Inspection on 12/12/06 for Grosvenor House Nursing Home

This inspection was carried out on 12th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Grosvenor House Nursing Home 17/11/08

Grosvenor House Nursing Home 21/03/06

Grosvenor House Nursing Home 19/10/05

Grosvenor House Nursing Home 24/01/05

Grosvenor House Nursing Home 21/07/04

Grosvenor House Nursing Home 12/02/04

Grosvenor House Nursing Home 13/10/03

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

CARE HOMES FOR OLDER PEOPLE Grosvenor House Nursing Home 39 Duchy Road Harrogate North Yorkshire HG1 2HA Lead Inspector Ms Anne-Marie Foster Key Unannounced Inspection 12th December 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 House Nursing Home DS0000027932.V324059.R01.S.doc Version 5.2 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 Nursing Home DS0000027932.V324059.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grosvenor House Nursing Home Address 39 Duchy Road Harrogate North Yorkshire HG1 2HA 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) 01423 523447 01423 527672 grosvenor.house@ashbourne-homes.co.uk www.southerncrosshealthcare.co.uk Apta Healthcare (UK) Ltd Mrs Glenda Maharani Ibbotson Care Home with nursing. 50 Category(ies) of Old age, not falling within any other category registration, with number (46), Terminally ill (4) of places Grosvenor House Nursing Home DS0000027932.V324059.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Age range 60 years plus - OP Age 45 years plus - TI 5 day care places 60 years upwards Date of last inspection 21st March 2006 Brief Description of the Service: Grosvenor House is a large, converted and extended detached house, which was a former school. It is situated on Duchy Road in a quiet residential area within a short drive of Harrogate town centre. There are pleasant gardens. The home benefits from a variety of spacious lounges and a large dining room. Service users bedrooms are spacious and are decorated to a high standard. Residential and nursing care is offered for up to 50 service users. The home is accessible to all service users and a vertical passenger lift is available. There is ample off street parking. Weekly fees as at January 2007 range from £447 to £700. Grosvenor House Nursing Home DS0000027932.V324059.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit took place over six hours. Information about the home was also gathered in a number of ways prior to the visit. The Commission sent a ‘Pre Inspection Questionnaire’ to the home, which asks about things such as fees, staff numbers and menus. Comment cards were sent to relatives and health practitioners associated with the home, to seek their views, and 3 were returned. Other notifications and information sent in to The Commission about the home such as complaints and illnesses are used as part of the inspection process. The registered manager was available to assist the inspector on the day. Service users and staff were spoken with, and the inspector spent some time observing the care being given. A tour of the home was made and this included bedrooms plus communal and service areas. What the service does well: What has improved since the last inspection? Rooms and corridors have been redecorated to a high standard and new furniture has been bought for the comfort of the service users. Grosvenor House Nursing Home DS0000027932.V324059.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Grosvenor House Nursing Home DS0000027932.V324059.R01.S.doc Version 5.2 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 Nursing Home DS0000027932.V324059.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. Service Users do not move into the home until they have an assessment of their needs done by an appropriate member of staff. The home will only admit a person if they are sure those needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager (who is a qualified nurse) and one of the senior nurses go out to do a full assessment of people’s care needs before accepting them for admission to the home. The assessment includes things such as mobility, communication, personal care and well-being. Any existing plan of care or information from either the hospital or social services will be included in the assessment. Grosvenor House Nursing Home DS0000027932.V324059.R01.S.doc Version 5.2 Page 9 The information gathered at the assessment will then be developed into the care plan so that staff can see what the care needs are of the individual. The inspector looked at four of these assessment records and found that they contained comprehensive detail and went on to link in well with the care plan. The home does not offer intermediate care. Grosvenor House Nursing Home DS0000027932.V324059.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. Service Users live in a home where their needs are met by caring staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service user’s care needs are set out in an individual plan of care. The inspector looked at four of these plans, and found them to be comprehensive and well written. This will help staff to understand what care should be given. The care plans are reviewed at least once a month, so that they can reflect the changing needs of the service user. Risk assessments were in place, where necessary, for example a falls risk assessment, a moving and handling risk assessment. These assessments point out any hazards, and highlight actions staff must take to keep service users safe, whilst also promoting their independence. These were looked at and were found to be appropriate and reviewed regularly. Grosvenor House Nursing Home DS0000027932.V324059.R01.S.doc Version 5.2 Page 