CARE HOMES FOR OLDER PEOPLE
Grosvenor House 11-14 Grosvenor Gardens St Leonards-on-Sea East Sussex TN38 0AE
Lead Inspector Jason Denny Unannounced 7 April 2005 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 Version 1.10 Page 3 SERVICE INFORMATION
Name of service Grosvenor House Address 11-14 Grosvenor Gardens St Leonards-on-Sea East Sussex TN38 0AE 01424 423831 020 7793 1177 headoffice@greensleeves.org.uk Greensleeves Homes Trust Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Janet Fox Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (OP) 28 of places Grosvenor House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The maximum number of residents to be accommodated is twenty-eight (28) 2. Residents must be aged sixty-five [65] years or over on admission Date of last inspection 29 November 2004 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 Leonard’s 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 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. Grosvenor House Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an Unannounced routine inspection [first of two planned before April1st 2006], which took place between 9.30am and 2.15pm. The Inspection found that of the 28 National Minimum Standards inspected, that 23 of these standards had been met, and 5 exceeded with 1 standard [6] not applicable. The overall focus of the inspection was on residents’ involvement in the home, which included discussions and examination of a range of records including minutes of residents meetings. The inspector started the inspection by speaking with residents [12 in total] and visitors in communal areas and touring the rest of home to inspect the building including looking at progress with the major ongoing building work. 1 resident was spoken with in their room. A discussion with the deputy manager took place around progress since the last inspection. A meal was taken with residents along with a kitchen inspection. Care and staff records, along with safety documentation were inspected. The inspector both interviewed and observed staff. What the service does well:
One person speaking in agreement with a group of fellow residents stated “Everyone is satisfied, nobody wants to leave, could not find anything better, food nice, staff nice, everything is nice”. The home was again found to do everything well, excelling in a number of areas. The management of the home was found to be especially good and dedicated to supporting residents and staff. The organisation which oversees the home was found to provide excellent support with training, financial help, and regular inspections involving residents. A range of ways were seen of how well residents are fully involved in the running of the home with regular meetings, all of which was confirmed in records and discussions with residents. The home deals well with Concerns from residents. Staff were again found to be well trained, supervised, and seen to be dedicated to their work. A meal was sampled, which in agreement with residents was found to be exceptional, with an excellent menu with a range of choices. The home continues to offer a range of activities and maintains strong links with the community. Regular summer coach trips continue to be organised along with seasonal events. Exceptional steps are taken to cater for people’s individual tastes. One resident wants a Cat and will be offered a Ground floor garden accessible room. The home was found to have gone to exceptional lengths to minimise the disruption created by the building works which when complete will lead to further standards being exceeded. Grosvenor House Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Grosvenor House Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Grosvenor House Version 1.10 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 standard(s) 1,3,4,5 and 6 The inspector found that the home provides both prospective and existing residents, with a good level of information to help prospective residents make a decision about the home. The homes information leaflet is attractively presented. The way in which the home assesses prospective or existing residents ensures that it continues to meet needs. EVIDENCE: A copy of the homes resident’s [service user] guide including a complaints and suggestions procedure is given to residents and visitors and is displayed in reception areas along with the most recent Inspection report. The guide also includes resident’s views, something useful for prospective residents to base a judgement upon. Residents were found to be knowledgeable about their rights. The Inspector found that the home’s assessment information was full, and tallied up with his observations and discussions with individual residents. The inspector found that the home manager had assessed residents before moving in. The manager also confirmed in writing to relevant people whether or not the home could meet particular needs. The home was also found to have supported residents to move on when their needs had been assessed to significantly change and could not be safely met by the home. Resident’s needs were seen to be met during the inspection. Residents sign their care-plans.
Grosvenor House Version 1.10 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 standard(s) 7,8,9 and 10 The home was found to be meeting resident’s health and general needs and was fully aware of what additional support was required. Care-plans were full, logically presented, and regularly reviewed and updated. The inspector judged that resident’s rights were strongly upheld. Medication arrangements were found to be soundly and competently managed. EVIDENCE: Three Individual plans of care were inspected 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 user-friendly 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 interviewed were found to have good knowledge of the 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 with a high level of ongoing risk-assessment. Medication was inspected and was found to meet all aspects of the standard In relation to storage, dispensing, training, and overall record keeping. There was one box of unlabeled over the counter medication, which was disposed off during the Inspection. One resident is supported to self-medicate. One resident was supported to go to hospital due to concerns.
Grosvenor House Version 1.10 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 standard(s) 12,13,14 and 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 o be encouraged to come down for meals where necessary. The inspector witnessed a resident reading club meeting. 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 and imaginative, along with the homely and imaginatively appointed dining room enjoying views of the channel and bowling-green. The home is looking at 2 staff being trained as activity co-coordinators. Some residents access the nearby promenade, with one seen returning from a woodwork class.
