CARE HOMES FOR OLDER PEOPLE
Grosvenor House 11-14 Grosvenor Gardens St Leonards-on-Sea East Sussex TN38 0AE Lead Inspector
Jason Denny Unannounced Inspection 20th December 2005 11:30 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 House DS0000021123.V269476.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 House DS0000021123.V269476.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Grosvenor House Address 11-14 Grosvenor Gardens St Leonards-on-Sea East Sussex TN38 0AE 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) 01424 423831 Greensleeves Homes Trust Mrs Janet Fox Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Grosvenor House DS0000021123.V269476.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The maximum number of service users to be accommodated is twenty-eight (28) Service users must be older people aged sixty-five (65) years or over on admission 7th April 2005 Date of last inspection Brief Description of the Service: Grosvenor House is a care home providing personal care and accommodation for up to 28 older people. The home is owned by the Greensleeves Homes Trust, a London based charity who operate 18 care homes throughout England. Grosvenor House is located on the west promenade of St Leonards on Sea, Nr Hastings. Although about 1½ miles from the centre of Hastings, there are shops, pubs, and other community facilities nearby. The property forms part of a Victorian terrace and overlooks a garden area and bowling green. Service users accommodation is on four floors. The home has recently installed a new modern lift, which gives access to all floors. All bedrooms are offered as single person accommodation unless people choose to share, such as married couples. The home is currently offering services to 18 people which is partly in response to needing space for the extensive building work which has began on the home and which by June 2005 will create en-suite rooms for all existing residents, and by the end of the year all future ones. Once the building work is complete [new date of February 2006] the home will have an environment fully suitable for older people. At this point the home will be able to offer services to up to 33 people with all bedrooms en-suite [29 single and 2 double rooms]. Grosvenor House DS0000021123.V269476.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an Unannounced routine inspection [second of two planned before April1st 2006], which took place between 11.30am and 3pm. The Inspection found that of the 11 National Minimum Standards inspected, that 7 of these standards had been fully met, with all others nearly met. Of the 7 standards met 5 were exceeded in the areas of meals, complaints handling, resident involvement in the home, management, and care- planning. This report should be read in conjunction with the last inspection report of April 7, 2005, which covered some standards not looked at on this visit. The overall focus of the inspection was on following up on the requirements and recommendations made at the last inspection, and looking at how new residents were settling into the home. The inspector started the inspection by talking with residents, having lunch followed by meeting with the manager to review progress since the last inspection. A tour of communal areas was undertaken to see progress with the extensive building works. Comment cards were sent to the home prior to the inspection for circulation to residents, relatives, and other representatives such as visiting professionals. Comments received back were found to be very positive. What the service does well: What has improved since the last inspection?
Grosvenor House DS0000021123.V269476.R01.S.doc Version 5.0 Page 6 The ongoing building work has already led to a brand new modern lift being installed, which is reliable and gives residents access to all floors. The home has moved its entrance reception area creating wide electronic sliding doors and full disabled access. All bedrooms used by residents now have full ensuite shower facilities along with baths in particular areas of the home. The home has also decided not to go above 18 residents until all the work is finished so that any new resident moves into a full en-suite room and not into a noisy environment. The home has sufficient staff on NVQ training courses to assist the eventual meeting of the Government target of at least 50 of carers reaching the basic standard. 40 now have this qualification with a further 40 due to finish by February 2006. 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 House DS0000021123.V269476.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 House DS0000021123.V269476.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): None of these standards were inspected at this visit. Standards 1, 3, 4, and 5 were found to be fully met at the last inspection 070405. Standard 6 is not applicable. EVIDENCE: Grosvenor House DS0000021123.V269476.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 An exceptional level of attention is given to the care-needs of residents. EVIDENCE: Two Individual plans of care were inspected of two new residents and were found to be sufficiently detailed, up to date, and contained clear information to support staff to meet the needs of residents. The plans were found to be userfriendly and covered the full range of health needs, which the inspector observed during the inspection. All residents interviewed indicated the way in which there health needs were being met by the home. Staff and management are fully involved in plans of care and were found to be actively involved in their regular review. The home was found to be particularly mindful of how to prevent the risk of falls or pressure sores with a high level of ongoing risk-assessment and clear guidance to staff. The home undertakes a full six-month review of each care-pan with a review meeting involving social services and relatives along with the resident. This took place during the inspection. A record of a review of a new resident, found both his relative and social worker to be highly impressed by the home with the residents settling in well. Plans benefit from detailed pre-assessments, which are carried out before someone moves in and which form the basis of the care-plan.
