Inspection on 13/10/05 for Grosvenor Court

This inspection was carried out on 13th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Grosvenor Court 26/10/06

Grosvenor Court 25/01/06

Grosvenor Court 20/02/05

Grosvenor Court 02/08/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Grosvenor Court 15 Julian Road Folkestone Kent CT19 5HP Lead Inspector Chris Randall Announced Inspection 13th October 2005 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Grosvenor Court Address 15 Julian Road, Folkestone, Kent, CT19 5HP. 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) 01303 221480 Counticare Ltd Mrs Christine Weathered CRH 17 Category(ies) of LD Learning Disability registration, with number of places Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 02.02.2005 Brief Description of the Service: Grosvenor Court is a care home providing residential care for up to 17 people with a severe learning disability. The home is a detached property made up of an original house which has been extended and linked to form the current accommodation. The grounds are well maintained and include a private walled garden and a parking area. The property is located in a quiet residential area in Folkestone but is within easy reach of facilities such as health centres, shops, recreational facilities, and the companys day centre Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was held over 2 days and took 14 hours (8.75 hours in the home plus preparation time). Time spent in the home comprised of a tour of the home and grounds; speaking to 9 staff (6 in some depth), 2 visitors, and the manager; interacting with service users; observation of the interaction between staff and service users; examination of various records; observation of medication storage, and observation of lunch being served. The home was clean and odour free throughout. There was a friendly and welcoming atmosphere in the home. Service users were witnessed to be free to move about the home in the manner best suited to them. Interaction between staff and service users was good. Most records were well kept. A visitor commented, “we are more than happy, they are brilliant with her”, and staff members commented, “It’s a lovely home”, “the first thing I noticed was the cleanliness and no smell”, and “I feel the home is well run, its team work and everyone does their best”. What the service does well: What has improved since the last inspection? Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 6 All of the service users bedrooms have been decorated and have new curtains or blinds. The communal rooms and hallways have been decorated, with the exception of the house lounge, and that was being painted on the day of the inspection. New carpets have been fitted in most of the corridors and communal lounges, and those not yet complete are scheduled to be done shortly. The extension to the laundry, mentioned as being in progress in the last inspection report, has now been completed and is in use. All service user plans have now been reviewed. Fire testing is now carried out weekly. New procedures have been put into place to minimise the risk of legionella. The company’s policies are all in the process of being updated. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4, & 5 Prospective service users and their supporters can be confident that the home will meet their needs and aspirations. EVIDENCE: The home makes available a statement of purpose and service user guide and these have been updated to reflect most of the relevant changes. However, currently the home has 2 service users who are over the age range of the current registration and a recommendation has been made that the home should not accommodate service users outside their registration category. It is suggested that a variation to registration be sought, if granted this should then be reflected in the statement of purpose and service user guide. If required the service user guide can be produced in other formats, e.g. including widgets. A copy of the statement of purpose and service user guides is given to prospective service users, their families and care managers prior to admission being agreed to help them in the decision making process. All prospective service users have their needs assessed prior to admission. Joint assessments are obtained from Care Managers. In addition the manager, together with her deputy or a team leader, visits prospective service users wherever they are at the time, this can be at home, in another home, or in a day unit. On this visit the manager completes the homes own assessment and the comments of family members or carers are taken into account. The manager, when considering whether the home can meet the person’s needs, Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 10 takes into consideration the information obtained from all relevant parties. Once admission is agreed a care plan for the service user is drawn up using all of the information obtained. If time and locality allow members of the staff team will also visit the prospective service user at home or day centre prior to admission. The home invites all prospective service users and their families to visit the home for lunch, tea or a look around prior to admission. The first three months living in the home are then deemed as a trial period and a review is carried out at the end of the period. This gives the home the chance to ensure that they are meeting the service users assessed needs, and the service user, their families, and care managers a similar opportunity. A visitor commented, “We had a choice of home and this was the nicest home we saw” Each service user is given a contract of terms and conditions between themselves and the home. The contract includes the number of the room that has been allocated to the service user. It also includes a list of what is and is not included in the contracted price. However, currently this list does not indicate whether or not holidays are included and a recommendation has been made that this be added. Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9, & 10 Service users individual needs are recorded in their care plans and they are encouraged to make choices in all aspects of daily living within the limits of their own physical and mental abilities. EVIDENCE: The home has produced a comprehensive care plan for each service user which includes an individual programme plan; a plan of care including needs, objectives, actions, who is involved and review date; a life plan package; personal and medical details; strengths and needs; day care and education; goals; clinical reports; environmental and personal risk assessments; care managers reviews, etc. Care plans are now regularly reviewed. The home is currently in the process of changing the format of their care plans. Despite the fact that the service users at Grosvenor Court all have severe learning disabilities the home ensures that they are enabled to exercise personal choice and make decisions on all aspects of daily life as far as their abilities allow. Amongst other things choices are given in time of rising and going to bed, what clothes to wear, what they want to eat or drink, whether they wish to go out or not, where they wish to sit or wander in the home, and who they wish to be with or see. Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 12 Staff comments included “when I started NVQ I learned about choice and independence”, and “once you study them you get to know what they want and how to communicate with them”. Despite previous requirements that service users should have their own named bank accounts the home have found it impossible to arrange for this. Some accounts were opened in one of the building societies but the building society then decided that they were inappropriate as the service users could not sign for themselves and these accounts were closed. The manager has even written to the banking ombudsman regarding this problem and has received a reply explaining that as the service users are unable to sign for themselves such accounts could be open to fraud and are therefore inappropriate. The requirement has therefore been changed to a recommendation that wherever possible service users finances should be paid directly into their own named bank accounts. Four of the current service users have social services appointees to deal with their finances, and family members look after some of the other service users finances. Monies that are looked after by the company are appropriately handled with cash being kept at head office and only small amounts of money are kept at the home. Staff purchase goods that are needed by service users, receipts are sent to accounts at head office and logged on individual accounts and the money is reimbursed to the home. The accounts section also log interest on to the individual accounts. For any larger spends a request is put in to headquarters or the family and, if sanctioned, the finance is made available. Due to the severity of learning disability and the lack of communication ability of the service users at the home they are not able to be involved in regular meetings, to participate in the day to day running of the home, to respond to service user questionnaires, or to help to develop policies and procedures. The home undertakes comprehensive risk assessments for all service users to allow them as independent lifestyle as possible whilst ensuring that their health and safety are protected. There is a clear confidentiality policy and all staff are made aware of this during their induction. Records kept are accurate and are securely stored either in the office or in a locked filing cabinet in the team leader area. Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 13, 14, 15, 16, & 17 Service users engage in appropriate leisure activities and mix in the local community. Their rights are respected and the maintenance of contact with families and friends is encouraged. EVIDENCE: No service users currently attend college, however those who wish and are able attend the company’s day care centre where they take part in such activities as physiotherapy, alternative therapies, art, pottery, woodwork, computers, games, and dance. The centre has a special needs area with a huge snoezelum. It also has its own bistro where the service users have their lunch. The homes own mini bus is available to transport service users to the centre. The home employs its own physio aide for 5 days a week and she works in conjunction with the physiotherapist who visits weekly. Currently no service users choose to attend any religious services. Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 14 Standard 12 is currently not appropriate to the client group at Grosvenor Court as service users do not have the necessary physical and mental capacity to enable them to attend educational establishments or to undertake jobs. Service users mix with the local community during their trips to the local supermarket and other shopping trips, visiting local public houses, walks in the park, visits to the farm park, and drives in the homes own mini bus or estate car, sometimes including the enjoyment of a picnic at a some local beauty spot. In house there is sensory or snoezelum equipment available and this is well used. Painting and other craft activities are also available. Staff members commented, “this home is really good with activities and getting them out”, and “they all have a good quality of life”. The manager completes the register of electors annually for service users but the lack of ability and understanding of the service user group make voting inappropriate at the current time. Other entertainment and leisure activities include a visiting entertainer who sings and plays his guitar 3 or 4 times a year, bar-b-que’s and parties, often including the service users