently up to date although the manager told us on the Annual Quality Assurance Assessment she completed that this was one of the things she hoped to achieve in the next 12 months. Care Homes for Older People Page 20 of 26 Evidence: There is a comprehensive recruitment and selection procedure in palce and no new member of staff starts work without all the requires legal checks being completed. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and organised, ensuring as much as possible that people living there are safe and receive a good quality service. Evidence: Although the manager was not present in the home on the day of the visit we are aware, from previous inspections, that she is an experienced and qualified manager. In discussion with the supervisors and members of the staff team, there was a general opinion that she approachable and fair. Comments received from those living in the home were, Sandra (manager) is lovely, I see her at some time each day and the manager is available when you want to ask a question. The home has a full set of policies and procedures in place that are provided and kept up to date by Cumbria Care. These are readily available to staff and are discussed during staff supervision meetings. There are health and safety procedures in place and an annual audit is completed each year by the organisational health and safety manager. This ensures that Grisedale Care Homes for Older People Page 22 of 26 Evidence: Croft is a safe place to live and work. All equipment is serviced under annual contracts and there is documented evidence to support this. There are procedures in place regarding any monies held on behalf of those living in the home with adequate and appropriate records being kept to ensure personal finances are safeguarded. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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