CARE HOMES FOR OLDER PEOPLE
Grosvenor Hall Care Home Newark Road Lincoln Lincs LN5 8QT Lead Inspector
Dawn Podmore Unannounced Inspection 26th October 2005 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.V260832.R01.S.doc Version 5.0 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.V260832.R01.S.doc Version 5.0 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.V260832.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered to provide personal care 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 19th May 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 almost a year ago. Grosvenor Hall Care Home DS0000061942.V260832.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 5½ hours and was undertaken by two inspectors, Dawn Podmore and Vanessa Gent. The manager and provider were present for most of the inspection time. The main method of inspection used is called case tracking which involves 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 tour of the premises was conducted, documentation examined and the care records of three residents were inspected. Several residents, a community district nurse, four of the five staff on duty and the manager were interviewed as well as the provider. What the service does well: What has improved since the last inspection?
The home has been greatly improved in all aspects. In the structure of the home, the entire roof has been replaced, new bathrooms have been installed and some shared rooms have been made into single ensuite rooms. Inside of the home, every area, including all residents’ bedrooms and the communal areas have been redecorated and new furnishings and carpets installed. New door locks have also been fitted offering residents privacy and security. Care plans continue to improve in content and order of filing within each document, making information easy to access. An activities organiser has been employed who will start work in one week’s time. The activities programme, which residents said that they enjoy taking part in, will be further expanded and developed by her to ensure everyone has access to appropriate activities. Staff have been undertaking appropriate training to make sure that they have sufficient knowledge to safeguard the residents and provide a good standard of care. Grosvenor Hall Care Home DS0000061942.V260832.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Grosvenor Hall Care Home DS0000061942.V260832.R01.S.doc Version 5.0 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.V260832.R01.S.doc Version 5.0 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 pre-admission procedure ensures that the needs of the residents admitted to the home are met. EVIDENCE: In the care plans examined, pre-admission assessments seen were comprehensive and detailed; this information is needed to ensure that people admitted to the home can be appropriately cared for. The home does not currently provide intermediate care. Grosvenor Hall Care Home DS0000061942.V260832.R01.S.doc Version 5.0 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, 9, 10 The home safeguards the health needs of the residents by ensuring that care plans are documented in sufficient detail and medication practices are adequate. Staff treat residents with dignity and respect. EVIDENCE: The format of the care plans has been further developed and the order of the documents improved to enable staff to easily read the contents and put them into action to deliver quality care and monitor the residents. Care staff are to receive training to enable them to competently take responsibility for the care plans of the people receiving personal care only. Medication practices were seen to be adequate, to ensure the health needs of the residents are safely met. Staff were seen to knock at residents’ doors and await admission. Staff spoke with residents in a considerate, patient and pleasant manner. They were seen chatting with residents, especially when assisting, seated and relaxed, with the lunchtime meal, and when moving and handling residents around the home and assisting them to use the toilet facilities. Grosvenor Hall Care Home DS0000061942.V260832.R01.S.doc Version 5.0 Page 10 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 home provides activities for communal events but not sufficient activities for residents with dementia to ensure they get adequate stimulation. Choice is given in all aspects of the lives of the residents in the home. Meals are pleasant occasions, both in the surroundings and food provided. EVIDENCE: The downstairs lounge was quiet, with only the television on, and the residents were left undisturbed for much of the morning. An activities organiser is shortly to start work at the home and staff say that the activities they currently provide will be better co-ordinated to meet the needs of the residents. A programme for communal activities and events was seen in the activities file and on notice boards. Records are kept of what activities have been provided, the individual participation in activities and the occasions when residents refused or preferred not to join in. People from the community are encouraged to come into the home; this included religious representatives and local organisations. One resident said that he had been out with his relatives but commented, “I would like to go out more but otherwise it’s okay here”. Residents say they have choice in their lives, including mealtimes, bedtimes and getting up, joining in activities and access to most parts of the home and garden. Grosvenor Hall Care Home DS0000061942.V260832.R01.S.doc Version 5.0 Page 11 The meal taken at lunchtime looked appetising, colourful and nutritious, with fresh vegetables being used and a choice of menu. The menu is rotated fourweekly. The dining room was attractive, with tablecloths and vases of flowers on the tables and new crockery and table-wear in use. Residents said that mealtimes are pleasant and the food always good, with plenty of choice, cooked by an expert chef. Residents said “the food is lovely” and “they feed us damn well here”. Grosvenor Hall Care Home DS0000061942.V260832.R01.S.doc Version 5.0 Page 12 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 The home does not have an adequate system in place for the recording of complaints; therefore they cannot demonstrate that complaints have been appropriately addressed. EVIDENCE: The complaints policy is displayed in the main hall with the other notices such as advocacy agencies and communal activities events. Staff say they can take concerns to the manager or provider and feel they are listened to. Residents spoken with say they have no complaints about any part of the service provided. There are form a available in the reception areas to allow people to comment/complain about the service but the home does not have a system in place to adequately record the detail of the complaint, any actions taken and the outcome. This information is needed to demonstrate that the home has addressed all complaints appropriately and inline with their policy. This was discussed with the manager who agreed to introduce appropriate documentation to capture this information. No complaints have been received directly by the Commission since the last inspection. Grosvenor Hall Care Home DS0000061942.V260832.R01.S.doc Version 5.0 Page 13 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, 20, 21, 24 The residents live in a comfortable, clean, safe environment and have the equipment and facilities they need to ensure their health and personal needs are met. EVIDENCE: The renovation and refurbishment programme is virtually complete – with residents and staff all saying that the communal and personal areas and rooms are looking clean, fresh and attractive. Equipment has been installed to ensure that residents are cared for in a safe and comfortable environment. The garden has been fenced and enclosed, and a patio built in front of the downstairs lounge to provide a safe, pleasant area for residents to sit in. The garden has two locked gates with access to the main road. The keys for these should be kept on 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. New bathrooms have been created and existing ones upgraded with new baths installed and bath hoists or specialised aids put in to assist residents.