Grosvenor House Version 1.10 Page 11 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 standard(s) 16 and 18 The home operates in an open and pro-active manner. Staff continue to demonstrate an sound understanding on how to prevent abuse and continue to benefit from adult protection training. Residents continue to be registered to vote and have all their rights upheld. 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 EVIDENCE: The manager and the staff team have received formal training in adult protection and prevention of abuse and recently did a refresher course entitled, POVA [protection of vulnerable people]. Staff who have been interviewed across several inspections continue to demonstrate a full and sound understanding of all the issues involved, including whistle blowing and who to report concerns too. 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. 2 of the 5 concerns over the last year were found to be upheld [substantiated] and were promptly remedied. Both residents are still at the home and were found to be positive about the service. The home maintains a suggestion scheme based on improving the service. Grosvenor House Version 1.10 Page 12 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 standard(s) 19,21,25 and 26 The home is impressive in scale, spaciousness, 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 significant communal space. The home was found to be clean and free from odour. EVIDENCE: The inspector toured the home finding it on schedule to complete the building works by November leading to all hot pipes and radiators being guarded, 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 tour of the home found it to be clean. The small kitchen where drinks are prepared was found to have a dust hazard created by building works. During the inspection the builders covered this gap. The large food kitchen was found to be in good order with no recommendations made at the most recent environmental health visit. Bedrooms seen were found to be well appointed. The new modern lift was found to be reliable [confirmed by residents] and stopped at all floors. The large sliding door entrance area to the home was found to be user-friendly.
Grosvenor House Version 1.10 Page 13 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30 There continues to be sufficient numbers of suitable staff on duty to meet needs of resident’s along with the cleaning and cooking tasks. The popular staff team are experienced and have worked in the home for a long time. Staff training was found to be excellent and well planned with the only shortfall being the number of staff with NVQ qualification with plans to rectify this. Recruitment procedures and practice were found to be sound. EVIDENCE: Staffing levels include 3 per day shift plus the hands on deputy manager and the manager plus 5 additional staff, 2 cleaners, 2 cooks, and a housekeeper, and 2 waking night-staff for the 18 residents. Staff were observed to operate with a clear sense of direction. The inspector observed that all residents’ needs were being promptly and calmly met by the available staffing, with routines unhurried and flexible such as Breakfast going beyond 10am. The home has an appropriate induction programme. Evidence was seen of most staff enrolled on NVQ courses with a number already complete. 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, and other training had been planned for the month of the Inspections. The overall planning of training was shown to have improved. The home was found to be waiting for all references, Police CRB and POVA checks before starting 2 staff that had recently applied for positions in the home. A high turnover of staff identified 2 years ago was found to have been stabilised with only occasional use of agency for support staff. Residents positively commented on staff variously describing them as “nice”, “very helpful” “alright” and “wonderful”.
Grosvenor House Version 1.10 Page 14 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35,38 A motivated and highly competent management team ensures an exceptionally well run home. The home was found to operate excellently in the registered managers absence. Staff were seen to operate with clear direction and confirmed how well supported they are. 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. EVIDENCE: The registered manager has managed the home for a number of years and is well qualified. 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 collected. The managing organisation produces detailed monthly reports, which include resident’s and staff’s views. Maintenance areas are promptly attended to, with all reasonable steps taken to maintain a safe home. Resident’s finances were again found to be in good order. Staff and records, confirmed that they receive supervision every 6-8 weeks.
Grosvenor House Version 1.10 Page 15 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 4
COMPLAINTS AND PROTECTION 2 x 2 x x x 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 4 4 4 x 3 x x 3 Grosvenor House Version 1.10 Page 16 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 19 Regulation 16 Requirement That all service users must have access to all parts of service users communal and private space by the provision of ramps and passenger lifts where required in achieving this. [Requirement of the last 6 inspections. Requirement first made April 2003] There must be a ratio of 1 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 6 inspections. Requirement frst made April 2003] That pipe work and radiators accessible to service users must be guarded or have guaranteed low temperature surfaces. [Requirement of the last 6 inspections. Requirement first made April 2003] 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
Version 1.10 Timescale for action Existing Timescale extension in line with Building advice. 31.11.05 Existing Timescale extension in line with Building advice. 31.11.05 Existing Timescale extension in line with Building advice. 31.11.05 Existing Timescale extension in line with Building advice.
Page 17 2. 21 23[1][j] 3. 25 13[4][a] [c] 4. 25 13[4][a] [c] Grosvenor House water close to 43ºC and therefore prevent risks from scalding. [Requirement of the last 6 inspections. Requirement first made April 2003] 31.11.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 28 Good Practice Recommendations That at least 50 of care staff are trained to at least NVQ level 2 or equivalent, as soon as is practically possible. Grosvenor House Version 1.10 Page 18 Commission for Social Care Inspection 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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