11 The home promotes and maintains service users health. Referrals are made to outside health professionals where necessary for example the GP, chiropodist and dentist. Records are kept of these visits. Three health professionals replied to a comment card questionnaire sent out by The Commission for Social Care Inspection. Each confirmed that they home communicated clearly and worked in partnership with them. Service user’s are able to keep their own G.P. wherever possible, and continue to access their entitlements to NHS services as they would if they still lived at home The medication system was examined. A medication round was observed and also the inspector looked at the medication storage. The medication administration records were looked at and no omissions were found. The controlled drugs were counted against the register and numbers were correct. The ordering and return of drugs works well and staff report no problems. Service user’s are supported by a safe medication system. Staff were observed as they carried out their duties. Service users reported to the inspector that “ staff are kind” “ staff treat me well” and one relative spoken with said “ staff are quiet and caring”. The staff were seen to work calmly and in a kind way with service users. Staff were seen to use the preferred term of address and to knock before entering rooms in order to preserve and promote people privacy and dignity. One younger member of staff was seen to talk ‘over’ a service user whilst hoisting this person into the chair. This was discussed with the manager in order that this poor practice can be discouraged. Grosvenor House Nursing Home DS0000027932.V324059.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. Service users live in a home that provides a range of quality activities, and where the daily routine is flexible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The routine at the home is flexible where possible. Service users are helped to make choices during the day, and can choose where to sit and which activity to participate in. One service user told the inspector “ I have my favourite lounge, but I can sit in my room if I wish - it’s up to me”. The home employs an activities organiser who works each day. Very good quality activities are planned, and a timetable of events is made available to service users and their relatives or friends. Activities include, for example; crafts, knitting, exercise classes, crosswords, bingo, birthday celebrations and trips out. Community contacts are maintained and the home had just had a carol concert from the local school that service users said they enjoyed. There Grosvenor House Nursing Home DS0000027932.V324059.R01.S.doc Version 5.2 Page 13 is a flexible visiting policy at the home and visitors are free to attend as the service user wishes, and are made welcome by the staff. On the day of the inspection service users were enjoying a film in the garden suite lounge. The lunchtime meal was observed. This was served in a calm and unhurried fashion. There were enough staff available to assist those service users that needed help .A menu is distributed throughout the home, staff help those service users that might need assistance with their choices. The menu offers a balanced, wholesome variety of food, and on the day of the inspection the lunch looked good and service users said that they had enjoyed their meal. The chef was spoken with, and is experienced in providing meals for those that need special therapeutic diets. A comment book is available for the service users so that they can pass on any remarks to the chef. The dining room is spacious, and the tables are pleasantly laid out, which helps to make mealtimes an enjoyable occasion. Grosvenor House Nursing Home DS0000027932.V324059.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. Service Users live in a home where they are protected by clear complaints and protection policies, and where staff are knowledgeable about the protection of vulnerable adults. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear complaints policy, which is available to all staff, service users and relatives. Complaints are recorded and are dealt with in a timely fashion. The Commission has received no complaints about the home since the last inspection. Service user’s spoken with told the inspector that they would know how to make a complaint, and that they were sure they would be listened to, taken seriously and their complaint acted upon. There are also regular ‘residents meetings’ and also a relative’s ‘surgery’ where people can voice their opinions and make suggestions. The home has an adult protection policy in place, which follows the current local authority guidance to help keep people safe from abuse. Staff spoken with were familiar with the policy and knew what they should so if they had any concerns, which helps to safeguard and protect the service users. Grosvenor House Nursing Home DS0000027932.V324059.R01.S.doc Version 5.2 Page 15 Grosvenor House Nursing Home DS0000027932.V324059.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. Service users live in a spacious, clean home that is well decorated and furnished. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is safe and well laid out. There are several areas to sit and relax. The decoration is of a high standard, and is homely in style. There is a rolling programme of renewal of fabric and decoration of the premises. Improvements are carried out before things start to look shabby. Service users spoken with were pleased with recent redecoration of their rooms and the choices of colour and fabric. The home is tidy, equipment is stored away neatly and is not intrusive. Grosvenor House Nursing Home DS0000027932.V324059.R01.S.doc Version 5.2 Page 17 The grounds are kept clean and tidy and there are several places to sit. The home is clean and hygienic, the housekeeper and cleaners are very knowledgeable about their role, and the prevention of cross infection. There are no bad smells. Bedrooms, communal, and public areas were looked at by the inspector and were very clean. The laundry room was inspected. The home runs a safe system for handling soiled laundry and the washing machine has a sluice/disinfector facility for washing at high temperatures. This will help to reduce the risks of cross contamination. The laundry room looked cluttered and needs a tidy out around the sink area. The laundry floor is a combination of quarry tiles and concrete. A new flooring which is sealed and impermeable would be easier to clean. Grosvenor House Nursing Home DS0000027932.V324059.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. Service Users are cared for by good numbers of well-trained staff. There is a large proportion of staff from overseas and this could give rise to some communication issues. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is currently well staffed and nearly all of the care staff have their NVQ (National Vocational Qualification) level 2 certificate in care. There are good numbers of qualified nurses and care assistants available at each shift. There is a robust recruitment procedure in place. The inspector looked at the staff files of four employees. These contained the documentation required by legislation, for example a CRB (criminal records bureau) check, two written references and an employment history questionnaire. These checks will help to reduce the risk of employing unsuitable people. A proportion of staff working at the home are from overseas. The inspector spoke with these staff and found communication easy, as their English is good. Three service users commented on ‘minor’ communication problems. There is a potential for issues to arise around this area because of heavy accents, especially for service users with either hearing problems or confusion. However Grosvenor House Nursing Home DS0000027932.V324059.R01.S.doc Version 5.2 Page 19 the registered manager is more than aware of the potential for problems and continues to monitor the situation and seek feed back from the service users. There is an ongoing staff-training programme in place, and staff spoken with say they are pleased with training that they get. The qualified nurses have recently attended training for Diabetes care, Dementia care, and PEG (percutaneous endoscopic gastric) feeding. Staff spoken with were very positive about working in the home. Grosvenor House Nursing Home DS0000027932.V324059.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. Service Users live in a home that is run in their best interests and is well managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is run by an experienced manager who is knowledgeable about caring for the elderly and who is also a qualified nurse. Service users spoken with said that they felt confident in her abilities. The Registered Manager has an obvious rapport with all service users and has an open style of management. Staff spoken with said that they felt the home was well run and that they could report any concerns to the manager. The home has a good quality assurance system, which seeks the views of those using, and coming into contact with the service. A questionnaire is Grosvenor House Nursing Home DS0000027932.V324059.R01.S.doc Version 5.2 Page 21 circulated to all interested parties, so that the home can check on its progress and measure any success in meeting its aims and objectives. The home looks after some small amounts of the service user’s cash. This is stored safely and all transactions are documented. The inspector looked at a sample of records and these were found to be in order, which will help to ensure that service user’s financial interests are safeguarded. The health and safety of service users and staff is promoted and protected. The registered manager was able to demonstrate safe working practices. The inspector looked at a sample of maintenance and associated records for example fire safety officer visit, fire safety equipment check, gas engineer service, environmental health officer visit, electrical wiring certificate, lift engineer check and hoist maintenance. All of these were in date, and suitably qualified people had carried out the checks. Hazardous chemicals are stored safely and control of substances hazardous to health (COSHH) assessments is in place to keep people safe. The Registered Manager works in a highly organised way. She is knowledgeable about all aspects of the home, including maintenance and health and safety to help ensure that the home is safe, and is run in the service users best interests. Grosvenor House Nursing Home DS0000027932.V324059.R01.S.doc Version 5.2 Page 22 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 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 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 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 4 Grosvenor House Nursing Home DS0000027932.V324059.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard OP10 OP26 Good Practice Recommendations Staff should be reminded of their ‘residents welfare’ training and about the need to respect service users dignity by not talking ‘over’ them The laundry room should have a complete de clutter and tidy out around the sink area. The floor should be made impermeable to reduce the risks of cross infection. 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