Inspection on 11/08/09 for Grosvenor Court Retirement Home

This inspection was carried out on 11th August 2009.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Grosvenor Court Retirement Home 17/09/08

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for older people Name: Address: Grosvenor Court Retirement Home 1-5 First Avenue Cliftonville Margate Kent CT9 2LF     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jo Griffiths     Date: 1 1 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Grosvenor Court Retirement Home 1-5 First Avenue Cliftonville Margate Kent CT9 2LF 01843228761 01843228575 vanessa.cornfoot@highmeadowgroup.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Grosvenor Court Care Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 60. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Grosvenor Court is owned and managed by Grosvenor Court ltd. It is registered to provide accommodation and support for up to 60 older people, but currently only has 22 people using the service due to some floors of the home being closed whilst refurbishments are planned. Care Homes for Older People Page 4 of 33 Over 65 60 0 1 7 0 9 2 0 0 8 Brief description of the care home The home is situated adjacent to the seafront and overlooks the oval and bandstand. It is within walking distance of local amenities and public transport. The ground floor of the home has lounge and dining space for residents. There are four floors of bedrooms above this, but only floors three and five are currently in use. These floors are accessed via a passenger lift. The current fee range for the service is £329.25 to £700 per week. For more information contact the manager of the home. Care Homes for Older People Page 5 of 33 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: zero star poor 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 was a key inspection of Grosvenor Court care home. Prior to the inspection the registered provider completed and returned an Annual Quality Assurance Assessment. This provides the Commission with useful information about the service and how they are meeting current standards and regulations. We undertook a visit to the service on 11th August 2009 between 10.30am and 6.45pm where a number of care plans and other records were seen and observations were made of the practices in the home. We also sent out six surveys to people that are residents in the home and received all six back completed. We also involved three other residents in our inspection, three members of staff and two relatives of residents. The newly appointed manager and the area manager were at the home during the inspection visit. At the time of the inspection there were twenty two residents, but two people were in Care Homes for Older People Page 6 of 33 hospital at the time of the visit to the home. This service has been rated as providing poor outcomes for people that use it. We are therefore holding a management review of this service under our enforcement procedures. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Whilst staff have a good understanding of what residents needs are, there are insufficient numbers of staff employed to ensure their needs are met and to ensure their safety, particularly in the afternoons. Residents often have to wait to have their personal care needs attended to and there are frequent occasions when high numbers of residents are left unsupervised whilst staff attend to the needs of others. Staff told us that they try their best to meet the needs of everyone, but that they cannot always deliver the care to meet individuals assessed needs. Residents told us that they feel there are not enough staff and that staff are pressured to do other tasks such as kitchen duties and comments from residents include; More staff please the staff are kind, but there are not enough of them Residents do not benefit from opportunities to go out of the home and participate in Care Homes for Older People Page 8 of 33 the activities that interest them. They told us that they would like more opportunities for this and comments include I would like to be taken out on shopping trips Please could we have more trips out I would like staff to have time to be able to sit and talk to me I would like staff to have more time to socialise and for compassion Would like more entertainment A number of the shortfalls identified in this inspection report could be addressed through the provision of adequate staffing in the home. Therefore a requirement has been made to ensure that staffing numbers are adequate to meet the personal, health, emotional and social needs of residents. There are not enough bathroom facilities that have been suitably adapted for people with mobility difficulties. The ensuite showers do not have shower curtains and a number do not have handrails or seats for those who find it difficult to stand for a shower. Two of the baths are not used as it is not possible to get a hoist under them and people have to travel in the lift to the third floor to use the assisted bath. People using the service do not get to have a bath as often as agreed in their care plan. The registered person must ensure that bathroom facilities in the home are appropriate for residents needs and preferences. The registered person must ensure that the manager of the home applies for registration to ensure she is assessed as fit to run the home. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 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 10 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are provided with the information they need about the home to enable them to make an informed decision about using the service. They have an assessment of their needs and receive confirmation that the home will be able to meet their needs before they move in. However, currently residents cannot be assured that the home will be able to fully meet their needs due to insufficient staffing numbers. Evidence: People that are interested in using the service are provided with a copy of the Service User Guide. This is a detailed document providing information about the service provided at the care home and makes references to the complaints procedure. Currently the Guide is only available in a standard text format and the benefits of offering other formats, for example large print, were discussed with the manager. Before moving to the home an assessment of need is carried