from a nearby home, games, events, or just sitting in the homes private garden area, and holidays in groups of not more than 4 service users with staff support on a 1:1 basis. The holidays are usually taken at various holiday camps where there are facilities available to meet the needs of the service users. So far this year there have been no holidays as staff availability has been limited due to supporting service users in hospital, however the manager is currently arranging for holidays to take place. A visitor commented, “xxx gets lots of attention”, and staff comments included “there is a wide range of day care, those who cant ‘do’ often observe the others”, “We try to get them out as often as we can”, “they play ball games”, “we have summer bar-b-que’s”, and “they are stimulated” The home encourages the maintenance of family links and family and friends are welcome at any time and can either take the service user out or see them in one of the communal rooms, in their own bedrooms, or when the weather permits in the garden. Staff expressed the opinion that they consider the service users to be part of their own family and comments included, “the clients are a great bunch”, and “I really know the clients, they are like an extended family”. A visitor commented, “we are always made welcome”, The home has a policy on sexuality. Daily routines at the home are flexible to meet the needs and choices of the service users. Service users were witnessed to be moving around the home as they wished the only restrictions being other service users rooms, the kitchen and the laundry. For the safety of the particular client group access to the garden area, although encouraged, is always with a member of staff or a Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 15 visitor. Staff knock on bedroom doors before entering and call the service users by their preferred name. Service users are able to choose when they wish to be alone in their own rooms or in company in one of the communal rooms and can choose whether or not to join in activities. None of the current service user group is able to take responsibility for housekeeping tasks. The home has a non-smoking policy; any service user of staff member who wishes to smoke must do so outside. None of the current service user group has the capability of using keys to access their bedrooms. To avoid the possibility of service users wandering into the bedrooms of their colleagues the home has fitted star locks to many of the doors. It is the policy that these locks are only used when the service users are not in their rooms. However in order to protect the vulnerable service users from the possibility of being locked in their rooms a requirement has been made that the current locks should be removed and be replaced with a different type of device which can be easily opened from inside the room, is suitable for the service user group, can be opened by staff in the event of an emergency, and meets with the requirements of the fire officer. The meals provided at Grosvenor Court are nutritious and well balanced and presentation is good. The home operates a four-week menu and has a summer and winter menu choice. Although there is not a stated alternative on the menu for lunch and dinner service users likes and dislikes are recorded and are taken into account with alternatives being provided whenever necessary. Currently there are 2 service users who are PEG fed but they are able to have small treats and the staff assist this in a sensitive manner and are fully aware of the dangers of choking. There are several service users who can only eat pureed food and their meals are nicely presented to resemble a proper meal. Staff comments included, “the food is lovely”, “its good food and well cooked, although sometimes there could be a bit more variety” and “I would eat the food”. The current service user group are unable to participate in the preparation and service of meals but the staff team fully and sensitively supports them. Staff also sensitivity assist those service users who need more assistance with feeding. Meals are served in the two dining rooms. The service users who go out to the day centre have their midday meal provided there. Although weights of service users are taken and recorded monthly, currently the home does not undertake a formal nutritional needs assessment of the service users and a recommendation has been added that this is commenced. Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20, & 21 Service users receive personal and healthcare support to meet their physical, emotional, and medication needs. EVIDENCE: Service users are supported in all aspects of their daily living. Intimate care is given in the privacy of their own bedrooms, or when appropriate in the homes bathrooms. Staff knock on bedroom doors before entering. Service users choose what time they get up and retire and which clothes they will wear each day. The appropriate equipment and technical aids that are assessed as needed are provided and staff are trained in their use. Specialist support is given by the learning disabilities team, the learning disability nurses, speech and language therapists, occupational therapists, physiotherapist, epilepsy nurse, district and community nurses, chiropodist, opticians, community dentist and dental specialist and of course the service users own general practitioners. The home operates a key worker system and these key workers are responsible for updating and reviewing the care plans of their allocated service users. Appropriately trained professionals assess service users health care needs prior to admission, and these assessments are regularly reviewed. The current service users are unable to manage their own medical conditions but are given full support from the staff team and various specialists to ensure their physical Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 17 and mental health