Inspection on 10/04/06 for Grosvenor Hall Care Home

This inspection was carried out on 10th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Hall Care Home 02/08/07

Grosvenor Hall Care Home 26/10/05

Grosvenor Hall Care Home 19/05/05

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

CARE HOMES FOR OLDER PEOPLE Grosvenor Hall Care Home Newark Road Lincoln Lincs LN5 8QT Lead Inspector Dawn Podmore Unannounced Inspection 10th April 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Grosvenor Hall Care Home DS0000061942.V289091.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Grosvenor Hall Care Home DS0000061942.V289091.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Grosvenor Hall Care Home Address Newark Road Lincoln Lincs LN5 8QT Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01522 528870 Mr Kanagasooriam Ravivaruman Angela Stella Lacy Care Home 31 Category(ies) of Dementia (12), Old age, not falling within any registration, with number other category (25) of places Grosvenor Hall Care Home DS0000061942.V289091.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide personal care with nursing for service users of both sexes whose primary needs fall within the following categories: Old Age, Not falling within any other category (OP) 19 Dementia - Over 65 years of age (DE(E)) 12 The maximum number of service users to be accommodated is 31 Date of last inspection 26th October 2005 Brief Description of the Service: Grosvenor Hall is a large two-storey, Victorian, listed building which is situated on a main road, south of the city of Lincoln and is within walking distance of local shops. Public transport is available to the city amenities. The home is set in its own grounds with a secure garden at the rear of the home. A patio has been constructed which provides an attractive, safe area for residents to sit in. Car parking is available to the front of the building. The home provides nursing and personal care for up to thirty-one people of both sexes, over 65 years of age, with emphasis on providing care for people with dementia. Accommodation is in twenty-three single and four shared rooms, some of which are ensuite, on the ground and first floor. A lift gives access to the first floor. The home has undergone extensive renovation and refurbishment since the present owner purchased the property in 2004. Fee rates range from £335 - £512 depending on peoples assesses care needs. Grosvenor Hall Care Home DS0000061942.V289091.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 7 hours. The manager and provider were present throughout the day. The main method of inspection used was called case tracking which involved selecting a proportion of residents and tracking the care they receive through the checking of records, discussion with them, the care staff and observation of care practices. A partial tour of the premises was conducted, documentation examined and the care records of 4 residents were examined. Other residents and some staff on duty during the morning and afternoon shifts were interviewed either formally or informally. There were no visitors at the home during the visit. What the service does well: What has improved since the last inspection? What they could do better: Although residents have a care plan which tells people about the care they need, these need to be improved to make sure that staff have access to detailed information about individual residents and how they wish to be cared for. The content of monthly care reviews also needs improving, as they do not always reflect the changes in people’s needs or comprehensively evaluate if the planned care is effective or not. Grosvenor Hall Care Home DS0000061942.V289091.R01.S.doc Version 5.1 Page 6 Although some regular activities, such as a weekly outings, sing-a-longs and film shows had been provided the home needs to produce a formal activities programme that caters for every residents individual needs. Recruitment practices need to be improved so that staff do not start to work at the home until all the required checks have been completed, as this helps to safeguard people living at the home. Although training at the home has been undertaken, some staff still need to receive essential training to ensure that they can meet peoples needs. Staff supervision sessions have not been provided regularly, therefore they are not provided with the opportunity to discuss any issues and identify any areas where they feel they need additional support. Four recommendations were also made regarding the documentation of additional medications, displaying the daily menu to remind people what is being offered, the provision of care planning training for care staff and the recording of shift times on the staffing rota. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Grosvenor Hall Care Home DS0000061942.V289091.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grosvenor Hall Care Home DS0000061942.V289091.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 The home’s assessment procedure ensures that it can meet the needs of people admitted to the home. EVIDENCE: Care records contained needs assessments carried out prior to residents being admitted to the home. Care staff confirmed that the manager or one of the nursing staff visit potential residents to completed assessments to make sure that they can be cared for appropriately by the home. The home does not provide intermediate care. Grosvenor Hall Care Home DS0000061942.V289091.