out for each individual. The assessments were seen for two people using the service. The assessment is Care Homes for Older People Page 11 of 33 Evidence: detailed and reflects all areas of the persons life in which they may require some level of support. It concludes with a statement about the reasons why the home can or cannot meet the persons needs. The process could be further developed to include asking the individuals for their views of their needs and the care they are looking to receive. We spoke to one resident, whose assessment had been seen, and their relatives who were visiting the home. They confirmed they had been happy with the assessment process and felt the move had been smooth. The person using the service indicated, through gestures, that they are happy with the support they are getting. Although the service is well aware of the assessed needs of individuals, and, as evidenced, this is documented, the current staffing levels in the home during the afternoons are not sufficient to meet these assessed needs. There are only two staff on duty for the twenty residents in the home and staff are required to carry out other duties in addition to their care role, which restricts them from being available to meet individuals needs. Evidence in relation to inadequate staffing arrangements in the home have been provided under the staffing section of this report. The home does not offer intermediate care, but can provide respite services as required. Care Homes for Older People Page 12 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a care plan that sets out what their health, personal and social care needs are. They have their health needs met, but do not always have their personal care needs or social needs met, in the way described in their care plan, due to insufficient staff numbers. The care plan records do not demonstrate all areas of the agreed care plan are being delivered. The medication practices in the home have improved, but insufficient staff numbers place residents at some risk. Residents are treated with respected and their privacy and dignity are maintained. Evidence: We looked at the care plans for two people currently using the service. The care plans give a clear expected outcome, based on the assessment of need, and the steps staff must follow to ensure this outcome is met. One of the care plans had been agreed and signed by the resident, but this was when it had been first completed and they had not been asked to sign the amended plan following review. The care plans are Care Homes for Older People Page 13 of 33 Evidence: reviewed monthly. Whilst the care plans cover all areas of need the home cannot demonstrate that they are able to ensure these needs are met at present, due to insufficient numbers of staff employed, particularly in the afternoons. Examples of unmet need in the care plans were one plan that stated, as an outcome, To maintain a good social life for X and had recorded that the resident would like to continue to stay in contact with friends and enjoys going out as much as she can to visit them. The resident in question was spoken with and indicated that they had not been out of the home since moving in. Another example of unmet need in the care plan is one plan that states, under carers observations, that X likes to have a bath at least twice a week. The records show that during the month of July the resident was only supported to have two baths and no showers. Staff confirmed that they try their best to offer people a bath as often as they can, but that staffing levels in the home do restrict this. Staff complete a daily report sheet for each resident that should reflect that the care plan is being met. Since the last inspection the arrangements for completing this have changed. Staff now make an entry onto the report following the night shift, at 07.30am and again at 11.00am. There are no further entires unless there are any significant incidents affecting a persons wellbeing. The manager said that this had been changed to reduce pressure on the staff on the afternoon shift. Currently the reports state how people have slept and what personal care they have had in the morning. There are no references to their wellbeing or occupation during the rest of the day. Systems for daily care plan reports must allow the manager to monitor that each persons needs are being met. Individuals primary health needs are identified in the care plan and people are supported to see the GP when they need to. The GP and other health professionals, including the district nurse and chiropodist, visit the home as requested. The records of health needs and involvement of the GP were up to date and had clearly recorded actions. Falls assessments have been completed as part of the care plan, although there is no actions recorded following the assessment. The manager stated that one person, who has recently had a high number of falls, was referred to the local falls clinic. Evidence was also seen of referrals made to the Mental Health team, as required. Residents are supported to manage their own personal care, as far as they are able, and the support they require is outlined in the care plan. As reported under the environment section of this report there are some issues with the facilities for personal Care Homes for Older People Page 14 of 33 Evidence: care that staff say cause difficulties for residents, for example no shower curtains, small basins and only one bath suitable for people with mobility difficulties. All personal care is provided in private. There is a hairdressing salon in the home and the hairdresser visits weekly. Feedback from residents was that they would like to be able to go out to do some of their own shopping for clothes and personal items with one person stating I would like to be taken out on shopping trips. We spoke with three residents during the inspection and received completed surveys from six people. The feedback confirmed that they are not currently supported to go out shopping. Since the last key inspection of the home there have been a number of concerns raised in relation to the safe administration of medication. Kent County Council carried out a visit to the home in January 2009 and found that some improvements had been made, but made some further recommendations. The manager of the home stated that these recommendations have been addressed and gave the example that the medication records now