is maintained. Visits from health care professionals take place in the privacy of service users own bedrooms. Staff support service users who need to attend medical appointments outside the home, and the mini bus or estate car are available for transport when necessary. Visitors commented, “she has physio on a daily basis”, and “they always inform us if she is poorly”, Staff comments included “Once you know them you know if they are unhappy or unwell”, The home uses the ‘dosette box’ system for the management of medication. There is a small medication room where the medicine trolley and all medication is stored. Although space is restricted the room was clean and tidy and storage is appropriate. Controlled drugs are correctly stored and recorded. Drugs received, given, and the return of unused medication are properly recorded and is appropriate to facilitate a medication audit. The MAR sheets were accurate, up to date and signed. Currently none of the service users are able to self medicate. The only staff that currently administer medication are the manager and team leaders and all have received training to undertake this task. Advice is sought from the pharmacist or G.P.’s about any medication queries or concerns. The home has a medication policy, which includes the use of homely remedies. From time to time the home has to deal with the death of a service user. There has been one unexpected death in the home during the past year. The staff team has supported some terminally ill service users whilst they were in hospital. The home has a policy on death and dying and if the G.P. and district nurses feel it is appropriate and the home is confident that they can meet the needs of the service user, the home will care for them at home. Staffing is increased at such a times to avoid putting a strain on the existing staff team. At this stage families are able to stay with the service user as long as they wish. There are no specific facilities for families to stay at the home but they are made comfortable, given blankets and pillows, and supported with tea, sandwiches and additional support from the staff team. Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, & 23 Service users and their supporters’ views are listed to and acted upon. Service users are put at risk of abuse through the failure to make appropriate checks of the POVA register prior to employment. EVIDENCE: The home has a clear and effective complaints procedure. Although 2 of the 8 pre-inspection questionnaires received at CSCI indicated that they were unaware of the home’s complaints procedure a copy is displayed in the entrance hallway for all to see, albeit with various other notices. To ensure clarity it is suggested that the home remind visitors of existence this policy. There have been no complaints received either at the home or direct to CSCI since the last inspection. The complaints register demonstrates that complaints are taken seriously and that not only details of the complaint but also the outcome is recorded. There is a clear policy regarding abuse and this is being revised to come into line with the latest adult protection guidelines received from Kent County Council. There is also a whistle blowing policy and staff are made aware of these policies on induction. Half of the staff team have undertaken adult protection training and the remainder are being scheduled to receive this training. There have been no referrals to the POVA list since the last inspection. Unfortunately not all staff employed have been checked against the POVA list prior to employment and a requirement has been made that no new staff shall be employed until a CRB enhanced disclosure has been submitted and a satisfactory POVA first check received. Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 19 The home has a no restraint policy, which is strictly adhered to. Service users who are likely to self-harm have this fact recorded in their care plan and they kept under carefully review. The homes procedures for dealing with service users finances have been mentioned earlier under Standard 7, and a recommendation regarding personal bank accounts has been made. Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 29 & 30 Service users live in a clean comfortable and homely environment with suitable facilities and equipment to meet their assessed needs. EVIDENCE: The environment at the home is appropriate to meet the needs of the service users. The communal lounges and one of the dining rooms have recently been redecorated and the second dining room was being painted on the day of the inspection. The hallways have been redecorated and re-carpeted apart from one staircase and another small area of corridor, and the new carpets for these areas are order. The company have their own maintenance and renewals team and problems are quickly dealt with. The furnishings and fittings in the communal rooms are appropriate to meet the needs of the service users. Service users bedrooms have all recently been decorated and new curtains or blinds have been fitted. Due to the levels of incontinence the service users bedrooms have anti slip flooring and rugs as opposed to carpets as these would be difficult to maintain clean and odour free. The rooms are all bright and cheerful and furnished to meet the service users needs. Some service users have brought in pieces of their own furniture and all have their own Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 21 choice of pictures and personal belongings to personalise their rooms. Many of the bedrooms have sensory equipment fitted. The home has 3 double rooms and all are provided with screens to ensure personal care can be carried out in privacy. The home has 2 single rooms that do not meet the 10 square metres of usable space requirement but this is made clear in the statement of purpose. None of the bedrooms have en-suite facilities but there are sufficient