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Shortfalls in care planning documentation means that staff may not be aware of peoples needs, which could lead to residents needs not being met. People’s health needs are being met. Medications are stored, administrated and disposed of appropriately. Staff treat residents with dignity and respect. EVIDENCE: Each resident has an individual plan, which contains information relating to his or her care needs. Some plans did not however provide sufficient guidance to staff. One plan for a resident admitted 6 days previously was incomplete and therefore staff had not been given enough information to enable them to provide comprehensive care. Risk assessments had been completed but some did not identify what actions the home had taken to minimised potential risks. For example although pressure relieving aids had been provided for a resident at risk of developing pressure damage, the risk assessment on file did not inform staff that this equipment was in place. Care plans had been regularly reviewed but entries did not evaluate the effectiveness of the planned care and contained statements such as ‘no Grosvenor Hall Care Home DS0000061942.V289091.R01.S.doc Version 5.1 Page 10 change’. Monthly reviews should contain meaningful evaluations that document any progress or deterioration towards planned goals or aims. Residents’ health needs were being met. Visits by doctors, chiropodists and district nurses were recorded on their files. The home has satisfactory policies, procedures and documentation concerning the receipt, storage, administration and disposal of medications. Observation of the lunchtime medication round demonstrated that the correct procedures were being followed and appropriately recorded. It was recommended that handwritten additions to the medication administration records be signed and dated by the person completing the information. Residents spoken with said that they were happy living at the home and with the care they received. Observation and comments from residents demonstrated that staff respected residents’ privacy and dignity. They were seen knocking on people’s doors, helping them to eat their meals and speaking to them in a friendly, respectful manner. Staff observed moving a resident with the help of a hoist ensured that her dignity was maintained by covering her legs. Although some residents were unable to communicate others commented: ‘I do what I want, when I want to do it, today I stayed in bed because I felt like it’ and ‘I like it here’. Grosvenor Hall Care Home DS0000061942.V289091.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The homes activity programme does not provide sufficient variety and stimulation to cater for individual peoples needs. Choice is given in all aspects of the lives of the residents in the home. Meals provided offer variety and choice. EVIDENCE: There was no activities programme advertised at the home on the day of the visit but records showed that activities had taken place. The home was decorated for Easter with springtime displays and some residents had made Easter bonnets. Records demonstrated that some residents had taken part in activities such as games, films show and sing-a-longs. However residents who were not able to participate in these activities, due to medical reasons or because they were confined to bed, were not been provided with alternative stimulation to meet their individual needs. The home needs to ensure that care plans reflect peoples past interests in more detail, especially for those residents with dementia, so that staff are aware of what they may be interested in doing. They should then use this information to devise a programme to meet these needs on a regular basis. One resident commented that she was happy knitting and watching television, but another said that although she liked the home there was not much to do. Grosvenor Hall Care Home DS0000061942.V289091.R01.S.doc Version 5.1 Page 12 The home takes a small number of residents out into the community one morning a week. Outings have included garden centres, museums and shopping at the local supermarket. Residents said that they had enjoyed these trips and staff commented that they hoped to include more varied outings once the weather improved. There were no visitors available during the visit but residents said that staff made their relatives’ welcome and one commented that his wife regularly came for meals at the home. People from the community are encouraged to come into the home this included local schools and the Salvation Army. The dining room was welcoming with two-toned tablecloths and flower displays on each table. The meal on the day of the visit was well presented and nutritionally balanced. The chef served the meal from a hot trolley and food taken to residents’ rooms was appropriately covered. Residents had been offered choices the day before and their preferences recorded. People said that the food was always good with a good choice was available. Lunch consisted of spring vegetable soup, stuffed chicken fillet or savoury mince cobbler, followed by fruit flan. Alternatives such as jacket potatoes, salads and omelettes could also be ordered. Aids such as plate guards and specialist cutlery were being used to help people eat independently. Following discussions with residents and staff it was recommended that the menu of the day be displayed in the dinning area to remind people of what was available. Grosvenor Hall Care Home DS0000061942.V289091.