Grosvenor House DS0000021123.V269476.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): 12,14 & 15 Residents are able to make a range of choices about their lives with significant consideration given to their views and feelings. The level of resident involvement in the home was assessed as exceptional. Food served by the home was found to be exceptional in terms of taste variety, and choice. The home was found to have impressive links with the local community. The home was found to provide a good range of activities based on resident preferences. EVIDENCE: The home operates a weekly-advertised timetable of activities, which includes music, dance, and bingo, along with visiting libraries, church services, and socially focused activities such as regular summer coach trips and a visiting magician and other actors. Some residents enjoy a strong community presence. Residents continue to be consulted on their activity and other needs such as at resident meetings or questionnaires. Some residents were found to have made a clear choice to remain in their rooms although were seen to be encouraged to come down for meals where necessary. It was evident from talking with residents and the manager as well as observations that participation in activities has reduced over the last few months. Due to building works the large upstairs lounge has had to be vacated with a temporary one set up with seating for 10 along. This lounge was found to suffer with high noise levels above this area due to building work taking place directly above. This work is due for completion by the end of January or
Grosvenor House DS0000021123.V269476.R01.S.doc Version 5.0 Page 11 February. The home was found to have arranged a Christmas programme of activities involving visiting entertainers and carol singers. Records indicated the range of choices open to residents such as the choice of a room key. Residents especially praised meal arrangements. The inspector sampled a meal and found it to be tasty, wholesome and imaginative. The home is looking at 2 staff being trained as activity co-coordinators. Some residents access the nearby promenade. Residents benefit form the provision of monthly residents meetings which most attend along with the manager. Residents were found to be well informed about the running of the home and forthcoming events. Grosvenor House DS0000021123.V269476.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 operates in an open and pro-active manner. All residents and visitors are made fully aware of how to complain or raise concerns. The home continues to treat even minor concerns as complaints and purposely encourages residents to air their views. The overall handling of complaints/concerns is exceptional. EVIDENCE: All residents spoken too confirmed the sensitive care they receive from an established staff team who were observed by the inspector to operate in an appropriately caring and patient manner. The home has a comprehensive complaint policy and form for reporting concerns. The inspector saw written examples of 2 residents raising concerns and receiving a prompt and thorough response. Just 2 of the 7 concerns over the last year were found to be upheld [substantiated] and were promptly remedied. Both residents are still at the home and have previously been found to be positive about the service when spoken with. All steps taken to resolve concerns are fully included in the complaints records including writing to the complainant. The quality of how such concerns are investigated in the interests of residents was found to be exceptional. The home maintains a suggestion scheme based on improving the service. Grosvenor House DS0000021123.V269476.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): 19,21 & 25 The home is impressive in scale, layout, and location. It is a well maintained Victorian building undergoing substantial modernisation to meet existing requirements and will exceed a range of standards once complete. Resident’s benefit from excellent rooms, views, and good facilities. Communal space is temporarily limited but will eventually be exceptional. EVIDENCE: The inspector toured the home finding the building works disappointedly behind schedule. The delays was described as being linked to various changes of plans mainly due to unforeseen complications with the building and further opportunities to improve quality such as replacing conservatories. Noise levels and disruption although minimised by the home was intrusive and made conversations difficult throughout the inspection. Although none of residents spoken with appreciated the noise and were spending more time in their bedrooms, they were all looking forward to the end product. They all felt well informed by the management and staff who they described as being as supportive as they could be. The building work when complete by the end of January/early February, will lead to all hot pipes and radiators being guarded,