show a photo of each resident for identification. The Commission has received notification of one further medication error made by staff in May 2009. The manager said that training was being provided in using the medication system, by Boots the chemist, and that further distance learning courses were being booked for staff in safe medication practice. During the inspection it was noted that one member of staff is required to do the medication in the evening, whilst the second member of staff on duty supervises the residents, washes up and attends to call bells. The staff member was observed to follow safe administration practice during the inspection, but feedback from staff was that this can take up to an hour on occasions and that they feel under pressure to complete this as quickly as they can as the other staff member is working alone with residents. This type of pressure on staff may result in further incidents of medication error and can put residents at risk. The registered person must ensure that sufficient staff numbers are on duty to allow staff adequate time to administer medication safely. Staff were observed to approach and support residents in a respectful manner. People using the service told us that they are happy with the way the staff support them, but feel there are not enough staff employed. They said that they feel their health needs are well met and one person commented I am happy with how I am looked after. Care Homes for Older People Page 15 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to participate in some activities in the home, but would benefit from more opportunities for meaningful occupation and interaction with staff during the day. Residents do not have the opportunity to participate in activities outside the home as often as they wish to. Residents are supported to receive visitors to the home and to stay in touch with family. Residents are supported to make choices in some areas of their daily lives, but their choices with regard to their personal care and how they spend their time in the day are limited due to inadequate staffing numbers to meet their needs. People living in the home benefit from a varied menu providing them with a balanced diet and sufficient choice. They enjoy the meals provided. Evidence: We spoke with three people that use the service and received completed surveys from a further six residents. Residents told us that they do not get to go out and that they would like to have more to do during the day. Comments included: Care Homes for Older People Page 16 of 33 Evidence: I would like to be taken out on shopping trips Please could we have more trips out I would like staff to have time to be able to sit and talk to me I would like staff to have more time to socialise and for compassion Would like more entertainment An occupational therapist is employed in the home for two days a week. The OT said that residents are supported to play games, make cards, have music sessions and be involved in reminiscence sessions. Three residents spoken with said they enjoy some of these activities but would like more on offer. There are also some entertainers who visit the home including singers who visited the previous week. The home has a computer room that residents can use and one person said I like the computer room. There is also a visiting library with books and audio books, two of the three residents spoken with said they make regular use of the library. The manager said it is planned that a relaxation room will also be developed. Observation during the afternoon of the inspection showed that staff do not have time to meet residents social needs. Staff and residents spoken with confirmed that there are no opportunities to go out as there are not enough staff on duty. One staff member said that there had been a recent occasion where three people had wanted to go to the carnival but had been unable to as there were no staff to go with them. Visitors are welcomed at anytime and some relatives were visiting during the inspection. There is a quiet lounge area for people to receive their visitors. There is a pay phone for use outside the lounge for people to stay in touch with their family and friends. A comment on one survey was that they would like to have a phone in their room. The registered person must ensure that people are supported to arrange for a phone line in their room if they wish. In June 2009 all residents were asked to complete a survey about the food provided in the home and the feedback was used to review the menu. Residents told us that they feel the food has improved recently and that they are happy with the meals provided. The menu covers a four week period and provides three choices of main meal and two choices for evening tea. Homemade cakes are on the menu daily and sandwiches are provided for supper mid evening. The manager said the chef is able to adapt the menu Care Homes for Older People Page 17 of 33 Evidence: to the individual needs of each resident if they have any dietary requirements or any likes and dislikes. The meals that were served during the inspection appeared well presented and appetising. People spoken with said they enjoyed their meal that day and that the food is always good. Three people prefer to have their meals in their rooms and one person requires 1-1 support from staff to eat their meals. The current staffing numbers have an impact on these needs and have been discussed under the staffing section of this report. Care Homes for Older People Page 18 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service know how to make a complaint if they need to, but records are not in place to demonstrate that they always have their complaints dealt with effectively. Residents are at some risk of neglect due to insufficient staff available to meet their needs and ensure their safety. Evidence: The home has a complaints procedure which tells people how to make a complaint and when they can expect a response. This is included in the Service User Guide and displayed in the entrance hall of the home, along with complaint forms. At the last key inspection a requirement was made that a record be maintained of all the complaints received by the home and the action that had been taken to address these. There had been a high number of complaints in relation to residents lost and missing belongings following refurbishment of the home in 2008. The manager provided the