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The home has satisfactory procedures for handling complaints and allegations of adult abuse. EVIDENCE: The complaints policy is displayed in the main hall with the other notices such as local advocacy agencies. There are also forms available in the reception area to allow people to comment/complain about the service being provided. Since the last inspection the home has introduced a complaints file, which detailed complaints and concerns, the actions taken by the home and any outcomes. The home had received 3 complaints since the last inspection, one of which was referred back to the provider by the Commission. All had been appropriately investigated and recorded. Staff said they could take any concerns to the manager or provider and feel that they are listened to. Residents spoken with said that they had no complaints about the care they received and complimented the staff on the care they provided. The home has a satisfactory procedure regarding the protection of vulnerable adults and has appropriately reported any concerns to the Commission and social services. Staff interviewed were able to give examples of the different types of abuse that may occur and who to report any concern to and the majority of staff have received training in this subject. Grosvenor Hall Care Home DS0000061942.V289091.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Residents living at the home live in a clean, comfortable and homely environment. EVIDENCE: The renovation and refurbishment programme has been completed and on the day of the visit an electrician was replacing light fittings to provide a more homely atmosphere to the corridors. A partial tour of the building showed that communal rooms were bright and airy. Bedrooms, which had been personalised by residents or their relatives, were clean and tidy with no unpleasant odours. The garden at the rear of the home is enclosed. It has a patio area to the front of the downstairs lounge to provide a safe, pleasant area for residents to sit when the weather is suitable. The garden has two locked gates with access to the main road. Since the last inspection the keys for these have been added to the key ring held by the person in charge to ensure that in the case of a fire, access to the home by the fire brigade or to residents and staff to exit the premises is available. Grosvenor Hall Care Home DS0000061942.V289091.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Staff are on duty in sufficient numbers and skill mix to ensure that the residents are cared for in a safe, caring and competent manner. The homes recruitment practices could put residents at risk. Although training has been provided some staff still need essential training to ensure that they have the knowledge and skills to meet the needs of the people living at the home. EVIDENCE: Staff duty rotas demonstrated that the home was providing adequate staffing levels. There is a nurse on duty 24 hours a day; they are supported by 4 carers in the morning, 3 in the afternoon, and two at night time, for the 27 residents currently living at the home. Most staff commented that they felt that there were enough staff on duty to care for residents but one felt that extra hours were needed to provide more activities. The staffing rota did not identify the working hours of staff so it was recommended that a key be added to the rota so that it clearly identified the times of each shift. Observations on the day demonstrated that staff cared for people in a calm, relaxed, unhurried manner and promoted good communication. Residents commented ‘the staff are nice’ and I am very happy with the way I am looked after’. Grosvenor Hall Care Home DS0000061942.V289091.R01.S.doc Version 5.1 Page 16 The home has a satisfactory recruitment procedure but examination of personnel records demonstrated that it had not followed this procedure. Although 2 files contained application forms, health checks and 2 satisfactory written references, C.R.B. (Criminal Records Bureau) or P.O.V.A. (Protection Of Vulnerable Adults) checks had not been received before the member of staff had commenced work. The manager and provider explained that in the first instance the C.R.B office had misplace the C.R.B form and were unable to process the P.O.V.A check until it was located. In the second instance a P.O.V.A check had been received 2 days after they started work and a satisfactory CRB check has since been returned. Both staff members had a satisfactory check from their previous employment therefore due to staff shortages a decision had been taken by the management team that they could