Grosvenor House DS0000021123.V269476.R01.S.doc Version 5.0 Page 14 all rooms being en-suite shower rooms, full disabled accessibility to the large decorative gardens, and hot water outlets accessible to residents delivering water at safe temperatures. The new modern lift was found to be reliable [confirmed by residents] and stopped at all floors. The large sliding automatic door entrance area to the home was found to be user-friendly with further work planned to make the inner door more secure along with the installation of CCTV to improve overall security of the home in a popular seaside location. This new front entrance is now level and fully wheelchair accessible. Grosvenor House DS0000021123.V269476.R01.S.doc Version 5.0 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): 28 Staff training was found to be excellent and well planned with the only shortfall being the number of staff with NVQ qualifications, with plans to rectify this. EVIDENCE: Evidence was seen of most staff enrolled on NVQ courses with a number already complete. The current percentage of those who have passed is 40 with a further 40 due to complete this course by February 2006. Overall training was not looked at in any detail as it was done so at the last inspection with the only shortfall being the number with National Vocational Qualification’s. All staff were found to have compulsory training such as Moving and Handling, First Aid, food hygiene and Fire. It was noted that challenging behaviour training, Health and Safety, Protection of Vulnerable Adults, and other training has taken place since the last inspection. The manager closely monitors staff training and development as seen on matrix style yearly planner’s and records. Grosvenor House DS0000021123.V269476.R01.S.doc Version 5.0 Page 16 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 A motivated and highly competent management team ensures an exceptionally well run home. Staff were seen to operate with a clear sense of direction. The home is openly managed in the best interests of residents. The management of the home ensure that they are well informed about resident’s and staff’s viewpoints. The quality of the monthly section 26 reports produced by the overall organisation has slipped since the last inspection. EVIDENCE: The registered manager has managed the home for a number of years and is well qualified. She has a National Vocational Qualification in a management and Care at level 4 and has worked in the home in senior capacity for 12 years with the deputy having worked for 14 years. Minutes indicated regular monthly meetings of staff and residents. Residents along with their representatives complete satisfaction questionnaires every 6 months with a full report and action plan developed in response to views
Grosvenor House DS0000021123.V269476.R01.S.doc Version 5.0 Page 17 collected. The last survey took place between October and November 2005 with a high number collected by residents, relatives and other professionals [stakeholders] comments were found to be highly positive with one relative stating “fantastic home” a report on these views is in the process of being written and will as usual appear in the homes service user guide as well as being circulated throughout the home. All residents spoken with during the inspection praised both the management and the staff who work in the home. The managing organisation Greensleeves have as commented at the last inspection produced detailed monthly reports of their visits, which include resident’s and staff’s views. These reports have more recently been reduced to less than 2 pages and contain no evidence to show what residents have been spoken with no specific comments. The organisation are asked to return to the previous format or use a similar more detailed version to show more evidence on how an opinion on the quality of care is reached, with more specific detail in these reports. The manager was given a copy of the CSCI detailed version for discussion with Greensleeves. All other aspects of the homes quality assurance systems such as monthly reviews of care-plans and six monthly review meetings were found to be exceptional. Grosvenor House DS0000021123.V269476.R01.S.doc Version 5.0 Page 18 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 X 2 X 2 X X X 2 X STAFFING Standard No Score 27 X 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X X X X X Grosvenor House DS0000021123.V269476.R01.S.doc Version 5.0 Page 19 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 OP19 Regulation 16 Timescale for action That all service users [Residents] 28/02/06 must have access to all parts of the home’s communal and private space by the provision of ramps and passenger lifts where required in achieving this. [Requirement of the last 7 inspections. Requirement first made April 2003] Timescale Extension to reflect the new planned completion date of February 2006 There must be a ratio of 1 28/02/06 assisted bathing facility for every 8 people accommodated and each service user must have a toilet within close proximity to his/her bedroom. [Requirement of the last 7 inspections. Requirement first made April 2003] Timescale Extension to reflect the new planned completion date of February 2006 That pipe work and radiators 28/02/06 accessible to service users must be guarded or have guaranteed low temperature surfaces.
DS0000021123.V269476.R01.S.doc Version 5.0 Page 20 Requirement 2. OP21 23[1j] 3. OP25 13[4a&c] Grosvenor House 4. OP25 13[4a] [Requirement of the last 7 inspections. Requirement first made April 2003] Timescale Extension to reflect the new planned completion date of February 2006 That all hot water outlets accessible to service users must be fitted locally with pre-set valves of a type unaffected by water pressure and which have fail safe devices to provide hot water close to 43ºC and therefore prevent risks from scalding. [Requirement of the last 7 inspections. Requirement first made April 2003]. Timescale Extension to reflect the new planned completion date of February 2006 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP33 Good Practice Recommendations That Monthly proportion of spoken with. show how an reached. section 26 reports show that a sufficient named residents [service users] have been That these reports are sufficiently detailed to opinion on the quality of care has been Grosvenor House DS0000021123.V269476.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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