complaints log that showed all the complaints in relation to the missing belongings had been recorded and addressed. There were two cases where the complaint has not yet been fully resolved, but there was evidence of the correct processes being followed. The rest of the complaints in this matter have been resolved. The manager said that there had been one further complaint received by the service in respect of high temperatures in the bedrooms. There was no record of this complaint Care Homes for Older People Page 19 of 33 Evidence: in the home and the manager said it was with the registered provider. A record must be held in the home of all complaints received in order to demonstrate the action taken to address the issues raised. Feedback from residents showed that they know how to make a complaint if the need to. The manager said that she aims to talk to all residents weekly to check they are happy with their care. A recent theft in the home was reported to the Commission. This involved theft of residents tobacco and staff money. The police were unable to investigate the matter further and the manager has taken action to ensure that residents tobacco is now locked away and only accessed by senior staff. Some staff have undertaken training in safeguarding adults and other staff are booked to do this training. Feedback from staff evidenced that they understood their responsibilities to report any allegations of abuse and how they would do this. As reported under other sections of this report the current staffing levels in the home, particularly in the afternoons, do not allow staff to effectively meet all residents needs. This places residents at some risk of neglect. Examples given are, a resident not being supported to have baths as outlined in their care plan and residents left unsupervised in the lounge whilst staff attend to others in the bathrooms or their bedrooms. Care Homes for Older People Page 20 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are suitable in layout for the current residents of the home. The communal areas are clean and comfortable and meet peoples needs. Everyone has their own bedroom, but would benefit from more storage space and being supported to personalise their rooms. There are not sufficient facilities for bathing, located near bedrooms, for those with limited mobility. There is a lack of adaptations to bathrooms to meet peoples needs and an assessment of the environment, to ensure suitable adaptations are in place, has not been completed. The home is generally kept clean. Individuals bedrooms are not maintained at a suitable temperature for their comfort and needs. There is some risk of neglect to residents who remain in their bedrooms on the upper floors in the afternoon, due to insufficient staffing numbers. Evidence: The home has two large lounge areas, a large dining room and a smaller quiet room. There is also a computer room for use by residents and a hairdressing salon. There is Care Homes for Older People Page 21 of 33 Evidence: comfortable seating, side tables and appropriate lighting through all areas of the home. All areas of the home appeared generally clean and well maintained. There are three female toilets downstairs near the lounge. The manager said that there had been issues with the hot water recently but these had now been resolved. When tested there was warm water in the basins. There is one male toilet on the ground floor that doubles as the disabled toilet. The bedrooms are located on floors three and five of the home. These are accessed by a lift. Floors two and four were closed off to residents as they are not currently occupied and require refurbishment. There was a recent incident where a resident entered one of these floors and fell, the doors have now been alarmed to alert staff if any are opened. The local fire department have visited the home and made a requirement that staff numbers at night be increased due to the risks involved of the unoccupied floors. A sleep-in staff member is now employed and they are required to check all areas of the building at night and in the morning. Each person has a single bedroom with ensuite facilities consisting of a toilet and basin and some rooms also have a shower. None of the showers had shower curtains and one shower cubicle was very small. There is no seating to enable people with limited mobility to use the showers and not all bathrooms had handrails. The manager said that there had not been an assessment of the property by an Occupational Therapist or appropriately qualified person. There is one hoist in the home and the manager said that currently only one person requires the use of this. The hoist has to be taken up and downstairs in the lift to the resident that requires it. There is a parker bath (suitable for people with limited mobility) on the third floor and a standard bath on the fifth floor. This is in addition to the ensuite facilities. The manager said that most people, from both floors, use the parker bath as it is the only one that is suitable for those with mobility difficulties, she said that few people use the showers in their bedrooms. This means that some people have to travel down to the third floor in the lift if they wish to have a bath. There is also a large jacuzzi bath on the ground floor, but the manager said this had never been used as you cannot get a hoist under the bath and that there are no plans to alter this at present. Some peoples bedrooms were quite bare and they had not yet been supported to personalise their rooms. There is a lack of shelving in the bedrooms for people to place their personal belongings and some people still have boxes of belongings on the floor. Everyone has been provided with the furniture they need in their room. Three residents spoken with said that their rooms were ok but that you get what you pay for, the better rooms are more expensive. Care Homes for Older People Page 22 of 33 Evidence: The floors where residents bedrooms are located were very hot on the day of the inspection. Thermometers are situated on each floor and they read at 30 degrees for the third floor and 26 degrees for the fifth floor. As we walked around the home a resident was complaining of the heat in their room on the third floor and was calling for staff to help them to get some fresh air. Only one of their windows open and the other has a safety restrictor fitted. The manager called for staff to support the