commence employment with appropriate induction and support provided. Staff training has taken place and is ongoing, with most staff attending mandatory training and other courses relevant to the needs of the residents, including dementia awareness. Staff who have not attended essential training must do so as soon as possible to ensure that they have the knowledge and skills to meet the needs of the people living at the home. Areas needing more attention included health and safety and adult protection. Plans for 2006 included: catheter care, basic food hygiene fire and manual handling. Four staff attained N.V.Q. (National Vocational Qualification) level 2 in 2005 and 6 are currently registered to undertake the course with a further 3 awaiting funding. Staff said that the provider and manager encourage training of all kinds, especially N.V.Q. Grosvenor Hall Care Home DS0000061942.V289091.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38 Sufficient leadership, guidance and direction are provided to staff to ensure residents receive consistent quality care. Residents’ finances are handling appropriately. The home has health and safety policies and procedures, which help to safeguard staff and residents. EVIDENCE: A suitable qualified and experienced manager who receives support from the provider and an administrator manages the home. Since the last inspection the provider has produced some reports to the Commission outlining how the home is operating. Although these have not been completed monthly as required it was evident that he monitored the running of the home on a regular basis. Staff said that the provider visits on most weekdays and usually phones at the weekend to check that all is well at the home Grosvenor Hall Care Home DS0000061942.V289091.R01.S.doc Version 5.1 Page 18 The home has a quality assurance system in place that includes questionnaire and comment cards and the manager confirmed that this information is to be included in the revised Statement of Purpose and Service Users Guide currently being developed. The finances of residents being case tracked were examined and found to be well documented including receipts and 2 signatures. The business administrator undertakes regular audits of financial records. Staff comments and records demonstrated that staff were not receiving regular supervision and appraisal sessions. Regular support sessions would provide staff with the opportunity to discuss any areas of concern on an individual basis. Minutes from staff meetings were available. Policies and procedures regarding health and safety are available to guide and instruct staff. Manual handling and fire training had been provided. There is a programme to service and maintain the equipment in the home on a regular basis. The Environmental Health officer had visited recently and although his report was not available the chef confirmed that no issues had been identified on the day. Kitchen records regarding the temperatures of fridges, freezers and foods being cooked and serviced were being maintained. Grosvenor Hall Care Home DS0000061942.V289091.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 3 3 Grosvenor Hall Care Home DS0000061942.V289091.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15(1) (2) (c) (d) Requirement Care plans and risk assessments must be in sufficient detail regarding all of the resident’s needs and preferences. Regular reviews must evaluate the plan of care and document relevant changes in care needs. The home must provide social stimulation to meet the needs of individual residents. The home must receive a satisfactory CRB or POVA check prior to new staff commencing employment. Training must be provided to all staff in both mandatory and specialist subjects. This must include topics such as health and safety and infection control. The previous timescales of 30/09/05 and 01/02/06 were not fully met but good progress has been made. Regular supervision and appraisal sessions must be provided to all staff. Timescale for action 01/07/06 2. 3. OP12 OP29 16 (2) (m) 19 01/06/06 01/05/06 4. OP30 18 (1) 01/09/06 5. OP36 18 (1) (a) 2 01/07/06 Grosvenor Hall Care Home DS0000061942.V289091.R01.S.doc Version 5.1 Page 21 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. 2. 3. 4. 5. Refer to Standard OP7 OP30 OP9 OP15 OP27 Good Practice Recommendations Care staff should receive training in care planning to enable them to be responsible for the residents receiving personal care only Care staff should receive training in care planning to enable them to be responsible for the residents receiving personal care only The person who enters additional information to medication record should sign and date the entry. The home should display the daily menu in the dining area so that people are reminded of what is being offered. To demonstrate that sufficient staff are on duty at anyone time duty rotas should indicate the times of shifts starting and ending. Grosvenor Hall Care Home DS0000061942.V289091.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Hall Care Home DS0000061942.V289091.R01.S.doc Version 5.1 Page 23 - 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. 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