toilet, bathing and showering facilities suitably adapted to meet the service users needs. In addition commodes are available in some of the bedrooms. Shared space at the home includes 2 lounges and 2 dining rooms. There is a very pleasant secure garden area, mainly laid to lawn with a few small flowerbeds. The rest of the grounds are also well maintained, and there is a dedicated parking area where the mini bus and estate car are kept. The home has a wide range of environmental adaptations and disability equipment available. A lift gives access to all but three of the bedrooms, and service users who have greater mobility use these rooms. Overhead tracking for hoists has been provided in two of the bathrooms; there are ‘parker’ baths, an ordinary bath with overhead lift tracking, and a walk/wheel in shower facility; grab rails are provided in the toilets; there is a ramped access for wheelchair users; the mini bus has been adapted to take 2 wheelchairs. All rooms are fitted with a nurse call system. Special beds have been provided, padding has been provided for service users who regularly fall, and equipment to promote tissue viability is available. The home is clean, and on the day of the inspection was totally odour free. Visitors comments included, “It’s always clean and smells nice”, and staff comments included “The home never smells, its always clean and tidy”, and “its very good cleanliness”. Infection control procedures are robust, with suitable hand wash facilities and aprons and gloves readily available, and the home has an infection control policy. The newly extended laundry houses a washing machine with double sluice facility and laundry is washed at appropriate temperatures. Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, & 36 Recruitment procedures and staffing levels need to be reviewed to fully protect the service users. The staff team undertake appropriate training and they are well supported. EVIDENCE: All staff have a clearly defined job description and understand their role and responsibilities. Staff are made fully aware of the aims and objectives of the home during their induction. There is a good relationship between the service users and the staff and staff are able to meet the individual needs of the service users. All staff are aware of the GSCC code of conduct. The home does not use volunteers. Currently 5 of the 20 care staff have achieved either NVQ level 2 or 3, this figure is 30 of the staff total and therefore under the recommended level of a minimum of 50 . However there are 5 members of staff currently undertaking this training and they are due to complete before the end of the year, the home will then have reached the 50 target. The home is encouraged to continue training staff to exceed this minimum standard. A staff member commented, “I enjoyed the NVQ training”. Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 23 Newly employed staff all undergo induction training to TOPPS standards. Other training undertaken includes basic food hygiene, diet & nutrition, first aid, Epilepsy, moving and handling, medication, fire, adult protection, and SKIP. One staff member commented, “I have learned some Makaton and can adapt it to use with some of our service users”. The normal staffing levels provide 5 or 6 carers on duty during the day shifts and 2 plus a sleeper overnight. However these levels had recently dropped slightly and there were times when there were only 4 carers on shift during the day, particularly at weekends. Comments received on the pre-inspection questionnaires circulated to visitors included comments on the question ‘in your opinion are there always sufficient numbers of staff on duty’ of 1 x don’t know, 1 x not at weekends, and 1 x variable. A specific written comment was also made that “there are occasions when we feel the staff are stretched”. The manager acknowledges that staffing numbers have been low at times and explained that this had been due to supporting service users who were in hospital. She was still confident that the Residential Forum Guidelines are being met. A recommendation has been made that the staffing levels should be kept under review to ensure that they not only comply with the Residential Forum Guidelines but that there are sufficient staff on duty to meet the service users needs at all times including at weekends. The home currently has staff vacancies for a team leader, a weekend carer, and a full time carer. Shortfalls in staffing are met by the employment of agency staff and the home have an arrangement with the agency that the same members of staff regularly work to ensure continuity for the service users. In addition to care workers the home employs cooking and domestic staff to complete the staff team. Turnover of staff at the home is fairly low, and 2 members of care staff left the home during the past year to take up nursing training. Recruitment procedures at the home need to be tightened up and a requirement has been made that no member of staff shall be employed in the home until a CRB enhanced disclosure has been sent and a satisfactory POVA first check has been received. The home also needs to update its staffing records to comply with the revised Schedule 2 and a recommendation has been added to this effect. Two written references are taken for all staff employed at the home. All staff have a copy of their terms and conditions of employment. Staff at the home receive support, supervision, and appraisal. Staff members commented, “We have supervision every 6 – 8 weeks”, “Supervision by the team leaders is very useful”, “I have had lots of support from carers, team leaders and the manager”, and “I definitely get support”. There are written policies on how to deal with physical aggression towards staff and all staff are aware of the homes written grievance and disciplinary procedures. Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 24 Other staff comments included, “I enjoy it”, “I like working here”, “I enjoy care and working here”, “I am happy here and if I weren’t I would not be here”, and “its really good, but sometimes its quite hard”. Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 40, 41, & 42 Service users benefit from a well run home with an open and inclusive ethos, and can be confident that their health, safety and welfare will be promoted and protected. EVIDENCE: The registered manager has been manager of the home for over 8 years, she is an enrolled nurse, holds a certificate in advanced management in care, and is an NVQ assessor. She is also currently undertaking NVQ 4, and attends various other training to keep her knowledge and skills up to date and relevant and to ensure that she maintains her nursing registration. The management ethos of the home is open and positive. The manager works as team leader on some of the shifts and communicates a clear sense of direction and leadership. Staff comments included, “I am really, really supported, particularly by the manager”, “I have never met a manager like Chris, she is so good, so supportive, and the home is so well run”, Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 26 Staff feel able to voice their opinions and any concerns them may have, one staff member commented, “we are able to air our opinions”. The home operates various quality assurance and quality monitoring systems. They are holders of the Investors in People award. A representative of the company carries out monthly Regulation 26 visits, health and safety assessments of the home are undertaken 6 monthly, reviews of clients are undertaken at least annually, some being done 6 monthly. The home holds regular staff meetings where minutes are taken, and informal team leader meetings without minutes. Service users families are circulated with a quality assurance questionnaire annually and a breakdown of comments was witnessed. At present the home has not extended its quality assurance to include visiting professionals and other stakeholders as required at the last inspection and a further requirement has been added to address this issue. The homes policies and procedures are currently under review and the draft copy was witnessed at inspection. Staff are kept up to date with any changes in policies and procedures as they are made. Record keeping at the home is good. All confidential records are appropriately stored, either in the office, which is kept locked when not in use, or in a locked filing cabinet in the team leader area. Records are kept up to date and relevant and comply with the Data Protection Act and other statutory requirements. The health and safety of service users is protected. Staff are trained in health and safety matters. Moving and handling training is undertaken 6 monthly. All staff are trained in fire safety at least once in every 12 month period. 18 staff have undertaken first aid training and there is always a member of staff trained in first aid on duty at all times. Staff are also trained in basic food hygiene and in infection control. All certificates witnessed for the maintenance and servicing of equipment was up to date. The home has recently updated its policy and procedure to control the risk of legionella and regular checks are documented. Kitchen cleanliness, food storage and temperature recording of refrigerators and freezers were all in order. The security of the home is appropriate to the needs of the service users. All accidents and incidents are recorded and the manager keeps a watching brief for trends and accident black spots. Standard 43 was not inspected at this time. Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 3 2 Standard No 22 23 ENVIRONMENT Score 3 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 2 x 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 N/A 3 3 3 1 2 Standard No 31 32 33 34 35 36 Score 3 3 2 1 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Grosvenor Court Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 1 3 3 3 x 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 28 Yes 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 16 Regulation 13 Requirement The star locks that are fitted on service users bedroom doors should be removed to avoid the danger of service users being locked into their rooms. Any new device should be agreed with the Fire Officer No staff member shall be employed in the home until a CRB enhanced disclosure has been submitted and a satisfactory POVA check has been received The home shall develop the Quality Assurance System to include other stakeholders and publish the results of the questionnaires (Previous timescale of 31/03/05 not met) Timescale for action 31.10.05 2. 23 19 31.10.05 3. 39 24 31.12.05 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 1 Good Practice Recommendations The home should not accommodate service users who fall 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 29 Grosvenor Court 2. 3. 4. 5. 5 7 17 33 6. 34 outside their category of registration. Service users contracts should clearly indicate whether or not holidays are included in the contacted price Wherever possible service users finances should be paid directly into their own named bank accounts. Service users nutritional needs should be assessed and regularly reviewed. Staffing levels should be kept under review to ensure that they not only comply with the Residential Forum Guidelines but also that there are sufficient staff on duty at all times, including weekends, to meet the needs of the service users. Staff records should be updated to comply with the revised Schedule 2 of the regulations. Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 30 Commission for Social Care Inspection 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Grosvenor Court 20051118 H56-H05 S23425 Grosvenor Court V235040 310805 stage 4.doc Version 1.40 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!