Grosvenor Hall Care Home DS0000061942.V260832.R01.S.doc Version 5.0 Page 14 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, 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. 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: Staffing levels have improved since the last inspection. The skill mix is appropriate for the number and needs of the residents to provide adequate care. Residents said, “I love living here”; “The staff are so kind”. A district nurse spoken with stated that staff are knowledgeable about all aspects of care that come within her remit, they are helpful and pleasant to have contact with and call her whenever they need advice or treatment for a resident. Staff training has taken place and is ongoing, with most staff being up-to-date with 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. Several staff have attained N.V.Q. (National Vocational Qualification) level 2 and 3 or are currently undertaking these courses. They say that the provider and manager encourage training of all kinds, especially N.V.Q.s.
Grosvenor Hall Care Home DS0000061942.V260832.R01.S.doc Version 5.0 Page 15 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, 38 Although the monthly, unannounced visit records have not been produced and the supervision of staff has not been fully implemented, other procedures and practices are in place to ensure that the health, welfare and safety of the residents and staff are safeguarded. EVIDENCE: Since the last inspection, the manager has produced evidence of her qualifications to manage the home and has been registered by the Commission. The provider visits almost daily but does not produce a monthly, unannounced visit report to monitor or audit the quality of the service provided, to ensure and demonstrate that the residents are cared for safely and with consideration for their needs and wishes. A questionnaire has been distributed and completed by residents, relatives and community healthcare professionals but now needs the evidence collating by the manager to incorporate the findings into the Service User Guide.
Grosvenor Hall Care Home DS0000061942.V260832.R01.S.doc Version 5.0 Page 16 The finances of three residents were examined and found to be welldocumented and audited. The business administrator does a regular auditing of financial records. Staff supervision had taken place but it was recommended that this should be provided on a more formal, regular basis to ensure that staff are adequately supported and the well being of the residents is maintained. Pre inspection documentation completed by the manager showed that regular service and maintenance checks had been carried out. The manager has procedures and policies in place, reports from the Environmental Health (July 04) and Fire Officer (Feb 05) were satisfactory and staff training is mostly upto-date, to ensure that all aspects of the home are safe for residents. Grosvenor Hall Care Home DS0000061942.V260832.R01.S.doc Version 5.0 Page 17 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 3 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 x 4 3 3 x x 4 x x STAFFING Standard No Score 27 3 28 3 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 3 x 3 Grosvenor Hall Care Home DS0000061942.V260832.R01.S.doc Version 5.0 Page 18 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 OP16 Regulation 22 Requirement The home must have a comprehensive system for the documentation of complaints. This must include details of the complaint, actions taken and the outcome. Training must be provided to all staff in both mandatory and specialist subjects. This must include subjects such as diabetes. The previous timescale for this was 30/09/05 and although most staff have attended appropriate training others have not. Visits must be made and documented in accordance with regulation 26. The previous timescales of 28/2/05 and 01/07/05 have not been met. Timescale for action 01/12/06 2 OP30 18 (1) 01/02/06 3 OP37 26(1,4,5) 31/10/05 Grosvenor Hall Care Home DS0000061942.V260832.R01.S.doc Version 5.0 Page 19 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. Refer to Standard OP30OP7 OP12 OP20 Op36 Good Practice Recommendations Care staff should receive training in care planning to enable them to be responsible for the residents receiving personal care only. The activities programme should be expanded to include appropriate activities for all residents including those with dementia. The keys for the garden gates should be kept on the keyring held by the person in charge in case of fire. Documented staff supervision should be undertaken six times per year. Grosvenor Hall Care Home DS0000061942.V260832.R01.S.doc Version 5.0 Page 20 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
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