resident downstairs where it was cooler. The registered person must ensure that appropriate temperatures are maintained in bedrooms, by use of fans and cooling systems if necessary, to ensure residents are not subject to uncomfortable temperatures and a lack of fresh air. There are call bells in each bedroom and one person has a portable call button in case of falls. During the inspection it was observed that people on the third and fifth floor called staff, using the bells, when they required support. During the afternoon when there was only two staff on duty, one staff was helping a resident in the bathroom when a call bell went. The second member of staff had to make the decision whether to respond to the bell or remain and supervise the residents in the lounge. This lack of sufficient staff can put residents at risk of neglect. A weekly health and safety check of each room in the home is carried out. The completed check for 06.08.09 was seen. Where issues have been identified it must be recorded what action is being taken to address these. For example, the checklist reported dried body fluids on one headboard but there was no recorded action to evidence whether this had been addressed. The kitchen is not accessible to residents. There are jugs of cold drinks placed in the lounge each day for people to help themselves. There are no tea and coffee making facilities for residents to use. Residents told us that they are usually offered a hot drinks on the tea trolley round. The registered person has built a new extension to the home and plans to apply for registration of this as a nursing wing. The manager expressed some concerns about the suitability of the rooms in this wing and these are being discussed with the registration team at the Commission. Care Homes for Older People Page 23 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are insufficient numbers of staff employed in the home to meet the needs of the people using the service. Staff are provided with suitable training and qualifications to support them in their roles, but staffing levels do not always allow appropriate supervision of staff who have not yet complete the training . Residents are safeguarded by the systems for recruiting new staff to the home. Evidence: Since the last key inspection the Commission has received information from an anoymous source sharing concerns about staffing levels at Grosvenor court. This information has been used to inform the planning of our inspection and in order to establish whether sufficient staff are employed to meet the needs of residents in the home a number of areas were looked at. We reviewed the staff rotas for the home, observed staff practice throughout the afternoon of the inspection, spoke with three staff members and the manager, spoke with three residents and reviewed six surveys completed by residents following the visit to the home. Care Homes for Older People Page 24 of 33 Evidence: The rotas show that there are four care staff employed in the morning, two in the afternoon and two at night, with an additional sleep-in staff member. There is also a cook on duty from 8-5 every day and the manager is usually in the home from 8-4 Monday to Friday. Domestic staff are employed and it is intended there will be two on per day. On that day of the inspection one domestic staff was on duty as a carer to cover as there were insufficient staff on the rota. The rota shows this occurs frequently. At weekends the care staff numbers change to three in the morning and three in the afternoon. The staff say that residents needs do not change at the weekends. Staff told us that in the afternoons it can be difficult to support all residents as they have to undertake other duties. They said they cannot always deliver care that meets individuals assessed needs. Whilst there is a chef employed the care staff are required to do the washing up and load the dishwasher. They are also often required to change residents beds and do the laundry. During the late afternoon it was observed that the two staff struggled to meet the needs of the residents in the home. One resident currently requires 1-1 support to use the toilet and three people remain in their bedrooms upstairs during the day. As reported under a previous section staff were unable to attend to residents needs and respond to call bells as well as supervise residents in the lounge to ensure their safety. At teatime one staff had to deliver the meals trays to the three people that choose to eat in their bedrooms, whilst the other carer provided 1-1 support to a resident to eat their meal. As this staff member was also required to supervise the other sixteen residents in the dining room she had to keep getting up, from helping the resident to eat, to assist other people. This meant that the resident who requires support to eat had a very disturbed meal. After tea one staff had to clear up and do the washing up and one had to administer the medication. The staff had to time this to allow one of them to be around to supervise the residents in the lounge. If a call bell from upstairs was to go off at this time the staff would not be able to attend to this and supervise the residents on the ground floor without suspending the medication round. Staff told us that they do not have time to take people out or to spend time doing activities with them. They also said they try to provide baths to as many people as possible but this can be limited, especially in the afternoons and evenings. Feedback from residents confirmed that they do not feel they have sufficient activities or opportunities to go out. Record confirm that people are not supported to have baths as frequently as stated in their care plans. Care Homes for Older People Page 25 of 33 Evidence: Feedback from residents confirmed that they like the staff and feel they treat them with kindness and do their best to provide quality care. All residents involved in the inspection told us that they feel there are not enough staff employed and comments from the surveys include More staff please the staff are kind, but there are not enough of them Caring My needs are met with kindness they do their best to please The Manager said they are not currently recruiting for new staff for the home. The staff recruitment records were seen for two staff members. These demonstrated that the appropriate checks are made before staff are employed in the home in order to safeguard residents. This includes written references and a criminal records check. All new staff are required to attend a one week training course to provide them with the skills and knowledge they need to safely and effectively support residents. This includes safeguarding adults, first aid, health and safety, moving and handling and infection control. Staff go on to complete other courses specific to residents needs including dementia, challenging behaviour, equality and diversity, nutrition and palliative care. Where staff have not yet completed all their training the area manager provided evidence that the courses had been booked. The registered person must ensure that staff that have not yet completed their required training courses are supervised when supporting residents, for example with using the hoist. All staff are working toward completing the induction and foundation standards in care and some staff have completed their NVQ award. The home achieved Investors In People Status in April 2009. Staff told us that some of the training is good, but they do not feel valued in their roles. They said that in June 2009 they had their pay cut and the manager confirmed that this was the case for all staff and it had been demoralising. Care Homes for Older People Page 26 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents do not currently benefit from a stable service that has a registered manager and that is run in their best interests. The Quality assurance systems for monitoring the service are not effective and residents are placed at some risk to their welfare by poor arrangements for staffing the home. Evidence: There is currently no registered manager in the home. A new manager has been appointed and must apply to the Commission for registration as a matter of priority. The appointed manager is a registered nurse and intends to complete a qualification in leadership and management. The quality of the service is monitored by the registered provider in a number of ways. An area manager undertakes a monthly quality audit, under regulation 26 of the Care Homes Regulations 2001, and reports back to the registered provider. There are six monthly quality surveys for residents to complete and a three monthly residents meeting. The appointed manager said she takes time to talk to each resident at least Care Homes for Older People Page 27 of 33 Evidence: weekly and was seen to talk with relatives when they visited during the inspection. Despite these actions to look at the service provision, there is no evidence that the current ratio of staff to resident needs has been identified as insufficient and addressed. This is clearly evidenced throughout this report, and demonstrates the quality assurance measures taken by the service are not effective. Where residents money and belongings are held on their behalf by the home these are stored securely. The systems for storing valuables and belongings have been reviewed following a theft in the home. The complaints made regarding lost and missing belongings during the refurbishment of the home have now been resolved in the majority. Health and safety checks are made weekly and this includes an infection control audit. There is also a monthly inspection by a pest control company. At present there is not a clear audit trail to show action taken in respect of any issues identified through the quality assurance system. For example, there are no actions recorded on the health and safety checklist or the accident forms that have been completed. The record keeping in the home does not allow the manager to monitor whether peoples needs, outlined in the care plans, are being met. As described throughout this report residents welfare is currently at risk due to insufficient numbers of staff to supervise them and meet their needs. Residents personal care and social needs are not always being met, as outlined in their assessments and care plans, and therefore they do not currently benefit from a service that is run in their best interests. The Commission will write to the registered provider following the inspection to request a copy of the annual financial accounts for the home. Care Homes for Older People Page 28 of 33 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 29 of 33 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 1 21 23 The registered person must ensure that residents have access to sufficient and suitable bathroom facilities that meet their needs. To ensure people can receive the personal care they require as outlined in their care plan. 21/09/2009 2 21 23 The registered person must 05/10/2009 ensure that the appropriate environmental adaptations have been made to meet the needs of the residents. To ensure residents can access the facilities they require and to promote their independence. 3 25 23 The registered person must 04/09/2009 ensure that the temperature of residents bedrooms is appropriate to their needs and preferences. Care Homes for Older People Page 30 of 33 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 To ensure residents bedrooms are comfortable for them. 4 27 18 The registered person must 04/09/2009 ensure that sufficient numbers of suitably trained staff are employed to meet the needs of residents in the home. To ensure residents assessed personal, health, emotional and social needs are met and to ensure their health and welfare are safeguarded in the home. 5 31 8 The registered person must ensure that an application for registration is made in respect of the appointed manager of the home. This is to ensure that residents benefit from a home that is run by manager registered as fit to manage the home. 6 33 24 The registered person must ensure that effective quality assurance systems are in place to monitor the quality of the service and that action is taken to address any shortfalls. 21/09/2009 11/09/2009 Care Homes for Older People Page 31 of 33 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 This is to ensure that residents receive a service that meets their assessed needs and expectations. 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 1 24 It is recommended that shelving be provided in residents bedrooms to allow them to store their personal belongings. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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. Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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